Comprehensive geriatric assessment for older patients with cancer

SOHO State of the Art Updates and Next Questions | Diffuse Large B-Cell Lymphoma in Older Adults: A Comprehensive Review

Older adults (OA) with DLBCL are a heterogenous population with suboptimal outcomes. In this review, we identify and address the unique challenges encountered in the care of OA with DLBCL. We elaborate on the role and limitations of current geriatric assessment (GA) tools and ways to incorporate fitness in therapeutic decision making. We suggest best practices to implement GA in routine practice and clinical trials. The most widely used tool is simplified GA (sGA) which categorizes patients into fit, unfit and frail groups. Patients who are fit benefit from full dose/curative approach, whereas consideration should be made to reduce the intensity of chemotherapy for unfit patients. Frail patients with DLBCL are a major unmet need without any satisfactory treatment options. Ongoing investigations combining novel therapies into chemotherapy-free regimens are underway with promising early results. In the relapsed/refractory (R/R) setting, anti-CD19 CAR-T cell therapy (CART) is now the standard of care for primary refractory disease or relapse within 12 months of completing therapy. Autologous stem cell transplant is still a consideration for fit OA with relapse >12 months after completing therapy. The recent approval of bispecific antibodies is a welcome advance that will greatly benefit OA not eligible for CART. Other regimens available for patients ineligible for CART or for those who experience progression post-CART include polatuzumab-rituximab±bendamustine, tafasitamab-lenalidomide, loncastuximab or chemotherapy-based approaches such as rituximab-gemcitabine-oxaliplatin. We discuss the changing paradigm in R/R DLBCL and spotlight emerging data from recent congresses that can improve outcomes in this vulnerable population.

Effectiveness and Toxicity in Older Patients Receiving Anticancer Agents: A Retrospective Analysis of Australian Patients

The number of older adults being treated for cancer is increasing. Despite this, older patients are under-represented in clinical trials. Those who are included are unlikely to be an accurate reflection of real-world patients as many are excluded based on performance status and comorbidities. There is a paucity of data examining the toxicity, and effectiveness, of systemic therapy in this group; particularly in a regional Australian cohort. Retrospective data from patients ≥75 years, on treatment for a solid organ malignancy in an Australian regional center was collected to assess the toxicity, and effectiveness, of immunotherapy and chemotherapy. Ninety-two patients were included. The mean age was 81. There was no significant difference in overall survival based on; age, Eastern Cooperative Oncology Group score, or number of comorbidities. Only 27% of treatments were ceased due to toxicity. 35% of patients on chemotherapy had had a dose reduction during treatment. Grade ≥3 toxicity was experienced by 32% of patients who received chemotherapy-containing regimens and 22% who received immunotherapy-containing regimens. To our knowledge, this is the first study providing real-world data on the effectiveness, and safety, of anti-cancer agents in older patients in a regional Australian center across multiple tumor streams. In older adults otherwise well enough for treatment, outcomes from treatment were not greatly affected by age. Other factors, rather than age and comorbidities alone, may predict outcomes. The use of screening tools may help select patients for comprehensive geriatric assessment.

Preliminary experience supporting older adults with breast cancer: Successes, challenges, and next steps for a program embedded in a breast oncology center

INTRODUCTION

Older adults diagnosed with cancer often have functional vulnerability and increased risk for treatment-related toxicity and poor outcomes, with emergent clinical strategies to mitigate these risks. The geriatric assessment (GA) is a widely recommended platform in the clinic to help inform treatment decisions and toxicity risk and initiate referrals, but incorporating the GA into busy clinical practice remains challenging.

MATERIALS AND METHODS

To promote a consistent approach in conducting the GA and connecting older adults with relevant resources and services while acknowledging the specific care needs for those with breast cancer, our National Cancer Institute-designated center launched the Program for Older Adults with Breast Cancer (OABC) in May 2022, embedded within the Breast Oncology Center. The OABC coordinator offers approached patients an introduction to program services and an opportunity to undergo the GA. The coordinator uses the GA responses to facilitate appropriate geriatrics and supportive care referrals, with recommendations and utilization of services tracked in the program database. We report the initial findings from systematic GA administration within a high-volume breast cancer program.

RESULTS

From 2022 to 2024, 362 patients were approached to enroll in OABC; 108 completed a GA. Overall, 32.1 % were aged 70-75 and 10 % were aged ≥86, and most (2/3) had non-metastatic disease. Approximately 30 % were hospitalized in the year before enrollment, 19 % had recent falls, and the majority reported having social supports for emotional and physical needs (>65 % for each). Based on the GA (n = 108), the most frequently recommended services were geriatrics (67 %) and social work (36 %). However, only 60 % of patients who completed the GA agreed to one or more referrals to any of the recommended supportive care services.

DISCUSSION

OABC systematically reaches patients at high risk for aging-relevant needs. Coordination of services was successful, but patient declines for geriatrics and supportive resources referrals were common despite having dedicated program staff. Further efforts will increase uptake of the GA and these important services.

Impact of D3 lymph node dissection on short-term and long-term outcomes in elderly patients with colon cancer

BACKGROUND

The oncologic impact of D3 lymph node dissection (LND) for colon cancer (CC) has been reported to be favorable. However, D3 LND is potentially more invasive than non-D3 LND, and whether it is beneficial for elderly patients with CC remains unclear. This study aimed to evaluate the perioperative safety and short- and long-term oncologic outcomes of D3 LND in elderly patients with CC.

METHODS

Subjects were 442 elderly patients aged ≥ 70 years who underwent curative surgery for pathologic stage (pStage) I-III CC between 2011 and 2022. Background clinical factors and short- and long-term outcomes were compared between patients who received D3 LND (D3 group; n = 363) and those who received non-D3 LND (non-D3 group; n = 79).

RESULTS

The D3 group had a significantly higher number of retrieved lymph nodes (median 20 vs. 12, p < 0.001) and a lower rate of postoperative complications (18% vs. 32%, p = 0.040) than the non-D3 group. In the overall cohort, overall survival (OS) did not differ between the two groups. Among pStage III patients, however, OS was significantly better (69.8% vs. 34.1%, p = 0.028), and RFS tended to be better (60.7% vs. 42.6%, p = 0.075) in the D3 group than in the non-D3 group. Multivariable analysis revealed that D3 LND was independently associated with better OS (HR 0.477; 95% CI 0.245-0.931, p = 0.030) and tended to be associated with better RFS (HR 0.588; 95% CI 0.329-1.051, p = 0.073).

CONCLUSION

D3 LND is safe and effective in improving the prognosis of elderly patients with pStage II/III CC.

Application of comprehensive geriatric assessment in oncology nursing: A literature review on optimizing treatment decisions and patient outcomes

With the global population aging, the care of elderly cancer patients has become increasingly complex and significant. Comprehensive geriatric assessment (CGA), a multidimensional evaluation tool, has been widely implemented in oncology nursing to enhance the precision of treatment decisions and improve patient outcomes. This review examines the application of CGA in oncology nursing, drawing on literature published between 2010 and 2024 in major databases using keywords such as "Comprehensive Geriatric Assessment" and "Oncology Nursing". It highlights how CGA contributes to optimizing treatment selection, monitoring the treatment process, and improving patients' quality of life and long-term outcomes. CGA provides a comprehensive evaluation of elderly cancer patients, including physical, psychological, and social aspects, enabling the identification of high-risk patients and reducing treatment-related side effects and complications. It also offers a critical foundation for developing personalized care plans. The article discusses various practical examples of CGA implementation across different countries and regions, including multidisciplinary collaborative models in France, the United States, and Australia, demonstrating CGA's flexible application in diverse healthcare settings. Although significant progress has been made in applying CGA in oncology nursing, numerous challenges remain in its implementation, such as resource limitations and insufficient personnel training. Future research will focus on integrating CGA with emerging technologies, such as artificial intelligence and precision medicine, to further improve the quality of care and treatment outcomes for elderly cancer patients. By summarizing the current status and challenges of CGA in oncology nursing, this review provides guidance for future research and clinical practice, emphasizing the importance of advancing CGA application to meet the growing demands of elderly oncology care.

Impact of comprehensive geriatric assessment on treatment decisions in older prostate cancer patients

BACKGROUND

Prostate cancer is the most common cancer in men aged above 75 years old. Given their heterogeneity, the International Society of Geriatric Oncology recommends using a comprehensive geriatric assessment (CGA) to adapt anticancer treatment management according to their geriatric status. While the theoretical value of this approach is in no doubt, the impact of the CGA on the final therapeutic decision remains elusive. This study therefore investigated the impact of comprehensive geriatric assessment on treatment decisions in older patients diagnosed with prostate cancer and described the factors associated with a change in treatment plan.

METHODS

This single-centre retrospective study included prostate cancer patients who received a CGA prior to a therapeutic decision from January 2012 to December 2022. The CGA included medical, nutritional, cognitive, social, functional and psychological evaluation.

RESULTS

140 patients were included, of whom 57 (40.7%) benefited from a change in their therapeutic plan after CGA, all in favour of a less aggressive treatment. There was no difference in event-free (EFS) or overall survival (OS) between patients with or without a therapeutic modification (HR for OS = 1.12 [0.68;1.84] p = 0.048). Factors associated with a change in treatment plan were a WHO performance status > 1, a high age-adjusted Charlson score, polymedication, an impaired functional independence with the ADL (Activities of Daily Living) scale and a 'frail' or 'vulnerable' geriatric profile according to Balducci's classification.

CONCLUSION

A comprehensive geriatric assessment prior to prostate cancer treatment plan initiation lead to therapeutic de-escalation in 40% of cases of without affecting overall survival or event-free survival. This adaptation offering a more tailored cancer management while preventing functional impact of treatment due to toxicity and improving patient quality of life.

TRIAL REGISTRATION

The study was registered as (number's register: F20240123102237) and MR004 (CNIL number: 23RDUROL01).

Systemic treatment among frail older patients with cancer: An observational cohort

INTRODUCTION

In the past, certain oncological therapies were not offered to frail older patients. However, the advancement of geriatric oncology, tailored chemotherapy regimens, the introduction of new treatments, and the optimization of supportive care have contributed to enhancing the therapeutic margin. We aimed to evaluate the benefit of systemic treatment among older adults by assessing the three-month survival of older frail patients with metastatic cancer.

MATERIALS AND METHODS

This retrospective cohort study included patients aged 70 and over with metastatic cancer who underwent pre-therapeutic geriatric assessment at Gustave Roussy Hospital between May 2020 and May 2022 and were categorized as "frail" according to the SIOG-1 classification, whether they received systemic treatment (ST group) or exclusive supportive care (SC group).

RESULTS

The ST group included 77 patients, and the SC group included 44 patients. Patients in the ST group had a median age of 80.6 years (82.7 years in SC group). The three-month overall survival rate was 81.8 % [95 % Confidence Interval (CI) 71.8; 88.9] in the ST group. The median survival rate was 10.6 months [95 % CI 6.3; 12.6] in the ST group. In multivariate analysis within the ST group, loss of autonomy assessed by activity of daily living (ADL) (HR 2.16 [1.09; 4.28]) and more frailty factors (HR 1.40 [1.01; 1.95]) were associated with lower three-month survival.

DISCUSSION

Older frail patients with metastatic cancer may benefit from systemic oncologic treatment. The introduction of such treatment for patients with loss of autonomy in ADL or cumulative frailty factors should be considered only with caution.

Therapeutic Management in Elderly Male Breast Cancer Patients: A Scoping Review

PURPOSE OF REVIEW

Male breast cancer (MBC) is a rare entity which often arises in elderly people. Aim of this review is to evaluate the principal issues related to MBC in elderly, because the therapeutic management of disease is not only related to the biological behavior of the tumor, but also to the comorbidities and frailty of older population. A scoping literature review was performed on Pubmed and Cochrane Database using the following keywords: therapeutic management/ male/ breast cancer/ elderly patients. Papers published before 2000, not edited in English or French language, or not related to the main topic, were excluded. Only articles related to therapeutic issues in MBC and including more than 10 elderly (≥ 65 years) patients were selected for the qualitative outcome analysis.

RECENT FINDINGS

36 papers regarding surgery, radiotherapy, systemic therapy, racial disparities and therapeutic management in retrospective series of MBC in elderly were examined in details. MBC has a different biological behavior and a poorer prognosis than female, especially in cases with positive nodes at diagnosis. Elderly MBC patients have often larger tumors in more advanced stages at the time of diagnosis compared with younger patients. In spite of the advanced tumors at presentation, older patients present often cancers with more favorable biological characteristics, but they receive less guideline-concordant curative treatments (as adequate lymph node staging or adjuvant radiation therapy) compared to women. Moreover, racial differences in treatment of older MBC were observed. Therapeutic management of MBC in elderly patients is a subject rarely addressed in literature. Our review highlighted differences in the treatment and in guidelines-concordance for elderly MBC patients. Adequate geriatric assessment and use of therapeutic schemes adapted to age and comorbidities can avoid under/overtreatment, contributing to a better standard of care in this frail population.

Chemotherapy plus immunotherapy as first line combination in older patients with extensive stage small cell lung cancer: A systematic review and meta-analysis

BACKGROUND

Small-cell lung cancer (SCLC) accounts for 10%-15% of all lung cancers. At diagnosis, nearly two thirds of patients with SCLC have extensive stage (ES), with a median overall survival (OS) less than 12 months. The combination of protein-death-1/protein-death-ligand-1 (PD-1/PD-L1) immune checkpoint inhibitors (ICIs) with first-line platinum plus etoposide chemotherapy has changed the therapeutic landscape for ES-SCLC. Older adults represent most of the cancers diagnosed and deaths by age group, with an expected increase over the next decade. In the real-world setting, about 30%-40% of patients with a diagnosis of SCLC are reported to be over 70-years-old at the time of diagnosis. However, this subgroup of patients is underrepresented in clinical trials. Based on this evidence, we performed this systematic review to define the activity of ICIs plus chemotherapy in older patients with previously untreated ES-SCLC.

METHODS

This systematic review was carried out in accordance with the statement in the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic search on multiple electronic databases was conducted from inception to the end of April to identify randomized trials that prospectively evaluated chemotherapy ± PD-1/PD-L1 ICIs. When more than one report of the same study was available, the most recent data (with longer follow-up and/or higher number of patients) was considered. The primary endpoint of the study was efficacy, in terms of overall survival, progression-free survival, and disease control rate.

RESULTS

We selected six randomized clinical trials that enrolled 3396 patients in the meta-analysis. In the experimental arm, 670 patients were 65 years of age and older compared to 504 in the control arm. In the subgroup of patients ≥65 years, adding ICIs to chemotherapy led to a significant benefit in OS [hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.72-0.90). There was moderate but not-significant heterogenity among the trials (I2 = 47%, P = 0.07).

CONCLUSION

This systematic review found that the combination of chemotherapy plus ICIs improved OS among older patients with ES-SCLC. Biomarker and comprehensive geriatric assessment are needed to improve the identification and selection of patients with cancer that are uniformly defined as older.

Autologous stem cell transplantation in patients older than 65 years with multiple myeloma: a real-world study

INTRODUCTION

The treatment of elderly multiple myeloma (MM) patients with autologous stem cell transplantation (ASCT) is a controversial procedure. Most clinical trials evaluating the safety and efficacy of ASCT have primarily included patients younger than 65 years.

DESIGN AND METHODS

This was a retrospective analysis of patients with MM who underwent ASCT between 2008 and 2018. Patients at or over 65 years were compared with patients under 65 years. We analyzed treatment-related mortality (TRM), response rate, progression-free survival (PFS) and overall survival (OS).

RESULTS

Two hundred and twenty-one patients were included: 50 patients at or over 65 years, (median age 68 years), including 7 patients over 70 years and 151 patients under 65 years, (median age 57 years). No differences were found in the neutrophil and platelet engraftment, median days of hospitalization and life support requirement during the hospitalization period for the ASCT. No statistically significant differences were found in the incidence of TRM between both groups at 100 days post-transplant (2% vs. 2.9%, p = 0.322). The ASCT improved complete response and stringent complete response rates (44% vs. 37%, p < 0.001). Survival was not modified by age: after a median follow-up of 53 months, the estimated PFS rates at three years were 63% and 60% (p = 0.88) and the OS rates at five years were 75% and 74% (p = 0.72), respectively.

CONCLUSIONS

Our data suggest that the ASCT is feasible in selected elderly patients with MM over 65 years of age, achieving response and survival rates similar to those of younger patients.

The association of frailty with morbidity and mortality following major mucosal head and neck surgery

OBJECTIVES

Frailty refers to a state of reduced physiological reserve and functional decline. We sought to analyse whether frailty, assessed using the 5-item modified frailty index (5mFI), was associated with increased morbidity and mortality following major mucosal head and neck surgery.

MATERIALS AND METHODS

We performed a retrospective study of patients undergoing major mucosal head and neck surgical resection over a 2-year period. Potential confounding variables were controlled by way of multivariable regression analysis.

RESULTS

There were 310 patients included with 77 (24.8 %) classified as frail. Most patients were male (219/310, 70.7 %), had a history of smoking (246/310, 79.4 %) and 151 patients (48.7 %) were older than 65 at time of surgery. Most surgeries related to oral cavity or oropharyngeal subsites (227/310, 73.2 %) and 150 patients (48.4 %) underwent microvascular free tissue reconstruction. On multivariable analysis, frail patients were more likely to suffer adverse outcomes such as a return to theatre (OR 3.47, 95 % CI 1.82-6.62, p < 0.001), a Clavien-Dindo grade IV complication (OR 6.23, 95 % CI 2.55-15.20, p < 0.001) or medical complications, such as respiratory complications (OR 2.61, 95 % CI 1.45-4.69; p = 0.001) or delirium (OR 5.05, 95 % CI 2.46-10.33; p < 0.001). Additionally, hospital length of stay was increased among frail patients (ß 16.46 days, 95 % CI 9.85-23.07 days; p < 0.001). Neither 90-day nor 1-year post-operative mortality was increased in frail patients.

CONCLUSION

Frailty assessed using the 5mFI was associated with greater post-operative morbidity, but not mortality following major mucosal head and neck surgery.

Endometrial cancer in the elderly: Characteristics, prognostic and risk factors, and treatment options

Endometrial cancer incidence and related mortality are on the rise due to aging demographics. This population often presents with unfavorable features, such as myometrial invasion, non-endometrioid histology, high-grade tumors, worse prognosis, etc. The role of age as an independent prognostic factor is still debated, and screening tools addressing frailty emerge as pivotal in guiding treatment decisions; however, they are still underutilized. Treatment disparities are evident in the case of older patients with endometrial cancer, who frequently receive suboptimal care, hindering their survival. Radiotherapy and minimally invasive surgical approaches could be performed in older patients. Data on chemotherapy and immunotherapy are scarce, but their potential remains promising and data are being gathered by recent trials, contingent on optimal patient selection through geriatric assessments. Overall, we recommend personalized, screening tool-guided approaches, adherence to guideline-recommended treatments, and inclusion of older people in clinical trials to help identify the best course of treatment.

Determination and Management of Risks for Practices and Procedures in the Elderly (DRIPP): the impact of a comprehensive geriatric evaluation in elderly with diffuse large B-cell lymphoma

INTRODUCTION

Diffuse large B-cell lymphoma (DLBCL) treatment in older patients is challenging. The Determination and Management of Risks for Practices and Procedures in the Elderly (DRIPP) is a multidimensional evaluation program that involves patients undergoing oncological treatments.

OBJECTIVE

We aimed to evaluate the overall survival and progression-free survival (PFS) of patients evaluated and those not evaluated by the DRIPP.

MATERIALS AND METHODS

Retrospective cohort study, patients > 65 years with DLBCL were included. They were divided into 3 groups: patients with a diagnosis prior to the DRIPP implementation (pre-DRIPP), patients with the DRIPP (DRIPP) and patients with a diagnosis after the DRIPP implementation, but who did not undergo the evaluation (non-DRIPP).

RESULTS

A total of 125 patients were analyzed. Fourteen (11%) patients in the pre-DRIPP group, 74 (59%) in the DRIPP group, and 37 (30%) in the non-DRIPP group. In 43 (58%) patients of the DRIPP group, some drug dose adjustments were made vs. 19 (15%) in the non-DRIPP (p = 0.03). There were no significant differences in terms of discontinuation of treatment or hematological toxicity between groups. The OS and PFS in one year was 64% (95%CI 34-83) and 50% (95%CI 23-72) for the pre-DRIPP group, 82% (95%CI 71-89) and 72% (95%CI 60-81) for the DRIPP group, 58% (95% CI 41-72) and 56% (95% CI 38-70) for the non-DRIPP group, (p = 0.08). The analysis was adjusted for probable confounders and no differences were found.

CONCLUSIONS

This is the first study to evaluate the DRIPP as a decision-making tool in patients with lymphoma and showed a trend towards improvement in the OS in evaluated patients.

Association between Frailty and Asthma

Background and Objectives: This study investigated whether there is an association between elderly frailty and asthma. Material Methods: We examined 9745 elderly participants who did not have asthma and 275 elderly patients who had asthma diagnosed by a doctor from the 2020 Survey of Living Conditions and Welfare Needs of Korean Older Persons Survey. Study Selections: The Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight (K-FRAIL) scale was used to determine their level of frailty. The relationship between frailty and geriatric asthma was examined using multiple logistic regression analysis, which was adjusted for a number of confounding variables (socioeconomic, health behavior, psychological characteristics, and functional status). Results: Frailty as defined by the K-FRAIL scale was significantly higher in the asthma group (7.6%) than the non-asthma group (4.9%). The frailty phenotype component showed that resistance, ambulation, and illness severity were more severe in the asthma group than the non-asthma group. After adjusting, asthma was significantly associated with an increased risk of frailty (OR 1.45; 95% confidence interval [CI] 1.01-2.09) compared to the non-asthma group. Conclusions: Frailty might be associated with elderly asthma in patients from the Korean population. Frailty may not only be associated with asthma, but also with other diseases. So, more evidence is needed to establish this association.

Systematic nutritional screening and assessment in older patients: Rationale for its integration into oncology practice

As the global population ages, so does the number of older people being diagnosed, treated and surviving cancer. Challenges to providing appropriate healthcare management stem from the heterogeneity common in this population. Although malnutrition is highly prevalent in older people with cancer, ranging between 30 % and 80 % according to some analyses, is associated with frailty, and has been shown to be a major risk factor for poor treatment response and worse overall survival, addressing nutrition status is not always a priority among oncology healthcare providers. Evaluation of nutritional status is a two-step process: screening identifies risk factors for reduced nutritional intake and deficits that require more in-depth assessment. Screening activities can be as simple as taking weight and BMI measurements or using short nutritional questionnaires and asking the patient about unintentional weight loss to identify potential nutritional risk. Using geriatric assessment, deficits in the nutritional domain as well as in others reveal potentially reversible geriatric and medical problems to guide specific therapeutic interventions. The authors of this paper are experts in the fields of geriatric medicine, oncology, and nutrition science and believe that there is not only substantial evidence to support regularly performing screening and assessment of nutritional status in older patients with cancer, but that these measures lead to the planning and implementation of patient-centered approaches to nutrition management and thus enhanced geriatric-oncology care. This paper presents rationale for systematic nutrition screening and assessment in older adults with cancer.

Factors influencing quality of life and functional status in head and neck cancer patients

OBJECTIVE

To assess the quality of life (QoL) and functional status factors of patients at various stages of treatment for head and neck cancer.

STUDY DESIGN

Cross-sectional survey study.

SETTING

Outpatient.

METHODS

Patients over the age of 18 who received care at the Markey Head and Neck Cancer Center Clinic since 2015 were invited to complete the survey. Survey items included: demographic information, characteristics of the patient's disease and treatments, as well as an 18-item survey assessing quality of life and functional status. A follow-up for each factor asked patients to rate how important it was to them.

RESULTS

Patients reported greatest difficulties with physical activity (2.18), sleep (2.20), stress (2.26), and fatigue (2.26). Patients indicated that information (3.00), medication management (2.67), and sleep (2.62) were the most important. Multimodal therapy, marital status, and education level were all found to have statistically significant associations with several QoL measures.

CONCLUSION

Quality of life and functional status in patients who have undergone treatment for head and neck cancer are both affected by many factors, particularly multimodal treatment, partner support, and education level. Identifying patients who may be more affected by treatment and targeting them with additional support and resources may lead to improved QoL in patients and their caregivers. This study would suggest that efforts to support physical activity, sleep, and stress management could lead to the most significant impact.

Impact of Frailty on Post-Treatment Dysphagia in Patients with Head and Neck Cancer

In the rising and frail head and neck cancer (HNC) population, geriatric assessments are crucial. Frail HNC patients often experience dysphagia. The coexistence of dysphagia and frailty presents complex health challenges, however, there is limited evidence on the prognostic value of frailty on post-treatment dysphagia. This study explores the relationship between pre-treatment frailty status and post-treatment dysphagia in HNC patients. A retrospective data analysis from the OncoLifeS data-biobank at the University Medical Center Groningen of 242 patients diagnosed with HNC between 2014 and 2016. The study involved several physical, functional and psychological pre-treatment geriatric assessments, and frailty screening using the Groningen Frailty Indicator (GFI) and the Geriatric-8 screening tool (G8). Outcome measures were swallowing-related quality of life (HNSW-QoL) and toxicity-related dysphagia evaluations (CTCAE-D) at 3, 6, 12 and 24 months. Linear mixed-effects models assessed factors associated with HNSW-QoL and CTCAE-D. Frail patients consistently reported worse HNSW-QoL and CTCAE-D than non-frail patients over time, with symptoms increasing at 3 months, but gradually decreasing by 24 months. Frailty status (G8 or GFI) was a significant predictor for lower HNSW-QoL (β = 11.770 and 10.936, both p < 0.001), and lower CTCAE-D (β = 0.245, p = 0.058; β = 0.331, p = 0.019), respectively. In this study, frailty was found to be associated with a worse of swallowing-related quality of life, and with increased toxicity-related dysphagia. These findings provide insights for the identification of HNC patients at higher risk of post-treatment swallowing-related issues, and offer opportunities for optimizing their post-treatment swallowing outcomes.

Association between frailty and cognitive status among ambulating Korean elderly: An observational study

We aimed to determine the association between frailty and cognitive status of the elderly population in Korea. We examined data from 9920 elders who participated in the 2020 Survey of Living Conditions and Welfare Needs of Korean Older Persons. Frailty was assessed using the Korean version of the Fatigue, Resistance, Ambulation, Illnesses, and Weight Loss scale. The Korean mini-mental status examination was used to test cognitive function. Several logistic regression analysis was performed, with correction for several confounding variables (socioeconomic, health behavior, psychological characteristics, and functional status), to evaluate the relationship between frailty and cognitive state. Of the elderly population in Korea, 1451 (14.6%) were frail and 5977 (60.3%) were pre-frail. Compared to the non-frail group (20.3%), cognitive impairment was considerably higher in the pre-frail (33.1%) and frail (39.8%) groups. When compared to the non-frail group, cognitive impairment was substantially linked to a higher risk of frailty after adjustment (pre-frail odds ratio [OR]: 1.66, 95% confidence interval [CI]: 1.47-1.88; frail OR: 2.00, 95% CI: 1.68-2.37). When cognitive impairment and frailty subcomponents were present, there was a higher likelihood of severe resistance (OR: 1.89; 95% CI: 1.70-2.11) and ambulation (OR: 1.46, 95% CI: 1.32-1.63) issues. Frailty is associated with cognitive impairment.

Treatment of elderly patients with head and neck cancer in an aging society: Focus on geriatric assessment and surgical treatment

Previous studies of the treatment of elderly head and neck cancer (HNC) patients were very limited and sometimes controversial. Although conclusions differ across various reports, it is often concluded that advanced chronological age does not directly affect prognosis, but that comorbidities and declines in physical and cognitive functions promote the occurrence of adverse events, especially with surgical treatment. Geriatric assessment (GA) and its screening tools are keys to help us understand overall health status and problems, predict life expectancy and treatment tolerance, and to influence treatment choices and interventions to improve treatment compliance. In addition, personal beliefs and values play a large role in determining policies for HNC treatment for elderly patients, and a multidisciplinary approach is important to support this. In this review, past research on HNC in older adults is presented, and the current evidence is explained, focusing on the management of elderly HNC patients, with an emphasis on the existing reports on each treatment stage and modality, especially the surgical procedures.

Risk Factor Analysis of Morbidity and 90-Day Mortality of Curative Resection in Patients with Stage IIIA-N2 Non-Small Cell Lung Cancer after Induction Concurrent Chemoradiation Therapy

Background

Major pulmonary resection after neoadjuvant concurrent chemoradiation therapy (nCCRT) is associated with a substantial risk of postoperative complications. This study investigated postoperative complications and associated risk factors to facilitate the selection of suitable surgical candidates following nCCRT in stage IIIA-N2 non-small cell lung cancer (NSCLC).

Methods

We conducted a retrospective analysis of patients diagnosed with clinical stage IIIA-N2 NSCLC who underwent surgical resection following nCCRT between 1997 and 2013. Perioperative characteristics and clinical factors associated with morbidity and mortality were analyzed using univariable and multivariable logistic regression.

Results

A total of 574 patients underwent major lung resection after induction CCRT. Thirty-day and 90-day postoperative mortality occurred in 8 patients (1.4%) and 41 patients (7.1%), respectively. Acute respiratory distress syndrome (n=6, 4.5%) was the primary cause of in-hospital mortality. Morbidity occurred in 199 patients (34.7%). Multivariable analysis identified significant predictors of morbidity, including patient age exceeding 70 years (odds ratio [OR], 1.8; p=0.04), low body mass index (OR, 2.6; p=0.02), and pneumonectomy (OR, 1.8; p=0.03). Patient age over 70 years (OR, 1.8; p=0.02) and pneumonectomy (OR, 3.26; p<0.01) were independent predictors of mortality in the multivariable analysis.

Conclusion

In conclusion, the surgical outcomes following nCCRT are less favorable for individuals aged over 70 years or those undergoing pneumonectomy. Special attention is warranted for these patients due to their heightened risks of respiratory complications. In high-risk patients, such as elderly patients with decreased lung function, alternative treatment options like definitive CCRT should be considered instead of surgical resection.

Considerations for Evaluating Older Adults with Cancer for Depression: A Qualitative Survey of Experts

OBJECTIVES

The objective of this study was to engage national experts in geriatric psychiatry and oncology in qualitative interviews to develop consensus regarding how older adult cancer survivors (OACS) experience depressive symptoms, and how best to assess OACs for depression.

METHODS

Expert clinicians in geriatric oncology disciplines were interviewed about approaches to assessing depression in OACs. Interviews were audio-recorded and transcribed, and conducted until thematic saturation was achieved. Thematic Content Analysis was utilized to identify key themes.

RESULTS

Experts (N = 8) were board certified geriatric psychiatrists and oncologists with specialization in geriatric medicine. Two conceptual domains were identified: Key indicators of depression in OACs (e.g. anhedonia; loss of meaning and purpose; loneliness and social withdrawal) and unique considerations for depression assessment in OACs (e.g. alternative phrasing to "depression," disentangling mood and cancer or treatment-related side effects).

CONCLUSIONS

The approaches identified tended to depart from traditional diagnostic criteria for depression.

CLINICAL IMPLICATIONS

Results provide additional insight into the limitations of existing depression measures for OACs. The themes and practices identified in the present study suggest that a revised measure of depression for OACs may be useful. Future research will continue to shed light on best practices for depression assessment in OACs.

Recommendations for the treatment and management of adult B-Cell acute lymphoblastic leukemia in Asia-Pacific: Outcomes from a pilot initiative

The outcomes of adult B-cell acute lymphoblastic leukemia (ALL) remain poor. Recent advancements in the field of leukemia research show potential for improved patient care. However, the adoption of research findings into clinical practice is fraught with practice- and country-specific challenges. The continued addition of new findings warrants critical evaluation for the feasibility of incorporation into clinical practice. A uniform set of evidence-based guidelines can favorably assist physicians in making optimal clinical decisions. Such a resource may also serve as a reference point for strategic planning of initiatives aimed at addressing critical barriers in the optimal management of B-cell ALL. This initiative was undertaken to seek a collaborative perspective and understand the existing challenges. Concordance-based recommendations were outlined through a systematic discussion on various aspects of treatment and management of adult B-cell ALL. The outcomes and experiences gained from this exercise will serve as a foundation for future efforts encompassing the more granular aspects of the management of B-cell ALL across the Asia-Pacific region.

Frailty: How to assess, prognostic role

Despite the clear clinical significance of frailty in surgical populations, there is no consensus on how best to define or measure frailty, even within the geriatric literature. A diversity of measures exists to measure some or all these domains, but only research-focused tools have been validated in surgical populations. These tools are too resource-intensive for rapid, cost-effective, preoperative screening of entire populations considering elective surgery. This narrative review deals with the definition of frailty and the different assessment methods of the phenotypic definition and the accumulation of deficits definition. Moreover, as in the area of surgery frailty seems to be an independent risk factor for mortality, morbidity, length of stay, and postoperative complication, different studies reporting the association of preoperative frailty with postoperative outcomes after cancer surgery and the association with postoperative mortality within 30 days are considered. Preoperative care should include a focus on the goals of treatment and care options. Patient-oriented functional and cognitive outcomes as well as the development and implementation of interventions that could potentially improve adverse postoperative effects must be further investigated.

Predictive value of the G8 screening tool for postoperative complications in older adults undergoing cancer surgery: A systematic review and meta-analysis

INTRODUCTION

Older adults with cancer who are being considered for cancer surgery are heterogenous, with variation in their physical, mental, and social baselines and risk of postoperative complications. Due in part to the complex nature of this population, the optimal preoperative evaluation method is not clearly defined. In this study we investigated whether geriatric-8 (G8), a screening tool for older patients with cancer that determines the need for a full geriatric assessment, is suitable for assessing the risk of postoperative complications in this population being considered for surgery.

MATERIALS AND METHODS

Studies that enrolled older patients undergoing cancer surgery and compared prevalence of postoperative complications in G8 "high" (≥15) patients and G8 "low" (<15) patients were identified using PubMed and EMBASE. A meta-analysis was conducted to calculate the risk ratio of postoperative complication rate. Postoperative mortality was systematically reviewed.

RESULTS

Eleven studies published between 2017 and 2022 were included in our analysis with a total of 2,691 older patients who underwent various types of cancer surgery and were characterized by their G8 scores: 1,255 G8 high (≥15) patients and 1,436 G8 low (<15) patients. G8 low patients had a significantly higher prevalence of postoperative complications than G8 high patients (risk ratio [95% confidence interval]: 1.56 [1.18-2.07], p = 0.002, I2 = 79%).

DISCUSSION

G8 can be an effective and efficient preoperative tool to assess risk of postoperative complications in older adults undergoing cancer surgery and identify potential need for further evaluation of an individual's risk with a comprehensive geriatric assessment.

Adjuvant Chemotherapy for Older Patients With Stage III Colorectal Cancer: A Real-World Analysis of Treatment Recommendations, Treatment Administered and Impact on Cancer Recurrence

BACKGROUND

A substantial proportion of patients with stage III colorectal cancer (CRC) are older than 70 years. Optimal adjuvant chemotherapy (AC) for older patients (OP) continues to be debated, with subgroup analyses of randomized trials not demonstrating a survival benefit from the addition of oxaliplatin to a fluoropyrimidine backbone.

PATIENTS AND METHODS

We analyzed the multisite Australian ACCORD registry, which prospectively collects patient, tumor and treatment data along with long term clinical follow-up. We compared OP (≥70) with stage III CRC to younger patients ([YP] <70), including the proportion recommended AC and any reasons for not prescribing AC. AC administration, regimen choice, completion rates, and survival outcomes were also examined.

RESULTS

One thousand five hundred twelve patients enrolled in the ACCORD registry from 2005 to 2018 were included. Median follow-up was 57.0 months. Compared to the 827 YP, the 685 OP were less likely to be offered AC (71.5% vs. 96.5%, P < .0001) and when offered, were more likely to decline treatment (15.1% vs. 2.8%, P < .0001). Ultimately, 60.0% of OP and 93.7% of YP received AC (P < .0001). OP were less likely to receive oxaliplatin (27.5% vs. 84.7%, P < .0001) and to complete AC (75.9% vs. 85.7%, P < .0001). The probability of remaining recurrence-free was significantly higher in OP who received AC compared to those not treated (HR 0.73, P = .04) but not significantly improved with the addition of oxaliplatin (HR 0.75, P = .18).

CONCLUSION

OP were less likely than YP to receive AC. Receipt of AC reduced recurrences in OP, supporting its use, although no significant benefit was observed from the addition of oxaliplatin.

Development and clinical application of a tool to identify frailty in elderly patients with gynecological cancers

OBJECTIVE

Frailty is more reliable than chronological age in predicting the effectiveness and tolerability of treatments in cancer patients. An increasing number of screening tools have been proposed, however none have received unanimous consent or been specifically designed for women with gynecological malignancies.This study's aim was to develop a clinical application of a screening tool to identify frail patients >70 years old diagnosed with either ovarian or endometrial cancers.

METHODS

A 20 item questionnaire was developed and administered to the cohort before surgery or neoadjuvant chemotherapy. A cut-off for frailty definition was determined by analyzing the correlation of questionnaire scores with the completion of treatments. The association between frailty and treatment related complications was assessed using a Chi-squared test for categorical variables and a t-test for continuous variables.

RESULTS

Our study included 100 patients, 50% diagnosed with endometrial cancer and 50% with ovarian cancer. A questionnaire score of 4 was the best cut-off for frailty definition (sensitivity 77%, specificity 100%). Surgical grade III and grade IV complications were observed only in frail patients (p=0.01) and hospitalization was significantly longer in frail women affected by ovarian cancer (p=0.01). Frail patients were more exposed to chemotherapy administration delay (p=0.0005), treatment discontinuation (p=0.001) and hematological toxicities, especially anemia ≥grade 2 (p=0.009) and thrombocytopenia any grade (p=0.0001).

CONCLUSION

With a cut-off score of 4, our tool can identify frail patients with significantly higher incidence of grade III-IV postoperative complications, length of stay, medical treatment discontinuation rates and hematological toxicities.

Efficacy and safety of systemic chemotherapy for radically resectable esophago-gastric adenocarcinoma in older patients: A systematic review and meta-analysis

INTRODUCTION

A significant proportion of locally-advanced esophago-gastric adenocarcinoma (EGA) is diagnosed in patients ≥70 years old (y.o.) who are commonly underrepresented in clinical trials.

MATERIALS AND METHODS

The PubMed database was searched for phase 2/3 clinical trials enrolling patients ≥70 y.o and reporting efficacy/safety information of chemotherapy for resectable EGA. The main outcomes were overall survival (OS) and recurrence-free survival (RFS).

RESULTS

Among 6,128 records, only seven studies reported these outcomes (three peri-operative, three adjuvant, and one neoadjuvant), including 1004 older patients, <20% of the overall population. No significant benefit in terms of OS and RFS was observed for perioperative or adjuvant chemotherapy vs surgery alone. No trial reported safety endpoints in this subgroup.

DISCUSSION

This work did not show any significant benefit in OS or RFS for chemotherapy vs surgery alone or conventional vs de-escalated chemotherapy in the curative setting of EGA in ≥70 y.o patients. Specific ad hoc trials should be performed to derive reliable data.

Expert consensus to optimize the management of older adult patients with advanced EGFR-mutated non-small cell lung cancer

Lung cancer (LC) is associated with ageing, with the average age of affected individuals being approximately 70 years. However, despite a higher incidence and prevalence among older people, the older adult population is underrepresented in clinical trials. For LC with Epidermal Growth Factor Receptor (EGFR) mutations, there is no clear association of this mutation with age. Geriatric assessments (GAs) and a multidisciplinary approach are essential for defining the optimal treatment. In this consensus, a group of experts selected from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (Sección de Oncogeriatría de la Sociedad Española de Oncología Médica-SEOM), the Spanish Lung Cancer Group (Grupo Español de Cáncer de Pulmón-GECP) and the Association for Research on Lung Cancer in Women (Asociación para la Investigación del Cáncer de Pulmón en Mujeres-ICAPEM) evaluate the scientific evidence currently available and propose a series of recommendations to optimize the management of older adult patients with advanced LC with EGFR mutations.

Diabetes Mellitus Is a Strong Independent Negative Prognostic Factor in Patients with Brain Metastases Treated with Radiotherapy

BACKGROUND

Brain metastases (BM) cause relevant morbidity and mortality in cancer patients. The presence of cerebrovascular diseases can alter the tumor microenvironment, cellular proliferation and treatment resistance. However, it is largely unknown if the presence of distinct cerebrovascular risk factors may alter the prognosis of patients with BM.

METHODS

Patients admitted for the radiotherapy of BM at a large tertiary cancer center were included. Patient and survival data, including cerebrovascular risk factors (diabetes mellitus (DM), smoking, arterial hypertension, peripheral arterial occlusive disease, hypercholesterolemia and smoking) were recorded.

RESULTS

203 patients were included. Patients with DM (n = 39) had significantly shorter overall survival (OS) (HR 1.75 (1.20-2.56), p = 0.003, log-rank). Other vascular comorbidities were not associated with differences in OS. DM remained prognostically significant in the multivariate Cox regression including established prognostic factors (HR 1.92 (1.20-3.06), p = 0.006). Furthermore, subgroup analyses revealed a prognostic role of DM in patients with non-small cell lung cancer, both in univariate (HR 1.68 (0.97-2.93), p = 0.066) and multivariate analysis (HR 2.73 (1.33-5.63), p = 0.006), and a trend in melanoma patients.

CONCLUSION

DM is associated with reduced survival in patients with BM. Further research is necessary to better understand the molecular mechanisms and therapeutic implications of this important interaction.

The impact of geriatric characteristics and comorbidities on distant metastases and other cause mortality in older women with non-metastatic breast cancer treated with primary endocrine therapy

INTRODUCTION

In recent years, primary surgical treatment of older women with non-metastatic breast cancer has decreased in favor of primary endocrine therapy (PET). PET can be considered in women with a remaining life expectancy of less than five years. The aim of this study was to (1) assess the risk of distant metastases and other cause mortality over ten years in women aged 65 and older with stage I-III breast cancer treated with PET, (2) whether this was associated with geriatric characteristics and comorbidities and to (3) describe the reasons on which the choice for PET was made.

METHODS

Women were included from the retrospective FOCUS cohort, which comprises all incident women diagnosed with breast cancer aged 65 or older between January 1997 and December 2004 in the Comprehensive Cancer Center Region West in the Netherlands. We selected women (N = 257) with stage I-III breast cancer and treated with PET from this cohort. Patient characteristics (including comorbidity, polypharmacy, walking, cognitive and sensory impairment), treatment and tumor characteristics were retrospectively extracted from charts. Outcomes were distant metastasis and other cause mortality. Cumulative incidences were calculated using the Cumulative Incidence for Competing Risks method (CICR); and subdistribution hazard ratios (SHR) were tested between groups based on age, geriatric characteristics and comorbidity with the Fine and Gray model.

RESULTS

Women treated with PET were on average 84 years old and 41% had one or more geriatric characteristics. Other cause mortality exceeded the cumulative incidence of distant metastasis over ten years (83 versus 5.6%). The risk of dying from another cause further increased in women with geriatric characteristics (SHR 2.06, p < 0.001) or two or more comorbidities (SHR 1.72, p < 0.001). Often the reason for omitting surgery was not recorded (52.9%), but if recorded surgery was omitted mainly at the patient's request (18.7%).

DISCUSSION

This study shows that the cumulative incidence of distant metastasis is much lower than other cause mortality in older women with breast cancer treated with PET, especially in the presence of geriatric characteristics or comorbidities. This confirms the importance of assessment of geriatric characteristics to aid counseling of older women.

Advanced Cutaneous Squamous Cell Carcinoma Management in Immunotherapy Era: Achievements and New Challenges

Introduction of immunotherapy (IT) has radically changed the therapeutic scenario in patients affected by locally advanced and/or metastatic cutaneous squamous cell carcinoma (cSCC) patients. If it is well consolidated the role of immunotherapy in the setting of a disease not amenable to curative surgery and/or radiation, how to integrate immune checkpoint inhibitors in the curative setting is still under evaluation. Surgery combined or not with adjuvant radiotherapy remains the mainstay of curative treatment in localized cSCC; however, promising data with neoadjuvant or perioperative immunotherapy could pave the way towards treatment de-escalation according to the response achieved. On the other side, data on adjuvant treatment with pembrolizumab and cemiplimab after surgery and radiation are still awaited. Several questions related to the activity and the safety of immunotherapy in the real-world setting still remain without answer, and several points need to be better explored. In the current review we will explore the updated literature on the use of immunotherapy in cSCC, and we will show the current challenges in its use.

Guidance for Treating the Older Adults with Colorectal Cancer

OPINION STATEMENT

The need for evidence-based data in the rapidly growing group of older patients is vast and more elderly-specific studies are desperately needed, for which there is clear demand from both patients and providers. Notably, many of the studies discussed in this review included unplanned subset analyses based on age and/or were not originally stratified by age; therefore, these data, particularly overall survival data, need to be interpreted with some caution as they may not be statistically valid based on the initial trial design and statistical plan. As we await data from ongoing elderly-specific trials, our recommendation for managing older patients with CRC should include geriatric screening tools (e.g., CSGA, VES-13, G8, CARG, CRASH) to help guide treatment adjustments for improved tolerability without sacrificing efficacy. For patients with a positive screen for significant geriatric concerns, a full geriatric assessment is recommended to guide treatment approach and supportive care. Prior data support the use of all approved medications for CRC in older adults who are fit; however, treatment breaks and dose attenuation with potential escalation are reasonable options for these patients. Ultimately, management decisions in the care of older adults with mCRC must be made through shared decision-making with the patient with consideration for the patient's functional status, comorbidities, goals of care, social support, as well as potential toxicities and possible effect on QoL.

Impact of Frailty on Health Care Resource Utilization and Costs of Care in Myelodysplastic Syndromes

PURPOSE

The role of frailty in affecting survival in myelodysplastic syndromes (MDS) is increasingly recognized. Despite this, a paucity of data exists on the association between frailty and other clinically meaningful outcomes including health care resource utilization and costs of care.

METHODS

We linked the Ontario subset of the prospective Canadian MDS registry (including baseline patient/disease characteristics) to population-based health system administrative databases. Baseline frailty was calculated from the 15-item MDS-specific frailty scale (FS-15). Primary outcomes were public health care utilization and 30-day standardized costs of care (2019 Canadian dollars) determined for each phase of disease (initial, continuation, and terminal phases). Negative binomial regression was used to assess the association between frailty and health care costs with Poisson regression to explore predictors of hospitalization.

RESULTS

Among 461 patients with complete FS-15 scores, 374 (81.1%) had a hospitalization with a mean length of stay of 10.6 days. Controlling for age, comorbidities, Revised International Prognostic Scoring System, and transfusion dependence, the FS-15 was independently associated with hospitalization during the initial (P = .02) and continuation (P = .01) phases but not the terminal disease phase (P = .09). The mean 30-day standardized cost per patient was $8,499 (median, $6,295; interquartile range, $2,798-$11,996), largely driven by cancer clinic visits and hospitalization. On multivariable analysis, the FS-15 was independently associated with costs of care during the initial disease phase (P = .02).

CONCLUSION

We demonstrate an association between frailty and clinically meaningful outcomes including hospitalization and costs of care in patients with MDS. Our results suggest that baseline frailty may help to inform patients and physicians of expected outcomes.

The GIANT trial (ECOG-ACRIN EA2186) methods paper: A randomized phase II study of gemcitabine and nab-paclitaxel compared with 5-fluorouracil, leucovorin, and liposomal irinotecan in older patients with treatment-naïve metastatic pancreatic cancer - defining a new treatment option for older vulnerable patients

INTRODUCTION

Pancreatic cancer is the fourth leading cause of cancer-related death in the US with an increasing incidence in older adults (OA) over age 70. There are currently no treatment guidelines for OA with metastatic pancreatic cancer (mPCA) and selecting a chemotherapy regimen for these patients is subjective, based largely on chronologic age and performance status (PS). Geriatric screening tools provide a more objective and accurate evaluation of a patient's overall health but have not yet been validated in patient selection for mPCA treatment. This study aims to elucidate the optimal chemotherapy treatment of vulnerable OA with mPCA and understand the geriatric factors that affect outcomes in this population.

METHODS/DESIGN

The GIANT (ECOG-ACRIN EA2186) study is multicenter, randomized phase II trial enrolling patients over age 70 with newly diagnosed mPCA. This study utilizes a screening geriatric assessment (GA) which characterizes patients as fit, vulnerable, or frail. Patients with mild abnormalities in functional status and/or cognition, moderate comorbidities, or over age 80 are considered vulnerable. Enrolled patients are randomized to one of two dose-reduced treatment regimens (gemcitabine/nab-paclitaxel every other week, or dose-reduced 5-fluoruracil (5FU)/ liposomal irinotecan (nal-IRI) every other week). GA and quality of life (QoL) evaluations are completed prior to treatment initiation and at each disease evaluation. Overall survival (OS) is the primary endpoint, with secondary endpoints including progression free survival (PFS) and objective response rate (ORR). Enrolled patients will be stratified by age (70-74 vs ≥75) and ECOG PS (0-1 vs 2). Additional endpoints of interest for OA include evaluation of risk factors identified through GA, QoL evaluation, and toxicities of interest for older adults. Correlative studies include assessment of pro-inflammatory biomarkers of aging in the blood (IL-6, CRP) and imaging evaluation of sarcopenia as predictors of treatment tolerance.

DISCUSSION

The GIANT study is the first randomized, prospective national trial evaluating vulnerable OA with mPCA aimed at developing a tailored treatment approach for this patient population. This trial has the potential to establish a new way of objectively selecting vulnerable OA with mPCA for modified treatment and to establish a new standard of care in this growing patient population.

TRIAL REGISTRATION

This trial is registered with ClinicalTrial.gov Identifier NCT04233866.

The Association Between Medication Use in Older Women with Early-Stage Operable Primary Breast Cancer and Decision Regarding Primary Treatment

BACKGROUND

Polypharmacy is one factor contributing to increased mortality, hospitalization, and adverse drug reactions in older adults. The aim of this study was to measure the prevalence of polypharmacy in a cohort of older women with early-stage operable primary breast cancer and the relationship of polypharmacy to primary treatment decision and functional status.

METHODS

A total of 139 patients with a new diagnosis of early-stage operable primary breast cancer proven histologically were recruited as part of a prospective study. The average age was 77 years. Assessment using a cancer-specific Comprehensive Geriatric Assessment (CGA) tool was conducted within 6 weeks of diagnosis of breast cancer. Association was determined between number of medications and treatment decision and physical status as measured by the CGA outcomes. Additional analysis was performed to determine the associations above with polypharmacy defined by ≥5 daily medications, and if cardiovascular-related diseases have a role in the treatment decision.

RESULTS

Polypharmacy was present in 48% of patients (n = 139). CGA determined that polypharmacy was associated with greater comorbidity (P < .001), reduced physical status rated by physicians (P = .009) and patients (P = .019), and reduced ability to perform activities of instrumental ADLs (P = .008). Similar findings were present in the analysis of cardiovascular-related diseases.

CONCLUSIONS

This work suggests that patients with polypharmacy are more likely to be frail. The number of medications could help us screen patients who should go on to receive full CGA.

'A real fine balancing act': A secondary qualitative analysis of power imbalance in comorbid cancer and dementia in an outpatient treatment setting

AIMS

Studies of health services reveal a focus on provision of scheduled care at the expense of patient need, placing the health service in a position of power and the patient as passive recipient. This secondary qualitative analysis of a focused ethnography draws on the Foucauldian concept of power as pervasive and relational, to examine how an imbalance of power is manifested in situations where people with both cancer and dementia are being treated for cancer.

DESIGN

Secondary qualitative analysis of a focused ethnographic study.

DATA SOURCES

In the original study, qualitative data were gathered from observation and interviews with people with cancer and dementia (n = 2), caregivers (n = 7) and staff (n = 20). The study was conducted in the outpatient departments of two teaching hospitals in England between January 2019 and July 2021. Data from all sources were analysed for this secondary analysis using constant comparison.

RESULTS

The principal theme was balance, encapsulating the competing priorities involved in delivering cancer treatment. There was tension between maintaining safety and ensuring an individual's right to treatment, and difficulty reconciling the needs of the system with the needs of individuals.

CONCLUSION

The pervasive nature of power can be harnessed to enhance the agency of people with cancer and dementia by incorporating principles of shared decision making.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

We recommend incorporating the principles of personalized care to achieve more equitable power relations, reduce health inequalities and ensure that cancer treatment offered to people with dementia is safe and appropriate.

REPORTING METHOD

EQUATOR (COREQ) guidelines have been used for reporting.

PATIENT OR PUBLIC CONTRIBUTION

Patients and the public were involved in designing the original research questions and the study protocol including documentation such as interview topic guides and participant information sheets.

Psychosocial needs of older patients with metastatic breast cancer treated at community centers

INTRODUCTION

Psychosocial status contributes to overall quality of life (QOL) for patients with cancer as psychosocial distress is commonly seen in this population. We sought to describe the psychosocial needs of older adults with metastatic breast cancer (MBC) treated in the community. We evaluated the correlation between the patient's psychosocial status and the presence of other geriatric abnormalities in this patient population.

MATERIALS AND METHODS

This is a secondary analysis of a completed study evaluating older adults (≥65 years) with MBC treated at community practices who received a geriatric assessment (GA). This analysis evaluated psychosocial factors collected during GA, including depression assessed by Geriatric Depression Scale (GDS), perceived social support (SS) assessed by Medical Outcomes Study Social Support Survey (MOS), and objective social supportassessed by demographic variables (living situation and marital status). Perceived SS was further subdivided into tangible social support (TSS) and emotional social support (ESS). Kruskal-Wallis tests, Wilcoxon tests, and Spearman's correlations were used to assess the relationship between psychosocial factors, patient characteristics, and geriatric abnormalities.

RESULTS

One hundred older patients with MBC were enrolled and completed GA with a median age of 73 years (65-90). Almost half of the participants (47%) were either single, divorced, or widowed and 38% lived alone, demonstrating a significant number of patients with objective social support deficits. Patients with HER2+ or triple negative MBC had lower overall SS scores compared to patients with ER/PR+ or HER2- MBC (p = 0.033). Patients on fourth line of therapy were more likely to screen positive for depression compared to patients on earlier lines of therapy (p = 0.047). About half (51%) of the patients indicated at least one SS deficit on the MOS. A higher GDS and lower MOS score correlated with greater total GA abnormalities (p = 0.016). Evidence of depression correlated with poor functional status, decreased cognition, and a high number of co-morbidities (p < 0.005). Abnormalities in functional status, cognition, and high GDS are associated with lower ESS (p = 0.025,0.031,0.006 respectively).

DISCUSSION

Psychosocial deficits are common among older adults with MBC treated in the community and are associated with the presence of other geriatric abnormalities. These deficits require a thorough evaluation and management to optimize treatment outcomes.

Definitive chemoradiotherapy in elderly patients with esophageal cancer: Safety and outcome

Objective: The efficacy and safety of definitive chemoradiotherapy (dCRT) for elderly patients with unresectable esophageal cancer (EC) are not yet fully understood. We conducted this study to evaluate the outcome and toxicity in elder patients (65 years and over) of unresectable EC treated with dCRT. Methods: From four Georgian cancer centers with a radiation oncology department, we identified 44 elderly patients with EC suitable according to the study criteria. Overall survival (OS) was estimated from the beginning of treatment and toxicity scored using CTCAE 5.0 criteria. Results: The median age of patients was 70.0 years (range 65-83 years), with male predominance (77.3%) and 59% of patients were with Eastern Cooperative Oncology Group (ECOG) performance status 1. Because of significant dysphagia (grade 3-4) nine patients underwent intervention (stenting or gastrostomy) before dCRT. More than two-thirds of patients were squamous cell histological type (77.3%). Localization of tumors was equally distributed between the middle and lower parts of the esophagus (38.6%) and in 26 patients (59.1%) tumor length was more than 5 cm. The majority of patients had stage III disease (61.4%). Median survival was 16.0 months (95% confidence interval [CI] 0-35.9). OS at 12 and 24 months was 53.7% and 43.6%, respectively. Fifteen patients (34%) were alive from 2.1 to 5.4 years after treatment. A statistically significant difference (p = 0.011) in median OS was found between patients who received full (not reached) versus overall survival (OS) was 9.0 months in patients who received nonfull dose of radiotherapy (RT) (95% CI 2.79-15.2). Additional analysis between age subgroups revealed that elder subgroup patients (>75 years) had the highest OS, compared to younger (65-70 years) and intermediate groups (71-75 years) (p = 0.001). The most common adverse events were grade 3-4 leukopenia (43.2%), anemia (29.5%), and esophagitis (27.3%). Conclusion: The results of our study support the feasibility and efficacy of dCRT for unresectable EC in carefully selected elderly patients. Survival was correlated to complete dose of RT and therefore accurate selection of patients is crucial for better long-term survival. Our study showed that chronological age alone does not reflect a patient's ability to tolerate dCRT. Toxicity of dCRT is always a very important issue and patient selection must be very cautious in geriatric patients, although dCRT might benefit highly selected patients.

Low Rates of Medical Oncology Consultation for Older Women (≥ 70 Years) with Newly Diagnosed, Non-Metastatic Breast Cancer: A Population-Based Study

BACKGROUND

Curative intent cancer treatment needs to be balanced with patient comorbidities and quality of life when treating older women with breast cancer. We examined consultation patterns and association of age at diagnosis with lack of specialist cancer consultations for older women with breast cancer.

METHODS

We conducted a population-based retrospective cohort study of older women (≥ 70 years of age) with incident, non-metastatic breast cancer (2010-2018) by linking administrative databases in Ontario, Canada. The outcomes of interest were lack of specialist cancer consultation (surgeon, medical oncology, or radiation oncology) within 12 months of diagnosis. Association of age with lack of specialist cancer consultation was examined using Poisson regression modeling.

RESULTS

Of 21,849 older women, 2.4% (n = 517) did not have any specialist cancer consultation within 12 months of diagnosis; lack of any specialist cancer consultation increased with age (0.8% for age 70-74 years, 1.3% for age 75-79 years, 2.5% for age 80-84 years, and 7.0% for age ≥ 85 years; p < 0.001). The proportion of patients who did not have consultations with surgeons, medical oncologists, and radiation oncologists was 8.6% (n = 1888), 34.4% (n = 7510), and 24.7% (n = 5404), respectively. Older age group was independently associated with an increased likelihood of lacking any specialist consultation, as well as not receiving surgical and medical oncology consultations.

CONCLUSION

More than one-third of women ≥ 70 years of age with non-metastatic breast cancer did not have a consultation with a medical oncologist, with women aged ≥ 85 years least likely to have a medical oncology consultation.

Risk of non-colorectal cancer-related death in elderly patients with the disease: A comparison of five preoperative risk assessment indices

BACKGROUND

A considerable number of elderly patients with colorectal cancer (CRC) die of non-CRC-related causes. The Controlling Nutritional Status (CONUT) score, American Society of Anesthesiologists Physical Status classification, Charlson Comorbidity Index, National Institute on Aging, and National Cancer Institute Comorbidity Index, and Adult Comorbidity Evaluation-27 score are all known predictors of survival in patients with CRC. However, the utility of these indices for predicting non-CRC-related death in elderly CRC patients is not known.

METHODS

The study population comprised 364 patients aged 80 years or more who received curative resection for stage I-III CRC between 2000 and 2016. The association of each index with non-CRC-related death was compared by competing-risks analysis such as the cumulative incidence function and proportional subdistribution hazards regression analysis as well as time-dependent receiver-operating characteristic (ROC) analysis.

RESULTS

There were 85 deaths (40 CRC-related and 45 non-CRC-related) during a median observation period of 53.2 months. Cumulative incidence function analysis identified CONUT score as the most suitable for risk stratification for non-CRC-related death. In proportional subdistribution hazards regression, risk of non-CRC-related death increased significantly as CONUT score worsened (2/3/4 vs. 0/1, hazard ratio 1.73, 95% confidence interval [CI] 0.91-3.15; ≥5 vs. 2/3/4, hazard ratio 2.71, 95% CI 1.08-6.81). Time-dependent ROC curve analysis showed that CONUT score were consistently superior to other indices during the 5-year observation period.

CONCLUSIONS

The majority of deaths in elderly patients with CRC were not CRC-related. CONUT score was the most useful predictor of non-CRC-related death in these patients.

Practical Implementation of the Comprehensive Geriatric Assessment to Optimise Care for Older Adults with Cancer

Whilst cancer remains a very serious health problem at any stage, cancer combined with increasing age creates an even more challenging situation for health care providers [...].

Objective Measurements of Physical Function to Predict Survival in Patients with Metastatic Cancer

BACKGROUND/OBJECTIVES

Physician-reported performance status (PS) constitutes the established method for stratifying oncologic patients in therapeutic decision-making. Objective measurements of physical function may further refine prognostication.

SUBJECTS/METHODS

In this prospective observational study, 103 patients with metastatic cancer who were referred for systemic therapy initiation were evaluated. PS was evaluated using the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) and five objective physical function measurements (handgrip strength [HGS], chair stand test [CST], timed up and go [TUG] test, 4-m gait speed [GS] test, and short physical performance battery [SPPB] test). Overall survival and treatment complications were recorded from the medical records.

RESULTS

Patients with low PS according to ECOG-PS (hazard ratio [HR]: 3.80, 95% confidence interval [CI]: 1.84, 7.80), HGS (HR: 2.37, 95% CI: 1.24, 4.55), SPPB (HR: 3.43, 95% CI: 1.55, 7.57), GS (HR: 3.03, 95% CI: 1.44, 6.38), and TUG (HR: 5.16, 95% CI: 2.19, 12.14) had shorter overall survival after adjustment for sex, age, symptomatology, comorbidity, percentage of weight loss, and tumor localization.

CONCLUSIONS

Among the studied objective physical function measurements, HGS, SPPB, GS, and TUG were independent predictors of survival in a sample of patients with metastatic cancer, with TUG showing the highest effect size.

The role of comprehensive geriatric assessment in older patients affected by knee osteoarthritis: a systematic review

Osteoarthritis (OA) is one of the most common musculoskeletal diseases and highly prevalent in older people. Whilst the management of knee OA is usually multidisciplinary, the use of comprehensive geriatric assessment (CGA) for this condition is still limited. Given this background, with this systematic review, we summarized the current literature regarding the importance of CGA in people affected by knee OA. A systematic search across several databases was run until 10th April 2022 and updated on 21st November 2022 for any study investigating the use of CGA in patients with knee OA. The data were summarized descriptively. Among 295 articles initially included, three studies made in the context of the osteoarthritis initiative (OAI) were included. All the three studies used the OAI multidimensional prognostic index (MPI), a composite score derived from the CGA. Higher MPI values were associated with a higher risk of falls, cardiovascular conditions, and fractures across a follow-up period of 8 years and after adjusting for potential confounders. In conclusion, in this systematic review we summarized the current evidence of CGA in knee OA, finding that the MPI, a CGA derived tool, could be useful to early find people at higher risk of conditions that are associated with knee OA and therefore that can be the target of personalized interventions for preventing these conditions.

Effect of comprehensive geriatric assessment for frail elderly patients operated for colorectal cancer—the colorectal cancer frailty study: study protocol for a randomized, controlled, multicentre trial

Background

Colorectal cancer (CRC) is the third most common cancer worldwide, with a median age of 72–75 years at diagnosis. Curative treatment usually involves surgery; if left untreated, symptoms may require emergency surgery. Therefore, most patients will be accepted for surgery, despite of high age or comorbidity. It is known that elderly patients suffer higher risks after surgery than younger patients, in terms of complications and mortality. Assessing frailty and offering frail elderly patients individualized treatment according to the comprehensive geriatric assessment (CGA) and care concept has been shown to improve the outcome for frail elderly patients in other clinical contexts.

Methods

This randomized controlled multicentre trial aims to investigate if CGA and care prior to curatively intended surgery for CRC in frail elderly patients will improve postoperative outcome. All patients ≥ 70 years with surgically curable CRC will be screened for frailty using the Clinical Frailty Scale (CFS-9). Frail patients will be offered inclusion. Randomization is stratified for colon or rectal cancer. Patients in the intervention group are, in addition to standard protocol, treated according to CGA and care. This consists of individualized assessments and interventions, established by a multiprofessional team. Patients in the control group are treated according to best known practice as stipulated by Swedish colorectal cancer treatment guidelines, within an enhanced recovery after surgery (ERAS) setting. The primary outcome is 90-day mortality. Secondary outcomes are the length of hospital stay and total number of hospital days within 3 months, discharge destination, 30-day readmission, ADL, safe medication assessment, CFS-9 score, complications, Health-Related Quality of Life (HRQoL) at 2-month follow-up in comparison to baseline measurements, health economical calculations including cost-effectiveness analysis based on costs of hospital care and primary care, mortality and HRQoL at baseline, 2- and 12-month follow-up and all-cause 1-year mortality.

Discussion

The trial is the first of its size and extent to investigate intervention with CGA and care prior to surgery for CRC in frail elderly patients. If this addition proves to be favourable, it could have implications on future care of frail elderly patients with CRC.

Trial registration

ClinicalTrials.gov NCT04358328. Registered on 4 February 2020

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06883-9.

Risk factors for non-gastric-cancer-related death after gastrectomy in elderly patients

Aim

To identify preoperative factors, especially other diseases that cause death, that are associated with the prognosis of gastrectomy in elderly patients with gastric cancer.

Methods

This retrospective study included a total of 211 consecutive patients aged ≥75 years who underwent radical gastrectomy due to gastric cancer. Time-dependent receiver operating characteristic curve analysis was performed to determine the optimal cutoff values for various perioperative factors. Risk factors for the overall survival and death from other diseases were analyzed using the Cox proportional hazards model.

Results

Among the all perioperative factors, sex, neutrophil-to-lymphocyte ratio, skeletal muscle mass index, and lymph node dissection in accordance with guidelines or not extracted as independent risk factors for death from other diseases. In an analysis restricted to the preoperative factors, sex, neutrophil-to-lymphocyte ratio, and skeletal muscle mass index of the patients were extracted as independent risk factors for death from other diseases and overall survival. We divided the patients into four groups according to the number of preoperative risk factors for death from other diseases and found that the 5-year non-gastric-cancer-related survival was different among the four groups (risk factor 0, 91.7%; risk factor 1, 83.3%; risk factor 2, 56.3%; risk factor 3, 27.2%; P < 0.001).

Conclusion

Male sex, low skeletal muscle mass index, and high neutrophil-to-lymphocyte ratio are risk factors for non-gastric-cancer-related death and the overall survival of elderly patients undergoing gastrectomy. Cautious treatment strategies are needed for elderly gastric cancer patients with many risk factors.

The Eosinophil Changes, Efficacy and Safety of Pembrolizumab in Advanced Urothelial Carcinoma Patients with an Older Age and a Poor Performance Status

Background

To evaluate the eosinophil changes, efficacy and safety of pembrolizumab treatment in advanced urothelial carcinoma patients of older age and those with a poor performance status (PS).

Materials and Methods

Consecutive patients with advanced UC who received pembrolizumab after the failure of platinum-based chemotherapy between January 2018 and June 2021 were retrospectively examined.

Results

105 patients (median age, 72 years), 71.4% of whom were men, were enrolled. Patients of ≥75 years of age were considered to be older patients (n=40), and patients with PS ≥2 were considered to have a poor PS (n=10). The objective response and disease control rates were 42.5% and 52.5%, respectively, in older patients and 0% and 10.0%, respectively, in patients with a poor PS. Overall survival (OS) in the older and younger groups did not differ to a statistically significant extent. However, a poor PS was significantly associated with poor survival. Safety analyses demonstrated no significant difference in the occurrence of any immune-related adverse events (irAEs), including grade ≥3, between the older and younger groups. However, a poor PS was significantly associated with the low occurrence of any irAEs. The change of the eosinophil count, the increase of the relative eosinophil count (REC) and the decrease of the neutrophil-to-eosinophil ratio (NER) did not differ to a statistically significant extent between the older and younger groups, but showed significant differences between the poor and good PS (PS 0–1) groups.

Conclusion

Pembrolizumab for advanced UC demonstrated similar changes in the eosinophil count, efficacy and toxicity in both older and younger patients. In patients with a poor PS, although toxicity was significantly lower, survival was significantly worse, and neither an increase in REC nor a decrease in NER were observed, but these values showed significant changes in patients with a good PS.

Older Patients with Lung Cancer: a Summary of Seminal Contributions to Optimal Patient Care

PURPOSE OF REVIEW

This review aspires to summarize the landmark advancements in the management of the non-small cell lung cancer (NSCLC), both historically and contemporarily with special focus in older adults.

RECENT FINDINGS

The past two decades have witnessed remarkable improvements in the diagnosis and management of lung cancer. Screening recommendations now facilitate earlier diagnosis in high-risk individuals, PET/CT scans have improved radiologic accuracy in identifying sites of disease, and surgical management with minimally invasive techniques has rendered surgery safer in those with limited physiologic reserve. Radiation enhancements, especially radiosurgery, have extended the reach and safety of radiation among high-risk populations. Finally, the revolution in precision medicine with identification of numerous actionable mutations, the advent of immunotherapy, and enhanced supportive care have revolutionized the outcomes in patients with advanced lung cancer. Older adults who represent a majority of patients battling lung cancer have not benefitted to the same extent as their younger counterparts. This special population is only expected to grow in coming days. Hence, addressing major gaps in the management of older adults with NSCLC and optimizing the care are much needed.

Safety and Efficacy of a First-Line Chemotherapy Tailored by G8 Score in Elderly Metastatic or Locally Advanced Gastric and Gastro-Esophageal Cancer Patients: A Real-World Analysis

Introduction: Gastric (GC) and gastro-esophageal cancer (GEC) are common neoplasms in the elderly. However, in clinical practice, the correct strategy for elderly patients who might benefit from chemotherapy (CT) is unknown. Prospective data are still poor. In this context, we performed a retrospective analysis of GC patients aged ≥75 years and treated at our institutions. Material and Methods: We retrospectively analyzed 90 patients with confirmed metastatic GC or GEC, treated with an upfront CT. Inclusion criteria were patients aged ≥75 years, PS 0−2, normal bone marrow/liver/renal function and no major comorbidities. All patients received a G8 score, and some patients with G8 ≤14 received a comprehensive geriatric assessment (CGA). The primary goal was to perform a safety evaluation based on the incidence of adverse events (AE), and the secondary goal was to determine the efficacy (PFS and OS). The chi-square test and the Kaplan−Meier method were used to estimate the outcomes. The statistical significance level was set at p < 0.05. Results: Toxicity rates were quite low: G1/G2 (51.1%) and G3/G4 (25.5%). No toxic deaths were reported. The median PFS was 6.21 months and the median OS 11 months. The G8 score and PS ECOG significantly influenced both PFS and OS. A statistically significant correlation among G8, weight loss, hypoalbuminemia and risk of G3/G4 adverse events was also found. Conclusion: Our research on selected elderly patients did not detect broad differences of efficacy and tolerability compared to a young population. Our study, although retrospective and small-sized, showed that G8 score might be an accurate tool to identify elderly GC/GEC patients who could be safely treated with CT, further recognizing patients who could receive a doublet CT and who may require a single agent chemotherapy or a baseline dose reduction.

Predicting systemic therapy toxicity in older adult patients with advanced non-small cell lung cancer: A prospective multicenter study of National Hospital Organization in Japan

INTRODUCTION

Previous studies have developed risk stratification schemas to assess systemic therapy toxicity. However, it is controversial which geriatric assessment variables should be used to assess the individual risk of severe treatment-associated toxicity in older adult patients.

MATERIALS AND METHODS

Patients aged ≥70 years with advanced non-small cell lung cancer (NSCLC) treated at 24 National Hospital Organization institutions completed a pre-first-line systemic therapy assessment, including patient characteristics, treatment variables, laboratory test values, and geriatric assessment variables. Patients were followed through one cycle of systemic therapy to assess grade 3 (severe) to grade 5 (death) adverse events according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0.

RESULTS

In total, 348 advanced NSCLC patients with a median age of 76 years (range, 70 to 95 years) joined this prospective study. Severe adverse events ≥grade 3 occurred in 136 patients (39.1%). Predictors of hematologic toxicity were treatment variables, body mass index, body weight loss, and limitation in daily living due to dementia. These predictors provided the predictive model of hematologic toxicity ≥grade 3; 0 point (22.2%), 1 point (33.8%), 2 points (59.6%), ≥3 points (73.3%). Sex, daily living independence level, and lactate dehydrogenase levels were associated with non-hematologic toxicity ≥grade 3 in multivariate analysis. A scoring system using these predictors distinguished the risk levels of non-hematologic toxicity ≥grade 3; 0 point (6.6%), 1 point (12.2%), 2 points (39.0%), 3 points (75.0%).

DISCUSSION

A stratification using individual extracted risk factors may be useful to predict the vulnerability to systemic therapy in older adult NSCLC patients.

Prognostic value of ambulation ability with albumin and C-reactive protein to predict 28-day mortality in elderly sepsis patients: a retrospective multicentre registry-based study

Background

Sepsis is a series of organ failures caused by dysregulated responses to infection. Risk factors for sepsis are multiple comorbidities, a poor nutrition status, and limited mobility. The primary purpose of the study was to determine whether ambulation ability with albumin and C-reactive protein are predictive of 28-day mortality of elderly patients with sepsis.

Methods

This was a retrospective observational study using a multicentre-based registry of elderly patients between November 2016 and February 2017. The inclusion criteria were a patient ≥65 years and a diagnosis of sepsis and exclusion criteria were a patient with covariates of ambulation ability such as central nervous system diseases, or malignancy. The area under the receiver operating characteristic curve of prediction models were calculated and compared. The survival rates according to the ambulation ability were estimated and compared by the log-rank test.

Results

2291 patients ≥65 years visited with infectious diseases. 496 subjects with central nervous system diseases, 710 subjects with malignancy and 817 subjects with a Sequential Organ Failure Assessment score ≤ 1 were excluded. Ultimately, 278 subjects were included in the primary analysis. 133 (47.8%) subjects were male and the median age was 78 years. 228 (82%) subjects could ambulate independently before morbidity and 28 (10.1%) subjects expired in 28 days. In the inability to ambulate and C-reactive protein to albumin ratio model, the area under the curve predicting 28-day mortality was 0.761 with no significant difference from the Sequential Organ Failure Assessment score (0.859, p = 0.097) and the estimated survival rate on 28th day according to the ability to ambulate showed a significant difference (hazard ratio = 1.212, p < 0.001).

Conclusion

The premorbid ambulation ability with albumin and C-reactive protein can be combined to predict 28-day mortality in elderly patients with sepsis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03339-2.