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Horiuchi K, Kuno T, Takagi H, Egorova NN, Afezolli D. Predictive value of the G8 screening tool for postoperative complications in older adults undergoing cancer surgery: A systematic review and meta-analysis. J Geriatr Oncol 2024; 15:101656. [PMID: 37940482 DOI: 10.1016/j.jgo.2023.101656] [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: 03/19/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Older adults with cancer who are being considered for cancer surgery are heterogenous, with variation in their physical, mental, and social baselines and risk of postoperative complications. Due in part to the complex nature of this population, the optimal preoperative evaluation method is not clearly defined. In this study we investigated whether geriatric-8 (G8), a screening tool for older patients with cancer that determines the need for a full geriatric assessment, is suitable for assessing the risk of postoperative complications in this population being considered for surgery. MATERIALS AND METHODS Studies that enrolled older patients undergoing cancer surgery and compared prevalence of postoperative complications in G8 "high" (≥15) patients and G8 "low" (<15) patients were identified using PubMed and EMBASE. A meta-analysis was conducted to calculate the risk ratio of postoperative complication rate. Postoperative mortality was systematically reviewed. RESULTS Eleven studies published between 2017 and 2022 were included in our analysis with a total of 2,691 older patients who underwent various types of cancer surgery and were characterized by their G8 scores: 1,255 G8 high (≥15) patients and 1,436 G8 low (<15) patients. G8 low patients had a significantly higher prevalence of postoperative complications than G8 high patients (risk ratio [95% confidence interval]: 1.56 [1.18-2.07], p = 0.002, I2 = 79%). DISCUSSION G8 can be an effective and efficient preoperative tool to assess risk of postoperative complications in older adults undergoing cancer surgery and identify potential need for further evaluation of an individual's risk with a comprehensive geriatric assessment.
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Affiliation(s)
- Kohei Horiuchi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA.
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizouka, Japan
| | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Debora Afezolli
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Campbell KH, Ahn DJ, Enger F, Zasadzinski L, Tanumihardjo J, Becker Y, Josephson M, Saunders MR. Utility of geriatric assessments in evaluation of older adults for kidney transplantation. Clin Transplant 2022; 36:e14813. [PMID: 36124434 PMCID: PMC10078529 DOI: 10.1111/ctr.14813] [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: 09/13/2021] [Revised: 07/28/2022] [Accepted: 08/29/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND While kidney transplantation has favorable outcomes in patients aged 65 years and older, many are not referred for evaluation despite having no contraindications. We wanted to determine whether incorporating geriatrics and geriatric assessments (GA), as part of kidney transplant evaluation at the University of Chicago Medicine, would help identify suitable candidates and improve transplantation outcomes among older adults. METHODS Between 2012 and 2016, as part of their multi-disciplinary transplant evaluation, 171 patients underwent an initial GA with the study geriatrician, who rated them on a five-point scale from "poor" to "excellent," and presented their cases to multidisciplinary transplant review meetings. Patients were followed until June 1st, 2021. Predictor variables included geriatric recommendation, clinical characteristics, and demographics. Outcomes of interest were mortality, receipt of transplant, and waitlist placement. RESULTS Compared to patients rated "poor," "marginal," or "fair," we found that patients that the geriatrician recommended as "good" or "excellent" were more likely to be waitlisted and receive a transplant. Favorably rated patients were also less likely to be removed from the waitlist due to becoming medically unfit, meaning worsening medical morbidity, frailty, and cognitive status. CONCLUSION Including geriatricians to perform GAs as part of the transplant evaluation process can help identify suitable elderly candidates.
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Affiliation(s)
- Kellie H. Campbell
- Geriatrics and Extended Care, Edward J. HinesJr. Veterans Affairs HospitalChicagoIllinoisUSA
| | - Daniel J. Ahn
- The University of Chicago Pritzker School of MedicineChicagoIllinoisUSA
| | - Frances Enger
- Section of General Internal Medicine, Department of MedicineUniversity of Chicago Medical CenterChicagoIllinoisUSA
| | - Lindsay Zasadzinski
- Section of General Internal Medicine, Department of MedicineUniversity of Chicago Medical CenterChicagoIllinoisUSA
| | - Jacob Tanumihardjo
- Section of General Internal Medicine, Department of MedicineUniversity of Chicago Medical CenterChicagoIllinoisUSA
| | - Yolanda Becker
- Section of Transplant Surgery, Department of SurgeryUniversity of Chicago Medical CenterChicagoIllinoisUSA
| | - Michelle Josephson
- Section of Nephrology, Department of MedicineUniversity of Chicago Medical CenterChicagoIllinoisUSA
| | - Milda R. Saunders
- Section of General Internal Medicine, Department of MedicineUniversity of Chicago Medical CenterChicagoIllinoisUSA
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3
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Chuang MH, Chen JY, Tsai WW, Lee CW, Lee MC, Tseng WH, Hung KC. Impact of comprehensive geriatric assessment on the risk of adverse events in the older patients receiving anti-cancer therapy: a systematic review and meta-analysis. Age Ageing 2022; 51:6625706. [PMID: 35776674 DOI: 10.1093/ageing/afac145] [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: 02/24/2022] [Revised: 04/26/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND to assess the efficacy of comprehensive geriatric assessment (CGA) for preventing treatment-related toxicity in older people undergoing non-surgical cancer therapies. METHODS MEDLINE, EMBASE and Cochrane library databases were searched from inception till January 2022 to identify randomised controlled trials (RCTs) on the incidence of toxicity measured by the Common Terminology Criteria for Adverse Events (primary outcome) and that of therapeutic modifications, early treatment discontinuation, progression-free survival, overall survival and hospitalisation (secondary outcomes). RESULTS analysis of six RCTs published from 2016 to 2021 recruiting 2,126 participants (median age: 71-77) who received chemotherapy as the major therapeutic approach revealed 51.7% and 64.7% of Grade 3+ toxicity in the CGA and control (i.e. standard care) groups, respectively (RR = 0.81, 95% CI: 0.7-0.94, P = 0.005, I2 = 65%, certainty of evidence [COE]: moderate). There were no significant differences in the incidence of early treatment discontinuation (RR = 0.88, P = 0.47; I2 = 63%,1,408 participants, COE: low), initial reduction in treatment intensity (RR = 0.99, P = 0.94; I2 = 83%, 2055 participants, COE: low), treatment delay (RR = 1.06, P = 0.77, I2 = 0%, 309 participants, COE: moderate), hospitalisation (RR = 0.86, P = 0.39, I2 = 41%, 914 participants, COE: moderate), progression-free and overall survival with or without CGA. However, there was an association between CGA and a lower incidence of dose reduction during treatment (RR = 0.73, P < 0.00001, 956 participants, COE: moderate). CONCLUSIONS our results demonstrated that comprehensive geriatric assessment may be associated with a lower incidence of treatment-related toxicity and dose reduction compared to standard care in older people receiving non-surgical cancer treatments. Further large-scale studies are warranted to support our findings.
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Affiliation(s)
- Min-Hsiang Chuang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Jui-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan.,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Wen-Wen Tsai
- Department of Education, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chia-Wei Lee
- Department of Neurology, Chi-Mei Medical Center, Tainan City, Taiwan
| | - Mei-Chuan Lee
- Department of Pharmacy, Chi Mei Medical Center, Tainan City, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Wen-Hsin Tseng
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan City, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.,Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
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Zuccarino S, Monacelli F, Antognoli R, Nencioni A, Monzani F, Ferrè F, Seghieri C, Antonelli Incalzi R. Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review. Cancers (Basel) 2022; 14:cancers14133235. [PMID: 35805005 PMCID: PMC9265029 DOI: 10.3390/cancers14133235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary The Comprehensive Geriatric Assessment is a multidimensional and multidisciplinary evaluation designed for elderly patients with the goal of structuring tailored care and follow-up. Despite the known benefits of this approach, the Comprehensive Geriatric Assessment is not universally applied to elderly cancer patients due to economic and practical barriers. This narrative review aims to investigate the cost-effectiveness of the Comprehensive Geriatric Assessment adopted in geriatric oncology. The results revealed a lack of research on the topic, but recurrent cost-saving effects of this approach in geriatric oncology settings were highlighted—suggesting a positive cost-effectiveness ratio. Further structured research with comprehensive economic evaluations is needed to confirm these findings. Abstract The Comprehensive Geriatric Assessment (CGA) and the corresponding geriatric interventions are beneficial for community-dwelling older persons in terms of reduced mortality, disability, institutionalisation and healthcare utilisation. However, the value of CGA in the management of older cancer patients both in terms of clinical outcomes and in cost-effectiveness remains to be fully established, and CGA is still far from being routinely implemented in geriatric oncology. This narrative review aims to analyse the available evidence on the cost-effectiveness of CGA adopted in geriatric oncology, identify the relevant parameters used in the literature and provide recommendations for future research. The review was conducted using the PubMed and Cochrane databases, covering published studies without selection by the publication year. The extracted data were categorised according to the study design, participants and measures of cost-effectiveness, and the results are summarised to state the levels of evidence. The review conforms to the SANRA guidelines for quality assessment. Twenty-nine studies out of the thirty-seven assessed for eligibility met the inclusion criteria. Although there is a large heterogeneity, the overall evidence is consistent with the measurable benefits of CGA in terms of reducing the in-hospital length of stay and treatment toxicity, leaning toward a positive cost-effectiveness of the interventions and supporting CGA implementation in geriatric oncology clinical practice. More research employing full economic evaluations is needed to confirm this evidence and should focus on CGA implications both from patient-centred and healthcare system perspectives.
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Affiliation(s)
- Sara Zuccarino
- Management and Health Laboratory, Institute of Management–Department Embeds, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy; (F.F.); (C.S.)
- Correspondence: (S.Z.); (F.M.); (R.A.I.)
| | - Fiammetta Monacelli
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, 16132 Genoa, Italy; (F.M.); (A.N.)
- IRCSS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Rachele Antognoli
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, 56126 Pisa, Italy;
| | - Alessio Nencioni
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, 16132 Genoa, Italy; (F.M.); (A.N.)
- IRCSS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, 56126 Pisa, Italy;
- Correspondence: (S.Z.); (F.M.); (R.A.I.)
| | - Francesca Ferrè
- Management and Health Laboratory, Institute of Management–Department Embeds, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy; (F.F.); (C.S.)
| | - Chiara Seghieri
- Management and Health Laboratory, Institute of Management–Department Embeds, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy; (F.F.); (C.S.)
| | - Raffaele Antonelli Incalzi
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University, 00128 Rome, Italy
- Correspondence: (S.Z.); (F.M.); (R.A.I.)
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Geriatric assessment in the management of older patients with cancer – A systematic review (update). J Geriatr Oncol 2022; 13:761-777. [DOI: 10.1016/j.jgo.2022.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022]
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Exploring Determinants of Interdisciplinary Collaboration within a Geriatric Oncology Setting: A Mixed-Method Study. Cancers (Basel) 2022; 14:cancers14061386. [PMID: 35326538 PMCID: PMC8946786 DOI: 10.3390/cancers14061386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Collaboration between oncologists and geriatricians has been shown to improve the quality of elderly cancer patient care. However, previous research has revealed how interpersonal factors might hinder this interdisciplinary work. This study aims to assess sprocessual and contextual determinants of the collaboration between these two disciplines, including shared time and routines, medical decision criteria and perceptions of age and needs of elderly patients. These aspects are important to develop a more efficient patient-centered approach in oncogeriatric care and improve collaboration between the different disciplines involved. Abstract Therapeutic challenges regarding the population of elderly cancer patients and their heterogeneity lead to the need to implement person-centered approaches in order to optimize care strategies and adapt oncology treatments to each pattern of aging. The International Society of Geriatric Oncology recommends a multidisciplinary evaluation of these patients and the use of screening tools prior to the initiation of treatments. However, previous research shows a poor implementation of these recommendations in geriatric oncology. Although some studies have identified how different perceptions of geriatric oncology might hinder routine teamwork, little is known about the impact of other factors on promoting the collaboration between the two specialties. This mixed-method exploratory study used an online questionnaire to assess the perception of a group of 22 geriatricians and oncology physicians on different determinants of oncology care and teamwork. In this sample, older oncology patients benefited from geriatric care. However, there was a variability regarding age criteria and a limited use of screening tools. The multidimensional framework for interprofessional teamwork by Reeves has been used to analyze some of the determinants of the collaboration between oncology physicians and geriatricians. This study has identified systematic issues to consider when promoting communication and common values between the two disciplines, including available resources in terms of shared time, space and routine actions.
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Abstract
BACKGROUND Most cancer treatment is provided in the ambulatory setting; thus, it is important to know what issues ambulatory oncology nurses identify in their practice with older cancer patients as well as resources that are helpful or are needed. OBJECTIVE The aim of this study was to capture ambulatory oncology nurses' perceptions of the unique aspects of caring for older patients and to present the development process, content validity testing, and psychometric evaluation of a survey designed to denote nurse perceptions of older adult care. METHODS An expert panel and 2 focus groups informed the development of a 34-item survey scored on a 5-point Likert-type agreement scale and 2 open-ended questions. Psychometric testing and descriptive statistics summarized the quantitative responses. Using thematic analysis, we identified the themes from the open-ended responses. RESULTS The survey demonstrated good psychometric qualities. A total of 401 participants, mostly staff from large, academic cancer centers, reported an average total score of 3.76, indicating generally positive perceptions of older adult care. The 269 (67%) open-ended responses were categorized into 4 main themes: concerns over medical issues, the need for specialized services, adequate support systems, and appropriate communication. CONCLUSIONS Although most perceived their geriatric practice environment favorably, nurses recognized the complexity of caring for older adults with cancer. They identified gaps in care, such as the need for geriatric specialists and better community resources, paid by insurance. IMPLICATIONS FOR PRACTICE Nurses need more time in the clinic to address complex advanced care planning, symptom burden and home services of older adults with cancer. Each institution should seek feedback from nurses to guide resource allocation.
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Lapteva ES, Ariev AL, Tsutsunava MR, Arieva GT. Comprehensive Geriatric Assessment—Resolved and Unresolved Issues (Review). ADVANCES IN GERONTOLOGY 2021. [DOI: 10.1134/s207905702104007x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Festen S, Nijmeijer H, van Leeuwen BL, van Etten B, van Munster BC, de Graeff P. Multidisciplinary decision-making in older patients with cancer, does it differ from younger patients? Eur J Surg Oncol 2021; 47:2682-2688. [PMID: 34127326 DOI: 10.1016/j.ejso.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/14/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In order to tailor treatment to the individual patient, it is important to take the patients context and preferences into account, especially for older patients. We assessed the quality of information used in the decision-making process in different oncological MDTs and compared this for older (≥70 years) and younger patients. PATIENTS AND METHODS Cross-sectional observations of oncological MDTs were performed, using an observation tool in a University Hospital. Primary outcome measures were quality of input of information into the discussion for older and younger patients. Secondary outcomes were the contribution of different team members, discussion time for each case and whether or not a treatment decision was formulated. RESULTS Five-hundred and three cases were observed. The median patient age was 63 year, 32% were ≥70. In both age groups quality of patient-centered information (psychosocial information and patient's view) was poor. There was no difference in quality of information between older and younger patients, only for comorbidities the quality of information for older patients was better. There was no significant difference in the contributions by team members, discussion time (median 3.54 min) or number of decision reached (87.5%). CONCLUSION For both age groups, we observed a lack of patient-centered information. The only difference between the age groups was for information on comorbidities. There were also no differences in contributions by different team members, case discussion time or number of decisions. Decision-making in the observed oncological MDTs was mostly based on medical technical information.
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Affiliation(s)
- S Festen
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - H Nijmeijer
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - B L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - B van Etten
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - B C van Munster
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - P de Graeff
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Tarchand GR, Morrison V, Klein MA, Watkins E. Use of Comprehensive Geriatric Assessment in Oncology Patients to Guide Treatment Decisions and Predict Chemotherapy Toxicity. Fed Pract 2021; 38:S22-S28. [PMID: 34177238 DOI: 10.12788/fp.0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose Our objective was to review the utility of pretreatment comprehensive geriatric assessment (CGA) and its impact on decision making regarding choice and intensity of oncologic therapeutic regimens for older, frail, or poor-functional-status patients, as well as using this prospective assessment to predict chemotherapy-related toxicities. Database searches were conducted in Medline, PubMed, and Ovid for clinical studies, review articles, and journal publications. Search terms included geriatric assessment, medical oncology, chemotherapy, frailty, toxicity, and functional status. Thirty-seven pertinent articles were retrieved and serve as the basis for this clinical review. Observations CGA is an important tool for examining aspects of frailty and functional status that are not captured by traditional performance status measures. These findings may then be used in selection of appropriate therapeutic regimens for a given patient that are efficacious and tolerable. Such pretreatment assessments also have been used in predicting therapy-related toxicities. Conclusions Frail and older patients are common in oncology practices and are at high risk for therapy-related toxicities because of comorbidities and physiologic changes, presenting a considerable clinical challenge. CGA establishes evidence-based strategies to better assess the functional status of such patients and is predictive for chemotherapy-related toxicities in this vulnerable group. Despite publications on these measures in the oncology literature, there is limited evidence-based research to demonstrate the utility of CGA by practicing oncology providers and how to implement it into practice.
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Affiliation(s)
- Gobind R Tarchand
- is a Physician Assistant, and is a Medical Oncologist, both in the Hematology-Oncology Section, Primary Care Service Line at the Minneapolis VA Health Care System in Minnesota. is Professor of Medicine in Medical Oncology and Infectious Diseases, and Mark Klein is Associate Professor of Medicine, both in the Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota in Minneapolis. is Associate Professor for the Lynchburg DMSc program at the University of Lynchburg in Virginia. Vicki Morrison is a Geriatric Oncologist in the Division of Hematology/Oncology, Department of Medicine at Hennepin County Medical Center in Minneapolis, Minnesota
| | - Vicki Morrison
- is a Physician Assistant, and is a Medical Oncologist, both in the Hematology-Oncology Section, Primary Care Service Line at the Minneapolis VA Health Care System in Minnesota. is Professor of Medicine in Medical Oncology and Infectious Diseases, and Mark Klein is Associate Professor of Medicine, both in the Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota in Minneapolis. is Associate Professor for the Lynchburg DMSc program at the University of Lynchburg in Virginia. Vicki Morrison is a Geriatric Oncologist in the Division of Hematology/Oncology, Department of Medicine at Hennepin County Medical Center in Minneapolis, Minnesota
| | - Mark A Klein
- is a Physician Assistant, and is a Medical Oncologist, both in the Hematology-Oncology Section, Primary Care Service Line at the Minneapolis VA Health Care System in Minnesota. is Professor of Medicine in Medical Oncology and Infectious Diseases, and Mark Klein is Associate Professor of Medicine, both in the Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota in Minneapolis. is Associate Professor for the Lynchburg DMSc program at the University of Lynchburg in Virginia. Vicki Morrison is a Geriatric Oncologist in the Division of Hematology/Oncology, Department of Medicine at Hennepin County Medical Center in Minneapolis, Minnesota
| | - Elyse Watkins
- is a Physician Assistant, and is a Medical Oncologist, both in the Hematology-Oncology Section, Primary Care Service Line at the Minneapolis VA Health Care System in Minnesota. is Professor of Medicine in Medical Oncology and Infectious Diseases, and Mark Klein is Associate Professor of Medicine, both in the Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota in Minneapolis. is Associate Professor for the Lynchburg DMSc program at the University of Lynchburg in Virginia. Vicki Morrison is a Geriatric Oncologist in the Division of Hematology/Oncology, Department of Medicine at Hennepin County Medical Center in Minneapolis, Minnesota
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11
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Bruijnen CP, Heijmer A, van Harten-Krouwel DG, van den Bos F, de Bree R, Witteveen PO, Emmelot-Vonk MH. Validation of the G8 screening tool in older patients with cancer considered for surgical treatment. J Geriatr Oncol 2020; 12:793-798. [PMID: 33172806 DOI: 10.1016/j.jgo.2020.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 09/06/2020] [Accepted: 10/27/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Geriatric 8 (G8) has proven to be one of the most sensitive frailty-screening tools for older patients with cancer undergoing systemic treatment. In this study we validated whether the G8 is also suitable for identifying impairments in their comprehensive geriatric assessment (CGA) in older patients with cancer undergoing surgery. Thereby, we investigated the differences in postoperative outcomes between the fit and frail patients classified by the G8. METHODS Patients ≥70 years with a surgery indication because of a (suspected) malignant disease were prospectively enrolled. In all patients, a CGA was performed. The G8 results were assessed in parallel. The diagnostic value of the G8 was determined by comparing the result with the CGA as a reference test. Deficits in CGA was defined as ≥ two impairments of the CGA. Postoperative complications were retrospectively obtained from the medical record and compared between the fit and frail patients. RESULTS In total, 143 patients were enrolled. The sensitivity, specificity, and negative predictive value of the G8 were 82% (95% CI 70-91), 63% (95% CI 52-73), and 85% (95% CI 75-91). In the patients with an impaired G8, a significantly prolonged hospital stay, higher rate of delirium, and higher 1-year mortality rate were seen. CONCLUSION The G8 is a simple and useful screening tool for identifying deficits in CGA in older patients with cancer requiring surgery. Second, we concluded that patients with an impaired G8 are more at risk for a complicated recovery from surgery.
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Affiliation(s)
- Cheryl P Bruijnen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Anne Heijmer
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Frederiek van den Bos
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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Griffiths AW, Ashley L, Kelley R, Cowdell F, Collinson M, Mason E, Farrin A, Henry A, Inman H, Surr C. Decision-making in cancer care for people living with dementia. Psychooncology 2020; 29:1347-1354. [PMID: 32567082 DOI: 10.1002/pon.5448] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/20/2020] [Accepted: 06/17/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Increasing numbers of people are expected to live with comorbid cancer and dementia. Cancer treatment decision-making for these individuals is complex, particularly for those lacking capacity, requiring support across the cancer care pathway. There is little research to inform practice in this area. This ethnographic study reports on the cancer decision-making experiences of people with cancer and dementia, their families, and healthcare staff. METHODS Participant observations, informal conversations, semi-structured interviews, and medical note review, in two NHS trusts. Seventeen people with dementia and cancer, 22 relatives and 19 staff members participated. RESULTS Decision-making raised complex ethical dilemmas and challenges and raised concerns for families and staff around whether correct decisions had been made. Whose decision it was and to what extent a person with dementia and cancer was able to make decisions was complex, requiring careful and ongoing consultation and close involvement of relatives. The potential impact dementia might have on treatment understanding and toleration required additional consideration by clinicians when evaluating treatment options. CONCLUSIONS Cancer treatment decision-making for people with dementia is challenging, should be an ongoing process and has emotional impacts for the individual, relatives, and staff. Longer, flexible, and additional appointments may be required to support decision-making by people with cancer and dementia. Evidence-based decision-making guidance on how dementia impacts cancer prognosis, treatment adherence and efficacy is required.
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Affiliation(s)
- Alys Wyn Griffiths
- Centre for Dementia Research, School of Health & Community Studies, Leeds Beckett University, Leeds, UK
| | - Laura Ashley
- School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Rachael Kelley
- Centre for Dementia Research, School of Health & Community Studies, Leeds Beckett University, Leeds, UK
| | - Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Ellen Mason
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Ann Henry
- Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,School of Medicine, University of Leeds, Leeds, UK
| | - Hayley Inman
- Oncology Services, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Claire Surr
- Centre for Dementia Research, School of Health & Community Studies, Leeds Beckett University, Leeds, UK
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Farrington N, Richardson A, Bridges J. Interventions for older people having cancer treatment: A scoping review. J Geriatr Oncol 2020; 11:769-783. [DOI: 10.1016/j.jgo.2019.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/24/2019] [Accepted: 09/25/2019] [Indexed: 01/05/2023]
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14
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Hamaker ME, van Huis-Tanja LH, Rostoft S. Optimizing the geriatrician's contribution to cancer care for older patients. J Geriatr Oncol 2020; 11:389-394. [DOI: 10.1016/j.jgo.2019.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/28/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022]
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15
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How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study. J Geriatr Oncol 2019; 10:951-959. [DOI: 10.1016/j.jgo.2019.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/22/2019] [Accepted: 04/04/2019] [Indexed: 12/27/2022]
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16
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Rostoft S, Hamaker ME. Basic geriatric principles for colorectal surgeons: How to optimize assessment and care of older patients in the perioperative period. Eur J Surg Oncol 2019; 46:310-315. [PMID: 31378416 DOI: 10.1016/j.ejso.2019.07.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/21/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The majority of patients with colorectal cancer are older. For surgeons dealing with older patients, it is important to recognize patients that are frail and have an increased risk of complications and mortality. In this review, we will go through pre-treatment assessment, peri-operative management, as well as discharge planning and rehabilitation. METHODS This review is based on searching the literature for studies regarding colorectal cancer, frailty, cognition, patient preferences and geriatric assessment as well as the academic and clinical experience of the authors. RESULTS In the pre-treatment assessment, surgeons need to consider capacity to consent, patient preferences, frailty and life-expectancy, risk of complications, and whether the patient can be optimized before surgery. Then, the patient and treatment options should be discussed at a multidisciplinary team meeting. When the patient is admitted for surgery, discharge planning should start immediately, and if complications such as delirium or falls occur, the patient should be co-managed with geriatric services. CONCLUSION Frail older adults with colorectal cancer need a tailored approach from pre-treatment assessment until discharge after surgery, and co-management with a geriatrician is recommended. If this is not possible, surgeons treating frail older patients may improve care by adapting some geriatric principles.
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Affiliation(s)
- S Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht-Zeist-Doorn, the Netherlands
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17
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DeWane MP, Sukumar N, Stolar MJ, Gill TM, Maung AA, Schuster KM, Davis KA, Becher RD. High-performance acute care hospitals: Excelling across multiple emergency general surgery operations in the geriatric patient. J Trauma Acute Care Surg 2019; 87:140-146. [PMID: 31259872 PMCID: PMC7656193 DOI: 10.1097/ta.0000000000002273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND As the geriatric population grows, the need for hospitals performing high quality emergency general surgery (EGS) on older patients will increase. Identifying clusters of high-performing geriatric emergency general surgery hospitals would substantiate the need for in-depth analyses of hospital-specific structures and practices that benefit older EGS patients. The objectives of this study were therefore to identify clusters of hospitals based on mortality performance for geriatric patients undergoing common EGS operations and to determine if hospital performance was similar for all operation types. METHODS Hospitals in the California State Inpatient Database were included if they performed a range of eight common EGS operations in patients 65 years or older, with a minimum requirement of three of each operation performed over 2 years. Multivariable beta regression models were created to define hospital-level risk-adjusted mortality. Centroid cluster analysis was used to identify groups of hospitals based on mortality and to determine if mortality-performance differed by operation. RESULTS One hundred seven hospitals were included, performing a total of 24,279 operations in older patients. Hospitals separated into three distinct clusters: high, average, and low performers. The high-performing hospitals had survival rates 1 to 2 standard deviations better than the low-performers (p < 0.001). For each cluster, high performance in any one EGS operation consistently translated into high performance across all EGS operations. CONCLUSION Hospitals conducting EGS operations in the geriatric patient population cluster into three distinct groups based on their survival performance. High-performing hospitals significantly outperform the average and low performers across every operation. The high-performers achieve reliable, high-quality results regardless of operation type. Further qualitative research is needed to investigate the perioperative drivers of hospital performance in the geriatric EGS population. LEVEL OF EVIDENCE Study Type Prognostic, level III.
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Affiliation(s)
- Michael P DeWane
- From the Section of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery (M.P.D., A.A.M., K.M.S., K.A.D., R.D.B.), Yale School of Medicine; Yale Center for Analytical Sciences (N.S., M.J.S.), Yale School of Public Health; and Section of Geriatrics, Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, Connecticut
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18
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Overcash J, Ford N, Kress E, Ubbing C, Williams N. Comprehensive Geriatric Assessment as a Versatile Tool to Enhance the Care of the Older Person Diagnosed with Cancer. Geriatrics (Basel) 2019; 4:geriatrics4020039. [PMID: 31238518 PMCID: PMC6630523 DOI: 10.3390/geriatrics4020039] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/14/2019] [Accepted: 06/20/2019] [Indexed: 12/27/2022] Open
Abstract
The comprehensive geriatric assessment (CGA) is a versatile tool for the care of the older person diagnosed with cancer. The purpose of this article is to detail how a CGA can be tailored to Ambulatory Geriatric Oncology Programs (AGOPs) in academic cancer centers and to community oncology practices with varying levels of resources. The Society for International Oncology in Geriatrics (SIOG) recommends CGA as a foundation for treatment planning and decision-making for the older person receiving care for a malignancy. A CGA is often administered by a multidisciplinary team (MDT) composed of professionals who provide geriatric-focused cancer care. CGA can be used as a one-time consult for surgery, chemotherapy, or radiation therapy providers to predict treatment tolerance or as an ongoing part of patient care to manage malignant and non-malignant issues. Administrative support and proactive infrastructure planning to address scheduling, referrals, and provider communication are critical to the effectiveness of the CGA.
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Affiliation(s)
- Janine Overcash
- The College of Nursing, The Ohio State University, 1585 Neil Ave, Newton Hall, Columbus, OH 43201, USA.
| | - Nikki Ford
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Elizabeth Kress
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Caitlin Ubbing
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Nicole Williams
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
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19
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Ahmed M, Wrightson JM. Malignant Pleural Effusions—Personalised Management. CURRENT GERIATRICS REPORTS 2018. [DOI: 10.1007/s13670-018-0246-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients – A systematic review. J Geriatr Oncol 2018; 9:430-440. [DOI: 10.1016/j.jgo.2018.03.014] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 12/24/2022]
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21
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Geessink NH, Schoon Y, Olde Rikkert MGM, van Goor H. Training surgeons in shared decision-making with cancer patients aged 65 years and older: a pilot study. Cancer Manag Res 2017; 9:591-600. [PMID: 29184443 PMCID: PMC5689024 DOI: 10.2147/cmar.s147312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Treatment decision-making in older patients with colorectal (CRC) or pancreatic cancer (PC) needs improvement. We introduced the EASYcare in Geriatric Onco-surgery (EASY-GO) intervention to optimize the shared decision-making (SDM) process among these patients. METHODS The EASY-GO intervention comprised a working method with geriatric assessment and SDM training for surgeons. A non-equivalent control group design was used. Newly diagnosed CRC/PC patients aged ≥65 years were included. Primary patient-reported experiences were the quality of SDM (SDM-Q-9, range 0-100), involvement in decision-making (Visual Analog Scale for Involvement in the decision-making process [range 0-10]), satisfaction about decision-making (Visual Analog Scale for Satisfaction concerning the decision-making process [range 0-10]), and decisional regret (Decisional Regret Scale [DRS], range 0-100). Only for DRS, lower scores are better. RESULTS A total of 71.4% of the involved consultants and 42.9% of the involved residents participated in the EASY-GO training. Only 4 trained surgeons consulted patients both before (n=19) and after (n=19) training and were consequently included in the analyses. All patient-reported experience measures showed a consistent but non-significant change in the direction of improved decision-making after training. According to surgeons, decisions were significantly more often made together with the patient after training (before, 38.9% vs after, 73.7%, p=0.04). Sub-analyses per diagnosis showed that patient experiences among older PC patients consistent and clinically relevant changed in the direction of improved decision-making after training (SDM-Q-9 +13.4 [95% CI -7.9; 34.6], VAS-I +0.27 [95% CI -1.1; 1.6], VAS-S +0.88 [95% CI -0.5; 2.2], DRS -10.3 [95% CI -27.8; 7.1]). CONCLUSION This pilot study strengthens the practical potential of the intervention's concept among older surgical cancer patients.
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Affiliation(s)
| | - Yvonne Schoon
- Department of Geriatric Medicine
- Radboud Institute for Health Sciences
| | | | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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22
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Byerly LK, Harper GM. Is it time for comprehensive geriatric assessment to move beyond primary care? The case for targeting medical sub-specialty practice. Isr J Health Policy Res 2017; 6:33. [PMID: 28593039 PMCID: PMC5460411 DOI: 10.1186/s13584-017-0158-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/29/2017] [Indexed: 02/08/2023] Open
Abstract
Comprehensive geriatric assessment (CGA) as a consultative service for older adults with complex medical and psychosocial challenges has existed for decades. However, studies have often showed inconsistent acceptance and implementation of geriatric recommendations by primary care providers (PCPs) raising doubts about the overall benefits of CGA in this setting. Press and colleagues investigated the patient- and provider-related factors that affect recommendation implementation, and like previous studies, they too found similarly low rates of implementation. In this commentary, we acknowledge the perennial challenges that exist to improving the acceptance of CGA in primary care practice, and we suggest an alternative target: medical sub-specialty practice. By highlighting three medical sub-specialty fields (oncology, nephrology, and cardiology), which have demonstrated that CGA can be incorporated into their respective clinical practices, we argue that CGA may prove to have greater impact in these settings than in primary care. We also propose initial research steps that could further delineate the trends, outcomes, and next steps for such consultations.
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Affiliation(s)
- Laura K Byerly
- Division of Geriatrics, University of California, San Francisco and San Francisco VA Medical Center, 4150 Clement Street, 181G, San Francisco, CA 94121 USA
| | - G Michael Harper
- Division of Geriatrics, University of California, San Francisco and San Francisco VA Medical Center, 4150 Clement Street, 181G, San Francisco, CA 94121 USA
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Schulkes KJG, Souwer ETD, Hamaker ME, Codrington H, van der Sar-van der Brugge S, Lammers JWJ, Portielje JEA, van Elden LJR, van den Bos F. The Effect of A Geriatric Assessment on Treatment Decisions for Patients with Lung Cancer. Lung 2017; 195:225-231. [PMID: 28280921 PMCID: PMC5387022 DOI: 10.1007/s00408-017-9983-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/04/2017] [Indexed: 11/28/2022]
Abstract
Background Decision-making for older patients with lung cancer can be complex and challenging. A geriatric assessment (GA) may be helpful and is increasingly being used since 2005 when SIOG advised to incorporate this in standard work-up for the elderly with cancer. Our aim was to evaluate the value of a geriatric assessment in decision-making for patients with lung cancer. Methods Between January 2014 and April 2016, data on patients with lung cancer from two teaching hospitals in the Netherlands were entered in a prospective database. Outcome of geriatric assessment, non-oncologic interventions, and suggested adaptations of oncologic treatment proposals were evaluated. Results 83 patients (median age 79 years) were analyzed with a geriatric assessment, of which 59% were treated with a curative intent. Half of the patients were classified as ECOG PS 0 or 1. The majority of the patients (78%) suffered from geriatric impairments and 43% (n = 35) of the patients suffered from three or more geriatric impairments (out of eight analyzed domains). Nutritional status was most frequently impaired (52%). Previously undiagnosed impairments were identified in 58% of the patients, and non-oncologic interventions were advised for 43%. For 33% of patients, adaptations of the oncologic treatment were proposed. Patients with higher number of geriatric impairments more often were advised a reduced or less intensive treatment (p < 0.001). Conclusion A geriatric assessment uncovers previously unknown health impairments and provides important guidance for tailored treatment decisions in patients with lung cancer. More research on GA-stratified treatment decisions is needed.
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Affiliation(s)
- Karlijn J G Schulkes
- Department of Internal Medicine, Diakonessenhuis Utrecht/Zeist/Doorn, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
| | - Esteban T D Souwer
- Department of Internal Medicine, Haga Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Henk Codrington
- Department of Pulmonology, Haga Hospital, The Hague, The Netherlands
| | | | - Jan-Willem J Lammers
- Department of Pulmonology, UMC Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Johanneke E A Portielje
- Department of Internal Medicine, Haga Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands
| | | | - Frederiek van den Bos
- Department of Internal Medicine, Haga Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands
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24
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Schulkes KJG, Souwer ETD, van Elden LJR, Codrington H, van der Sar-van der Brugge S, Lammers JWJ, Portielje JEA, van den Bos F, Hamaker ME. Prognostic Value of Geriatric 8 and Identification of Seniors at Risk for Hospitalized Patients Screening Tools for Patients With Lung Cancer. Clin Lung Cancer 2017; 18:660-666.e1. [PMID: 28320638 DOI: 10.1016/j.cllc.2017.02.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/08/2017] [Accepted: 02/21/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Because of the time-consuming aspect of geriatric assessments, cancer specialists are seeking shorter screening tools to distinguish fit and frail patients. We analyzed the predictive value of the Geriatric 8 (G8) and Identification of Seniors at Risk for Hospitalized Patients (ISAR-HP) in elderly patients with lung cancer. PATIENTS AND METHODS From January 2014 to April 2016, the data from patients with lung cancer aged > 70 years at 2 teaching hospitals in the Netherlands were included in a database. The patients were classified as potentially frail if they had a G8 of ≤ 14 or ISAR-HP of ≥ 2. RESULTS Of the 142 included patients (median age, 77 years; interquartile range, 73-82 years), 108 (76%) were potentially frail. After correction for possible confounders, the potentially frail patients had a significantly greater risk of 1-year mortality (hazard ratio [HR], 4.08; 95% confidence interval [CI] 1.67-9.99; P = .02). Higher disease stage (HR, 1.72; 95% CI, 1.40-2.12; P < .001) was also a significant predictor of mortality; however, initial treatment (standard or otherwise) and age were not. When using both screening instruments separately, an impaired score on the G8 and higher disease stage were the variables remaining in the regression analyses (HR for impaired G8, 3.01; 95% CI, 1.35-6.72; P < .001). Patients with impaired scores on the ISAR-HP and G8 had more geriatric impairments than did patients with only an impaired G8 score. CONCLUSION G8 screening is useful for the prognostication of elderly patients with lung cancer and could be used in combination with ISAR-HP to increase specificity at the cost of sensitivity. Using the ISAR-HP as the only screening tool would be insufficient.
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Affiliation(s)
- Karlijn J G Schulkes
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, Netherlands.
| | | | | | - Henk Codrington
- Department of Pulmonology, Haga Hospital, The Hague, Netherlands
| | | | - Jan-Willem J Lammers
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, Netherlands
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Weller D. Living with cancer: challenges across the lifespan. Eur J Cancer Care (Engl) 2016; 25:345-7. [DOI: 10.1111/ecc.12506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2016] [Indexed: 11/30/2022]
Affiliation(s)
- D. Weller
- Centre for Population Health Sciences; University of Edinburgh; Edinburgh UK
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Marosi C, Köller M. Challenge of cancer in the elderly. ESMO Open 2016; 1:e000020. [PMID: 27843603 PMCID: PMC5070391 DOI: 10.1136/esmoopen-2015-000020] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 12/21/2022] Open
Abstract
Despite the sustained trend of decreasing overall cancer incidence, the number of elderly patients with cancer will considerably increase in the coming years, as the incidence of cancer is elevated 11-fold after the age of 65 years compared to adults up to 65 years. This soon-to-erupt tsunami of elderly patients with cancer requires adequate treatment, for which guidelines and evidence-based data are still scarce, given the longlasting under-representation of elderly patients with cancer in cancer trials. Older adults present not only with the physiological decreases of organ functions related to age, but also with an individual burden of comorbidities, other impairments and social factors that might impact on their potential for undergoing cancer care. Close collaboration with gerontologists and other health professionals to assess the personal resources and limitations of each person enables providing adequate therapy to elderly patients with cancer. There are promising achievements in each of the requirements listed, but a huge, holistic effort has still to be made.
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Affiliation(s)
- Christine Marosi
- Clinical Division of Medical Oncology, Department of Internal Medicine I , Medical University of Vienna , Vienna , Austria
| | - Marcus Köller
- Sophienspital der Gemeinde Wien & Department of Internal Medicine III , Medical University of Vienna , Vienna , Austria
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