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Wu X, Chen M, Liu K, Wu Y, Feng Y, Fu S, Xu H, Zhao Y, Lin F, Lin L, Ye S, Lin J, Xiao T, Li W, Lou M, Lv H, Qiu Y, Yu R, Chen W, Li M, Feng X, Luo Z, Guo L, Ke H, Zhao L. Molecular classification of geriatric breast cancer displays distinct senescent subgroups of prognostic significance. MOLECULAR THERAPY. NUCLEIC ACIDS 2024; 35:102309. [PMID: 39296329 PMCID: PMC11408383 DOI: 10.1016/j.omtn.2024.102309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 08/12/2024] [Indexed: 09/21/2024]
Abstract
Breast cancer in the elderly presents distinct biological characteristics and clinical treatment responses compared with cancer in younger patients. Comprehensive Geriatric Assessment is recommended for evaluating treatment efficacy in elderly cancer patients based on physiological classification. However, research on molecular classification in older cancer patients remains insufficient. In this study, we identified two subgroups with distinct senescent clusters among geriatric breast cancer patients through multi-omics analysis. Using various machine learning algorithms, we developed a comprehensive scoring model called "Sene_Signature," which more accurately distinguished elderly breast cancer patients compared with existing methods and better predicted their prognosis. The Sene_Signature was correlated with tumor immune cell infiltration, as supported by single-cell transcriptomics, RNA sequencing, and pathological data. Furthermore, we observed increased drug responsiveness in patients with a high Sene_Signature to treatments targeting the epidermal growth factor receptor and cell-cycle pathways. We also established a user-friendly web platform to assist investigators in assessing Sene_Signature scores and predicting treatment responses for elderly breast cancer patients. In conclusion, we developed a novel model for evaluating prognosis and therapeutic responses, providing a potential molecular classification that assists in the pre-treatment assessment of geriatric breast cancer.
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Affiliation(s)
- Xia Wu
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
- Ningbo Clinical Pathology Diagnosis Center, Ningbo, Zhejiang 315021, China
| | - Mengxin Chen
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Kang Liu
- Ganzhou People's Hospital, Ganzhou 341000, China
| | - Yixin Wu
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Yun Feng
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Shiting Fu
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Huaimeng Xu
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Yongqi Zhao
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Feilong Lin
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Liang Lin
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Shihui Ye
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Junqiang Lin
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Taiping Xiao
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Wenhao Li
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Meng Lou
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Hongyu Lv
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Ye Qiu
- Huankui Academy, Nanchang University, Nanchang, Jiangxi 330031, China
| | - Ruifan Yu
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Wenyan Chen
- Department of Medical Oncology, Nanchang People's Hospital, Nanchang 330008, China
| | - Mengyuan Li
- Department of Gynaecology and Obstetrics, Chongqing General Hospital, Chongqing 401147, China
| | - Xu Feng
- Xianlin High School, Weinan 714000, China
| | | | - Lu Guo
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310000, China
| | - Hao Ke
- Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006, China
- School of Life Science, Nanchang University, Nanchang 330031, China
| | - Limin Zhao
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
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Harada T, Tsuji T, Yanagisawa T, Ueno J, Hijikata N, Ishikawa A, Hiroshige K, Kotani D, Kojima T, Fujita T. Skeletal muscle mass recovery after oesophagectomy and neoadjuvant chemotherapy in oesophageal cancer: retrospective cohort study. BMJ Support Palliat Care 2024; 14:326-334. [PMID: 37130721 DOI: 10.1136/spcare-2023-004245] [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: 02/27/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Skeletal muscle mass (SMM) is an important biomarker for prognosis and health in older patients with cancer. Limited information is available on the recovery course of SMM after oesophagectomy following neoadjuvant chemotherapy (NAC) in older patients. This study was performed to investigate the recovery course of SMM after oesophagectomy following NAC and the preoperative predictors of delayed recovery in older patients with locally advanced oesophageal cancer (LAEC). METHODS This single-centre retrospective cohort study involved older (≥65 years) and non-older (<65 years) patients with LAEC who underwent oesophagectomy following NAC. The SMM index (SMI) was calculated using CT images. One-way analysis of variance and multivariate logistic regression analysis were performed. RESULTS In total, 110 older patients and 57 non-older patients were analysed. Loss of the SMI after NAC to 12 months postoperatively was significantly greater in older patients than in non-older patients (p<0.01). The significant preoperative predictor of delayed recovery of the SMI 12 months after surgery was loss of the SMI during NAC in older patients (per 1%: adjusted OR 1.249; 95% CI 1.131 to 1.403; p<0.001), but not in non-older patients (per 1%: OR 1.074; 95% CI 0.988 to 1.179; p=0.108). CONCLUSIONS There is an especially large unmet need for preventing the long-term sequelae of SMM loss in older patients with LAEC after oesophagectomy following NAC. In older patients, loss of SMM during NAC is an especially useful biomarker for prescribing postoperative rehabilitation to prevent postoperative loss of SMM.
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Affiliation(s)
- Tsuyoshi Harada
- Department of Rehabilitation Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Takumi Yanagisawa
- Department of Rehabilitation Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Junya Ueno
- Department of Rehabilitation Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
| | - Nanako Hijikata
- Department of Rehabilitation Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Keiichi Hiroshige
- Department of Physical Therapy, Kyushu Nutrition Welfare University, Kitakyushu, Fukuoka, Japan
| | - Daisuke Kotani
- Department of Gastrointestinal Oncology, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
| | - Takashi Kojima
- Department of Gastrointestinal Oncology, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
| | - Takeo Fujita
- Department of Esophageal Surgery, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
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3
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Fonseca VC, Sidiropoulou Z. Geriatric Breast Cancer: Staging, Molecular Surrogates, and Treatment. A Review & Meta-analysis. Aging Dis 2024; 15:1602-1618. [PMID: 37962462 PMCID: PMC11272193 DOI: 10.14336/ad.2023.1002] [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: 07/21/2023] [Accepted: 10/02/2023] [Indexed: 11/15/2023] Open
Abstract
Breast cancer (BC) is one of the most frequent cancers in females across the globe. Treatment recommendations for BC patients are primarily driven by patient age, staging and tumor molecular subtype. Thus, we updated the general overview of BC staging, molecular surrogates, and treatment choices for women >70 years based on a systematic study encompassing the years 2013-2023. A PRISMA guidelines and PICO framework were followed, and relevant research articles were searched using different data bases (Web of Sciences, PubMed, MEDLINE, and Scopus). Mixed Methods Appraisal Tool was used for studies quality assessment. The research articles that made it into the systematic review were compiled using qualitative criteria. In the meanwhile, heterogeneity was determined using meta-analysis with RevMan 5.4. We applied a random effects model with a 0.05 significance level. Overall, there were 4151 research articles, after screening only 17 articles with 39,906 patients were included. Conclusion: Elderly patients with breast cancer should be treated differently in an adapted way. The treatment should not be the same worldwide due to different health systems. Molecular surrogates are different in geriatric patients. Surgery is the best option for treatment in this subset of patients. We need to have therapeutic decision appointments for elderly patients with breast cancer. The guidelines and medical authority should be used in the best decision.
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Affiliation(s)
- Vasco C Fonseca
- Department of Oncology, Hospital Centre of West Lisbon, Portugal.
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You J, Ganann R, Wilson M, Carusone SC, MacNeil M, Whitmore C, Dafel A, Dhamanaskar R, Ling E, Dingman L, Falbo AT, Kirk M, Luyckx J, Petrie P, Weldon D, Boothe K, Abelson J. Public Engagement in Health Policy-Making for Older Adults: A Systematic Search and Scoping Review. Health Expect 2024; 27:e70008. [PMID: 39188109 PMCID: PMC11347750 DOI: 10.1111/hex.70008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/29/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024] Open
Abstract
INTRODUCTION As the world's population ages, there has been increasing attention to developing health policies to support older adults. Engaging older adults in policy-making is one way to ensure that policy decisions align with their needs and priorities. However, ageist stereotypes often underestimate older adults' ability to participate in such initiatives. This scoping review aims to describe the characteristics and impacts of public engagement initiatives designed to help inform health policy-making for older adults. METHODS A systematic search of peer-reviewed and grey literature (English only) describing public engagement initiatives in health policy-making for older adults was conducted using six electronic databases, Google and the Participedia website. No geographical, methodological or time restrictions were applied to the search. Eligibility criteria were purposefully broad to capture a wide array of relevant engagement initiatives. The outcomes of interest included participants, engagement methods and reported impacts. RESULTS This review included 38 papers. The majority of public engagement initiatives were funded or initiated by governments or government agencies as a formal activity to address policy issues, compared to initiatives without a clear link to a specific policy-making process (e.g., research projects). While most initiatives engaged older adults as target participants, there was limited reporting on efforts to achieve participant diversity. Consultation-type engagement activities were most prevalent, compared to deliberative and collaborative approaches. Impacts of public engagement were frequently reported without formal evaluations. Notably, a few articles reported negative impacts of such initiatives. CONCLUSION This review describes how public engagement practices have been conducted to help inform health policy-making for older adults and the documented impacts. The findings can assist policymakers, government staff, researchers and seniors' advocates in supporting the design and execution of public engagement initiatives in this policy sector. PATIENT OR PUBLIC CONTRIBUTION Older adult partners from the McMaster University Collaborative for Health and Aging provided strategic advice throughout the key phases of this review, including developing a review protocol, data charting and synthesis and interpreting and presenting the review findings. This collaborative partnership was an essential aspect of this review, enhancing its relevance and meaningfulness for older adults.
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Affiliation(s)
- Jeonghwa You
- Department of Health Research Methods, Evidence and Impact (HEI)McMaster UniversityHamiltonCanada
| | | | - Michael Wilson
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonCanada
- McMaster Health ForumHamiltonCanada
| | - Soo Chan Carusone
- Department of Health Research Methods, Evidence and Impact (HEI)McMaster UniversityHamiltonCanada
- McMaster Collaborative for Health and AgingHamiltonCanada
| | | | | | - Andrea Dafel
- Department of Health Research Methods, Evidence and Impact (HEI)McMaster UniversityHamiltonCanada
| | - Roma Dhamanaskar
- Department of Health Research Methods, Evidence and Impact (HEI)McMaster UniversityHamiltonCanada
| | - Eugenia Ling
- School of NursingMcMaster UniversityHamiltonCanada
| | - Lance Dingman
- McMaster Collaborative for Health and AgingHamiltonCanada
| | - A. Tina Falbo
- McMaster Collaborative for Health and AgingHamiltonCanada
| | - Michael Kirk
- McMaster Collaborative for Health and AgingHamiltonCanada
| | - Joyce Luyckx
- McMaster Collaborative for Health and AgingHamiltonCanada
| | | | - Donna Weldon
- McMaster Collaborative for Health and AgingHamiltonCanada
| | - Katherine Boothe
- Department of Political ScienceMcMaster UniversityHamiltonCanada
- Centre for Health Economics and Policy Analysis (CHEPA)McMaster UniversityHamiltonCanada
| | - Julia Abelson
- Department of Health Research Methods, Evidence and Impact (HEI)McMaster UniversityHamiltonCanada
- Centre for Health Economics and Policy Analysis (CHEPA)McMaster UniversityHamiltonCanada
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Han CY, Chan RJ, Ng HS, Sharma Y, Yaxley A, Baldwin C, Miller M. Pre-Frailty and Frailty in Hospitalized Older Adults: A Comparison Study in People with and without a History of Cancer in an Acute Medical Unit. Cancers (Basel) 2024; 16:2212. [PMID: 38927918 PMCID: PMC11201449 DOI: 10.3390/cancers16122212] [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: 05/16/2024] [Revised: 06/05/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
A prospective observational study was conducted in a cohort of older adults ≥65 years (n = 329), admitted to the acute medical unit (AMU) of a tertiary hospital, to describe and compare characteristics including frailty status and clinical outcomes. Multivariable models compared older adults with and without a history of cancer to determine characteristics associated with frailty and pre-frailty. An adjusted Poisson regression model was used to compare the length of hospital stay (LOS) between the two groups. About one-fifth (22%) of the cohort had a history of cancer. The most common cancer types were prostate (n = 20), breast (n = 13), lung (n = 8) and gastrointestinal (n = 8). There was no difference in the prevalence of pre-frailty/frailty among patients with or without a history of cancer (58% vs. 57%, p > 0.05). Pre-frailty/frailty was associated with polypharmacy (OR 8.26, 95% CI: 1.74 to 39.2) and malnutrition (OR 8.91, 95% CI: 2.15 to 36.9) in patients with a history of cancer. Adjusted analysis revealed that the risk of having a longer LOS was 24% higher in older adults with a history of cancer than those without (IRR 1.24, 95% CI 1.10 to 1.41, p < 0.001). Clinicians in the AMU should be aware that older adults with a history of cancer have a higher risk of a longer LOS compared to those without.
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Affiliation(s)
- Chad Yixian Han
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (R.J.C.); (A.Y.); (C.B.); (M.M.)
| | - Raymond Javan Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (R.J.C.); (A.Y.); (C.B.); (M.M.)
- Faculty of Health, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Huah Shin Ng
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia; (H.S.N.); (Y.S.)
- SA Pharmacy, SA Health, Adelaide, SA 5001, Australia
| | - Yogesh Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia; (H.S.N.); (Y.S.)
- Department of Acute and General Medicine, Flinders Medical Centre, Adelaide, SA 5042, Australia
| | - Alison Yaxley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (R.J.C.); (A.Y.); (C.B.); (M.M.)
| | - Claire Baldwin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (R.J.C.); (A.Y.); (C.B.); (M.M.)
| | - Michelle Miller
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (R.J.C.); (A.Y.); (C.B.); (M.M.)
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Diaz FC, Hamparsumian A, Loh KP, Verduzco-Aguirre H, Abdallah M, Williams GR, Hsu T, Soto-Perez-de-Celis E, Elias R. Geriatric Oncology: A 5-Year Strategic Plan. Am Soc Clin Oncol Educ Book 2024; 44:e100044. [PMID: 38709980 PMCID: PMC11463154 DOI: 10.1200/edbk_100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
The increasing rate of the older adult population across the world over the next 20 years along with significant developments in the treatment of oncology will require a more granular understanding of the older adult population with cancer. The ASCO Geriatric Oncology Community of Practice (COP) herein provides an outline for the field along three fundamental pillars: education, research, and implementation, inspired by ASCO's 5-Year Strategic Plan. Fundamental to improving the understanding of geriatric oncology is research that intentionally includes older adults with clinically meaningful data supported by grants across all career stages. The increased knowledge base that is developed should be conveyed among health care providers through core competencies for trainees and continuing education for practicing oncologists. ASCO's infrastructure can serve as a resource for fellowship programs interested in acquiring geriatric oncology content and provide recommendations on developing training pathways for fellows interested in pursuing formalized training in geriatrics. Incorporating geriatric oncology into everyday practice is challenging as each clinical setting has unique operational workflows with barriers that limit implementation of valuable geriatric tools such as Geriatric Assessment. Partnerships among experts in quality improvement from the ASCO Geriatric Oncology COP, the Cancer and Aging Research Group, and ASCO's Quality Training Program can provide one such venue for implementation of geriatric oncology through a structured support mechanism. The field of geriatric oncology must continue to find innovative strategies using existing resources and partnerships to address the pressing needs of the older adult population with cancer to improve patient outcomes.
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Affiliation(s)
- Fernando C Diaz
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
- Division of Geriatrics, University of North Carolina, Chapel Hill, NC
| | - Anahid Hamparsumian
- Geriatric Research Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Haydeé Verduzco-Aguirre
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Maya Abdallah
- Section of Hematology/Oncology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA
| | - Grant R Williams
- Lewis and Faye Manderson Cancer Center at DCH Regional Medical Center, Tuscaloosa, AL
- Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Tina Hsu
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rawad Elias
- Division of Hematology-Oncology, UMass Chan Medical School-Baystate, Springfield, MA
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7
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Montégut L, López-Otín C, Kroemer G. Aging and cancer. Mol Cancer 2024; 23:106. [PMID: 38760832 PMCID: PMC11102267 DOI: 10.1186/s12943-024-02020-z] [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: 04/19/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
Aging and cancer exhibit apparent links that we will examine in this review. The null hypothesis that aging and cancer coincide because both are driven by time, irrespective of the precise causes, can be confronted with the idea that aging and cancer share common mechanistic grounds that are referred to as 'hallmarks'. Indeed, several hallmarks of aging also contribute to carcinogenesis and tumor progression, but some of the molecular and cellular characteristics of aging may also reduce the probability of developing lethal cancer, perhaps explaining why very old age (> 90 years) is accompanied by a reduced incidence of neoplastic diseases. We will also discuss the possibility that the aging process itself causes cancer, meaning that the time-dependent degradation of cellular and supracellular functions that accompanies aging produces cancer as a byproduct or 'age-associated disease'. Conversely, cancer and its treatment may erode health and drive the aging process, as this has dramatically been documented for cancer survivors diagnosed during childhood, adolescence, and young adulthood. We conclude that aging and cancer are connected by common superior causes including endogenous and lifestyle factors, as well as by a bidirectional crosstalk, that together render old age not only a risk factor of cancer but also an important parameter that must be considered for therapeutic decisions.
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Affiliation(s)
- Léa Montégut
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, Villejuif, France
| | - Carlos López-Otín
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, Paris, France
- Facultad de Ciencias de la Vida y la Naturaleza, Universidad Nebrija, Madrid, Spain
| | - Guido Kroemer
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, Paris, France.
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, Villejuif, France.
- Institut du Cancer Paris CARPEM, Department of Biology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
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James ND, Tannock I, N'Dow J, Feng F, Gillessen S, Ali SA, Trujillo B, Al-Lazikani B, Attard G, Bray F, Compérat E, Eeles R, Fatiregun O, Grist E, Halabi S, Haran Á, Herchenhorn D, Hofman MS, Jalloh M, Loeb S, MacNair A, Mahal B, Mendes L, Moghul M, Moore C, Morgans A, Morris M, Murphy D, Murthy V, Nguyen PL, Padhani A, Parker C, Rush H, Sculpher M, Soule H, Sydes MR, Tilki D, Tunariu N, Villanti P, Xie LP. The Lancet Commission on prostate cancer: planning for the surge in cases. Lancet 2024; 403:1683-1722. [PMID: 38583453 DOI: 10.1016/s0140-6736(24)00651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/28/2023] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Nicholas D James
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
| | - Ian Tannock
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Felix Feng
- University of California, San Francisco, USA
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Syed Adnan Ali
- University of Manchester, Manchester, UK; The Christie Hospital, Manchester, UK
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Eva Compérat
- Tenon Hospital, Sorbonne University, Paris; AKH Medical University, Vienna, Austria
| | - Ros Eeles
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | - Áine Haran
- The Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | | | | | - Stacy Loeb
- New York University, New York, NY, USA; Manhattan Veterans Affairs, New York, NY, USA
| | | | | | | | - Masood Moghul
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Michael Morris
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Declan Murphy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | | | | | | | | | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | | | - Derya Tilki
- Martini-Klinik Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Türkiye
| | - Nina Tunariu
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Li-Ping Xie
- First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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9
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de Barros LPL, de Oliveira Muniz Koch L, de Oliveira Lima JT, Apolinario TL, Dettino ALA, Petrarca CR, Martins JC, de Souza PMR, Rodrigues M, de Souza E Silva JT, Karnakis T, Junior LAG, Junior MGA, Honorato M, Abalos VR, Alvarado OC, Navarrete G, Rebelatto TF, Soto-Perez-de-Celis E. Development of geriatric oncology in Latin America: A report from the Latin American Cooperative Oncology Group. J Geriatr Oncol 2024; 15:101642. [PMID: 37977899 DOI: 10.1016/j.jgo.2023.101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/01/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023]
Abstract
Population aging represents a critical issue for global cancer care, notably in low- and middle-income countries (LMIC). Latin America is a large region composed of 21 countries with notable diversity in both human development and access to quality healthcare. Thus, it is necessary to understand how care for older individuals is being delivered in such large and diverse regions of the world. This review describes the recent advances made in Mexico, Brazil, and Chile, focusing on the creation and implementation of educational, research, and clinical activities in geriatric oncology. These initiatives intend to change healthcare professionals' perceptions about the care for older adults and to improve the way older patients are being treated.
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Affiliation(s)
- Luciola Pontes Leite de Barros
- Oncology and Hematology Department, HCor, São Paulo, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil.
| | - Ludmila de Oliveira Muniz Koch
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Oncology and Hematology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Theodora Karnakis
- Cancer Institute of São Paulo, University of São Paulo, São Paulo, Brazil
| | | | | | - Macarena Honorato
- Department of Geriatrics, Clínica Alemana de Santiago, Santiago, Chile
| | | | - Oscar Calderón Alvarado
- Department of Geriatrics, Clínica Alemana de Santiago, Santiago, Chile; Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Gonzalo Navarrete
- Hospital Clínico Universidad de Chile, Santiago, Chile; Fundación Arturo Lopez Perez, Santiago, Chile
| | | | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, México City, Mexico
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Mizutani T, Cheung KL, Hakobyan Y, Lane H, Decoster L, Karnakis T, Puts M, Calderon O, Jørgensen TL, Boulahssass R, Wedding U, Karampeazis A, Chan WWL, Banerjee J, Falci C, van Leeuwen BL, Fonseca V, Gironés Sarrió R, Vetter M, Dougoud V, Naeim A, Ashman J, Musolino N, Kanesvaran R. Leave no one behind: A global survey of the current state of geriatric oncology practice by SIOG national representatives. J Geriatr Oncol 2024; 15:101709. [PMID: 38310661 DOI: 10.1016/j.jgo.2024.101709] [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: 10/02/2023] [Revised: 12/06/2023] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION The Sustainable Development Goals of the United Nations include a commitment to "leave no one behind" as a universal goal. To achieve this in geriatric oncology (GO) worldwide, it is important to understand the current state of GO at an international level. The International Society of Geriatric Oncology (SIOG) has several National Representatives (NRs) who act as SIOG's delegates in their respective countries. The NRs took part in this international survey exploring the state of GO practice, identifying barriers and solutions. MATERIALS AND METHODS The NRs answered open-ended questions by email from February 2020 to October 2022. The questionnaire domains included the demographic information of older adults for their countries, and the NRs' opinions on whether GO is developing, what the barriers are to developing GO, and proposed actions to remove these barriers. The demographic data of each country reported in the survey was adjusted using literature and database searches. RESULTS Twenty-one of thirty countries with NRs (70%) participated in this questionnaire study: 12 European, four Asian, two North American, two South American, and one Oceanian. The proportion of the population aged ≥75 years varied from 2.2% to 15.8%, and the average life expectancy also varied from 70 years to 86 years. All NRs reported that GO was developing in their country; four NRs (18%) reported that GO was well developed. Although all NRs agreed that geriatric assessment was useful, only three reported that it was used day-to-day in their countries' clinical practice (14%). The major barriers identified were the lack of (i) evidence to support GO use, (ii) awareness and interest in GO, and (iii) resources (time, manpower, and funding). The major proposed actions were to (i) provide new evidence through clinical trials specific for GO patients, (ii) stimulate awareness through networking, and (iii) deliver educational materials and information to healthcare providers and medical students. DISCUSSION This current survey has identified the barriers to GO and proposed actions that could remove them. Broader awareness seems to be essential to implementing GO. Additional actions are needed to develop GO within countries and can be supported through international partnerships.
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Affiliation(s)
- Tomonori Mizutani
- Kyorin University Faculty of Medicine, Department of Medical Oncology, Tokyo, Japan.
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Yervand Hakobyan
- Hematology Center after Prof. Yeolyan, Hematology and Transfusion Medicine department of NIH Armenia, Yerevan, Armenia
| | - Heather Lane
- Sir Charles Gairdner Hospital, Geriatric and Rehabilitation Medicine Department, Perth, Australia
| | - Lore Decoster
- UZ Brussel, Vrije Universiteit Brussel, Department of Medical Oncology, Brussels, Belgium
| | - Theodora Karnakis
- The Cancer Institute of the State of São Paulo/University, Division of Geriatric Medicine, São Paulo, Brazil
| | - Martine Puts
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Canada
| | - Oscar Calderon
- Clínica Alemana de Santiago and Complejo Asistencial Dr. Sótero del Río, Department of Geriatric Medicine, Santiago, Chile
| | | | | | - Ulrich Wedding
- University Hospital Jena, Department of Palliative Care, Jena, Germany
| | | | | | - Joyita Banerjee
- All India Institute of Medical Sciences, Department of Geriatric Medicine, New Delhi, India
| | - Cristina Falci
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Barbara L van Leeuwen
- University medical center Groningen, Department of Surgery, Groningen, the Netherlands
| | - Vasco Fonseca
- Centro Hospitalar de Lisboa Ocidental, Department of Oncology, Lisboa, Portugal
| | - Regina Gironés Sarrió
- Hospital Universitari i Politècnic La FE, Department of Medical Oncology, Valencia, Spain
| | - Marcus Vetter
- Affiliation Cancer Center Baselland, Kantonsspital Baselland, Liestal, Switzerland
| | - Vérène Dougoud
- The HFR Hospital, Department of Medical Oncology, Fribourg, Switzerland
| | - Arash Naeim
- UCLA and Samueli School of Engineering and Applied Science, Departments of Medicine and Bioengineering, Calfornia, United States
| | - Jed Ashman
- Sandwell and West Birmingham NHS Trust, Birmingham City Hospital, Birmingham, United Kingdom; International Society of Geriatric Oncology, Geneva, Switzerland
| | - Najia Musolino
- International Society of Geriatric Oncology, Geneva, Switzerland
| | - Ravindran Kanesvaran
- National Cancer Centre Singapore, Department of Medical Oncology, Singapore, Singapore
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11
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Hodge O, Rasekaba T, Blackberry I, Steer CB. Age-friendly healthcare: integrating the 4Ms to enable age-friendly cancer care. Curr Opin Support Palliat Care 2024; 18:9-15. [PMID: 38252057 DOI: 10.1097/spc.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
PURPOSE OF REVIEW There is a growing movement towards person-centred, age-friendly healthcare in the care of older adults, including those with cancer. The Age-Friendly Health Systems (AFHS) initiative uses the 4Ms framework to enable this change. This review documents the utility and implications of 4Ms implementation across different settings, with a particular focus on cancer care. RECENT FINDINGS The AFHS initiative 4Ms framework uses a set of core, evidence-based guidelines (focussing on What Matters, Medication, Mentation and Mobility) to improve person-centred care. The successful implementation of the 4Ms has been documented in many different healthcare settings including orthopaedics primary care, and cancer care. Implementation of the 4Ms framework into existing workflows complements the use of geriatric assessment to improve care of older adults with cancer. Models for implementation of the 4Ms within a cancer centre are described. Active engagement and education of healthcare providers is integral to success. Solutions to implementing the What Matters component are addressed. SUMMARY Cancer centres can successfully implement the 4Ms framework into existing workflows through a complex change management process and development of infrastructure that engages healthcare providers, facilitating cultural change whilst employing quality improvement methodology to gradually adapt the status quo to age-friendly processes.
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Affiliation(s)
- Oliver Hodge
- UNSW School of Clinical Medicine, Rural Clinical Campus, Albury Campus, NSW
| | | | - Irene Blackberry
- John Richards Centre for Rural Ageing Research
- Care Economy Research Institute, La Trobe University, Wodonga, VIC
| | - Christopher B Steer
- UNSW School of Clinical Medicine, Rural Clinical Campus, Albury Campus, NSW
- John Richards Centre for Rural Ageing Research
- Border Medical Oncology and Haematology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia
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12
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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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13
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Li H, Kilgour H, Leung B, Cho M, Pollock J, Culbertson S, Hedges P, Mariano C, Haase KR. Caring for older adults with cancer in Canada: Views from healthcare providers and cancer care allies in the community. Support Care Cancer 2024; 32:157. [PMID: 38358430 DOI: 10.1007/s00520-023-08303-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 12/29/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Cancer is common and disproportionately impacts older adults. Moreover, cancer care of older adults is complex, and the current Canadian cancer care system struggles to address all of the dimensions. In this project, our goal was to understand the barriers and facilitators to caring for older adults with cancer from perspectives of healthcare professionals and cancer care allies, which included community groups, seniors' centers, and other community-based supports. METHODS In collaboration with a patient advisory board, we conducted focus groups and interviews with multiple local healthcare professionals and cancer care allies in British Columbia, Canada. We used a descriptive qualitative approach and conducted a thematic analysis using NVivo software. RESULTS A total of 71 participants of various disciplines and cancer care allies participated. They identified both individual and system-level barriers. Priority system-level barriers for older adults included space and staffing constraints and disconnections within healthcare systems, and between healthcare practitioners and cancer care allies. Individual-level barriers relate to the complex health states of older adults, caregiver/support person needs, and the needs of an increasingly diverse population where English may not be a first or preferable language. CONCLUSIONS This study identified key barriers and facilitators that demonstrate aligned priorities among a diverse group of healthcare practitioners and cancer care allies. In conjunction with perspectives from patients and caregivers, these findings will inform future improvements in cancer care. Namely, we emphasize the importance of connections among health systems and community networks, given the outpatient nature of cancer care and the needs of older adults.
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Affiliation(s)
- Hong Li
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Heather Kilgour
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Bonnie Leung
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| | - Michelle Cho
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Kristen R Haase
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.
- BC Cancer Research Institute, Vancouver, BC, Canada.
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14
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Byun YH, Ha J, Kang H, Park CK, Jung KW, Yoo H. Changes in the Epidemiologic Pattern of Primary CNS Tumors in Response to the Aging Population: An Updated Nationwide Cancer Registry Data in the Republic of Korea. JCO Glob Oncol 2024; 10:e2300352. [PMID: 38301181 PMCID: PMC10846785 DOI: 10.1200/go.23.00352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 02/03/2024] Open
Abstract
PURPOSE Primary CNS tumors (PCNSTs) are tumors originating from the brain and surrounding tissues. These tumors account for a significant proportion of cancer deaths and morbidity globally. Accurate epidemiologic data are essential for shaping clinical practices, research priorities, and health care policies. This study presents the latest 2020 national data on PCNSTs from the Republic of Korea (ROK) and explores the trends in incidence and their societal implications in the context of an aging population. METHODS This is a cross-sectional, observational study conducted using data sourced from the Korea National Cancer Incidence Database by the Korea Central Cancer Registry. The study analyzed national data on PCNSTs in the ROK for the years 2010, 2013, 2016, and 2020. RESULTS In 2020, 15,568 new PCNST cases were diagnosed in the ROK. The overall crude rate was 30.32, and the age-standardized rate was 19.37 per 100,000 persons. A decade-long trend analysis revealed an increasing trend in newly diagnosed glioblastoma and lymphoma, and a decreasing trend in embryonal tumors, in relation to the aging population of the ROK. CONCLUSION This study shows the significant impact of demographic shifts on the epidemiologic patterns of PCNSTs in the ROK. Our findings emphasize the need for collaborative efforts to address the rising challenges posed by the changing incidence of PCNSTs related to an aging population.
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Affiliation(s)
- Yoon Hwan Byun
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Johyun Ha
- Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Republic of Korea
| | - Ho Kang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-Do, Republic of Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyu-Won Jung
- Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Republic of Korea
| | - Heon Yoo
- Department of Neuro-Oncology Clinic, National Cancer Center, Goyang, Republic of Korea
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15
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Duchesneau ED, Klepin HD, Hanchate AD, Lin MY, Bluethmann SM. Big Data for Geriatric Oncology Research. N C Med J 2024; 85:20-24. [PMID: 39359617 PMCID: PMC11444596 DOI: 10.18043/001c.91420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
Cancer is the second leading cause of death in North Carolina and approximately half of cancers are diagnosed in older adults (≥65 years). Cancer clinical trials in older adults are limited and there is a lack of evidence on optimal care strategies in this population. We highlight how big data can fill in gaps in geriatric oncology research.
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Affiliation(s)
- Emilie D Duchesneau
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Heidi D Klepin
- Section on Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Amresh D Hanchate
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Meng-Yun Lin
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Shirley M Bluethmann
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
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16
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Ginsburg O, Vanderpuye V, Beddoe AM, Bhoo-Pathy N, Bray F, Caduff C, Florez N, Fadhil I, Hammad N, Heidari S, Kataria I, Kumar S, Liebermann E, Moodley J, Mutebi M, Mukherji D, Nugent R, So WKW, Soto-Perez-de-Celis E, Unger-Saldaña K, Allman G, Bhimani J, Bourlon MT, Eala MAB, Hovmand PS, Kong YC, Menon S, Taylor CD, Soerjomataram I. Women, power, and cancer: a Lancet Commission. Lancet 2023; 402:2113-2166. [PMID: 37774725 DOI: 10.1016/s0140-6736(23)01701-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Ophira Ginsburg
- Centre for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Carlo Caduff
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Nazik Hammad
- Department of Medicine, Division of Hematology-Oncology, St. Michael's Hospital, University of Toronto, Canada; Department of Oncology, Queens University, Kingston, Canada
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland; Gender Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | - Somesh Kumar
- Jhpiego India, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Erica Liebermann
- University of Rhode Island College of Nursing, Providence, RI, USA
| | - Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Deborah Mukherji
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Clemenceau Medical Center Dubai, Dubai, United Arab Emirates
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong Special Administrative Region, China
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | | | - Gavin Allman
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Jenna Bhimani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - María T Bourlon
- Department of Hemato-Oncology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Michelle A B Eala
- College of Medicine, University of the Philippines, Manila, Philippines; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Yek-Ching Kong
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sonia Menon
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Mackenzie P, Vajdic C, Delaney G, Comans T, Agar M, Gabriel G, Barton M. Development of an age- and comorbidity- adjusted optimal radiotherapy utilisation rate for lung, rectal, prostate and cervical cancers. Radiother Oncol 2023; 188:109862. [PMID: 37619661 DOI: 10.1016/j.radonc.2023.109862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Optimal radiotherapy utilisation (RTU) modelling estimates the proportion of people with cancer who would benefit from radiotherapy. Assessment of comorbidities is an important component of the assessment of suitability for radiotherapy in addition to chronological age and life expectancy. Comorbidities have not been considered in previous optimal RTU models. We aimed to develop an age- and comorbidity- adjusted optimal RTU model for patients with lung, rectal, prostate, and cervical cancer, and compare them to actual RTU rates, with a particular focus on those aged 80+ years, METHODS: New South Wales (NSW) Cancer Registry data (2010-2014) linked to radiotherapy data (2010-2015) and hospitalisation data (2008-2015) were used to determine the number of patients diagnosed with lung, rectal, prostate and cervical cancer. The Cancer Specific C3 'all sites' comorbidity index was calculated from hospital diagnosis data for each patient to determine suitability for radiotherapy. The index was then incorporated into a tumour site-specific decision tree model. The actual RTU was also calculated using the linked datasets. RESULTS 14,696 patients were diagnosed with non-small cell lung cancer (NSCLC), 1839 with small cell lung cancer (SCLC), 5551 with rectal cancer, 30,935 with prostate cancer and 1216 with cervical cancer in New South Wales from 2010-2014. The proportion of patients aged 80+ years at cancer diagnosis was 25% (3603 patients), 15% (279 patients), 17% (943 patients), 12% (3745 patients), and 7% (88 patients) respectively. The age- and comorbidity- adjusted optimal RTU rates for patients aged 80+ years using the C3 index were 49% (NSCLC), 49% (SCLC), 43% (rectal), 51% (prostate) and 40% (cervical). The corresponding actual RTU rates for patients aged 80+ years were 25%, 32%, 27%, 16%, and 56%. CONCLUSION Even after adjusting for age and comorbidities, the actual radiotherapy utilisation rates were lower than optimal radiotherapy utilisation rates in patients aged 80+ years except for patients with cervical cancer. This warrants further assessment and research into reasons and solutions.
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Affiliation(s)
- Penny Mackenzie
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), The University of New South Wales, Sydney, Australia; The Royal Brisbane and Women's Hospital, Queensland, Australia.
| | - Claire Vajdic
- The Kirby Insitute, The University of New South Wales, Sydney, Australia
| | - Geoff Delaney
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), The University of New South Wales, Sydney, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Australia
| | - Meera Agar
- The University of Technology, Sydney, Australia
| | - Gabriel Gabriel
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), The University of New South Wales, Sydney, Australia
| | - Michael Barton
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), The University of New South Wales, Sydney, Australia
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Xie Y, Deng Y, Wei S, Huang Z, Li L, Huang K, Wei C, Xu J, Dong L, Zhang Q, Zhao J, Zou Q, Yang J. Age has a U-shaped relationship with breast cancer outcomes in women: a cohort study. Front Oncol 2023; 13:1265304. [PMID: 37860197 PMCID: PMC10583555 DOI: 10.3389/fonc.2023.1265304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023] Open
Abstract
Background and Objectives Age is a significant determinant of susceptibility to breast cancer. Currently, the available evidence regarding the non-linear correlation between the age of diagnosis and the prognosis of breast cancer patients is contradictory. Insufficient data currently exist regarding the influence of age at diagnosis on the prognosis of breast cancer. The objective of our investigation was to examine the relationship between age at diagnosis and overall survival (OS), breast cancer-specific survival (BCSS), and disease-free survival (DFS). Methods This retrospective cohort study included 1054 patients diagnosed with breast cancer between March 7, 2013 and December 31, 2019. The hazard ratios (HRs) and 95% confidence interval (CI) for OS, BCSS, DFS were assessed using Cox proportional hazard ratio models and restricted cubic splines (RCS). Results The study included 1054 breast cancer patients who met the criteria. With a median follow-up of 4.86 years, 71 patients (6.74%) died and 144 patients (13.66%) relapsed. After multivariable adjustment, age showed a U-shaped association with OS, BCSS, and DFS, with significantly higher risk at two ends, with age inflection points of 44, 44, and 41 years for OS, BCSS, and DFS, respectively. For OS, Quartile 1 (HR, 2.09; 95% CI: 0.90-4.84), Quartile 3 (HR, 2.44; 95% CI: 1.05-5.65) and Quartile 4 (HR, 3.38; 95% CI: 1.51-7.54) had poorer OS compared with Quartile 2. Similar results were found for BCSS and DFS. Conclusions This study confirmed a U-shaped association between age at diagnosis and breast cancer outcome.
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Affiliation(s)
- Yujie Xie
- Department of Breast and Thyroid Surgery, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Yongqing Deng
- The Family Planning Office of Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Suosu Wei
- Department of Scientific Cooperation of Guangxi Academy of Medical Sciences, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Zhen Huang
- Department of Breast and Thyroid Surgery, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Lihui Li
- Department of Breast and Thyroid Surgery, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Kai Huang
- Department of Breast and Thyroid Surgery, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Chunyu Wei
- Department of Breast and Thyroid Surgery, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Jinan Xu
- Department of Breast and Thyroid Surgery, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Lingguang Dong
- Department of Breast and Thyroid Surgery, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Qiuhuan Zhang
- Department of Colorectal and Anal Surgery, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Jiehua Zhao
- Department of Breast and Thyroid Surgery, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Quanqing Zou
- Department of Breast and Thyroid Surgery, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Jianrong Yang
- Department of Breast and Thyroid Surgery, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
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Alemania E, Hind A, Samara J, Turner M, Ralph N, Paterson C. Nurse-led interventions among older adults affected by cancer: An integrative review. Asia Pac J Oncol Nurs 2023; 10:100289. [PMID: 37886720 PMCID: PMC10597832 DOI: 10.1016/j.apjon.2023.100289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/31/2023] [Indexed: 10/28/2023] Open
Abstract
Objective Aging can introduce significant changes in health, cognition, function, social status, and emotional status among older adults affected by cancer. Little is known about how existing nurse-led interventions address the needs of older adults. The objective was to identify existing nurse-led interventions among older adults to optimize recovery and survivorship needs. Methods A integrative systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 Guidelines. Electronic databases (APA PsycINFO, CINAHL, MEDLINE, Scopus, and Google Scholar databases) were searched using key search terms. Articles were assessed for inclusion according to a pre-determined eligibility criterion. Data extraction and quality appraisal were conducted. Findings were integrated into a narrative synthesis. Results Twenty-one studies were included, and a total of 4253 participants were represented. There were a range of study designs: quantitative (n = 10), randomised controlled trials (n = 6), mixed methods studies (n = 3), qualitative (n = 1), and a non-randomized controlled study (n = 1). Most participants had prostate cancer, with some representation in colorectal, lung, head and neck, renal, esophageal, and mixed cancer patient populations. Conclusions This review shows a lack of evidence on the inclusion of geriatric assessments for older people with cancer within existing nurse-led interventions. Further research is needed to test nurse-led interventions with the inclusion of geriatric assessments and their contribution to the multidisciplinary team across the cancer care continuum for various cancer patient populations.
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Affiliation(s)
| | - Alica Hind
- Faculty of Health, University of Canberra, Australia
| | - Juliane Samara
- Calvary Public Hospital Bruce, Clare Holland House Specialist Palliative Aged Care, Barton ACT, Australia
| | - Murray Turner
- Faculty of Health, University of Canberra, Australia
| | - Nick Ralph
- School of Nursing & Midwifery, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia
| | - Catherine Paterson
- Faculty of Health, University of Canberra, Australia
- Caring Futures Institute, Flinders University, Australia
- Central Adelaide Local Health Network, Adelaide, Australia
- Robert Gordon University, Aberdeen, Scotland, UK
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20
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García-Baztán A, Oteiza-Olaso J, Gonzales-Montejo NJ, Ramón-Espinoza MF, Tamayo-Rodríguez I, Martínez-Velilla N, Viguria-Alegria MC. Treatment Individualization in Diffuse Large B-Cell Lymphoma: Is Frailty Enough for Old Adults? An Original Article. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e348-e359. [PMID: 37487908 DOI: 10.1016/j.clml.2023.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Toxicity risk evaluation based on frailty assessment is recommended for treatment individualization in old adults with diffuse large B-cell lymphoma (DLBCL). However, no specific assessment method to guide decision-making has been established yet. Here, we implement a therapeutic algorithm based on the information obtained in an updated comprehensive geriatric assessment (CGA) to assess the value that other prognostic factors add to frailty. MATERIAL AND METHODS We prospectively recruited 31 patients aged 70 or older recently diagnosed with DLBCL. Standard dose regimen R-CHOP and dose-attenuated R-miniCHOP were the therapeutic options. A CGA-based algorithm was used for the initial treatment recommendation. The sample was compared according to frailty and treatment allocation to describe baseline differential characteristics and treatment tolerance. RESULTS Mean age was 79 (SD: 5.5) and 45.1% were above 80. Half of the patients (51.6%) were frail; their survival was inferior to that observed in fit adults (p: .034). The mean Short Physical Performance Battery (SPPB) score of patients responding to therapy was higher than non-responders´ media (8.6 vs. 5.9; p: .022). However, when RCHOP was allocated to high functional patients within fit and frail groups, no differences in survival were found compared to R-miniCHOP. The prevalence of toxic events was higher with the standard regimen in fit (p: .054) and frail patients (p: 0.016). CONCLUSIONS The combination of frailty and physical performance assessment in an algorithm is a promising method to guide the decision-making process in old adults with DLBCL. SPPB might complete frailty predictive information on toxicity risk.
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Affiliation(s)
| | - Julio Oteiza-Olaso
- Universidad Pública de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain; Department of Medicine, Hospital Universitario de Navarra, Pamplona, Spain
| | | | | | - Ibai Tamayo-Rodríguez
- Division of Methodology, Biomedical Research Centre of the Government of Navarra (Navarrabiomed). Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
| | - Nicolás Martínez-Velilla
- Department of Geriatrics, Hospital Universitario de Navarra, Pamplona, Spain; Universidad Pública de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain; Biomedical Research Centre of the Government of Navarra (Navarrabiomed), Pamplona, Navarra, Spain
| | - Mari Cruz Viguria-Alegria
- Universidad Pública de Navarra, Pamplona, Spain; Department of Hematology, Hospital Universitario de Navarra, Pamplona, Spain
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21
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García-Baztán A, Viguria-Alegria MC, Ramón-Espinoza MF, Tamayo-Rodríguez I, Gonzales-Montejo NJ, Martínez-Velilla N, Oteiza-Olaso J. Hand grip strength, short physical performance battery, and gait speed: key tools for function in Non-Hodgkin Lymphoma. Ann Hematol 2023; 102:2823-2834. [PMID: 37566279 DOI: 10.1007/s00277-023-05397-x] [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: 10/29/2022] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
This study aimed to determine which performance assessment tools included in Comprehensive Geriatric Assessment (CGA) are the most sensitive for the functional approach in the initial evaluation and during the therapy of old adults diagnosed with Diffuse Large B-Cell Lymphoma (DLBCL). We prospectively recruited 31 patients aged 70 years or older presenting for an initial consultation in the Hematology Clinic of a tertiary hospital. We implemented an updated physical performance evaluation as part of CGA at baseline and during treatment. Baseline characteristics of the sample were compared according to age, Geriatric 8 (G8), frailty, Short Physical Performance Battery (SPPB), and sarcopenia measured by hand grip strength (HGS). Functional changes were monitored during the treatment period using HGS, gait speed (GS) and SPPB. The mean age was 79.0 (5.5) years and 51.6% of the sample was frail; 65,5% were treated with standard chemotherapy and 35,5% with a therapeutic regimen with attenuated doses. All the assessment tools included in CGA found functional differences at baseline when the sample was stratified and compared according to frailty, sarcopenia, and SPPB, but not according to G8 score and age. Only SPPB was able to detect functional differences between groups stratified by age at baseline. GS was the only score that identified clinically significant functional changes during the treatment. In conclusion, HGS and SPPB are appropriate performance scores to complete the functional approach in the initial hematologic evaluation, and GS is a promising option to detect functional decline during therapy in old adults with DLBCL.
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Affiliation(s)
| | - Mari Cruz Viguria-Alegria
- Department of Hematology, Hospital Universitario de Navarra, Pamplona, Spain
- Universidad Pública de Navarra, Pamplona, Spain
| | | | - Ibai Tamayo-Rodríguez
- Division of Methodology, Biomedical Research Centre of the Government of Navarra (Navarrabiomed), Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Red de Investigación en Cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS), Pamplona, Spain
| | | | - Nicolás Martínez-Velilla
- Department of Geriatrics, Hospital Universitario de Navarra, Pamplona, Spain
- Universidad Pública de Navarra, Pamplona, Spain
- Biomedical Research Centre of the Government of Navarra (Navarrabiomed), Pamplona, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - Julio Oteiza-Olaso
- Universidad Pública de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
- Department of Medicine, Hospital Universitario de Navarra, Pamplona, Spain
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Khoury EG, Nuamek T, Heritage S, Fulton-Ward T, Kucharczak J, Ng C, Kalsi T, Gomes F, Lind MJ, Battisti NML, Cheung KL, Parks R, Pearce J, Baxter MA. Geriatric Oncology as an Unmet Workforce Training Need in the United Kingdom-A Narrative Review by the British Oncology Network for Undergraduate Societies (BONUS) and the International Society of Geriatric Oncology (SIOG) UK Country Group. Cancers (Basel) 2023; 15:4782. [PMID: 37835476 PMCID: PMC10571920 DOI: 10.3390/cancers15194782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Cancer is a disease associated with ageing. Managing cancer in older adults may prove challenging owing to pre-existing frailty, comorbidity, and wider holistic needs, as well as the unclear benefits and harms of standard treatment options. With the ongoing advances in oncology and the increasing complexity of treating older adults with cancer, the geriatric oncology field must be a priority for healthcare systems in education, research, and clinical practice. However, geriatric oncology is currently not formally taught in undergraduate education or postgraduate training programmes in the United Kingdom (UK). In this commentary, we outline the landscape of geriatric oncology undergraduate education and postgraduate training for UK doctors. We highlight current challenges and opportunities and provide practical recommendations for better preparing the medical workforce to meet the needs of the growing population of older adults with cancer. This includes key outcomes to be considered for inclusion within undergraduate and postgraduate curricula.
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Affiliation(s)
- Emma G. Khoury
- Academic Cancer Sciences Unit, University of Southampton, Southampton SO16 6YD, UK
| | - Thitikorn Nuamek
- Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (T.N.)
| | | | - Taylor Fulton-Ward
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Joanna Kucharczak
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 OSP, UK
| | - Cassandra Ng
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
| | - Tania Kalsi
- Department of Ageing of Health, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- School of Life Course and Population Sciences, King’s College London, London WC2R 2LS, UK
| | - Fabio Gomes
- Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (T.N.)
| | - Michael J. Lind
- Queens Centre for Oncology and Haematology, Hull and East Yorkshire NHS Trust, Hull HU16 5JQ, UK
- Cancer Research Group, Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - Nicolò M. L. Battisti
- Breast Unit, Department of Medicine, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Ruth Parks
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Jessica Pearce
- Leeds Institute of Medical Research at St James’, University of Leeds, Leeds LS2 9JT, UK
| | - Mark A. Baxter
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD2 1SY, UK
- Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee DD2 1SG, UK
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23
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Ju W, Zheng R, Wang S, Zhang S, Zeng H, Chen R, Sun K, Li L, Wei W. The occurence of cancer in ageing populations at global and regional levels, 1990 to 2019. Age Ageing 2023; 52:afad043. [PMID: 37725972 DOI: 10.1093/ageing/afad043] [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: 05/05/2022] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND population ageing contributes to increased cancer cases and deaths and has profound implications for global healthcare systems. We estimated the trends of cancer cases and deaths in ageing populations at global and regional levels. METHODS using data from the Global Burden of Disease Study 2019, we analysed the change in cancer cases and deaths associated with population ageing, population growth and epidemiological factors from 1990 to 2019 using decomposition analysis. Additionally, we estimated the proportions of people aged 65 years and over accounting for total cases and deaths, and investigated relationships between the proportions and the Sociodemographic Index (SDI) using the Pearson correlation coefficient. RESULTS from 1990 to 2019, there was an increase of 128.9% for total cases and 74.8% for total deaths in all cancers combined; the percentages of older people increased from 48.6% to 56.4% for cases and from 52.0% to 61.9% for deaths. Population ageing contributed to the largest increase in global cancer occurrence, with 56.5% for cases and 63.3% for deaths. However, the changes attributed to epidemiological factors was 5.2% for cancer cases and -33.4% for cancer deaths. The proportions of total cases and deaths of older adults were positively correlated with socioeconomic development of the country. CONCLUSION our findings revealed that the main contributor to increased cancer cases and deaths has changed from comprehensive epidemiological factors to demographic shifts. To respond to the rapidly growing occurrence of cancer in ageing populations, the global health priority should focus on meeting the rising demand for cancer diagnosis, treatment and care services for older people.
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Affiliation(s)
- Wen Ju
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Rongshou Zheng
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shaoming Wang
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Siwei Zhang
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hongmei Zeng
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ru Chen
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Kexin Sun
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Li Li
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wenqiang Wei
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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24
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Harada T, Tsuji T, Ueno J, Hijikata N, Ishikawa A, Kotani D, Kojima T, Fujita T. Association of sarcopenia with relative dose intensity of neoadjuvant chemotherapy in older patients with locally advanced esophageal cancer: A retrospective cohort study. J Geriatr Oncol 2023; 14:101580. [PMID: 37478514 DOI: 10.1016/j.jgo.2023.101580] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/28/2023] [Accepted: 06/29/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Sarcopenia impacts the toxicity of chemotherapy in patients with cancer, but there is little information on the association of sarcopenia with the relative dose intensity (RDI) of chemotherapy. We investigated the association of sarcopenia with RDI of neoadjuvant chemotherapy (NAC) in older patients with locally advanced esophageal cancer (LAEC). MATERIALS AND METHODS This was a single-center retrospective cohort study of patients aged ≥65 years who underwent curative esophagectomy after NAC for LAEC between 2016 and 2020. Skeletal muscle mass index (SMI) was calculated from computed tomography images at the L3 level. Sarcopenia was defined using the Youden index of SMI. Average RDI was calculated from delivered-dose intensity and standard-dose intensity of all drugs. The cutoff point of low average RDI was defined as <85%. The multivariate logistic regression model was used for the endpoint. RESULTS We analyzed 188 patients with a mean age of 71.3 years. The cutoff points of sarcopenia for low average RDI were defined as 42.81 cm2/m2 in males and 37.48 cm2/m2 in females. Sarcopenia significantly affected low average RDI, adjusted for age, sex, body mass index, drug regimen, clinical stage, and creatinine clearance (adjusted odds ratio: 2.195, 95% confidence interval: 1.107-4.411, p = 0.024). Compared with the non-sarcopenia patients, the sarcopenia patients with low average RDI had a higher rate of dose reduction, delayed, or discontinuation after the first cycle because of neutropenia (45% vs. 38%), and decreased performance status (11% vs. 0%). DISCUSSION Sarcopenia predicted low average RDI (<85%) of NAC in older patients with LAEC. In the future, the information about the mechanism of association of sarcopenia with RDI will progress the development of intervention strategy and novel supportive care.
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Affiliation(s)
- Tsuyoshi Harada
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Department of Rehabilitation Medicine, Keio University Graduate School, Shinjuku, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
| | - Junya Ueno
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Nanako Hijikata
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Daisuke Kotani
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takashi Kojima
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takeo Fujita
- Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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25
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Seghers PAL, Alibhai SMH, Battisti NML, Kanesvaran R, Extermann M, O'Donovan A, Pilleron S, Mislang AR, Musolino N, Cheung KL, Staines A, Girvalaki C, Soubeyran P, Portielje JEA, Rostoft S, Hamaker ME, Trépel D, O'Hanlon S. Geriatric assessment for older people with cancer: policy recommendations. Glob Health Res Policy 2023; 8:37. [PMID: 37653521 PMCID: PMC10472678 DOI: 10.1186/s41256-023-00323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
Most cancers occur in older people and the burden in this age group is increasing. Over the past two decades the evidence on how best to treat this population has increased rapidly. However, implementation of new best practices has been slow and needs involvement of policymakers. This perspective paper explains why older people with cancer have different needs than the wider population. An overview is given of the recommended approach for older people with cancer and its benefits on clinical outcomes and cost-effectiveness. In older patients, the geriatric assessment (GA) is the gold standard to measure level of fitness and to determine treatment tolerability. The GA, with multiple domains of physical health, functional status, psychological health and socio-environmental factors, prevents initiation of inappropriate oncologic treatment and recommends geriatric interventions to optimize the patient's general health and thus resilience for receiving treatments. Multiple studies have proven its benefits such as reduced toxicity, better quality of life, better patient-centred communication and lower healthcare use. Although GA might require investment of time and resources, this is relatively small compared to the improved outcomes, possible cost-savings and compared to the large cost of oncologic treatments as a whole.
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Affiliation(s)
- P A L Seghers
- Department of Geriatric Medicine, Diakonessenhuis, 3582 KE, Utrecht, The Netherlands
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, ON, M5G 2C4, Canada
- Department of Medicine, University of Toronto, Toronto, ON, M5G 2C4, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, M5G 2C4, Canada
| | - Nicolò Matteo Luca Battisti
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK
- Breast Cancer Research Division, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK
| | | | - Martine Extermann
- Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Anita O'Donovan
- Applied Radiation Therapy Trinity (ARTT), School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sophie Pilleron
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
| | - Anna Rachelle Mislang
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, SA, 5042, Australia
| | - Najia Musolino
- International Society of Geriatric Oncology (SIOG), International Environmental House 2, Chemin de Balexert 7-9, 1219, Chatelaine, Switzerland
| | | | - Anthony Staines
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Charis Girvalaki
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Pierre Soubeyran
- Department of Medical Oncology, Institut Bergonié, Inserm U1312, SIRIC BRIO, Université de Bordeaux, 33076, Bordeaux, France
| | - Johanneke E A Portielje
- Department of Medical Oncology, Leiden University Medical Center-LUMC, 2333 ZA, Leiden, The Netherlands
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0318, Oslo, Norway
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, 3582 KE, Utrecht, The Netherlands
| | - Dominic Trépel
- Global Brain Health Institute, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Shane O'Hanlon
- Department of Geriatric Medicine, St Vincent's University Hospital, Dublin, D04 T6F4, Ireland.
- Department of Geriatric Medicine, University College Dublin, Dublin, D04 V1W8, Ireland.
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26
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Pilleron S, Gnangnon F, Noronha V, Soto-Perez-de-Celis E. Cancer incidence estimates in adults aged 60 years and older living in low-and-middle-income countries for the years 2020 and 2040. Ecancermedicalscience 2023; 17:1594. [PMID: 37799947 PMCID: PMC10550290 DOI: 10.3332/ecancer.2023.1594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Indexed: 10/07/2023] Open
Abstract
Previous studies have shown a disproportionate rise in cancer incidence in low-and-middle-income countries (LMICs) due to rapid population ageing. This study aims to describe the cancer incidence in adults aged 60 years and older in LMICs to inform cancer control planning. Using the latest GLOBOCAN estimates for 2020, we describe the cancer incidence and the top five cancer sites among adults aged 60 years and older living in LMICs. We also project the incidence in 2040 by applying population projections, assuming no changes in incidence rates and risk profiles over time. In 2020, 6.3 million new cancer cases were diagnosed in older adults in LMICs, constituting over half of the global incidence burden (55%). In females aged 60 years and older living in LMICs, breast, lung, colon, stomach, and cervix uteri were the most frequent cancer types representing 51% of the total number of new cancer cases in older females. In males aged 60 years and older living in LMICs, lung, prostate, stomach, liver and colon were the most frequent cancer types representing 58% of the total number of new cancer cases in this subgroup. Variations were observed between income categories. The number of new cancer diagnoses in adults aged 60 years and older living in LMICs will almost double by 2040, reaching 11.5 million new cancer cases. The greatest increase is expected to happen in lower-income countries (+158% in lower-middle-income countries (excluding India) and +99% in low-income countries versus +38% in upper-middle-income countries). In conclusion, our findings call for an urgent adaptation of healthcare systems in LMICs by developing geriatric oncology and by including older adults in research, clinical guidelines, insurance schemes and cancer prevention policies.
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Affiliation(s)
- Sophie Pilleron
- Department of Precision Health, Ageing, Cancer, and Disparities Research Unit, Luxembourg Institute of Health, 1A-B, Rue Thomas Edison, 1445 Strassen, Luxembourg
- https://orcid.org/0000-0001-7146-4740
| | - Freddy Gnangnon
- Department of Visceral Surgery, National Teaching Hospital-Hubert Koutoukou Maga (CNHU-HKM), Avenue Pape Jean-Paul Il, 01 BP 386, Cotonou, Benin
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City 14080, Mexico
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Harada T, Tsuji T, Tanaka M, Konishi N, Yanagisawa T, Koishihara Y, Ueno J, Mizutani T, Nishiyama N, Soeda R, Hijikata N, Ishikawa A, Hayashi R. Priority of the basic and instrumental activities of daily living in older patients with cancer prescribed rehabilitation: a cross-sectional survey. Support Care Cancer 2023; 31:503. [PMID: 37526784 DOI: 10.1007/s00520-023-07975-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/27/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND There is no information on whether vulnerable older patients with cancer consider basic activities of daily living (BADL) and instrumental activities of daily living (IADL) important outcomes. Our survey aimed to investigate the priority of BADL and IADL in outcomes among vulnerable older patients with cancer. METHODS This was a single-center survey in a Japanese cancer center. Eligible patients were ≥ 65 years of age and were prescribed in-hospital rehabilitation while under cancer treatment. Using original self-administered ranking questionnaires, patients were asked to rank outcomes and subdomain of BADL and IADL. High-priority domains were defined as the highest, second-highest, and third-highest priority domains in individuals. RESULTS A total of 169 patients were analyzed. The mean age was 74.0 years (standard deviation, 5.1 years) and the number of males was 107 (63%). The order of ranking of high-priority outcomes was BADL and IADL (n = 155), cognitive function (n = 91), mental function (n = 82), nutrition (n = 61), social function (n = 51), comorbidity (n = 39), and life span (n = 28). The top three high-priority independence subdomains of BADL and IADL were toilet use (n = 140), feeding (n = 134), and mobility (n = 69) among the BADL and shopping (n = 93), food preparation (n = 88), and ability to handle finances (n = 85) among the IADL. CONCLUSIONS BADL and IADL can be considered the most important health outcomes in clinical trials and in practice among older patients with cancer and physical vulnerabilities.
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Affiliation(s)
- Tsuyoshi Harada
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
- Department of Rehabilitation Medicine, Keio University Graduate School, Shinjuku, Tokyo, Japan.
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Motoki Tanaka
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Nobuko Konishi
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takumi Yanagisawa
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yu Koishihara
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Junya Ueno
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Tomonori Mizutani
- Department of Medical Oncology, Faculty of Medicine, Kyorin University, Mitaka, Tokyo, Japan
| | - Nanako Nishiyama
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Osaka, Japan
| | - Ryo Soeda
- Department of Rehabilitation Medicine, Keio University Graduate School, Shinjuku, Tokyo, Japan
- Department of Rehabilitation, Tsurumaki Onsen Hospital, Hadano, Kanagawa, Japan
| | - Nanako Hijikata
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Ryuichi Hayashi
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
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Castelo-Loureiro A, Perez-de-Acha A, Torres-Perez AC, Cunha V, García-Valdés P, Cárdenas-Reyes P, Soto-Perez-de-Celis E. Delivering Palliative and Supportive Care for Older Adults with Cancer: Interactions between Palliative Medicine and Geriatrics. Cancers (Basel) 2023; 15:3858. [PMID: 37568674 PMCID: PMC10417379 DOI: 10.3390/cancers15153858] [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: 07/03/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The world's population is aging rapidly, with projections indicating that by 2050 one in six people will be aged ≥65 years. As a result, the number of cancer cases in older people is expected to increase significantly. Palliative care is an essential component of cancer care with a direct impact on quality of life. However, older adults with cancer often suffer from multiple comorbidities, cognitive impairment, and frailty, posing unique challenges in the delivery of palliative care. The complex healthcare needs of older patients with cancer therefore require a comprehensive assessment, including a geriatric evaluation. Collaboration between geriatrics and palliative care can offer a solution to the challenges faced by older people with cancer, since this is a population with overlapping concerns for both disciplines. This review highlights the importance of palliative care for older adults with cancer and the benefits of a multidisciplinary approach. It also addresses the coordination of palliative care and geriatrics for specific symptom management and decision making.
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Affiliation(s)
| | - Andrea Perez-de-Acha
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Ana Cristina Torres-Perez
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Vanessa Cunha
- School of Medicine, University of Toronto, Toronto, ON M5S 3G5, Canada
| | - Paola García-Valdés
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
- Department of Palliative Care, Hospital Gea González, Mexico City 14080, Mexico
| | - Paula Cárdenas-Reyes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
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Extermann M, Al-Jumayli M, Sam C, Kish JA. Oncogeriatric Developments. Gerontology 2023; 69:1045-1055. [PMID: 37321185 DOI: 10.1159/000531559] [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: 01/02/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
Cancer is a disease of aging and is rapidly becoming the number one cause of mortality in older people. Over their lifetime, one in two men and one in three women will develop a cancer, with half of the risk being beyond the age of seventy. Therefore, cancer is a problem frequently encountered by geriatricians. In this article, we review a few recent progresses that will be of interest to the geriatric community. First, we now have robust evidence that a comprehensive geriatric assessment and management change outcomes in older cancer patients, notably allowing decreased treatment toxicity, better treatment completion, and increased functional outcomes. In gastrointestinal cancers and breast cancer, several recent studies have addressed when treatment intensity can be decreased, and when it cannot. New treatments for acute myeloid leukemia are finally beginning to improve outcomes for older patients and such patients should be referred to oncologists for management. In prostate cancer, new imaging techniques (e.g., PSMA scan) and treatment options can allow better treatment targeting and spare some hormonal and chemotherapy toxicity. Finally, we review recent public policy efforts to address the epidemiologic wave of cancer in older patients on a global scale.
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Affiliation(s)
- Martine Extermann
- Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Christine Sam
- Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, Florida, USA
| | - Julie A Kish
- Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, Florida, USA
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30
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Papachristou N, Kartsidis P, Anagnostopoulou A, Marshall-McKenna R, Kotronoulas G, Collantes G, Valdivieso B, Santaballa A, Conde-Moreno AJ, Domenech JR, Kokoroskos E, Papachristou P, Sountoulides P, Levva S, Avgitidou K, Tychala C, Bakogiannis C, Stafylas P, Ramon ZV, Serrano A, Tavares V, Fernandez-Luque L, Hors-Fraile S, Billis A, Bamidis PD. A Smart Digital Health Platform to Enable Monitoring of Quality of Life and Frailty in Older Patients with Cancer: A Mixed-Methods, Feasibility Study Protocol. Semin Oncol Nurs 2023; 39:151437. [PMID: 37149438 DOI: 10.1016/j.soncn.2023.151437] [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: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVES LifeChamps is an EU Horizon 2020 project that aims to create a digital platform to enable monitoring of health-related quality of life and frailty in patients with cancer over the age of 65. Our primary objective is to assess feasibility, usability, acceptability, fidelity, adherence, and safety parameters when implementing LifeChamps in routine cancer care. Secondary objectives involve evaluating preliminary signals of efficacy and cost-effectiveness indicators. DATA SOURCES This will be a mixed-methods exploratory project, involving four study sites in Greece, Spain, Sweden, and the United Kingdom. The quantitative component of LifeChamps (single-group, pre-post feasibility study) will integrate digital technologies, home-based motion sensors, self-administered questionnaires, and the electronic health record to (1) enable multimodal, real-world data collection, (2) provide patients with a coaching mobile app interface, and (3) equip healthcare professionals with an interactive, patient-monitoring dashboard. The qualitative component will determine end-user usability and acceptability via end-of-study surveys and interviews. CONCLUSION The first patient was enrolled in the study in January 2023. Recruitment will be ongoing until the project finishes before the end of 2023. IMPLICATIONS FOR NURSING PRACTICE LifeChamps provides a comprehensive digital health platform to enable continuous monitoring of frailty indicators and health-related quality of life determinants in geriatric cancer care. Real-world data collection will generate "big data" sets to enable development of predictive algorithms to enable patient risk classification, identification of patients in need for a comprehensive geriatric assessment, and subsequently personalized care.
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Affiliation(s)
- Nikolaos Papachristou
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Panagiotis Kartsidis
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandra Anagnostopoulou
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Grigorios Kotronoulas
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | | | | | - Ana Santaballa
- University and Polytechnic La Fe Hospital of Valencia, Valencia, Spain
| | | | | | | | - Panagiotis Papachristou
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden; Department of Neurobiology, Care Science and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Petros Sountoulides
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sophia Levva
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kelly Avgitidou
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Healthink (Medical Research & Innovation, PC), Thessaloniki, Greece
| | - Christiana Tychala
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Healthink (Medical Research & Innovation, PC), Thessaloniki, Greece
| | - Costas Bakogiannis
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panos Stafylas
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Healthink (Medical Research & Innovation, PC), Thessaloniki, Greece
| | | | | | | | | | | | - Antonios Billis
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis D Bamidis
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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31
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Arora SP, Puts M. Lessons learned from organizing International Society of Geriatric Oncology (SIOG) geriatric assessment workshops. J Geriatr Oncol 2023; 14:101528. [PMID: 37230931 PMCID: PMC11147499 DOI: 10.1016/j.jgo.2023.101528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Sukeshi Patel Arora
- Division of Hematology/Oncology, Department of Medicine, Mays Cancer Center, University of Texas Health San Antonio, 7979 Wurzbach Rd., MC 8232, San Antonio, TX 78229, USA.
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College street suite 130, Toronto M5P1T8, ON, Canada.
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Soo WK, Yin V, Crowe J, Lane H, Steer CB, Dārziņš P, Davis ID. Integrated care for older people with cancer: a primary care focus. THE LANCET. HEALTHY LONGEVITY 2023:S2666-7568(23)00058-2. [PMID: 37172606 DOI: 10.1016/s2666-7568(23)00058-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/27/2023] [Indexed: 05/15/2023] Open
Affiliation(s)
- Wee Kheng Soo
- Eastern Health Clinical School, Monash University, Melbourne, VIC 3128, Australia; Aged Medicine Program, Eastern Health, Melbourne, VIC, Australia; Cancer Services, Eastern Health, Melbourne, VIC, Australia.
| | - Vicky Yin
- Aged Medicine Program, Eastern Health, Melbourne, VIC, Australia
| | - Jane Crowe
- Deepdene Surgery, Melbourne, VIC, Australia; Australian Prostate Centre, Melbourne, VIC, Australia
| | - Heather Lane
- Geriatric, Acute and Rehabilitation Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Christopher B Steer
- Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia; Rural Clinical School-Albury Campus, University of New South Wales, Albury, NSW, Australia
| | - Pēteris Dārziņš
- Eastern Health Clinical School, Monash University, Melbourne, VIC 3128, Australia; Aged Medicine Program, Eastern Health, Melbourne, VIC, Australia
| | - Ian D Davis
- Eastern Health Clinical School, Monash University, Melbourne, VIC 3128, Australia; Cancer Services, Eastern Health, Melbourne, VIC, Australia
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Roeder F, Jensen AD, Lindel K, Mattke M, Wolf F, Gerum S. Geriatric Radiation Oncology: What We Know and What Can We Do Better? Clin Interv Aging 2023; 18:689-711. [PMID: 37168037 PMCID: PMC10166100 DOI: 10.2147/cia.s365495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/22/2023] [Indexed: 05/13/2023] Open
Abstract
Elderly patients represent a growing subgroup of cancer patients for whom the role of radiation therapy is poorly defined. Older patients are still clearly underrepresented in clinical trials, resulting in very limited high-level evidence. Moreover, elderly patients are less likely to receive radiation therapy in similar clinical scenarios compared to younger patients. However, there is no clear evidence for a generally reduced radiation tolerance with increasing age. Modern radiation techniques have clearly reduced acute and late side effects, thus extending the boundaries of the possible regarding treatment intensity in elderly or frail patients. Hypofractionated regimens have further decreased the socioeconomic burden of radiation treatments by reducing the overall treatment time. The current review aims at summarizing the existing data for the use of radiation therapy or chemoradiation in elderly patients focusing on the main cancer types. It provides an overview of treatment tolerability and outcomes with current standard radiation therapy regimens, including possible predictive factors in the elderly population. Strategies for patient selection for standard or tailored radiation therapy approaches based on age, performance score or comorbidity, including the use of prediction tests or geriatric assessments, are discussed. Current and future possibilities for improvements of routine care and creation of high-level evidence in elderly patients receiving radiation therapy are highlighted.
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Affiliation(s)
- Falk Roeder
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
| | - Alexandra D Jensen
- Department of Radiation Oncology, University Hospital Marburg-Giessen, Giessen, Germany
| | - Katja Lindel
- Department of Radiation Oncology, Städtisches Klinikum, Karlsruhe, Germany
| | - Matthias Mattke
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
| | - Frank Wolf
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
| | - Sabine Gerum
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
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Bringuier M, Carton M, Debieuvre D, Pasquier D, Perol M, Filleron T, Léna H, Quantin X, Simon G, Baldini C. Enrolment of older adults with advanced or metastatic non-small cell lung cancer in first-line clinical trials in the multicentre ESME cohort. J Geriatr Oncol 2023; 14:101423. [PMID: 36657245 DOI: 10.1016/j.jgo.2022.101423] [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: 07/27/2022] [Revised: 11/30/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION There is a great need for data based on clinical trials for the older population in order to improve treatment. Historically, the inclusion rate of older adults in clinical trials has been low, but the rate specific to lung cancer is unknown, as are the factors associated with enrolment. MATERIALS AND METHODS We used the national Epidemio-Strategy and Medical Economics Advanced or Metastatic Lung Cancer (AMLC) Data Platform, a multicentre real-life database. Inclusion criteria were patients with advanced or metastatic non-small cell lung cancer (AMNSCLC) aged 70 years or older, with at least one line of systemic treatment from 01 January 2015 to 31 December 2018. The primary objective was to evaluate the proportion of older adults enrolled in clinical trials. Secondary objectives were to identify factors associated with enrolment in clinical trials for older patients and to compare the overall survival of older adults included in trials versus those not included. RESULTS There were 3488 patients aged ≥70 years (median age at AMNSCLC 75 years). Among older patients, 234 (6.7%) were enrolled in a clinical trial in the first-line setting. Significant factors associated with enrolment in the multivariable analysis in older patients were: good Eastern Cooperative Oncology Group (ECOG) Performance Status (PS 0) (p < 0.001), de novo versus recurrent presentation at diagnosis (p < 0.001), and non-central nervous system (CNS) metastases versus advanced setting or CNS metastases (p < 0.001). Medical history was associated with fewer inclusions (odds ratio [OR] = 0.74, 95% confidence interval [CI] [0.56; 0.99]). Among older patients, being enrolled in a trial in the first-line setting was not associated with better overall survival (OS) (hazard ratio [HR] = 1.03; 95%CI 0.86-1.22) in the multivariable analysis. DISCUSSION In this large database, few older AMNSCLC patients were enrolled in a trial. Factors associated with enrolment were: good ECOG PS, absence of medical history, de novo AMNSCLC, and presentation with non-CNS metastases.
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Affiliation(s)
- Michael Bringuier
- Department of Medical Oncology and Department of Supportive Care, Institut Curie, PSL Research University, Saint-Cloud, France.
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, PSL Research University, Saint-Cloud, France.
| | - Didier Debieuvre
- Pneumology Department, Groupe hospitalier de la région de Mulhouse Sud Alsace, Mulhouse, France.
| | - David Pasquier
- Department of Radiotherapy, Centre Oscar Lambret, Lille, France; Lille University, CRIStAL UMR, 9189 Lille, France.
| | - Maurice Perol
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France.
| | - Thomas Filleron
- Biostastistic and Health Data science Unit, Institut Claudius Régaud IUCT-O, Toulouse, France.
| | - Herve Léna
- Pneumology Department, Centre Hospitalier Universitaire, Rennes, France.
| | - Xavier Quantin
- Department of Medical Oncology, Institut régional du cancer de Montpellier, Université de Montpellier, INSERM Unité, 1194 Montpellier, France.
| | - Gaëtane Simon
- Real-world Data Department, Unicancer, Paris, France.
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Komatsu H, Komatsu Y. The Role of Nurse on the Treatment Decision Support for Older People with Cancer: A Systematic Review. Healthcare (Basel) 2023; 11:546. [PMID: 36833079 PMCID: PMC9956907 DOI: 10.3390/healthcare11040546] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Background: The number of older adults with cancer is increasing worldwide. The role of nurses in supporting patients' decision-making is expanding, as this process is fraught with complexity and uncertainty due to comorbidities, frailty, cognitive decline, etc., in older adults with cancer. The aim of this review was to examine the contemporary roles of oncology nurses in the treatment decision-making process in older adults with cancer. Methods: A systematic review of PubMed, CINAHL, and PsycINFO databases was conducted in accordance with PRISMA guidelines. Results: Of the 3029 articles screened, 56 full texts were assessed for eligibility, and 13 were included in the review. We identified three themes regarding nurses' roles in the decision-making process for older adults with cancer: accurate geriatric assessments, provision of available information, and advocacy. Nurses conduct geriatric assessments to identify geriatric syndromes, provide appropriate information, elicit patient preferences, and communicate efficiently with patients and caregivers, promoting physicians. Time constraints were cited as a barrier to fulfilling nurses' roles. Conclusions: The role of nurses is to elicit patients' broader health and social care needs to facilitate patient-centered decision-making, respecting their preferences and values. Further research focusing on the role of nurses that considers diverse cancer types and healthcare systems is needed.
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Affiliation(s)
- Hiroko Komatsu
- Japanese Red Cross Kyushu International College of Nursing, 1-1 Asty, Munakata-City 811-4157, Fukuoka, Japan
| | - Yasuhiro Komatsu
- Department of Healthcare Quality and Safety, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan
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Lawler M, Davies L, Oberst S, Oliver K, Eggermont A, Schmutz A, La Vecchia C, Allemani C, Lievens Y, Naredi P, Cufer T, Aggarwal A, Aapro M, Apostolidis K, Baird AM, Cardoso F, Charalambous A, Coleman MP, Costa A, Crul M, Dégi CL, Di Nicolantonio F, Erdem S, Geanta M, Geissler J, Jassem J, Jagielska B, Jonsson B, Kelly D, Kelm O, Kolarova T, Kutluk T, Lewison G, Meunier F, Pelouchova J, Philip T, Price R, Rau B, Rubio IT, Selby P, Južnič Sotlar M, Spurrier-Bernard G, van Hoeve JC, Vrdoljak E, Westerhuis W, Wojciechowska U, Sullivan R. European Groundshot-addressing Europe's cancer research challenges: a Lancet Oncology Commission. Lancet Oncol 2023; 24:e11-e56. [PMID: 36400101 DOI: 10.1016/s1470-2045(22)00540-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
Cancer research is a crucial pillar for countries to deliver more affordable, higher quality, and more equitable cancer care. Patients treated in research-active hospitals have better outcomes than patients who are not treated in these settings. However, cancer in Europe is at a crossroads. Cancer was already a leading cause of premature death before the COVID-19 pandemic, and the disastrous effects of the pandemic on early diagnosis and treatment will probably set back cancer outcomes in Europe by almost a decade. Recognising the pivotal importance of research not just to mitigate the pandemic today, but to build better European cancer services and systems for patients tomorrow, the Lancet Oncology European Groundshot Commission on cancer research brings together a wide range of experts, together with detailed new data on cancer research activity across Europe during the past 12 years. We have deployed this knowledge to help inform Europe's Beating Cancer Plan and the EU Cancer Mission, and to set out an evidence-driven, patient-centred cancer research roadmap for Europe. The high-resolution cancer research data we have generated show current activities, captured through different metrics, including by region, disease burden, research domain, and effect on outcomes. We have also included granular data on research collaboration, gender of researchers, and research funding. The inclusion of granular data has facilitated the identification of areas that are perhaps overemphasised in current cancer research in Europe, while also highlighting domains that are underserved. Our detailed data emphasise the need for more information-driven and data-driven cancer research strategies and planning going forward. A particular focus must be on central and eastern Europe, because our findings emphasise the widening gap in cancer research activity, and capacity and outcomes, compared with the rest of Europe. Citizens and patients, no matter where they are, must benefit from advances in cancer research. This Commission also highlights that the narrow focus on discovery science and biopharmaceutical research in Europe needs to be widened to include such areas as prevention and early diagnosis; treatment modalities such as radiotherapy and surgery; and a larger concentration on developing a research and innovation strategy for the 20 million Europeans living beyond a cancer diagnosis. Our data highlight the important role of comprehensive cancer centres in driving the European cancer research agenda. Crucial to a functioning cancer research strategy and its translation into patient benefit is the need for a greater emphasis on health policy and systems research, including implementation science, so that the innovative technological outputs from cancer research have a clear pathway to delivery. This European cancer research Commission has identified 12 key recommendations within a call to action to reimagine cancer research and its implementation in Europe. We hope this call to action will help to achieve our ambitious 70:35 target: 70% average 10-year survival for all European cancer patients by 2035.
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Affiliation(s)
- Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Faculty of Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, UK.
| | - Lynne Davies
- International Cancer Research Partnership, International House, Cardiff, UK
| | - Simon Oberst
- Organisation of European Cancer Institutes, Brussels, Belgium
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK; European Cancer Organisation Patient Advisory Committee, Brussels, Belgium
| | - Alexander Eggermont
- Faculty of Medicine, Utrecht University Medical Center, Utrecht, Netherlands; Princess Máxima Centrum, Utrecht, Netherlands
| | - Anna Schmutz
- International Agency for Cancer Research, Lyon, France
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Peter Naredi
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tanja Cufer
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; Institute of Cancer Policy, King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Matti Aapro
- Genolier Cancer Center, Genolier, Switzerland
| | - Kathi Apostolidis
- Hellenic Cancer Federation, Athens, Greece; European Cancer Patient Coalition, Brussels, Belgium
| | - Anne-Marie Baird
- Lung Cancer Europe, Bern, Switzerland; Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Fatima Cardoso
- Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Andreas Charalambous
- European Cancer Organisation Brussels, Brussels, Belgium; Department of Nursing, Cyprus University of Technology, Limassol, Cyprus; Department of Oncology, University of Turku, Turku, Finland
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Csaba L Dégi
- Faculty of Sociology and Social Work, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Federica Di Nicolantonio
- Department of Oncology, University of Turin, Turin, Italy; Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Sema Erdem
- European Cancer Organisation Patient Advisory Committee, Europa Donna, Istanbul, Türkiye
| | - Marius Geanta
- Centre for Innovation in Medicine and Kol Medical Media, Bucharest, Romania
| | - Jan Geissler
- Patvocates and CML Advocates Network, Leukaemie-Online (LeukaNET), Munich, Germany
| | | | - Beata Jagielska
- Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Olaf Kelm
- International Agency for Research on Cancer, Lyon, France
| | | | - Tezer Kutluk
- Faculty of Medicine & Cancer Institute, Hacettepe University, Ankara, Türkiye
| | - Grant Lewison
- Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, UK
| | | | | | - Thierry Philip
- Organisation of European Cancer Institutes, Brussels, Belgium; Institut Curie, Paris, France
| | - Richard Price
- European Cancer Organisation Brussels, Brussels, Belgium
| | - Beate Rau
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Peter Selby
- School of Medicine, University of Leeds, Leeds, UK
| | | | | | - Jolanda C van Hoeve
- Organisation of European Cancer Institutes, Brussels, Belgium; Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Eduard Vrdoljak
- Department of Oncology, University Hospital Center Split, School of Medicine, University of Split, Split, Croatia
| | - Willien Westerhuis
- Organisation of European Cancer Institutes, Brussels, Belgium; Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | | | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, UK
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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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Marshall-McKenna R, Kotronoulas G, Kokoroskos E, Granados AG, Papachristou P, Papachristou N, Collantes G, Petridis G, Billis A, Bamidis PD. A multinational investigation of healthcare needs, preferences, and expectations in supportive cancer care: co-creating the LifeChamps digital platform. J Cancer Surviv 2022:10.1007/s11764-022-01289-7. [DOI: 10.1007/s11764-022-01289-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Purpose
This study is to evaluate healthcare needs, preferences, and expectations in supportive cancer care as perceived by cancer survivors, family caregivers, and healthcare professionals.
Methods
Key stakeholders consisted of cancer survivors diagnosed with breast cancer, prostate cancer, or melanoma; adult family caregivers; and healthcare professionals involved in oncology. Recruitment was via several routes, and data were collected via either online surveys or telephone interviews in Greece, Spain, Sweden, and the UK. Framework analysis was applied to the dataset.
Results
One hundred and fifty-five stakeholders participated: 70 cancer survivors, 23 family caregivers, and 62 healthcare professionals (13 clinical roles). Cancer survivors and family caregivers’ needs included information and support on practical/daily living, as frustration was apparent with the lack of follow-up services. Healthcare professionals agreed on a multidisciplinary health service with a “focus on the patient” and availability closer to home. Most healthcare professionals acknowledged that patient-reported outcomes may provide “better individualised care”. Cancer survivors and family caregivers generally felt that the digital platform would be useful for timely personalised support and aided communication. Healthcare professionals were supportive of the “proactive” functionality of the platform and the expected advantages. Anticipated challenges were integration obstacles such as workload/infrastructure and training/support in using the new technology.
Conclusions
Obtaining key stakeholders’ insights provided a foundation for action to further co-create the LifeChamps digital platform to meet needs and priorities and deliver enhanced supportive care to “older” cancer survivors.
Implications for cancer survivors
Co-creation provided insight into gaps where digital support may enhance health and well-being.
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Van Poppel H, Battisti NML, Lawler M, Kolarova T, Daly J, Rizvi K, Greene R, Buyens G, Oliver K, Price R, Osmanovic N, Venegoni E. European Cancer Organisation's Inequalities Network: Putting Cancer Inequalities on the European Policy Map. JCO Glob Oncol 2022; 8:e2200233. [PMID: 36252165 PMCID: PMC9812450 DOI: 10.1200/go.22.00233] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Hendrik Van Poppel
- European Association of Urology, Arnhem, the Netherlands,Katholieke Universiteit Leuven, Leuven, Belgium
| | - Nicolò Matteo Luca Battisti
- International Society of Geriatric Oncology, Châtelaine, Switzerland,The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Mark Lawler
- Queens University Belfast, Belfast, Northern Ireland
| | | | | | | | - Robert Greene
- HungerNdThirst Foundation, Amsterdam, the Netherlands
| | | | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth Surrey, UK
| | | | | | - Enea Venegoni
- European Cancer Organisation, Brussels, Belgium,Enea Venegoni, Rue de la Science 41, 1000, Brussels, B-1040, Belgium; e-mail:
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40
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Marinho J, Custódio S. Geriatric Oncology in Portugal: Where We Are and What Comes Next—A Survey of Healthcare Professionals. Geriatrics (Basel) 2022; 7:geriatrics7050091. [PMID: 36136800 PMCID: PMC9498886 DOI: 10.3390/geriatrics7050091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
In keeping with the trend worldwide, in Portugal, more than 60% of newly diagnosed patients with cancer are aged 65 years or older, which makes older adults the most common population seen in an oncology practice. This study’s objectives were to assess geriatric oncology practices in Portugal and investigate medical professionals’ current needs and perceptions on the treatment of elderly cancer patients. Methods: A cross-sectional study was conducted using a web-based survey of healthcare providers treating elderly patients. Results: There were 222 responses: 62.6% of physicians reported the absence of geriatric oncology and/or geriatrics consultations in their institutions, 14.9% had guidelines for the management of older patients with cancer and 4.5% had physicians dedicated to geriatric oncology. The reported use of geriatric assessment tools was 23.4%. Medical oncologists and physicians from medical specialties (p = 0.009) and those practicing in the south of Portugal (p = 0.054) were more likely to use geriatric assessment. Education and training in geriatric oncology was identified by 95.0% of respondents as an unmet need. The inquiries identified that geriatric assessment could be useful to define a therapeutic strategy (85.1%), detect frailty (77.5%), predict toxicity and improve quality of life (73.4%). Conclusions: There is a paucity of expertise and training in geriatric oncology in Portugal but an increasing perception of the value of geriatric assessment and the demand for education. In the next years, Portugal will progress in this area with the aid of the recently created Geriatric Oncology Working Group.
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Affiliation(s)
- Joana Marinho
- Medical Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
- Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), 4410-406 Vila Nova de Gaia, Portugal
- Correspondence: ; Tel.: +351934264447
| | - Sandra Custódio
- Medical Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
- Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), 4410-406 Vila Nova de Gaia, Portugal
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Harada T, Tsuji T, Ueno J, Koishihara Y, Konishi N, Hijikata N, Ishikawa A, Kotani D, Kojima T, Fujiwara H, Fujita T. Prognostic Impact from the Loss of Skeletal Muscle Mass During Neoadjuvant Chemotherapy on Older Patients with Esophageal Cancer. Ann Surg Oncol 2022; 29:8131-8139. [PMID: 35978207 DOI: 10.1245/s10434-022-12379-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND In older adults, skeletal muscle mass is an important factor for health and prognosis. The loss of SMM during neoadjuvant therapy affects the prognosis of patients with locally advanced esophageal cancer. However, information is limited regarding this possibility in older patients. This study aimed to establish the prognostic impact of SMM loss during neoadjuvant chemotherapy on older patients with locally advanced esophageal cancer. METHODS This was a single-center retrospective cohort study. Patients age 65 years or older had undergone R0 curative esophagectomy after NAC. The skeletal muscle mass index before and after NAC was calculated from computed tomography images. The percentage change in the SMI during NAC (SMI%) was calculated from the SMI before and after NAC. RESULTS The study analyzed 150 patients with a mean age of 71.1 ± 3.7 years. The mean value of the SMI was 42.7 ± 7.2 cm2/m2 before NAC, and the SMI% was - 6.4% ± 5.9%. The cutoff of SMI% for overall survival was defined by the log-rank test as - 12%. The Cox proportional hazard model showed that major loss of the SMI (≥ 12%) significantly influenced OS (hazard ratio, 2.490; 95% confidence interval, 1.121-5.529; p = 0.025) independently of age, sex, pathologic T and N factors, or treatment regimen. CONCLUSIONS Major SMI loss has an impact on OS after R0 curative esophagectomy for older patients with locally advanced esophageal cancer.
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Affiliation(s)
- Tsuyoshi Harada
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Department of Rehabilitation Medicine, Keio University Graduate School, Shinjuku, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. .,Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
| | - Junya Ueno
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Yu Koishihara
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Nobuko Konishi
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Nanako Hijikata
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Aiko Ishikawa
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Daisuke Kotani
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takashi Kojima
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hisashi Fujiwara
- Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takeo Fujita
- Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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42
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Hu FY, O'Mara L, Tulebaev S, Orkaby AR, Cooper Z, Bernacki RE. Geriatric surgical service interventions in older emergency general surgery patients: Preliminary results. J Am Geriatr Soc 2022; 70:2404-2414. [PMID: 35670490 DOI: 10.1111/jgs.17916] [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: 02/22/2022] [Revised: 04/21/2022] [Accepted: 05/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Older adults comprise an increasing proportion of emergency general surgery (EGS) admissions and face high morbidity and mortality. We created a geriatric surgical service with geriatric and palliative expertise to mitigate risks of hospitalization most hazardous to older patients. We sought to identify geriatric surgical service interventions most relevant to EGS patients. METHODS We prospectively identified patients ≥75 years admitted to the EGS service at an urban tertiary care hospital from January 2020-March 2021 who screened positive for frailty (FRAIL score ≥3 [scale 0-5, higher being worse]) or with cognitive impairment. A pilot geriatric surgical service, led by a dually-board certified geriatric and palliative care specialist, conducted a comprehensive geriatric assessment and modified Rockwood Frailty Index calculation for each eligible patient. Patient, hospital admission, and geriatric consultation characteristics were collected via chart review. RESULTS Fifty consecutive patients (median age 82 years [IQR 78-90], 56% female) received geriatric consultation (median time 3 days [IQR 1-6] from admission). The most common admission diagnosis was bowel obstruction (32%). Sixty-four percent of patients underwent ≥1 surgical procedure. Using the Frailty Index, 64% were moderately or severely frail. Interventions most frequently performed by the geriatric team included delirium prevention and management (66%), consideration of swallowing function (52%), individualized pain management (50%), and facilitation of serious illness conversations (58%). CONCLUSIONS Geriatric service involvement addresses a high burden of both geriatric and palliative care needs in older EGS patients. Geriatric recommendations may direct interventions for surgical education in fundamental geriatric and palliative care knowledge to maximize geriatric resources for the most high-risk patients.
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Affiliation(s)
- Frances Y Hu
- Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Woman's Hospital, Boston, Massachusetts, USA
| | - Lynne O'Mara
- Department of Surgery, Brigham and Woman's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Samir Tulebaev
- Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ariela R Orkaby
- Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Woman's Hospital, Boston, Massachusetts, USA
| | - Rachelle E Bernacki
- Department of Medicine, Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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43
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Harada T, Tsuji T, Fujita T. ASO Author Reflections: Significance of Postoperative Loss of Skeletal Muscle Mass in Older Patients with Esophageal Cancer. Ann Surg Oncol 2022; 29:5646-5647. [PMID: 35552924 DOI: 10.1245/s10434-022-11844-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Tsuyoshi Harada
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. .,Department of Rehabilitation Medicine, Keio University Graduate School, Shinjuku, Tokyo, Japan.
| | - Tetsuya Tsuji
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Takeo Fujita
- Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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Harada T, Tatematsu N, Ueno J, Koishihara Y, Konishi N, Hijikata N, Ishikawa A, Tsuji T, Fujiwara H, Fujita T. Prognostic Impact of Postoperative Loss of Skeletal Muscle Mass in Patients Aged 70 Years or Older with Esophageal Cancer. Ann Surg Oncol 2022; 29:5638-5645. [PMID: 35499789 DOI: 10.1245/s10434-022-11801-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/04/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The number of patients with esophageal cancer aged ≥ 70 years with a poor prognosis is increasing. In general patients with esophageal cancer, postoperative loss of skeletal muscle mass (SMM) is a prognostic factor. This study was designed to investigate the prognostic impact of postoperative loss of SMM in patients aged ≥ 70 years with esophageal cancer. METHODS This study was a single-center, retrospective cohort study. Patients with esophageal cancer who underwent R0 esophagectomy between 2016 and 2020 were included. The percentage postoperative loss of skeletal muscle mass index (SMI%) was calculated using computed tomography images before and at 4 ± 2 months after surgery. RESULTS The number of subjects in the ≥ 70-year and < 70-year age groups was 166 and 218, respectively. The median SMI% was 5% in all patients; thus, 5% was defined as the cutoff point to define major loss of SMI. Major loss of SMI impacted 3-year overall survival (OS) in the ≥ 70-year age group, independent of age, sex, clinical stage, pathological T and N factors, Charlson comorbidity index, and length of hospital stay (adjusted hazard ratio [HR]: 4.400; 95% confidence interval: 1.202-16.105; P = 0.025). The adjusted HR of major loss of SMI in the ≥ 70-year age group was higher than in the < 70-year age group (adjusted HR: 4.400 vs. 2.388, respectively). CONCLUSIONS Postoperative loss of SMI in patients with esophageal cancer aged ≥ 70 years more strongly impacted 3-year OS than in patients aged < 70 years.
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Affiliation(s)
- Tsuyoshi Harada
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Department of Rehabilitation Medicine, Keio University Graduate School, Tokyo, Japan
| | - Noriatsu Tatematsu
- Department of Integrated Health Sciences, Nagoya University, Nagoya, Aichi, Japan
| | - Junya Ueno
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Yu Koishihara
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Nobuko Konishi
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Nanako Hijikata
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Aiko Ishikawa
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hisashi Fujiwara
- Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takeo Fujita
- Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
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Chinen T, Sasabuchi Y, Matsui H, Yamaguchi H, Yasunaga H. Oxaliplatin- versus cisplatin-based regimens for elderly individuals with advanced gastric cancer: a retrospective cohort study. BMC Cancer 2022; 22:460. [PMID: 35473591 PMCID: PMC9044765 DOI: 10.1186/s12885-022-09581-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/20/2022] [Indexed: 12/11/2022] Open
Abstract
Background Whether an oxaliplatin- or cisplatin-based regimen is more optimal for treating elderly patients with advanced gastric cancer, in terms of survival and adverse events remains unclear. Methods In this retrospective cohort study, we used stacked claim data of residents in two Japanese prefectures collected between 2012 and 2017 and between 2014 and 2019, respectively. We included patients with advanced gastric cancer who received oxaliplatin-based and cisplatin-based regimens. Propensity score overlap weighting analysis was conducted to compare overall survival and granulocyte colony-stimulating factor use during chemotherapy between the oxaliplatin- and cisplatin-based treatment groups. Results A total of 242 patients were included in the study. After propensity score weighting, Kaplan–Meier analysis showed no significant differences in overall survival between the two groups (hazard ratio: 1.13; 95% confidence interval, 0.60–2.11; p = 0.70). However, the proportion of patients receiving granulocyte colony-stimulating factor was significantly lower in the oxaliplatin group than in the cisplatin group (2.3% vs.22.7%, p = 0.01). Conclusions Survival did not differ significantly between elderly patients with advanced gastric cancer treated with oxaliplatin-based versus cisplatin-based regimens; however, the oxaliplatin-based regimen was associated with less granulocyte colony-stimulating factor use. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09581-6.
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Affiliation(s)
- Takashi Chinen
- Department of Clinical Oncology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0498, Japan. .,Data Science Center, Jichi Medical University, Tochigi, Japan.
| | | | - Hiroki Matsui
- Data Science Center, Jichi Medical University, Tochigi, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Hironori Yamaguchi
- Department of Clinical Oncology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0498, Japan
| | - Hideo Yasunaga
- Data Science Center, Jichi Medical University, Tochigi, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
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Sawaki M, Shimomura A, Shien T, Iwata H. Management of breast cancer in older patients. Jpn J Clin Oncol 2022; 52:682-689. [DOI: 10.1093/jjco/hyac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/28/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Japanese women have the highest life expectancy in the world and breast cancer is the most prevalent cancer among them. However, little data are available to support the evidence-based clinical management due to the fact that older adults are commonly excluded from most clinical trials. In Japan the rate of other cause of death in older patient was about a half, then we should consider whether or not breast cancer may affect the patient’s life expectancy to avoid either overtreatment or undertreatment. Although management principles in older patients may be similar with those of younger age, these differences would be caused by relatively short life expectancy, some comorbidity, drug interactions and low functional status. Then, their treatment needs to be individualized. To this end, employing a comprehensive geriatric assessment may be advantageous, which enables to evaluate patient vulnerability from several different aspects, to predict adverse events of chemotherapy and to identify geriatric problems in advance so that extra support and modified treatment can be provided. Before treatment we should assess the patient’s goals and values regarding the management of the cancer, especially on balancing survival benefit with immediate quality of life impairment due to anti-cancer therapy. In Japan Clinical Oncology Group (JCOG) , a randomized controlled trial for older patients with advanced stage HER2-positive breast cancer is ongoing as an inferiority design including geriatric assessment (JCOG1607, HARB TEA study). Best practice, current management and how to approach decision making in older patients with breast cancer are summarized.
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Affiliation(s)
- Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akihiko Shimomura
- Department of Breast and Medical Oncology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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Extermann M, Hernández-Favela CG, Soto Perez de Celis E, Kanesvaran R. Global Aging and Cancer: Advancing Care Through Innovation. Am Soc Clin Oncol Educ Book 2022; 42:1-8. [PMID: 35452248 DOI: 10.1200/edbk_359154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The oncology field, like many others, is digitalizing rapidly, a phenomenon that may have been accelerated by the COVID-19 pandemic. This movement is creating opportunities and challenges. Another rapidly developing change is the aging of the global population; because cancer is a disease of aging, there is a need for health systems to adapt to taking care of such patients. In this article, we address how these innovative technologies can be leveraged to improve the care of older patients with cancer beyond academic centers, such as in underserved areas and low- and middle-income countries. We review how digital technologies can be used to enhance the follow-up of patients in low- and middle-income countries. We also tackle the issue of training a global workforce to treat cancer in an aging population and how to leverage innovations in this matter. Finally, we review opportunities to expand the usefulness of big data and machine learning beyond academic centers to support private practices and underserved areas.
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Affiliation(s)
| | | | - Enrique Soto Perez de Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Webb T, Verduzco-Aguirre HC, Rao AR, Ramaswamy A, Noronha V. Addressing the Needs of Older Adults With Cancer in Low- and Middle-Income Settings. Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35427187 DOI: 10.1200/edbk_349829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The number of older adults in the world is projected to increase steeply over the next 30 years; most older adults will live in low- and middle-income countries. This will have a direct impact on the global cancer burden, as cancer is largely a disease of aging. A revolution in the way we care for older adults in low- and middle-income settings is needed to meet rapidly rising demands. Regardless of a nation's relative wealth or resources, implementing the geriatric assessment in cancer care has presented a challenge because of omission of the principles of geriatric oncology from formal training and continuing education, lack of time, and a shortage of qualified personnel. To meet the challenge of caring for older adults globally, we must: (1) re-imagine aging-focused training for providers and nurses, (2) create and strengthen collaborations/partnerships between geriatric oncology teams and aging-service organizations, and (3) increase advocacy for age-friendly health care policy. By harnessing technology, the reach of specialized oncology education and care can be extended even-or especially-to low- and middle-income settings.
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Affiliation(s)
- Tracy Webb
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | | | - Abhijith Rajaram Rao
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Xie Y, Gou Q, Zhang Y, Xie K, Zheng D, Luo C, Suo J, Zhong X, Luo T. Association between age at initial diagnosis and post-metastasis mortality among women with recurrent metastatic breast cancer in China. BMC Cancer 2022; 22:385. [PMID: 35397518 PMCID: PMC8994897 DOI: 10.1186/s12885-022-09454-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 03/15/2022] [Indexed: 12/13/2022] Open
Abstract
Background Little is known about whether age at initial diagnosis influences the prognosis of recurrent metastatic breast cancer (rMBC). Here, we analyzed the association between age at initial diagnosis and rMBC mortality in China. Methods A total of 1636 women diagnosed with rMBC between 1989 and 2020 at West China Hospital, Sichuan University were included in this study. The age at initial diagnosis was categorized as young (≤ 40 years), middle-aged (41–64 years) and elderly (≥ 65 years). Post-metastasis mortality was the primary outcome and its associated factors were analyzed by Cox proportional hazards models. Results During a median follow-up of 5.2 years after initial diagnosis of breast cancer, 620 deaths were identified. Compared with middle-aged patients, elderly patients had a 70% increased risk of post-metastasis mortality (95%CI, 1.24–2.33) after adjusting for demographics, tumor characteristics and treatment modes. Similarly, elderly patients were associated with a 75% increased risk of post-metastasis mortality (95%CI, 1.19–2.59) compared with young patients. Subgroup analyses also showed similar trends. Conclusion Our findings suggest that in breast cancer, elderly patients at initial diagnosis face a higher risk of post-metastasis mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09454-y.
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Abstract
Cancer is predominantly a disease of aging, and older adults represent the majority of cancer diagnoses and deaths. Older adults with cancer differ significantly from younger patients, leading to important distinctions in cancer treatment planning and decision-making. As a consequence, the field of geriatric oncology has blossomed and evolved over recent decades, as the need to bring personalized cancer care to older adults has been increasingly recognized and a focus of study. The geriatric assessment (GA) has become the cornerstone of geriatric oncology research, and the past year has yielded promising results regarding the implementation of GA into routine cancer treatment decisions and outcomes for older adults. In this article, we provide an overview of the field of geriatric oncology and highlight recent breakthroughs with the use of GA in cancer care. Further work is needed to continue to provide personalized, evidence-based care for each older adult with cancer.
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