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Functional Decline in the Cancer Patient: A Review. Cancers (Basel) 2022; 14:cancers14061368. [PMID: 35326520 PMCID: PMC8946657 DOI: 10.3390/cancers14061368] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
A decline in functional status, an individual's ability to perform the normal activities required to maintain adequate health and meet basic needs, is part of normal ageing. Functional decline, however, appears to be accelerated in older patients with cancer. Such decline can occur as a result of a cancer itself, cancer treatment-related factors, or a combination of the two. The accelerated decline in function seen in older patients with cancer can be slowed, or even partly mitigated through routine assessments of functional status and timely interventions where appropriate. This is particularly important given the link between functional decline and impaired quality of life, increased mortality, comorbidity burden, and carer dependency. However, a routine assessment of and the use of interventions for functional decline do not typically feature in the long-term care of cancer survivors. This review outlines the link between cancer and subsequent functional decline, as well as potential underlying mechanisms, the tools that can be used to assess functional status, and strategies for its prevention and management in older patients with cancer.
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Overcash J, Riffle H, Sinnott L, Williams N. Self-Reported and Performance-Based Evaluations of Functional Status in Older Women With Breast Cancer. Oncol Nurs Forum 2021; 48:657-668. [PMID: 34673762 DOI: 10.1188/21.onf.657-668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate self-reported and performance-based functional status (FS) in older women with breast cancer according to stage and time of visit during treatment. SAMPLE & SETTING 72 women with breast cancer aged 78 years or older and receiving any type of treatment at a midwestern outpatient clinic. METHODS & VARIABLES FS was evaluated using grip strength, the Index of Activities of Daily Living (ADLs), the instrumental ADLs (IADLs) scale, and the Timed Up and Go Test (TUGT). Mixed models were fit for grip strength and the TUGT, and generalized estimating equations were used to fit binary logistic regressions for the Index of ADLs and the IADLs scale. Continuous FS outcomes were evaluated using means and standard deviations. RESULTS Cancer stage and time of visit did not affect self-reported or performance-based FS scores. Most participants were considered independent on the Index of ADLs, the IADLs scale, and the TUGT, which did not change significantly between visits. Self-reported measures revealed less impairment. IMPLICATIONS FOR NURSING Monitoring FS using self-reported and performance-based measures can ensure that older patients receive timely support.
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Navarrete-Reyes AP, Animas-Mijangos K, Gómez-Camacho J, Juárez-Carrillo Y, Torres-Pérez AC, Cataneo-Piña DJ, Negrete-Najar JP, Soto-Perez-de-Celis E. Geriatric principles for patients with cancer. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.5327/z2447-212320212100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cancer is primarily a disease of older persons. Given the heterogeneity of aging, physiological age, rather than chronological age, better expresses the cumulative effect of environmental, medical, and psychosocial stressors, which modifies life expectancy. Comprehensive geriatric assessment, a tool that helps ascertain the physiological age of older individuals, is the gold standard for assessing older adults with cancer. Several international organizations recommend using the geriatric assessment domains to identify unrecognized health problems that can interfere with treatment and predict adverse health-related outcomes, aiding complex treatment decision making. More recently, it has been shown that geriatric assessment-guided interventions improve quality of life and mitigate treatment toxicity without compromising survival. In this review, we discuss the role of comprehensive geriatric assessment in cancer care for older adults and provide the reader with useful information to assess potential treatment risks and benefits, anticipate complications, and plan interventions to better care for older people with cancer.
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Sahara K, Paredes AZ, Merath K, Tsilimigras DI, Bagante F, Ratti F, Marques HP, Soubrane O, Beal EW, Lam V, Poultsides GA, Popescu I, Alexandrescu S, Martel G, Aklile W, Guglielmi A, Hugh T, Aldrighetti L, Endo I, Pawlik TM. Evaluation of the ACS NSQIP Surgical Risk Calculator in Elderly Patients Undergoing Hepatectomy for Hepatocellular Carcinoma. J Gastrointest Surg 2020; 24:551-559. [PMID: 30937717 DOI: 10.1007/s11605-019-04174-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/20/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator (SRC) aims to help predict patient-specific risk for morbidity and mortality. The performance of the SRC among an elderly population undergoing curative-intent hepatectomy for hepatocellular carcinoma (HCC) remains unknown. METHODS Patients > 70 years of age who underwent hepatectomy for HCC between 1998 and 2017 were identified using a multi-institutional international database. To estimate the performance of SRC, 12 observed postoperative outcomes were compared with median SRC-predicted risk, and C-statistics and Brier scores were calculated. RESULTS Among 500 patients, median age was 75 years (IQR 72-78). Most patients (n = 324, 64.8%) underwent a minor hepatectomy, while 35.2% underwent a major hepatectomy. The observed incidence of venous thromboembolism (VTE) (3.2%) and renal failure (RF) (4.4%) exceeded the median predicted risk (VTE, 1.8%; IQR 1.5-3.1 and RF, 1.0%; IQR 0.5-2.0). In contrast, the observed incidence of 30-day readmission (7.0%) and non-home discharge (2.5%) was lower than median-predicted risk (30-day readmission, 9.4%; IQR 7.4-12.8 and non-home discharge, 5.7%; IQR 3.3-11.7). Only 57.8% and 71.2% of patients who experienced readmission (C-statistic, 0.578; 95%CI 0.468-0.688) or mortality (C-statistic, 0.712; 95%CI 0.508-0.917) were correctly identified by the model. CONCLUSION Among elderly patients undergoing hepatectomy for HCC, the SRC underestimated the risk of complications such as VTE and RF, while being no better than chance in estimating the risk of readmission. The ACS SRC has limited clinical applicability in estimating perioperative risk among elderly patients being considered for hepatic resection of HCC.
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Affiliation(s)
- Kota Sahara
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.,Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Anghela Z Paredes
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Katiuscha Merath
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Fabio Bagante
- Department of Surgery, University of Verona, Verona, Italy
| | | | - Hugo P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - Olivier Soubrane
- Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France
| | - Eliza W Beal
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Vincent Lam
- Department of Surgery, Westmead Hospital, Sydney, Australia
| | | | - Irinel Popescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | | | | | - Workneh Aklile
- Department of Surgery, University of Ottawa, Ottawa, Canada
| | | | - Tom Hugh
- Department of Surgery, The University of Sydney, School of Medicine, Sydney, Australia
| | | | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Timothy M Pawlik
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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Blakely AM, Chanson D, Wong FL, Eng OS, Sentovich SM, Melstrom KA, Lai LL, Fong Y, Sun V. Health-related quality of life and oncologic outcomes after surgery in older adults with colorectal cancer. Support Care Cancer 2019; 28:2857-2865. [PMID: 31729565 DOI: 10.1007/s00520-019-05087-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Data regarding changes in functional status and health-related quality of life (HRQOL) before and after surgery are lacking. We identified colorectal cancer patients from the SEER-Medicare Health Outcomes Survey (MHOS) linked database to evaluate the association between HRQOL and survival. METHODS HRQOL survey data captured physical/mental health, activities of daily living (ADLs), and medical comorbidities. Patients who underwent surgery with HRQOL surveys prior to cancer diagnosis and ≥ 1 year after diagnosis were selected. Patient, disease, and HRQOL measures were analyzed in regard to overall survival (OS), disease-specific survival (DSS), and non-DSS. RESULTS Of 590 patients included, 55% were female, 75% were Caucasian, and 83% had colonic primary. Disease extent was localized for 52%, regional for 41%, and distant for 7%. Median OS was 83 months. Decreased OS was independently associated with age ≥ 75 (HR 1.7, p < 0.0001), male sex (HR 1.4, p = 0.011), advanced disease (regional-HR 2.0, p < 0.0001; distant-HR 7.0, p < 0.0001), and decreased mental HRQOL (HR 1.4, p = 0.005). Decreased DSS was independently associated with advanced disease (regional-HR 4.1, p < 0.0001; distant-HR 16.5, p < 0.0001) and rectal primary (HR 1.6, p = 0.047). Decreased non-DSS was independently associated with age ≥ 75 (HR 2.2, p < 0.0001), male sex (HR 1.4, p = 0.03), decreased mental HRQOL (HR 1.4, p = 0.02), and increased comorbidities (HR 1.4, p = 0.04). CONCLUSIONS The potential overall survival benefit of oncologic surgery is diminished by declines in physical and mental health. Early identification of older surgical patients at risk for functional and HRQOL declines may improve survival following colorectal cancer surgery.
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Affiliation(s)
- Andrew M Blakely
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91104, USA.
| | - Dayana Chanson
- Department of Graduate Medical Education and Clinical Training, City of Hope National Medical Center, Duarte, CA, USA
| | - F Lennie Wong
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Oliver S Eng
- Section of General Surgery and Surgical Oncology, University of Chicago, Chicago, IL, USA
| | - Stephen M Sentovich
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91104, USA
| | - Kurt A Melstrom
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91104, USA
| | - Lily L Lai
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91104, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91104, USA
| | - Virginia Sun
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91104, USA.,Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
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Propofol-based Total Intravenous Anesthesia Is Associated with Better Survival Than Desflurane Anesthesia in Colon Cancer Surgery. Anesthesiology 2019; 129:932-941. [PMID: 30028726 DOI: 10.1097/aln.0000000000002357] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Previous research has shown different effects of anesthetics on cancer cell growth. Here, the authors investigated the association between type of anesthetic and patient survival after elective colon cancer surgery. METHODS A retrospective cohort study included patients who received elective colon cancer surgery between January 2005 and December 2014. Patients were grouped according to anesthesia received: propofol or desflurane. After exclusion of those who received combined propofol anesthesia with inhalation anesthesia or epidural anesthesia, survival curves were constructed from the date of surgery to death. After propensity matching, univariable and multivariable Cox regression models were used to compare hazard ratios for death. Subgroup analyses were performed for tumor-node-metastasis staging and postoperative metastasis. RESULTS A total of 706 patients (307 deaths, 43.5%) with desflurane anesthesia and 657 (88 deaths, 13.4%) with propofol anesthesia were eligible for analysis. After propensity matching, 579 patients remained in each group (189 deaths, 32.6%, in the desflurane group vs. 87, 15.0%, in the propofol group). In the matched analyses, the propofol-treated group had a better survival, irrespective of lower tumor-node-metastasis stage (hazard ratio, 0.22; 95% CI, 0.11 to 0.42; P < 0.001) or higher tumor-node-metastasis stage (hazard ratio, 0.42; 95% CI, 0.32 to 0.55; P < 0.001) and presence of metastases (hazard ratio, 0.67; 95% CI, 0.51 to 0.86; P = 0.002) or absence of metastases (hazard ratio, 0.08; 95% CI, 0.01 to 0.62; P = 0.016). Simple propensity score adjustment produced similar findings. CONCLUSIONS Propofol anesthesia for colon cancer surgery is associated with better survival irrespective of tumor-node-metastasis stage.
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Lei M, Linkov F. Comment on: Preoperative functional health status as a predictor of short-term postoperative morbidity and mortality following bariatric surgery. Surg Obes Relat Dis 2019; 15:e17. [PMID: 31255234 DOI: 10.1016/j.soard.2019.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ming Lei
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Xiangya Hospital, Central South University, China
| | - Faina Linkov
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Ventral hernia repair outcomes predicted by a 5-item modified frailty index using NSQIP variables. Hernia 2019; 23:891-898. [DOI: 10.1007/s10029-019-01923-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/25/2019] [Indexed: 12/21/2022]
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Couderc AL, Boulahssass R, Nouguerède E, Gobin N, Guérin O, Villani P, Barlesi F, Paillaud E. Functional status in a geriatric oncology setting: A review. J Geriatr Oncol 2019; 10:884-894. [PMID: 30824222 DOI: 10.1016/j.jgo.2019.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 01/07/2019] [Accepted: 02/11/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Comprehensive Geriatric Assessment (CGA), is used in older patients with cancer to identify frailties, which can interfere with specialized treatment, and to help with therapeutic care. Functional Status (FS) is a domain of CGA in which Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) are evaluation tools. OBJECTIVE Our study reviewed the data available on the most frequently used tools to assess ADL and IADL in a geriatric oncology setting and their predictive values on overall survival (OS), toxicity, treatment feasibility or decision and postoperative complications. DESIGN This review was based on a systematic search of the MEDLINE® database for articles published in English and French between January 1, 2010, and December 31, 2017. In the final analysis, 40 out of 4061 studies were included. RESULTS The most common ADL and IADL scales used are the Katz ADL (KL-ADL) in 25 studies and the Lawton IADL (IADL8) in 22 studies. FS is predictive of OS in 11 out of 24 studies, chemotoxicity in 2 out of 7 studies, treatment feasibility in 2 out of 5 studies, treatment decisions in 2 out of 3 studies, and postoperative complications in 4 out of 6 studies. CONCLUSION FS is of prognostic value in a geriatric oncology setting despite heterogeneous methodology and inclusion criteria, in the studies included. Additional research is needed to explore more precisely the prognostic value of FS in overall survival, toxicity, treatment feasibility or decision and postoperative complications, in older cancer patients.
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Affiliation(s)
- Anne-Laure Couderc
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France; Coordination Unit for Geriatric Oncology (UCOG), PACA West, France.
| | - Rabia Boulahssass
- Geriatric Department, Coordination Unit for Geriatric Oncology (UCOG) PACA East, Cimiez Hospital, Nice, France
| | - Emilie Nouguerède
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France
| | - Nirvina Gobin
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France
| | - Olivier Guérin
- Geriatric Department, Coordination Unit for Geriatric Oncology (UCOG) PACA East, Cimiez Hospital, Nice, France; Nice Sophia-Antipolis University, Nice, France
| | - Patrick Villani
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France; Aix-Marseille University, Marseille, France
| | - Fabrice Barlesi
- Aix-Marseille University, Marseille, France; Division of Multidisciplinary Oncology and Therapeutic Innovations, North Hospital, AP-HM, Marseille, France
| | - Elena Paillaud
- Department of Geriatrics, Geriatric Oncology Unit, APHP, Hospital European Georges Pompidou, Paris, France; Clinical Epidemiology and Ageing Unit, EA, 7376, Universite' Paris-Est, Creteil, France
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Newman JM, Stroud SG, Yang A, Sodhi N, Dixit A, Doran JP, Hayden AJ, Casagrande DJ, Mont MA. Total shoulder arthroplasty in octogenarians: Is there a higher risk of adverse outcomes? J Orthop 2018; 15:671-675. [PMID: 29881218 DOI: 10.1016/j.jor.2018.05.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022] Open
Abstract
This study used the National Surgical Quality Improvement Program to evaluate octogenarians who underwent total shoulder arthroplasty (TSA). Specifically, we evaluated: (1) patient demographics; (2) perioperative factors; and (3) 30-day postoperative complications. Compared to controls, the octogenarians had more females, white patients, lower BMIs, fewer smokers, less functionally independent, higher ASA scores, shorter operative times, and longer LOS. Octogenarians had greater odds for developing any (OR = 2.05; 95%CI, 1.70-2.46), any major (OR = 2.28; 95%CI, 1.66-3.13), and any minor (OR = 1.99; 95%CI, 1.63-2.45) complications. Perioperative risk management strategies for elective TSA in the elderly may help mitigate the increased perioperative risks associated with age.
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Affiliation(s)
- Jared M Newman
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Sarah G Stroud
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Andrew Yang
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, United States.,Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, United States
| | - Anant Dixit
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - James P Doran
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Andrew J Hayden
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Danielle J Casagrande
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, United States
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