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Afolabi HA, Salleh SM, Zakaria Z, Seng CE, Nafi NM, Bin AbdulAziz AA, Wada Y, Irekeola AA, Al-Ml-hanna SB, Mussa A. Targeted variant prevalence of FBXW7 gene mutation in colorectal carcinoma propagation. The first systematic review and meta-analysis. Heliyon 2024; 10:e31471. [PMID: 38845996 PMCID: PMC11154211 DOI: 10.1016/j.heliyon.2024.e31471] [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: 09/08/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/09/2024] Open
Abstract
FBXW7 is a tumour suppressor gene that functions as E3-ubiquitin-ligase, targeting numerous oncoproteins for degradation, i.e., Cyclin-E, c-Myc, and Notch. FBXW7 performs a pivotal role in regulating cell cycle progression. FBXW7 mutation is frequently implicated in various cancers. Methodology A systematic review and meta-analysis done on several studies using "Preferred Reporting Items for Systemmatic Reviews and Meta-Analysis (PRISMA)" criteria and registered with PROSPERO (registration-number-CRD42023388845). The preliminary search comprises 1182 articles; however, 58 studies were subsequently chosen after eliminating non-eligible studies. To explore the prevalence of FBXW7 mutation among colorectal cancer patients, data were analysed using "OpenMeta Analyst and comprehensive meta-analysis-3.0 (CMA-3.0)" software. Results This meta-analysis involves 13,974 respondents; most were males 7825/13,974, (56.0 %). Overall prevalence of FBXW7 mutations was 10.3 %, (95%CI: 8.6-12.4), I2 = 90.5 %, (P < 0.001). The occurrence of FBXW7 mutations was highest in Russia [19.0 %, (95%CI: 9.8-33.7)] and Taiwan [18.8 %, (95%CI: 8.7-35.9)], P-values< 0.05 while the least prevalence was reported in Netherland (4 %) and Italy (5 %), both P-values< 0.001. Overall prevalence of FBXW7 abberation was greatest amongst male gender: "53.9 %, (95%CI: 8.3-62.0 %)", Tumour location (colon): 59.8 %, (95%CI: 53.9-65), tumour site (left): 61.6 %, (95%CI: 53.8-68.9), Tumour-grade (Moderate): 65.9 %, (95%CI: 54.9-75.4 %), and Tumour late-stage: 67.9 %, (95%CI: 49.7-84.3 %), all P-values< 0.001. When stratified according to study-period, an increasing trend was noted from 2018 till present with the highest mutation rate recorded in 2022 (15.3 %). Conclusion Overall prevalence of FBXW7 mutations was 10.3 % with male gender, left side, and late-stage being most mutated, and these outcomes conform with severally published articles on FBXW7 mutation.
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Affiliation(s)
- Hafeez Abiola Afolabi
- Department of General Surgery, School of Medical Sciences, Hospital Universiti Sains Malaysia (HUSM), Health Campus, Universiti Sains Malaysia (USM), Kubang Kerian, Kelantan, 16150, Malaysia
| | - Salzihan Md Salleh
- Department of Pathology, School of Medical Sciences, Hospital Universiti Sains Malaysia (HUSM), Health Campus, Universiti Sains Malaysia (USM), Kubang Kerian, 16150, Kelantan, Malaysia
| | - Zaidi Zakaria
- Department of General Surgery, School of Medical Sciences, Hospital Universiti Sains Malaysia (HUSM), Health Campus, Universiti Sains Malaysia (USM), Kubang Kerian, Kelantan, 16150, Malaysia
| | - Ch'ng Ewe Seng
- Department of Pathology, Advanced Medical & Dental Institute, Universiti Sains Malaysia (USM), Kepala Batas, 13200, Malaysia
| | - Norasikin Mohd Nafi
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia (USM), Health Campus, Kubang Kerian, 16150, Malaysia
| | - Ahmad Aizat Bin AbdulAziz
- Department of Human Genome Centre, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Yusuf Wada
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
- Department of Zoology, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Ahmad Adebayo Irekeola
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Sameer Badri Al-Ml-hanna
- Department of Exercise Physiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Ali Mussa
- Department of Biology, Faculty of Education, Omdurman Islamic University, Omdurman, P.O. Box 382, Sudan
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
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Wei MYK, Besson A, Popovska G, Yeung JMC. Can POPS (proactive care of older people undergoing surgery) solve "An Age Old Problem" in colorectal surgery? ANZ J Surg 2023; 93:2796-2797. [PMID: 37475196 DOI: 10.1111/ans.18606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Matthew Y K Wei
- Department of Colorectal Surgery, Western Health, Footscray, Victoria, Australia
- Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
| | - Alex Besson
- Department of Colorectal Surgery, Western Health, Footscray, Victoria, Australia
| | - Gordana Popovska
- Department of Geriatric Medicine, Western Health, Footscray, Victoria, Australia
| | - Justin M C Yeung
- Department of Colorectal Surgery, Western Health, Footscray, Victoria, Australia
- Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
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Chen MZ, Tan M, Walter T, Rich G, Barto W. Colonoscopy in the nonagenarian population. ANZ J Surg 2023; 93:2143-2147. [PMID: 36881524 DOI: 10.1111/ans.18374] [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: 12/18/2022] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND With increasing life expectancy, there is an increasing proportion of nonagenarians undergoing both elective and emergency surgical procedures. The decision as to whom will benefit from surgical procedures is however difficult to ascertain and still remains a challenge to clinicians. This study is aimed to evaluate the clinical outcomes of colonoscopy in the nonagenarian population, and to determine if the outcomes are acceptable for us to continue to offer such interventions. METHODS Retrospective study of patients of Dr. G.R (Gastroenterologist) and Dr. W.B (Colorectal Surgeon) between 1 January 2018 and 31 November 2022. All patients who were ≥90 years old and had a colonoscopy was included in the study. Exclusion criteria were patients who were less than 90 years old, had a flexible sigmoidoscopy or colonoscopy as part of their surgical procedure. PRIMARY OUTCOME MEASURES post-colonoscopy complications and length of stay. SECONDARY OUTCOME MEASURES reasons for colonoscopy, significant colonoscopy findings, 30-day morbidity and mortality. RESULTS Sixty patients were included in the study. Median age was 91 (90-100) years old. 33.3% of the patients were males. Seventy percent of the patients were ASA 3. Median length of hospital stay was 1 day. 11.7% of patients were found to have colorectal malignancy. There were no complications after the colonoscopy. There were no 30-day re-admission, morbidity or mortality. CONCLUSION Colonoscopy can be performed safely in carefully selected nonagenarian patients with acceptable low complication rates.
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Affiliation(s)
- Michelle Zhiyun Chen
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Min Tan
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Tim Walter
- Department of Gastroenterology, Sydney Adventist Hospital, Sydney, New South Wales, Australia
- Australian National University, Sydney, New South Wales, Australia
| | - Graeme Rich
- Department of Gastroenterology, Sydney Adventist Hospital, Sydney, New South Wales, Australia
- Australian National University, Sydney, New South Wales, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Walid Barto
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
- Department of Surgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia
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Waring J, Martin GP, Hartley P, Partridge JSL, Dhesi JK. Implementing a perioperative care of older people undergoing surgery (POPS) service: findings from a multi-site qualitative implementation study. Age Ageing 2023; 52:afad149. [PMID: 37566561 PMCID: PMC10418147 DOI: 10.1093/ageing/afad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The Perioperative care for Older People undergoing Surgery (POPS) service model is increasingly being implemented across care providers in the English and Welsh National Health Services. OBJECTIVE The study aimed to produce evidence regarding clinical leaders' activities to implement POPS across different service contexts and to produce generalisable recommendations for future implementation. METHODS A qualitative interview study was undertaken across six National Health Services hospitals with established POPS services. Interview participants were recruited on the basis of their direct involvement in the implementation and leadership of the service. Data collection involved semi-structured interviews with 26 people carried out between November 2022 and May 2023. RESULTS The implementation of POPS is often hampered by a lack of managerial and financial support, and apprehension amongst surgeons and anaesthetist about new ways of working. POPS leaders address these through five interconnected activities, each targeted at a combination of implementation factors. (i) Securing management and financial support. (ii) Professional engagement. (iii) Evidence building as a resource for demonstrating the clinical and operational benefits of POPS. (iv) Communication and engagement activities to promote and legitimise POPS to stakeholder groups. (v) Designated and distributed leadership to promote and coordinate implementation activities and to spread the service to new pathways. CONCLUSIONS Through a combination of activities POPS can be effectively implemented across different organisational contexts. Some aspects of these activities can be guided by shared resources and learning across sites, but others require adaption to local contextual barriers and drivers.
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Affiliation(s)
- Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, UK
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Graham P Martin
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Peter Hartley
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Judith S L Partridge
- Division of Health and Social Care Research, Kings College London, London, UK
- Department of Ageing and Health, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Jugdeep K Dhesi
- Division of Health and Social Care Research, Kings College London, London, UK
- Department of Ageing and Health, Guy's and St Thomas’ NHS Foundation Trust, London, UK
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Dolin TG, Mikkelsen MK, Jakobsen HL, Vinther A, Zerahn B, Nielsen DL, Johansen JS, Lund CM, Suetta C. The prevalence of sarcopenia and cachexia in older patients with localized colorectal cancer. J Geriatr Oncol 2023; 14:101402. [PMID: 36424269 DOI: 10.1016/j.jgo.2022.11.001] [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: 05/07/2022] [Revised: 10/17/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The incidence of colorectal cancer (CRC) increases with age. In combination with an ageing population, the number of older patients undergoing surgical treatment for CRC is therefore expected to increase. Sarcopenia and cachexia are potentially modifiable risk factors of a negative surgical outcome. Sarcopenia can be categorized into primary (age-related) and secondary where diseases, such as malignancy, are influential factors. We aimed to investigate the prevalence of preoperative sarcopenia and cachexia in older (≥65 years) vulnerable patients with localized CRC. MATERIALS AND METHODS Patients included in the randomized study "Geriatric assessment and intervention in older vulnerable patients undergoing resection for colorectal cancer," were screened for sarcopenia and cachexia prior to surgery. All patients in the present cohort were considered vulnerable with Geriatric 8 ≤ 14 points. Sarcopenia was defined according to European Guidelines (EWGSOP2), based on low muscle strength-low handgrip-strength and/or slow 5xChair-Stand-Test-and low appendicular lean mass assessed by dual-energy X-ray absorptiometry. Cachexia was defined as self-reported unintended weight loss >5% within three months or 2-5% with body mass index <20 kg/m2. RESULTS Sixty-four patients (mean age 79.6 years ±6.4 years, 36 women) were assessed. Of these, 28% (n = 18, 11 women) had low muscle strength and 13% (n = 8, 4 women) fulfilled the criteria for sarcopenia, however, 33% (n = 21, 13 women) had low muscle mass. There was no correlation between low muscle strength and low muscle mass (r = 0.16, P = 0.22). The prevalence of cachexia was 36% (n = 23, 16 women). Low muscle mass was associated with cachexia (φ = 0.38, P = 0.005), but there was no association between sarcopenia and cachexia (φ = 0.01, P = 1.0). DISCUSSION Despite the included patients who fulfilled the criteria for vulnerability according to G8, relatively few (28%) had low muscle strength. Moreover, there was poor overlap between the prevalence of sarcopenia according to the EWGSOP2 guidelines (13%) and prevalence of low muscle mass (33%) in older patients with CRC. Of note also, there was no association between sarcopenia and cachexia, but an association between cachexia and low muscle mass, which highlights the importance of assessing muscle mass in patients with cancer. TRIAL REGISTRATION The GEPOC trial has been prospectively registered at http://clinicaltrials.gov (NCT03719573).
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Affiliation(s)
- Troels Gammeltoft Dolin
- Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; CopenAge - Copenhagen Center for Clinical Age Research - University of Copenhagen, Denmark.
| | - Marta Kramer Mikkelsen
- Department of Oncology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - Henrik Loft Jakobsen
- Department of Gastrointestinal Surgery, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy - Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark; Hospital Secretariat and Communications; Research, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Dorte Lisbet Nielsen
- Department of Oncology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Julia Sidenius Johansen
- Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Oncology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Cecilia Margareta Lund
- Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; CopenAge - Copenhagen Center for Clinical Age Research - University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Charlotte Suetta
- Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
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Comprehensive geriatric assessment and multidisciplinary team interventions for hospitalized older adults: A scoping review. Arch Gerontol Geriatr 2023; 104:104831. [PMID: 36279806 DOI: 10.1016/j.archger.2022.104831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND/OBJECTIVES Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic and treatment process to evaluate medical, psychosocial, and functional capability. It is useful to develop a coordinated and integrated plan for frail older patients. This study aimed to examine the current scope of CGA based multidisciplinary team interventions in acute care setting to improve the health outcomes for older adults. METHODS We searched electronic databases: PubMed, Ovid, PsychINFO, Scopus, RISS and KoreaMed from 2011 to 2021. The selected articles were extracted by three reviewers and cross checked by the fourth reviewer to resolve any conflicts. Data were synthesized and analyzed descriptively and thematically. Articles are nested three themes: inpatient (IN), emergency room (ER) and oncology patient (ONCO). RESULTS Of the 1830 articles that were screened, 710 were potentially eligible. Finally, 26 articles were selected and categorized as IN (n=8), ER (n=7) and ONCO (n=11). Geriatricians and nurses participated in most of the multidisciplinary teams followed by other health professionals. The most effective primary outcomes were focused and retrieved across five domains, screening, prevention, treatment, quality of care, and rehabilitation. The subdomains are problem lists which is common and problematic among hospitalized older patients and retrieved from the most commonly used multidisciplinary interventions according to each domain. CONCLUSION CGA based multidimensional intervention (MDI) are likely to be an effective in care of older adults. There is remarkable paradigm shift required to improve better health outcomes for hospitalized older adults. It also suggests that there is a need to design the CGA based MDI to build a standardized protocol for older adults to maintain functional capacity and increase likelihood of living in their own home.
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Olsen AP, Vinther A, Ragle AM, Dolin TG, Johansen JS, Vistisen K, Nielsen DL, Lund CM. Physical exercise program to older frail patients receiving chemotherapy for colorectal cancer - feasibility and experiences from the GERICO study. J Geriatr Oncol 2023; 14:101382. [PMID: 36328878 DOI: 10.1016/j.jgo.2022.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Older and frail patients with cancer are at high risk of physical and functional decline during chemotherapy. Exercise interventions can often counteract chemotherapy related toxicity and may help patients to improve or retain physical function and quality of life. Studies evaluating feasibility and the effect of exercise in older patients are lacking. The aim of this study was to investigate the feasibility and effect of an exercise intervention in older frail patients during chemotherapy for colorectal cancer (CRC). MATERIALS AND METHODS This is a secondary analysis from the GERICO study investigating the effect of geriatric interventions in frail patients ≥70 years receiving chemotherapy for CRC. All patients in the present analysis were patients randomized to geriatric interventions and who were found physically frail (low handgrip strength or slow 10 m gait speed) and therefore offered referral to the exercise program for twelve weeks. We evaluated reasons for dropping out and feasibility of an individually tailored exercise program twice a week for twelve weeks. Each 60 min session comprised warm-up followed by progressive resistance training and cool-down followed by an oral protein supplement. Baseline characteristics and the effect of exercise for patients with high and low adherence (attendance of <50% of exercise sessions) were compared. RESULTS Of 71 patients in the intervention group, 47 (66%) were found physically frail and were offered referral to the exercise program. Seven patients were referred to municipal physiotherapy before study start. In the remaining population (N = 40) 19 had exercise adherence >50% and 21 had no or low exercise adherence. Baseline characteristics were similar between patients with high and low/no adherence, except for sex (68% and 33% were men in high and low/ no adherence group, respectively). Patients with >50% attendance had significant improvements in physical tests after twelve weeks of exercise. DISCUSSION Low adherence to the exercise program was seen due to lack of energy and/or treatment related adverse events. Patients with high adherence benefitted from exercise during chemotherapy but did not differ from patients with low adherence at baseline. Consequently, exercise should be offered to all older frail patients receiving chemotherapy for CRC.
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Affiliation(s)
- Anne Pries Olsen
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark.
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark; Hospital Secretariat and Communications, Research, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Anne-Mette Ragle
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Troels Gammeltoft Dolin
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark
| | - Julia Sidenius Johansen
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark; Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Kirsten Vistisen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark
| | - Dorte L Nielsen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Cecilia Margareta Lund
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, 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
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Afolabi HA, Salleh SM, Zakaria Z, Ch’ng ES, Mohd Nafi SN, Abdul Aziz AAB, Irekeola AA, Wada Y, Al-Mhanna SB. A GNAS Gene Mutation's Independent Expression in the Growth of Colorectal Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14225480. [PMID: 36428574 PMCID: PMC9688108 DOI: 10.3390/cancers14225480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Globally, colorectal carcinoma CRC is the third most common cancer and the third most common reason for cancer-associated mortality in both genders. The GNAS mutations are significantly linked with poor prognosis and failed treatment outcomes in CRC. A systematic review and meta-analysis of multiple studies executed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria and registered with PROSPERO (registration number: CRD42021256452). The initial search includes a total of 271 publications; however, only 30 studies that merit the eligibility criteria were eventually chosen. Data analysis via OpenMeta Analyst and comprehensive meta-analysis 3.0 (CMA 3.0) software were used to investigate the prevalence of GNAS gene mutation among CRC patients. The meta-analysis consisted of 10,689 participants with most being males 6068/10,689 (56.8%). Overall, prevalence of GNAS mutations was 4.8% (95% CI: 3.1−7.3) with I2 = 94.39% and (p < 0.001). In 11/30 studies, the frequency of GNAS gene mutations was majorly in codons R201C [40.7% (95% CI: 29.2−53.2%)] and in codon R201H [39.7% (95% CI = 27.1−53.8)]. Overall prevalence of GNAS mutations was highest among the male gender: 53.9% (95% CI: 48.2−59.5%: I2 = 94.00%, (p < 0.001), tumour location (colon): 50.5% (95% CI: 33.2−67.6%: I2 = 97.93%, (p < 0.001), tumour grade (Well): 57.5% (95% CI: 32.4−79.2%: I2 = 98.10%, (p < 0.001) and tumour late stage: 67.9% (95% CI: 49.7−84.3%: I2 = 98.%, (p < 0.001). When stratified according to study location, a higher prevalence was observed in Japan (26.8%) while Italy has the lowest (0.4%). Overall prevalence of GNAS gene mutations was 4.8% with codons R201C and R201H being the most mutated, and the results conformed with numerous published studies on GNAS mutation.
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Affiliation(s)
- Hafeez Abiola Afolabi
- Department of General Surgery, School of Medical Sciences, Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Salzihan Md Salleh
- Department of Pathology, School of Medical Sciences, Hospital Universiti Sains Malaysia (HUSM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia (USM), Health Campus, Kubang Kerian 16150, Malaysia
- Correspondence: or
| | - Zaidi Zakaria
- Department of General Surgery, School of Medical Sciences, Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Ewe Seng Ch’ng
- Advanced Medical and Dental Institute, Universiti Sains Malaysia USM, Kepala Batas 13200, Malaysia
| | - Siti Norasikin Mohd Nafi
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia (USM), Health Campus, Kubang Kerian 16150, Malaysia
| | - Ahmad Aizat Bin Abdul Aziz
- Department of Human Genome Centre, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Ahmad Adebayo Irekeola
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Yusuf Wada
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Sameer Badri Al-Mhanna
- Department of Physiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
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Miller RL, Barnes JD, Mouton R, Braude P, Hinchliffe R. Comprehensive geriatric assessment (CGA) in perioperative care: a systematic review of a complex intervention. BMJ Open 2022; 12:e062729. [PMID: 36270763 PMCID: PMC9594523 DOI: 10.1136/bmjopen-2022-062729] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Comprehensive geriatric assessment (CGA) is a complex intervention applied to older people with evidence of benefit in medical populations. The aim of this systematic review was to describe how CGA is applied to surgical populations in randomised controlled trials. This will provide a basis for design of future studies focused on optimising CGA as a complex intervention. SETTING A systematic review of randomised controlled trials. PARTICIPANTS A systematic search was performed for studies of CGA in the perioperative period across Ovid MEDLINE, Ovid EMBASE, CINAHL and Cochrane CENTRAL, from inception to March 2021. INTERVENTIONS Any randomised controlled trials of perioperative CGA versus 'standard care' were included. OUTCOME MEASURES Qualitative description of CGA. RESULTS 12 121 titles and abstracts were screened, 68 full-text articles were assessed for eligibility and 22 articles included, reporting on 13 trials. 10 trials focused on inpatients with hip fracture, with 7 of these delivering CGA on a geriatric medicine ward, 3 on a surgical ward. The remaining three trials were in elective general surgery all delivering CGA on a surgical ward. CGA components, duration of intervention and personnel delivering the intervention were highly variable across the different studies. Trials favoured postoperative delivery of CGA (11/13). Only four trials reported data on adherence to the CGA intervention. CONCLUSIONS CGA as an intervention is variably described and delivered in randomised controlled trials in the perioperative setting. The reporting of both the intervention and standard care is often poor with little focus on adherence. Future research should focus on clearly defining and standardising the intervention as well as measuring adherence within trials. PROSPERO REGISTRATION NUMBER CRD42020221797.
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Affiliation(s)
- Rachael Lucia Miller
- Translational Health Sciences, University of Bristol, Bristol, UK
- Vascular Surgery, North Bristol NHS Trust, Bristol, England
| | | | - Ronelle Mouton
- Translational Health Sciences, University of Bristol, Bristol, UK
- Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Philip Braude
- CLARITY (Collaborate Ageing Research) group, North Bristol NHS Trust, Bristol, UK
| | - Robert Hinchliffe
- Translational Health Sciences, University of Bristol, Bristol, UK
- Vascular Surgery, North Bristol NHS Trust, Bristol, England
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Ford KL, Prado CM, Weimann A, Schuetz P, Lobo DN. Unresolved issues in perioperative nutrition: A narrative review. Clin Nutr 2022; 41:1578-1590. [PMID: 35667274 DOI: 10.1016/j.clnu.2022.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 12/23/2022]
Abstract
Surgical patients are at an increased risk of negative outcomes if they are malnourished or at risk of malnutrition preoperatively. Optimisation of nutritional status should be a focus throughout the perioperative continuum to promote improved surgical outcomes. Enhanced Recovery after Surgery (ERAS) protocols are increasingly applied in the surgical setting but are not yet widespread. This narrative review focused on areas of perioperative nutrition that are perceived as controversial or are lacking in agreement. A search for available literature was conducted on 1 March 2022 and relevant high-quality articles published since 2015 were considered for inclusion. Most malnutrition screening tools are not specific to the surgical population except for the Perioperative Nutrition Screen (PONS) although more large-scale initiatives are needed to improve the prevalence of preoperative nutrition screening. Poor muscle health is common in patients with malnutrition and further exacerbates negative health outcomes indicating that prevention, detection and treatment is of high importance in this population. Although a lack of consensus remains for who should receive preoperative nutritional therapy, evidence suggests a positive impact on muscle health. Additionally, postoperative nutritional support benefits surgical outcomes, with some patients requiring enteral and/or parenteral feeding routes and showing benefit from immunonutrition. The importance of nutrition extends beyond the time in hospital and should remain a priority post-discharge. The impact of individual or personalised nutrition based on select patient characteristics remains to be further investigated. Overall, the importance of perioperative nutrition is evident in the literature despite select ongoing areas of contention.
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Affiliation(s)
- Katherine L Ford
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, Klinikum St. Georg, Leipzig, Germany
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
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11
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Afolabi H, Md Salleh S, Zakaria Z, Seng CE, Mohd Nafil SNB, Abdul Aziz AAB, Wada Y, Irekeola A. A Systematic Review and Meta-analysis on the Occurrence of Biomarker Mutation in Colorectal Cancer among the Asian Population. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5824183. [PMID: 35782059 PMCID: PMC9246611 DOI: 10.1155/2022/5824183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/24/2022] [Indexed: 12/24/2022]
Abstract
Globally, colorectal carcinoma (CRC) is the third most common cancer and the third major cause of cancer-related death in both sexes. KRAS and BRAF mutations are almost mutually exclusively involved in the pathogenesis of CRC. Both are major culprits in treatment failure and poor prognosis for CRC. Method. A systematic review and meta-analysis of various research was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. This trial is registered with PROSPERO CRD42021256452. The initial search included 646 articles; after the removal of noneligible studies, a total of 88 studies was finally selected. Data analysis was carried out using OpenMeta Analyst and Comprehensive Meta-Analysis 3.0 (CMA 3.0) software to investigate the prevalence of KRAS and BRAF mutations among patients with CRC in Asia. Results. The meta-analysis comprises of 25,525 sample sizes from Asia with most being male 15,743/25525 (61.7%). Overall prevalence of KRAS mutations was (59/88) 36.3% (95% CI: 34.5-38.2) with I 2 = 85.54% (P value < 0.001). In 43/59 studies, frequency of KRAS mutations was majorly in codon 12 (76.6% (95% CI: 74.2-78.0)) and less in codon 13 (21.0% (95% CI: 19.1-23.0)). Overall prevalence of BRAF mutations was 5.6% (95% CI: 3.9-8.0) with I 2 = 94.00% (P value < 0.001). When stratified according to location, a higher prevalence was observed in Indonesia (71.8%) while Pakistan has the lowest (13.5%). Conclusion. Total prevalence of KRAS and BRAF mutations in CRC was 36.6% and 5.6%, respectively, and the results conformed with several published studies on KRAS and BRAF mutations.
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Affiliation(s)
- Hafeez Afolabi
- Department of General Surgery, School of Medical Sciences, Universiti Sains Malaysia Hospital, Malaysia
| | - Salzihan Md Salleh
- Department of Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kelantan, Malaysia
| | - Zaidi Zakaria
- Department of General Surgery, School of Medical Sciences, Universiti Sains Malaysia Hospital, Malaysia
| | - Ch'ng Ewe Seng
- Department of Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kelantan, Malaysia
| | - Siti Norasikin Binti Mohd Nafil
- Department of Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kelantan, Malaysia
| | - Ahmad Aizat Bin Abdul Aziz
- School of Medical Sciences, Hospital Universiti Sains Malaysia HUSM, Universiti Sains Malaysia USM, Kubang Kerian, 16150 Kelantan, Malaysia
| | - Yusuf Wada
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kelantan, Malaysia
| | - Ahmad Irekeola
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kelantan, Malaysia
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12
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Giannotti C, Massobrio A, Carmisciano L, Signori A, Napolitano A, Pertile D, Soriero D, Muzyka M, Tagliafico L, Casabella A, Cea M, Caffa I, Ballestrero A, Murialdo R, Laudisio A, Incalzi RA, Scabini S, Monacelli F, Nencioni A. Effect of Geriatric Comanagement in Older Patients Undergoing Surgery for Gastrointestinal Cancer: A Retrospective, Before-and-After Study. J Am Med Dir Assoc 2022; 23:1868.e9-1868.e16. [DOI: 10.1016/j.jamda.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
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13
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De Nardi P, Giani A, Maggi G, Braga M. Relation between skeletal muscle volume and prognosis in rectal cancer patients undergoing neoadjuvant therapy. World J Gastrointest Oncol 2022; 14:423-433. [PMID: 35317319 PMCID: PMC8919003 DOI: 10.4251/wjgo.v14.i2.423] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/01/2021] [Accepted: 01/06/2022] [Indexed: 02/06/2023] Open
Abstract
The prognostic role of body composition indexes, and specifically sarcopenia, has recently been explored in different cancer types. However, conflicting results have been reported. Heterogeneity in cancer type, cancer stage or oncological treatments, as well as different methodology and definition of sarcopenia, could be accounted for different conclusions retrieved from literature. When focusing on colorectal cancer, it clearly appears that colon and rectal cancers are often treated as a single entity though they have different behaviors and treatments. Particularly, patients with advanced rectal cancer represent a peculiar group of patients that according to current guidelines are treated with neoadjuvant chemotherapy and radiotherapy followed by radical surgery. This review was restricted to a homogeneous group of patients with advanced lower rectal cancer and the aim of exploring whether there is a correlation between skeletal muscle depletion and prognosis. Literature was searched for articles related to patients with advanced rectal cancer undergoing neoadjuvant chemo-radiotherapy (NCRT) followed by radical surgery, in whom muscle mass and/or change in muscle mass during neoadjuvant treatment were measured. Eight full-text articles were selected and included in the present review. The main findings of our review were: (1) The majority of the studies defined sarcopenia as muscle mass alone over muscle strength or physical performance; (2) There was a great deal of heterogeneity in the definition and measures of sarcopenia, in the definition of cut-off values, and in the method to measure change in muscle mass; (3) There was not full agreement on the association between sarcopenia at baseline and/or after chemo-radiotherapy and prognosis, and only few studies found a significance in the multivariate analysis; and (4) It seems that a loss in skeletal muscle mass during NCRT is associated with the worst outcomes in terms of disease-free survival. In conclusion, analysis of muscle mass might provide prognostic information on patients with rectal cancer, however more robust evidence is needed to define the role of muscle depletion and/or muscle change during neoadjuvant treatments, related to this specific group of patients. If a prognostic role would be confirmed by future studies, the role of preoperative intervention aimed at modifying muscle mass could be explored in order to improve outcomes.
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Affiliation(s)
- Paola De Nardi
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milano 20132, Italy
| | - Alessandro Giani
- Department of Surgery, School of Medicine, University of Milano-Bicocca, Milan Italy, Monza 20900, Italy
| | - Giulia Maggi
- Department of Oncologic Surgery, Policlinico Casilino, Rome 00169, Italy
| | - Marco Braga
- Department of Surgery, San Gerardo Hospital, University Milano Bicocca, Monza 20900, Italy
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14
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Cao A, Ferrucci LM, Caan BJ, Irwin ML. Effect of Exercise on Sarcopenia among Cancer Survivors: A Systematic Review. Cancers (Basel) 2022; 14:cancers14030786. [PMID: 35159052 PMCID: PMC8833677 DOI: 10.3390/cancers14030786] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Sarcopenia is a condition characterized by loss of skeletal muscle mass and low muscle strength or physical performance. Cancer survivors are likely to be impacted by sarcopenia and suffer from a worse prognosis. Exercise has been suggested to be a promising tool to attenuate sarcopenia, but its effect among cancer survivors has not been systematically tested yet. We conducted a systematic review of seven interventional studies examining the effects of exercise on sarcopenia among cancer survivors. Results suggested that exercise improved muscle quantity and potentially reversed sarcopenia among breast, gastric, prostate and liver cancer survivors. If the relationship is further supported by larger trials, we could potentially identify cancer survivors at higher risk of adverse health outcomes by screening for sarcopenia and improve their prognosis and quality of life through exercise interventions. Abstract Sarcopenia is related to adverse health outcomes in cancer survivors. Previous reviews reported exercise improved muscle mass or function in cancer survivors, but thus far a systematic review examining the effect of exercise on sarcopenia in this population has not been conducted. Therefore, we systematically searched PubMed, CENTRAL (Cochrane Central Register of Controlled Trials) and ClinicalTrials.gov for publications and ongoing trials (through November 2021) that reported exercise interventions and diagnosed sarcopenia among cancer survivors. Seven exercise trials were eligible for this review. Six of seven studies showed exercise increased skeletal muscle post intervention (1.6% to 5.4% increase within intervention groups compared to baseline, p ≤ 0.07; 2.1% to 12.8% greater increase for intervention than control groups, p ≤ 0.02) and in the three studies that reported sarcopenia reversal, an improvement (18.2% to 42.9% decrease in sarcopenia in exercise groups, 5.2% increase to 16.7% decrease in sarcopenia in control groups, p = 0.04) was observed. Existing research indicates the potential for exercise to improve health outcomes for cancer survivors through building muscle and attenuating sarcopenia. More high-quality, long-term, large randomized controlled trials examining effects of different exercise types and doses to improve sarcopenia should be conducted to further explore this important topic.
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Affiliation(s)
- Anlan Cao
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA; (L.M.F.); (M.L.I.)
- Correspondence: ; Tel.: +1-475-837-8503
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA; (L.M.F.); (M.L.I.)
- Yale Cancer Center, New Haven, CT 06520-8034, USA
| | - Bette J. Caan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA;
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA; (L.M.F.); (M.L.I.)
- Yale Cancer Center, New Haven, CT 06520-8034, USA
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15
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Parks R, Cheung KL. Challenges in Geriatric Oncology-A Surgeon's Perspective. Curr Oncol 2022; 29:659-674. [PMID: 35200558 PMCID: PMC8870873 DOI: 10.3390/curroncol29020058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 01/29/2023] Open
Abstract
As our global population ages, we will see more cancer diagnoses in older adults. Surgery is an important treatment modality for solid tumours, forming the majority of all cancers. However, the management of older adults with cancer can be more complex compared to their younger counterparts. This narrative review will outline the current challenges facing older adults with cancer and potential solutions. The challenges facing older adults with cancer are complex and include lack of high-level clinical trials targeting older adults and selection of the right patient for surgery. This may be standard surgical treatment, minimally invasive surgery or alternative therapies (no surgery) which can be local or systemic. The next challenge is to identify the individual patient's vulnerabilities to allow them to be maximally optimised for treatment. Prehabilitation has been shown to be of benefit in some cancer settings but uniform guidance across all surgical specialties is required. Greater awareness of geriatric conditions amongst surgical oncologists and integration of geriatric assessment into a surgical clinic are potential solutions. Enhanced recovery programmes tailored to older adults could reduce postoperative functional decline. Ultimately, the greatest challenge an older adult with cancer may face is the mindset of their treating clinicians-a shared care approach between surgical oncologists and geriatricians is required.
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Affiliation(s)
- Ruth Parks
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Kwok-Leung Cheung
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham NG7 2RD, UK;
- School of Medicine, Royal Derby Hospital Centre, Uttoxeter Road, University of Nottingham, Derby DE22 3DT, UK
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16
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Inoue D, Yamamoto M, Arima H, Tamura K, Yoshida Y. A nationwide web-based survey of oncologic surgeons to clarify the current status of preoperative assessment for elderly cancer surgery patients in Japan. Sci Rep 2021; 11:22789. [PMID: 34815510 PMCID: PMC8611021 DOI: 10.1038/s41598-021-02319-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/15/2021] [Indexed: 11/09/2022] Open
Abstract
Elderly cancer patients requiring surgical treatment are increasing, and the deterioration of quality of life and shortening of healthy life expectancy due to postoperative complications represent major problems. This study investigated the current status of medical treatment, including perioperative evaluations, for elderly cancer patients requiring surgical treatment at cancer treatment facilities nationwide. A total of 436 cancer care facilities around Japan were invited to participate in this web-based survey regarding management of cancer patients ≥ 65 years old who had undergone surgical treatment in 2018. A total of 919 department heads from 245 facilities agreed to participate. Although most respondents answered that performance status, preoperative examinations, and comorbidities were important when deciding on a treatment plan, age, Geriatric Assessment (GA), and guidelines were "not important" for > 10% of all respondents. GA was familiar to 195 department heads (21%), and awareness of GA was significantly lower among respondents from medical education institutions than the other types of hospitals (18.5% vs 26.3%; P = 0.006). This large survey revealed that the use of GA is not widespread, and its awareness in medical education institutions remains low. We believe that accumulating evidence of geriatric oncology surgery is an urgent issue in Japan.
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Affiliation(s)
- Daisuke Inoue
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Makoto Yamamoto
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, 7-45-1 Nanakuma, Jhonan-ku, Fukuoka, Fukuoka, Japan
| | - Kazuo Tamura
- Emeritus Professor, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jhonan-ku, Fukuoka, Fukuoka, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
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