1
|
Nicolò E, Gandini S, Giugliano F, Uliano J, D'Ecclesiis O, Morganti S, Ferraro E, Trapani D, Tarantino P, Zagami P, Boldrini L, Caramella I, Carnevale Schianca A, Cristofanilli M, Locatelli MA, Esposito A, Belli C, Minchella I, Criscitiello C, Marra A, Curigliano G. Effect of age on safety and efficacy of novel cancer drugs investigated in early-phase clinical trials. Eur J Cancer 2024; 207:114181. [PMID: 38909537 DOI: 10.1016/j.ejca.2024.114181] [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: 05/03/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Elderly patients are underrepresented in clinical trials, particularly in early-phase studies. Our study assessed the safety and efficacy of novel anti-cancer treatments investigated in early-phase clinical trials, comparing outcomes between younger and elderly patients. METHODS This retrospective study analyzed data from patients enrolled in phase I/II trials at our center between January 2014 and April 2021. We evaluated clinicopathologic characteristics, toxicity, and clinical efficacy, categorizing patients into younger (≤ 65 years) and elderly (> 65 years) groups. RESULTS 419 patients were included with a median age of 56 years. Among these, 107 (26 %) were older than 65 years. Predominant cancers included breast (48 %), lung (10 %), and melanoma (5 %). Patients were treated in 64 trials, predominantly receiving immunotherapy-based (47 %) or targeted therapy-based (45 %) treatment. Elderly presented with poorer ECOG performance status (P = 0.001) and had fewer prior therapy lines (P = 0.01) than younger patients. Grade ≥ 3 adverse events (AEs) were similar across age groups (31 % younger vs 33 % elderly; P = 0.7), including in combination therapy scenarios. However, elderly patients experienced more AEs with antibody-drug conjugates compared to younger counterparts (56 % vs 14 %, P = 0.036) and were more likely to discontinue treatment due to toxicity (15 % vs 7 %; P = 0.011). No significant age-related differences in response rates and survival outcomes were observed across treatment modalities, except for immunotherapy-based regimens for which elderly patients exhibited higher response rates, disease control rates, and prolonged progression-free survival. CONCLUSIONS Our findings suggest that elderly exhibit comparable safety and efficacy outcomes to younger patients in early-phase clinical trials for new cancer drugs. This underscores the importance of including elderly patients in phase I/II trials to ensure the generalizability of study results and mitigate age-related disparities in cancer treatment access.
Collapse
Affiliation(s)
- Eleonora Nicolò
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy; Department of Medicine, Division of Hematology-Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Sara Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Federica Giugliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Jacopo Uliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Oriana D'Ecclesiis
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Stefania Morganti
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Emanuela Ferraro
- Breast Cancer Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dario Trapani
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Paolo Tarantino
- Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Paola Zagami
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Laura Boldrini
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Irene Caramella
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Ambra Carnevale Schianca
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Massimo Cristofanilli
- Department of Medicine, Division of Hematology-Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Marzia Adelia Locatelli
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy
| | - Angela Esposito
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy
| | - Carmen Belli
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy
| | - Ida Minchella
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy
| | - Carmen Criscitiello
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Antonio Marra
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy
| | - Giuseppe Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy.
| |
Collapse
|
2
|
Habbous S, Alibhai SMH, Menjak IB, Forster K, Holloway CMB, Darling G. The effect of age on the opportunity to receive cancer treatment. Cancer Epidemiol 2022; 81:102271. [PMID: 36209661 DOI: 10.1016/j.canep.2022.102271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Older adults with cancer may not receive the same opportunities for treatment as younger patients. In this retrospective population-based cohort study, we explored whether age was an independent predictor of receiving specialist consultation and treatment. METHODS Patients age 45-99 were identified from the Ontario Cancer Registry having a primary solid tumor diagnosed between 01/Jan/2010 and 31/Dec/2019. We used logistic regression adjusted sociodemographic and clinical characteristics to compare the likelihood of consultation or receipt of treatment using linear splines at critical ages of 65, 80, and 90 years. RESULTS A total 168,232 (42%), 165,205 (41%), 57,360 (14%), and 7810 (2%) patients were diagnosed age 45-64, 65-79, 80-89, and 90-99, respectively. The likelihood of surgical consultation decreased as patients reached 65 years [adjusted odds ratio (aOR) 0.86 (0.84-0.89)], which decreased further among octogenarians [aOR 0.63 (0.59-0.67)]. Similar results were observed for consultation with a medical oncologist and radiation oncologist. Receipt of surgery also decreased with age. Three-month post-operative mortality was higher among older patients [aRR 1.38 (1.26-1.50) per 10 years, p < 0.0001], an effect that remained similar as patients reached age 65 + years of age (p = 0.09 for change). For stage I patients, 3-month post-operative survival was high across all age groups, ranging from 99.8% in 45-64 year-olds, 99.4% in 65-79 year-olds, and 98.1% among octogenarians and nonagenarians (lung, colorectal, breast, cervical cancer patients). CONCLUSION Older patients were less likely to have specialist consultations. More comprehensive data collection on clinical factors and referral patterns is needed to improve care for elderly cancer patients.
Collapse
Affiliation(s)
- Steven Habbous
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, Ontario, Canada; Epidemiology & Biostatistics, Western University, London, Ontario, Canada.
| | - Shabbir M H Alibhai
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ines B Menjak
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Katharina Forster
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, Ontario, Canada
| | - Claire M B Holloway
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gail Darling
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Ao G, de Miguel M, Gomes A, Liu R, Boni V, Moreno I, Cárdenas JM, Cubillo A, Ugidos L, Calvo E. Toxicity and antitumor activity of novel agents in elderly patients with cancer included in phase 1 studies. Invest New Drugs 2021; 39:1694-1701. [PMID: 34287771 DOI: 10.1007/s10637-021-01150-1] [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: 05/01/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
Introduction The number of cancer cases among the elderly continue to increase as the worldwide population ages. This patient subset is underrepresented in clinical trials, partly because of unresolved uncertainties about age-associated tolerabilities and antitumor activities. We reviewed phase 1 trial data to study tolerance and efficacy of novel agents used for treatment of elderly patients with cancer. Methods Data from 773 consecutive evaluable patients in 85 phase 1 clinical trials (2008-2016) at START Madrid-CIOCC were analyzed according to age, with respect to objective response, survival, and toxicity. Results The mean age was 58.7 (range: 18-87) years; 260 (33.6%) patients were >65 y (elderly group). One hundred thirty-seven (17.8%) patients received immunotherapy drugs, 308 (39.8%) received targeted agents, and 328 (42.4%) received chemotherapy. No statistically significant differences in overall survival, objective response, or severe toxicity rates were found according to treatment type. Similar toxicities and clinical activities were found between the two age subgroups; 18.8% of the elderly and 20.7% of the younger patients experienced severe hematological toxicity (p=0.5), and 30.2% and 32.7%, respectively, experienced severe non-hematological toxicity (p=0.4). Regarding antitumor activity, 12.4% of the elderly and 15% of the younger patients achieved objective responses (p=0.41). There were no significant between-group differences in overall survival (9.7 versus 11.5 months, respectively, p=0.1) or progression-free survival (2.3 versus 2.2 months, respectively, p=0.7). Conclusions This retrospective study found that elderly and younger populations had comparable antitumor activities and toxicity profiles. These results support including elderly patients with cancer in early-phase trials.
Collapse
Affiliation(s)
- Geriletu Ao
- START Madrid-HM CIOCC, Centro Integral Oncológico Clara Campal, Hospital Universitario HM Sanchinarro, Calle Oña, 10. 28050, Madrid, Spain
| | - Maria de Miguel
- START Madrid-HM CIOCC, Centro Integral Oncológico Clara Campal, Hospital Universitario HM Sanchinarro, Calle Oña, 10. 28050, Madrid, Spain
| | - Ana Gomes
- START Madrid-HM CIOCC, Centro Integral Oncológico Clara Campal, Hospital Universitario HM Sanchinarro, Calle Oña, 10. 28050, Madrid, Spain
| | - Runhan Liu
- START Madrid-HM CIOCC, Centro Integral Oncológico Clara Campal, Hospital Universitario HM Sanchinarro, Calle Oña, 10. 28050, Madrid, Spain
| | - Valentina Boni
- START Madrid-HM CIOCC, Centro Integral Oncológico Clara Campal, Hospital Universitario HM Sanchinarro, Calle Oña, 10. 28050, Madrid, Spain
| | - Irene Moreno
- START Madrid-HM CIOCC, Centro Integral Oncológico Clara Campal, Hospital Universitario HM Sanchinarro, Calle Oña, 10. 28050, Madrid, Spain
| | - José Miguel Cárdenas
- Departamento de Matemática Aplicada y Estadística, San Pablo CEU University. Calle Julián Romea, 18. 28003, Madrid, Spain
| | - Antonio Cubillo
- Centro Integral, Oncológico Clara Campal. Hospital Universitario HM Sanchinarro. Calle Oña, 10. 28050, Madrid, Spain.,Facultad de Medicina, Departamento de Ciencias Médicas Clínicas, Universidad CEU San Pablo. Plaza Montepríncipe, 1D, 28668, Alcorcón, Madrid, Spain
| | - Lisardo Ugidos
- Centro Integral, Oncológico Clara Campal. Hospital Universitario HM Sanchinarro. Calle Oña, 10. 28050, Madrid, Spain
| | - Emiliano Calvo
- START Madrid-HM CIOCC, Centro Integral Oncológico Clara Campal, Hospital Universitario HM Sanchinarro, Calle Oña, 10. 28050, Madrid, Spain.
| |
Collapse
|
4
|
Issa DE, Dinmohamed AG, Wondergem MJ, Blommestein HM, Huijgens PC, Lugtenburg PJ, Visser O, Zweegman S, Chamuleau MED. A population-based study on different regimens of R-CHOP in patients with newly diagnosed DLBCL in The Netherlands. Leuk Lymphoma 2020; 62:549-559. [PMID: 33213245 DOI: 10.1080/10428194.2020.1842394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Randomized controlled trials have studied different dose-intensity and dose-interval regimens of R-CHOP for patients with diffuse large B-cell lymphoma (DLBCL). This study was undertaken to confirm these results in a population-based setting, with special emphasis on the value of 6xR-CHOP21 among patients aged 18-64 years. Two thousand three hundred and thirty-eight stage II-IV DLBCL patients, ≥18 years, we confirmed the similar efficacy of six versus eight cycles of R-CHOP and of R-CHOP21 versus R-CHOP14 regimens across all age groups on overall survival (median follow-up 36.4 (1.3-167.6) months). Nevertheless, overall survival decreased with older age. Interestingly, in patients 18-64 years, the adjusted risk of mortality among recipients of 6xR-CHOP21 compared to other R-CHOP regimens seems to be similar (HR 0.62; 95%CI: 0.38-1.02; p= .059). Although this finding might suggest that 6xR-CHOP21 could be considered as first-line regimen for all stage II-IV DLBCL patients, it should be confirmed in forthcoming population-based studies with larger patient numbers and longitudinal follow-up.
Collapse
Affiliation(s)
- Djamila E Issa
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Hematology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Avinash G Dinmohamed
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marielle J Wondergem
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hedwig M Blommestein
- Erasmus School of Health Policy & Management, Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Peter C Huijgens
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | | | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Sonja Zweegman
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martine E D Chamuleau
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
5
|
The impact of comprehensive geriatric assessment for optimal treatment of older patients with cancer: A randomized parallel-group clinical trial. J Geriatr Oncol 2020; 11:488-495. [DOI: 10.1016/j.jgo.2019.06.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/27/2019] [Accepted: 06/26/2019] [Indexed: 01/01/2023]
|
6
|
Delay in the Diagnosis of Breast and Colorectal Cancer in People With Severe Mental Disorders. Cancer Nurs 2019; 43:E356-E362. [PMID: 31261182 DOI: 10.1097/ncc.0000000000000727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND People with severe mental disorders have a worse cancer prognosis, with higher mortality rates than the general population, and this could be partially attributed to a later detection. Breast cancer and colorectal cancer have mass population screenings in Spain, but the influence in early diagnosis is unknown in persons with severe mental disorders. OBJECTIVE To compare the severity of breast and colorectal cancers at diagnosis in people with and without mental disorders. METHODS This was an observational, retrospective, case-control study with 1:2 matching performed in Eastern Spain. Data were retrieved for analysis from electronic medical records. RESULTS The study included 111 oncology patients (75 with breast cancer and 36 with colorectal cancer). Individuals with mental disorders had a significantly higher (P = .002) relative risk (odds ratio [OR], 3.93; 95% confidence interval [CI], 1.60-9.65) to be diagnosed with an advanced tumor stage (clinical stages IIIA, IIIB, IIIC, and IV), for both breast and colorectal cancers when analyzed separately. The variables associated with advanced cancer at the time of diagnosis were the presence of a previous mental disorder (OR, 4.67; 95% CI, 1.73-12.61) and older age (OR, 1.08; 95% CI, 1.02-1.14). CONCLUSIONS Individuals with severe mental disorders showed a higher risk of being diagnosed with breast and colorectal cancers at advanced stages. IMPLICATIONS FOR PRACTICE Cancer screening for earlier detection and intervention in people with severe mental disorders needs improvement. Mental health nurses, screening nurses, and oncology nurses could serve an essential role in increasing the screening adherence of this group of individuals.
Collapse
|
7
|
Sattar S, Alibhai SM, Spoelstra SL, Puts MT. The assessment, management, and reporting of falls, and the impact of falls on cancer treatment in community-dwelling older patients receiving cancer treatment: Results from a mixed-methods study. J Geriatr Oncol 2019; 10:98-104. [DOI: 10.1016/j.jgo.2018.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/19/2018] [Accepted: 08/07/2018] [Indexed: 12/13/2022]
|
8
|
Sattar S, Spoelstra SL, Alibhai SM, Puts MT. Circumstances of falls and fear of falling in community-dwelling older adults with cancer: Results from a mixed-methods study. J Geriatr Oncol 2019; 10:105-111. [DOI: 10.1016/j.jgo.2018.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/26/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
|
9
|
Wedding U, Honecker F, Bokemeyer C, Pientka L, Höffken K. Tolerance to Chemotherapy in Elderly Patients with Cancer. Cancer Control 2017; 14:44-56. [PMID: 17242670 DOI: 10.1177/107327480701400106] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Due to demographic changes, the number of elderly people with cancer will increase in the next decades. In the past, elderly patients with cancer were often excluded from clinical trials. Chronological age has been considered a risk factor for increased toxicity and reduced tolerance to chemotherapy. Methods We present a review on toxicity of chemotherapy and factors associated with toxicity in elderly patients with cancer, and we discuss chemotherapeutic agents and treatment options in treating this patient population. Results Age is a risk factor for increased toxicity to chemotherapy and decreased tolerance. However, few trials have been reported with adjustment for age-associated changes such as impairment of functional status and increased comorbidity, which also show an independent association with increased toxicity. Published data may include several biases, such as referral and publication bias. Conclusions Decision making in elderly cancer patients should be based on the results of a geriatric assessment. Patients with few or no limitations should be treated as younger patients are treated. Data with a high level of evidence are unavailable for patients showing moderate or severe limitations in a geriatric assessment.
Collapse
Affiliation(s)
- Ulrich Wedding
- Klinik und Poliklinik fur Innere Medizin II, Department of Hematology and Oncology, Friedrich Schiller Universitat, Erlanger Allee 101, D-07747 Jena, Germany.
| | | | | | | | | |
Collapse
|
10
|
Sattar S, Alibhai SMH, Spoelstra SL, Fazelzad R, Puts MTE. Falls in older adults with cancer: a systematic review of prevalence, injurious falls, and impact on cancer treatment. Support Care Cancer 2016; 24:4459-69. [PMID: 27450557 DOI: 10.1007/s00520-016-3342-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this systematic review was to update and expand the existing systematic review with the aim to answer the following questions: (1) How often do older adults (OA)s with cancer fall? (2) What are the predictors of falls in OA with cancer? (3) What is the rate of injurious falls and predictors of injurious falls in OA with cancer? (4) What are the circumstances and outcomes of falls in this population? (5) How do falls in cancer patients affect subsequent cancer treatment? METHODS Medline, Pubmed, Embase, and CINAHL were searched. Eligible studies included clinical trials, cross-sectional, cohort, case-control, and qualitative studies in which the entire sample or a sub-group of the sample were OA aged 60 and above, had cancer, in which falls were examined as a primary or secondary outcome and published in English. RESULTS Twenty-seven studies met our inclusion criteria with most involving the outpatient setting. Fall rates and injurious fall rates varied widely. Consistent predictors of falls were prior falls among outpatients and cognitive impairment among inpatients. There were no data on impact of falls on cancer treatment. Data on circumstances of falls were limited. CONCLUSION Falls and fall-related injuries are common in older cancer patients. However, little is known about circumstances of falls and impact of falls on cancer treatment. Many known fall predictors in community-dwelling OA have not been explored in oncology. More research is needed to address gaps in these areas.
Collapse
Affiliation(s)
- Schroder Sattar
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite, Toronto, ON, 130M5T 1P8, Canada.
| | - Shabbir M H Alibhai
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, 200 Elizabeth Street, Toronto, M5G 2C4, Canada
| | - Sandra L Spoelstra
- Kirkhof College of Nursing, Grand Valley State University, 301 Michigan Street, NE, Michigan, MI, 49502, USA
| | - Rouhi Fazelzad
- Library and Information Services, University Health Network, 5-407, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite, Toronto, ON, 130M5T 1P8, Canada
| |
Collapse
|
11
|
Gorini A, Mazzocco K, Pravettoni G. Decision-Making Process Related to Participation in Phase I Clinical Trials: A Nonsystematic Review of the Existing Evidence. Public Health Genomics 2015; 18:359-65. [PMID: 26529420 DOI: 10.1159/000441559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Due to the lack of other treatment options, patient candidates for participation in phase I clinical trials are considered the most vulnerable, and many ethical concerns have emerged regarding the informed consent process used in the experimental design of such trials. Starting with these considerations, this nonsystematic review is aimed at analyzing the decision-making processes underlying patients' decision about whether to participate (or not) in phase I trials in order to clarify the cognitive and emotional aspects most strongly implicated in this decision. Considering that there is no uniform decision calculus and that many different variables other than the patient-physician relationship (including demographic, clinical, and personal characteristics) may influence patients' preferences for and processing of information, we conclude that patients' informed decision-making can be facilitated by creating a rigorously developed, calibrated, and validated computer tool modeled on each single patient's knowledge, values, and emotional and cognitive decisional skills. Such a tool will also help oncologists to provide tailored medical information that is useful to improve the shared decision-making process, thereby possibly increasing patient participation in clinical trials.
Collapse
Affiliation(s)
- Alessandra Gorini
- Department of Health Science, University of Milan, and European Institute of Oncology, Milan, Italy
| | | | | |
Collapse
|
12
|
Charbonnier C, Marilier S, Dabakuyo S, Cueff A, Quipourt V, Manckoundia P. Assessment of the interest of the geriatric oncology consultation among French general practitioners. J Geriatr Oncol 2015; 7:47-52. [PMID: 26515435 DOI: 10.1016/j.jgo.2015.10.184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/14/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We assessed the interest of the geriatric oncology (GO) consultation (GOC) among general practitioners (GPs). MATERIALS AND METHODS We conducted a survey among GPs whose patients had had a GOC in 2012. A questionnaire was sent to GPs. The 1st part collected GPs' characteristics including medical education in geriatrics and GO, and knowledge of GOC. The following parts concerned the GOC and included the cancer type, GOC report and care plan. RESULTS One-hundred twenty-six questionnaires corresponding to 94 GPs were collected. Concerning the GPs' characteristics, age range 50-59 (44.7%), men (62.8%) and urban practice (79.8%) were the most represented, 80.8% had no expertise in geriatrics, 60.6% knew of the existence of GOCs, and 14.9% had received medical education in GO. The most frequent cancer location was gynecological (40.7%) (82.6% were breast cancers). Of the GPs, 69.8% had received a GOC report and 92% were (very) satisfied with the delivery time. A care plan was proposed after the GOC in 83% of cases. It was satisfactory in 96.4% of cases, and applied by 74.7% of GPs. Sixteen percent of GPs were called by the GO team. The less the GP was satisfied with the GOC, the more he or she wanted phone contact (p=0.02); 94% of GPs considered the GOC (very) satisfactory. Sixty-seven percent of GPs wanted to be trained in GO. CONCLUSION Very few GPs had been trained in geriatrics and/or GO. They were mostly satisfied with GOC and expressed a wish to be trained in GO.
Collapse
Affiliation(s)
- Claire Charbonnier
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France
| | - Sophie Marilier
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France
| | - Sandrine Dabakuyo
- Côte d'Or Breast and Gynaecological Cancer Registry, Centre George François Leclerc, 1 rue du Professeur Marion, BP 77980, Dijon Cedex, France
| | - Adèle Cueff
- Côte d'Or Breast and Gynaecological Cancer Registry, Centre George François Leclerc, 1 rue du Professeur Marion, BP 77980, Dijon Cedex, France
| | - Valérie Quipourt
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France
| | - Patrick Manckoundia
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France; Inserm/U1093 Cognition, Action and Sensorimotor Plasticity, University of Burgundy Franche-Comté, Dijon, France.
| |
Collapse
|
13
|
Blank L, Baxter S, Woods HB, Goyder E, Lee A, Payne N, Rimmer M. What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03240] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BackgroundDemand management describes any method used to monitor, direct or regulate patient referrals. Several strategies have been developed to manage the referral of patients to secondary care, with interventions targeting primary care, specialist services, or infrastructure.ObjectiveThis research aimed to conduct an inclusive systematic review and logic model synthesis in order to better understand factors impacting on the effectiveness of interventions targeting referral between primary and secondary medical health care.DesignThe approach combined systematic review with logic modelling synthesis techniques to develop an evidence-based framework of factors influencing the pathway between interventions and system-wide changes.SettingPrimary health care.Main outcome measuresReferral from primary to secondary care.Review methodsSystematic searches were undertaken to identify recent, relevant studies. Quality of individual studies was appraised, with consideration of overall strength of evidence. A narrative synthesis and logic model summary of the data was completed.ResultsFrom a database of 8327 unique papers, 290 were included in the review. The intervention studies were grouped into four categories of education interventions (n = 50); process change interventions (n = 49); system change interventions (n = 38); and patient-focused interventions (n = 3). Effectiveness was assessed variously in these papers; however, there was a gap regarding the mechanisms whereby these interventions lead to demand management impacts. The findings suggest that, although individual-level interventions may be popular, the stronger evidence relates only to peer-review and feedback interventions. Process change interventions appeared to be more effective when the change resulted in the specialist being provided with more or better quality information about the patient. System changes including the community provision of specialist services by general practitioners, outreach provision by specialists and the return of inappropriate referrals appeared to have evidence of effect. The pathway whereby interventions might lead to service-wide impact was complex, with multiple factors potentially acting as barriers or facilitators to the change process. Factors related, first, to the doctor (including knowledge, attitudes and beliefs, and previous experiences of a service), second, to the patient (including condition and social factors) and, third, to the influence of the doctor–patient relationship. We also identified a number of potentially influential factors at a local level, such as perceived waiting times and the availability of a specialist. These elements are key factors in the pathway between an intervention and intended demand management outcomes influencing both applicability and effectiveness.ConclusionsThe findings highlight the complexity of the referral process and multiple elements that will impact on intervention outcomes and applicability to a local area. Any interventions seeking to change referral practice need to address factors relating to the individual practitioner, the patient and also the situation in which the referral is taking place. These conclusions apply especially to referral management in a UK context where this whole range of factors/issues lies well within the remit of the NHS. This work highlights that intermediate outcomes are important in the referral pathway. It is recommended that researchers include measure of these intermediate outcomes in their evaluation of intervention effectiveness in order to determine where blocks to or facilitators of system-wide impact may be occurring.Study registrationThe study is registered as PROSPERO CRD42013004037.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Lindsay Blank
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Helen Buckley Woods
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Lee
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Nick Payne
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Melanie Rimmer
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| |
Collapse
|
14
|
Harrington DW, Wilson K, Rosenberg M, Bell S. Access granted! barriers endure: determinants of difficulties accessing specialist care when required in Ontario, Canada. BMC Health Serv Res 2013; 13:146. [PMID: 23607393 PMCID: PMC3637586 DOI: 10.1186/1472-6963-13-146] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 04/11/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the Canadian context, health care services are governed by the Canada Health Act, which ensures that primary care doctors, specialists, hospitals and dental surgeries are covered through provincial health insurance plans. This ensures access to medically necessary health care services for all Canadians regardless of ability to pay. Despite this important piece of legislation, research has shown persistent inequalities in access between and within socio-demographic groups, and geographic areas. To date, most research has focused on access to primary care, with much less attention paid to specialist care as an important component of the health care continuum. Thus, the objectives of this research are to address this gap in knowledge by examining the factors associated with difficulty accessing specialist services, and the reasons why particular subpopulation groups report experiencing difficulties. METHODS This research uses multivariate logistic regression to analyze data from the Canadian Community Health Surveys' optional content from the province of Ontario (n=21,526) related to accessing specialist health care services. The multivariate logistic regression model identifies several subpopulation groups that are more likely to report difficulty accessing specialist care when required. Cross-tabulations are subsequently used to establish the main reasons why difficulties are faced. RESULTS Over 26% of respondents required a specialist visit in the 12 months preceding administration of the survey. Of these, 22% reported difficulty accessing specialist care. Those with difficulties were more likely to be immigrants, post-secondary educated, and have one or more chronic conditions. People living in urban health regions were also more likely to report difficulties accessing care. Primarily wait times were cited as reasons for these difficulties, followed by a perceived lack of availability. CONCLUSIONS There are difficulties faced by the general population as a whole (e.g., wait times) as well as particular difficulties experienced more frequently by certain groups (e.g., transportation, language, and cost barriers for newcomers). These issues are important, as they may discourage individuals from using necessary health care services, and may contribute to feelings of dissatisfaction with the health care system.
Collapse
Affiliation(s)
- Daniel W Harrington
- Department of Geography, University of Toronto Mississauga, 3359 Mississauga Rd. N., W.G. Davis Bldg., Mississauga, Ontario, L5L 1C6, Canada
| | - Kathi Wilson
- Department of Geography, University of Toronto Mississauga, 3359 Mississauga Rd. N., W.G. Davis Bldg., Mississauga, Ontario, L5L 1C6, Canada
| | - Mark Rosenberg
- Department of Geography, Queens University, Kingston, Ontario, Canada
| | - Scott Bell
- Department of Geography and Planning, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
15
|
Management of Elderly Patients with Primary Central Nervous System Lymphoma. Curr Neurol Neurosci Rep 2013; 13:344. [DOI: 10.1007/s11910-013-0344-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
16
|
Affiliation(s)
- Pierre Soubeyran
- Institut Bergonié, Comprehensive Cancer Center; Bordeaux Segalen University, Bordeaux, France
| | - Véronique Brouste
- Institut Bergonié; Institut National de la Santé et de la Recherche Médicale, Clinical Investigation Centre, Bordeaux, France
| | - Carine Bellera
- Institut Bergonié; Institut National de la Santé et de la Recherche Médicale, Clinical Investigation Centre, Bordeaux, France
| | - Muriel Rainfray
- Bordeaux Segalen University; Centre Hospitalier Universitaire, Bordeaux, France
| |
Collapse
|
17
|
Horn L, Keedy VL, Campbell N, Garcia G, Hayes A, Spencer B, Carbone DP, Sandler A, Johnson DH. Identifying barriers associated with enrollment of patients with lung cancer into clinical trials. Clin Lung Cancer 2012; 14:14-8. [PMID: 22591607 DOI: 10.1016/j.cllc.2012.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/09/2012] [Accepted: 03/12/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Enrollment of patients with lung cancer into clinical trials is required to accelerate the pace of new therapy development and contribute to a better understanding of the biological characteristics of cancer. METHODS We conducted a retrospective chart review of all patients seen by the thoracic medical oncology team at the Vanderbilt Ingram Cancer Center (VICC) from November 2005 to November 2008 to determine the barriers associated with patient enrollment in to clinical trials. RESULTS One thousand forty-three patient charts were audited: 32% of patients were eligible for enrollment, and 14% enrolled in a study. There were no significant differences in protocol availability or eligibility by sex, smoking status, or age. Patients living further from the cancer center were significantly less likely to have a study protocol available (P = .009), but if a protocol was available they were more likely to be eligible for enrollment (P < .001). Significantly more protocols were available for patients with non-small-cell lung cancer (NSCLC) compared with those who had small-cell lung cancer (SCLC) (63% vs. 48%; P < .001). Patients with advanced disease were more likely to have a protocol available (P < .001) and enter a study (P = .031). The most common reasons for patients not being eligible for enrollment were poor performance status (32%) and presence of comorbid disease (27%). The most common reasons for potentially eligible patients not enrolling in a study included preference for treatment closer to home (49%) and patient refusal (43%). CONCLUSION Additional strategies are required to increase accrual of patients into lung cancer trials, including development of protocols for early-stage disease and modifying eligibility and performance status criteria for this unique patient population.
Collapse
Affiliation(s)
- Leora Horn
- Vanderbilt Ingram Cancer Center, Nashville, TN 37232, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Delva F, Soubeyran P, Rainfray M, Mathoulin-Pélissier S. Referral of elderly cancer patients to specialists: action proposals for general practitioners. Cancer Treat Rev 2012; 38:935-41. [PMID: 22534283 DOI: 10.1016/j.ctrv.2012.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 03/26/2012] [Accepted: 03/28/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many studies have identified advanced age as a barrier to accessing specialized oncological care. OBJECTIVES To identify elements from the literature influencing general practitioners (GPs) in their decisions to refer elderly patients with cancer to oncology teams, and propose focused actions to improve referral processes. METHODS Eligible articles published up to July 2010 identifying factors associated with referral decisions for elderly cancer patients were selected. A quality assessment of each article was performed. All factors identified were considered for possible interventions classified by the Effective Practice and Organisation of Care (EPOC) taxonomy and development of recommendations for referral of elderly patients. RESULTS Thirty eligible articles were found with only 18 articles specifically exploring factors influencing physicians in the referral of their patients with cancer. Twelve focused on delay to treatment and only two uniquely on elderly patients. Patient age was the main factor associated with referral decisions, but this factor can influence GP's differently depending on the type of cancer. The small size of these studies, heterogeneity of study populations, and diversity of outcome measures used meant that compilation of guidelines based on high-quality evidence was not possible. However, organizational factors hindering decisions to refer are identified and highlighted as crucial for inclusion in intervention programs, specifically to reach GPs in smaller locations or with less experience in collaborating with specialists. For patient-related factors, professional and organizational interventions are necessary, aimed at both GPs and patients to update knowledge of the non-linear relationship between chronological age and a patient's ability to tolerate treatment. CONCLUSIONS First and foremost, this article highlights the scarcity of literature specific to elderly patients with cancer. It also identifies the public health need for better knowledge of the factors for referral of elderly patients. Focussed action proposals are presented to improve knowledge and consequently, optimize the referral process.
Collapse
Affiliation(s)
- Fleur Delva
- Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France; Inserm U897, CIC-EC7, Bordeaux, France
| | | | | | | |
Collapse
|
19
|
Vieillissement et cancers: quel champ d’intervention en psycho-oncologie ? PSYCHO-ONCOLOGIE 2012. [DOI: 10.1007/s11839-012-0353-7] [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]
|
20
|
Soubeyran P, Henriques de Figueiredo B, Soubeyran I, Mertens C, Cazeau A. Therapeutic strategies in elderly and very elderly patients. Best Pract Res Clin Haematol 2012; 25:91-100. [DOI: 10.1016/j.beha.2012.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
21
|
Effect of urologists and medical oncologists on treatment of elderly men with Stage IV prostate cancer. Urology 2011; 77:1088-95. [PMID: 21439617 DOI: 10.1016/j.urology.2010.11.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 11/12/2010] [Accepted: 11/25/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine, among elderly men with incident advanced prostate cancer (PCa), their treatment, in general, and chemotherapy, in particular, in association with a posturologist medical oncologist/hematologist (PUMOH) visit. The role of specialists in the management of advanced PCa is evolving in response to positive chemotherapy trials of PCa. METHODS Linked Surveillance, Epidemiology, and End results and Medicare data included patients with Stage IV PCa diagnosed from 1994 to 2002 who had visited a urologist after the diagnosis and received treatment. The visits and treatment were examined, comparing patients with and without PUMOH visits. RESULTS Most (77%) patients received treatment of their PCa and 85% of treated patients had a subsequent visit with a urologist, of whom 91% saw the urologist first (n = 5435). Of these, 43% saw only the urologist, 41% saw a medical oncologist/hematologist, and 32% saw a radiation oncologist. Of the 5435 patients, 16% received chemotherapy and the adjusted odds of chemotherapy receipt were 7.2 times greater (95% confidence interval 6.0-8.7, P < .001) among those with a PUMOH visit. Compared with non-Hispanic whites, black Americans were less likely (adjusted odds ratio 0.53, P < .001) to receive chemotherapy, although the likelihood of a PUMOH visit was similar (adjusted odds ratio 0.86, P = .14) among the groups. CONCLUSIONS The results of our study have shown that nearly one quarter of men with Stage IV PCa receive no PCa treatment. Although a PUMOH visit is a significant predictor of chemotherapy receipt, many men with advanced PCa received chemotherapy without a medical oncologist/hematologist visit. Black American and elderly men were less likely to receive chemotherapy for advanced PCa.
Collapse
|
22
|
Delva F, Marien E, Fonck M, Rainfray M, Demeaux JL, Moreaud P, Soubeyran P, Sasco AJ, Mathoulin-Pélissier S. Factors influencing general practitioners in the referral of elderly cancer patients. BMC Cancer 2011; 11:5. [PMID: 21211031 PMCID: PMC3024300 DOI: 10.1186/1471-2407-11-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 01/06/2011] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND A number of studies have identified advanced age as a barrier to accessing specialised oncological care. Many factors can influence the care provided for elderly patients after a diagnosis of cancer has been established or is suspected. Only one European study has analysed the decision processes leading general practitioners (GPs) to refer elderly patients with cancer to oncologists. The objectives of the current study are to describe the factors that influence these decisions and to identify the particular factors and GP characteristics that are associated with systematic referral of these patients in South-West France. METHODS This is a cross-sectional study on a representative sample of GPs in Aquitaine, South-West France. Questionnaire items were selected using a Delphi consensus approach and sent by post. Two logistic regression models were constructed to investigate GPs' decisions to refer these patients. RESULTS The response rate obtained was 30%. Half of the general practitioners reported "always" referring their elderly cancer patients to oncologists. More than 75% reported being influenced by patient-related elements (patient and/or family wishes, comorbid factors, unsuitability of invasive investigations, physical and mental autonomy), by cancer-related elements (severity of symptoms, expected side-effects) and an organisational element (whether the general practitioner was used to collaborating with oncologists). Logistic regression analysis showed that cancer site and organisational difficulties in patient management were significantly associated with the decision to refer elderly patients with early-stage cancer. For advanced stages, oncology training, patient age, organisational difficulties in patient management and stage of cancer were significantly associated with the decision to refer elderly patients. CONCLUSIONS Cancer-linked factors and organisational difficulties have been highlighted as influencing the decisions of GPs in the referral of elderly patients to a cancer team. These results highlight the need to implement continuous medical education specific for the management of elderly patients, to better apprehend the nature of these difficulties and to suggest solutions suited to local settings.
Collapse
Affiliation(s)
- Fleur Delva
- Institut Bergonié, Comprehensive Cancer Centre, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Abel GA, Friese CR, Magazu LS, Richardson LC, Fernandez ME, De Zengotita JJ, Earle CC. Delays in referral and diagnosis for chronic hematologic malignancies: A literature review. Leuk Lymphoma 2009; 49:1352-9. [PMID: 18604724 DOI: 10.1080/10428190802124281] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
24
|
Campos S, Presutti R, Zhang L, Salvo N, Hird A, Tsao M, Barnes EA, Danjoux C, Sahgal A, Mitera G, Sinclair E, DeAngelis C, Nguyen J, Napolskikh J, Chow E. Elderly patients with painful bone metastases should be offered palliative radiotherapy. Int J Radiat Oncol Biol Phys 2009; 76:1500-6. [PMID: 19540056 DOI: 10.1016/j.ijrobp.2009.03.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 03/11/2009] [Accepted: 03/17/2009] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate the efficacy of palliative radiotherapy (RT) in relieving metastatic bone pain in elderly patients. METHODS AND MATERIALS The response to RT for palliation of metastatic bone pain was evaluated from a prospective database of 558 patients between 1999 and 2008. The pain scores and analgesic intake were used to calculate the response according to the International Bone Metastases Consensus Working Party palliative RT endpoints. Subgroup analyses for age and other demographic information were performed. RESULTS No significant difference was found in the response rate in patients aged >or=65, >or=70, and >or=75 years compared with younger patients at 1, 2, or 3 months after RT. The response was found to be significantly related to the performance status. CONCLUSION Age alone did not affect the response to palliative RT for bone metastases. Elderly patients should be referred for palliative RT for their painful bone metastases, regardless of age, because they receive equal benefit from the treatment.
Collapse
Affiliation(s)
- Sarah Campos
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Geriatric oncology, general practitioners and specialists: current opinions and unmet needs. Crit Rev Oncol Hematol 2009; 75:47-57. [PMID: 19349189 DOI: 10.1016/j.critrevonc.2009.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 02/23/2009] [Accepted: 03/04/2009] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To describe the patterns of care of elderly cancer patients (ECPs) (>70 years old) and the factors affecting the referral by general practitioners (GPs) of patients to cancer specialists (SPs), in Alsace France. METHODS A postal mail questionnaire was sent to a total of 2818 physicians including primary care physicians and specialists. The factors possibly responsible for a poor referral rate of ECPs and the factors affecting treatment implementation by specialists were explored. We also searched for unmet needs such as the incorporation of geriatric assessment into routine practice and continuous medical education (CME) programs. RESULTS A total of 1217 questionnaires were returned (46.9%) from 1053 GPs and 214 SPs. Patients' age did not negatively impact referral to SPs as opposed to patients' performance status, wishes, and co-morbidities. Conversely, a significant decrease in patients' file presentation by SPs to tumor boards was observed for patients over 80 years old. Neither reimbursement nor SPs' waiting lists were an issue. The need for CME programs in geriatric oncology was emphasized by both GPs and SPs. CONCLUSIONS Age was not the governing variable that impacted patient referral. The need for CME in geriatrics was highlighted for both GPs and SPs.
Collapse
|
26
|
Wedding U, Höffken K, Friedrich C, Pientka L. [Health services research and geriatrics: deficits and research approaches using the example of colorectal carcinoma and anaemia]. ACTA ACUST UNITED AC 2008; 101:587-92. [PMID: 18269048 DOI: 10.1016/j.zgesun.2007.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The number of elderly people with cancer will increase within the next decades. Cancer will surpass cardiovascular diseases as the leading cause of death. In comparison to younger patients elderly patients with cancer are less often treated within the scope of clinical trials. Data from health care research demonstrate that the treatment of elderly patients is less often guideline-directed than that of younger patients. This will be demonstrated in more detail for patients with colorectal carcinoma and for patients with anaemia. Older people are reluctant to participate in programs for the early detection of colorectal carcinoma and its precursors. They less often receive adjuvant chemotherapy in stage III disease, despite the fact that adjuvant chemotherapy is no more toxic than in younger patients and equally effective and therefore recommended in the guidelines. Compared to younger patients, elderly patients less often receive palliative chemotherapy in stage IV disease. Anaemia has a prevalence of about 10% in people aged 65 and more; the reported values are highly variable. There is a lack of data on the grade of evaluation. Also, there are no diagnostic and therapeutic guidelines in Germany. Health services research will play an important role in assessing deficits in the diagnosis and therapy of cancer diseases in the elderly and in determining the goals for future efforts in health care and research.
Collapse
Affiliation(s)
- Ulrich Wedding
- Klinik und Poliklinik für Innere Medizin II, Abteilung Hämatologie und Onkologie, Friedrich-Schiller-Universität, Jena.
| | | | | | | |
Collapse
|
27
|
Umutyan A, Chiechi C, Beckett LA, Paterniti DA, Turrell C, Gandara DR, Davis SW, Wun T, Chen MS, Lara PN. Overcoming barriers to cancer clinical trial accrual: impact of a mass media campaign. Cancer 2008; 112:212-9. [PMID: 18008353 DOI: 10.1002/cncr.23170] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Annually, only 3% of adult patients participate in cancer clinical trials (CCT). Accrual barriers include lack of CCT awareness and uncertain third-party coverage. In 2002, a California law (SB37) required all insurers to reimburse costs related to CCT. The objective of the current study was to increase awareness of CCT and SB37 through a mass multimedia campaign (MMC) in the University of California (UC) Davis (UCD) Cancer Center catchment area. The authors assessed willingness to participate in and accrual to CCT. METHODS Changes in CCT/SB37 awareness and willingness to participate were investigated before the MMC versus after the MMC and in UCD respondents versus UC San Diego (UCSD) catchment respondents-a control group that was not exposed to the MMC-by Pearson chi-square and logistic regression analyses. RESULTS Of 1081 post-MMC respondents, 957 were from UCD, and 124 from UCSD. UCD respondents had a greater awareness of CCT (59% vs 65%; P < .01) and SB37 (17% vs 32%; P < .01) compared with UCSD respondents. Willingness to participate did not change in either cohort. Awareness level predicted willingness (odds ratio, 2.3; P < .01). Blacks, Asians, and lowest income (<$25 K per year) groups were the least willing to participate (P < .01, P < .04, and P < .02, respectively). The CCT accrual rate at UCD was unchanged. CONCLUSIONS CCT and SB37 awareness increased significantly in the UCD cohort after the MMC. However, it was unclear whether this increase was attributable entirely to the MMC or to varying demographic variables. Enhancing patient willingness and accrual will require targeting other variables, such as physician or resource barriers, rather than just CCT and reimbursement awareness.
Collapse
Affiliation(s)
- Ari Umutyan
- University of California Davis Cancer Center, Sacramento, California 95817, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Screening. Oncology 2007. [DOI: 10.1007/0-387-31056-8_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
29
|
Étude ELIPPSE 65-80. Med Sci (Paris) 2007; 23 Spec No 3:52-4. [DOI: 10.1051/medsci/2007233s52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
30
|
Luo R, Giordano SH, Zhang DD, Freeman J, Goodwin JS. The role of the surgeon in whether patients with lymph node-positive colon cancer see a medical oncologist. Cancer 2007; 109:975-82. [PMID: 17265530 PMCID: PMC1851914 DOI: 10.1002/cncr.22462] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chemotherapy improves survival for patients with stage III colon cancer, but some older patients with lymph node-positive colon cancer do not see a medical oncologist and, thus, do not receive adjuvant chemotherapy. METHODS To evaluate the role of the surgeon in determining referrals to medical oncology among patients with stage III colon cancer, the authors conducted a retrospective cohort study of 6158 patients aged >or=66 years who were diagnosed with stage III colon cancer from 1992 through 1999 by using the Surveillance, Epidemiology, and End Results-Medicare linked database. Multilevel analysis was used to simultaneously model variations in patients' seeing a medical oncologist at the patient and surgeon levels. RESULTS Twenty-one percent of the total variance in seeing a medical oncologist was attributable to the surgeon after adjusting for available patient, tumor, and surgeon characteristics. The individual surgeon characteristics that significantly predicted whether the patient saw a medical oncologist were year since graduation (<or=10 years vs >20 years; hazard ratio [HR], 1.60; 95% confidence interval [95% CI], 1.19-2.16), practicing in a teaching hospital (yes vs. no: HR; 1.30; 95% CI, 1.07-1.58), and volume of patients with colon cancer (<30 patients vs >or=121 patients; HR, 0.66; 95% CI, 0.46-0.94). Surgeon sex, race, board certification, and type of practice were not independent predictors of medical oncology referral. CONCLUSIONS Surgeons accounted for approximately 20% of the variation in patients seeing a medical oncologist. Interventions at the level of the surgeon may be appropriate to improve the care of patients with colon cancer.
Collapse
Affiliation(s)
- Ruili Luo
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
| | - Sharon H. Giordano
- Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Dong D. Zhang
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
| | - Jean Freeman
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
| | - James S. Goodwin
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
| |
Collapse
|
31
|
Wedding U, Roehrig B, Klippstein A, Steiner P, Schaeffer T, Pientka L, Höffken K. Comorbidity in patients with cancer: prevalence and severity measured by cumulative illness rating scale. Crit Rev Oncol Hematol 2007; 61:269-76. [PMID: 17207632 DOI: 10.1016/j.critrevonc.2006.11.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Revised: 08/31/2006] [Accepted: 11/10/2006] [Indexed: 12/27/2022] Open
Abstract
Comorbidity is defined as the presence of one or more diseases in addition to an index disease. In elderly people, the number and severity of comorbidity increase with age. We report the comorbidity data of 536 patients treated as in-patients: 231 elderly cancer patients (ECP), 172 younger cancer patients (YCP) and 133 elderly patients admitted for non-cancer reasons (EMP). Comorbidity was assessed with the cumulative illness rating scale geriatric version (CIRS-G). Data on number of affected organ systems (levels 1-4), number of affected organ systems with severe disease (levels 3-4), and sum score of levels per patient are reported. The number of comorbidities increases with age. A 76% of ECP, 51% of YCP, and 79% of EMP have severe comorbidity. Palliative treatment approach is not associated with higher levels of comorbidity in ECP. Vascular disorders were the most common comorbidity. The difficulty to rate haematological comorbidity in cancer patients is reflected. This is the first report on detailed results of assessment of comorbidity measured by CIRS-G in cancer patients. In addition, we provide a comparison to an elderly group of patients admitted for non-cancer reasons.
Collapse
Affiliation(s)
- Ulrich Wedding
- Department for Internal Medicine II, Division of Haematology and Medical Oncology, Friedrich Schiller University, Erlanger Allee 101, 07747 Jena, Germany.
| | | | | | | | | | | | | |
Collapse
|
32
|
Castel P, Négrier S, Boissel JP. Why don’t cancer patients enter clinical trials? A review. Eur J Cancer 2006; 42:1744-8. [PMID: 16777404 DOI: 10.1016/j.ejca.2005.10.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Revised: 10/20/2005] [Accepted: 10/21/2005] [Indexed: 11/27/2022]
Abstract
Despite widespread agreement about the value of clinical trials, the proportion of patients who are enrolled in such trials is often considered to be too low. A comprehensive literature search was carried out for the period 1980 to the present, in order to review current data on barriers and facilitators to the development of multicentre clinical trials. Of 364 articles initially identified, 35 articles and 1 book were selected in order to assess the reasons that doctors and/or patients participate in clinical trials. This review emphasises the fact that doctors play a key role in the development and non-development of clinical trials. More studies, in particular studies outside the United States of America (USA), are needed in order better to understand doctors' attitudes towards clinical trials. Such studies should combine multivariate analyses and comparative approaches in order to associate doctors' behaviours with their individual characteristics, with the organisational context of their working environment and with the healthcare system.
Collapse
Affiliation(s)
- Patrick Castel
- ONCORA, Centre Léon Bérard, 28 rue Laënnec, 69008 Lyon, France.
| | | | | |
Collapse
|
33
|
Retornaz R, Wan-Chow-Wah D. Premier colloque en oncologie gériatrique, soigner les personnes âgées atteintes de cancer : un art, une science, un défi, 16 et 17 septembre 2005, Montréal. Rev Med Interne 2006; 27:357-62. [PMID: 16703669 DOI: 10.1016/j.revmed.2005.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R Retornaz
- Division of Geriatric Medicine, Lady Davis Institute, Jewish General Hospital, 3755, chemin cote Sainte-Catherine, Montréal, Québec H3T1R2, Canada.
| | | |
Collapse
|
34
|
Tournoux C, Katsahian S, Chevret S, Levy V. Factors influencing inclusion of patients with malignancies in clinical trials. Cancer 2006; 106:258-70. [PMID: 16397866 DOI: 10.1002/cncr.21613] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Participation in clinical trials remains low and is a central issue in oncology. The authors identified, through a systematic review, 75 papers published up to August 2004 that report barriers to recruitment of patients in clinical trials. These barriers range from patient preference and concern about information/consent to clinical problems with protocols. Strategies to overcome barriers on the part of patients and clinicians are needed and should be carefully evaluated. Thirty-three (44%) papers reported factors related to patients as influencing the inclusion of patients, 28 (37%) reported clinician's related factors, and 37 (49%) other factors from either specific groups of patients (30 papers, 40%) and/or other scopes (13 papers, 17%). No differences in prevalence were found between papers dedicated to hematologic malignancies and solid tumors. Factors related to clinicians as influential were more frequently reported before 1995 (70%) than thereafter (25%; P = 0.0009). Reporting specific groups of patients as influential was more frequent in North American articles (50%) than in others (14%, P = 0.008). Patients' barriers included mostly patient preference (12 papers), concern about information and/or consent (11 papers), worry about uncertainty (7 papers), and/or relationship with medical team (7 papers). Concerning clinicians, incompatibility of protocol with normal practice (nine papers), problems in complying with the protocol (eight papers), and/or consent procedure (eight papers) were the most reported factors. The remaining factors mostly relied on specific groups of patients (30 papers), notably age of patients (18 papers) and/or minority population (11 papers, all from the USA). Strategies to overcome these barriers are needed and should be carefully evaluated.
Collapse
Affiliation(s)
- Caroline Tournoux
- Department of Biostatistics, Hospital Saint Louis, APHP, Paris, France
| | | | | | | |
Collapse
|
35
|
Townsley CA, Chan KK, Pond GR, Marquez C, Siu LL, Straus SE. Understanding the attitudes of the elderly towards enrolment into cancer clinical trials. BMC Cancer 2006; 6:34. [PMID: 16466574 PMCID: PMC1382233 DOI: 10.1186/1471-2407-6-34] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Accepted: 02/08/2006] [Indexed: 11/17/2022] Open
Abstract
Background The optimal cancer treatment for an older population is largely unknown because of the low numbers of elderly patients accrued into clinical trials. This project focuses on the attitudes of the elderly about participation in clinical trials to determine if this is one of the barriers to the involvement of this population in clinical trials. Methods The first phase of this study was a self-administered questionnaire mailed to 425 elderly persons with cancer, selected from Princess Margaret Hospital oncology clinics. The second phase consisted of individual semi-structured interviews with cancer patients to assess their attitudes towards cancer, its management and enrolment into cancer clinical trials. Results Ninety-four patients responded to the survey giving a response rate of 22.1%. Three quarters of respondents stated that they would be willing to participate in a clinical trial. The factors that most influenced older patients' willingness to participate in a cancer study were recommendations from a cancer doctor and the chance that the study treatment may help them feel better. Seventeen survey responders participated in interviews. Common themes from these interviews included patient-physician communication, the referral process, and the role of age in cancer care decision-making. Conclusion Most elderly people, who responded to this survey, are willing to consider participation in cancer clinical trials however, elderly patients do not appear to actively seek clinical trials and few were informed of the availability of clinical trials. Physician barriers and availability of appropriate clinical trials may play a bigger role in preventing accrual of elderly cancer patients into trials.
Collapse
Affiliation(s)
- Carol A Townsley
- Princess Margaret Hospital (PMH) and University of Toronto, Toronto, Canada
| | - Kelvin K Chan
- Princess Margaret Hospital (PMH) and University of Toronto, Toronto, Canada
| | - Gregory R Pond
- Princess Margaret Hospital (PMH) and University of Toronto, Toronto, Canada
| | | | - Lillian L Siu
- Princess Margaret Hospital (PMH) and University of Toronto, Toronto, Canada
| | - Sharon E Straus
- Toronto General Hospital and University of Toronto, Toronto, Canada
| |
Collapse
|
36
|
Townsley C, Pond GR, Peloza B, Kok J, Naidoo K, Dale D, Herbert C, Holowaty E, Straus S, Siu LL. Analysis of treatment practices for elderly cancer patients in Ontario, Canada. J Clin Oncol 2005; 23:3802-10. [PMID: 15923574 DOI: 10.1200/jco.2005.06.742] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Older patients are underrepresented in many areas of cancer services utilization and in clinical trial enrollment. This study evaluates whether age, when adjusted for sex, comorbidity, stage, tumor site, geography, and time period, is predictive of cancer treatment practice. METHODS First, we used the Ontario Cancer Registry (OCR) to examine for any apparent differences in treatment practices between elderly (> or = 70 years) and younger patients in the last three decades. Second, we performed a chart review of 1,505 patients with lung, breast, and colorectal cancers seen in Ontario either at an urban center, the Princess Margaret Hospital, or at a rural center, the Northwestern Regional Cancer Centre. Patients were randomly selected from two time periods, 1977 to 1978 and 1997; and the study population was to comprise at least 50% elderly patients. RESULTS OCR data demonstrated that, in some settings, such as colorectal cancer, the proportions of elderly cancer patients who were referred to cancer centers and who received any cancer treatment were lower than their younger counterparts. The chart review data showed that increasing age was a significant negative predictor for receiving any cancer treatment (P < .001, multivariate analysis) and for having a clinical trial discussion with the treating specialist (P < .001, multivariate analysis). CONCLUSION Independent of other factors, older age is consistently a cause of disparity in cancer treatment practice and in clinical trial discussion with patients. By increasing the accrual rate of elderly cancer patients in clinical trials, a better understanding of appropriate therapies for this patient population can be obtained and may, thereby, impact on their cancer-related morbidity and mortality.
Collapse
Affiliation(s)
- Carol Townsley
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, University Health Network, 610 University Ave, Ste 5-210, Toronto, Ontario, M5G 2M9, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|