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Anic K, Birkert S, Schmidt MW, Linz VC, Heimes AS, Krajnak S, Schwab R, Schmidt M, Westphalen C, Hartmann EK, Hasenburg A, Battista MJ. G-8 Geriatric Screening Tool Independently Predicts Progression-Free Survival in Older Ovarian Cancer Patients Irrespective of Maximal Surgical Effort: Results of a Retrospective Cohort Study. Gerontology 2021; 68:1101-1110. [PMID: 34875663 DOI: 10.1159/000520328] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We evaluated the prognostic impact of various global health assessment tools in patients older than 60 years with ovarian cancer (OC). METHODS G-8 geriatric screening tool (G-8 score), Lee Schonberg prognostic index, Eastern Cooperative Oncology Group (ECOG) performance status, and Charlson Comorbidity Index (CCI) were determined retrospectively in a consecutive cohort of elderly patients with OC. Univariate and multivariate Cox regression analyses and Kaplan-Meier method were performed to analyze the impact of the preoperative global health status on survival. RESULTS 116 patients entered the study. In multivariate analysis adjusted for clinical-pathological factors, only the G-8 score retained significance as a prognostic parameter of progression-free survival (PFS) (hazard ratio [HR]: 1.970; 95% confidence interval [CI] [1.056-3.677]; p = 0.033). Fifty-six patients were classified as G-8-nonfrail with an increased PFS compared to 50 G-8-frail patients (53.4% vs. 16.7%; p = 0.010). A higher CCI was associated with decreased PFS (45.1% vs. 22.2%; p = 0.012), but it did not influence the risk of recurrences or death (p = 0.360; p = 0.111). The Lee Schonberg prognostic index, the ECOG, and age were not associated with survival. CONCLUSIONS The G-8 score independently predicted PFS in elderly OC patients regardless of maximal surgical effort. Thus, it could be useful to assess surgical treatment based on frailty rather than age alone.
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Affiliation(s)
- Katharina Anic
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sophie Birkert
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mona Wanda Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Valerie Catherine Linz
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anne-Sophie Heimes
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Slavomir Krajnak
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Roxana Schwab
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marcus Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christiane Westphalen
- Department of Geriatric Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Erik Kristoffer Hartmann
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Annette Hasenburg
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marco Johannes Battista
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Lo Torto F, Frattaroli JM, Kaciulyte J, Mori FLR, Troisi L, Ciudad P, Manrique OJ, Marcasciano M, Pajardi GE, Casella D, Cigna E, Ribuffo D. The Keystone Flap: A Multi-centric Experience in Elderly Patients Treatment. J Plast Reconstr Aesthet Surg 2021; 75:226-239. [PMID: 34642063 DOI: 10.1016/j.bjps.2021.08.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/03/2021] [Accepted: 08/26/2021] [Indexed: 12/19/2022]
Abstract
Soft tissue reconstruction in elderly patients must be rapid and reliable. The keystone island flap (KF) offers an effective solution, with low complication rates and quick recovery. This multi-centric study aims to show authors' experience with KFs in treating soft tissue defects of trunk and limbs. Patients with soft tissue defects suitable for KF reconstruction were recruited from March 2019 to December 2019. Active inflammation and previous surgeries in the same region were considered exclusion criteria. Complications that occurred during follow-up were recorded, and their incidence pattern was assessed with the Fisher test. Seventy-two patients with mean age of 76.2 years old were selected. They presented lesions in torso (46; 63.9%) or in upper (4; 5.6%) or lower (22; 30.6%) limb regions. Fifteen (20.8%) wounds were non-oncologic lesions, and the others were oncologic lesions, mostly non-melanoma skin cancers. KF type I was carried out in 42 (58.3%) cases, KF type II-A in 13 (18%) cases, double opposed type III KF in 16 (22.2%) patients, and 1 (1.4%) case required partial flap's undermining (IV KF). Mean post-operative recovery period was 4.3 days (range, 1-9 days). Post-surgical complications occurred in 15 (20.8%) cases, 7 (9.7%) of them were considered major complications. No statistically significant difference in complications' incidence, nor among different surgical sites nor among KF types, was registered. Reconstructive surgeons have to adapt their work to elderly patients. The KF allows rapid operative times, low morbidity rates, and short post-operative recovery time, thus appearing as a feasible solution.
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Affiliation(s)
- Federico Lo Torto
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy.
| | - Jacopo M Frattaroli
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy
| | - Juste Kaciulyte
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy
| | - Francesco L R Mori
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy
| | - Luigi Troisi
- University Department of Hand Surgery and Rehabilitation - San Giuseppe Hospital - IRCCS MultiMedica Group, Milano, Italy
| | - Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, United States
| | - Marco Marcasciano
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, "Breast Unit" Integrata di Livorno Cecina, Piombino Elba, Azienda USL Toscana Nord Ovest, Livorno, Italy
| | - Giorgio E Pajardi
- University Department of Hand Surgery and Rehabilitation - San Giuseppe Hospital - IRCCS MultiMedica Group, Milano, Italy
| | - Donato Casella
- Azienda Ospedaliera Universitaria Senese, UOC Chirurgia Oncologica della Mammella, Siena, Italy
| | - Emanuele Cigna
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Diego Ribuffo
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy
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Deschler B, Ihorst G, Hüll M, Baier P. Regeneration of older patients after oncologic surgery. A temporal trajectory of geriatric assessment and quality of life parameters. J Geriatr Oncol 2018; 10:112-119. [PMID: 30314954 DOI: 10.1016/j.jgo.2018.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/08/2018] [Accepted: 09/27/2018] [Indexed: 12/27/2022]
Abstract
AIMS The effectiveness of surgery depends on it being carried out safely, which allows patients to return to independent lives. Because gastrointestinal cancers are a major cause of morbidity and mortality in older people, we examined the dynamics of recuperation after elective, curative surgery. As disease parameters alone may not suffice to address geriatric patients' issues after onco-surgical interventions, Comprehensive Geriatric and QOL Assessments (CGA/QOL) were performed at four time points to gain information on clinical, functional, and cognitive aspects. METHODS CGA/QOL including standard geriatric instruments, socio-demographic, clinical data, and the EORTCQLQ-C30 questionnaire were applied pre-operatively (T1), at discharge (T2), after three (T3), and after six months (T4). RESULTS 200 patients gave their informed consent, 70 patients declined. At T1 n = 195, at T2 n = 155, at T3 n = 130, and at T4 n = 124 patients were actually assessed. Patients experienced a significant decline in most functional capabilities and increased symptoms at T2. While most parameters re-approached baseline results by T4, sophisticated abilities (instrumental ADL, IADL) remained impaired. Fatigue was the most prominent symptom that persisted in many at T4. Risk for malnutrition as well as BMI significantly decreased during regeneration. Global QOL correlated with parameters of independence (ADL, IADL) and low symptom burden. Role and social functions' correlation with global QOL increased from T1 to T4. CONCLUSIONS Longitudinal assessments before and after oncologic surgery highlight changes even after six months in QOL and independence that may be ameliorated by focused supportive care. Trial registry number: DRKS: 00000425.
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Affiliation(s)
| | - Gabriele Ihorst
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Germany
| | - Michael Hüll
- Clinic for Geriatric Psychiatry, Emmendingen, Germany
| | - Peter Baier
- University of Freiburg Surgical Department, Freiburg, Germany; Caritas Krankenhaus Bad Mergentheim, Germany
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Zhang R, Kyriss T, Dippon J, Hansen M, Boedeker E, Friedel G. American Society of Anesthesiologists physical status facilitates risk stratification of elderly patients undergoing thoracoscopic lobectomy. Eur J Cardiothorac Surg 2017; 53:973-979. [DOI: 10.1093/ejcts/ezx436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 11/12/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
- Ruoyu Zhang
- Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Chest Hospital Schillerhoehe, Robert-Bosch-Krankenhaus, Teaching Hospital of the University of Tuebingen, Stuttgart, Germany
| | - Thomas Kyriss
- Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Chest Hospital Schillerhoehe, Robert-Bosch-Krankenhaus, Teaching Hospital of the University of Tuebingen, Stuttgart, Germany
| | - Jürgen Dippon
- Institue of Stochastics and Applications, Department of Mathematics, University Stuttgart, Stuttgart, Germany
| | - Matthias Hansen
- Department of Anesthesia, Chest Hospital Schillerhoehe, Robert-Bosch-Krankenhaus, Teaching Hospital of the University of Tuebingen, Stuttgart, Germany
| | - Enole Boedeker
- Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Chest Hospital Schillerhoehe, Robert-Bosch-Krankenhaus, Teaching Hospital of the University of Tuebingen, Stuttgart, Germany
| | - Godehard Friedel
- Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Chest Hospital Schillerhoehe, Robert-Bosch-Krankenhaus, Teaching Hospital of the University of Tuebingen, Stuttgart, Germany
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Arcangeli S, Agolli L, Portalone L, Migliorino MR, Lopergolo MG, Monaco A, Dognini J, Pressello MC, Bracci S, Donato V. Patterns of CT lung injury and toxicity after stereotactic radiotherapy delivered with helical tomotherapy in early stage medically inoperable NSCLC. Br J Radiol 2015; 88:20140728. [PMID: 25645106 PMCID: PMC4651249 DOI: 10.1259/bjr.20140728] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/28/2015] [Accepted: 02/02/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To evaluate toxicity and patterns of radiologic lung injury on CT images after hypofractionated image-guided stereotactic body radiotherapy (SBRT) delivered with helical tomotherapy (HT) in medically early stage inoperable non-small-cell lung cancer (NSCLC). METHODS 28 elderly patients (31 lesions) with compromised pulmonary reserve were deemed inoperable and enrolled to undergo SBRT. Patterns of lung injury based on CT appearance were assessed at baseline and during follow up. Acute (6 months or less) and late (more than 6 months) events were classified as radiation pneumonitis and radiation fibrosis (RF), respectively. RESULTS After a median follow-up of 12 months (range, 4-20 months), 31 and 25 lesions were examined for acute and late injuries, respectively. Among the former group, 25 (80.6%) patients showed no radiological changes. The CT appearance of RF revealed modified conventional, mass-like and scar-like patterns in three, four and three lesions, respectively. No evidence of late lung injury was demonstrated in 15 lesions. Five patients developed clinical pneumonitis (four patients, grade 2 and one patient, grade 3, respectively), and none of whom had CT findings at 3 months post-treatment. No instance of symptomatic RF was detected. The tumour response rate was 84% (complete response + partial response). Local control was 83% at 1 year. CONCLUSION Our findings show that HT-SBRT can be considered an effective treatment with a mild toxicity profile in medically inoperable patients with early stage NSCLC. No specific pattern of lung injury was demonstrated. ADVANCES IN KNOWLEDGE Our study is among the few showing that HT-SBRT represents a safe and effective option in patients with early stage medically inoperable NSCLC, and that it is not associated with a specific pattern of lung injury.
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Affiliation(s)
- S Arcangeli
- 1 Department of Radiotherapy, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
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Lavelle K, Sowerbutts AM, Bundred N, Pilling M, Todd C. Pretreatment health measures and complications after surgical management of elderly women with breast cancer. Br J Surg 2015; 102:653-67. [PMID: 25790147 DOI: 10.1002/bjs.9796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/13/2014] [Accepted: 01/29/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Elderly patients with breast cancer are less likely to be offered surgery, partly owing to co-morbidities and reduced functional ability. However, there is little consensus on how best to assess surgical risk in this patient group. METHODS The ability of pretreatment health measures to predict complications was investigated in a prospective cohort study of a consecutive series of women aged at least 70 years undergoing surgery for operable (stage I-IIIa) breast cancer at 22 English breast units between 2010 and 2013. Data on treatment, surgical complications, health measures and tumour characteristics were collected by case-note review and/or patient interview. Outcome measures were all complications and serious complications within 30 days of surgery. RESULTS The study included 664 women. One or more complications were experienced by 41·0 per cent of the patients, predominantly seroma or primary/minor infections. Complications were serious in 6·5 per cent. More extensive surgery predicted a higher number of complications, but not serious complications. Older age did not predict complications. Several health measures were associated with complications in univariable analysis, and were included in multivariable analyses, adjusting for type/extent of surgery and tumour characteristics. In the final models, pain predicted a higher count of complications (incidence rate ratio 1·01, 95 per cent c.i. 1·00 to 1·01; P = 0·004). Fatigue (odds ratio (OR) 1·02, 95 per cent c.i. 1·01 to 1·03; P = 0·004), low platelet count (OR 4·19, 1·03 to 17·12: P = 0·046) and pulse rate (OR 0·96, 0·93 to 0·99; P = 0·010) predicted serious complications. CONCLUSION The risk of serious complications from breast surgery is low for older patients. Surgical decisions should be based on patient fitness rather than age. Health measures that predict surgical risk were identified in multivariable models, but the effects were weak, with 95 per cent c.i. close to unity.
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Affiliation(s)
- K Lavelle
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Core Technology Facility, Manchester, UK
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Abstract
BACKGROUND Symptom distress remains a significant health problem among older adults with cancer following surgery. Understanding factors influencing older adults' symptom distress may lead to early identification and interventions, decreasing morbidity and improving outcomes. OBJECTIVE We conducted this study to identify factors associated with symptom distress following surgery among 326 community-residing patients 65 years or older with a diagnosis of thoracic, digestive, gynecologic, and genitourinary cancers. METHODS This secondary analysis used combined subsets of data from 5 nurse-directed intervention clinical trials targeting patients after surgery at academic cancer centers in northwest and northeastern United States. Symptom distress was assessed by the Symptom Distress Scale at baseline and at 3 and 6 months. RESULTS A multivariable analysis, using generalized estimating equations, showed that symptom distress was significantly less at 3 and 6 months (3 months: P < .001, 6 months: P = .002) than at baseline while controlling for demographic, biologic, psychological, treatment, and function covariates. Thoracic cancer, comorbidities, worse mental health, and decreased function were, on average, associated with increased symptom distress (all P < .05). Participants 75 years or older reported increased symptom distress over time compared with those aged 65 to 69 years (P < .05). CONCLUSIONS Age, type of cancer, comorbidities, mental health, and function may influence older adults' symptom distress following cancer surgery. IMPLICATIONS FOR PRACTICE Older adults generally experience decreasing symptom distress after thoracic, abdominal, or pelvic cancer surgery. Symptom management over time for those with thoracic cancer, comorbidities, those with worse mental health, those with decreased function, and those 75 years or older may prevent morbidity and improve outcomes of older adults following surgery.
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Guerra M, Neves P, Miranda J. Surgical treatment of non-small-cell lung cancer in octogenarians. Interact Cardiovasc Thorac Surg 2013; 16:673-80. [PMID: 23396622 DOI: 10.1093/icvts/ivt020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Reluctance to recommend lung cancer surgery for octogenarians is partly based on the expectation that the rate of complications and mortality is higher in this group of patients, and on the impression that the life expectancy of an octogenarian with lung cancer is limited by death from natural causes. Moreover, the belief that radiation therapy and observation yield similar results to surgery in early-stage disease have influenced low resection rates in this population. Nevertheless, advances in surgical techniques, anaesthesia and postoperative care have made surgical lung resection a safer procedure than it was in the past. Judging from the more recent findings, surgery should not be withheld because of postoperative mortality, but suboptimal or palliative treatment may be necessary in patients with poor physical or mental function. To enable informed decision-making, both patients and clinicians need information on the risks of surgical treatment. In this review, available information from the literature was collected in an effort to understand the real benefit of surgical treatment in octogenarians with non-small-cell lung cancer, and to determine what should be done or avoided during the selection course.
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Affiliation(s)
- Miguel Guerra
- Department of Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nove de Gaia, Portugal.
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Abstract
Colorectal cancer (CRC) largely affects older individuals; almost half of cases occur in patients >75 years old. The incidence increases with advancing age, doubling every 7 years in patients aged ≥50 years. The medical and societal burdens of CRC will probably worsen over the coming decades as the number of older individuals (>70) continues to grow. No evidence-based guidelines are available for this age group, as older patients with CRC are generally excluded from randomized clinical trials and the fit ones who are recruited are not representative of the general elderly population. When feasible, surgery is the most successful treatment option for eradicating the primary lesion, as well as any metastases. The operative risk under elective conditions is not markedly different in older than in younger patients; however, the acute setting is to be avoided as it is associated with high operative death rates. Well-selected older patients can tolerate chemotherapy, but benefits need to be balanced against potentially limited life expectancy and reduced quality of life. The use of combination chemotherapy is an area of much controversy, but this treatment should not necessarily be withheld because of the age of the patient. Careful monitoring of toxicities and early intervention is essential in older patients undergoing chemotherapy.
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Affiliation(s)
- Riccardo A Audisio
- University of Liverpool, St Helens Teaching Hospital, Department of Surgery, Marshalls Cross Road, St Helens, Liverpool WA9 3DA, UK.
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Frailty predicts outcome of elective laparoscopic cholecystectomy in geriatric patients. Surg Endosc 2012; 27:1144-50. [PMID: 23052539 DOI: 10.1007/s00464-012-2565-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 08/23/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Frailty is a phenotype characterized by complex and challenging medical problems and higher susceptibility to adverse health outcomes. It can be derived at by a multidimensional process known as comprehensive geriatric assessment (CGA), which assesses the functional reserves of the elderly. In this study we report for the first time on a prospective evaluation of the association between CGA and postoperative complications after elective laparoscopic cholecystectomy for biliary disease. METHODS Fifty-seven patients older than 65 years who were to undergo elective laparoscopic cholecystectomy for uncomplicated biliary disease were prospectively examined. Preoperative CGA was performed and the patients were categorized as fit or frail. The main outcome of the study was the rate of any postoperative complication within 30 days of surgery. RESULTS There were 29 women (50.9 %) and the median (interquartile range) age of the cohort was 73 (8.8) years. Thirty-two patients (56.1 %) were categorized as frail and 25 (43.9 %) as fit. The overall incidence of postoperative complications was 23.7 %, most of which were grade I and II (18.8 %). Frail patients, according to the CGA assessment, experienced a significantly higher incidence of postoperative complications compared to their fit counterparts (84.6 vs. 15.4 %, p = 0.023). Frail patients experienced a significantly higher frequency of prolonged (more than 2 days) postoperative hospital stay compared with their fit counterparts (p = 0.023). CONCLUSIONS Preoperative CGA may predict postoperative complications and prolonged postoperative hospital stay of elderly patients who undergo elective laparoscopic cholecystectomy. Larger-scale studies independently assessing this association are warranted.
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Smith SL, Palma D, Parhar T, Alexander CS, Wai ES. Inoperable early stage non-small cell lung cancer: comorbidity, patterns of care and survival. Lung Cancer 2011; 72:39-44. [PMID: 20801544 DOI: 10.1016/j.lungcan.2010.07.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 07/10/2010] [Accepted: 07/29/2010] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate comorbidities, patterns of care and outcomes for patients with inoperable stage I and II non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Patients diagnosed with stage I or II NSCLC in British Columbia between 1996 and 2005 who did not undergo primary surgery and were referred for oncology assessment were identified in a retrospective analysis. Baseline comorbidity and pulmonary function data for patients treated with curative radiotherapy (CurRT; biologically effective dose [BED]>58 Gy(10)) were abstracted by chart review. Kaplan-Meier and Cox regression were used to determine factors associated with overall survival (OS) and cause-specific survival (CSS) based on treatment group [no radiotherapy (NoRT), palliative radiotherapy (PallRT), or CurRT]. RESULTS Of 1043 patients identified, approximately 1/3 received CurRT, and these patients had better performance status and lower stage disease than the other groups. There was a high prevalence of comorbid conditions in the CurRT group; 90% of CurRT patients had an age-adjusted Charlson comorbidity index (CCI) score ≥5. CurRT patients had a median survival 1-year longer than patients treated with PallRT or NoRT (p < 0.0001). In CurRT patients, CCI was predictive of OS (HR 1.1 per point CCI increase; p = 0.044), but not CSS. Patients receiving PallRT with a BED > 50 Gy(10) had significantly longer OS than those receiving PallRT of ≤50 Gy(10) (p < 0.0001). CONCLUSIONS Treatment of medically inoperable early stage NSCLC patients with CurRT is associated with a significantly longer survival, and for these patients CCI is a significant predictor of OS. For patients treated with PallRT, higher doses of palliative thoracic RT is associated with improved OS.
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Affiliation(s)
- S L Smith
- Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Island Centre, 410 Lee Avenue, Victoria, British Columbia V8R 6V5, Canada.
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Treatment of stage I NSCLC in elderly patients: a population-based matched-pair comparison of stereotactic radiotherapy versus surgery. Radiother Oncol 2011; 101:240-4. [PMID: 21775007 DOI: 10.1016/j.radonc.2011.06.029] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/13/2011] [Accepted: 06/13/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Elderly patients with stage I NSCLC who undergo surgical resection are at high risk of treatment-related toxicity. Stereotactic body radiation therapy (SBRT) may provide an alternative treatment with a favorable toxicity profile. METHODS A population-based registry in North-Holland was used to conduct a matched-pair analysis of overall survival (OS) after surgery versus SBRT for elderly patients (age ⩾75) who were diagnosed between 2005 and 2007. Patients were matched by age, stage, gender, and treatment year; co-morbidity data was not available. SBRT was delivered at two centers; 17 centers provided surgery. RESULTS A total of 120 patients could be matched (60 surgery, 60 SBRT). Median age was 79years, 67% were male, and 64% had T1 disease. Median follow-up was 43months. Thirty-day mortality was 8.3% after surgery and 1.7% after SBRT. OS at one- and three-years was 75% and 60% after surgery, and 87% and 42% after SBRT, respectively (log-rank p=0.22). Limiting the analysis to SBRT patients with pathological confirmation of disease and their matches revealed no significant difference between groups. CONCLUSION Similar OS outcomes are achieved with surgery or SBRT for stage I NSCLC in elderly patients. Comorbidity data and outcomes from centralized surgical programs are needed for more robust conclusions.
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Bellury LM, Ellington L, Beck SL, Stein K, Pett M, Clark J. Elderly cancer survivorship: an integrative review and conceptual framework. Eur J Oncol Nurs 2011; 15:233-42. [PMID: 21530396 DOI: 10.1016/j.ejon.2011.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 03/22/2011] [Accepted: 03/25/2011] [Indexed: 12/27/2022]
Abstract
UNLABELLED The intersection of ageing and cancer in the phase of post-treatment survivorship represents a large and growing population with unique needs. PURPOSE The goal of this work is to review and integrate the current gerontology and oncology literature relevant to elderly cancer survivorship, to identify knowledge gaps and research opportunities and to propose a conceptual model to guide future research. The long-term, global goal is the prevention of morbidity and mortality in elderly cancer survivors by identification of vulnerable elders, maintenance of independence, tailoring of treatment, establishing intervention guidelines and planning for necessary resources within the entire trajectory of cancer survival for older survivors. METHODS Targeted and integrative review of selected literature from multiple disciplines. Search engines included PubMed, article reference lists and internet searches for epidemiological data (US Census, World Health Organization, American Cancer Society, Canadian Cancer Cancer Society, etc). RESULTS A conceptual model that incorporates the gerontologic, oncologic and personal characteristics of older cancer survivors is proposed that may provide a comprehensive approach by which to frame elderly survivorship research. CONCLUSION Cancer survivorship among the elderly is quantitatively and qualitatively different from cancer survivorship among other age groups. The current large numbers and predicted increase in elderly cancer survivors in the near future mandate attention to this population. Future research must consider the complexity of intersecting needs in the gero-oncology population.
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Chaufour-André C, Bajard A, Fingal C, Roux P, Fiorletta I, Gertych W, Rivoire M, Bonnefoy M, Bachmann P. Conséquences nutritionnelles de la chirurgie en oncogériatrie. Étude descriptive et prospective. NUTR CLIN METAB 2011. [DOI: 10.1016/j.nupar.2010.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Palma D, Visser O, Lagerwaard FJ, Belderbos J, Slotman BJ, Senan S. Impact of Introducing Stereotactic Lung Radiotherapy for Elderly Patients With Stage I Non–Small-Cell Lung Cancer: A Population-Based Time-Trend Analysis. J Clin Oncol 2010; 28:5153-9. [DOI: 10.1200/jco.2010.30.0731] [Citation(s) in RCA: 369] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose Stereotactic body radiotherapy (SBRT) for stage I non–small-cell lung cancer (NSCLC) is associated with high local control rates. The impact of introducing SBRT in patients 75 years of age or older was studied using a population-based cancer registry. Methods The Amsterdam Cancer Registry was assessed in three eras: 1999 to 2001 (period A, pre-SBRT); 2002 to 2004 (period B, some availability of SBRT), and 2005 to 2007 (period C, full access to SBRT). χ2, Kaplan-Meier, and Cox regression were used to compare treatment patterns and overall survival (OS) in three treatment groups: surgery, radiotherapy (RT), or neither. Results A total of 875 elderly patients were diagnosed with stage I NSCLC in the study period. Median follow-up was 54 months. Primary treatment was surgery in 299 patients (34%), RT in 299 patients (34%), and neither in 277 patients (32%). RT use increased between periods A and C (26% v 42%, P < .01), corresponding to a decrease in untreated patients. The percentage of RT patients undergoing SBRT in periods B and C was 23% and 55%, respectively. Median survival for all patients increased from 16 months in period A to 21 months in period C (log-rank P < .01; hazard ratio [HR] = 0.65; 95% CI, 0.54 to 0.80). The improvement in OS was confined to RT patients (HR = 0.70; 95% CI, 0.49 to 0.99), whereas no significant survival improvements were seen in the other groups. Conclusion SBRT introduction was associated with a 16% absolute increase in RT use, a decline in the proportion of untreated elderly patients, and an improvement in OS.
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Affiliation(s)
- David Palma
- From the Vrije Universiteit University Medical Center; Comprehensive Cancer Centre Amsterdam; and Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Otto Visser
- From the Vrije Universiteit University Medical Center; Comprehensive Cancer Centre Amsterdam; and Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Frank J. Lagerwaard
- From the Vrije Universiteit University Medical Center; Comprehensive Cancer Centre Amsterdam; and Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jose Belderbos
- From the Vrije Universiteit University Medical Center; Comprehensive Cancer Centre Amsterdam; and Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ben J. Slotman
- From the Vrije Universiteit University Medical Center; Comprehensive Cancer Centre Amsterdam; and Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Suresh Senan
- From the Vrije Universiteit University Medical Center; Comprehensive Cancer Centre Amsterdam; and Netherlands Cancer Institute, Amsterdam, the Netherlands
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Lasithiotakis KG, Petrakis IE, Garbe C. Cutaneous melanoma in the elderly: epidemiology, prognosis and treatment. Melanoma Res 2010; 20:163-70. [PMID: 20375923 DOI: 10.1097/cmr.0b013e328335a8dd] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The incidence and mortality of cutaneous melanoma (CM) has increased over the last decades in fair-skinned populations. Incidence and mortality, as well as rates of increase, have been significantly higher in elderly people compared with younger age groups. Lower survival rates from CM among elderly are mainly the result of late diagnosis of tumors with dismal prognostic features. Expansion of current preventive strategies to include older age groups is therefore warranted. Despite differences in clinical presentation and pathological characteristics of CM in the elderly, there is no evidence that primary surgical treatment should differ from that proposed generally for melanoma. However, the rate of positive sentinel node dissection decreases with age, even though overall survival is shorter in older patients, a paradox that remains to be explained. The use of adjuvant treatment with interferon-alpha in elderly patients requires careful discussion of the risks and benefits, especially when serious illness coexists. For metastatic melanoma, complete metastasectomy is the only treatment associated with benefit for overall survival. However, careful selection of surgical oncogeriatric candidates is necessary, probably with the use of tools to provide a comprehensive geriatric assessment, to identify patients more likely to benefit from this treatment. In the absence of any effective systemic treatment for disseminated CM, new therapeutic agents are urgently needed. Practical means to improve accrual of older patients in clinical trials are necessary to provide better evidence for their treatment.
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Palma DA, Tyldesley S, Sheehan F, Mohamed IG, Smith S, Wai E, Murray N, Senan S. Stage I non-small cell lung cancer (NSCLC) in patients aged 75 years and older: does age determine survival after radical treatment? J Thorac Oncol 2010; 5:818-24. [PMID: 20521349 DOI: 10.1097/jto.0b013e3181d6e052] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Curative treatment of stage I non-small cell lung cancer (NSCLC) in elderly patients represents a therapeutic challenge. Data examining outcomes for the elderly after radical radiotherapy (RT) or surgery in the same geographic population are limited. METHODS Using prospective databases from British Columbia, patients with stage I NSCLC treated curatively with either surgery or RT between 2000 and 2006 were identified. Kaplan-Meier, Cox regression, and competing risk analyses were used to assess overall survival (OS) and disease-specific survival in the elderly, and the relationship between age and survival outcomes. RESULTS Of a total of 558 patients with stage I disease, 310 (56%) received surgery and 248 (44%) received RT. Elderly patients (age > or =75 years) were less likely to undergo resection than their younger counterparts (43% versus 72%, p < 0.0001). Actuarial OS after surgery for elderly patients was 87% at 2 years and 69% at 5 years. On multivariate analysis, OS after surgery was dependent on tumor stage (p = 0.034) and performance status (p = 0.03), but not age (p = 0.87). After RT, actuarial OS for elderly patients was 53% at 2 years and 23% at 5 years. On multivariate analysis, age did not predict for OS after RT (p = 0.43), whereas tumor stage (p = 0.033), sex (p = 0.044), and dose (p = 0.01) were significant predictors. CONCLUSIONS Survival after radical treatment for stage I NSCLC is dependent on factors such as tumor stage, performance status, sex, and RT dose, but not age. Elderly patients who are sufficiently fit should not be considered ineligible for radical treatment based on age alone.
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Affiliation(s)
- David A Palma
- Department of Radiation Oncology, BC Cancer Agency, Vancouver, Canada.
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Abstract
BACKGROUND Lung cancer has progressively become a disease of older people, with the median age at diagnosis now exceeding 70 years. Octogenarians represent a rapidly growing proportion of patients diagnosed with lung cancer and can present distinct challenges. Nevertheless, current literature that has set the evidence-based standards of care in this disease does not include significant numbers of patients older than 80 years. METHODS We have compiled and reviewed the available literature on the specific management and treatment of lung cancer in patients older than 80 years. RESULTS Retrospective series suggest that surgery is safe and effective in treating early-stage non-small cell lung cancer in selected patients older than 80 years. There is minimal data to support the use of adjuvant chemotherapy in this group. In addition, no data exist on the use of combined chemotherapy and radiotherapy for locally advanced disease. In advanced or metastatic disease, similar to younger elderly populations, single-agent chemotherapy is feasible and seems to offer benefit in terms of symptoms and outcomes. Small cell lung cancer in this population is not well characterized, but small studies suggest symptom improvement and prolongation of survival with the use of chemotherapy. CONCLUSION Based on retrospective series, octogenarians with lung cancer can derive benefit from many of the treatment modalities used for younger patients including surgery for early-stage disease and single-agent chemotherapy for advanced disease. More elderly specific trials are needed to better refine treatment decisions and improve the care of lung cancer in this group.
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Milet PR, Mallet Y, El Bedoui S, Penel N, Servent V, Lefebvre JL. Head and neck cancer surgery in the elderly – Does age influence the postoperative course? Oral Oncol 2010; 46:92-5. [DOI: 10.1016/j.oraloncology.2009.10.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 10/02/2009] [Accepted: 10/02/2009] [Indexed: 11/24/2022]
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Pallis AG, Papamichael D, Audisio R, Peeters M, Folprecht G, Lacombe D, Van Cutsem E. EORTC Elderly Task Force experts' opinion for the treatment of colon cancer in older patients. Cancer Treat Rev 2009; 36:83-90. [PMID: 19944536 DOI: 10.1016/j.ctrv.2009.10.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 10/28/2009] [Accepted: 10/29/2009] [Indexed: 02/07/2023]
Abstract
As a result of an increasing life expectancy, the incidence of colon cancer in the older population is rising. As a consequence oncologists and their older patients commonly face the dilemma of whether or not to give/receive treatment for colon cancer. However, the paucity of large, well conducted prospective trials makes it difficult to provide evidence-based clinical recommendations for these patients. The current evidence supports the safety and efficacy of treatment for colon cancer in fit older patients and demonstrates that treatment outcome can be similar to that of their younger counterparts. However, it should be noted that these data are derived from retrospective studies which are likely to suffer from selection bias. Despite a growing body of data, further work is still needed to establish optimal strategies to care for this special population and prospective specific trials for older colon cancer patients are clearly needed.
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Affiliation(s)
- A G Pallis
- EORTC Headquarters, EORTC-Elderly Task Force, Brussels, Belgium.
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Kristjansson SR, Farinella E, Gaskell S, Audisio RA. Surgical risk and post-operative complications in older unfit cancer patients. Cancer Treat Rev 2009; 35:499-502. [PMID: 19435652 DOI: 10.1016/j.ctrv.2009.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Surgeons have always dealt with elderly cancer patients, but understanding frailty and tailoring treatment is a new achievement endeavour. Mounting evidence is resulting in the introduction of geriatric assessment into clinical practice. Particularly, undernourishment should be assessed and corrected in order to avoid emergency situations whenever possible.
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Affiliation(s)
- Siri R Kristjansson
- Department of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway
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Affiliation(s)
- Stuart M Lichtman
- Memorial Sloan-Kettering Cancer Center, Commack, NY, and New York, NY, USA
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