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Wang W, Shen T, Wang J. Analysis of the impact of radiotherapy and surgical treatment regimens based on the SEER database on the survival outcomes of rectal cancer patients over 70 years. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2024; 21:4463-4484. [PMID: 38549336 DOI: 10.3934/mbe.2024197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
OBJECTIVE This study evaluates the impact of different combinations of treatment regimens, such as additional radiation, chemotherapy, and surgical treatments, on the survival of elderly rectal cancer patients ≥ 70 years of age to support physicians' clinical decision-making. METHODS Data from a sample of elderly rectal cancer patients aged ≥ 70 years diagnosed from 2005-2015 from the US surveillance, epidemiology, and end results (SEER) database were retrospectively analyzed. The best cut-off point was selected using the x-tile software for the three continuity indices: age, tumor size, and number of regional lymph nodes. All patients were categorized into either the neoadjuvant radiotherapy and surgery group (R_S group), the surgical treatment group (S group), or the surgery and adjuvant radiotherapy group (S_R group). The propensity score allocation was used to match each included study subject in a 1:1 ratio, and the restricted mean survival time method (RMST) was used to predict the mean survival of rectal cancer patients within 5 and 10 years. The prognostic risk factors for rectal cancer patients were determined using univariate and multivariate Cox regression analyses, and nomograms were constructed. A subgroup stratification analysis of patients with different treatment combination regimens was performed using the Kaplan-Meier method, and log-rank tests were used for between-group comparisons. The model's predictive accuracy was assessed by receiver operating characteristic (ROC) curves, correction curves, and a clinical decision curve analysis (DCA). RESULTS A total of 7556 cases of sample data from 2005 to 2015 were included, which were categorized into 6639 patients (87.86%) in the S group, 408 patients (5.4%) in the R_S group, and 509 patients (6.74%) in the S_R group, according to the relevant order of radiotherapy and surgery. After propensity score matching (PSM), the primary clinical characteristics of the groups were balanced and comparable. The difference in the mean survival time before and after PSM was not statistically significant in both R_S and S groups (P value > 0.05), and the difference in the mean survival time after PSM was statistically substantial in S_R and S groups (P value < 0.05). In the multifactorial Cox analysis, the M1 stage and Nodes ≥ 9 were independent risk factors. An age between 70-75 was an independent protective factor for patients with rectal cancer in the R_S and S groups. The Marital_status, T4 stage, N2 stage, M1 stage, and Nodes ≥ 9 were independent risk factors for patients with rectal cancer in the S_R and S groups, and an age between 70-81 was an independent protective factor. The ROC curve area, the model C index, and the survival calibration curve suggested good agreement between the actual and predicted values of the model. The DCA for 3-year, 5-year, and 10-year survival periods indicated that the model had some potential for application. CONCLUSIONS The results of the study showed no significant difference in the overall survival (OS) between elderly patients who received neoadjuvant radiotherapy and surgery and those who received surgery alone; elderly patients who received surgery and adjuvant radiotherapy had some survival benefits compared with those who received surgery alone, though the benefit of adjuvant radiotherapy was not significant. Therefore, radiotherapy for rectal cancer patients older than 70 years old should be based on individual differences in condition, and a precise treatment plan should be developed.
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Affiliation(s)
- Wei Wang
- The First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei, China
| | - Tongping Shen
- School of Information Engineering, Anhui University of Chinese Medicine, Hefei, China
- Graduate School, Angeles University Foundation, Angeles, Philippines
| | - Jiaming Wang
- School of Information Engineering, Anhui University of Chinese Medicine, Hefei, China
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Leung CK, Walton NC, Kheder E, Zalpour A, Wang J, Zavgorodnyaya D, Kondody S, Zhao C, Lin H, Bruera E, Manzano JGM. Understanding Potentially Preventable 7-day Readmission Rates in Hospital Medicine Patients at a Comprehensive Cancer Center. Am J Med Qual 2024; 39:14-20. [PMID: 38127668 PMCID: PMC10841441 DOI: 10.1097/jmq.0000000000000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
This study aimed to describe the potentially preventable 7-day unplanned readmission (PPR) rate in medical oncology patients. A retrospective analysis of all unplanned 7-day readmissions within Hospital Medicine at MD Anderson Cancer Center from September 1, 2020 to February 28, 2021, was performed. Readmissions were independently analyzed by 2 randomly selected individuals to determine preventability. Discordant reviews were resolved by a third reviewer to reach a consensus. Statistical analysis included 138 unplanned readmissions. The estimated PPR rate was 15.94%. The median age was 62.50 years; 52.90% were female. The most common type of cancer was noncolon GI malignancy (34.06%). Most patients had stage 4 cancer (69.57%) and were discharged home (64.93%). Premature discharge followed by missed opportunities for goals of care discussions were the most cited reasons for potential preventability. These findings highlight areas where care delivery can be improved to mitigate the risk of readmission within the medical oncology population.
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Affiliation(s)
- Cerena K. Leung
- Department of Hospital Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Natalie C. Walton
- Department of Hospital Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Ed Kheder
- Department of Hospital Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Ali Zalpour
- Department of Pharmacy Clinical Programs, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Justine Wang
- Department of Pharmacy Clinical Programs, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sonia Kondody
- Department of Hospital Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Christina Zhao
- Department of Hospital Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Heather Lin
- Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Joanna-Grace M. Manzano
- Department of Hospital Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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Hukkinen T, Olenius T, Koskensalo S, Lepistö A, Koskenvuo L, Böckelman C. Short- and Long-Term Survival among Elderly Colorectal Cancer Patients in Finland, 2006-2015: A Nationwide Population-Based Registry Study. Cancers (Basel) 2023; 16:135. [PMID: 38201562 PMCID: PMC10777947 DOI: 10.3390/cancers16010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
This population-based registry study aimed to report 30-day and one-year postoperative survival, five-year overall survival (OS), and disease-specific survival (DSS) among elderly (≥75 years old) colorectal cancer (CRC) patients. All new colorectal cancer cases from 2006-2015 were included and followed until death or the end of follow-up (end of 2016). Among 27,088 CRC patients, 11,306 patients were ≥75 years old. Among patients ≥ 75 years, 36.8% (n = 4160) had right-sided colon cancer, 21.9% (n = 2478) left-sided colon cancer, and 32.3% (n = 3650) rectal cancer. In this study population, 932 patients were aged ≥ 90. The 30-day postoperative OS for patients aged 75-79 was 96.1% (95% confidence interval [CI] 95.3-96.9) falling to 93.2% (95% CI 92.0-94.4) for patients aged 80-84. The one-year postoperative OS among patients aged 75-79 was 86.3% (95% CI 84.7-87.9) compared with 80.5% (95% CI 78.7-82.3) among patients aged 80-84. Five-year OS among patients aged 75-79 was 47.6% (95% CI 46.0-49.2) and 36.6% (95% CI 34.8-38.4) among patients aged 80-84, compared with 61.7% (95% CI 60.9-62.5) among younger patients (<75 years old). Survival among elderly CRC patients (≥75 years old) was in general fairly good when compared with younger patients, especially among patients aged 75-79 and 80-84 with localized or locally advanced disease.
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Affiliation(s)
- Tanja Hukkinen
- Department of Gastroenterological Surgery, Abdominal Center, Helsinki University Hospital, Faculty of Medicine, University of Helsinki, Meilahden Sairaalakampus, Palvelukeskus PAKE.PA3.30, Stenbäckinkatu 9A, PL 440, 00029 Helsinki, Finland
| | - Tobias Olenius
- Department of Gastroenterological Surgery, Abdominal Center, Helsinki University Hospital, Faculty of Medicine, University of Helsinki, Meilahden Sairaalakampus, Palvelukeskus PAKE.PA3.30, Stenbäckinkatu 9A, PL 440, 00029 Helsinki, Finland
| | - Selja Koskensalo
- Department of Gastroenterological Surgery, Abdominal Center, Helsinki University Hospital, Faculty of Medicine, University of Helsinki, Meilahden Sairaalakampus, Palvelukeskus PAKE.PA3.30, Stenbäckinkatu 9A, PL 440, 00029 Helsinki, Finland
| | - Anna Lepistö
- Department of Gastroenterological Surgery, Abdominal Center, Helsinki University Hospital, Faculty of Medicine, University of Helsinki, Meilahden Sairaalakampus, Palvelukeskus PAKE.PA3.30, Stenbäckinkatu 9A, PL 440, 00029 Helsinki, Finland
| | - Laura Koskenvuo
- Department of Gastroenterological Surgery, Abdominal Center, Helsinki University Hospital, Faculty of Medicine, University of Helsinki, Meilahden Sairaalakampus, Palvelukeskus PAKE.PA3.30, Stenbäckinkatu 9A, PL 440, 00029 Helsinki, Finland
| | - Camilla Böckelman
- Department of Gastroenterological Surgery, Abdominal Center, Helsinki University Hospital, Faculty of Medicine, University of Helsinki, Meilahden Sairaalakampus, Palvelukeskus PAKE.PA3.30, Stenbäckinkatu 9A, PL 440, 00029 Helsinki, Finland
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Yasui K, Shida D, Ahiko Y, Takamizawa Y, Moritani K, Tsukamoto S, Kanemitsu Y. Risk of non-colorectal cancer-related death in elderly patients with the disease: A comparison of five preoperative risk assessment indices. Cancer Med 2023; 12:2290-2302. [PMID: 35871776 PMCID: PMC9939130 DOI: 10.1002/cam4.5052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
- Kohei Yasui
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Shida
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.,Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yuka Ahiko
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.,Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Takamizawa
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Konosuke Moritani
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
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Akinoso-Imran AQ, O'Rorke M, Kee F, Jordao H, Walls G, Bannon FJ. Surgical under-treatment of older adult patients with cancer: A systematic review and meta-analysis. J Geriatr Oncol 2022; 13:398-409. [PMID: 34776385 DOI: 10.1016/j.jgo.2021.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/12/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Older patients with cancer often have lower surgery rates and survival than younger patients, but this may reflect surgical contraindications of advanced disease, comorbidities, and frailty - and not necessarily under-treatment. OBJECTIVES This review aims to describe variations in surgery rates and observed or net survival among younger (<75) and older (≥75) patients with breast, lung and colorectal cancer, while taking account of pre-existing health factors, in order to understand how under-treatment is defined and estimated in the literature. METHOD MEDLINE, EMBASE, Web of Science and PubMed databases were searched for studies reporting surgery rates and observed or net survival among younger and older patients with breast, lung, and colorectal cancer. Study quality was assessed using the Newcastle Ottawa Scale, and random effects meta-analyses were used to combine study results. The I-squared statistic and subgroup analyses were used to assess heterogeneity. RESULTS Thirty relatively high-quality studies of patients with breast (230,200; 71.9%), lung (77,573; 24.2%), and colorectal (12,407; 3.9%) cancers were identified. Compared to younger patients, older patients were less likely to receive surgical treatment for 1) breast cancer after adjusting for comorbidity, performance status (PS), functional status and patient choice, 2) lung cancer after accounting for stage, comorbidity, PS, and 3) colorectal cancer after adjusting for stage, comorbidity, and gender. The pooled unadjusted analyses showed lower surgery receipt in older patients with breast (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.13-0.78), lung (OR 0.54, 95% CI 0.39-0.75), and colorectal (OR 0.59, 95% CI 0.51-0.68) cancer. In separate analyses, older patients with breast, lung and colorectal cancer had lower observed and net survival, compared to younger patients. CONCLUSIONS Lower surgery rates in older patients may contribute to their poorer survival compared to younger patients. Future research quantifying under-treatment should include necessary clinical factors, patient choice, patient's quality of life and a statistically-robust approach, which will demonstrate how much of the survival deficit in older patients is due to their receiving lower surgery rates.
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Affiliation(s)
- Abdul Qadr Akinoso-Imran
- Centre for Public Health, Queens University Belfast, Institute of Clinical Sciences, Block B, Grosvenor Road, Belfast BT12 6BA, UK.
| | - Michael O'Rorke
- College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, United States of America
| | - Frank Kee
- Centre for Public Health, Queens University Belfast, Institute of Clinical Sciences, Block B, Grosvenor Road, Belfast BT12 6BA, UK
| | - Haydee Jordao
- Centre for Public Health, Queens University Belfast, Institute of Clinical Sciences, Block B, Grosvenor Road, Belfast BT12 6BA, UK
| | - Gerard Walls
- Johnston Centre for Centre for Cancer Research, 97 Lisburn Rd, Belfast BT9 7AE, UK; Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast BT7 7AB, UK
| | - Finian J Bannon
- Centre for Public Health, Queens University Belfast, Institute of Clinical Sciences, Block B, Grosvenor Road, Belfast BT12 6BA, UK
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Nejadghaderi SA, Roshani S, Mohammadi E, Yoosefi M, Rezaei N, Esfahani Z, Azadnajafabad S, Ahmadi N, Shahin S, Kazemi A, Namazi Shabestari A, Khosravi A, Mokdad AH, Larijani B, Farzadfar F. The global, regional, and national burden and quality of care index (QCI) of colorectal cancer; a global burden of disease systematic analysis 1990-2019. PLoS One 2022; 17:e0263403. [PMID: 35446852 PMCID: PMC9022854 DOI: 10.1371/journal.pone.0263403] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/18/2022] [Indexed: 12/27/2022] Open
Abstract
Background Colorectal cancer (CRC) is among the five most incident and lethal cancers in world and its burden varies between countries and sexes. We aimed to present a comprehensive measure called the quality of care index (QCI) to evaluate the inequity and healthcare quality of care regarding CRC by sex and location. Methods Data on the burden of CRC were extracted from the Global Burden of Disease study 2019. It was transformed to four ratios, including mortality-to-incidence, disability-adjusted life years (DALYs)-to-prevalence, prevalence-to-incidence, and years of life lost (YLLs)-to-years lived with disability (YLDs). Principal component analysis was implemented on the four ratios and the most influential component was considered as QCI with a score ranging from zero to 100, for which higher scores represented better quality of care. Gender Disparity Ratio (GDR) was calculated by dividing QCI for females by males. Results The global incidence and death numbers of CRC were 2,166,168 (95% uncertainty interval: 1,996,298–2,342,842) and 1,085,797 (1,002,795–1,149,679) in 2019, respectively. Globally, QCI and GDR values were 77.6 and 1.0 respectively in 2019. There was a positive association between the level of quality of care and socio-demographic index (SDI) quintiles. Region of the Americas and African Region had the highest and lowest QCI values, respectively (84.4 vs. 23.6). The QCI values started decreasing beyond the age of 75 in 2019 worldwide. Conclusion There is heterogeneity in QCI between SDI quintiles. More attention should be paid to people aged more than 75 years old because of the lower quality of care in this group.
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Affiliation(s)
- Seyed Aria Nejadghaderi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Roshani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esfahani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarvenaz Shahin
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Kazemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Namazi Shabestari
- Department of Geriatric Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail: ,
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Ramírez-Martín R, Pérez-Rodríguez P, Menéndez-Colino R, Martín Maestre I, Gazo Martínez JA, Marijuán Martín JL, Alarcón Alarcón T, Díez Sebastián J, González-Montalvo JI. Prehabilitation and perioperative geriatric care in patients aged over 80 years with colorectal cancer: Results of a cross-speciality geriatrics program. J Geriatr Oncol 2022; 13:813-820. [DOI: 10.1016/j.jgo.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/27/2022] [Accepted: 03/07/2022] [Indexed: 12/24/2022]
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Zhang Y, Lin Y, Zhu Y, Zhang X, Tao L, Yang M. ARHGAP25 expression in colorectal cancer as a biomarker associated with favorable prognosis. Mol Clin Oncol 2022; 16:84. [PMID: 35251635 PMCID: PMC8892469 DOI: 10.3892/mco.2022.2517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/21/2022] [Indexed: 12/24/2022] Open
Abstract
Although progress has been made in the early diagnosis of colorectal cancer (CRC) and in the systemic therapy of patients with CRC, the prognosis for advanced CRC remains poor. Our previous study demonstrated that ARHGAP25 overexpression significantly inhibits CRC cell growth, invasion and migration. However, it was not possible to evaluate and analyze the overall survival (OS) rate of patients with CRC. Thus, the discovery of relevant factors and their expression on the basis of existing research is necessary to predict the OS rate of patients with advanced CRC. Therefore, the aim of the present study was to define the value of Rho GTPase-activating protein 25 (ARHGAP25) expression in predicting the OS rate in patients with CRC. The clinical data of 153 patients with CRC who underwent colorectal resection were retrospectively analyzed. In order to explore the expression of ARHGAP25, immunohistochemical analysis of the tumor tissues of these patients, was performed. Univariate Cox regression analysis was used to assess the prognostic value of ARHGAP25 expression for OS. Multivariate analysis was used to evaluate the effect of ARHGAP25 expression in the presence of other variables. Confounding factors and interaction were assessed by a stratified analysis using ARHGAP25 expression and other variables associated with survival. The univariate analysis revealed that, ARHGAP25 expression was associated with an improved OS in patients with CRC (P<0.05). The multivariate analysis revealed that ARHGAP25 expression was still correlated with an improved OS after adjusting for sex, age, invasion degree, lymph node metastasis, distant metastasis, TNM stage, tumor location, histological type, histological grade, tumor deposits, and postoperative treatment (P<0.05). The stratified analysis demonstrated that the predictive value of ARHGAP25 for the OS of patients with CRC was stronger in males, elderly patients (>70 years old), patients with T3 stage tumor, lymph node metastasis, TNM stage III, right hemicolon location and patients with a poorly differentiated tumor (P<0.05). Overall, our results demonstrated that ARHGAP25 may have an important potential value for improving the prognosis of patients with CRC.
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Affiliation(s)
- Yue Zhang
- Department of Oncology, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P.R. China
| | - Yi Lin
- Department of Oncology, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P.R. China
| | - Yingjie Zhu
- Department of Oncology, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P.R. China
| | - Xiaoyun Zhang
- Department of Pathology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P.R. China
| | - Li Tao
- Department of Oncology, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P.R. China
| | - Ming Yang
- Phase I Clinical Research Laboratory of Shanghai LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P.R. China
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Shang JY, Bao F, Wu LR, Deng ZG, Xiang CH. Prognosis of laparoscopic surgery for colorectal cancer in middle-aged patients. J Minim Access Surg 2022; 19:263-271. [PMID: 35915539 DOI: 10.4103/jmas.jmas_81_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The prognosis of middle-aged patients with colorectal cancer (CRC) treated by laparoscopic resection (LR) is unclear. This study aimed to evaluate the survival outcomes of LR compared with open resection (OR) for middle-aged patients with CRC. Patients and Methods This retrospective cohort study used the data from a database of all consecutive colorectal resections performed between January 2009 and December 2017. Propensity score matching (PSM) was performed to handle the selection bias based on age, gender, body mass index, tumour location, AJCC stage and admission year. Univariate and multivariate COX regression model was used to identify risk factors of overall survival (OS) and disease-free survival (DFS). Results After PSM, 154 patients were included in each group. Compared with the OR group in the total cohort, there were better survival outcomes in the LR group for 5-year OS and 5-year DFS (both P < 0.001). These differences were observed for Stage II and III diseases and for all CRC, irrespective of location. The multivariate analysis showed that tumour ≥5 cm (hazard ratio [HR] = 1.750, 95% confidence interval [CI]: 1.026-2.986, P = 0.040), Stage III (HR = 14.092, 95% CI: 1.894-104.848, P = 0.010) and LR (HR = 0.300, 95% CI: 0.160-0.560, P < 0.001) were independently associated with OS. Pre-operative carcinoembryonic antigen ≥5 ng/ml (HR = 3.954, 95% CI: 1.363-11.473, P = 0.011), Stage III (HR = 6.206, 95% CI: 1.470-26.200, P = 0.013) and LR (HR = 0.341, 95% CI: 0.178-0.653, P = 0.001) were independently associated with DFS. Conclusions In middle-aged patients with CRC, LR achieves better survival than OR. Complications are similar, except for less blood loss and shorter post-surgical hospital stay with LR.
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Serum and Erythrocyte Antioxidant Defense in Colorectal Cancer Patients during Early Postoperative Period: Potential Modifiers and Impact on Clinical Outcomes. Antioxidants (Basel) 2021; 10:antiox10070999. [PMID: 34201536 PMCID: PMC8300787 DOI: 10.3390/antiox10070999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 12/23/2022] Open
Abstract
A better understanding of antioxidant status, its modifiers, and its effect on clinical outcomes in patients undergoing colorectal cancer surgery is needed for effective antioxidant-based interventions. The objectives of this cohort study were: to determine baseline serum (total antioxidant capacity (TAC) and ferric reducing antioxidant power (FRAP); n = 72) and erythrocyte (superoxide dismutase (SOD) and glutathione peroxidase (GPx); n = 47) antioxidant capacity and time-course during the 72 h postoperative period, to identify potential modifiers, and to establish impact on clinical outcomes. Older patients with comorbidities had lower baseline FRAP. TAC was inversely and SOD directly correlated with inflammatory markers. Cancer pathology affected GPx (lower in advanced and more aggressive cancers) and SOD (higher in advanced cancers). Surgical intervention induced a transient increase in FRAP and TAC with greater FRAP elevation in older, obese patients with several comorbidities. SOD activity significantly increased while GPx non-significantly decreased between 8 and 24 h post-incision. Poorer health status was associated with an increase in SOD and a decrease in GPx at 72 h. Clinical manifestation of postoperative ileus was preceded by decreased TAC at 24 h and an increase in SOD between 8 and 24 h and anastomotic leak was manifested by diminished SOD at 72 h compared to activities at 8 and 24 h. The time-frame between 8 and 24 h post-incision might be the most critical regarding oxidant/antioxidant balance and therefore the best suited for antioxidant-based intervention.
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Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116072. [PMID: 34199923 PMCID: PMC8200127 DOI: 10.3390/ijerph18116072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 12/24/2022]
Abstract
Six out of every 10 new colorectal cancer (CRC) diagnoses are in people over 65 years of age. Current standardized surgical approaches have proved to be tolerable on the elderly population, although post-operative complications are more frequent than in the younger CRC population. Frailty is common in elderly CRC patients with surgical indication, and it appears to be also associated with an increase of post-operative complications. Fast-track pathways have been developed to assure and adequate post-operative recovery, but comprehensive geriatric assessments (CGA) are still rare among the preoperative evaluation of elderly CRC patients. This review provides a thorough study of the effects that a CGA assessment and a geriatric intervention have in the prognosis of CRC elderly patients with surgical indication.
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Tamai K, Okamura S, Makino S, Yamamura N, Fukuchi N, Ebisui C, Inoue A, Yano M. C-reactive protein/albumin ratio predicts survival after curative surgery in elderly patients with colorectal cancer. Updates Surg 2021; 74:153-162. [PMID: 33677820 DOI: 10.1007/s13304-021-01011-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/20/2021] [Indexed: 02/07/2023]
Abstract
Inflammation-based markers, including the C-reactive protein/albumin ratio (CAR), lymphocyte/monocyte ratio (LMR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), Onodera's prognostic nutritional index (PNI), and Glasgow Prognostic Score (GPS), have been demonstrated to serve as prognostic indicators in various malignancies. This study aimed to evaluate their potential predictive value for colorectal cancer (CRC) in the elderly. We retrospectively evaluated 163 patients with CRC, aged 80 years and older, who had undergone curative surgery. The receiver operating characteristic curve analyses and the corresponding areas under the curve (AUCs) were used to determine and compare the discriminatory ability of the inflammation-based markers. Besides, the associations of inflammatory markers and clinical characteristics with overall survival (OS), relapse-free survival (RFS), and cancer-specific survival (CSS) were analyzed. The CAR had a significantly larger AUC than the GPS, PLR, NLR, and LMR (p = 0.006, 0.012, 0.018, and 0.002, respectively), except for the PNI (p = 0.052). The optimal cut-off value was 0.106 for the CAR and 44.894 for the PNI. Moreover, a CAR ≥ 0.106 turned out to be significantly associated with worse 5-year OS, RFS, and CSS compared with a CAR < 0.106. The multivariate analysis indicated that the CAR ≥ 0.106 was an independent prognostic factor for poor OS (HR = 3.596, p = 0.0006), RFS (HR = 2.945, p = 0.003), and CSS (HR = 4.411, p = 0.02). CAR is a useful and promising prognostic marker in elderly patients undergoing curative surgery for CRC.
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Affiliation(s)
- Koki Tamai
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Shu Okamura
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan.
| | - Shunichiro Makino
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Noriyuki Yamamura
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Nariaki Fukuchi
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Chikara Ebisui
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Akira Inoue
- Department of Gastroenterological Surgery, Osaka General Medical Center, Mandaihigashi 3-1-56, Sumiyoshi-ku, Osaka City, Osaka, 558-8558, Japan
| | - Masahiko Yano
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
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Shen L, Meng K, Wang Y, Yu X, Wang P, Zhang X. The clinical features, management, and survival of elderly patients with colorectal cancer. J Gastrointest Oncol 2021; 12:89-99. [PMID: 33708427 DOI: 10.21037/jgo-21-63] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background As the population ages, the number of elderly patients with colorectal cancer is increasing year by year. However, older people have rarely been the focus of studies on colorectal cancer. Therefore, in the present study, we aimed to carry out a retrospective analysis of this patient subgroup. Methods A retrospective study of clinical data of patients aged over 80 years who died from colorectal cancer in our hospital between 1993 and 2020 was performed. Logistic regression, the Kaplan-Meier method, and a multivariate Cox proportional hazards model were used to analyze the overall survival and treatment outcomes of the patients. Results A total of 87 patients were included in the study. The overall median survival was 45 months. In most patients, the primary lesion was located in the right colon. One-quarter of the patients refused to accept any treatment. Patients with stage IV tumors, who accounted for the largest proportion of the study population, displayed a higher rate of abandoning treatment than did patients of other stages. Almost all patients with stages II and III accepted surgery. Patients who underwent surgery to treat their colorectal cancer had longer survival than those who did not. Conclusions Old age should not be a reason for giving up treatment for colorectal cancer. The treatment of colorectal cancer patients aged 80 years and above requires individualized evaluation and more aggressive treatment to achieve greater benefits.
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Affiliation(s)
- Lei Shen
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, China
| | - Ke Meng
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, China
| | - Yifei Wang
- Medical Big-data Research Center, Medical Innovation Research Division, PLA General Hospital, Beijing, China
| | - Xiangli Yu
- Outpatient Department, the First Medical Center of PLA General Hospital, Beijing, China
| | - Ping Wang
- Department of Respiratory and Critical Care Medicine, the Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Xiaomei Zhang
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, China
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Bojesen RD, Friis M, Gögenur I. Age is an individual risk factor for not being referred to adjuvant chemotherapy in patients resected for UICC III colorectal cancer: a nationwide cohort study. Acta Oncol 2020; 59:1538-1542. [PMID: 32752903 DOI: 10.1080/0284186x.2020.1795251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rasmus Dahlin Bojesen
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital, Køge, Denmark
| | - Marie Friis
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital, Køge, Denmark
- Department of Geriatric Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital, Køge, Denmark
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Liu W, Zhang M, Wu J, Tang R, Hu L. Oncologic Outcome and Efficacy of Chemotherapy in Colorectal Cancer Patients Aged 80 Years or Older. Front Med (Lausanne) 2020; 7:525421. [PMID: 33195291 PMCID: PMC7645236 DOI: 10.3389/fmed.2020.525421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 09/03/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose: The present study aimed to evaluate the oncologic outcomes of patients 80 years or older compared with younger patients, and we then further investigated the efficacy of chemotherapy in individuals 80 years or older. Methods: A retrospective analysis was conducted using the Surveillance, Epidemiology and End Results database. The χ2 test was used to analyze the different clinicopathologic and demographic variables between 65- and 79-year and ≥80-year groups. Kaplan-Meier analysis and log-rank testing were used to compare colorectal cancer (CRC)-specific survival (CCSS) curves between different groups. Multivariate and univariate Cox proportional hazards models with hazard ratios (HRs) and 95% confidence intervals (CIs) were also used to assess CCSS and OS. Results: A total of 189,926 patients were included in our study. Compared with 65- to 79-year-old patients, age 80 years or older was associated with 48.4% increased CRC-specific mortality (HR = 1.484, 95% CI = 1.453-1.516, P < 0.0001; using 65-79 years old as the reference). Moreover, not receiving chemotherapy was significantly associated with an increased risk of CRC-related death, independent of other prognostic factors (HR = 0.615, 95% CI = 0.589-0.643, P < 0.0001) in individuals 80 years or older. Conclusions: This large population-based study showed that older age was associated with worse oncologic outcomes compared to younger age. Chemotherapy could offer survival benefit for very old patients diagnosed with CRC, and we strongly believed that very old patients were undertreated in the present medical practices.
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Affiliation(s)
- Wenting Liu
- Geriatric Department, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, China
| | - Mengyuan Zhang
- Geriatric Department, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, China
| | - Jun Wu
- Geriatric Department, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, China
| | - Ran Tang
- Department of Pediatric Surgery, Anhui Provincial Children's Hospital, Hefei, China
| | - Liqun Hu
- Geriatric Department, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, China
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Pupwe G, Ngalamika O, Akudugu J. Chemotherapy for elderly colorectal cancer patients at a tertiary hospital in South Africa. Pan Afr Med J 2020; 37:100. [PMID: 33425133 PMCID: PMC7757304 DOI: 10.11604/pamj.2020.37.100.18515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/28/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction surgical treatment of colorectal cancer (CRC) in elderly patients has improved, but data on the tolerability and benefits of adjuvant and palliative chemotherapy in this growing population remains scarce. Methods we conducted a retrospective study to compare chemotherapy-associated toxicities in CRC patients aged < 70 years and ≥ 70 years at Tygerberg Hospital (South Africa). We also assessed tumor-related mortality, progression free survival (PFS), and overall survival (OS) including predictive factors of OS. Results a total of 50 patients received either adjuvant or palliative chemotherapy. There was no difference in overall toxicity between the two groups. Out of the 50 patients, 8 (16%) had Grade 3-4 toxicity. 4 of these patients made up 15% of the < 70 years age group, whereas the other 4 made up 17% of the ≥ 70 years age group. The mean follow-up time was 47.5 months (95% CI 41.5 - 53.5 months). The 5-year over-all survival rate for stage II and III patients < 70 years and ≥ 70 years were 80.9% and 69.5%, respectively, and not significantly different (P = 0.52). Furthermore, the 5-year progression-free survival rates of the < 70 and ≥ 70 age groups were 70.7% and 58.8%, respectively, and also not statistically significantly different (P = 0.49). For stage IV patients, there were no significant differences in survival between the two age groups. Conclusion the benefits from adjuvant and palliative chemotherapy for elderly CRC patients are similar to that of younger patients. Therefore, standardized adjuvant and palliative chemotherapy is recommended for elderly patients.
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Affiliation(s)
- George Pupwe
- Division of Clinical and Radiation Oncology, Tygerberg Hospital, Cape Town, South Africa.,Cancer Diseases Hospital, Lusaka, Zambia
| | - Owen Ngalamika
- Dermatology and Venereology Section, University Teaching Hospital, University of Zambia School of Medicine, Lusaka, Zambia
| | - John Akudugu
- Division of Radiobiology, Stellenbosch University, Cape Town, South Africa
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DuMontier C, Loh KP, Bain PA, Silliman RA, Hshieh T, Abel GA, Djulbegovic B, Driver JA, Dale W. Defining Undertreatment and Overtreatment in Older Adults With Cancer: A Scoping Literature Review. J Clin Oncol 2020; 38:2558-2569. [PMID: 32250717 PMCID: PMC7392742 DOI: 10.1200/jco.19.02809] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The terms undertreatment and overtreatment are often used to describe inappropriate management of older adults with cancer. We conducted a comprehensive scoping review of the literature to clarify the meanings behind the use of the terms. METHODS We searched PubMed (National Center for Biotechnology Information), Embase (Elsevier), and CINAHL (EBSCO) for titles and abstracts that included the terms undertreatment or overtreatment with regard to older adults with cancer. We included all types of articles, cancer types, and treatments. Definitions of undertreatment and overtreatment were extracted, and categories underlying these definitions were derived through qualitative analysis. Within a random subset of articles, C.D. and K.P.L. independently performed this analysis to determine final categories and then independently assigned these categories to assess inter-rater reliability. RESULTS Articles using the terms undertreatment (n = 236), overtreatment (n = 71), or both (n = 51) met criteria for inclusion in our review (n = 256). Only 14 articles (5.5%) explicitly provided formal definitions; for the remaining, we inferred the implicit definitions from the terms' surrounding context. There was substantial agreement (κ = 0.81) between C.D. and K.P.L. in independently assigning categories of definitions within a random subset of 50 articles. Undertreatment most commonly implied less than recommended therapy (148; 62.7%) or less than recommended therapy associated with worse outcomes (88; 37.3%). Overtreatment most commonly implied intensive treatment of an older adult in whom the harms of treatment outweigh the benefits (38; 53.5%) or intensive treatment of a cancer not expected to affect an older adult in his/her remaining lifetime (33; 46.5%). CONCLUSION Undertreatment and overtreatment of older adults with cancer are imprecisely defined concepts. We propose new, more rigorous definitions that account for both oncologic factors and geriatric domains.
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Affiliation(s)
- Clark DuMontier
- Brigham and Women’s Hospital, Boston, MA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | | | | | - Tammy Hshieh
- Brigham and Women’s Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Jane A. Driver
- Brigham and Women’s Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
- Veterans Affairs Boston Healthcare System, New England Geriatric Research Education and Clinical Center, Boston, MA
| | - William Dale
- City of Hope Comprehensive Cancer Center, Duarte, CA
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González-Montalvo JI, Ramírez-Martín R, Menéndez Colino R, Alarcón T, Tarazona-Santabalbina FJ, Martínez-Velilla N, Vidán MT, Pi-Figueras Valls M, Formiga F, Rodríguez Couso M, Hormigo Sánchez AI, Vilches-Moraga A, Rodríguez-Pascual C, Gutiérrez Rodríguez J, Gómez-Pavón J, Sáez López P, Bermejo Boixareu C, Serra Rexach JA, Martínez Peromingo J, Sánchez Castellano C, González Guerrero JL, Martín-Sánchez FJ. [Cross-speciality geriatrics: A health-care challenge for the 21st century]. Rev Esp Geriatr Gerontol 2020; 55:84-97. [PMID: 31870507 DOI: 10.1016/j.regg.2019.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
Increasing numbers of older persons are being treated by specialties other than Geriatric Medicine. Specialists turn to Geriatric Teams when they need to accurately stratify their patients' risk and prognosis, predict the potential impact of their, often, invasive interventions, optimise their clinical status, and contribute to discharge planning. Oncology and Haematology, Cardiology, General Surgery, and other surgical departments are examples where such collaborative working is already established, to a varying extent. The use of the term "Cross-speciality Geriatrics" is suggested when geriatric care is provided in clinical areas traditionally outside the reach of Geriatric Teams. The core principles of Geriatric Medicine (comprehensive geriatric assessment, patient-centred multidisciplinary targeted interventions, and input at point-of-care) are adapted to the specifics of each specialty and applied to frail older patients in order to deliver a holistic assessment/treatment, better patient/carer experience, and improved clinical outcomes. Using Comprehensive Geriatric Assessment methodology and Frailty scoring in such patients provides invaluable prognostic information, helps in decision making, and enables personalised treatment strategies. There is evidence that such an approach improves the efficiency of health care systems and patient outcomes. This article includes a review of these concepts, describes existing models of care, presents the most commonly used clinical tools, and offers examples of excellence in this new era of geriatric care. In an ever ageing population it is likely that teams will be asked to provide Cross-specialty Geriatrics across different Health Care systems. The fundamentals for its implementation are in place, but further evidence is required to guide future development and consolidation, making it one of the most important challenges for Geriatrics in the coming years.
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Affiliation(s)
- Juan Ignacio González-Montalvo
- Servicio de Geriatría, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España.
| | | | | | - Teresa Alarcón
- Servicio de Geriatría, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | | | - Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IDISNA, Pamplona, España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, IiSGM, Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Madrid, España
| | | | - Francesc Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, IDIBELL, Hospital Universitario de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España
| | | | - Ana Isabel Hormigo Sánchez
- Servicio de Geriatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Arturo Vilches-Moraga
- Servicio de Geriatría, Salford Royal NHS Foundation Trust, Facultad de Medicina, Universidad de Manchester, Manchester, Inglaterra
| | | | - José Gutiérrez Rodríguez
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
| | - Javier Gómez-Pavón
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, Facultad de Medicina, Universidad Alfonso X el Sabio, Madrid, España
| | - Pilar Sáez López
- Unidad de Geriatría, Hospital Universitario Fundación de Alcorcón, IdiPAZ, Alcorcón, Madrid, España
| | | | - José Antonio Serra Rexach
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, IiSGM, Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Madrid, España
| | | | | | - José Luis González Guerrero
- Servicio de Geriatría, Hospital San Pedro de Alcántara, Complejo Hospitalario Universitario de Cáceres, Cáceres, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos, IdiSSC, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Sakamoto Y, Miyamoto Y, Tokunaga R, Akiyama T, Daitoku N, Hiyoshi Y, Iwatsuki M, Baba Y, Iwagami S, Yoshida N, Baba H. Long-term outcomes of colorectal cancer surgery for elderly patients: a propensity score-matched analysis. Surg Today 2019; 50:597-603. [PMID: 31844988 DOI: 10.1007/s00595-019-01934-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/18/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the effect of old age on the perioperative, short-term, and long-term surgical outcomes of elderly patients undergoing curative surgery for colorectal cancer (CRC). METHODS The subjects of this retrospective study were 526 patients who underwent curative resections for stage I-III CRC between March 2005 and March 2016. We divided the patients into a young group (< 75 years old, n = 361) and an elderly group (≥ 75 years old, n = 165) and compared the clinicopathological factors and prognoses of the two groups. We performed a propensity score-matched (PSM) analysis with inverse probability of treatment weighting (IPTW) to avoid confounding bias. RESULTS The elderly group had more right-sided tumors and more comorbidities than the young group. After PSM, there were 148 patients in each group. Although the elderly group had significantly shorter overall survival than the young group, the two groups did not differ significantly in cancer-specific survival (CSS; P = 0.136) or recurrence rate (RR; P = 0.317). Multivariate analysis with IPTW also revealed no significant difference in CSS (P = 0.171) or RR (P = 0.284) between the young and elderly groups. Our findings were limited by the study's retrospective single-institute conditions, and the inclusion of only patients who underwent radical resections. CONCLUSION Primary tumor resection is appropriate for elderly patients with CRC.
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Affiliation(s)
- Yuki Sakamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Ryuma Tokunaga
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takahiko Akiyama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Nobuya Daitoku
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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Sarasqueta C, Perales A, Escobar A, Baré M, Redondo M, Fernández de Larrea N, Briones E, Piera JM, Zunzunegui MV, Quintana JM. Impact of age on the use of adjuvant treatments in patients undergoing surgery for colorectal cancer: patients with stage III colon or stage II/III rectal cancer. BMC Cancer 2019; 19:735. [PMID: 31345187 PMCID: PMC6659283 DOI: 10.1186/s12885-019-5910-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background Many older patients don’t receive appropriate oncological treatment. Our aim was to analyse whether there are age differences in the use of adjuvant chemotherapy and preoperative radiotherapy in patients with colorectal cancer. Methods A prospective cohort study was conducted in 22 hospitals including 1157 patients with stage III colon or stage II/III rectal cancer who underwent surgery. Primary outcomes were the use of adjuvant chemotherapy for stage III colon cancer and preoperative radiotherapy for stage II/III rectal cancer. Generalised estimating equations were used to adjust for education, living arrangements, area deprivation, comorbidity and clinical tumour characteristics. Results In colon cancer 92% of patients aged under 65 years, 77% of those aged 65 to 80 years and 27% of those aged over 80 years received adjuvant chemotherapy (χ2trends < 0.001). In rectal cancer preoperative radiotherapy was used in 68% of patients aged under 65 years, 60% of those aged 65 to 80 years, and 42% of those aged over 80 years (χ2trends < 0.001). Adjusting by comorbidity level, tumour characteristics and socioeconomic level, the odds ratio of use of chemotherapy compared with those under age 65, was 0.3 (0.1–0.6) and 0.04 (0.02–0.09) for those aged 65 to 80 and those aged over 80, respectively; similarly, the odds ratio of use of preoperative radiotherapy was 0.9 (0.6–1.4) and 0.5 (0.3–0.8) compared with those under 65 years of age. Conclusions The probability of older patients with colorectal cancer receiving adjuvant chemotherapy and preoperative radiotherapy is lower than that of younger patients; many of them are not receiving the treatments recommended by clinical practice guidelines. Differences in comorbidity, tumour characteristics, curative resection, and socioeconomic factors do not explain this lower probability of treatment. Research is needed to identify the role of physical and cognitive functional status, doctors’ attitudes, and preferences of patients and their relatives, in the use of adjuvant therapies. Electronic supplementary material The online version of this article (10.1186/s12885-019-5910-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Sarasqueta
- Biodonostia Health Research Institute - Donostia University Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Paseo Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Gipuzkoa, Spain.
| | - A Perales
- Biodonostia Health Research Institute - Donostia University Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Paseo Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Gipuzkoa, Spain
| | - A Escobar
- Research Unit, Hospital Basurto / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Avda Montevideo, 18, 48013, Bilbao, Bizkaia, Spain
| | - M Baré
- Clinical Epidemiology and Cancer Screening, Corporació Sanitaria Parc Taulí / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - M Redondo
- Research Unit, Costa del Sol Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Autovía A-7, Km 187, 29603, Marbella, Málaga, Spain
| | - N Fernández de Larrea
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III / Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avda de Monforte de Lemos, 5, 28029, Madrid, Spain
| | - E Briones
- Epidemiology Unit, Seville Health District, Andalusian Health Service / Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avda de la Constitución, 18, 41071, Seville, Spain
| | - J M Piera
- Medical Oncology Unit, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014, Donostia-San Sebastián, Gipuzkoa, Spain
| | - M V Zunzunegui
- Departement de médecine sociale et préventive Institut de recherche en santé publique (IRSPUM), University of Montréal, Pavillon 7101, salle 3111 7101, Avenue du Parc Montréal, Montréal, Québec, H3N 1X9, Canada
| | - J M Quintana
- Research Unit, Galdakao-Usansolo Hospital / REDISSEC, Labeaga Auzoa, 48960, Galdakao, Bizkaia, Spain
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21
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[Integral approach to the older patient with cancer]. NUTR HOSP 2019; 36:18-25. [PMID: 31189316 DOI: 10.20960/nh.02677] [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: 11/02/2022] Open
Abstract
Introduction The world population, as well as the number of elderly people, grow exponentially. Elderly individuals are at a higher risk of developing an oncological disease, especially because they are subject to a longer period of exposure to carcinogens, and a worse capacity for regeneration of their deoxyribonucleic acid (DNA) (1). Cancer in elderly individuals represents 80% of the annual deaths secondary to this pathology (2). The older patient with cancer presents many differences with respect to the rest of elderly individuals. On the one hand, functional limitation and geriatric syndromes are more prevalent (3), as well as the presence of frailty (4). In addition, they habitually have a worse perception of their health status (4). For all these reasons, the attention to oncological older patients must be specialized and, in their evaluation, the use of a fundamental tool is required, the Comprehensive Geriatric Assessment (CGA). As its name indicates, its application requires collaboration between different specialties (5,6). This multidisciplinary work will improve the baseline situation of the patient, in those cases in which it is possible, and will facilitate the subsequent therapeutic management (7). Finally, the existence of concrete organizational models, such as the Oncogeriatrics Units, or the Cancer Consultations in the Elderly, can facilitate and favor this integral approach (5). In this article a review of all these concepts is carried out.
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Mao W, Zhang Z, Huang X, Fan J, Geng J. Marital Status and Survival in Patients with Penile Cancer. J Cancer 2019; 10:2661-2669. [PMID: 31258774 PMCID: PMC6584924 DOI: 10.7150/jca.32037] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/27/2019] [Indexed: 01/06/2023] Open
Abstract
Purpose: We aimed to reveal the effects of marital status on survival outcomes in patients with penile cancer. Methods: Patients with penile cancer who were diagnosed between 2004 and 2015 were identified by using the Surveillance, Epidemiology and End Results (SEER) database. Kaplan-Meier and Cox regressions were used to analyse the effects of marital status on overall survival (OS) and cancer-specific survival (CSS). Results: Among 3,195 eligible patients with penile cancer, 1,951 (61.1%) patients were married, 365 (11.4%) were divorced or separated, 327 (10.2%) were widowed and 552 (17.3%) were single. The widowed patients had the worst OS median survival time (22 months) and CSS median survival time (23.5 months). Marital status was an independent prognostic factor for OS and CSS of penile cancer patients. The multivariate Cox regression showed that widowed patients exhibited the poorest OS (hazard ratio [HR]: 1.73; 95% confidence interval [CI]: 1.48-2.03, p < 0.001) and the poorest CSS (HR: 1.64; 95% CI: 1.144-1.279, p < 0.001) compared with married patients. Similar results were observed in our centre database and the subgroup analyses based on the SEER stage and grade. Conclusions: In our study, we found that marital status was an independent prognostic factor for survival in patients with penile cancer. Additionally, widowed patients had the lowest OS and CSS compared with married patients.
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Affiliation(s)
- Weipu Mao
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Ziwei Zhang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Xin Huang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Jie Fan
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jiang Geng
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
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23
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Yan Q, Zhang K, Guo K, Liu S, Wasan HS, Jin H, Yuan L, Feng G, Shen F, Shen M, Ma S, Ruan S. Value of tumor size as a prognostic factor in metastatic colorectal cancer patients after chemotherapy: a population-based study. Future Oncol 2019; 15:1745-1758. [PMID: 31038364 DOI: 10.2217/fon-2018-0785] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: To evaluate the relationship between tumor size and survival in metastatic colorectal cancer (mCRC) patients who received chemotherapy. Materials & methods: SEER database was accessed for eligible patients. Multivariate Cox regression analysis was performed to compare the effect of tumor size on overall survival (OS) and CRC-specific survival (CCSS). Results: Tumor size ≥5 cm was an independent risk factor for OS and CCSS in mCRC patients treated with chemotherapy. Tumor size <5 cm did not show a survival advantage in patients whose primary tumor site was rectosigmoid junction, while tumor size ≥5 cm was associated with poor OS and CCSS in left-and right-sided colorectal cancer. Conclusion: Tumor size ≥5 cm was associated with poor prognosis after receiving chemotherapy treatment and a risk factor for survival of mCRC.
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Affiliation(s)
- Qingying Yan
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, PR China
| | - Kai Zhang
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, PR China.,Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 110065, USA
| | - Kaibo Guo
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, PR China
| | - Shan Liu
- Department of Assessment Center, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310006, PR China
| | - Harpreet S Wasan
- Department of Cancer Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, W12 0HS, UK
| | - Huimin Jin
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, PR China
| | - Li Yuan
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, PR China
| | - Guan Feng
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, PR China
| | - Fengfei Shen
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, PR China
| | - Minhe Shen
- Department of Medical Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310006, PR China
| | - Shenglin Ma
- Department of Oncology, The Forth Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, PR China
| | - Shanming Ruan
- Department of Medical Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310006, PR China.,Department of Oncology, The Forth Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, PR China
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Ramos MFKP, Pereira MA, Dias AR, Yagi OK, Zaidan EP, Ribeiro-Júnior U, Zilberstein B, Cecconello I. Surgical outcomes of gastrectomy with D1 lymph node dissection performed for patients with unfavorable clinical conditions. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 45:460-465. [PMID: 30497814 DOI: 10.1016/j.ejso.2018.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 10/16/2018] [Accepted: 11/18/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastric cancer (GC) patients with advanced age and/or multiple morbidities have limited expected survival and may not benefit from extended lymph node resection. The aim of this study was to evaluate the surgical outcomes of these GC patients who underwent gastrectomy with D1 dissection. METHODS We retrospectively reviewed all GC patients who underwent gastrectomy with curative intent from 2009 to 2017. The decision to perform D1 was based on preoperative multidisciplinary meeting, and/or intraoperative clinical judgment. RESULTS Among 460 enrolled patients, 73 (15.9%) underwent D1 lymphadenectomy and 387 (84.1%) D2 lymphadenectomy. Male gender, older age, American Society of Anesthesiologists score (ASA) III/IV, higher neutrophil-to-lymphocyte ratio (NLR) and higher Charlson Comorbidity Index (CCI) were more common in the D1 group. Postoperative major complications were significantly higher in D1 group (24.7% vs 12.4%, p < 0.001) and mostly related to clinical complications. Locoregional recurrence was higher in the D1 group (53.8% vs 39.5%, p = 0.330) however, without statistical significance. No difference was found in disease-free survival (DFS) between D1 and D2 patients with positive lymph nodes (p = 0.192), whereas overall survival was longer in the D2 group (p < 0.001). Multivariate analysis showed a statistically significant impact on survival of age ≥70 years, CCI ≥5, total gastrectomy, D1 lymphadenectomy and advanced stages (III/IV). CONCLUSIONS Frail patients had high surgical mortality even when submitted to D1 dissection. DFS was comparable to D2. Extent of lymphadenectomy in high-risk patients should take in account the expectation of a decrease in surgical risk with the possibility of impairment of long-term survival.
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Affiliation(s)
| | | | - Andre Roncon Dias
- Cancer Institute, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Osmar Kenji Yagi
- Cancer Institute, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Ulysses Ribeiro-Júnior
- Cancer Institute, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Bruno Zilberstein
- Cancer Institute, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Ivan Cecconello
- Cancer Institute, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
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25
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Recommendations for follow-up of colorectal cancer survivors. Clin Transl Oncol 2019; 21:1302-1311. [PMID: 30762206 DOI: 10.1007/s12094-019-02059-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/01/2019] [Indexed: 12/11/2022]
Abstract
Colorectal cancer (CRC) is one of the tumours with the highest incidence and mortality in the Spanish population. Nevertheless, the advances in prevention and treatment have contributed to an increased number of patients who survive for prolonged periods of time. In addition, despite recurrences, improved survival following metastasis resection is likewise on the rise. This underscores the importance of carrying out follow-up programmes even in low-risk patients for the early detection of recurrence. The main objective of this article is to provide a set of recommendations for optimising the follow-up of CRC survivors as well as for managing the sequelae that result from either pharmacological or surgical treatment.
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26
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Weerink LBM, Gant CM, van Leeuwen BL, de Bock GH, Kouwenhoven EA, Faneyte IF. Long-Term Survival in Octogenarians After Surgical Treatment for Colorectal Cancer: Prevention of Postoperative Complications is Key. Ann Surg Oncol 2018; 25:3874-3882. [PMID: 30244418 PMCID: PMC6245105 DOI: 10.1245/s10434-018-6766-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Indexed: 12/13/2022]
Abstract
Background Whether to treat octogenarians with colorectal cancer (CRC) in the same manner as younger patients remains a challenging issue. The purpose of this study was to analyse postoperative complications and long-term survival in a consecutive cohort of octogenarians who were surgically treated for CRC. Methods Octogenarians with primary CRC suitable for curative surgery between January 2008 and December 2011 were included. Data about comorbidities, tumour stage, and complications were retrospectively collected from patient files. Data about survival were retrieved with use of the Dutch database for persons and addresses. To identify factors associated with severe postoperative complications and postoperative survival, logistic regression analyses, and Cox regression analyses were performed. Odds ratios and hazard ratios (HR) with 95% confidence intervals (CI) were estimated. Results In a series of 108 octogenarians, median age was 83 years (range 80–94 years). Median follow-up was 47 (range 1–107) months. Major postoperative complications occurred in 25% of the patients. No risk factors for development of severe postoperative complications could be identified. The 30-day mortality was 7%; 1- and 5-year mortality was 19% and 56%, respectively. Overall median survival was 48 months: 66 months in patients without complications versus 13 months in patients with postoperative complications. Postoperative complications were most predictive of decreased survival (HR 3.16; 95% CI 1.79–5.59), even including tumour characteristics, comorbidity, and emergency surgery. Conclusions Long-term survival in octogenarians deemed fit for surgery is reasonably good. Prevention of major postoperative complications could further improve clinical outcome.
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Affiliation(s)
- Linda B M Weerink
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,Department Surgery, Hospital Group Twente, Almelo, The Netherlands.
| | - Christina M Gant
- Department Surgery, Hospital Group Twente, Almelo, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Ian F Faneyte
- Department Surgery, Hospital Group Twente, Almelo, The Netherlands
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27
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Oh BY, Huh JW, Kim HC, Park YA, Cho YB, Yun SH, Lee WY, Chun HK. Oncologic outcome of colorectal cancer patients over age 80: a propensity score-matched analysis. Int J Colorectal Dis 2018; 33:1011-1018. [PMID: 29564541 DOI: 10.1007/s00384-018-3028-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE It remains unclear whether old age is a poor prognostic factor in colorectal cancer (CRC). We compared oncologic outcomes in CRC patients according to age, using 80 as the dividing point. METHODS CRC patients who underwent radical surgery from 2000 to 2011 were evaluated. We performed matched and adjusted analyses comparing oncologic outcomes between patients with ≥ 80 and < 80 years old. RESULTS Among 9562 patients, 222 were elderly. The median age was 82.0 years in elderly patients and 59.0 years in young patients. Elderly patients received less neoadjuvant or adjuvant therapy compared to young patients (p < 0.001). After recurrence, significantly fewer elderly patients received additional treatments (p < 0.001). Before matching, disease-free survival (DFS) and cancer-specific survival (CSS) were significantly lower for elderly patients compared to those for young patients (p < 0.001 and p < 0.001, respectively). After matching, DFS and CCS were not significantly different between the two groups (p = 0.400 and p = 0.267, respectively). In a multivariate analysis for prognostic factors, old age was not an independent poor prognostic factor of DFS and CCS (p = 0.619 and p = 0.137, respectively). CONCLUSIONS Elderly patients aged ≥ 80 years with CRC had similar oncologic outcome to young patients, and age was not an independent prognostic factor.
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Affiliation(s)
- Bo Young Oh
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jung Wook Huh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
| | - Yoon Ah Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Yong Beom Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Ho-Kyung Chun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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The effect of marital status by age on patients with colorectal cancer over the past decades: a SEER-based analysis. Int J Colorectal Dis 2018; 33:1001-1010. [PMID: 29546559 DOI: 10.1007/s00384-018-3017-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Marital status has been found as an independent prognostic factor for survival in colorectal cancer (CRC). However, it is unclear whether patients with different marital status have benefited the same from the treatment improvement. METHODS We queried the Surveillance, Epidemiology, and End Results (SEER) 9 database for patients diagnosed with CRC from 1975 to 2009. Yearly survival data was presented with overlying loess smoothing lines, stratifying by marital status. We further referred to the SEER 18 database for patients diagnosed with CRC from 1973 to 2014. We also performed yearly data for stage proportion, surgery-performed rate, cancer-specific survival (CSS), and multivariate hazard ratio with overlying loess smoothing lines across all marital status. RESULTS Five-year CSS of married, single, and separated/divorced patients showed remarkable increase since 1975; however, survival of widowed patients remained low and no survival gains were observed since 1990. The same trends persisted after stratifying patients by stage and gender. Married and widowed patients tended to have more localized disease and less distant disease compared with the other two groups, and married patients were more likely to receive surgery. Multivariate analysis revealed the hazard ratio of widowed patients dropped dramatically when including age at diagnosis. CONCLUSIONS Widowed patients have not benefited substantially from the remarkable treatment improvement over the past four decades, which may be the result of the older age of this particular group. This study is a wake-up call to the medical community for additional care for the widowed patients.
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Niu Q, Lu Y, Wu Y, Xu S, Shi Q, Huang T, Zhou G, Gu X, Yu J. The effect of marital status on the survival of patients with bladder urothelial carcinoma: A SEER database analysis. Medicine (Baltimore) 2018; 97:e11378. [PMID: 30024509 PMCID: PMC6086512 DOI: 10.1097/md.0000000000011378] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
To identify whether marital status is associated with survival in patients with bladder urothelial carcinoma (UC). Using Surveillance, Epidemiology, and End Results population-based data, 133,846 patients diagnosed with bladder UC between 1988 and 2009 were identified. Kaplan-Meier methods and multivariable Cox regression models were used for survival analyses and evaluation of the association between marital status and survival, after controlling for gender, age, race, primary site, tumor (topography), lymph node, metastasis stage, pathological grading, and surgery. Patients in the married group had a higher proportion of men within group comparisons, more often white, older, earlier clinical stage at diagnosis, surgical treatment, all of which were statistically significant (P < .001). Widowed patients had the worst bladder UC cause-specific survival (CSS) compared with married, never married, and so on groups classified by stage and grade. The 5-year CSS of widowed patients compared with that of married patients was, respectively, all (P < .001), 89.8% versus 95.8% at noninvasive papillary carcinoma stage, 84.1% versus 91.6% at occur in situ stage, 74.3% versus 86.1% at I stage, 41.2% versus 61.6% at II stage, 39.2 versus 52.5% at III stage, and 8.8% versus 17.0% at IV stage. Widowed patients tend to have a significantly higher risk of bladder-cancer-specific mortality. Marital status was relevant to improved CSS in patients with bladder UC.
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Affiliation(s)
- Quan Niu
- Department of Dalian Medical University, Dalian, Liaoning
- Department of Urology, Subei People's Hospital of Jiangsu Province GClinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Youyi Lu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Shangdong
| | | | - Shigao Xu
- Department of Urology, Subei People's Hospital of Jiangsu Province GClinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Qun Shi
- Department of Urology, Subei People's Hospital of Jiangsu Province GClinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Tianbao Huang
- Department of Urology, Subei People's Hospital of Jiangsu Province GClinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Guangchen Zhou
- Department of Urology, Subei People's Hospital of Jiangsu Province GClinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xiao Gu
- Department of Urology, Subei People's Hospital of Jiangsu Province GClinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Junjie Yu
- Department of Urology, Subei People's Hospital of Jiangsu Province GClinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
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Schreckenbach T, Zeller MV, El Youzouri H, Bechstein WO, Woeste G. Identification of factors predictive of postoperative morbidity and short-term mortality in older patients after colorectal carcinoma resection: A single-center retrospective study. J Geriatr Oncol 2018; 9:649-658. [PMID: 29779798 DOI: 10.1016/j.jgo.2018.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/23/2018] [Accepted: 05/01/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim of this study is to investigate the effect of age on patient outcome after colorectal carcinoma (CRC) resection in patients over 65 years of age. METHODS This study included patients aged 65 years and older who underwent CRC resection between 2003 and 2013 at a single-center institution. Patients were divided into two groups: Group A (65-74 years old) and Group B (≥75 years old). RESULTS Multivariable logistic analysis of 415 patients revealed serum albumin levels on the third postoperative day (POD) (Odds Ratio (OR), 0.44; 95% CI, 0.21-0.94; P = 0.03) and C-reactive protein (CRP) levels (OR, 1.05; 95% CI, 1.00-1.01; P = 0.04) in patients with colon cancer as predictive factors for morbidity. In addition, the multivariable logistic analysis revealed serum albumin levels (OR, 0.27; 95% CI, 0.08-0.87; P = 0.03) in patients with rectal cancer as predictive factors for morbidity. The multivariate Cox Proportional Hazards Model identified re-intervention for colon cancer (Hazard Ratio (HR), 4.57; 95% CI, 1.36-15.4 P = 0.01) and for rectal cancer (HR, 11.8; 95% CI, 1.08-129 P = 0.04) as a predictive factor for 30-day mortality. Serum albumin level on the third POD was predictive of 30-day mortality (HR, 0.30; 95% CI, 0.13-0.71; P = 0.01) and of 1-year mortality (HR, 0.34; 95% CI, 0.17-0.66; P < 0.01) in patients with colon cancer. CONCLUSION Age is not predictive of postoperative morbidity and mortality in patients with CRC. Serum albumin levels on the third POD can predict morbidity and mortality for colon and rectal carcinoma in older patients undergoing colorectal resections.
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Affiliation(s)
- Teresa Schreckenbach
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
| | - Matthias Valentin Zeller
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Hanan El Youzouri
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Wolf Otto Bechstein
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Guido Woeste
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
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Chronological Age and Risk of Chemotherapy Nonfeasibility: A Real-Life Cohort Study of 153 Stage II or III Colorectal Cancer Patients Given Adjuvant-modified FOLFOX6. Am J Clin Oncol 2017; 41:73-80. [PMID: 26669742 DOI: 10.1097/coc.0000000000000233] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To assess nonfeasibility of adjuvant-modified FOLFOX6 chemotherapy in patients with stage II or III colorectal cancer. METHODS Consecutive patients managed between 2009 and 2013 in 2 teaching hospitals in the Paris urban area were included in the CORSAGE (COlorectal canceR, AGe, and chemotherapy fEasability study) cohort study. Nonfeasibility was defined by the frequencies of empirical first-cycle dose reduction (>15%), early discontinuation (<12 cycles), and low relative dose intensity (RDI) (<0.85). Risk factors for chemotherapy nonfeasibility were identified using multivariate logistic regression. RESULTS Among 153 patients, 56.2% were male (median age, 65.6 y; 35.3%≥70 y; 7.3% with performance status [PS]≥2). For 5-fluorouracil (5-FU), 20.9% of patients had first-cycle dose reduction and 28.1% early discontinuation; RDI was 0.91 (25th to 75th percentiles, 0.68 to 0.99). Factors independently associated with first-cycle 5-FU dose reduction were aged 65 to 69 years versus those younger than 65 years (adjusted odds ratio [aOR], 5.5; 95% confidence interval [CI], 1.5-19.9) but not age 70 years and older, PS≥2 (aOR, 6.02; 95% CI, 1.15-31.4), higher Charlson Comorbidity Index (aOR1-point increase, 1.4; 95% CI, 1.05-1.82), or larger number of medications (aOR 1-medication increase, 1.19; 95% CI, 1.00-1.42). Oxaliplatin dose reduction occurred in 52.3% of patients and early discontinuation in 62.7%; the latter was more common in the 70 years and older group (92.6% vs. 74.6% in the <65-y group; P=0.01); RDI was 0.7 (95% CI, 0.55-0.88). CONCLUSIONS In the real-world setting, compared with their younger and older counterparts, patients aged 65 to 69 years given modified FOLFOX6 for stage II or III colorectal cancer had higher frequencies of 5-FU nonfeasibility defined based on first-cycle dose reduction, early discontinuation, and RDI; and these differences were independent from PS, comorbidities, and number of medications.
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Wan JF, Yang LF, Zhu J, Li GC, Zhang Z. Adjuvant chemotherapy for patients with ypT0-2N0-category after neoadjuvant chemoradiotherapy for rectal cancer. Mol Clin Oncol 2017; 7:864-868. [PMID: 29181181 DOI: 10.3892/mco.2017.1426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 08/04/2017] [Indexed: 01/13/2023] Open
Abstract
Locally advanced rectal cancer patients with ypT0-2N0 have good prognosis and may not require as many cycles of adjuvant chemotherapy as patients with a poor (ypT3-4 or N+) response. The aim of the present study was to evaluate the three-year disease-free and overall survival between patients with ypT0-2N0 rectal adenocarcinoma who received 0-3 cycles of 5-fluorouracil-based adjuvant chemotherapy and those who received >3 cycles. A total of 106 patients with locally advanced rectal cancer, classified as ypT0-2N0 after surgery at the Fudan University Shanghai Cancer Center (Shanghai, China) between 2006 and 2012, were identified. The patients were divided into two groups depending on the number of cycles of adjuvant chemotherapy: Group 1 received 0-3 cycles (n=32) and group 2 received ≥4 cycles of adjuvant chemotherapy (n=74). The three-year disease-free survival and overall survival rates were 86.8 and 93.1% for group 1 (P=0.633), and 88.5 and 96.8% for group 2 (P=0.381). No statistically significant difference was observed between the two groups, suggesting that patients with ypT0-2N0 status may not require more than three cycles of post-operative chemotherapy. Further evaluation in prospective studies is urgently recommended.
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Affiliation(s)
- Jue-Feng Wan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Li-Feng Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Ji Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Gui-Chao Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
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Zhang Q, Wang Y, Hu H, Huang R, Xie L, Liu E, Chen YG, Wang G, Wang X. Impact of socioeconomic status on survival of colorectal cancer patients. Oncotarget 2017; 8:106121-106131. [PMID: 29285319 PMCID: PMC5739706 DOI: 10.18632/oncotarget.20859] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 05/29/2017] [Indexed: 12/18/2022] Open
Abstract
Socioeconomic status (SES) has an impact on the survival of various cancers, but it has not been fully understood in colorectal cancer (CRC). The Surveillance, Epidemiology and End Results database was adopted to detect the role of SES in the survival outcomes of CRC. A total of 184,322 eligible patients were included and SES status was analyzed. The multivariable analysis showed that Non-Hispanic Black (HR, 1.20; 95% CI, 1.15-1.24), being widowed (HR, 1.04; 95% CI, 1.01-1.07), any Medicaid (HR, 1.36; 95% CI, 1.33-1.39) and the lowest education level group patients had relative poorer prognosis. Besides, sex, tumor location, age, differentiation level and American Joint Committee on Cancer stage also had significant effects on overall survival of CRC. The individuals were further divided into five groups according to the number of survival-adverse factors. All of the four groups containing adverse factors showed impaired survival outcomes compared with the group containing no adverse factor.
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Affiliation(s)
- Qian Zhang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, PR China.,Colorectal Cancer Institute of Harbin Medical University, Harbin, Heilongjiang 150086, PR China
| | - Yufu Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, PR China.,Colorectal Cancer Institute of Harbin Medical University, Harbin, Heilongjiang 150086, PR China
| | - Hanqing Hu
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, PR China.,Colorectal Cancer Institute of Harbin Medical University, Harbin, Heilongjiang 150086, PR China
| | - Rui Huang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, PR China.,Colorectal Cancer Institute of Harbin Medical University, Harbin, Heilongjiang 150086, PR China
| | - Lei Xie
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, PR China.,Colorectal Cancer Institute of Harbin Medical University, Harbin, Heilongjiang 150086, PR China
| | - Enrui Liu
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, PR China.,Colorectal Cancer Institute of Harbin Medical University, Harbin, Heilongjiang 150086, PR China
| | - Ying-Gang Chen
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, PR China.,Colorectal Cancer Institute of Harbin Medical University, Harbin, Heilongjiang 150086, PR China
| | - Guiyu Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, PR China.,Colorectal Cancer Institute of Harbin Medical University, Harbin, Heilongjiang 150086, PR China
| | - Xishan Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, PR China.,Colorectal Cancer Institute of Harbin Medical University, Harbin, Heilongjiang 150086, PR China.,Department of Colorectal Surgery, Cancer Hospital of Chinese Academy Sciences, Beijing, 100021, PR China
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Zhao L, Bao F, Yan J, Liu H, Li T, Chen H, Li G. Poor prognosis of young patients with colorectal cancer: a retrospective study. Int J Colorectal Dis 2017; 32:1147-1156. [PMID: 28389779 DOI: 10.1007/s00384-017-2809-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE The present study aimed to explore the survival outcomes of patients with colorectal cancer (CRC) aged 35 years and younger. METHODS This retrospective cohort study included a total of 995 patients with CRC treated between January 2003 and September 2011. The patients were assorted into the young (aged 18-35 years) and older (aged 36-75 years) groups. The clinical characteristics and survival outcomes of the patients in the young group were compared with those of the patients in the older group for evaluation. RESULTS Compared with the older group, a significantly higher number of patients in the young group had right-sided colon cancer (30.9 vs. 19.6%, P = 0.026), high histologic grade tumor (14.7 vs. 6.4%, P = 0.021), and stage III disease (50.0 vs. 35.5%, P = 0.016). In stage III disease, compared with the older group, the patients in the young group had worse survival outcome in terms of 5-year overall survival (OS, P = 0.007), cancer-specific survival (CSS, P = 0.010), and disease-free survival (DFS, P = 0.039). Multivariate analysis revealed that age ≤35 years was an independent risk factor in terms of 5-year OS (hazard ratio [HR] = 1.68; 95% confidence interval [CI]: 1.12-2.54; P = 0.012), CSS (HR = 1.74; 95% CI: 1.15-2.65; P = 0.009), and DFS (HR = 1.58; 95% CI: 1.06-2.35; P = 0.024). CONCLUSIONS The young patients with CRC aged 35 years and younger had worse prognosis compared with older patients, especially for stage III disease.
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Affiliation(s)
- Liying Zhao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Feng Bao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China.,Department of General Surgery, Mianyang Central Hospital, Mianyang, People's Republic of China
| | - Jun Yan
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Tingting Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Hao Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China.
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Mothes H, Bauschke A, Schuele S, Eigendorff E, Altendorf-Hofmann A, Settmacher U. Surgery for colorectal cancer in elderly patients: how can we improve outcome? J Cancer Res Clin Oncol 2017; 143:1879-1889. [PMID: 28534171 DOI: 10.1007/s00432-017-2438-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/11/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Patients over 70 years of age are characterised by diminished long-term survival rates following resection of colorectal cancer (CRC) compared to younger patients. The aim of this study was to clarify whether reduced survival is a result of malignancy, comorbidities or the treatment received. METHODS All patients with CRC, who were admitted to our institution over a period of 10 years, were selected from a prospectively maintained database. Disease-specific, disease-free and overall survival rates were calculated dependent on variables considered potentially relevant for the patients' prognosis. RESULTS 915 patients were included in the study. Observed 5- and 10-year survival rates for the whole group were 48 ± 2% and 40 ± 2%, respectively, but 10-year survival rates dropped to 14 ± 4% for patients aged 80 and older. Resection of the primary tumour was attempted in all cases independent of age. Emergency admission, Charlson index ≥2, ECOG ≥2, old age, second malignancies, distant metastases, high grading and non-resective surgery were identified as independent prognostic parameters associated with decreased overall survival. In contrast, disease-specific and disease-free survival rates for patients after elective radical resection in UICC-stage I-III did not show significant differences related to age. Tumour site, UICC-stage and resection status were independent statistically significant predictors of disease-specific survival. CONCLUSIONS Similar disease-specific survival rates in all age groups speak in favour of tumour resection in curative intent even in old patients. Better outcome may be achieved, if regular screening for colorectal cancer is considered even in the elderly to avoid late presentation requiring emergency surgery.
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Affiliation(s)
- Henning Mothes
- Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Astrid Bauschke
- Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Silke Schuele
- Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Ekkehard Eigendorff
- Department of Hematology and Oncology, University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Annelore Altendorf-Hofmann
- Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
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Antonio M, Saldaña J, Carmona-Bayonas A, Navarro V, Tebé C, Nadal M, Formiga F, Salazar R, Borràs JM. Geriatric Assessment Predicts Survival and Competing Mortality in Elderly Patients with Early Colorectal Cancer: Can It Help in Adjuvant Therapy Decision-Making? Oncologist 2017; 22:934-943. [PMID: 28487465 DOI: 10.1634/theoncologist.2016-0462] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/25/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The challenge when selecting elderly patients with colorectal cancer (CRC) for adjuvant therapy is to estimate the likelihood that death from other causes will preclude cancer events from occurring. The aim of this paper is to evaluate whether comprehensive geriatric assessment (CGA) can predict survival and cancer-specific mortality in elderly CRC patients candidates for adjuvant therapy. MATERIAL AND METHODS One hundred ninety-five consecutive patients aged ≥75 with high-risk stage II and stage III CRC were prospectively included from May 2008 to May 2015. All patients underwent CGA, which evaluated comorbidity, polypharmacy, functional status, geriatric syndromes, mood, cognition, and social support. According to CGA results, patients were classified into three groups-fit, medium-fit, and unfit-to receive standard therapy, adjusted treatment, and best supportive care, respectively. We recorded survival and cause of death and used the Fine-Gray regression model to analyze competing causes of death. RESULTS Following CGA, 85 (43%) participants were classified as fit, 57 (29%) as medium-fit, and 53 (28%) as unfit. The univariate 5-year survival rates were 74%, 52%, and 27%. Sixty-one (31%) patients died due to cancer progression (53%), non-cancer-related cause (46%), and unknown reasons (1%); there were no toxicity-related deaths. Fit and medium-fit participants were more likely to die due to cancer progression, whereas patients classified as unfit were at significantly greater risk of non-cancer-related death. CONCLUSION CGA showed efficacy in predicting survival and discriminating between causes of death in elderly patients with high-risk stage II and stage III resected CRC, with potential implications for shaping the decision-making process for adjuvant therapies. IMPLICATIONS FOR PRACTICE Adjuvant therapy in elderly patients with colorectal cancer is controversial due to the high risk for competing events among these patients. In order to effectively select older patients for adjuvant therapy, we have to weigh the risk of cancer-related mortality and the potential survival benefits with treatment against the patient's life expectancy, irrespective of cancer. This prospective study focused on the prognostic value of geriatric assessment for survival using a competing-risk analysis approach, providing an important contribution on the treatment decision-making process and helping clinicians to identify elderly patients who might benefit from adjuvant chemotherapy among those who will not.
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Affiliation(s)
- Maite Antonio
- Medical Oncology Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Institut Català d'Oncologia (ICO)-Hospital Duran i Reynals, University of Barcelona, Spain
| | - Juana Saldaña
- Medical Oncology Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Institut Català d'Oncologia (ICO)-Hospital Duran i Reynals, University of Barcelona, Spain
| | | | - Valentín Navarro
- Research Clinical Unit, Institut Català d'Oncologia (ICO)-Hospital Duran I Reynals, Barcelona, Spain
| | - Cristian Tebé
- Statisical Assessment Service, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL) and Universitat Rovira i Virgili, Spain
| | - Marga Nadal
- Research Management Unit, Institut Català d'Oncologia (ICO)-Hospital Duran I Reynals, Barcelona, Spain
| | - Francesc Formiga
- Internal Medicine Service, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, University of Barcelona, Spain
| | - Ramon Salazar
- Medical Oncology Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Institut Català d'Oncologia (ICO)-Hospital Duran i Reynals, University of Barcelona, Spain
| | - Josep Maria Borràs
- Department of Clinical Sciences, University of Barcelona and Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
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[Colorectal cancer in the elderly. Surgical treatment, chemotherapy, and contribution from geriatrics]. Rev Esp Geriatr Gerontol 2017; 52:261-270. [PMID: 28126268 DOI: 10.1016/j.regg.2016.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 12/12/2022]
Abstract
Age is the biggest risk factor for colorectal cancer, with 70% of the cases in patients over 70 years old. For this reason, a review is presented on the surgical treatment and chemotherapy of cancer of colon and rectum in the elderly. A search was performed in PubMed, including words such as elderly, surgery, colorectal cancer, chemotherapy, radiotherapy, and oncogeriatrics, and review articles and originals on treatment of colorectal cancer in the elderly were selected. A narrative form was developed from the latest evidence with the results obtained on the treatment of this pathology. Although the treatment of colorectal cancer is standardised, a prior comprehensive geriatric assessment is required in the case of the elderly, before deciding the type of treatment in order to offer these robust elderly-standardised guidelines for the robust elderly and adapt them for use in fragile patients.
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Agasi-Idenburg SC, Thong MSY, Punt CJA, Stuiver MM, Aaronson NK. Comparison of symptom clusters associated with fatigue in older and younger survivors of colorectal cancer. Support Care Cancer 2016; 25:625-632. [PMID: 27770205 DOI: 10.1007/s00520-016-3451-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/10/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Cancer-related fatigue (CRF) is one of the most frequently reported symptoms in cancer survivors. To be able to optimally treat CRF, knowledge of symptoms that interact with CRF is helpful. During aging, changes occur in body composition with progressive deterioration in physiological functions and metabolic processes causing a decline of adaptive capacity. Therefore, symptoms caused by cancer and its treatment might coexist in different symptom clusters in older cancer survivors, compared to younger survivors. The purpose of this analysis was to identify and compare symptom clusters that include CRF between older and younger survivors of colorectal cancer (CRC). METHODS Data were drawn from a cross-sectional study from the Netherlands Cancer Registry. In total, 1698 stage I and II CRC survivors diagnosed from 2000 to 2009 completed questionnaires on fatigue and psychological distress. Survivors were categorized in two groups based on age (≤65 versus >65 years) Symptom clusters were assessed using principal component analysis. A sensitivity analysis was performed on the results with categorical principal component analysis. RESULTS In both age groups, three components including two symptom clusters were identified: an emotional symptom cluster containing anxiety, fatigue, and depression; a pain symptom cluster containing pain and insomnia; and a third component containing dyspnea only. CONCLUSIONS Symptom clusters in survivors of CRC appear to be independent of age. In treating CRC survivors for fatigue, regardless of age, it is advisable to assess depression and anxiety and, if necessary, refer for further diagnosis and treatment.
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Affiliation(s)
- S C Agasi-Idenburg
- Department of Physical therapy, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - M S Y Thong
- Department of Medical Psychology, Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands
| | - C J A Punt
- Department of Medical Oncology, Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands
| | - M M Stuiver
- Department of Physical therapy, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Ribera Casado JM, Bustillos A, Guerra Vaquero AI, Huici Casal C, Fernández-Ballesteros R. [Age discrimination. Point of view of the professionals]. Rev Esp Geriatr Gerontol 2016; 51:270-5. [PMID: 27264615 DOI: 10.1016/j.regg.2016.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 12/11/2015] [Accepted: 03/08/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION It is generally believed that legislation is an essential resource in the prevention of discriminatory behaviour against older people. This study first examines the Spanish legislation for potential age discrimination and then uses the C-EVE-D questionnaire to ask professionals in social work and health care settings the extent to what certain ageist behaviours described in the questionnaire are observed in practice. METHODS The field study was carried out with professionals in geriatrics and gerontology, who are members of Spanish Society for Geriatrics and Gerontology (SEGG). The EVE discrimination questionnaire consists of 28 items which investigate the existence of age discrimination in medical and social care contexts. RESULTS A total of 174 people (63% women; mean age: 45.6 years) took part in the study, with a mean professional experience of 17.2 years. Doctors made up 59% of the sample, psychologists 19%, with the rest coming from other professions. The first 20 discrimination items of the EVE-D questionnaire were significantly positively reported by more than 60% of the sample. CONCLUSIONS Although Spanish legislation, from the constitution down to the rules that govern social and health care settings, clearly prohibits any kind of discrimination with regard to age, our results show that Spanish professionals most closely involved in the care of older people perceive both direct and indirect age discrimination. Furthermore, evidence was found of prejudice in the treatment of older people as a phenomenon in day-to-day health and social services care, both when analysing medical cases and, to a greater extent, cases of a more general nature and/or relating to co-existence.
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Affiliation(s)
- Jose Manuel Ribera Casado
- Departamento de Medicina, Facultad de Medicina, Hospital Clínico San Carlos, Universidad Complutense, Madrid, España.
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Chen J, Chen J, Xu Y, Long Z, Zhou Y, Zhu H, Wang Y, Shi Y. Impact of Age on the Prognosis of Operable Gastric Cancer Patients: An Analysis Based on SEER Database. Medicine (Baltimore) 2016; 95:e3944. [PMID: 27311007 PMCID: PMC4998493 DOI: 10.1097/md.0000000000003944] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
To investigate the impact of age on the clinicopathological features and survival of patients with gastric cancer (GC), and hope to better define age-specific patterns of GC and possible associated risk factors.Using the surveillance, epidemiology, and end results (SEER) database to search the patients who diagnosed GC between 2007 and 2011 with a known age. The overall and 5-year gastric cancer specific survival (CSS) data were obtained using Kaplan-Meier plots. Multivariable Cox regression models were built for the analysis of long-term survival outcomes and risk factors.A total of 7762 GC patients treated with surgery during the 4-year study period were included in the final study cohort. We divided into five subgroups according to the different age ranges. The overall 5-year cause-specific survival (CSS) was 60.3% in Group 1 (below 45 years), 60.3% in the Group 2 (45-55 years), 61.2% in Group 3 (56-65 years), 59.2% in Group 4 (66-75 years), and 59.2% in Group 5 (older than 76 years). Kaplan-Meier plots showed that patients older than 76 years had the worst 5-year CSS of 56.0% rate in all the subgroups. Age, tumor size, primary site, histological type, and Tumor Node Metastasis stage were identified as significant risk factors for poor survival on univariate analysis (all P < 0.001, log-rank test). Additionally, as the age increased, the risk of death for GC demonstrated a significant increase.In conclusion, our analysis of the SEER database revealed that the prognosis of GC varies with age. Patients at age 56 to 65 group have more favorable clinicopathologic characteristics and better CSS than other groups.
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Abstract
PURPOSE Colorectal cancer has a distinct clinicopathologic presentation in younger patients. The aim of this paper was to evaluate the outcome of younger (age below 50 y) and older patients with stage IV (advanced) colorectal cancer in the modern era of combination chemotherapy. METHODS Cases of metastatic colorectal cancer reported in Surveillance, Epidemiology, and End Results registry (1973 to 2008) were reviewed. Demographics, tumor characteristics, and overall and cancer-specific survivals in patients below 50 and above 50 years of age were compared by Cox proportional hazard analyses. Joinpoint regression analysis was used to evaluate secular trends in 2-year survival. RESULTS Younger patients had a greater proportion of negative clinicopathologic features (male sex, African American ethnicity, and signet ring or mucinous histology). In multivariate analysis, older age, male sex, African American ethnicity, right-sided tumors, and signet ring histology were associated with higher mortality risk. Younger patients had improved survival (hazard ratio 0.72; 95% confidence interval: 0.70-0.75) compared with older patients, whereas all patients experienced increased 2-year survival by joinpoint analysis beginning in 1999-2000. CONCLUSIONS The results confirm decreased mortality from advanced colorectal cancer in the era of modern combination chemotherapy in younger and older patients. Younger age, non-right-sided tumors, and absence of signet ring histology significantly associate with better survival.
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Li Q, Gan L, Liang L, Li X, Cai S. The influence of marital status on stage at diagnosis and survival of patients with colorectal cancer. Oncotarget 2016; 6:7339-47. [PMID: 25749515 PMCID: PMC4466689 DOI: 10.18632/oncotarget.3129] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/09/2015] [Indexed: 12/11/2022] Open
Abstract
Marital status was found to be an independent prognostic factor for survival in various cancer types, but it hasn’t been fully studied in colorectal cancer (CRC). The Surveillance, Epidemiology and End Results database was used to compare survival outcomes with marital status in each stage. In total, 112, 776 eligible patients were identified. Patients in the widowed group were more frequently elderly women, more common of colon cancer, and more stage I/II in tumor stage (P < 0.001), but the surgery rate was comparable to that for the married group (94.72% VS 94.10%). Married CRC patients had better 5year cause-specific survival (CSS) than those unmarried (P < 0.05). Further analysis showed that widowed patients always presented the lowest CSS compared with that of other’ group. Widowed patients had 5% reduction 5-year CSS compared with married patients at stage I (94.8% vs 89.8%, P < 0.001), 9.4% reduction at stage II (85.9% vs 76.5%, P < 0.001), 16.7% reduction at stage III (70.6% vs 53.9%, P < 0.001) and 6.2% reduction at stage IV(14.4% VS 8.2%, P < 0.001). These results showed that unmarried patients were at greater risk of cancer specific mortality. Despite favorable clinicpathological characteristics, widowed patients were at highest risk of death compared with other groups.
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Affiliation(s)
- Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Lu Gan
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Lei Liang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Xinxiang Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
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Millan M, Merino S, Caro A, Feliu F, Escuder J, Francesch T. Treatment of colorectal cancer in the elderly. World J Gastrointest Oncol 2015; 7:204-20. [PMID: 26483875 PMCID: PMC4606175 DOI: 10.4251/wjgo.v7.i10.204] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/30/2015] [Accepted: 08/30/2015] [Indexed: 02/05/2023] Open
Abstract
Colorectal cancer has a high incidence, and approximately 60% of colorectal cancer patients are older than 70, with this incidence likely increasing in the near future. Elderly patients (> 70-75 years of age) are a very heterogeneous group, ranging from the very fit to the very frail. Traditionally, these patients have often been under-treated and recruited less frequently to clinical trials than younger patients, and thus are under-represented in publications about cancer treatment. Recent studies suggest that fit elderly patients can be treated in the same way as their younger counterparts, but the treatment of frail patients with comorbidities is still a matter of controversy. Many factors should be taken into account, including fitness for treatment, the wishes of the patient and family, and quality of life. This review will focus on the existing evidence for surgical, oncologic, and palliative treatment in patients over 70 years old with colorectal cancer. Careful patient assessment is necessary in order to individualize treatment approach, and this should rely on a multidisciplinary process. More well-designed controlled trials are needed in this patient population.
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Prognostic value of age in neurological cancer: an analysis of 22,393 cases from the SEER database. Tumour Biol 2015; 36:8341-8. [DOI: 10.1007/s13277-015-3599-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022] Open
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Bouassida M, Charrada H, Chtourou MF, Hamzaoui L, Mighri MM, Sassi S, Azzouz MM, Touinsi H. Surgery for Colorectal Cancer in Elderly Patients: How Could We Improve Early Outcomes ? J Clin Diagn Res 2015; 9:PC04-8. [PMID: 26155516 DOI: 10.7860/jcdr/2015/12213.5973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/22/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Age is one of the causes behind the undertreatment of elderly colorectal cancer patients. The increase of mortality among elderly colorectal cancer (CRC) patients is due to competing causes of death occurring in the early post operative period. The purpose of this study was to evaluate the risk factors for post operative mortality and morbidity among elderly CRC patients. MATERIALS AND METHODS A retrospective descriptive chart review was performed on consecutive patients older than 70 y with CRC. We have collected data of 124 patients who were admitted from January 2001 to January 2010. Demographic characteristics, operative and postoperative informations were retrospectively analysed. RESULTS Early postoperative morbidity, operation related to morbidity and mortality were observed in 44 (35.5%), 9 (7.3%) and 20 (16.1%) cases, respectively. No other factors but ASA score (p = 0.002 and 0.005 in univariate and multivariate analyses, respectively) and emergency operations (p<0.001 and 10(-3) in univariate and multivariate analyses, respectively), were found to be risk factors of mortality. The results of multivariate analyses indicated that anaemia (p=0.021) and rectal cancer (p=0.015) had significant impact on the risk of anastomotic leakage. On the other hand, diabetes mellitus and rectal cancer were indicators that correlated with the width of hospitalization. CONCLUSION Elderly CRC patients should no longer be undertreated only because of their age. They should be exposed to more aggressive management than they are currently receiving. Careful preoperative evaluation, followed by medical optimization and planning of perioperative care could improve outcomes of colorectal surgery for elderly patients.
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Affiliation(s)
- Mahdi Bouassida
- Professor, Department of Surgery , Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
| | - Hédi Charrada
- Faculty, Department of Anaesthesiology, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
| | - Mohamed Fadhel Chtourou
- Professor, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
| | - Lamine Hamzaoui
- Professor, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
| | - Mohamed Mongi Mighri
- Student, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
| | - Selim Sassi
- Professor, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
| | - Mohamed M'Saddak Azzouz
- Student, Department of Gastro Enterology, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
| | - Hassen Touinsi
- Student, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
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Li J, Wang Z, Yuan X, Xu L, Tong J. The prognostic significance of age in operated and non-operated colorectal cancer. BMC Cancer 2015; 15:83. [PMID: 25885448 PMCID: PMC4345025 DOI: 10.1186/s12885-015-1071-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 02/03/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The prognostic significance of age in colorectal cancer remains controversial. Our purpose was to determine the impact of age at diagnosis on cause- specific survival and overall survival in patients with colorectal cancer. METHODS Using Surveillance, Epidemiology, and End Results (SEER) population-based data, we identified 226,430 patients with colorectal cancer diagnosed between 1996 and 2005. Patients were separated into 10-year age groups. Five-year cancer cause-specific survival and overall survival data were obtained. Kaplan-Meier methods were adopted and multivariable Cox regression models were built for the analysis of long-term survival outcomes and risk factors. RESULTS In the operated group, those aged 51-60 had the best prognosis with 5-year cause-specific survival of 72.3% and 5-year overall survival of 68.3%.In the non-operated group, those of young age 15-30 had the best prognosis with 5-year cause-specific survival of 21.2% and 5-year overall survival of 18.2%, and there was continued worsening in cause-specific survival and overall survival with increasing age, except for a small increase in the 51-60 age group (P < 0.001). Multivariable analysis demonstrated a statistically significant disadvantage in cause-specific survival in patients older than 60 (P < 0.001), but the difference between the 51-60 age group and the younger age group (15-30, 31-40, 41-50) wasn't statistically significant (P > 0.05) in both operated and non-operated patients. CONCLUSIONS There was no apparent difference in survival in colorectal cancer patients 60 and younger, but in those older than 60 years, there was worsening in overall survival and cause-specific survival in both operated and non-operated patients.
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Affiliation(s)
- Jing Li
- Department of Oncology, The Second Clinical School of Yangzhou University (Yangzhou NO.1 People's Hospital), Mid Hanjiang Road, Yangzhou, 225009, Jiangsu Province, People's Republic of China. .,Research Center of Cancer Prevention and Treatment, Medical College of Yangzhou University, Number 11, Huaihai Road, Yangzhou, 225001, Jiangsu Province, People's Republic of China.
| | - Zhu Wang
- Department of Oncology, The Second Clinical School of Yangzhou University (Yangzhou NO.1 People's Hospital), Mid Hanjiang Road, Yangzhou, 225009, Jiangsu Province, People's Republic of China.
| | - Xin Yuan
- Department of Oncology, The Second Clinical School of Yangzhou University (Yangzhou NO.1 People's Hospital), Mid Hanjiang Road, Yangzhou, 225009, Jiangsu Province, People's Republic of China.
| | - Lichun Xu
- Research Center of Cancer Prevention and Treatment, Medical College of Yangzhou University, Number 11, Huaihai Road, Yangzhou, 225001, Jiangsu Province, People's Republic of China.
| | - Jiandong Tong
- Department of Oncology, The Second Clinical School of Yangzhou University (Yangzhou NO.1 People's Hospital), Mid Hanjiang Road, Yangzhou, 225009, Jiangsu Province, People's Republic of China.
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Bojer AS, Roikjær O. Elderly patients with colorectal cancer are oncologically undertreated. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2015; 41:421-5. [PMID: 25592663 DOI: 10.1016/j.ejso.2014.10.065] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/30/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
AIMS Colorectal cancer (CRC) is mainly a disease of the elderly. Our primary aim was to investigate if age had influence on treatment decisions in regards to surgery, referral to an oncologist and treatment by an oncologist. METHOD We identified patients with CRC in our department from 2004 through 2011 in the Danish Colorectal Cancer Group (DCCG) database. According to age ≤75 and >75 years multivariate logistic regression analysis was used on treatment decisions: surgery, referral to an oncologist and oncologic treatment. Independent variables were age, ASA score, tumorlocation, stage, gender and year of diagnosis. Additional analysis was performed for stage III and IV patients as a subgroup. RESULTS 1701 patients were included of which 525 were >75 years of age. In multivariate analysis there was no association between age and chance of surgery. Older patients had a significantly lower odds ratio for referral to an oncologist (OR 0.624, p < 0.0001) and for oncological treatment if referred (OR 0.218, p < 0.0001). Being an elderly patient with stage III or IV CRC OR was 0.233 for referral- and for receiving treatment by an oncologist OR was 0.210 (p < 0.0001 for both), after adjusting for possible confounders. CONCLUSION Based on age elderly patients are on a lesser extent referred to an oncologist and get oncologic treatment less frequently. Surgically the elderly are not undertreated.
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Affiliation(s)
- A S Bojer
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - O Roikjær
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Surgery, Copenhagen University Hospital Roskilde, Denmark
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Kaufmann A, Schmidt H, Ostheimer C, Ullrich J, Landenberger M, Vordermark D. Quality of life in very elderly radiotherapy patients: a prospective pilot study using the EORTC QLQ-ELD14 module. Support Care Cancer 2014; 23:1883-92. [PMID: 25475738 DOI: 10.1007/s00520-014-2546-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/30/2014] [Indexed: 12/26/2022]
Abstract
PURPOSE In very elderly cancer patients, health-related quality of life (HRQOL) is a particularly important issue but has rarely been studied due to a lack of specific instruments and of reference data. We performed a prospective analysis of HRQOL in patients ≥80 years undergoing radiotherapy with the newly validated elderly-specific HRQOL module EORTC QLQ-ELD14. METHODS We prospectively assessed HRQOL in n = 50 radiotherapy patients ≥80 years (32% lung, 20% gastrointestinal, 8% each of breast, head and neck, gynecologic cancer) at the start (t1), end (t2), and 6 months after (t3) radiotherapy, using EORTC QLQ-C30 and EORTC QLQ-ELD14. Overall survival was determined in the whole cohort and subgroups. RESULTS Median overall survival from the start of radiotherapy was 15 months; 1-year and 2-year overall survival rates were 57.1 and 31.0%, respectively. Eastern Cooperative Oncology Group (ECOG) performance status <2, Charlson comorbidity index ≤6, curative treatment intention, local tumor stage Union Internationale Contre le Cancer (UICC I, II), and total dose >45 Gy were associated with prolonged survival. No significant changes in any HRQOL domain were observed during the course of treatment (t1 to t2). Six months after radiotherapy (t3), a significant and clinically relevant deterioration of HRQOL was seen in EORTC QLQ-C30 for physical function and role function and in EORTC QLQ-ELD14 for future worries, burden of illness, and family support. CONCLUSIONS In radiotherapy patients ≥80 years, HRQOL was maintained until the end of radiotherapy but deteriorated in general and elderly-specific areas thereafter, suggesting a need to develop specific supportive interventions for this age group.
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Affiliation(s)
- Anne Kaufmann
- Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Dryanderstr. 4, 06110, Halle/Saale, Germany
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Abstract
Background and Objectives: Emergency surgery for large bowel obstruction is associated with high morbidity and mortality rates, especially in elderly patients. Colonic self-expanding metal stents may provide temporary relief of obstructions and enable preoperative evaluation. The aim of this retrospective study was to assess the clinical outcomes of emergency stenting in elderly patients with large bowel obstructions. Methods: Between 1997 and 2010, patients presenting with large bowel obstructions were treated predominantly with self-expanding metal stent insertion. Clinical data, including age, site of obstruction, success rate, and surgery and mortality rates, were collected. Patients were divided into 3 groups (I, II, and III) according to age: <69, 70 to 79, or >80 years. Results: One hundred thirty-two consecutive patients underwent stent implantation, with a mean age of 72.1 years (range, 28–95 years). Similar diversity of sex, indication, and stricture location was found. There were no significant differences in clinical success (88.7%, 73.8%, and 78.4%, P = .16) and stent-related mortality (2.1%, 3.3%, and 3.6%, P = 1.00). Similar rates of stoma creation were also found (59.3%, 46.7%, and 60.0%, P = .76). In contrast, rates of surgery were lower in older patients (50.9%, 38.1%, and 13.5%, P = .0013), and mortality during the same admission was significantly higher in patients >70 years of age (4.0%, 15.0%, and 22.2%, P = .027). Kaplan-Meier 30-day survival curves for the 3 groups showed a trend toward earlier death among patients >70 years of age. Conclusions: This study demonstrates that stenting provides similar success rates in all age groups but is associated with higher mortality rates in older patients.
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Affiliation(s)
- Hagar Mizrahi
- Department of Colorectal Surgery, Darent Valley Hospital, Kent, UK
| | - Nissim Geron
- Department of General Surgery, The Baruch Padeh Medical Center Poriya, Israel
| | - Michael C Parker
- Department of Colorectal Surgery, Darent Valley Hospital, Kent, UK
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Sattar S, Alibhai SMH, Wildiers H, Puts MTE. How to implement a geriatric assessment in your clinical practice. Oncologist 2014; 19:1056-68. [PMID: 25187477 PMCID: PMC4200997 DOI: 10.1634/theoncologist.2014-0180] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/17/2014] [Indexed: 12/21/2022] Open
Abstract
Cancer is a disease that mostly affects older adults. Other health conditions, changes in functional status, and use of multiple medications change the risks and benefits of cancer treatment for older adults. Several international organizations, such as the International Society of Geriatric Oncology, the European Organization for Research and Treatment of Cancer, recommend the conduct of a geriatric assessment (GA) for older adults with cancer to help select the most appropriate treatment and identify any underlying undetected medical, functional, and psychosocial issues that can interfere with treatment. The aim of this review is to describe what a GA is and how to implement it in daily clinical practice for older adults with cancer in the oncology setting. We provide an overview of commonly used tools. Key considerations in performing the GA include the resources available (staff, space, and time), patient population (who will be assessed), what GA tools to use, and clinical follow-up (who will be responsible for using the GA results for developing care plans and who will provide follow-up care). Important challenges in implementing GA in clinical practice include not having easy and timely access to geriatric expertise, patient burden of the additional hospital visits, and establishing collaboration between the GA team and oncologists regarding expectations of the population referred for GA and expected outcomes of the GA. Finally, we provide some possible interventions for problems identified during the GA.
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Affiliation(s)
- Schroder Sattar
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Shabbir M H Alibhai
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
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