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Bauer JM, Pattwell M, Barazzoni R, Battisti NML, Soto-Perez-de-Celis E, Hamaker ME, Scotté F, Soubeyran P, Aapro M. Systematic nutritional screening and assessment in older patients: Rationale for its integration into oncology practice. Eur J Cancer 2024; 209:114237. [PMID: 39096852 DOI: 10.1016/j.ejca.2024.114237] [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: 07/04/2024] [Accepted: 07/15/2024] [Indexed: 08/05/2024]
Abstract
As the global population ages, so does the number of older people being diagnosed, treated and surviving cancer. Challenges to providing appropriate healthcare management stem from the heterogeneity common in this population. Although malnutrition is highly prevalent in older people with cancer, ranging between 30 % and 80 % according to some analyses, is associated with frailty, and has been shown to be a major risk factor for poor treatment response and worse overall survival, addressing nutrition status is not always a priority among oncology healthcare providers. Evaluation of nutritional status is a two-step process: screening identifies risk factors for reduced nutritional intake and deficits that require more in-depth assessment. Screening activities can be as simple as taking weight and BMI measurements or using short nutritional questionnaires and asking the patient about unintentional weight loss to identify potential nutritional risk. Using geriatric assessment, deficits in the nutritional domain as well as in others reveal potentially reversible geriatric and medical problems to guide specific therapeutic interventions. The authors of this paper are experts in the fields of geriatric medicine, oncology, and nutrition science and believe that there is not only substantial evidence to support regularly performing screening and assessment of nutritional status in older patients with cancer, but that these measures lead to the planning and implementation of patient-centered approaches to nutrition management and thus enhanced geriatric-oncology care. This paper presents rationale for systematic nutrition screening and assessment in older adults with cancer.
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Affiliation(s)
- Jürgen M Bauer
- Center for Geriatric Medicine, University Clinic Heidelberg, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacher Straße 149, 69126 Heidelberg, Germany.
| | | | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Nicolò Matteo Luca Battisti
- Department of Medicine, Breast Unit and Senior Adult Oncology Programme, The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico; Division of Medical Oncology, University of Colorado, Anschutz Medical Campus, USA
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, the Netherlands
| | | | - Pierre Soubeyran
- Department of Medical Oncology, Institute Bergonié, Regional Comprehensive Cancer Centre, Université de Bordeaux, Bordeaux, France
| | - Matti Aapro
- Sharing Progress in Cancer Care (SPCC), Switzerland.
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Lund CM, Nielsen DL, Schultz M, Dolin TG. Physical decline, falls, and hospitalization among vulnerable older patients in the trajectory of colorectal cancer treatment. J Geriatr Oncol 2024; 15:101820. [PMID: 38955634 DOI: 10.1016/j.jgo.2024.101820] [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: 04/13/2023] [Revised: 04/02/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Resilience to anticancer treatment for colorectal cancer (CRC) among older patients varies. Many experience weight loss, physical decline, falls, and hospitalization during treatment, often leading to early discontinuation of otherwise effective chemotherapy. Screening for vulnerability might help to identify patients at risk of these adverse outcomes in older adults. MATERIALS AND METHODS This is a secondary analysis from the GERICO trial. Patients aged ≥70 years assessed for chemotherapy for CRC were screened for eligibility for the GERICO trial with the geriatric-8 (G8) frailty screening tool. The present study population comprised patients who were (1) screened with G8 but for reasons not included in the GERICO study and (2) patients who were randomized to the GERICO control group. We evaluated whether patients identified as vulnerable with G8 (≤14/17) or retrospectively constructed mG8 (≥6/35) had higher risk of experiencing decline in performance status (PS), falls, and unplanned hospitalization during treatment. The association between frailty status and the adverse outcomes was analyzed with univariate and multivariate logistic regression. The discriminative ability of G8/mG8 to predict outcomes was analyzed using the area under the curve for receiver operating characteristics curves. RESULTS In total, 238 patients (median age 74 years [range 70-91]) were included in this analysis. More vulnerable than fit patients experienced decline in PS (G8: 41% vs. 14%, p = 0.006 and mG8: 28% vs. 17%, p = 0.04) during treatment. Furthermore, more vulnerable than fit patients experienced falls (G8 14% vs. 6% p = 0.04) and unplanned hospitalization (G8: 31% vs. 14%, p = 0.009 and mG8: 34% vs. 13%, p < 0.001). Multivariate analyses showed an association between G8 vulnerability and decline in PS, falls, and hospitalization. DISCUSSION Patients with G8 or mG8 vulnerability were more likely to experience decline in PS and unplanned hospitalization during chemotherapy for CRC than fit patients. More G8 vulnerable patients experienced falls compared with fit patients. Appropriate interventions should be offered to older patients with CRC assessed as vulnerable with G8 or mG8 to maintain PS during chemotherapy.
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Affiliation(s)
- Cecilia M Lund
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark.
| | - Dorte L Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark; Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark
| | - Martin Schultz
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Troels G Dolin
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark
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Albalak G, Noordam R, van der Elst M, Kervezee L, Exadaktylos V, van Bodegom D, van Heemst D. Older adults exercising ON TIME: protocol for a randomized controlled cross-over study to assess the effect of physical activity timing on insomnia severity. Trials 2024; 25:523. [PMID: 39103937 DOI: 10.1186/s13063-024-08310-7] [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: 02/22/2024] [Accepted: 07/03/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND There are increased indications that physical activity timing, irrespective of intensity, impacts insomnia and circadian clock function. Here, we describe the rationale and design of a randomized cross-over study, called ON TIME, to examine the effects of (changing) physical activity timing on insomnia severity and on multiple exploratory outcomes that are linked to circadian clock function. METHODS We will conduct a randomized cross-over trial in 40 healthy older adults (aged 65 to 75 years) with subclinical or clinical insomnia (Insomnia Severity Index (ISI) scores of ≥ 10) from the Dutch municipality of Leiden and surroundings. Participants will undergo 3 intervention periods (14 days each) consecutively: one sedentary period and two periods of increased physical activity (one period with morning activity and one period with evening activity). The intervention periods are separated by a wash-out period of 1 week. In both active intervention arms, participants will follow coached or uncoached outdoor physical exercise sessions comprising endurance, strength, and flexibility exercises for 14 days. The primary outcome is change in insomnia severity as measured by the ISI. Additional exploratory outcomes include multiple components of objective sleep quality measured with tri-axial accelerometry and subjective sleep quality assessed by questionnaires as well as dim light melatonin onset and 24-h rhythms in heart rate, heart rate variability, breathing rate, oxygen saturation, mood, and objective emotional arousal and stress. Additionally, we will collect diary data on eating patterns (timing and composition). Finally, fasting blood samples will be collected at baseline and after each intervention period for measurements of biomarkers of metabolic and physiological functioning and expression of genes involved in regulation of the biological clock. DISCUSSION We anticipate that this study will make a significant contribution to the limited knowledge on the effect of physical activity timing. Optimizing physical activity timing has the potential to augment the health benefits of increased physical exercise in the aging population. TRIAL REGISTRATION Trial was approved by the Medical Ethics Committee Leiden, The Hague, Delft, The Netherlands (June, 2023). The trial was registered in the CCMO-register https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm under study ID NL82335.058.22 and named ("Ouderen op tijd in beweging" or in English "Older adults exercising on time"). At time of manuscript submission, the trial was additionally registered at ClinicalTrials.gov under study ID: NL82335.058.22 and is awaiting approval.
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Affiliation(s)
- Gali Albalak
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, Leiden, 2300 RC, The Netherlands.
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Marjan van der Elst
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Laura Kervezee
- Department of Cell and Chemical Biology, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | | | - David van Bodegom
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
- Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, Leiden, 2333 AA, The Netherlands
| | - Diana van Heemst
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
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Ishii R, Ohkoshi A, Katori Y. Treatment of elderly patients with head and neck cancer in an aging society: Focus on geriatric assessment and surgical treatment. Auris Nasus Larynx 2024; 51:647-658. [PMID: 38631257 DOI: 10.1016/j.anl.2024.04.005] [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: 12/14/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
Previous studies of the treatment of elderly head and neck cancer (HNC) patients were very limited and sometimes controversial. Although conclusions differ across various reports, it is often concluded that advanced chronological age does not directly affect prognosis, but that comorbidities and declines in physical and cognitive functions promote the occurrence of adverse events, especially with surgical treatment. Geriatric assessment (GA) and its screening tools are keys to help us understand overall health status and problems, predict life expectancy and treatment tolerance, and to influence treatment choices and interventions to improve treatment compliance. In addition, personal beliefs and values play a large role in determining policies for HNC treatment for elderly patients, and a multidisciplinary approach is important to support this. In this review, past research on HNC in older adults is presented, and the current evidence is explained, focusing on the management of elderly HNC patients, with an emphasis on the existing reports on each treatment stage and modality, especially the surgical procedures.
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Affiliation(s)
- Ryo Ishii
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Japan.
| | - Akira Ohkoshi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Japan
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Pîslaru AI, Albișteanu SM, Ilie AC, Ștefaniu R, Mârza A, Moscaliuc Ș, Nicoară M, Turcu AM, Grigoraș G, Alexa ID. Lung Cancer: New Directions in Senior Patients Assessment. Geriatrics (Basel) 2024; 9:101. [PMID: 39195131 DOI: 10.3390/geriatrics9040101] [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: 06/04/2024] [Revised: 07/10/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024] Open
Abstract
Age is but one significant prognostic factor in lung cancer, influencing survival, treatment response, and outcomes. This narrative review synthesizes findings from searches of 11 leading databases of research studies, systematic reviews, book chapters, and clinical trial reports on lung cancer in senior patients, with a focus on geriatric assessment as well as biomarkers. Key prognostic factors for lung cancer in seniors include biological age, functional capability, physical and psychological comorbidities, frailty, nutrition, status, and biomarkers like DNA methylation age. We identified the most valuable assessments that balance efficacy with quality of life. Optimizing care and improving outcomes with senior lung cancer patients benefits from a tailored therapeutic approach incorporating a complex geriatric assessment. A multidisciplinary collaboration between geriatricians, oncologists, and pulmonologists is crucial.
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Affiliation(s)
- Anca Iuliana Pîslaru
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Sabinne-Marie Albișteanu
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Adina Carmen Ilie
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ramona Ștefaniu
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Aurelia Mârza
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ștefan Moscaliuc
- Department of Oncology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mălina Nicoară
- Department of Oncology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ana-Maria Turcu
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Gabriela Grigoraș
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ioana Dana Alexa
- Department of Medical Specialties II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
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Loh KP, Liposits G, Arora SP, Neuendorff NR, Gomes F, Krok-Schoen JL, Amaral T, Mariamidze E, Biganzoli L, Brain E, Baldini C, Battisti NML, Frélaut M, Kanesvaran R, Mislang ARA, Papamichael D, Steer C, Rostoft S. Adequate assessment yields appropriate care-the role of geriatric assessment and management in older adults with cancer: a position paper from the ESMO/SIOG Cancer in the Elderly Working Group. ESMO Open 2024; 9:103657. [PMID: 39232585 PMCID: PMC11410714 DOI: 10.1016/j.esmoop.2024.103657] [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: 05/15/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 09/06/2024] Open
Abstract
With the aging population, older adults constitute a growing proportion of the new cancer cases. Given the heterogeneous health status among older adults and their susceptibility to aging-related vulnerabilities, understanding their diversity and its implications becomes increasingly crucial for prognostication and guiding diagnostics, treatment decisions, and follow-up, as well as informing supportive care interventions. Geriatric assessment and management (GAM) refers to the comprehensive evaluation of an older individual's health status with subsequent management plans focusing on both oncologic and non-oncologic interventions. In 2019, the European Society for Medical Oncology (ESMO) and the International Society of Geriatric Oncology (SIOG) established the ESMO/SIOG Cancer in the Elderly Working Group. This position paper reflects the recommendations of the working group. Our paper summarizes the existing evidence with a focus on recent key trials and based on this, we propose several recommendations and future directions.
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Affiliation(s)
- K P Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, USA.
| | - G Liposits
- Department of Oncology, Odense University Hospital, Odense, Denmark. https://twitter.com/G_LipositsMD
| | - S P Arora
- Division of Hematology/Oncology, Department of Medicine, Mays Cancer Center, University of Texas Health San Antonio, San Antonio, USA. https://twitter.com/DrSukeshiArora
| | - N R Neuendorff
- Department of Geriatrics, Marien Hospital Herne, University Hospital, Ruhr University Bochum, Herne, Germany. https://twitter.com/neuendorff_nr
| | - F Gomes
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester; Senior Adult Oncology, The Christie NHS Foundation Trust, Manchester, UK. https://twitter.com/FabioGomes_go
| | - J L Krok-Schoen
- Comprehensive Cancer Center, The Ohio State University, Columbus; School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, USA. https://twitter.com/KrokSchoen
| | - T Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany. https://twitter.com/TeeresaSAmaral
| | - E Mariamidze
- Todua Clinic-Department of Oncology and Hematology, Tbilisi, Georgia; Ospedale Policlinico San Martino-Clinica di Oncologia Medica, Genoa. https://twitter.com/EMariamidze
| | - L Biganzoli
- "Sandro Pitigliani" Department of Medical Oncology, Hospital of Prato, Prato, Italy
| | - E Brain
- Department of Medical Oncology, Institut Curie/Saint-Cloud, Saint-Cloud. https://twitter.com/EtienneB66
| | - C Baldini
- Drug Development Department (DITEP), Gustave Roussy, Villejuif; Paris Saclay University, Villejuif, France. https://twitter.com/CapuBaldini
| | - N M L Battisti
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK. https://twitter.com/nicolobattisti
| | - M Frélaut
- Department of Medical Oncology, Gustave Roussy, Villejuif, France. https://twitter.com/frelaut_m
| | - R Kanesvaran
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore. https://twitter.com/ravikanesvaran
| | - A R A Mislang
- College of Medicine and Public Health, Flinders University, Adelaide; Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Adelaide, Australia. https://twitter.com/AnnaMislang
| | - D Papamichael
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - C Steer
- Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury; UNSW School of Clinical Medicine, Rural Clinical Campus, Albury; John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga, Australia. https://twitter.com/drcbsteer
| | - S Rostoft
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. https://twitter.com/SRostoft
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Chen Q, Ying S, Qin J, Zhang L. Optimization of treatment strategies for elderly patients with advanced non-small cell lung cancer. Front Oncol 2024; 14:1384906. [PMID: 39081714 PMCID: PMC11286424 DOI: 10.3389/fonc.2024.1384906] [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: 02/11/2024] [Accepted: 07/02/2024] [Indexed: 08/02/2024] Open
Abstract
Lung cancer stands as a malignant neoplasm bearing the highest burden of morbidity and mortality within the elderly population on a global scale. Among the lung cancer subtypes, non-small cell lung cancer (NSCLC) prevails as the most prevalent. As age advances, elderly patients often present with an increased prevalence of comorbidities, diminished organ reserve function, and alterations in drug pharmacokinetics, including absorption, distribution, metabolism, and clearance. These factors collectively contribute to a reduction in their capacity to tolerate therapeutic interventions. Regrettably, there exists a paucity of research data and evidence regarding the management of elderly patients afflicted by advanced lung cancer. This article endeavors to compile and elucidate strategies for the enhancement of treatment approaches, with the aim of aiding clinical decision-making. Prior to the selection of clinical treatment modalities for elderly patients with advanced NSCLC, a comprehensive assessment should be conducted, taking into account various facets, including tumor characteristics, patient age, physiological status, and the presence of comorbidities. The treatment strategy should be implemented in a tiered fashion, thereby affording the opportunity for the tailoring of individualized therapeutic approaches for elderly patients afflicted by advanced NSCLC. The demographic of elderly patients confronting advanced NSCLC presents a complex landscape marked by intricate underlying conditions, necessitating the imperative optimization of treatment strategies.
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Affiliation(s)
- Qiang Chen
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, China
| | - Shuo Ying
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jianwen Qin
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, China
| | - Li Zhang
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, China
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Gul S, Tepetam H, Alomari O, Çolpan Öksüz D, Turhal SN, Öner Dinçbaş F. A Survey of the Turkish Oncology Group (TOG): Are the Oncologists Trained for Decision Making on Geriatric Cancer Patients? Cureus 2024; 16:e64533. [PMID: 39139354 PMCID: PMC11321900 DOI: 10.7759/cureus.64533] [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] [Accepted: 07/14/2024] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION Most newly diagnosed cancers occur in older adults, and it is important to understand a patient's underlying health status when making treatment decisions. Therefore, clinicians need enhanced competencies and skills to effectively care for this population. However, most clinicians receive minimal to no training in geriatrics. This study aims to evaluate the education and training levels in geriatric oncology among Turkish physicians and to understand the factors influencing oncologists' treatment decisions for geriatric cancer patients. MATERIALS AND METHODS A 24-question survey was prepared to obtain the participating physicians' demographic information, as well as to inquire whether they had received training during their medical education and residency on how to approach geriatric patients, in what process(es) they had received the training, whether they were currently treating geriatric patients, what they focused on when evaluating geriatric patients, and what they thought about their training and preparedness for approaching geriatric patients. The questionnaire was sent online to radiation and medical oncologists, and the link was published on the Turkish Society of Radiation Oncology and the Turkish Society of Medical Oncology websites. RESULTS Two hundred and three physicians participated in the survey, 131 of whom were women. The median age was 41.66 years (24-69 years). One hundred and fifty-six physicians (76.1%) received specialty education at the university hospital. One hundred and three of them were radiation oncologists, and 80 were medical oncologists. Of the physicians, 19.7% received education in geriatrics before they specialized in oncology, and 6.9% said they were educated after specialization. When determining suitability for radiotherapy, 10.7% of radiation oncologists said that they use geriatric assessment tools. Similarly, 13.8% of medical oncologists claimed that they used geriatric assessment tools in determining suitability for chemotherapy. Of the physicians, 177 (86.3%) thought that geriatric evaluation could independently increase patient survival rate. Furthermore, patient cognitive status, functional status, physiological age, polypharmacy, geriatric specialist recommendations, inpatient services, patient relatives, and similar factors were found to be useful in treatment decisions. Finally, 92.7% of the participants believed that receiving education would have changed their perspectives on treating geriatric patients. CONCLUSION Our results provide perspectives on developing knowledge on and skills in geriatric training among oncologists. Learning new approaches is necessary for oncologists who more frequently confront geriatric patients with cancer.
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Affiliation(s)
- Sule Gul
- Radiation Oncology, Health Sciences University, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, TUR
| | - Huseyin Tepetam
- Radiation Oncology, Health Sciences University, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, TUR
| | - Omar Alomari
- Medicine and Surgery, Hamidiye International Faculty of Medicine, University of Health Sciences, Istanbul, TUR
| | - Didem Çolpan Öksüz
- Radiation Oncology, Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, TUR
| | - Serdar N Turhal
- Internal Medicine, Department of Medical Oncology, Anatolian Health Center, Istanbul, TUR
| | - Fazilet Öner Dinçbaş
- Radiation Oncology, Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, TUR
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9
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Meerkerk CDA, Bruijnen CP, van den Bos F, Emmelot-Vonk MH, de Bree R. The geriatric assessment and sarcopenia to assess frailty in older patients with cancer. J Geriatr Oncol 2024; 15:101776. [PMID: 38677936 DOI: 10.1016/j.jgo.2024.101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/23/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Christiaan D A Meerkerk
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Cheryl P Bruijnen
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Frederiek van den Bos
- Department of Geriatrics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Marielle H Emmelot-Vonk
- Department of Geriatrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
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10
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Scholtz K, Borchers F, Mörgeli R, Krampe H, Schmidt M, Eckardt-Felmberg R, von Dossow V, Sehouli J, Stief CG, Pohrt A, Spies CD. Self-reported exhaustion and a 4-item physical frailty index to predict the incidence of major complications after onco-geriatric surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108421. [PMID: 38870573 DOI: 10.1016/j.ejso.2024.108421] [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: 12/15/2023] [Revised: 04/24/2024] [Accepted: 05/15/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND The aim of this study was to analyze four pre-operative physical frailty indicators from a geriatric assessment (GA) independently and combined in a physical frailty index, in their ability to predict postoperative 30 d-complications. MATERIALS AND METHODS In this secondary analysis of data from the published PERATECS study (ClinicalTrials.gov: NCT01278537), the predictive value of four physical frailty indicators from a defined GA battery was examined with univariable and multivariate logistic regression models in a sample of 493 onco-geriatric surgical patients. The primary endpoint was incidence of major (Clavien-Dindo ≥ grade 2 [CD ≥ 2]) complications within 30 postoperative days. Predictors of the first model included self-reported exhaustion (SRE), body mass index (BMI), Timed Up-and-Go (TUG) and handgrip strength (HGS) independently, and a second model combined these four items as a Physical Frailty Index (4i-PFI). Both regression models were adjusted for age, gender, American Society of Anesthesiologists (ASA) status, tumor sites, duration of surgery time and Mini Nutritional Assessment (MNA) score. RESULTS A total of 233 patients (47 %) developed CD ≥ 2 complications. In addition to ASA score, length of surgery, and gynecological and upper gastrointestinal tumor sites, the first model showed that SRE (OR 1.866) predicted CD ≥ 2 complications, but not TUG, BMI and HGS. In the second model, the 4i-PFI predicted CD ≥ 2 complications (OR pre-frail = 1.808, frail = 3.787). CONCLUSIONS Physical frailty indicators as SRE revealed a better ability to predict CD ≥ 2 complications than BMI, TUG and HGS. However, prediction of CD ≥ 2 complications was enhanced when these parameters were combined in a novel 4i-PFI.
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Affiliation(s)
- Kathrin Scholtz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Friedrich Borchers
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Rudolf Mörgeli
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Henning Krampe
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Maren Schmidt
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Schlosspark-Klinik Berlin, Heubnerweg 2, 14059, Berlin, Germany.
| | - Rahel Eckardt-Felmberg
- St. Joseph Krankenhaus Berlin-Tempelhof GmbH, Wüsthoffstraße 15, 12101, Berlin, Germany.
| | - Vera von Dossow
- Institute of Anesthesiology and Pain Therapy, Heart, and Diabetes Center NRW, Ruhr University Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
| | - Jalid Sehouli
- Department of Gynecology, European Competence Center of Ovarian Cancer, Charité Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Anne Pohrt
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Claudia D Spies
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Augustenburger Platz 1, 13353, Berlin, Germany.
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11
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Yajima S, Masuda H. The significance of G8 and other geriatric assessments in urologic cancer management: A comprehensive review. Int J Urol 2024; 31:607-615. [PMID: 38402450 DOI: 10.1111/iju.15432] [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: 12/14/2023] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
In urologic oncology, which often involves older patients, it is important to consider how to manage their care appropriately. Geriatric assessment (GA) is a method that can address the specific needs of older cancer patients. The GA encompasses various assessment domains, but these domains exhibit variations across the literature. Some of the common items include functional ability, nutrition, comorbidities, cognitive ability, psychosocial disorders, polypharmacy, social and financial support, falls/imbalance, and vision/hearing. Despite the diversity of domains, there is limited consensus on reliable measurement methods. This review discusses the role of GA in managing urologic cancer in unique scenarios, such as those necessitating temporary or permanent urinary catheters or stomas due to urinary diversion. A comprehensive GA is time and human-resource-intensive in real-world clinical practice. Hence, simpler tools such as the Geriatric-8 (G8), capable of identifying high-risk patients requiring a detailed GA, are also under investigation in various contexts. Therefore, we conducted a systematic literature review on the G8. Our findings indicate that patients with low G8 scores encounter difficulties with stoma self-care after urinary diversion and have higher risks of urinary tract infections and ileus after radical cystectomy. The utilization of G8 as a screening tool for urologic cancer patients may facilitate the delivery of appropriate and personalized treatment and care.
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Affiliation(s)
- Shugo Yajima
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| | - Hitoshi Masuda
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
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12
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Van Zyl M, Barell A, Cooley B, Hanwell J, Parlak J, Banerji U, De Bono J, Sharp A, Lopez J, Battisti NML, Minchom A. A single-centre study evaluating a geriatric screening tool in oncology phase I trial patients. Cancer Rep (Hoboken) 2024; 7:e2083. [PMID: 38923791 PMCID: PMC11199084 DOI: 10.1002/cnr2.2083] [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: 01/08/2024] [Revised: 03/13/2024] [Accepted: 04/08/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Though cancer is more prevalent in the older population, this patient group are underrepresented in phase I oncology trials. AIMS We evaluated the use of a geriatric screening tool (SAOP3) in patients of 70 years of age or older who attended a Phase I Clinical Trials Unit, with the aim of assessing the feasibility of the tool and identifying potential unmet needs in this patient group. METHODS Twenty-two patients over the age of 70 completed the SAOP3 questionnaire. Geriatric impairments and needs were analysed with descriptive statistics. Qualitative responses were grouped in themes using structured thematic analysis. RESULTS All of patients triggered at least 1 geriatric domain, most commonly mobility. Six core themes were identified as being important to the patient including family, friends and positivity. On cognition assessment over 20% of patients triggered as requiring further cognitive assessment. The group had a relatively high screen fail risk. CONCLUSION In conclusion, routine geriatric screening withSAOP3 was feasible and identified areas of patient need. Results highlight the prevalence of psychological distress and cognitive impairment. Geriatric screening offers an opportunity for prehabilitation prior to trial and support during trial participation to optimise safety and improve trial access.
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Affiliation(s)
- Mary Van Zyl
- Drug Development UnitRoyal Marsden Hospital/Institute of Cancer ResearchSuttonUK
| | - Anne Barell
- Senior Adult Oncology ProgrammeRoyal Marsden HospitalSuttonUK
| | - Bridget Cooley
- Drug Development UnitRoyal Marsden Hospital/Institute of Cancer ResearchSuttonUK
| | - Janet Hanwell
- Drug Development UnitRoyal Marsden Hospital/Institute of Cancer ResearchSuttonUK
| | - Josie Parlak
- Drug Development UnitRoyal Marsden Hospital/Institute of Cancer ResearchSuttonUK
| | - Udai Banerji
- Drug Development UnitRoyal Marsden Hospital/Institute of Cancer ResearchSuttonUK
| | - Johann De Bono
- Drug Development UnitRoyal Marsden Hospital/Institute of Cancer ResearchSuttonUK
| | - Adam Sharp
- Drug Development UnitRoyal Marsden Hospital/Institute of Cancer ResearchSuttonUK
| | - Juanita Lopez
- Drug Development UnitRoyal Marsden Hospital/Institute of Cancer ResearchSuttonUK
| | - Nicolo Matteo Luca Battisti
- Senior Adult Oncology ProgrammeRoyal Marsden HospitalSuttonUK
- Breast Unit & Senior Adult Oncology ProgrammeRoyal Marsden HospitalSuttonUK
| | - Anna Minchom
- Drug Development UnitRoyal Marsden Hospital/Institute of Cancer ResearchSuttonUK
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13
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Winters AM, Bakker J, Ten Hoor J, Bilo HJG, Roodbol PF, Edens MA, Finnema EJ. Prognostic value of Geriatric-8 for adverse outcomes within 30 days of surgery in older adults with colorectal cancer: A retrospective cohort study. Eur J Oncol Nurs 2024; 70:102591. [PMID: 38652933 DOI: 10.1016/j.ejon.2024.102591] [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: 12/15/2023] [Revised: 03/29/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE It is unclear whether the Geriatric-8 (G8) has the accuracy to preselect patients for complete geriatric assessment, and has the ability to predict adverse outcomes in patients with colorectal cancer (CRC). We therefore aimed to determine whether the G8, or other variables present in the medical record, are applicable in predicting 30-day adverse outcomes in older patients undergoing surgery for CRC. METHODS We performed a retrospective cohort study involving patients ≥70 years who had surgery for CRC between 2018 and 2020 in a general hospital in the Netherlands. The primary outcome was adverse outcome(s), which is a composite of surgical and non-surgical complications, readmission and mortality, all within 30 days of surgery. The secondary endpoints were the individual components, such as delirium, infection and ileus. We explored potential prognostic factors using multivariable logistic regression analysis. Data were collected from the Dutch ColoRectal Audit (DRCA) and medical records. RESULTS The study included 200 patients (mean age 78.9 years: 50% female), with 36.5% having adverse outcomes in the first 30 days of surgery. In neither univariate nor multivariable analysis were G8 scores associated with adverse outcomes. Factors with higher odds of adverse outcomes were male gender, and having cognitive decline or previous delirium. CONCLUSION This study confirms that G8 scores have no prognostic value for adverse outcomes, complications and mortality within 30 days of surgery among older adults with CRC. Therefore, the G8 should not be the tool for short-term risk prediction of adverse outcomes in these patients.
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Affiliation(s)
- A M Winters
- Department of Internal Medicine/Geriatrics, Isala Hospital, Zwolle, the Netherland; Nursing Science, Department of Health Sciences, University Medical Center Groningen and University of Groningen, Groningen, the Netherland.
| | - J Bakker
- Department of Oncology, Isala Hospital, Zwolle, the Netherland
| | - J Ten Hoor
- Department of Pediatric Medicine, Zaans Medical Center, Zaandam, the Netherland
| | - H J G Bilo
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherland; Stichting Onderzoekcentrum Chronische Ziekten, Zwolle, the Netherland
| | - P F Roodbol
- Nursing Science, Department of Health Sciences, University Medical Center Groningen and University of Groningen, Groningen, the Netherland
| | - M A Edens
- Stichting Onderzoekcentrum Chronische Ziekten, Zwolle, the Netherland; Department of Innovation and Science, Epidemiology Unit, Isala Hospital, Zwolle, the Netherland
| | - E J Finnema
- Nursing Science, Department of Health Sciences, University Medical Center Groningen and University of Groningen, Groningen, the Netherland; Hanze University of Applied Sciences, Groningen, the Netherland; NHL Stenden University of Applied Sciences, Leeuwarden, the Netherland
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14
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Atre SY, Soulos PR, Kuderer NM, Gross CP, Baum LVM, Dinan MA, Lustberg MB. Characterization of time toxicity in older patients with metastatic breast cancer. Breast Cancer Res Treat 2024:10.1007/s10549-024-07379-7. [PMID: 38816556 DOI: 10.1007/s10549-024-07379-7] [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: 03/17/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Recognizing that receiving healthcare can be time intensive and burdensome, time toxicity has been conceptualized as the time spent by patients seeking healthcare. This study investigates the association between age at diagnosis and time toxicity for patients with Metastatic Breast Cancer (MBC) and identifies major components of care that confer the greatest time toxicity. METHODS We conducted a retrospective cohort study among patients with MBC aged 67 or older using the SEER-Medicare database. We assessed time toxicity using the number of encounter days patients interacted with the healthcare system per 100 days, within the first year of starting cancer treatment. We used a Poisson model to analyze the association between age and encounter days, adjusting for clinical and sociodemographic factors. We stratified the mean encounter days for each age cohort by treatment types. FINDINGS The final sample included 2949 patients; 51.4% were between 70 and 79 years old, and 81.3% were white. Although unadjusted analysis showed an association between older age and more encounter days (Rate Ratio (RR) 1.12; 95% CI 1.02, 1.22), there was no significant association after adjusting for comorbidities and treatment type. Patients with more than three comorbidities had significantly higher encounter days compared to those without comorbidities [RR 1.36 (95% CI 1.26, 1.46)]. Receipt of radiotherapy [RR: 1.45 95% CI (1.37, 1.54)] was associated with more encounter days compared to not receiving radiotherapy, while receipt of bone-modifying agents was associated with fewer encounter days compared to not using Bone modifying agents [RR 0.75 (95% CI 0.70, 0.79)]. CONCLUSION Our study identified comorbidities and cancer treatment modality, including radiotherapy, as the factors affecting time toxicity in older patients with MBC. Assessment of an individual's comorbid medical conditions and types of treatment planned are crucial to understanding age-related impacts on encounter days and to support shared decision making in older patients.
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Affiliation(s)
- Swarali Y Atre
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA.
| | - Pamela R Soulos
- Associate Director, COPPER Center, Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | | | - Cary P Gross
- Section of General Medicine, Department of Medicine and Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - Laura V M Baum
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michaela A Dinan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Maryam B Lustberg
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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15
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Liu WY, Tang Y, Li N, Tang Y, Cheng YJ, Yang L, Fang H, Lu NN, Qi SN, Chen B, Wang SL, Song YW, Liu YP, Li YX, Liu Z, Liang JW, Pei W, Wang XS, Zhang HZ, Wang J, Zhou HT, Jin J. Preoperative chemoradiotherapy in older patients with rectal cancer guided by comprehensive geriatric assessment within a multidisciplinary team-a multicenter phase II trial. BMC Geriatr 2024; 24:442. [PMID: 38773457 PMCID: PMC11106876 DOI: 10.1186/s12877-024-05046-6] [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: 04/23/2023] [Accepted: 05/06/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the safety and efficacy of preoperative concurrent chemoradiotherapy (preCRT) for locally advanced rectal cancer in older people who were classified as "fit" by comprehensive geriatric assessment (CGA). METHODS A single-arm, multicenter, phase II trial was designed. Patients were eligible for this study if they were aged 70 years or above and met the standards of "fit" (SIOG1) as evaluated by CGA and of the locally advanced risk category. The primary endpoint was 2-year disease-free survival (DFS). Patients were scheduled to receive preCRT (50 Gy) with raltitrexed (3 mg/m2 on days 1 and 22). RESULTS One hundred and nine patients were evaluated by CGA, of whom eighty-six, eleven and twelve were classified into the fit, intermediate and frail category. Sixty-eight fit patients with a median age of 74 years were enrolled. Sixty-four patients (94.1%) finished radiotherapy without dose reduction. Fifty-four (79.3%) patients finished the prescribed raltitrexed therapy as planned. Serious toxicity (grade 3 or above) was observed in twenty-four patients (35.3%), and fourteen patients (20.6%) experienced non-hematological side effects. Within a median follow-up time of 36.0 months (range: 5.9-63.1 months), the 2-year overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) rates were 89.6% (95% CI: 82.3-96.9), 92.4% (95% CI: 85.9-98.9) and 75.6% (95% CI: 65.2-86.0), respectively. Forty-eight patients (70.6%) underwent surgery (R0 resection 95.8%, R1 resection 4.2%), the corresponding R0 resection rate among the patients with positive mesorectal fascia status was 76.6% (36/47). CONCLUSION This phase II trial suggests that preCRT is efficient with tolerable toxicities in older rectal cancer patients who were evaluated as fit based on CGA. TRIAL REGISTRATION The registration number on ClinicalTrials.gov was NCT02992886 (14/12/2016).
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Affiliation(s)
- Wen-Yang Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yun-Jie Cheng
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lin Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning-Ning Lu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Wei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Pei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi-Shan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hai-Zeng Zhang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
| | - Hai-Tao Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Department of Radiation Oncology, National Cancer Center/ Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
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16
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Guven DC, Martinez-Cannon BA, Testa GD, Martins JC, Velasco RN, Kalsi T, Gomes F. Immunotherapy use in older adults with cancer with frailty: A young SIOG review paper. J Geriatr Oncol 2024; 15:101742. [PMID: 38472009 DOI: 10.1016/j.jgo.2024.101742] [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: 09/30/2023] [Revised: 02/04/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
Immune checkpoint inhibitors (ICIs) became a treatment option in most tumor types and improved survival in patients with cancer in the last decade. Older patients with cancer are underrepresented in the pivotal clinical trials with ICIs. Older patients with cancer often have significant comorbidities and geriatric syndromes like frailty, which can complicate cancer care and treatment decisions. Frailty is among the most prevalent geriatric syndromes in patients with cancer and could lead to inferior survival and a higher risk of complications in patients treated with chemotherapy. However, the effect of frailty on the efficacy and safety of ICIs is understudied. This review focuses on the available evidence regarding the association between frailty and ICI efficacy and safety. Although the survival benefits of ICIs have generally been shown to be independent of age, the available real-world data has generally suggested higher rates of immune-related adverse events (irAEs) and treatment discontinuation in older patients. While international organizations recommend conducting a comprehensive geriatric assessment CGA to assess and address frailty before the start of anti-cancer therapies, an Eastern Cooperative Oncology Group (ECOG) performance status of 2 or higher is frequently used in clinical practice as synonymous with frailty, albeit with significant limitations. The available data has generally demonstrated diminished ICI efficacy in patients with an ECOG 2 or higher compared to patients with better performance status, while the incidence of high-grade irAEs were similar. Whilst evidence regarding outcomes with ICI in older patients and in those with sub-optimal performance status is growing, there is very limited data specifically evaluating the role of frailty with ICIs. These studies found a shortened overall survival, yet no evidence of a lower response rate to ICIs. These patients experienced more AEs, but they did not necessarily have a higher incidence of irAEs.
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Affiliation(s)
- Deniz Can Guven
- Medical Oncology Clinic, Health Sciences University, Elazig City Hospital, Elazig, Turkey.
| | | | - Giuseppe Dario Testa
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | | | - Rogelio N Velasco
- Clinical Trial and Research Division, Philippine Heart Center, Quezon City, Philippines
| | - Tania Kalsi
- Department of Ageing and Health, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Fabio Gomes
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK
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17
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Inoo S, Kono Y, Kanzaki H, Horiguchi S, Kato H, Yamasaki Y, Hirata S, Kuraoka S, Matsueda K, Okanoue S, Satomi T, Hamada K, Iwamuro M, Kawano S, Kawahara Y, Okada H, Otsuka M. Association of screening tool scores with overall survival in older patients with unresectable gastrointestinal or biliary pancreatic cancer: A retrospective study. J Geriatr Oncol 2024; 15:101714. [PMID: 38331689 DOI: 10.1016/j.jgo.2024.101714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Shoko Inoo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Yoshiyasu Kono
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Department of Internal Medicine, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama, 708-0841, Japan
| | - Shigeru Horiguchi
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Hironari Kato
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Yasushi Yamasaki
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Shoichiro Hirata
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Sakiko Kuraoka
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Katsunori Matsueda
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Shotaro Okanoue
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Takuya Satomi
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Kenta Hamada
- Department of Practical Gastrointestinal endoscopy, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Yoshiro Kawahara
- Department of Internal Medicine, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama, 708-0841, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Department of Internal Medicine, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji 670-8540, Japan
| | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
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18
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Untch M, Ditsch N, Fasching PA, Busch S, Ettl J, Haidinger R, Harbeck N, Jackisch C, Lüftner D, Müller L, Ruckhäberle E, Schumacher-Wulf E, Thomssen C, Wuerstlein R, Müller V. Discussion of ABC7 Consensus and German Recommendations. Geburtshilfe Frauenheilkd 2024; 84:431-442. [PMID: 38817599 PMCID: PMC11136526 DOI: 10.1055/a-2263-5152] [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: 02/05/2024] [Accepted: 03/11/2024] [Indexed: 06/01/2024] Open
Abstract
The rationale behind the "International Consensus Conference for Advanced Breast Cancer" (ABC) is to standardize the treatment of patients with advanced or metastatic breast cancer worldwide using an evidence-based approach. The aim is also to ensure that patients in all countries receive adequate treatment based on current treatment recommendations and standards. The 7th International Consensus Conference on Advanced Breast Cancer (ABC7) took place from November 9 to 12, 2023 in Lisbon/Portugal. ABC7 focused on metastatic disease as well as on locally advanced and inflammatory breast cancer. Special topics included the treatment of oligometastatic patients, leptomeningeal disease, treatment of brain metastases, and pregnant women with ABC. As in previous years, patient advocates from all over the world participated in the consensus conference and were involved in decision making.
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Affiliation(s)
- Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Brustzentrum, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Peter A. Fasching
- Frauenklinik des Universitätsklinikums Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Steffi Busch
- Onkologische Schwerpunktpraxis, Dr. Busch MVZ GmbH, Mühlhausen,Germany
| | - Johannes Ettl
- Klinik für Gynäkologie und Geburtshilfe, Klinik für Hämatologie, Onkologie und Palliativmedizin, Klinikverbund Allgäu gGmbH, Klinikum Kempten, Kempten, Germany
| | - Renate Haidinger
- Brustkrebs Deutschland e. V., Hohenbrunn, Germany; patient advocate, board member ABC Global Alliance
| | - Nadia Harbeck
- Brustzentrum, Frauenklinik und Comprehensive Cancer Center (CCC), LMU Klinikum München, München, Germany; ABC7 panel member
| | - Christian Jackisch
- Klinik für Gynäkologie und Frauenheilkunde, Sana Klinikum Offenbach, Offenbach, Germany
| | - Diana Lüftner
- Immanuel Klinik Märkische Schweiz, Buckow & Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin, Germany
| | - Lothar Müller
- Onkologie UnterEms, Studienzentrum UnterEms, Leer, Germany
| | - Eugen Ruckhäberle
- Universitätsfrauenklinik, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Eva Schumacher-Wulf
- Mamma Mia! Brustkrebsmagazin, Köln, Germany; patient advocate, co-chair, ABC7 panel member
| | - Christoph Thomssen
- Klinik und Poliklinik für Gynäkologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Rachel Wuerstlein
- Brustzentrum, Frauenklinik und Comprehensive Cancer Center (CCC), LMU Klinikum München, München, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsfrauenklinik und Brustzentrum Hamburg-Eppendorf, Hamburg Germany; ABC7 panel member
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19
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Rottenberg Y, Cooper L, Rose AJ. Geriatric assessment tools for older patients with cancer: Are they screening tools, or something else? J Geriatr Oncol 2024; 15:101752. [PMID: 38561311 DOI: 10.1016/j.jgo.2024.101752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/04/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Yakir Rottenberg
- The Department of Oncology, Hadassah-Hebrew University Medical Center, Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel.
| | - Lisa Cooper
- Geriatric Medicine, Rabin Medical Center, Petach Tikva, and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Adam J Rose
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem.
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20
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Kim VS, Carrozzi A, Papadopoulos E, Tejero I, Thiruparanathan T, Perlis N, Hope AJ, Jang RW, Alibhai SMH. Exploring the Language Used to Describe Older Patients at Multidisciplinary Cancer Conferences. Cancers (Basel) 2024; 16:1477. [PMID: 38672559 PMCID: PMC11047842 DOI: 10.3390/cancers16081477] [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: 02/29/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Older adults with cancer often present with distinct complexities that complicate their care, yet the language used to discuss their management at multidisciplinary cancer conferences (MCCs) remains poorly understood. A mixed methods study was conducted at a tertiary cancer centre in Toronto, Canada, where MCCs spanning five tumour sites were attended over six months. For presentations pertaining to a patient aged 75 or older, a standardized data collection form was used to record their demographic, cancer-related, and non-cancer-related information, as well as the presenter's specialty and training level. Descriptive statistics and thematic analysis were employed to explore MCC depictions of older patients (n = 75). Frailty status was explicitly mentioned in 20.0% of presentations, but discussions more frequently referenced comorbidity burden (50.7%), age (33.3%), and projected treatment tolerance (30.7%) as surrogate measures. None of the presentations included mentions of formal geriatric assessment (GA) or validated frailty tools; instead, presenters tended to feature select GA domains and subjective descriptions of appearance ("looks to be fit") or overall health ("relatively healthy"). In general, MCCs appeared to rely on age-focused language that may perpetuate ageism. Further work is needed to investigate how frailty and geriatric considerations can be objectively incorporated into discussions in geriatric oncology.
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Affiliation(s)
- Valerie S. Kim
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (V.S.K.); (A.C.)
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Anthony Carrozzi
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (V.S.K.); (A.C.)
| | | | - Isabel Tejero
- Department of Geriatrics, Hospital del Mar, 08003 Barcelona, Spain;
| | | | - Nathan Perlis
- Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, ON M5G 2C4, Canada;
| | - Andrew J. Hope
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada;
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Raymond W. Jang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
| | - 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 M5T 3M6, Canada
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21
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Paredero-Pérez I, Jimenez-Fonseca P, Cano JM, Arrazubi V, Carmona-Bayonas A, Covela-Rúa M, Fernández-Montes A, Martín-Richard M, Gironés-Sarrió R. State of the scientific evidence and recommendations for the management of older patients with gastric cancer. J Geriatr Oncol 2024; 15:101657. [PMID: 37957106 DOI: 10.1016/j.jgo.2023.101657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/25/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
Gastric cancer is one of the most frequent and deadly tumours worldwide. However, the evidence that currently exists for the treatment of older adults is limited and is derived mainly from clinical trials in which older patients are poorly represented. In this article, a group of experts selected from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (SEOM), the Spanish Group for the Treatment of Digestive Tumours (TTD), and the Spanish Multidisciplinary Group on Digestive Cancer (GEMCAD) reviews the existing scientific evidence for older patients (≥65 years old) with gastric cancer and establishes a series of recommendations that allow optimization of management during all phases of the disease. Geriatric assessment (GA) and a multidisciplinary approach should be fundamental parts of the process. In early stages, endoscopic submucosal resection or laparoscopic gastrectomy is recommended depending on the stage. In locally advanced stage, the tolerability of triplet regimens has been established; however, as in the metastatic stage, platinum- and fluoropyrimidine-based regimens with the possibility of lower dose intensity are recommended resulting in similar efficacy. Likewise, the administration of trastuzumab, ramucirumab and immunotherapy for unresectable metastatic or locally advanced disease is safe. Supportive treatment acquires special importance in a population with different life expectancies than at a younger age. It is essential to consider the general state of the patient and the psychosocial dimension.
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Affiliation(s)
- Irene Paredero-Pérez
- Lluís Alcanyís de Játiva Hospital, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Valencia, Spain
| | - Paula Jimenez-Fonseca
- Asturias Central University Hospital (HUCA), Health Research Institute of the Principality of Asturias (ISPA), Spanish Cooperative Group for the Treatment of Digestive Tumours (TTD), Oviedo, Spain
| | - Juana María Cano
- Ciudad Real University Hospital, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Ciudad Real, Spain.
| | - Virginia Arrazubi
- Navarra University Hospital, Navarra Institute for Health Research (IdiSNA), Spanish Society of Medical Oncology (SEOM), Pamplona, Spain
| | - Alberto Carmona-Bayonas
- IMIB Morales Meseguer University Hospital, Murcia University (UMU), Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Murcia, Spain
| | - Marta Covela-Rúa
- Lucus Agusti University Hospital (HULA), Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Lugo, Spain
| | - Ana Fernández-Montes
- Ourense University Hospital Complex (CHUO), Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Orense, Spain
| | - Marta Martín-Richard
- Institut Català d'Oncologia (ICO) - Duran i Reynals University Hospital, Multidisciplinary Spanish Group of Digestive Cancer (GEMCAD), Barcelona, Spain.
| | - Regina Gironés-Sarrió
- Polytechnic la Fe University Hospital, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Valencia, Spain
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22
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Stueger A, Joerger M, De Nys K. Geriatric evaluation methods in oncology and their use in clinical studies: A systematic literature review. J Geriatr Oncol 2024; 15:101684. [PMID: 38072709 DOI: 10.1016/j.jgo.2023.101684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/04/2023] [Accepted: 12/01/2023] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Therapeutic options in oncology keep on expanding. Nonetheless, older adults are underrepresented in clinical trials and those enrolled often have a better health status than their average peers, resulting in a lack of representative evidence for this heterogenous population. The inclusion of older patients and a uniform categorization of "frailty" is becoming increasingly urgent. Standardized tools could contribute to the quality and comparability of clinical trials and facilitate clinical decisions. The aim of this literature review was to elaborate an overview of the use of geriatric evaluation (GE) methods in clinical cancer research. MATERIALS AND METHODS We performed a literature review of the PubMed database. Clinical pharmacotherapy studies that applied or evaluated a clearly defined system for the GE of oncological patients were included. Data retrieved encompassed the applied GE method(s), cancer type(s), and pharmacotherapy investigated, the number of included patients, study type, year of publication, as well as the primary purpose of the GE. The GEs used most frequently were depicted in more depth. RESULTS In this literature review, 103 publications were selected for inclusion. The biggest proportion of studies (36%, n = 34) used clearly defined, but not previously validated, GE methods (study-specific GE). Standardized GE methods encountered in at least five publications were the G8 screening test (applied in 18% of included studies, n = 17), the Balducci score (7%, n = 7), and a geriatric assessment based on Hurria (5%, n = 5). The primary purpose of GE was predominantly an appraisal of its potential role in pharmacotherapy optimization. The GE also served as baseline and outcome measure, inclusion/exclusion criterion, factor for stratified randomization, and to determine treatment allocation. DISCUSSION The wide range of GE methods used across studies make direct comparisons difficult, and many methods are poorly characterized and/or not previously validated. The further inclusion of representative older patients in clinical trials combined with the use of a standardized GE could help clinicians in the decision-making process.
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Affiliation(s)
- Amelie Stueger
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland.
| | - Markus Joerger
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland; Department of Oncology and Hematology, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9000 St. Gallen, Switzerland.
| | - Katelijne De Nys
- Palliativzentrum, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9000 St. Gallen, Switzerland; KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, ON2 Herestraat 49 - box 424, BE-3000 Leuven, Belgium.
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23
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Ditsch N, Untch M, Fasching PA, Busch S, Ettl J, Haidinger R, Jackisch C, Lüftner D, Müller L, Müller V, Ruckhäberle E, Schumacher-Wulf E, Thomssen C, Harbeck N, Wuerstlein R. ABC7 Consensus: Assessment by a German Group of Experts. Breast Care (Basel) 2024; 19:116-128. [PMID: 38638343 PMCID: PMC11023691 DOI: 10.1159/000535997] [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: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 04/20/2024] Open
Abstract
Background The "International Consensus Conference for Advanced Breast Cancer" was initiated more than 10 years ago. The rationale was to standardize treatment of advanced breast cancer (ABC) based on available evidence and to ensure that all ABC patients worldwide receive adequate treatment and access to new therapies. Topics of ABC7 The 7th International Consensus Conference for ABC (ABC7) took place from November 9 to 11, 2023 - as in previous years in Lisbon/Portugal. ABC7 focused not only on metastatic disease but also on locally advanced and inflammatory breast cancer. Special topics were the management of oligometastatic disease, leptomeningeal disease, brain metastases, and pregnant women with ABC. Due to the current situation worldwide, there was a special interest to patients living in conflict zones. As in previous years, patient advocates from around the world were integrated into the ABC conference and had a major input to the consensus. Rationale for the Manuscript A German breast cancer expert panel comments on the voting results of the ABC7 panelists regarding their relevance for routine clinical practice in Germany. As with previous meetings, the ABC7 votes focused on modified or new statements. Regarding the statements not modified for the ABC7 consensus, they are discussed in the published manuscript from 2021 in which the German experts commented on the ABC6 consensus. The German comments are always based on the current recommendations of the "Breast Committee" of the Gynecological Oncology Working Group (Arbeitsgemeinschaft Gynäkologische Onkologie, AGO Mamma).
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Affiliation(s)
- Nina Ditsch
- Department of Gynecology and Obstetrics, Breast Cancer Center, University Hospital Augsburg, Augsburg, Germany
| | - Michael Untch
- Department of Gynecology and Obstetrics, Multidisciplinary Breast Cancer and Gynecologic Oncology Center, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Peter A. Fasching
- Women’s Hospital at the University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Steffi Busch
- Onkologische Schwerpunktpraxis, Dr. Busch MVZ GmbH, Mühlhausen, Germany
| | - Johannes Ettl
- Department of Gynecology and Obstetrics, Clinic for Hematology, Oncology and Palliative Care, Klinikverbund Allgäu gGmbH, Klinikum Kempten, Kempten, Germany
| | - Renate Haidinger
- Brustkrebs Deutschland e.V.; Patient Advocate, Board Member ABC Global Alliance, Munich, Germany
| | - Christian Jackisch
- Department of Gynecology and Obstetrics, Sana Klinikum Offenbach, Offenbach, Germany
| | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz, Buckow, Germany, and Immanuel Hospital Rüdersdorf, Medical University of Brandenburg, Rüdersdorf, Germany
| | - Lothar Müller
- Onkologie UnterEms, Studienzentrum UnterEms, Leer, Germany
| | - Volkmar Müller
- Department of Gynecology, University Hospital, Hamburg-Eppendorf, ABC7 Panel Member, Hamburg, Germany
| | - Eugen Ruckhäberle
- Department of Obstetrics and Gynecology of The Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Eva Schumacher-Wulf
- Mamma Mia! Breast cancer magazine, Patient Advocate, Co-chair, ABC7 Panel Member, Köln, Germany
| | | | - Nadia Harbeck
- Breast Center and Comprehensive Cancer Center (CCC) Munich, University of Munich (LMU), Department of Obstetrics and Gynecology, ABC7 Panel Member, Munich, Germany
| | - Rachel Wuerstlein
- Breast Center and Comprehensive Cancer Center (CCC) Munich, University of Munich (LMU), Department of Obstetrics and Gynecology, Munich, Germany
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24
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Daviu Cobián C, Oreskov JO, Blaakaer J, Jespersen E, Jørgensen TL, Ryg J, Herrstedt J, Høgdall C, Lund CM, Seibæk L, Vinther A, Ekmann-Gade AW, Schnack TH. Impact of FRAilty screening and Geriatric assessment and INtervention in older patients with epithelial Ovarian Cancer: A multicenter randomized clinical trial protocol (FRAGINOC). J Geriatr Oncol 2024; 15:101713. [PMID: 38326125 DOI: 10.1016/j.jgo.2024.101713] [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: 11/10/2023] [Revised: 01/11/2024] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Radical surgery combined with chemotherapy is the only potential curative treatment of patients with advanced epithelial ovarian cancer (EOC). However, 43% of older Danish patients with EOC are not referred to surgery due to frailty, age, or fear of complications. Comprehensive geriatric assessment (CGA) has demonstrated ability to reduce frailty in older patients, but there is a knowledge gap regarding its effect before or during treatment in older adults with EOC. This protocol presents a randomized controlled trial (RCT), which evaluates the effect of CGA-based interventions including individualized physical exercise therapy in older adults with EOC during neoadjuvant chemotherapy (NACT). MATERIALS AND METHODS This RCT will include patients aged ≥70 years with primary EOC referred to NACT. Patients will be randomized 1:1 to intervention or standard of care, along with neoadjuvant antineoplastic treatment. Stratification for performance status and center of inclusion will be performed. In the intervention arm, a geriatrician will perform CGA and corresponding geriatric interventions and patients will undergo an individualized home-based exercise program managed by a physiotherapist. All patients will be evaluated with Geriatric-8, modified Geriatric-8, clinical frailty scale, and physical tests at randomization. Predictive values (positive/negative) will be evaluated for CGA detected impairments. The primary endpoint is the proportion of patients referred to interval debulking surgery (IDS). Secondary endpoints include the proportion who complete oncological treatment, improvements in physical tests, quality of life measured by European Organization for Research and Treatment of Cancer-Quality of Life questionnaires at inclusion, after three cycles of chemotherapy, and at end of chemotherapy treatment. Furthermore, the association between results of geriatric screening tests, CGA, and physical tests with complication rate and progression free survival will be examined. The primary outcome will be analyzed with logistic regression in the intention-to-treat population. Power calculations reveal the need to enroll 216 patients. DISCUSSION The present study examines whether CGA-based interventions including individualized physical exercise can increase the referral rate for potential curative IDS in older patients with EOC. If successful, this will result in more patients undergoing surgery and completing chemotherapy, preventing complications, and ultimately improving quality of life and survival. The study setup may establish the basis for direct clinical implementation if proven effective.
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Affiliation(s)
- Cristina Daviu Cobián
- Department of Gynecology and Obstetrics, Zealand University Hospital, Roskilde, Denmark; Department of Gynecology and Obstetrics, Odense University Hospital, Denmark.
| | - Jakob O Oreskov
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jan Blaakaer
- Department of Gynecology and Obstetrics, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
| | - Eva Jespersen
- Department of Clinical Research, University of Southern Denmark, Denmark; Department of Oncology, Odense University Hospital, Denmark
| | - Trine L Jørgensen
- Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark; Department of Oncology, Odense University Hospital, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark; Department of Geriatric Medicine, Odense University Hospital, Denmark
| | - Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Claus Høgdall
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Cecilia M Lund
- Department of Medicine, Herlev and Gentofte hospital, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Lene Seibæk
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark; Hospital Secretariat and Communications, Research, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Anne Weng Ekmann-Gade
- Department of Obstetrics and Gynecology, Herlev University Hospital, Herlev, Denmark
| | - Tine H Schnack
- Department of Gynecology and Obstetrics, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
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25
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Extermann M, Artz A, Rebollo MA, Klepin HD, Krug U, Loh KP, Mims AS, Neuendorff N, Santini V, Stauder R, Vey N. Treating acute myelogenous leukemia in patients aged 70 and above: Recommendations from the International Society of Geriatric Oncology (SIOG). J Geriatr Oncol 2024; 15:101626. [PMID: 37741771 DOI: 10.1016/j.jgo.2023.101626] [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: 02/23/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023]
Abstract
Acute myeloid leukemia (AML) treatment is challenging in older patients. There is a lack of evidence-based recommendations for older patients ≥70, a group largely underrepresented in clinical trials. With new treatment options being available in recent years, recommendations are needed for these patients. As such the International Society of Geriatric Oncology (SIOG) assembled a task force to review the evidence specific to treatment and outcomes in this population of patients ≥70 years. Six questions were selected by the expert panel in domains of (1) baseline assessment, (2) frontline therapy, (3) post-remission therapy, (4) treatment for relapse, (5) targeted therapies, and (6) patient reported outcome/function and enhancing treatment tolerance. Information from current literature was extracted, combining evidence from systematic reviews/meta-analyses, decision models, individual trials targeting these patients, and subgroup data. Accordingly, recommendations were generated using a GRADE approach upon reviewing current evidence by consensus of the whole panel. It is our firm recommendation and hope that direct evidence should be generated for patients aged ≥70 as a distinct group in high need of improvement of their survival outcomes. Such studies should integrate information from a geriatric assessment to optimize external validity and outcomes.
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Affiliation(s)
- Martine Extermann
- Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, FL, USA.
| | - Andrew Artz
- Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Maite Antonio Rebollo
- Institut Català d'Oncologia, Oncohematogeriatrics Unit, L'Hospitalet de Llobregat, Spain
| | - Heidi D Klepin
- Wake Forest University School of Medicine, Department of Internal Medicine, Section on Hematology and Oncology, Winston-Salem, NC, USA
| | - Utz Krug
- Klinikum Leverkusen, Department of Medicine 3, Leverkusen, Germany
| | - Kah Poh Loh
- University of Rochester Medical Center, Department of Medicine, Division of Hematology and Oncology, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Alice S Mims
- The Ohio State University Wexner Medical Center, Department of Internal Medicine, Columbus, OH, USA
| | - Nina Neuendorff
- University Hospital Essen, Department of Hematology and Stem-Cell Transplantation, Essen, Germany
| | - Valeria Santini
- MDS Unit, AOUC, Hematology, University of Florence, Florence, Italy
| | - Reinhard Stauder
- Department of Internal Medicine V (Hematology Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Norbert Vey
- Aix-Marseille University, Institut Paoli-Calmettes, Hematology Department, Marseille, France
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26
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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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Moreno-Carmona MR, Serra-Prat M, Riera SA, Estrada O, Ferro T, Querol R. Effect of frailty on postoperative complications, mortality, and survival in older patients with non-metastatic colon cancer: A systematic review and meta-analysis. J Geriatr Oncol 2024; 15:101639. [PMID: 37806888 DOI: 10.1016/j.jgo.2023.101639] [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: 03/09/2023] [Revised: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION New evidence has emerged on the impact of frailty on prognosis in colon cancer, but the findings are not always consistent and conclusive. The aim of this systematic review was to assess the effect of frailty on postoperative complications and mortality in patients with non-metastatic colon cancer (CC) aged 65 years and older. MATERIALS AND METHODS We systematically searched for original studies published in the PubMed and Web of Science databases up to June 2021. Two independent reviewers selected the studies and extracted predefined data. A meta-analysis was performed using the random effects model to assess the effect of frailty on 30-day, 3- to 6-month and 1-year mortality, survival, and postoperative complications. RESULTS The search yielded 313 articles, of which 14 were included in this systematic review. The meta-analysis showed an effect for frailty on 30-day, 3- to 6-month, and 1-year mortality with respective pooled odds ratios (ORs) of 3.67 (95% confidence interval [CI] 1.53-8.79, p = 0.004), 8.73 (95% CI 4.03-18.94, p < 0.0001), and 3.99 (95% CI 2.12-7.52, p < 0.0001). Frailty also had an effect on survival, with a pooled hazard ratio of 2.99 (95% CI 1.70-5.25. p < 0.0001), and on overall and severe postoperative complications with pooled ORs of 2.34 (95% CI 1.75-3.15; p < 0.0001) and 2.43 (95% CI 1.72-3.43; p < 0.0001), respectively. DISCUSSION Frailty in older patients with CC is a risk factor for postoperative complications and mortality in the short term (30 days), medium term (3-6 months), and long term (1 year).
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Affiliation(s)
- Mª Rosario Moreno-Carmona
- Department of Oncology, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain.
| | - Mateu Serra-Prat
- Research Unit, Fundació Salut del Consorci Sanitari del Maresme (Mataró), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
| | - Stephanie A Riera
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain; Department of Surgery and Morphological Sciences, University Autonomous of Barcelona, 08193 Cerdanyola del Vallès, Catalunya, Spain
| | - Oscar Estrada
- Department of Surgery, Hospital of Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain.
| | - Tarsila Ferro
- Department of Oncology, Hospital Duran i Reynals. Institut Català d'Oncologia (ICO), 08908 L'Hospitalet de Llobregat, Catalunya, Spain.
| | - Rosa Querol
- Department of Oncology, Consorci Corporació Sanitària Parc Taulí de Sabadell, 08208 Sabadell, Catalunya, Spain
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Bech D, Lietzen LW, Meldgaard P, Ryltoft AK, Ørum M. Diagnostic accuracy of the geriatric screening tools G8 and modified G8 in older patients with lung cancer: A diagnostic performance study. J Geriatr Oncol 2024; 15:101645. [PMID: 37903667 DOI: 10.1016/j.jgo.2023.101645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/30/2023] [Accepted: 10/03/2023] [Indexed: 11/01/2023]
Affiliation(s)
- Danny Bech
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark.
| | - Lone Winther Lietzen
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark; Aarhus University, Aarhus, Denmark
| | - Peter Meldgaard
- Aarhus University, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Marianne Ørum
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
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Tejero I, Amor E, Vázquez-Ibar O. Virtual geriatric and frailty assessment for older adults with cancer. Curr Opin Support Palliat Care 2024; 18:16-21. [PMID: 38277339 DOI: 10.1097/spc.0000000000000696] [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: 01/28/2024]
Abstract
PURPOSE OF REVIEW Since SARS-CoV2 pandemic, many specialties have introduced virtual assessments within clinical practice. Conducting an online geriatric assessment, or relying on self-reported questionnaires, may be more challenging than a conventional medical appointment. This review aims to discuss the state of research on virtual assessment and self-reported questionnaires in the general geriatric population and specifically in Oncology. RECENT FINDINGS Virtual assessment of older adults has been the focus of two separate position papers. Aside from videoconferences or phone appointments, self-reported questionnaires have emerged in recent years as reliable tools to screen for frailty and triage patients who would benefit from a comprehensive in-person assessment, with adequate correlation with in-person tests, good acceptance by the respondents and being well received by healthcare providers. Although some have been tried in geriatric oncology, many still lack validation, and their widespread use may be limited by digital literacy, cognitive impairment, and social supports. SUMMARY The development, validation and adoption of self-reported questionnaires and virtual assessment in the care of older adults with cancer may overcome the staffing limitations and time constrains that frequently hampers the widespread evaluation of this population to improve their care.
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Affiliation(s)
- Isabel Tejero
- Department of Geriatrics, Hospital del Mar, Barcelona, Spain
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Topcu A, Yasin AI, Besiroglu M, Sucuoglu Isleyen Z, Alaca Topcu Z, Simsek M, Turk HM, Seker M, Soysal P. Prevalence and co-incidence of geriatric syndromes according to the ECOG performance status in older cancer patients. Front Med (Lausanne) 2024; 11:1331246. [PMID: 38439897 PMCID: PMC10910106 DOI: 10.3389/fmed.2024.1331246] [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: 10/31/2023] [Accepted: 01/29/2024] [Indexed: 03/06/2024] Open
Abstract
Background Geriatric syndromes may be more common in older cancer patients than in those without cancer. Geriatric syndromes can cause poor clinical outcomes. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is often used as a clinically reported functional status score in oncology practice. Methods Our study was designed as a cross-sectional study and included 218 older cancer patients. This study aimed to determine the prevalence and relationship of geriatric syndromes according to the ECOG-PS in older cancer patients. Results The mean age of 218 participants was 73.0 ± 5.6 years, with 47.7% being women and 52.3% men in our study. ECOG-PS 0, 1, and 2 groups contained 51, 39, and 10% of the patients, respectively. The mean number of geriatric syndromes in the ECOG 0, 1, and 2 groups was 2.3 ± 2.2, 4.3 ± 2.4, and 5.7 ± 2.1, respectively (p < 0.001). After adjusting for age and sex, it was determined that dynapenia was 2.9 times, probable sarcopenia was 3.5 times, frailty was 4.2 times, depression was 2.6 times, malnutrition was 3.3 times, insomnia 2 was.2 times, falls was 2.5 times, and the risk of falling (TUG) was 2.4 times more likely in those with ECOG-PS 1 compared to those with ECOG-PS 0. In addition, it was found that dynapenia was 6 times, probable sarcopenia was 6.8 times, frailty was 10.8 times, depression was 3.3 times, malnutrition was 6.3 times, the risk of falling (Tinnetti Balance) was 28 times, and the risk of falling (TUG) was 13.6 times more likely in those with ECOG-PS 2 compared to those with ECOG-PS 0. Conclusion Our study found that the prevalence of geriatric syndromes increased as the ECOG-PS increased. Geriatric syndromes and their co-incidence were common in older cancer patients, even in normal performance status. Oncologists should incorporate geriatric syndromes into the decision-making process of cancer treatment to maximize the impact on clinical outcomes in older patients with cancer.
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Affiliation(s)
- Atakan Topcu
- Bezmialem Vakif University Hospital, İstanbul, Türkiye
| | | | - Mehmet Besiroglu
- Istanbul Medeniyet University Göztepe Prof Dr Süleyman Yalçın City Hospital, İstanbul, Türkiye
| | | | - Zeynep Alaca Topcu
- Istanbul Medeniyet University Göztepe Prof Dr Süleyman Yalçın City Hospital, İstanbul, Türkiye
| | - Melih Simsek
- Bezmialem Vakif University Hospital, İstanbul, Türkiye
| | | | - Mesut Seker
- Bezmialem Vakif University Hospital, İstanbul, Türkiye
| | - Pinar Soysal
- Bezmialem Vakif University Hospital, İstanbul, Türkiye
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Ushimaru Y, Nagano S, Nishikawa K, Kawabata R, Takeoka T, Kitagawa A, Ohara N, Tomihara H, Maeda S, Imazato M, Noura S, Miyamoto A. A comprehensive study on non-cancer-related mortality risk factors in elderly gastric cancer patients post-curative surgery. BMC Gastroenterol 2024; 24:78. [PMID: 38373885 PMCID: PMC10875761 DOI: 10.1186/s12876-024-03170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/11/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND The increasing incidence of gastric cancer in the elderly underscores the need for an in-depth understanding of the challenges and risks associated with surgical interventions in this demographic. This study aims to investigate the risk factors and prognostic indicators for non-cancer-related mortality following curative surgery in elderly gastric cancer patients. METHODS This retrospective analysis examined 684 patients with pathological Stage I-III gastric cancer who underwent curative resection between January 2012 and December 2021. The study focused on patients aged 70 years and above, evaluating various clinical and pathological variables. Univariate analysis was utilized to identify potential risk factors with to non-cancer-related mortality and to access prognostic outcomes. RESULTS Out of the initial 684 patients, 244 elderly patients were included in the analysis, with 33 succumbing to non-cancer-related causes. Univariate analysis identified advanced age (≥ 80 years), low body mass index (BMI) (< 18.5), high Charlson Comorbidity Index (CCI), and the presence of overall surgical complications as significant potential risk factors for non-cancer related mortality. These factors also correlated with poorer overall survival and prognosis. The most common cause of non-cancer-related deaths were respiratory issues and heart failure. CONCLUSION In elderly gastric cancer patients, managing advanced age, low BMI, high CCI, and minimizing postoperative complications are essential for reducing non-cancer-related mortality following curative surgery.
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Affiliation(s)
- Yuki Ushimaru
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan.
| | - Shinnosuke Nagano
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Kazuhiro Nishikawa
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Ryohei Kawabata
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Tomohira Takeoka
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Akihiro Kitagawa
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Nobuyoshi Ohara
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Hideo Tomihara
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Sakae Maeda
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Mitsunobu Imazato
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Shingo Noura
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Atsushi Miyamoto
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
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Vinod SK, Merie R, Harden S. Quality of Decision Making in Radiation Oncology. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00067-0. [PMID: 38342658 DOI: 10.1016/j.clon.2024.02.001] [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: 11/09/2023] [Revised: 01/04/2024] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
High-quality decision making in radiation oncology requires the careful consideration of multiple factors. In addition to the evidence-based indications for curative or palliative radiotherapy, this article explores how, in routine clinical practice, we also need to account for many other factors when making high-quality decisions. Foremost are patient-related factors, including preference, and the complex interplay between age, frailty and comorbidities, especially with an ageing cancer population. Whilst clinical practice guidelines inform our decisions, we need to account for their applicability in different patient groups and different resource settings. With particular reference to curative-intent radiotherapy, we explore decisions regarding dose fractionation schedules, use of newer radiotherapy technologies and multimodality treatment considerations that contribute to personalised patient-centred care.
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Affiliation(s)
- S K Vinod
- Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia; South West Sydney Clinical Campuses, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.
| | - R Merie
- Icon Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - S Harden
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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AlSendi M, Flynn CR, Khan MR, Selvadurai P, Crown J, McDermott RS, Walshe JM, Fennelly DW, Hanrahan EO, Doherty M, Higgins MJ. Pilot study of the implementation of G8 screening tool, Cognitive screening assessment and Chemotherapy Toxicity assessment in older adults with cancer in a Tertiary University Hospital in Ireland. Ir J Med Sci 2024; 193:45-50. [PMID: 37450258 DOI: 10.1007/s11845-023-03446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) is recommended by international guidelines prior to initiation of systemic anti-cancer treatment (SACT). In practice, CGA is limited by time constraints, lack of resources and expert interpretation. AIMS The primary objective of this pilot study was to establish the prevalence of frailty (assessed by G8), cognitive impairment (assessed by Mini-Cog), and risk of chemotherapy toxicity (assessed by CARG Chemo-Toxicity Calculator) among patients (pts) ≥65 years commencing SACT. We selected these three screening tools due to the ease of conducting them in a busy outpatient setting. In addition, they have been validated to predict frailty and risk of toxicity from SACT among older adults with cancer. METHODS Eligible participants were identified from medical oncology clinics. Assessments were conducted in an outpatient setting by treating physicians. Pt records were reviewed to gather demographic and cancer details. Statistical analyses were conducted using SPSS statistical software. RESULTS Sixty-three participants were enrolled. The mean age of participants was 73yrs (range=65-88). Thirty-three (52.4%) were female and 30 (47.6%) were male. The majority (n=38, 60.3%) had metastatic cancer. The mean G8 score was 11.9 (range=6-19). Eighty-three percent had a G8 score ≤14. Mini-Cog was positive in 13 pts (21%). The mean CARG score was 7.5 (range=0-16), and 80% had a risk of at least 50% grade ≥3 toxicity. Of these, 48 (76.2%) received chemotherapy and 15 (23.8%) received non-cytotoxic SACT. In multi-variate analyses, age, cancer type, treatment type, and disease stage did not impact G8, Mini-Cog, or CARG scores. CONCLUSIONS Our study has several limitations but suggests that the majority of older adults with cancer would qualify for formal CGA assessment. The risk of high-grade toxicity from SACT is substantial in this cohort. Chronological age was not found to negatively impact pts' frailty, cognition, or risk of toxicity.
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Affiliation(s)
- Maha AlSendi
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - Calvin R Flynn
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Muhammad R Khan
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Paul Selvadurai
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - John Crown
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Raymond S McDermott
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Janice M Walshe
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - David W Fennelly
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Emer O Hanrahan
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Mark Doherty
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Michaela J Higgins
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Toquero P, Mondéjar R, Romero-Laorden N, Méndez E, Castillo L, Hernández Marín B, Donnay O, Colomer R. Is Older Age an Independent Prognostic Factor of Survival in Metastatic Colorectal Cancer? Oncology 2024; 102:747-758. [PMID: 38232719 DOI: 10.1159/000535187] [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: 09/18/2023] [Accepted: 11/03/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Older patients (≤75 years) with advanced colorectal cancer (CRC) may have worse survival than non-older patients. We hypothesized that, rather than age alone, concurrent factors may be more relevant for real-world survival. METHODS Patients diagnosed with CRC in a 5-year period (2014-2018) were analyzed to determine which factors influenced in overall survival (OS). Kaplan-Meier method was used to estimate OS. Univariate and multivariate analysis was conducted by Cox regression analysis. The study was approved by Ethics Committee. RESULTS Out of 477 patients diagnosed with CRC, 231 had advanced disease. Ninety-two patients (40%) were older than 75 years; median OS (mOS) was 17.1 m (95% CI: 14.3-23.3), p < 0.001. In non-older patients, mOS was 26.7 m (95% CI: 21.9-32.6), p < 0.001. We evaluated eighteen concurrent factors that included characteristics related to the patient (age, sex, comorbidities, polypharmacy, Eastern Cooperative Oncology Group (ECOG), and nutritional status), to the tumor (stage at diagnosis, tumor side, molecular profile, tumor burden, location, and number of metastasis), and to the treatment administered (systemic treatment for advanced disease, chemotherapy schedule and number of lines, severe adverse events and dose reductions, and surgery of liver metastasis). In the univariate analysis, age at diagnosis, ECOG, nutritional status, tumor side, molecular profile, tumor burden, systemic treatment for advanced disease, and surgery of liver metastases had significant impact on survival. However, multivariate analysis revealed that only four factors (tumor burden, nutritional status, systemic treatment for advanced disease, and surgery of liver metastases) were independently associated with OS but not older age at diagnosis. CONCLUSION Older age is not an independent survival prognostic factor for advanced CRC. Tumor burden, nutritional status, systemic treatment for advanced disease, and surgery of liver metastasis were significant factors associated with OS. These findings suggest that older patients should not be excluded from cancer treatment based on age alone.
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Affiliation(s)
- Patricia Toquero
- Medical Oncology Department, La Princesa University Hospital, Madrid, Spain
- Precision Medicine Chair, Medical Oncology Department, Universidad Autónoma de Madrid - Roche Institute Foundation- Hospital Universitario de La Princesa, Madrid, Spain
| | - Rebeca Mondéjar
- Medical Oncology Department, La Princesa University Hospital, Madrid, Spain
- Precision Medicine Chair, Medical Oncology Department, Universidad Autónoma de Madrid - Roche Institute Foundation- Hospital Universitario de La Princesa, Madrid, Spain
| | - Nuria Romero-Laorden
- Medical Oncology Department, La Princesa University Hospital, Madrid, Spain
- Precision Medicine Chair, Medical Oncology Department, Universidad Autónoma de Madrid - Roche Institute Foundation- Hospital Universitario de La Princesa, Madrid, Spain
| | - Elena Méndez
- Medical Oncology Department, Henares University Hospital, Coslada, Spain
| | - Lucía Castillo
- Medical Oncology Department, La Princesa University Hospital, Madrid, Spain
| | - Berta Hernández Marín
- Medical Oncology Department, La Princesa University Hospital, Madrid, Spain
- Precision Medicine Chair, Medical Oncology Department, Universidad Autónoma de Madrid - Roche Institute Foundation- Hospital Universitario de La Princesa, Madrid, Spain
| | - Olga Donnay
- Medical Oncology Department, La Princesa University Hospital, Madrid, Spain
| | - Ramon Colomer
- Medical Oncology Department, La Princesa University Hospital, Madrid, Spain
- Precision Medicine Chair, Medical Oncology Department, Universidad Autónoma de Madrid - Roche Institute Foundation- Hospital Universitario de La Princesa, Madrid, Spain
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Swartz K, Chapman A, Zhan T, Wen KY. Process evaluation of a G8 screening tool implementation in an outpatient oncology center. J Geriatr Oncol 2024; 15:101605. [PMID: 37633778 PMCID: PMC10843632 DOI: 10.1016/j.jgo.2023.101605] [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: 03/20/2023] [Revised: 07/18/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023]
Affiliation(s)
| | - Andrew Chapman
- Sidney Kimmel Cancer Center, Thomas Jefferson University, USA
| | - Tingting Zhan
- Sidney Kimmel Cancer Center, Thomas Jefferson University, USA
| | - Kuang-Yi Wen
- Sidney Kimmel Cancer Center, Thomas Jefferson University, USA
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Giger AKW, Ditzel HM, Ditzel HJ, Ewertz M, Jørgensen TL, Pfeiffer P, Lund CM, Ryg J. Effects of comprehensive geriatric assessment-guided interventions on physical performance and quality of life in older patients with advanced cancer: A randomized controlled trial (PROGNOSIS-RCT). J Geriatr Oncol 2024; 15:101658. [PMID: 37939628 DOI: 10.1016/j.jgo.2023.101658] [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: 08/25/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Older patients with frailty starting oncological treatment are at higher risk of experiencing declining physical performance, loss of independence, and quality of life (QoL). This study examines whether comprehensive geriatric assessment (CGA)-guided interventions added to standard oncological care can prevent declining physical performance and QoL in older patients with frailty initiating palliative treatment. MATERIALS AND METHODS Patients aged ≥70 years, with a Geriatric-8 score of ≤14, initiating palliative oncological treatment were enrolled in an open label randomized controlled trial and randomized 1:1 to receive either CGA-guided interventions in addition to oncological standard care or oncological care alone. Baseline characteristics, physical performance measures, and QoL questionnaires were retrieved before group allocation. CGA was performed using a fixed set of domains and validated tests by a geriatrician-led team. The primary endpoint, physical performance, was measured by the 30-s chair stand test (30s-CST) at three months. Additional outcomes included 30s-CST at six months, handgrip strength test, and QoL. Outcomes were analyzed using linear mixed regression models. The trial was registered at clinicaltrials.org (NCT04686851). RESULTS From November 1, 2020 to May 31, 2022, 181 patients were included; 88 in the interventional arm and 93 in the control arm. Median age was 77 (interquartile range [IQR] 73-81) years, 69% were male, median Geriatric-8 score was 12 (IQR 10-13), 69% had a Performance Status of 0-1, and the median 30s-CST was 9 (IQR 5-11) repetitions. The between-group difference in 30s-CST at three months was 0.67 (95%CI: -0.94 - 2.29) and 1.57 (95%CI: -0.20 - 3.34) at six months, which were not statistically significant. Subgroup analysis including participants with a baseline Geriatric-8 of 12-14 found borderline significant between-group differences in 30s-CST scores at three and six months of 2.04 (95% confidence interval [CI]: -0.07 - 4.2, P = 0.06) and 2.25 (95%CI: 0.01-4.5, P = 0.05), respectively. No within-group or between-group differences in the summary score or the Elderly Functional Index score (measuring QoL) were found. DISCUSSION This study did not find significant between-group differences in the 30s-CST in older patients receiving palliative care. However, a tendency towards improved physical performance was seen in the least frail. These patients may represent a target group wherein CGA interventions provide particular benefit.
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Affiliation(s)
- Ann-Kristine W Giger
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN, Open Patient Data Explorative Network, Odense University Hospital, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark.
| | - Helena M Ditzel
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark; OPEN, Open Patient Data Explorative Network, Odense University Hospital, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
| | - Henrik J Ditzel
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
| | - Marianne Ewertz
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Trine Lembrecht Jørgensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
| | - Per Pfeiffer
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
| | - Cecilia M Lund
- Department of Medicine, Copenhagen University Hospital, Herlev, Gentofte, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; CopenAge, Copenhagen Center for Clinical Age research, University of Copenhagen, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
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Camera S, Rimini M, Rossari F, Tada T, Suda G, Shimose S, Kudo M, Yoo C, Cheon J, Finkelmeier F, Lim HY, Presa J, Masi G, Bergamo F, Salani F, Marseglia M, Amadeo E, Vitiello F, Kumada T, Sakamoto N, Iwamoto H, Aoki T, Chon HJ, Himmelsbach V, Iavarone M, Cabibbo G, Montes M, Foschi FG, Vivaldi C, Lonardi S, Sho T, Niizeki T, Nishida N, Steup C, Hirooka M, Kariyama K, Tani J, Atsukawa M, Takaguchi K, Itobayashi E, Fukunishi S, Tsuji K, Ishikawa T, Tajiri K, Ochi H, Yasuda S, Toyoda H, Ogawa C, Nishimura T, Hatanaka T, Kakizaki S, Shimada N, Kawata K, Hiraoka A, Tada F, Ohama H, Nouso K, Morishita A, Tsutsui A, Nagano T, Itokawa N, Okubo T, Imai M, Kosaka H, Naganuma A, Koizumi Y, Nakamura S, Kaibori M, Iijima H, Hiasa Y, Persano M, Foti S, Piscaglia F, Scartozzi M, Cascinu S, Casadei-Gardini A. Safety and Efficacy of Lenvatinib in Very Old Patients with Unresectable Hepatocellular Carcinoma. Target Oncol 2024; 19:29-39. [PMID: 38252195 DOI: 10.1007/s11523-023-01029-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Data concerning the use of lenvatinib in very old patients (≥ 80 years) are limited, although the incidence of hepatocellular carcinoma (HCC) in this patient population is constantly increasing. OBJECTIVE This analysis aimed to evaluate the efficacy and safety of lenvatinib in a large cohort of very old patients (≥ 80 years) with unresectable HCC. PATIENTS AND METHODS The study was conducted on a cohort of 1325 patients from 46 centers in four Western and Eastern countries (Italy, Germany, Japan, and the Republic of Korea) who were undergoing first-line treatment with lenvatinib between July 2010 and February 2022. Patients were stratified according to age as very old (≥ 80 years) and not very old (< 80 years). RESULTS The median overall survival (OS) was 15.7 months for patients < 80 years old and 18.4 months for patients ≥ 80 years old [hazard ratio (HR) = 1.02, 95% confidence interval (CI) 0.84-1.25, p = 0.8281]. Median progression free survival (PFS) was 6.3 months for patients < 80 years old and 6.5 months for patients ≥ 80 years old (HR = 1.07, 95% CI 0.91-1.25, p = 0.3954). No differences between the two study groups were found in terms of disease control rate (DCR; 80.8% versus 78.8%; p = 0.44) and response rate (RR; 38.2% versus 37.9%; p = 0.88). Patients < 80 years old experienced significantly more hand-foot skin reaction (HFSR) grade ≥ 2 and decreased appetite grade ≥ 2. Conversely, patients ≥ 80 years old experienced significantly more fatigue grade ≥ 2. In the very old group, parameters associated with prognosis were AFP, albumin-bilirubin (ALBI) grade, Barcelona Clinic Liver Cancer (BCLC), and Child-Pugh score. BCLC stage was the only independent predictor of overall survival (OS; HR = 1.59, 95% CI 1.11-2.29, p = 0.01115). CONCLUSIONS Our study highlights the same efficacy and safety of lenvatinib between very old and not very old patients.
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Affiliation(s)
- Silvia Camera
- Department of Oncology and Hematology, San Martino Hospital, Oristano, Italy
| | - Margherita Rimini
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, via Olgettina 60, 20132, Milan, Italy.
| | - Federico Rossari
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, via Olgettina 60, 20132, Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Toshifumi Tada
- Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Himeji, Japan
| | - Goki Suda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Shigeo Shimose
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Changhoon Yoo
- Department of Oncology, ASAN Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jaekyung Cheon
- Department of Medical Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Fabian Finkelmeier
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Ho Yeong Lim
- Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | | | - Gianluca Masi
- Unit of Medical Oncology 2, University Hospital of Pisa, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesca Bergamo
- Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Francesca Salani
- Unit of Medical Oncology 2, University Hospital of Pisa, Pisa, Italy
- Institute of Interdisciplinary Research "Health Science", Scuola Superiore Sant'Anna, Pisa, Italy
| | - Mariarosaria Marseglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elisabeth Amadeo
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, via Olgettina 60, 20132, Milan, Italy
| | - Francesco Vitiello
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, via Olgettina 60, 20132, Milan, Italy
| | - Takashi Kumada
- Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hideki Iwamoto
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan
| | - Tomoko Aoki
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hong Jae Chon
- Department of Medical Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Vera Himmelsbach
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Massimo Iavarone
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties PROMISE, University of Palermo, Palermo, Italy
| | | | | | - Caterina Vivaldi
- Unit of Medical Oncology 2, University Hospital of Pisa, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Sara Lonardi
- Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Takuya Sho
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Takashi Niizeki
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Christoph Steup
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kazuya Kariyama
- Department of Gastroenterology, Okayama City Hospital, Okayama, Japan
| | - Joji Tani
- Department of Gastroenterology and Hepatology, Kagawa University, Kagawa, Japan
| | - Masanori Atsukawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Koichi Takaguchi
- Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Ei Itobayashi
- Department of Gastroenterology, Asahi General Hospital, Asahi, Japan
| | - Shinya Fukunishi
- Department of Gastroenterology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kunihiko Tsuji
- Center of Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Toru Ishikawa
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Kazuto Tajiri
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Hironori Ochi
- Hepato-biliary Center, Japanese Red Cross Matsuyama Hospital, Matsuyama, Japan
| | - Satoshi Yasuda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Chikara Ogawa
- Department of Gastroenterology, Japanese Red Cross Takamatsu Hospital, Takamatsu, Japan
| | - Takashi Nishimura
- Department of Internal medicine, Division of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan
| | - Takeshi Hatanaka
- Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Satoru Kakizaki
- Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Noritomo Shimada
- Division of Gastroenterology and Hepatology, Otakanomori Hospital, Kashiwa, Japan
| | - Kazuhito Kawata
- Department of Hepatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsushi Hiraoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Fujimasa Tada
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hideko Ohama
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Kazuhiro Nouso
- Department of Gastroenterology, Okayama City Hospital, Okayama, Japan
| | - Asahiro Morishita
- Department of Gastroenterology and Hepatology, Kagawa University, Kagawa, Japan
| | - Akemi Tsutsui
- Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Takuya Nagano
- Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Norio Itokawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Tomomi Okubo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Michitaka Imai
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Hisashi Kosaka
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - Atsushi Naganuma
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Yohei Koizumi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Shinichiro Nakamura
- Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Himeji, Japan
| | - Masaki Kaibori
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - Hiroko Iijima
- Department of Internal medicine, Division of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Mara Persano
- Medical Oncology, University and University Hospital of Cagliari, Cagliari, Italy
| | - Silvia Foti
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, via Olgettina 60, 20132, Milan, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mario Scartozzi
- Medical Oncology, University and University Hospital of Cagliari, Cagliari, Italy
| | - Stefano Cascinu
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, via Olgettina 60, 20132, Milan, Italy
| | - Andrea Casadei-Gardini
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, via Olgettina 60, 20132, Milan, Italy
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Rassu PC. Healthcare delivery to elderly and unfit patients with breast disease and comorbidities under an outpatient regime: A report of a personal surgical technique named "Cut&Sew". Surg Open Sci 2023; 16:49-57. [PMID: 37808422 PMCID: PMC10550772 DOI: 10.1016/j.sopen.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/10/2023] [Accepted: 09/17/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction A growing need for proper geriatric assessment and short-stay surgical programs supported by the availability of less invasive approaches, even in ambulatory settings, is being recognized as a feasible option for breast cancer patients with comorbidities who are usually distressed after standard surgery with ordinary hospitalization. Few studies have been conducted in Italian breast centers with dedicated techniques and approach for frail patients with breast diseases due to a jeopardized approach to ambulatory surgery among institutions. Methods This study included 58 women diagnosed with breast disease and comorbidities between March 2019 and December 2022 at the Ambulatory of Senology of San Giacomo Hospital in Novi Ligure (AL, Italy) and Civil Hospital in Ovada (AL, Italy). The patients were evaluated by a multidisciplinary consensus according to the guidelines provided to limit sentinel lymph node biopsy (SLNB) in older women. This kind of ambulatory surgery technique has been designed for i) patients with advanced age and/or comorbidities, ii) frail patients who psychologically do not accept other kinds of surgery, iii) patients who do not require SLNB, and iv) patients who need a surgical biopsy for lesions classified as B3 or small lesions with dubious radiological imaging. With this technique, the quadrant and whole breast may be removed in an outpatient setting with local anesthesia to limit blood loss by immediately cutting and suturing small portions of the gland. Local anesthetic infiltration is sequential and occurs stepwise before providing short passages of approximately 2 cm during resection and immediately suturing the surgical wound. This overclock technique, named "Cut&Sew," requires no more than 20-25 min and allows for a 1-2 h patient discharge with no drainage. The follow-up period was set at 60 months during routine yearly visits. Results The patients were older or super-older with most primary pT1/pT2 tumors and ductal type cancers, which were distributed in molecular subtypes Luminal A (37.1 %) and Luminal B (41.5 % Luminal B, with 11.2 % being HER2 positive). The tumour grade was mostly G2-G3. Mastectomy was performed in 10 patients, whereas quadrantectomy was performed in 48 patients, with the majority of tumors localized in Q1.While accompanied by a relative or a caregiver, all 58 patients acceded the "Cut&Sew" surgical technique in an ambulatory setting reporting negligible pain during the surgery and no pain within 10 days post-surgery. No post-operative complications or readmissions were recorded, and no discomfort or recurrence was detected during scheduled visits. Finally, the extent of satisfaction with the overall surgery was recorded immediately and corroborated by most patients during the follow-up period. Conclusions Although the small volume of cases collected does not allow for a controlled study necessary to evaluate the safety and efficacy of this technique for approaching frail and older women with comorbidities, through the "Cut&Sew" surgical technique, frail, older, and super older patients may benefit from a minimal psychological impact of surgery, while improving the patients' disease-free life so to corroborate the advised surgical de-escalation but avoiding undertreatment for this kind of patient category. Moreover, a stricter assessment of patient pain and overall satisfaction with the collection of a larger amount of reliable data could allow this technique to be extended to frail and/or older patients as a valuable and safe alternative to the more common hospitalization with general anesthesia. Other advantages include reduced hospitalization costs for sanitary structures.
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Affiliation(s)
- Pier Carlo Rassu
- General Surgery Department, San Giacomo Hospital, Via Edilio Raggio 12, Novi Ligure, Alessandria, Italy
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Yu SM, Hsu CC, Hsueh SW, Hung CY, Lu CH, Yeh KY, Wang HM, Lin SY, Hung YS, Chou WC. Frailty assessment by two screening instruments in non-elderly patients with head and neck cancer. Oral Oncol 2023; 147:106621. [PMID: 37931492 DOI: 10.1016/j.oraloncology.2023.106621] [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: 08/22/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Frailty assessment is often overlooked in non-elderly patients with cancer, possibly due to the lack of an effective frailty screening tool. This study aimed to evaluate the performance of two modern frailty screening tools, the Flemish version of the Triage Risk Screening Tool (fTRST) and the modified 5-Item Frailty Index (mFI-5), compared to the gold standard comprehensive geriatric assessment (GA) among non-elderly patients with head and neck cancer (HNC). METHODS We prospectively included 354 consecutive patients aged < 65 years with newly diagnosed HNC scheduled for definitive concurrent chemoradiotherapy (CCRT) at three academic hospitals in Taiwan between January 2020 and December 2022. Frailty assessment using the GA, fTRST, and mFI-5 was performed in all patients to evaluate the relationship between frailty and treatment outcomes. RESULTS The prevalence of frailty was 27.1%, 37.0%, and 42.4% based on GA, mFI-5, and fTRST, respectively. mFI-5 and fTRST demonstrated good predictive value in identifying frail patients compared to the GA. Patients with frailty, as defined by GA, mFI-5, and fTRST, exhibited higher risks of treatment-related complications, incomplete treatment, and poorer baseline quality of life (QoL). However, only GA showed significant prognostic value for overall survival. CONCLUSIONS Frailty assessment using fTRST and mFI-5 is valuable for predicting treatment-related adverse events, treatment tolerance, and QoL in non-elderly patients with HNC. Incorporating frailty assessment into the management of non-elderly cancer patients can aid in the identification of high-risk individuals. However, the performance of these tools varies, highlighting the need for further validation and refinement.
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Affiliation(s)
- Shao-Ming Yu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chung Hsu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shun-Wen Hsueh
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chia-Yen Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chang-Hsien Lu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Kun-Yun Yeh
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Hung-Ming Wang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shinn-Yn Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shin Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Loria A, Fleming FJ. Restoration of Quality of Life and Functional Recovery After Colorectal Cancer Surgery in Older Adults. J Clin Oncol 2023; 41:5225-5227. [PMID: 37390379 DOI: 10.1200/jco.23.01066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/31/2023] [Indexed: 07/02/2023] Open
Affiliation(s)
- Anthony Loria
- Department of Surgery, University of Rochester Medial Center, Rochester, NY
| | - Fergal J Fleming
- Department of Surgery and Oncology, University of Rochester Medical Center, Rochester, NY
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Lonardi S, Rasola C, Lobefaro R, Rossini D, Formica V, Scartozzi M, Frassineti GL, Boscolo G, Cinieri S, Di Donato S, Pella N, Bergamo F, Raimondi A, Arnoldi E, Antonuzzo L, Granetto C, Zustovich F, Ronzoni M, Leo S, Morano F, Loupakis F, Buggin F, Zagonel V, Fassan M, Cremolini C, Boni L, Pietrantonio F. Initial Panitumumab Plus Fluorouracil, Leucovorin, and Oxaliplatin or Plus Fluorouracil and Leucovorin in Elderly Patients With RAS and BRAF Wild-Type Metastatic Colorectal Cancer: The PANDA Trial by the GONO Foundation. J Clin Oncol 2023; 41:5263-5273. [PMID: 37535876 DOI: 10.1200/jco.23.00506] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/25/2023] [Accepted: 06/21/2023] [Indexed: 08/05/2023] Open
Abstract
PURPOSE To verify whether both doublet chemotherapy with a modified schedule of fluorouracil, leucovorin, and oxaliplatin (mFOLFOX) and monochemotherapy with fluorouracil plus leucovorin (5-FU + LV) achieve satisfactory efficacy when both regimens are combined with panitumumab (PAN) as initial treatment of elderly patients with RAS/BRAF wild-type metastatic colorectal cancer (mCRC). PATIENTS AND METHODS PANDA (ClinicalTrials.gov identifier: NCT02904031) was an open-label, randomized phase II noncomparative trial in previously untreated patients age 70 years and older with unresectable RAS/BRAF wild-type mCRC. Patients were randomly assigned 1:1 to mFOLFOX + PAN (arm A) or 5-FU + LV + PAN (arm B) for up to 12 cycles, followed by PAN maintenance. The primary end point was progression-free survival (PFS). In each arm, assuming a null hypothesis of median PFS time ≤6 months and target PFS ≥9.65, 90 patients per arm were needed to achieve 90% power and 5% type I error (one-sided Brookmeyer-Crowley test). RESULTS Between July 2016 and April 2019, 91 patients were randomly assigned to arm A and 92 to arm B. At a median follow-up of 50.0 months (IQR, 45.6-56.4), median PFS was 9.6 and 9.0 months for arm A and B, respectively (P < .001 in each arm). Overall response rate was 69% and 52%, whereas median overall survival was 23.5 and 22.0 months in arm A and B, respectively. The overall rate of grade >2 chemotherapy-related adverse events was 60% and 37%, respectively. Baseline G8 and Chemotherapy Risk Assessment Scale for High-Age Patients scores were prognostic, but they were not associated with efficacy and safety of the two arms. CONCLUSION Both mFOLFOX and 5-FU + LV + PAN are reasonable options as initial therapy of elderly patients with RAS/BRAF wild-type mCRC. 5-FU + LV + PAN is associated with a better safety profile.
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Affiliation(s)
- Sara Lonardi
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Cosimo Rasola
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Riccardo Lobefaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Daniele Rossini
- Unit of Medical Oncology 2, University Hospital of Pisa, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Mario Scartozzi
- Department of Medical Sciences and Public Health, Medical Oncology Unit, "Azienda Ospedaliero Universitaria" of Cagliari, University of Cagliari, Cagliari, Italy
| | - Giovanni Luca Frassineti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST), Meldola, Italy
| | - Giorgia Boscolo
- Medical Specialties Department, Oncology and Oncological Haematology, ULSS 3 Serenissima, Mirano, Italy
| | - Saverio Cinieri
- Department of Medical Oncology, Hospital "Senatore Perrino", Brindisi, Italy
| | | | - Nicoletta Pella
- Department of Oncology, ASUFC University Hospital, Udine, Italy
| | - Francesca Bergamo
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Alessandra Raimondi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ermenegildo Arnoldi
- Department of Oncology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Fable Zustovich
- Dipartimento di Oncologia Clinica, UOC Oncologia di Belluno, AULSS 1 Dolomiti, Ospedale S. Martino, Belluno, Italy
| | - Monica Ronzoni
- Oncologia Medica, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Silvana Leo
- Medical Oncology Unit, Vito Fazzi Hospital, Lecce, Italy
| | - Federica Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Fotios Loupakis
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Federica Buggin
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Vittorina Zagonel
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padova, Padova, Italy
- Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Luca Boni
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Vinod S, Khoo A, Berry M, Bell K, Ahmed E, Campisi J, Gollon C, Pal A, Seto SK, Tcharkhedian E, Tran T, Bray V. Implementation and evaluation of a geriatric-oncology model of care for older adults with lung cancer. J Geriatr Oncol 2023; 14:101578. [PMID: 37422350 DOI: 10.1016/j.jgo.2023.101578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Shalini Vinod
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; South Western Sydney Clinical Campuses, University of NSW, Liverpool, NSW, Australia; Faculty of Science, Medicine and Health, University of Wollongong, Liverpool, NSW, Australia.
| | - Angela Khoo
- South Western Sydney Clinical Campuses, University of NSW, Liverpool, NSW, Australia; Department of Geriatrics, Liverpool Hospital, Liverpool, NSW, Australia
| | - Megan Berry
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; South Western Sydney Clinical Campuses, University of NSW, Liverpool, NSW, Australia
| | - Katherine Bell
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; Department of Dietetics, Liverpool Hospital, Liverpool, NSW, Australia
| | - Elhassan Ahmed
- Department of Physiotherapy, Liverpool Hospital, Liverpool, NSW, Australia
| | - Josephine Campisi
- Department of Occupational Therapy, Liverpool Hospital, Liverpool, NSW, Australia
| | - Cara Gollon
- Department of Occupational Therapy, Liverpool Hospital, Liverpool, NSW, Australia
| | - Abhijit Pal
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; University of Sydney, Camperdown, NSW, Australia
| | - Sau Kwan Seto
- Department of Occupational Therapy, Liverpool Hospital, Liverpool, NSW, Australia
| | - Elise Tcharkhedian
- Department of Physiotherapy, Liverpool Hospital, Liverpool, NSW, Australia
| | - Thomas Tran
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia
| | - Victoria Bray
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; Western Sydney University, Liverpool, NSW, Australia
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Nadal E, Oré-Arce M, Remon J, Bernabé-Caro R, Covela-Rúa M, de Castro-Carpeño J, Massutí-Sureda B, Guillot-Morales M, Majem M, Maestu-Maiques I, Morilla-Ruíz I, Gironés R. Expert consensus to optimize the management of older adult patients with advanced EGFR-mutated non-small cell lung cancer. Clin Transl Oncol 2023; 25:3139-3151. [PMID: 37566345 PMCID: PMC10514135 DOI: 10.1007/s12094-023-03286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/17/2023] [Indexed: 08/12/2023]
Abstract
Lung cancer (LC) is associated with ageing, with the average age of affected individuals being approximately 70 years. However, despite a higher incidence and prevalence among older people, the older adult population is underrepresented in clinical trials. For LC with Epidermal Growth Factor Receptor (EGFR) mutations, there is no clear association of this mutation with age. Geriatric assessments (GAs) and a multidisciplinary approach are essential for defining the optimal treatment. In this consensus, a group of experts selected from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (Sección de Oncogeriatría de la Sociedad Española de Oncología Médica-SEOM), the Spanish Lung Cancer Group (Grupo Español de Cáncer de Pulmón-GECP) and the Association for Research on Lung Cancer in Women (Asociación para la Investigación del Cáncer de Pulmón en Mujeres-ICAPEM) evaluate the scientific evidence currently available and propose a series of recommendations to optimize the management of older adult patients with advanced LC with EGFR mutations.
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Affiliation(s)
- Ernest Nadal
- Department of Medical Oncology, Institut Català d’Oncologia (ICO), Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Duran i Reynals University Hospital, Barcelona, Spain
| | - Martín Oré-Arce
- Department of Medical Oncology, Marina Baixa de Villajoyosa Hospital, Alicante, Spain
| | - Jordi Remon
- Department of Medical Oncology, HM Nou Delfos Hospital, Barcelona, Spain
| | - Reyes Bernabé-Caro
- Department of Medical Oncology, Virgen del Rocío University Hospital, Sevilla University, Seville, Spain
| | - Marta Covela-Rúa
- Department of Medical Oncology, Lucus Augusti University Hospital, Lugo, Spain
| | | | | | | | - Margarita Majem
- Department of Medical Oncology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | | | - Idoia Morilla-Ruíz
- Department of Medical Oncology, Navarra University Hospital-NavarraBioMed, IdisNa, Pamplona, Spain
| | - Regina Gironés
- Department of Medical Oncology, Polytechnic la Fe University Hospital, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Valencia Spain
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Bakas AT, Polinder-Bos HA, Streng F, Mattace-Raso FUS, Ziere G, de Jong RJB, Sewnaik A. Frailty in Non-geriatric Patients With Head and Neck cancer. Otolaryngol Head Neck Surg 2023; 169:1215-1224. [PMID: 37264978 DOI: 10.1002/ohn.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/10/2023] [Accepted: 05/01/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Patients with head and neck cancer (HNC) are characterized by a poor lifestyle and comorbidity. The Geriatric 8 (G8) is an established screening tool to identify frail older patients with cancer. However, studies evaluating frailty in younger HNC patients are lacking. The aim of this study is to evaluate if the G8 can identify frailty and if it is related to mortality in younger HNC patients. STUDY DESIGN Case-control study design. SETTING Tertiary cancer center. METHODS We studied patients <70 years with HNC. Patients with G8 ≤ 14 were considered frail. Patients were matched to nonfrail (G8 > 14) control patients. Patients were matched according to sex, age, smoking, tumor location, and period of first consultation. Baseline health characteristics were compared between frail patients and nonfrail controls. Second, the treatment plan and adverse outcomes were compared. RESULTS Forty-five patients with G8 ≤ 14 were included and matched to 90 nonfrail controls. The median follow-up time was 357 days. Frail patients had a significantly lower body mass index and level of education, a worse World Health Organization performance status, and reported lower experienced overall health. 28.9% of the frail patients died after 1 year versus 10% of the nonfrail control patients (hazard ratio: 3.87 [95% confidence interval: 1.32-11.36], p = 0.014). CONCLUSION The G8 is a valid screening tool to identify frail patients in younger HNC patients.
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Affiliation(s)
- Ajay T Bakas
- Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Harmke A Polinder-Bos
- Department of Internal Medicine, Division of Geriatric Medicine, Rotterdam, The Netherlands
| | - Fleur Streng
- Department of Internal Medicine, Division of Geriatric Medicine, Rotterdam, The Netherlands
| | | | - Gijsbertus Ziere
- Department of Internal Medicine, Division of Geriatric Medicine, Rotterdam, The Netherlands
| | - Rob J Baatenburg de Jong
- Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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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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Disalvo D, Moth E, Soo WK, Garcia MV, Blinman P, Steer C, Amgarth-Duff I, Power J, Phillips J, Agar M. The effect of comprehensive geriatric assessment on care received, treatment completion, toxicity, cancer-related and geriatric assessment outcomes, and quality of life for older adults receiving systemic anti-cancer treatment: A systematic review. J Geriatr Oncol 2023; 14:101585. [PMID: 37573197 DOI: 10.1016/j.jgo.2023.101585] [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: 03/22/2023] [Revised: 06/01/2023] [Accepted: 07/03/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION This systematic review aims to summarise the available literature on the effect of geriatric assessment (multidimensional health assessment across medical, social, and functional domains; "GA") or comprehensive geriatric assessment (geriatric assessment with intervention or management recommendations; "CGA") compared to usual care for older adults with cancer on care received, treatment completion, adverse treatment effects, survival and health-related quality of life. MATERIALS AND METHODS A systematic search of MEDLINE, EMBASE, CINAHL, and PubMed was conducted to identify randomised controlled trials or prospective cohort comparison studies on the effect of GA/CGA on care received, treatment, and cancer outcomes for older adults with cancer. RESULTS Ten studies were included: seven randomised controlled trials (RCTs), two phase II randomised pilot studies, and one prospective cohort comparison study. All studies included older adults receiving systemic therapy, mostly chemotherapy, for mixed cancer types (eight studies), colorectal cancer (one study), and non-small cell lung cancer (one study). Integrating GA/CGA into oncological care increased treatment completion (three of nine studies), reduced grade 3+ chemotherapy toxicity (two of five studies), and improved quality of life scores (four of five studies). No studies found significant differences in survival between GA/CGA and usual care. GA/CGA incorporated into care decisions prompted less intensive treatment and greater non-oncological interventions, including supportive care strategies. DISCUSSION GA/CGA integrated into the care of an older adult with cancer has the potential to optimise care decisions, which may lead to reduced treatment toxicity, increased treatment completion, and improved health-related quality of life scores.
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Affiliation(s)
- Domenica Disalvo
- Improving Palliative, Aged and Chronic Care, through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Erin Moth
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Macquarie University Hospital, Macquarie University, Sydney NSW, Australia
| | - Wee Kheng Soo
- Eastern Health Clinical School, Monash University, Victoria, Australia; Cancer Services, Eastern Health, Victoria, Australia; Department of Aged Medicine, Eastern Health, Victoria, Australia
| | - Maja V Garcia
- Improving Palliative, Aged and Chronic Care, through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Prunella Blinman
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Concord Repatriation General Hospital, Sydney, NSW, Australia
| | | | - Ingrid Amgarth-Duff
- Improving Palliative, Aged and Chronic Care, through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jack Power
- Improving Palliative, Aged and Chronic Care, through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jane Phillips
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Meera Agar
- Improving Palliative, Aged and Chronic Care, through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Bouzan J, Willschrei P, Horstmann M. Additional Value of Mini-Cog© in Urogeriatric Patients Concurrently Screened by G8 Scores. MEDICINES (BASEL, SWITZERLAND) 2023; 10:56. [PMID: 37887263 PMCID: PMC10608063 DOI: 10.3390/medicines10100056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/09/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
Background: Cognitive impairment is poorly addressed in G8 screening. The aim of the present study was to evaluate the additional value of Mini-Cog© in urogeriatric patients concurrently screened by G8 scores. Methods: Seventy-four consecutive urogeriatric patients aged 75 and above were evaluated. All patients underwent G8 and Mini-Cog© screening. Patients with a G8 score above 14 were considered geriatric "healthy or fit". A Mini-Cog© from four to five points was considered inconspicuous in screening for cognitive impairment. The additional information of a Mini-Cog© screening during G8 screening was evaluated by looking at G8 "fit and healthy" patients who had conspicuous Mini-Cog© tests and vice versa. Additionally, the results of the neuropsychological subitem "E" of the G8 score were compared with the results of the Mini-Cog© screening. Results: The mean age of the patients was 83 y (min. 75-max. 102). Sixty-one of the patients were males, and 13 were females. Twenty-nine of the patients had a normal G8 score and were considered "healthy or fit", and 45 were not. Forty-three of the patients had an inconspicuous Mini-Cog©, and 31 had a conspicuous Mini-Cog© of less than four points. The majority of G8 "healthy or fit" patients (n = 24/29) had an inconspicuous Mini-Cog© test. However, of them, five patients had a Mini-Cog© of less than four points, which is suspicious for cognitive disorders. Furthermore, of the 43 patients with a normal G8 subscore in item "E" of two points, 6 patients had a conspicuous Mini-Cog© of less than four points. Conclusions: As shown by the present study, the Mini-Cog© might extend the G8 screening with regard to the detection of cognitive functional impairments that are not detected by the G8 screening alone. It can be easily added to G8 screening.
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Affiliation(s)
- Jobar Bouzan
- Department of Urology, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany;
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuersten Str. 69, 47829 Krefeld, Germany
| | - Peter Willschrei
- Department of Geriatrics, Evang. Hospital Essen-Steele, Am Deimelsberg 34, 45276 Essen, Germany
| | - Marcus Horstmann
- Department of Urology, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany;
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuersten Str. 69, 47829 Krefeld, Germany
- Department of Urology, Klinikum Guetersloh, Reckenberger Str. 19, 33332 Gütersloh, Germany
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Kanninen JC, Holm A, Koivisto AL, Hietasalo P, Heikkilä AM, Kunvik S, Bergman J, Airaksinen M, Puustinen J. Development of a Preventive Health Screening Procedure Enabling Supportive Service Planning for Home-Dwelling Older Adults (PORI75): Protocol for an Action Research Study. JMIR Res Protoc 2023; 12:e48753. [PMID: 37788079 PMCID: PMC10582811 DOI: 10.2196/48753] [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: 05/08/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND In Finland, at least 1 in 4 residents will be >75 years of age in 2030. The national aging policy has emphasized the need to improve supportive services to enable older people to live in their own homes for as long as possible. OBJECTIVE This study aimed to develop a preventive health screening procedure for home-dwelling older adults aged 75 years to enable the use of clinical patient data for purposes of strategic planning of supportive services in primary care. METHODS The action research method was applied to develop the health screening procedure with selected validated health measures in cooperation with the local practicing interprofessional health care teams from 10 primary care centers in the Social Security Center of Pori, Western Finland (99,485 residents, n=11,938, 12% of them >75 years). The selection of evidence-based validated health measures was based on the national guide to screen factors increasing fall risk and the national functioning measures database. The cut-off points of the selected health measures and laboratory tests were determined in consecutive consensus meetings with the local primary care physicians, with decisions based on internationally validated measures, national current care guidelines, and local policies in clinical practice. RESULTS The health screening procedure for 75-year-old residents comprised 30 measures divided into three categories: (1) validated self-assessments (9 measures), (2) nurse-conducted screenings (14 measures), and (3) laboratory tests (7 measures). The procedure development process comprised the following steps: (1) inventory and selection of the validated health measures and laboratory tests, (2) training of practical nurses to perform screenings for the segment of 75-year-old residents and to guide them to possible further medical actions, (3) creation of research data from clinical patient data for secondary use purposes, (4) secondary data analysis, and (5) consensus meeting after the pilot test of the health screening procedure for 75-year-old residents procedure in 2019 based on the experiences of health care professionals and collected research data. CONCLUSIONS The developed preventive health screening procedure for 75-year-old residents enables the use of clinical patient data for purposes of strategic planning of supportive services in primary care if the potential bias by a low participation rate is controlled. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48753.
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Affiliation(s)
- Jonna Carita Kanninen
- Faculty of Technology, Satakunta University of Applied Sciences, Pori, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Satasairaala Central Hospital, Pori, Finland
| | - Anu Holm
- Faculty of Technology, Satakunta University of Applied Sciences, Pori, Finland
| | | | | | | | - Susanna Kunvik
- Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
| | - Jussi Bergman
- Faculty of Technology, Satakunta University of Applied Sciences, Pori, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Juha Puustinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Unit of Neurology, Satasairaala Central Hospital, Satakunta Wellbeing County, Pori, Finland
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Leo S, Marinelli F, Zurlo IV, Guarini V, Accettura C, Falco A, Leone S, Saracino V, Giudetti AM, Piscitelli P. Bioimpedentiometry parameters used as indicators of frailty and malnutrition: association between G8 score and Phase angle (PHA) in elderly cancer patients. Aging Clin Exp Res 2023; 35:2219-2225. [PMID: 37626230 DOI: 10.1007/s40520-023-02512-w] [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: 09/29/2022] [Accepted: 07/18/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Since the incidence of cancer increases with age, in older cancer patients important information may be missed without a Comprehensive Geriatric Assessment (CGA). On the other side, CGA is a time-consuming and complex instrument, so that Geriatric 8 (G8) has been proposed as a more feasible screening tool to identify patients who could benefit from a CGA evaluation. G8 consists of 8 questions (patient age + 7 items derived from the Mini Nutritional Assessment questionnaire). A G8 score ≤ 14 is considered associated with frailty and risk of malnutrition. Another screening test is Bioelectrical Impedance Analysis (Bioimpedentiometry, BIA), which enables to evaluate the nutritional status through a specific parameter known as Phase angle (PhA). This study is aimed at assessing the ability of G8 alone or in combination with PhA to detect elderly cancer patients at higher risk for malnutrition who cannot undergo immediate anticancer treatments. METHODS A total of 289 cancer patients (168 men and 121 women) aged ≥ 70 years old were enrolled and performed both G8 test, body mass index (BMI) and BIA assessments. A concurrent G8 score ≤ 14 and PhA < 5 defined subjects most exposed to the risk of malnutrition. RESULTS An association between BMI and G8 (p < 0.001, OR 1.54) and a clinically significant relationship between G8 and PhA (p = 0.013) were observed. CONCLUSION G8 can be used to identify patients at risk for malnutrition who would benefit from comprehensive CGA. The concurrent use of G8 and BIA presents a higher power in discriminating subjects at higher risk of malnutrition than a single test. This study suggests the need for routine assessment of nutritional status in cancer patients using combinations of methods, in order to implement strategies for individually-tailored care before starting any treatment.
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Affiliation(s)
- Silvana Leo
- Division of Oncology, Vito Fazzi Hospital, Lecce, Italy
| | - Fabiana Marinelli
- Department of Biological and Environmental Sciences and Technologies (DISTEBA), University of Salento, Lecce, Italy
| | | | | | | | | | - Stefania Leone
- Department of Biological and Environmental Sciences and Technologies (DISTEBA), University of Salento, Lecce, Italy
| | | | - Anna Maria Giudetti
- Department of Biological and Environmental Sciences and Technologies (DISTEBA), University of Salento, Lecce, Italy
| | - Prisco Piscitelli
- Division of Oncology, Vito Fazzi Hospital, Lecce, Italy.
- Department of Biological and Environmental Sciences and Technologies (DISTEBA), University of Salento, Lecce, Italy.
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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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