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Salis F, Cossu E, Mandas A. The multidimensional prognostic index (MPI) predicts long-term mortality in old type 2 diabetes mellitus patients: a 13-year follow-up study. J Endocrinol Invest 2024; 47:191-200. [PMID: 37332086 PMCID: PMC10776747 DOI: 10.1007/s40618-023-02135-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE The Multidimensional Prognostic Index (MPI) is a tool capable of holistically frame older patients in different settings and affected by different pathologies, establishing a risk of adverse events. Among them, type 2 diabetes mellitus (T2DM), a common metabolic disease in the elderly, is responsible for complications and deaths. Few previous works have focused specifically on MPI and DM, and none have followed up the patients for more than 3 years. The aim of the present study is to analyze MPI accuracy in predicting mortality in a cohort of T2DM patients followed-up for 13 years. METHODS The enrolled subjects were evaluated with MPI, identifying three levels of risk: MPI1 (low risk, 0.0-0.33), MPI2 (moderate risk, 0.34-0.66), and MPI3 (severe risk, 0.67-1.0), and with glycated hemoglobin, and years since T2DM diagnosis. RESULTS One hundred and seven patients met the inclusion criteria. MPI3 was excluded by further analysis since it was made up of only three patients. Overall, cognitive performances, autonomies in daily living, nutritional status, risk of pressure injuries, comorbidities, and taken drugs were better (p ≤ 0.0077) in MPI1 than MPI2; moreover, the story of T2DM was shorter (p = 0.0026). Cox model showed an overall 13-year survival of 51.9%, and survival rates were significantly smaller in MPI2 (HR: 4.71, p = 0.0007). Finally, increased age (HR: 1.15), poorer cognitive abilities (HR: 1.26), vascular (HR: 2.15), and kidney (HR: 2.17) diseases were independently associated with death. CONCLUSION Our results prove that MPI predicts short-, mid-, and even long-term mortality in T2DM patients, whose death seems to be related to age and cognitive status, and even more to vascular and kidney diseases.
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Affiliation(s)
- F Salis
- Department of Medical Sciences, and Public Health, University of Cagliari, SS 554 bivio Sestu, 09042, Monserrato, Cagliari, Italy.
| | - E Cossu
- University Hospital "Azienda Ospedaliero-Universitaria" of Cagliari, Cagliari, Italy
| | - A Mandas
- Department of Medical Sciences, and Public Health, University of Cagliari, SS 554 bivio Sestu, 09042, Monserrato, Cagliari, Italy
- University Hospital "Azienda Ospedaliero-Universitaria" of Cagliari, Cagliari, Italy
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Prevalence of multidimensional frailty and pre-frailty in older people in different settings: A systematic review and meta-analysis. Ageing Res Rev 2021; 72:101498. [PMID: 34700009 DOI: 10.1016/j.arr.2021.101498] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022]
Abstract
Frailty is a common condition in older people. The epidemiological data available, however, are mainly based on the physical frailty phenotype. An extensive literature has suggested that frailty should be identified using a multidimensional approach. Based on these recommendations, we estimated the prevalence of frailty and pre-frailty in the older population, using the multidimensional prognostic index (MPI), a common tool for defining multidimensional frailty. We searched several databases until 10th May 2021 for studies reporting the prevalence of frailty according to MPI values. MPI was categorized, where possible, in < 0.33 (robustness), 0.33-0.66 (pre-frailty) and > 0.66 (frailty) or using a RECursive Partition and AMalgamation approach. A meta-analysis of the prevalence, with the correspondent 95% confidence intervals (CIs) of pre-frailty and frailty was performed stratified by setting (population-based, ambulatory, nursing home, and hospital). Among 177 papers initially screened, we included 57 studies for a total of 56,407 older people. The mean age was 78.6 years, with a slight prevalence of women (58%). The overall prevalence of multidimensional frailty (MPI-3) was 26.8% (95%CI: 22.1-31.5), being higher in nursing home setting (51.5%) and lower in population-based studies (13.3%). The prevalence of pre-frailty (MPI-2) was 36.4% (95%CI: 33.1-39.7), being higher in hospital setting (39.3%) and lower in nursing home (20%). In conclusion, frailty and pre-frailty, according to a multidimensional definition, are common in older people affecting, respectively, one person over four and one over three. Our work further strengths the importance of screening frailty in older people using a multidimensional approach.
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Bakas AT, Sewnaik A, van Straaten J, Baatenburg de Jong RJ, Mattace-Raso FUS, Polinder-Bos HA. The Multidimensional Prognostic Index as a Measure of Frailty in Elderly Patients with Head and Neck Cancer. Clin Interv Aging 2021; 16:1679-1689. [PMID: 34556980 PMCID: PMC8453644 DOI: 10.2147/cia.s323740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/08/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose The multidimensional prognostic index (MPI) is a prognostic model derived from the comprehensive geriatric assessment (CGA) which can predict 1-year mortality risk in elderly individuals. We hypothesized that the MPI also reflects the degree of frailty and thus will correlate with established measures of frailty. Therefore, the aim of this study is to explore whether the MPI-score is a measure of frailty in older head and neck cancer patients and is associated with several physical functioning measurements. Patients and Methods From November 2019 to July 2020, a prospective cohort study enrolled patients with head and neck cancer aged ≥70 years, and patients <70 years with an abnormal G8 score. The MPI-score ranged from 0 to 1 and was categorized in MPI-stage 1 (≤0.33, non-frail); MPI-stage 2 (0.34-0.66, mildly frail), and MPI-stage 3 (≥0.67, severe frail). Pearson's correlation coefficient and multivariable linear regression were used to study the association between MPI-score and the physical functioning measurements handgrip strength, gait speed, and the timed up and go test (TUGT). Results A total of 163 patients were included. One hundred four (63.8%) patients were categorized as non-frail according MPI-stage 1, and 59 (36.2%) patients as mildly or severe frail (n=55 MPI-stage 2; n=4 MPI-stage 3, respectively). A higher MPI-score was significantly associated with lower hand grip strength (B -0.49 [95% CI -0.71; -0.28] p<0.001), lower gait speed (B -0.41 [95% CI -0.55; -0.25] p<0.001), and a slower TUGT (B 0.53 [95% CI 0.66; 0.85] p<0.001). Conclusion Almost one-third of the included patients with head and neck cancer was mild or severe frail. A higher MPI-score, indicating higher degree of frailty, was associated with worse physical performance by lower handgrip strength, gait speed, and a slower TUGT. Thus, the MPI reflects the degree of frailty.
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Affiliation(s)
- Ajay T Bakas
- Department of Otorhinolaryngology, Erasmus MC University Cancer Institute, Rotterdam, the Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology, Erasmus MC University Cancer Institute, Rotterdam, the Netherlands
| | - Jaclyn van Straaten
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Francesco U S Mattace-Raso
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Harmke A Polinder-Bos
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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4
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Mattace-Raso F, Pilotto A. The challenge of the multifaceted prognosis in the older people and the Multidimensional Prognostic Index. Eur Geriatr Med 2021; 12:223-226. [PMID: 33620704 PMCID: PMC7900797 DOI: 10.1007/s41999-021-00457-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Francesco Mattace-Raso
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Alberto Pilotto
- Geriatric Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, Italy. .,Department of Interdisciplinary Medicine, University of Bari, Bari, Italy.
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Ximenes CRC, Bergmann A, Lima JTDO, Cavalcanti AS, Britto MCAD, Mello MJG, Thuler LCS. Impact of age in health-related quality of life in older adults with cancer. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.5327/z2447-212320212000106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE: To evaluate the impact of age in health-related quality of life (HRQoL) in older adults with cancer. METHODS: This was a cross-sectional study of 608 older adults diagnosed with cancer. Age groups were considered an independent variable. For the analysis of HRQoL, the mean scores of age groups were compared by analysis of variance and the Scheffé comparison test. For measuring the association between age and HRQoL, we used simple and multiple linear regression analyses. RESULTS: Cognitive function showed the highest scores (average 87.94 ± 26.87), while physical function showed the lowest ones (68.04 ± 28.63). The highest symptom score was observed for financial difficulties (34.21 ± 39.06), followed by pain (29.47 ± 33.92) and insomnia (28.51 ± 37.03). After adjustment, we observed a decrease in physical function (p = 0.028) and an improvement in emotional function (p = 0.003) with increasing age. Conclusions: In older patients with cancer, age negatively impacted physical function and positively impacted emotional function.
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Affiliation(s)
| | - Anke Bergmann
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Brazil
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Pata G, Bianchetti L, Rota M, Marengoni A, Chiesa D, Cassinotti E, Palmisano S, Colombi M, Del Zotto G, Romanelli G, Calza S, Boni L, De Manzini N, Fumagalli Romario U. Multidimensional Prognostic Index (MPI) score has the major impact on outcome prediction in elderly surgical patients with colorectal cancer: The FRAGIS study. J Surg Oncol 2020; 123:667-675. [PMID: 33238052 DOI: 10.1002/jso.26314] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/12/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study aims (I) to evaluate whether the Multidimensional Prognostic Index (MPI) score is associated with postoperative outcomes and (II) to develop a prognostic model for individual complication-risk prediction following colorectal cancer (CRC) surgery. METHOD This is a prospective multicentric cohort study. Consecutive ≥75-year-old candidates for elective CRC surgery were enrolled from October 2017 to August 2019. Patients underwent standardized preoperative geriatric assessment including the MPI. Patients with MPI score > 0.33 were classified as frail. Logistic regression models were employed to evaluate variables associated with major postoperative complications and mortality, using 10-fold cross-validated LASSO (least absolute shrinkage and selection operator) for model selection. RESULTS In all, 104 patients were included, 34 (33%) had MPI score > 0.33. Major postoperative complications occurred in 52% of frail versus 16% of fit (MPI score ≤ 0.33) patients (p < .01). Both 30-day (9% vs. 0%; p = .033) and 90-day mortality (18% vs. 1%; p < .01) were higher among frail patients. In multivariate analysis, MPI score was associated with adverse outcomes. A final postoperative complication predictive model was created, including MPI score, gait-speed test, ASA (American Society of Anesthesiology) score, surgical approach, and stoma creation. CONCLUSION MPI score is strongly associated with postoperative major complications in CRC elderly patients and it is a primary component of an individual prediction model.
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Affiliation(s)
- Giacomo Pata
- General Surgery 2 Unit, University Hospital ASST Spedali Civili of Brescia, Brescia, Italy
| | - Luca Bianchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Rota
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Deborah Chiesa
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS-Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Silvia Palmisano
- Department of Surgery, Ospedali Riuniti, University of Trieste, Trieste, Italy
| | - Marta Colombi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giulio Del Zotto
- Department of Surgery, Ospedali Riuniti, University of Trieste, Trieste, Italy
| | - Giuseppe Romanelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Big and Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Brescia, Italy
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS-Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Nicolò De Manzini
- Department of Surgery, Ospedali Riuniti, University of Trieste, Trieste, Italy
| | - Uberto Fumagalli Romario
- General Surgery 2 Unit, University Hospital ASST Spedali Civili of Brescia, Brescia, Italy.,Digestive Surgery Unit, European Institute of Oncology (IEO), IRCCS, Milan, Italy
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Liuu E, Hu C, Valero S, Brunet T, Jamet A, Bureau ML, Pilotto A, Saulnier PJ, Paccalin M. Comprehensive geriatric assessment in older patients with cancer: an external validation of the multidimensional prognostic index in a French prospective cohort study. BMC Geriatr 2020; 20:295. [PMID: 32811435 PMCID: PMC7433061 DOI: 10.1186/s12877-020-01692-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 08/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Older patients with cancer require specific and individualized management. The 3-group Multidimensional Prognostic Index (MPI) based on the Comprehensive Geriatric Assessment (CGA) has shown a predictive interest in terms of mortality. The objective of our study was to assess the prognostic value of MPI for 1-year mortality in an external prospective French cohort of elderly patients with cancer. METHODS From March 2015 to March 2017 a prospective single-center cohort study enrolled all patients with cancer, aged 75 years and older referred to the geriatric oncology clinic. We used a proportional hazard model for 1-year mortality adjusted for age, sex, tumor sites and metastatic status. C-statistics were used to assess the incremental predictive value of MPI index to these risk factors. RESULTS overall, 433 patients underwent CGA with MPI (women 42%; mean age 82.8 ± 4.8 years). The most common tumor sites were prostate (23%), skin (17%), colorectum (15%) and breast (12%); 29% of patients had a metastatic disease; 231 patients (53%) belonged to the "MPI-1" group, 172 (40%) to the "MPI-2" group and 30 patients were classified in the "MPI-3" group. One-year mortality rate was 32% (23% in MPI-1, 41% in MPI-2 and 53% in MPI-3, p = 0.024). All domains of MPI except cognition and living status were significantly associated with mortality at one-year, as well as tumor sites and metastatic status. Higher MPI was associated with a higher mortality risk (adjusted HR 1.56 [95%CI 1.70-2.09] and 1.72 [1.33-2.22] for MPI groups 2 and 3 compared to 1; p < 0.0001). CONCLUSIONS In addition to established risk factors, MPI improves risk prediction of 1-year mortality. This practical prognostic tool may help to optimize management of these vulnerable patients.
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Affiliation(s)
- Evelyne Liuu
- Department of Geriatrics, Poitiers University Hospital, Poitiers, France.
- Clinical Investigation Centre CIC1402, CHU Poitiers, University of Poitiers, INSERM, Poitiers, France.
| | - Chunyun Hu
- Department of Geriatrics, Poitiers University Hospital, Poitiers, France
| | - Simon Valero
- Department of Geriatrics, Poitiers University Hospital, Poitiers, France
| | - Thomas Brunet
- Department of Geriatrics, Poitiers University Hospital, Poitiers, France
| | - Amelie Jamet
- Department of Geriatrics, Poitiers University Hospital, Poitiers, France
| | - Marie-Laure Bureau
- Department of Geriatrics, Poitiers University Hospital, Poitiers, France
| | - Alberto Pilotto
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy
- Department of interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Pierre-Jean Saulnier
- Clinical Investigation Centre CIC1402, CHU Poitiers, University of Poitiers, INSERM, Poitiers, France
| | - Marc Paccalin
- Department of Geriatrics, Poitiers University Hospital, Poitiers, France
- Clinical Investigation Centre CIC1402, CHU Poitiers, University of Poitiers, INSERM, Poitiers, France
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Pilotto A, Custodero C, Maggi S, Polidori MC, Veronese N, Ferrucci L. A multidimensional approach to frailty in older people. Ageing Res Rev 2020; 60:101047. [PMID: 32171786 PMCID: PMC7461697 DOI: 10.1016/j.arr.2020.101047] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 02/13/2020] [Accepted: 03/10/2020] [Indexed: 12/13/2022]
Abstract
Frailty is an important factor determining a higher risk of adverse health outcomes in older adults. Although scientific community in the last two decades put a lot of effort for its definition, to date no consensus was reached on its assessment. The mainstream thinking describes frailty as a loss of physical functions or as accumulation of multiple deficits. Recently, a novel conceptual model of frailty has emerged based on the loss of harmonic interaction between multiple domains (also referred as dimensions) including genetic, biological, functional, cognitive, psychological and socio-economic domain that ultimately lead to homeostatic instability. Therefore, the multidimensional aspects of frailty condition could be captured by the comprehensive geriatric assessment (CGA) and its derived Multidimensional Prognostic Index (MPI). This instrument has been applied in different clinical settings and in several cohorts of older adults with specific acute and chronic diseases, showing always excellent accuracy in stratifying population according the mortality risk and other negative health outcomes, i.e. hospitalization, institutionalization or admission to homecare services. This MPI "plasticity" provides a single numerical prognostic index which could be helpful in clinical decision making for the management of frail older adults.
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Affiliation(s)
- Alberto Pilotto
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy; Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy.
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Stefania Maggi
- National Research Council (CNR), Aging Section, Padova, Italy
| | | | - Nicola Veronese
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy; Azienda ULSS 3 Serenissima, Primary Care Department, District 3, Venice, Italy
| | - Luigi Ferrucci
- National Institute on Aging, NIH, Baltimore, MD, United States
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9
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Sbrana A, Antognoli R, Pasqualetti G, Linsalata G, Okoye C, Calsolaro V, Paolieri F, Bloise F, Ricci S, Antonuzzo A, Monzani F. Effectiveness of Multi-Prognostic Index in older patients with advanced malignancies treated with immunotherapy. J Geriatr Oncol 2019; 11:503-507. [PMID: 31672558 DOI: 10.1016/j.jgo.2019.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/07/2019] [Accepted: 09/30/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Older adults with cancer are less likely to be offered treatment for cost-benefit concern. The Multi-Prognostic Index (MPI) has been validated in various clinical settings for survival estimation. We aimed to evaluate MPI as a screening tool for older adults with cancer eligible to receive immunotherapy. PATIENTS AND METHODS Older adults with advanced or metastatic cancer, admitted to the Oncology Day Hospital of the University Hospital of Pisa from January 2017 to May 2018, eligible to receive immunotherapy were prospectively enrolled. In addition to routine oncological evaluation, each patient received a comprehensive geriatric assessment with MPI calculation. Overall survival (Cox-adjusted curve) was stratified by tertiles of MPI score. Drug toxicity was assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (Version 4.03: June 14, 2010). RESULTS Seventy-nine patients [26.6% women, mean age (±SD) 74.0 ± 6.1 years] were enrolled with the following diagnosis: melanoma (51.9%), non-small cell lung cancer (25.3%), renal cell cancer (12.7%), urothelial cancer (8.9%) and Merkel cell carcinoma (1.2%). Median follow-up was 7 months (range 1-35). The patients' survival rate resulted progressively longer proceeding from the first to the third MPI tertile [HR 1.76 (0.49-6.31) Vs 2nd tertile, p < 0.05; HR 5.33 (1.68-16.89) Vs 3rd tertile, p < 0.01]. CONCLUSIONS MPI score is an effective tool for the stratification of older patients with cancer eligible for immunotherapy with checkpoint inhibitors. Further studies are required to achieve conclusive remarks on MPI usefulness in different underlying tumor types.
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Affiliation(s)
- Andrea Sbrana
- Oncology Unit 1, Pisa University Hospital, via Roma 67, 56126 Pisa, Italy
| | - Rachele Antognoli
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University of Pisa, via Savi 10, 56127 Pisa, Italy
| | - Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University of Pisa, via Savi 10, 56127 Pisa, Italy.
| | - Giuseppe Linsalata
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University of Pisa, via Savi 10, 56127 Pisa, Italy
| | - Chukwuma Okoye
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University of Pisa, via Savi 10, 56127 Pisa, Italy
| | - Valeria Calsolaro
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University of Pisa, via Savi 10, 56127 Pisa, Italy
| | - Federico Paolieri
- Oncology Unit 1, Pisa University Hospital, via Roma 67, 56126 Pisa, Italy
| | - Francesco Bloise
- Oncology Unit 1, Pisa University Hospital, via Roma 67, 56126 Pisa, Italy
| | - Sergio Ricci
- Oncology Unit 1, Pisa University Hospital, via Roma 67, 56126 Pisa, Italy
| | - Andrea Antonuzzo
- Oncology Unit 1, Pisa University Hospital, via Roma 67, 56126 Pisa, Italy.
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University of Pisa, via Savi 10, 56127 Pisa, Italy
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Hathout L, Maloney-Patel N, Malhotra U, Wang SJ, Chokhavatia S, Dalal I, Poplin E, Jabbour SK. Management of locally advanced rectal cancer in the elderly: a critical review and algorithm. J Gastrointest Oncol 2018; 9:363-376. [PMID: 29755777 DOI: 10.21037/jgo.2017.10.10] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Colorectal cancer incidence and death rates have been declining over the past 10 years. However, it remains the second leading cause of death in men ages 60-79 and the third leading cause of death in men over 80 and in women over 60 years old. However, there is little data specific to the treatment of the elder patient, since few of these patients are included in trials. With the advent of improved therapies, there are many alternative options available. Still, no definitive consensus or guidelines have been defined for this particular patient population. The goal of this study is to review the literature on the management of rectal cancer in the elderly and to propose treatment algorithms to help the oncology team in treatment decision-making.
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Affiliation(s)
- Lara Hathout
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Nell Maloney-Patel
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Usha Malhotra
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Shang-Jui Wang
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | | | - Ishita Dalal
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Elizabeth Poplin
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
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11
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Polypharmacy in Older Adults with Cancer: Evaluating Polypharmacy as Part of the Geriatric Assessment. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0221-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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12
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de Lucia C, Komici K, Borghetti G, Femminella GD, Bencivenga L, Cannavo A, Corbi G, Ferrara N, Houser SR, Koch WJ, Rengo G. microRNA in Cardiovascular Aging and Age-Related Cardiovascular Diseases. Front Med (Lausanne) 2017; 4:74. [PMID: 28660188 PMCID: PMC5466994 DOI: 10.3389/fmed.2017.00074] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/26/2017] [Indexed: 12/17/2022] Open
Abstract
Over the last decades, life expectancy has significantly increased although several chronic diseases persist in the population, with aging as the leading risk factor. Despite improvements in diagnosis and treatment, many elderlies suffer from cardiovascular problems that are much more frequent in an older, more fragile organism. In the long term, age-related cardiovascular diseases (CVDs) contribute to the decline of quality of life and ability to perform normal activities of daily living. microRNAs (miRNAs) are a class of small non-coding RNAs that regulate gene expression at the posttranscriptional level in both physiological and pathological conditions. In this review, we will focus on the role of miRNAs in aging and age-related CVDs as heart failure, hypertension, atherosclerosis, atrial fibrillation, and diabetes mellitus. miRNAs are key regulators of complex biological mechanisms, representing an exciting potential therapeutic target in CVDs. Moreover, one major challenge in geriatric medicine is to find reliable biomarkers for diagnosis, prognosis, and prediction of the response to specific drugs. miRNAs represent a very promising tool due to their stability in the circulation and unique signature in CVDs. However, further studies are needed to investigate their translational potential in the real clinical practice.
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Affiliation(s)
- Claudio de Lucia
- Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.,Center for Translational Medicine, Department of Pharmacology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Klara Komici
- Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Giulia Borghetti
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Grazia Daniela Femminella
- Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Leonardo Bencivenga
- Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Alessandro Cannavo
- Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.,Center for Translational Medicine, Department of Pharmacology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Nicola Ferrara
- Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.,Scientific Institute of Telese Terme, Salvatore Maugeri Foundation, IRCCS, Benevento, Italy
| | - Steven R Houser
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Walter J Koch
- Center for Translational Medicine, Department of Pharmacology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Giuseppe Rengo
- Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.,Scientific Institute of Telese Terme, Salvatore Maugeri Foundation, IRCCS, Benevento, Italy
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