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Lafont C, Paillaud E, Bertolus C, Baron M, Caillet P, Bouvard E, Laurent M, Salvan D, Chaumette L, de Decker L, Piot B, Barry B, Raynaud-Simon A, Sauvaget E, Minard A, Anota A, Panjo H, Brugel L, Canouï-Poitrine F. Geriatric assessment and quality of life for 2 years in older patients with head and neck cancer. J Natl Cancer Inst 2024; 116:758-763. [PMID: 38335935 DOI: 10.1093/jnci/djae027] [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] [Received: 09/08/2023] [Revised: 11/20/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Due to the location and toxicity of treatments, head and neck cancer (HNC) has a major impact on quality of life (QoL). Objective: to assess the effects of geriatric-assessment (GA)-driven interventions on QoL over 2 years in older adults with HNC.EGeSOR was a randomized study of HNC patients aged ≥65, receiving a pretreatment GA, a geriatric intervention and follow-up (intervention) or standard of care (control). The primary endpoint was QoL score using the European Organisation for Research and Treatment of Cancer's (EORTC QLQ-C30) and HNC (QLQ-HN35) QoL questionnaires over 24 months.In total, 475 patients were included (median age: 75.3; women: 31%; oral cancer: 44%). QoL scores improved over 24 months with various trajectories, without significant differences between the groups. A total of 74% of patients (interventional group) did not receive the complete intervention. Cancer characteristics, functional status, and risk of frailty were associated with change in the Global Health Status QoL score.There is a need to develop an alternative model of implementation such as patient-centered health-care pathways. TRIAL REGISTRATION NCT02025062.
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Affiliation(s)
- Charlotte Lafont
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
- Service de Santé Publique, AP-HP, Hôpital Henri-Mondor, Creteil, France
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
- Département de Gériatrie, AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Paris, France
| | - Chloe Bertolus
- Service de Chirurgie Maxillo-Faciale, AP-HP, Sorbonne Université, Hôpital Pitié Salpêtrière, Paris, France
| | - Melany Baron
- Service de Soins de Suites et de Réadaptation Gériatrique, AP-HP, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Ivry sur Seine, France
| | - Philippe Caillet
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
- Département de Gériatrie, AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Paris, France
| | - Eric Bouvard
- Service de Gériatrie, AP-HP, Hôpital Tenon, Paris, France
| | - Marie Laurent
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
- Département de Gériatrie, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Didier Salvan
- Service ORL et Cervico-Facial, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Laurence Chaumette
- Service de Court Sejour Gériatrique, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Laure de Decker
- Service de Gériatrie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Benoit Piot
- Service de Chirurgie Maxillo-Faciale et Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Beatrix Barry
- Service ORL et Chirurgie Cervico-Faciale, AP-HP, Université de Paris, Hôpital Bichat, Paris, France
| | | | - Elisabeth Sauvaget
- Service ORL et Chirurgie Cervico-Faciale, Groupe Hospitalier Paris-Saint Joseph, Paris, France
| | | | - Amélie Anota
- Clinical Research and Innovation Department and Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France
- French National Platform Quality of Life and Cancer, Lyon, France
| | - Henri Panjo
- Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France
| | - Lydia Brugel
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
- Service de Santé Publique, AP-HP, Hôpital Henri-Mondor, Creteil, France
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2
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Wolfson JA, Grimes AC, Nuno M, Bergheimer CL, Ramakrishnan S, Beauchemin M, Dickens D, Levine JM, Roth ME, Scialla M, Woods W, Vargas S, Boayue KB, Chang GJ, Stock W, Hershman D, Curran E, Advani A, O’Dwyer K, Luger S, Liu JJ, Freyer D, Sung L, Parsons SK. Characteristics of Health Care Settings Where Adolescents and Young Adults Receive Care for ALL. JCO Oncol Pract 2024; 20:491-502. [PMID: 38252911 PMCID: PMC11085951 DOI: 10.1200/op.23.00328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/04/2023] [Accepted: 11/06/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE Individuals diagnosed with cancer between 15 and 39 years (adolescent and young adult [AYA]) face unique vulnerability. Detail is lacking about care delivery for these patients, especially those with ALL. We address these knowledge gaps by describing AYA ALL care delivery details at National Cancer Institute Community Oncology Research Program (NCORP) (sub)affiliates by model of care. METHODS Participating institutions treated at least one AYA with ALL from 2012 to 2016. Study-specific criteria were used to determine the number of unique clinical facilities (CFs) per NCORP and their model of care (adult/internal medicine [IM], pediatric, mixed [both]). Surveys completed by NCORPs for each CF by model of care captured size, resources, services, and communication. RESULTS Among 84 participating CFs (adult/IM, n=47; pediatric, n=15; mixed, n=24), 34% treated 5-10 AYAs with ALL annually; adult/IM CFs more often treated <5 (adult/IM, 60%; pediatric, 40%; mixed, 29%). Referral decisions were commonly driven by an age/diagnosis combination (58%), with frequent ALL-specific age minimums (87%) or maximums (80%). Medical, navigational, and social work services were similar across models while psychology was available at more pediatric CFs (pediatric, 80%; adult/IM, 40%; mixed, 46%-54%). More pediatric or mixed CFs reported oncologists interacting with pediatric/adult counterparts via tumor boards (pediatric, 93%; adult/IM, 26%; mixed, 96%) or initiating contact (pediatric, 100%; adult/IM, 77%; mixed 96%); more pediatric CFs reported an affiliated counterpart (pediatric, 53%; adult, 19%). Most CFs reported no AYA-specific resources (79%) or meetings (83%-98%). CONCLUSION System-level aspects of AYA ALL care delivery have not been examined previously. At NCORPs, these characteristics differ by models of care. Additional work is ongoing to investigate the impact of these facility-level factors on guideline-concordant care in this population. Together, these findings can inform a system-level intervention for diverse practice settings.
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Affiliation(s)
- Julie A. Wolfson
- Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Allison C. Grimes
- Division of Pediatric Hematology-Oncology, University of Texas Health Science Center San Antonio
| | - Michelle Nuno
- Children’s Oncology Group
- Department of Population and Public Health Sciences, University of Southern California
| | | | | | | | - David Dickens
- Division of Pediatric Hematology-Oncology, University of Iowa
| | - Jennifer M. Levine
- Division of Pediatric Hematology-Oncology, Children’s National Medical Center
| | - Michael E. Roth
- Division of Pediatric Hematology-Oncology, MD Anderson Cancer Center
| | | | - Wendy Woods
- Division of Pediatric Hematology-Oncology, Blank Children’s Hospital
| | | | - Koh B. Boayue
- Division of Pediatric Hematology-Oncology, University of New Mexico Cancer Center
| | - George J. Chang
- Alliance Cancer Care Delivery Research; Department of Colon and Rectal Surgery and Department of Health Services Research, The University of Texas, MD Anderson Cancer Center
| | - Wendy Stock
- Alliance Leukemia; Division of Hematology-Oncology, University of Chicago Medicine
| | - Dawn Hershman
- SWOG Cancer Care Delivery Research; Division of Hematology-Oncology, Columbia University
| | - Emily Curran
- Alliance Leukemia; Division of Hematology-Oncology, University of Cincinnati
| | - Anjali Advani
- SWOG Leukemia; Division of Hematologic Oncology and Blood Disorders, Cleveland Clinic, Taussig Cancer Institute
| | - Kristen O’Dwyer
- SWOG Leukemia; Division of Hematology-Oncology, University of Rochester, Wilmot Cancer Institute
| | - Selina Luger
- ECOG-ACRIN Leukemia, Division of Hematology-Oncology, University of Pennsylvania
| | - Jane Jijun Liu
- Alliance Community Oncology; Heartland NCORP, Division of Hematology-Oncology, Illinois CancerCare
| | - David Freyer
- Division of Pediatric Hematology-Oncology, Children’s Hospital Los Angeles
| | - Lillian Sung
- Division of Pediatric Hematology-Oncology, The Hospital for Sick Children
| | - Susan K. Parsons
- Division of Hematology/Oncology and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
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3
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Ozluk AA, Outlaw D, Akce M, Fowler ME, Hess DL, Giri S, Williams GR. Management of Older Adults With Colorectal Cancer: The Role of Geriatric Assessment. Clin Colorectal Cancer 2023; 22:390-401. [PMID: 37949790 PMCID: PMC11065137 DOI: 10.1016/j.clcc.2023.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/17/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
Older adults share a growing burden of cancer morbidity and mortality. This is present across the spectrum of oncologic diagnoses and is particularly true with colorectal cancer (CRC), where older adults continue to share the burden of diagnoses. However, optimal cancer treatment decision making in older adults remains a significant challenge, as the majority of previous clinical trials shaping the current treatment landscape have focused on younger patients, often with more robust performance status and fewer medical comorbid conditions. The heterogeneous aging process of older adults with CRC necessitates a personalized treatment approach, as approximately three-quarters of older adults with CRC also have a concominant geriatric syndrome and more than half of older adults with CRC are pre-frail or frail. Treatment decisions shoud be multifaceted, including consultation with the patient and their familes regarding their wishes, with consideration of the patient's quality of life, functional status, medical comorbid conditions, social support, and treatment toxicity risk. Geriatric assessment is a systematic and validated approach to assess an older adults's potential strengths and vulnerabilities, which can in turn be used to assist with comprehensive cancer care planning and support. In this review, we will summarize current treatment approaches for older adults with CRC, with a particular focus on the incorporation of the geriatric assessment.
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Affiliation(s)
- Ahmet Anil Ozluk
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Darryl Outlaw
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mehmet Akce
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mackenzie E Fowler
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Daniel L Hess
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Smith Giri
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
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4
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Arana-Chicas E, Prisco LMH, Sharma S, Stauffer F, McGee M, Dauphin S, Ban-Hoefen M, Navarette J, Zittel J, Cupertino AP, Magnuson A, Mustian KM, Mohile SG. Cancer survivorship challenges of rural older adults: a qualitative study. BMC Cancer 2023; 23:917. [PMID: 37770838 PMCID: PMC10536752 DOI: 10.1186/s12885-023-11395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Although research has advanced the field of oncologic geriatrics with survivors to assess their cancer-related needs and devise patient-centered interventions, most of that research has excluded rural populations. This study aimed to understand the survivorship challenges and recommendations in the perspective of rural older adults. METHODS This was a qualitative study that explored the survivorship challenges and recommendations of rural older adults who have completed curative intent chemotherapy for a solid tumor malignancy in the 12 months prior to enrollment in the present study. RESULTS Twenty-seven older adult survivors from rural areas completed open-ended semi-structured interviews. The mean age was 73.4 (SD = 5.0). Most participants were non-Hispanic White (96.3%), female (59.3%), married (63.0%), and had up to a high school education (51.9%). Rural older survivors reported a general lack of awareness of survivorship care plans, communication challenges with healthcare team, transportation challenges, financial toxicity, psychological challenges, and diet and physical challenges. Rural older survivors recommend the provision of nutritional advice referral to exercise programs, and social support groups and for their healthcare providers to discuss their survivorship plan with them. CONCLUSIONS Although study participants reported similar survivorship challenges as urban older adult survivors, additional challenges reported regarding transportation and consideration of farm animals have not been previously reported. Heightened awareness of the survivorship needs of rural older adults may result in better survivorship care for this population.
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Affiliation(s)
- Evelyn Arana-Chicas
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA.
| | - Laura M Hincapie Prisco
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA
| | - Saloni Sharma
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA
| | - Fiona Stauffer
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA
| | - Martha McGee
- Specialized Oncology Care & Research for our Elders Board Patient and Caregiver Advocate Board (SOCAREboard), University of Rochester Medical Center, Rochester, NY, USA
| | | | - Makiko Ban-Hoefen
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Jason Zittel
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Ana Paula Cupertino
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Allison Magnuson
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, New York, USA
| | - Karen M Mustian
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, New York, USA
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5
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Parsons SK, Beauchemin MP, Dupuis L, Sugalski A, Wolfson JA, Santacroce SJ, Marchak JG, Sung L, Roth ME. Children's Oncology Group 2023 blueprint for research: Cancer care delivery research. Pediatr Blood Cancer 2023; 70 Suppl 6:e30579. [PMID: 37469004 PMCID: PMC10686255 DOI: 10.1002/pbc.30579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023]
Abstract
The National Cancer Institute (NCI) has a 40-year history of initiatives to encourage the participation of community oncology sites into clinical trials research and clinical care. In 2014, the NCI re-organized to form the NCI Community Oncology Research Program (NCORP) network across seven research bases, including the Children's Oncology Group (COG), and numerous community sites. The COG portfolio for Cancer Care Delivery Research (CCDR), mirroring the larger NCORP network, has included two studies addressing guideline congruence, as an important marker of quality cancer care, and another focusing on financial toxicity, addressing the pervasive problems of healthcare cost. CCDR is a cross-cutting field that frequently examines intersectional aspects of healthcare delivery. With that in mind, we explicitly define domains of CCDR to propel our research agenda into the next phase of the NCORP CCDR program while acknowledging the complex and dynamic fields of clinical care, policy level decisions, research findings, and needs of communities served by the NCORP network that will inform the subsequent research questions. To ensure programmatic success, we will engage a broad interdisciplinary group of investigators and clinicians with expertise and dedication to community oncology and the populations they serve.
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Affiliation(s)
- Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies and the Division of Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Melissa P. Beauchemin
- Columbia University School of Nursing, CUIMC Minority/Underserved NCI Community Oncology Research Program, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Lee Dupuis
- Department of Pharmacy, The Hospital for Sick Children and Leslie Dan Faculty of Pharmacy, University of Toronto, Canada
| | - Aaron Sugalski
- University Health System Pediatric Blood and Cancer Center, Division Hematology/Oncology, University of Texas Health San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, Texas
| | - Julie Anna Wolfson
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham
| | - Sheila J. Santacroce
- School of Nursing and Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, North Carolina
| | - Jordan G. Marchak
- Emory University School of Medicine, Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta, Georgia
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Michael E. Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Loh KP, Wang Y, Yilmaz S, Nightingale CL, Parsons SK, Braun-Inglis C, Gada U, Montes A, Magnuson A, Culakova E, Strause S, Kamen C, Dressler E, Mustian K, Morrow G, Mohile S. Information Technology and Telemedicine Services in Community Oncology Practices. JCO Clin Cancer Inform 2023; 7:e2300086. [PMID: 37540817 PMCID: PMC10569779 DOI: 10.1200/cci.23.00086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 08/06/2023] Open
Abstract
PURPOSE We described information technology support and use of telemedicine for cancer care and research purposes at community oncology practices within the National Cancer Institute Community Oncology Research Program (NCORP). METHODS We used data from the NCORP 2017 and 2022 Landscape Assessments. Separate logistic regression models were used to assess factors associated with the use of telemedicine for delivery of cancer care in 2017 and for research purposes in 2022 (cancer care delivery not assessed in 2022). RESULTS Information was available from 210 and 259 practice groups excluding pediatric-only groups in 2017 and 2022, respectively. In 2017, 30% of practice groups used telemedicine for delivery of cancer care; half of these (15% overall) could use telemedicine for research purposes. In 2022, telemedicine was used for research purposes in 73% of practice groups. In multivariable models, self-identifying as a safety-net hospital was associated with a lower odd of telemedicine use for delivery of cancer care (adjusted odds ratio [AOR], 0.39; 95% CI, 0.17 to 0.93), whereas affiliation with a designated critical access hospital was associated with a higher odd of telemedicine use for delivery of cancer care (AOR, 2.29; 95% CI, 1.10 to 4.76). Having a general survivorship clinic (AOR, 1.92; 95% CI, 1.04 to 3.54) and number of oncology providers (increase per 10 providers; AOR, 1.32; 95% CI, 1.05 to 1.65) were associated with telemedicine use for research purposes. CONCLUSION Almost one third of NCORP practice groups used telemedicine for cancer care delivery in 2017. In 2022, there is high capacity among NCORP practices (almost three-quarters) to use telemedicine for research purposes, especially among practices with a general survivorship clinic and a greater provider number.
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Affiliation(s)
- Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Ying Wang
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Sule Yilmaz
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Chandylen L. Nightingale
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston Salem, NC
| | - Susan K. Parsons
- Departments of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Christa Braun-Inglis
- University of Hawaii Cancer Center/Hawaii Minority/Underserved NCORP, Honolulu, HI
| | - Umang Gada
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Alexander Montes
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Allison Magnuson
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Eva Culakova
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Sarah Strause
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Charles Kamen
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Emily Dressler
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC
| | - Karen Mustian
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Gary Morrow
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Supriya Mohile
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
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7
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Han BH, Bronson J, Washington L, Yu M, Kelton K, Tsai J, Finlay AK. Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans. Med Care 2023; 61:477-483. [PMID: 37204150 PMCID: PMC10330246 DOI: 10.1097/mlr.0000000000001864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Older veterans involved in the criminal legal system (CLS) may have patterns of multimorbidity that place them at risk for poor health outcomes. OBJECTIVES To estimate the prevalence of medical multimorbidity (≥2 chronic medical diseases), substance use disorders (SUDs), and mental illness among CLS-involved veterans aged 50 and older. RESEARCH DESIGN Using Veterans Health Administration health records, we estimated the prevalence of mental illness, SUD, medical multimorbidity, and the co-occurrence of these conditions among veterans by CLS involvement as indicated by Veterans Justice Programs encounters. Multivariable logistic regression models assessed the association between CLS involvement, the odds for each condition, and the co-occurrence of conditions. SUBJECTS Veterans aged 50 and older who received services at Veterans Health Administration facilities in 2019 (n=4,669,447). METHODS Mental illness, SUD, medical multimorbidity. RESULTS An estimated 0.5% (n=24,973) of veterans aged 50 and older had CLS involvement. For individual conditions, veterans with CLS involvement had a lower prevalence of medical multimorbidity compared with veterans without but had a higher prevalence of all mental illnesses and SUDs. After adjusting for demographic factors, CLS involvement remained associated with concurrent mental illness and SUD (adjusted odds ratio [aOR] 5.52, 95% CI=5.35-5.69), SUD and medical multimorbidity (aOR=2.09, 95% CI=2.04-2.15), mental illness and medical multimorbidity (aOR=1.04, 95% CI=1.01-1.06), and having all 3 simultaneously (aOR=2.42, 95% CI=2.35-2.49). CONCLUSIONS Older veterans involved in the CLS are at high risk for co-occurring mental illness, SUDs, and medical multimorbidity, all of which require appropriate care and treatment. Integrated care rather than disease-specific care is imperative for this population.
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Affiliation(s)
- Benjamin H. Han
- University of California San Diego Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, San Diego, CA
- Veterans Affairs San Diego Healthcare System, Jennifer Moreno Department of Veterans Affairs Medical Center, San Diego, CA
| | - Jennifer Bronson
- National Association of State Mental Health Program Directors Research Institute (NRI), Falls Church, VA
| | - Lance Washington
- National Association of State Mental Health Program Directors Research Institute (NRI), Falls Church, VA
| | - Mengfei Yu
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA
| | - Katherine Kelton
- South Texas Veteran Health Care System, Audie L. Murphy Veteran Hospital San Antonio, TX
| | - Jack Tsai
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Andrea K. Finlay
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA
- National Center on Homelessness Among Veterans, Department of Veterans Affairs
- Schar School of Policy and Government, George Mason University
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8
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Tian BWCA, Stahel PF, Picetti E, Campanelli G, Di Saverio S, Moore E, Bensard D, Sakakushev B, Galante J, Fraga GP, Koike K, Di Carlo I, Tebala GD, Leppaniemi A, Tan E, Damaskos D, De'Angelis N, Hecker A, Pisano M, Maier RV, De Simone B, Amico F, Ceresoli M, Pikoulis M, Weber DG, Biffl W, Beka SG, Abu-Zidan FM, Valentino M, Coccolini F, Kluger Y, Sartelli M, Agnoletti V, Chirica M, Bravi F, Sall I, Catena F. Assessing and managing frailty in emergency laparotomy: a WSES position paper. World J Emerg Surg 2023; 18:38. [PMID: 37355698 DOI: 10.1186/s13017-023-00506-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/27/2023] [Indexed: 06/26/2023] Open
Abstract
Many countries are facing an aging population. As people live longer, surgeons face the prospect of operating on increasingly older patients. Traditional teaching is that with older age, these patients face an increased risk of mortality and morbidity, even to a level deemed too prohibitive for surgery. However, this is not always true. An active 90-year-old patient can be much fitter than an overweight, sedentary 65-year-old patient with comorbidities. Recent literature shows that frailty-an age-related cumulative decline in multiple physiological systems, is therefore a better predictor of mortality and morbidity than chronological age alone. Despite recognition of frailty as an important tool in identifying vulnerable surgical patients, many surgeons still shun objective tools. The aim of this position paper was to perform a review of the existing literature and to provide recommendations on emergency laparotomy and in frail patients. This position paper was reviewed by an international expert panel composed of 37 experts who were asked to critically revise the manuscript and position statements. The position paper was conducted according to the WSES methodology. We shall present the derived statements upon which a consensus was reached, specifying the quality of the supporting evidence and suggesting future research directions.
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Affiliation(s)
- Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Philip F Stahel
- Department of Orthopedic Surgery and Department of Neurosurgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO, USA
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
| | | | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | - Ernest Moore
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Denis Bensard
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Boris Sakakushev
- Research Institute of Medical University Plovdiv/University Hospital St George Plovdiv, Plovdiv, Bulgaria
| | - Joseph Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | - Gustavo P Fraga
- Faculdade de Ciências Médicas (FCM), Unicamp Campinas, Campinas, SP, Brazil
| | - Kaoru Koike
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy
| | - Giovanni D Tebala
- Oxford University Hospitals NHSFT John Radcliffe Hospital, Headley Way, HeadingtonOxford, OX3 9DU, UK
| | - Ari Leppaniemi
- General Surgery Department, Helsinki University Hospital, Helsinki, Finland
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Dimitris Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nicola De'Angelis
- Hôpital Henri Mondor, Université Paris Est, Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Créteil, France
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital, Giessen, Germany
| | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Ron V Maier
- Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Francesco Amico
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Manos Pikoulis
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Walt Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA, USA
| | - Solomon Gurmu Beka
- School of Medicine and Health Science, University of Otago, Wellington Campus, Wellington, New Zealand
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | | | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Mircea Chirica
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Hôpital Principal Dakar, Dakar, Senegal.
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
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9
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Sharon CE, Strohl C, Saur NM. Frailty Assessment and Prehabilitation as Part of a PeRioperative Evaluation and Planning (PREP) Program for Patients Undergoing Colorectal Surgery. Clin Colon Rectal Surg 2023; 36:184-191. [PMID: 37113278 PMCID: PMC10125297 DOI: 10.1055/s-0043-1761151] [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: 04/29/2023]
Abstract
Frailty assessment and prehabilitation can be incrementally implemented in a multidisciplinary, multiphase pathway to improve patient care. To start, modifications can be made to a surgeon's practice with existing resources while adapting standard pathways for frail patients. Frailty screening can identify patients in need of additional assessment and optimization. Personalized utilization of frailty data for optimization through prehabilitation can improve postoperative outcomes and identify patients who would benefit from adapted care. Additional utilization of the multidisciplinary team can lead to improved outcomes and a strong business case to add additional members of the team.
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Affiliation(s)
- Cimarron E. Sharon
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Catherine Strohl
- Department of Geriatrics, University of Pennsylvania, Philadelphia, Pennsylvania
- Geriatric Surgery Program, Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Nicole M. Saur
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Geriatric Surgery Program, Pennsylvania Hospital, Philadelphia, Pennsylvania
- Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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10
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Hsu T, Elias R, Swartz K, Chapman A. Developing Sustainable Cancer and Aging Programs. Am Soc Clin Oncol Educ Book 2023; 43:e390980. [PMID: 37155945 DOI: 10.1200/edbk_390980] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Geriatric assessment (GA) has been shown to decrease toxicity from systemic therapy, improve completion of chemotherapy, and reduce hospitalizations in older adults with cancer. Given the aging of the cancer population, this has the potential to have a positive impact on the care of a large swath of patients seen. Despite endorsement by several international societies, including the American Society of Clinical Oncology, uptake of GA has been low. Lack of knowledge, time, and resources has been cited as reasons for this. Although challenges to developing and implementing a cancer and aging program vary depending on the health care context, GA is adaptable to every health care context from low- to high-resource settings, as well as those in which geriatric oncology is a well-established or just emerging field. We provide an approach for clinicians and administrators to develop, implement, and sustain aging and cancer programs in a doable and sustainable way.
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Affiliation(s)
- Tina Hsu
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Rawad Elias
- Hartford HealthCare Cancer Institute, Hartford, CT
- University of Connecticut School of Medicine, Farmington, CT
| | - Kristine Swartz
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Jefferson Health, Philadelphia, PA
| | - Andrew Chapman
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Jefferson Health, Philadelphia, PA
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11
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Fowler ME, Kenzik KM, Al-Obaidi M, Harmon C, Giri S, Arora S, Stephenson C, Khushman M, Outlaw D, Bhatia S, Williams GR. Rural-urban disparities in mortality and geriatric assessment among older adults with cancer: The cancer & aging resilience evaluation (CARE) registry. J Geriatr Oncol 2023; 14:101505. [PMID: 37087962 PMCID: PMC10207384 DOI: 10.1016/j.jgo.2023.101505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/13/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Rural-urban disparities persist in cancer mortality, despite improvement in cancer screening and treatment. Although older adults represent the majority of cancer cases and are over-represented in rural areas, few studies have explored rural-urban disparities in mortality and age-related impairments among older adults with cancer. MATERIALS AND METHODS We included 962 newly-diagnosed older adults (≥60 years) with cancer who underwent geriatric assessment (GA) at their first pre-chemotherapy visit to an academic medical center in the Southeastern United States. We used Rural-Urban Commuting Area (RUCA) codes to classify residence at time of diagnosis into urban and rural areas. We used one-year survival and pre-treatment frailty as outcomes. We used Cox proportional hazards regression to evaluate the association between residence and one-year mortality, and logistic regression to evaluate the association between residence and pre-treatment frailty. All tests were two-sided. RESULTS Median age at GA was 68.0 (interquartile rage [IQR]: 64.0, 74.0) years; most had colorectal cancer (24.3%) with advanced stage (III/IV 73.2%) disease. Overall, 11.4% resided in rural and 88.6% in urban areas. Rural areas had a higher proportion of White and less educated participants. After adjustment for age, sex, race, education, employment status, and cancer type/stage, rural residence was associated with higher hazard of one-year mortality (hazard ratio [HR] = 1.78, 95% confidence interval [CI] = 1.23, 2.57) compared to urban residence. Frailty was an effect modifier of this association (HROverall = 1.83, 95% CI = 1.27, 2.57; HRFrail = 2.05, 95% CI = 1.23, 3.41; HRNot Frail = 1.55, 95% CI = 0.90, 2.68). DISCUSSION Among older adults with newly diagnosed cancer, rural residence was associated with reduced one-year survival, particularly among frail older adults. The rural-urban disparities observed in the current study may be due to frailty in conjunction with disparities in social determinants of health across rural and urban areas. Future studies should focus on understanding and intervening on underlying causes of these disparities.
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Affiliation(s)
- Mackenzie E Fowler
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA.
| | - Kelly M Kenzik
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA.
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA.
| | - Christian Harmon
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA.
| | - Smith Giri
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA.
| | - Sankalp Arora
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA.
| | | | - Moh''d Khushman
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA.
| | - Darryl Outlaw
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA.
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA; Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Building, Birmingham, AL 35233-1771, USA.
| | - Grant R Williams
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA.
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12
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Gluszak C, Campion L, Seegers V, Cojocarasu O, Commer JM, Priou F, Rolland F, Terret C, Abadie-Lacourtoisie S. Geriatric Assessment Implementation before Chemotherapy in MEtastatic Prostate Cancer, Results from the Real-Life Study GAMERS. J Clin Med 2023; 12:jcm12041636. [PMID: 36836171 PMCID: PMC9961170 DOI: 10.3390/jcm12041636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Geriatric assessment (GA) can predict and improve treatment tolerance and estimate overall survival in older patients with cancer. Several international organizations promote GA; however, data related to its implementation in daily clinical practice are still limited. We aimed to describe GA implementation in patients over 75 years old with metastatic prostate cancer treated with docetaxel as first-line treatment, and with positive G8 screening test or frailty criteria. This retrospective real-world study included 224 patients treated from 2014 to 2021 in four French centers, including 131 patients with a theoretical indication of GA. Among the latter, 51 (38.9%) patients had GA. The main barriers to GA were the lack of systematic screening (32/80, 40.0%), unavailability of geriatric physician (20/80, 25.0%), and absence of referral despite a positive screening test (12/80, 15.0%). With GA performed in only one-third of the patients with a theoretical indication in daily clinical practice, mostly due to an absence of screening test, the use of GA is currently sub-optimal.
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Affiliation(s)
- Cassandre Gluszak
- Department of Medical Oncology, Integrated Center of Oncology (ICO) Paul Papin, 49055 Angers, France
- Correspondence: ; Tel.: +33-6-06-44-25-12
| | - Loïc Campion
- Department of Biostatistics, Integrated Center of Oncology (ICO) René Gauducheau, 44800 Saint-Herblain, France
| | - Valérie Seegers
- Department of Biostatistics, Integrated Center of Oncology (ICO) Paul Papin, 49055 Angers, France
| | - Oana Cojocarasu
- Department of Medical Oncology, Centre Hospitalier Le Mans, 72037 Le Mans, France
| | - Jean-Marie Commer
- Department of Supportive Care, Integrated Center of Oncology (ICO) Paul Papin, 49055 Angers, France
| | - Frank Priou
- Department of Medical Oncology, Centre Hospitalier La Roche-sur-Yon, 85000 La Roche-sur-Yon, France
| | - Frédéric Rolland
- Department of Medical Oncology, Integrated Center of Oncology (ICO) René Gauducheau, 44800 Saint-Herblain, France
| | - Catherine Terret
- Department of Medical Oncology, Leon Berard Institute, 69008 Lyon, France
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Sedrak MS, Sun CL, Ji J, Cohen HJ, Gross CP, Tew WP, Klepin HD, Wildes TM, Dotan E, Freedman RA, O'Connor T, Chow S, Fenton MA, Moy B, Chapman AE, Dale W, Katheria V, Kuderer NM, Lyman GH, Magnuson A, Muss HB. Low-Intensity Adjuvant Chemotherapy for Breast Cancer in Older Women: Results From the Prospective Multicenter HOPE Trial. J Clin Oncol 2023; 41:316-326. [PMID: 36455189 PMCID: PMC9839299 DOI: 10.1200/jco.22.01440] [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] [Received: 06/24/2022] [Revised: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Older women with high-risk early breast cancer (EBC) benefit from adjuvant chemotherapy, but their treatment is frequently complicated by toxic side effects, resulting in dose reductions and delays. This makes it challenging for oncologists to maintain a relative dose intensity (RDI) ≥ 85%, as recommended for optimal curative-intent treatment. Understanding which women are at risk of receiving suboptimal RDI may inform treatment discussions and guide early, targeted supportive care or geriatric comanagement interventions. METHODS This was a prespecified secondary analysis of the HOPE trial, which enrolled women age ≥ 65 years with EBC initiating neoadjuvant or adjuvant chemotherapy. RDI was calculated as the ratio of delivered to planned chemotherapy dose intensity. The primary outcome was low RDI, defined as RDI < 85%. Multivariable logistic regression with stepwise selection was used to evaluate the association between baseline variables (demographic, clinical, and geriatric assessment) and low RDI. Survival probability was estimated using the Kaplan-Meier method, and the log-rank test was used to compare overall survival. RESULTS Three hundred twenty-two patients (median age at diagnosis, 70 years; range, 65-86 years) were included. The median follow-up was 4 years. Sixty-six patients (21%) had a low RDI. Age ≥ 76 years (odds ratio [OR], 2.57; 95% CI, 1.12 to 5.91; P = .03), lower performance status (OR, 4.32; 95% CI, 1.98 to 9.42; P < .001), and use of anthracycline-based or cyclophosphamide, methotrexate, and fluorouracil regimens (OR, 3.47; 95% CI, 1.71 to 7.05; P < .001) were associated with low RDI. The 5-year overall survival probability was 0.80 versus 0.91 in patients with RDI < 85 versus ≥ 85%, respectively (log-rank P = .02). CONCLUSION One in five older patients with EBC treated with standard chemotherapy received low RDI and had inferior survival outcomes. Older patients at risk for low RDI should be identified and targeted upfront before initiating chemotherapy.
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Affiliation(s)
- Mina S. Sedrak
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Can-Lan Sun
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Supportive Care Medicine, City of Hope, Duarte, CA
| | - Jingran Ji
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Harvey J. Cohen
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Cary P. Gross
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - William P. Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heidi D. Klepin
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Tanya M. Wildes
- Department of Medical Oncology, Nebraska Medicine, Omaha, NE
| | - Efrat Dotan
- Department of Hematology Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Rachel A. Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Tracey O'Connor
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Selina Chow
- Department of Medicine, University of Chicago, Chicago, IL
| | | | - Beverly Moy
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Andrew E. Chapman
- Department of Medical Oncology, Sidney Kimmel Cancer Center/Jefferson Health, Philadelphia, PA
| | - William Dale
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Supportive Care Medicine, City of Hope, Duarte, CA
| | - Vani Katheria
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Supportive Care Medicine, City of Hope, Duarte, CA
| | | | - Gary H. Lyman
- Department of Medicine, University of Washington, Seattle, WA
| | - Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Hyman B. Muss
- Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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14
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Giri S, Al-Obaidi M, Harmon C, Clark D, Ubersax C, Dai C, Young-Smith C, Outlaw D, Gbolahan O, Khushman M, Bhatia S, Williams GR. Patient-reported geriatric assessment-based frailty index among older adults with gastrointestinal malignancies. J Am Geriatr Soc 2023; 71:136-144. [PMID: 36208421 PMCID: PMC9870847 DOI: 10.1111/jgs.18054] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/27/2022] [Accepted: 08/21/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Older adults with cancer are at increased risk of treatment-related toxicities and excess mortality. We evaluated whether a patient-reported geriatric assessment (GA) based frailty index can identify those at risk of adverse outcomes. METHODS Older adults (≥60 years) enrolled in a single-institutional prospective registry underwent patient-reported GA at initial evaluation in our medical oncology clinic. Using deficit accumulation method, we constructed a 44-item frailty index (CARE-FI), categorizing patients as robust, pre-frail, and frail. The primary outcome was overall survival (OS). Secondary outcomes included (a) functional decline at 3 months post-therapy (b) incident grade ≥3 treatment-related toxicities at six-month post-treatment. We used multivariate Cox and logistic regression models respectively to study the impact of frailty on primary and secondary outcomes. RESULTS We identified 589 older adults with a median age of 69 years; 55% males and 73% Whites. Overall, 168 (29%) were pre-frail and 230 (39%) frail. Being frail (vs. robust) was associated with worse OS (Hazards Ratio, HR 1.83, 95% Confidence Interval, CI 1.34-2.49, p < 0.001) after adjusting for age, sex, race/ethnicity, cancer type, cancer stage, and line of therapy. Similarly, frailty was associated with increased risk of functional decline (OR 3.01; 95% CI 1.33-6.81; p = 0.008) and grade ≥3 non-hematologic toxicities (OR 3.65; 95% CI 1.54-8.69; p = 0.003) but not hematologic toxicities (OR 1.01; 95% CI 0.46-2.22; p = 0.97). CONCLUSIONS Our frailty index using a patient-reported GA is a robust predictor of survival, functional decline, and treatment related toxicity among older adults with GI malignancies.
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Affiliation(s)
- Smith Giri
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, AL, USA
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, AL, USA
| | - Christian Harmon
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, AL, USA
| | - Deanna Clark
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, AL, USA
| | - Clare Ubersax
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, AL, USA
| | - Chen Dai
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, AL, USA
| | - Crystal Young-Smith
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Darryl Outlaw
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olumide Gbolahan
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Moh’d Khushman
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, AL, USA
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, AL, USA
| | - Grant R. Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, AL, USA
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Kimmick G, Sedrak MS, Williams G, McCleary NJ, Rosko AE, Berenberg JL, Freedman RA, Smith ML, Ahmed A, Muss HB, Chow S, Dale W. Infrastructure to Support Accrual of Older Adults to National Cancer Institute Clinical Trials. J Natl Cancer Inst Monogr 2022; 2022:151-158. [PMID: 36519814 PMCID: PMC9753220 DOI: 10.1093/jncimonographs/lgac025] [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] [Received: 06/16/2022] [Revised: 09/30/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022] Open
Abstract
As part of ongoing efforts to meaningfully improve recruitment, enrollment, and accrual of older adults into cancer clinical trials, the National Cancer Institute (NCI) sponsored a workshop with experts across the country entitled Engaging Older Adults in the NCI Clinical Trials Network: Challenges and Opportunities. Three working groups, including Study Design, Infrastructure, and Stakeholders, were formed, who worked together to offer synergistic improvements in the system. Here, we summarize the workshop discussions of the Infrastructure Working Group, whose goal was to address infrastructural challenges, identify underlying resources, and offer solutions to facilitate accrual of older adults into cancer clinical trials. Based on preconference work and workshop discussions, four key recommendations to strengthen NCI infrastructure were proposed: 1) further centralize resources and expertise; 2) provide training for clinical research staff; (3) develop common data elements; and 4) evaluate what works and does not work. These recommendations provide a strategy to improve the infrastructure to enroll more older adults in cancer clinical trials.
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Affiliation(s)
- Gretchen Kimmick
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center/Duke Cancer Institute, Durham, NC, USA
| | - Mina S Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Grant Williams
- Institute for Cancer Outcomes & Survivorship and Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nadine J McCleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ashley E Rosko
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Jeffrey L Berenberg
- Department of Medicine, Division of Medical Oncology, Hawaii Minority Underserved National Cancer Institute Community Oncology Research Program, Honolulu, HI, USA
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Amina Ahmed
- Department of Obstetrics and Gynecology, Division of Gyn Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Selina Chow
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, USA
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Hopkins JO, Braun-Inglis C, Guidice S, Wells M, Moorthi K, Berenberg J, St. Germain D, Mohile S, Hudson MF. Enrolling Older Adults Onto National Cancer Institute-Funded Clinical Trials in Community Oncology Clinics: Barriers and Solutions. J Natl Cancer Inst Monogr 2022; 2022:117-124. [PMID: 36519815 PMCID: PMC9753219 DOI: 10.1093/jncimonographs/lgac019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/27/2022] [Accepted: 08/19/2022] [Indexed: 12/23/2022] Open
Abstract
In April 2021, the National Cancer Institute (NCI) Division of Cancer Prevention collaborated with the NCI Division of Cancer Treatment and Diagnosis to produce a virtual workshop that developed recommendations for enhancing NCI-sponsored clinical trial accrual of older adults. Prior to the workshop, a multidisciplinary group of stakeholders (eg, community oncologists, advanced practice practitioners, clinic and research staff, and patient advocates) gathered information related to accrual of older adults to clinical trials from the literature. Subsequently, a survey was conducted to detail NCI Community Oncology Research Program members' perspective on accrual barriers for this population; 305 individuals responded to the survey. Barriers to clinical trial accruals included comorbidity-attributed trial ineligibility, transportation and time issues, concern that the proposed regimen is too toxic for older adults, patient or family caregiver declined participation, and lack of trials relevant to older patients. Identified solutions included broadening clinical trial inclusion criteria, increasing the number of clinical trials specifically designed for older adults, simplifying consent forms, improving recruitment materials for older adults and their families, and facilitating transportation vouchers. At the workshop, participants, including stakeholders, used prior literature and survey results to develop recommendations, including interventions to address clinician bias, implement geriatric assessment, and promote clinician and staff engagement as mechanisms to improve accrual of older adults to clinical trials.
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Affiliation(s)
- Judith O Hopkins
- Novant Health Cancer Institute/SCOR National Cancer Institute Community Oncology Research Program (NCORP), Kernersville, NC, USA
| | - Christa Braun-Inglis
- University of Hawaii Cancer Center/Hawaii Minority/Underserved NCORP, Honolulu, HI, USA
| | - Sofia Guidice
- University of Rochester Cancer Center (URCC) NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
| | - Meg Wells
- University of Rochester Cancer Center (URCC) NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
| | - Kiran Moorthi
- University of Rochester Cancer Center (URCC) NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeffrey Berenberg
- University of Hawaii Cancer Center/Hawaii Minority/Underserved NCORP, Honolulu, HI, USA
| | - Diane St. Germain
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - Supriya Mohile
- Correspondence to: Supriya G. Mohile, MD, Departments of Medicine and Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box 704, Rochester, NY 14642, USA (e-mail: )
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Ellis SD, Vaidya R, Unger JM, Stratton K, Gills J, Van Veldhuizen P, Mederos E, Dressler EV, Hudson MF, Kamen C, Neuman HB, Kazak AE, Carlos RC, Weaver KE. Access to urologists for participation in research: An analysis of NCI's Community Oncology Research Program landscape survey. Contemp Clin Trials Commun 2022; 29:100981. [PMID: 36033360 PMCID: PMC9403500 DOI: 10.1016/j.conctc.2022.100981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 11/08/2022] Open
Abstract
Purpose Urological cancer clinical trials face accrual challenges, which may stem from structural barriers within cancer programs. We sought to describe the extent to which urology cancer care providers are available within community cancer research programs and explore the role of oncology practice group ownership in their access to urology practices to participate in research. Materials and methods We conducted secondary analysis of organizational survey data collected in 2017 among National Cancer Institute Community Oncology Research Program practice groups. We used logistic regression to assess the association of self-reported access to urologists to participate in research and oncology practice group ownership type: independent, payor-provider, health-system, or public ownership. Results Of the 209 community oncology practice groups in the analysis sample, 133 (63.6%) had access to urologists for research participation. Ownership was not statistically significantly associated with access to urology practices after controlling for other covariates (p = 0.4). Instead, having a hospital outpatient clinic (p = 0.008) and identifying as a safety-net hospital (p = 0.035) were both positively significantly associated with access to urologists to participate in research. Conclusions Two-thirds of community cancer research groups have access to urology. Oncology ownership status was not associated with access to urologists for research. Research groups may need support to increase their capacity to engage non-oncology cancer care providers in research.
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Affiliation(s)
- Shellie D. Ellis
- University of Kansas Cancer Center, University of Kansas Medical Center, USA
| | - Riha Vaidya
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Joseph M. Unger
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Kelly Stratton
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, USA
| | - Jessie Gills
- Gulf South NCORP, Louisiana State University Health Sciences Center, USA
| | | | - Eileen Mederos
- Gulf South NCORP, Louisiana State University Health Sciences Center, USA
| | - Emily V. Dressler
- Wake Forest School of Medicine, Department of Biostatistics and Data Science, Winston-Salem, NC, USA
| | | | | | - Heather B. Neuman
- University of Wisconsin School of Medicine and Public Health, Madison, USA
| | | | - Ruth C. Carlos
- University of Michigan School of Medicine, Ann Arbor, USA
| | - Kathryn E. Weaver
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
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18
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Nipp RD. Palliative and Supportive Care for Individuals with Pancreatic Adenocarcinoma. Hematol Oncol Clin North Am 2022; 36:1053-1061. [PMID: 36154784 DOI: 10.1016/j.hoc.2022.07.009] [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: 11/28/2022]
Abstract
Individuals with pancreatic adenocarcinoma experience a complex constellation of palliative and supportive care needs. Notably, when caring for patients with pancreatic adenocarcinoma, clinicians must carefully assess and address these individuals' palliative and supportive care needs, as these can have important implications related to their treatment experience and care outcomes. Importantly, prior research has consistently demonstrated the benefits of palliative and supportive care interventions for patients with cancer to help address symptom burden, illness understanding, coping mechanisms, and informed decision making. However, much of this research did not specifically tailor the interventions to the unique concerns of a pancreatic cancer population. Thus, an urgent need exists to design and conduct rigorous research with the goal of enhancing care delivery and outcomes for the highly symptomatic population of individuals with pancreatic adenocarcinoma.
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Affiliation(s)
- Ryan D Nipp
- University of Oklahoma Health Sciences Center, Stephenson Cancer Center, 800 Northeast 10th Street, Oklahoma City, OK 73104, USA.
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19
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Marinho J, Custódio S. Geriatric Oncology in Portugal: Where We Are and What Comes Next—A Survey of Healthcare Professionals. Geriatrics (Basel) 2022; 7:geriatrics7050091. [PMID: 36136800 PMCID: PMC9498886 DOI: 10.3390/geriatrics7050091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
In keeping with the trend worldwide, in Portugal, more than 60% of newly diagnosed patients with cancer are aged 65 years or older, which makes older adults the most common population seen in an oncology practice. This study’s objectives were to assess geriatric oncology practices in Portugal and investigate medical professionals’ current needs and perceptions on the treatment of elderly cancer patients. Methods: A cross-sectional study was conducted using a web-based survey of healthcare providers treating elderly patients. Results: There were 222 responses: 62.6% of physicians reported the absence of geriatric oncology and/or geriatrics consultations in their institutions, 14.9% had guidelines for the management of older patients with cancer and 4.5% had physicians dedicated to geriatric oncology. The reported use of geriatric assessment tools was 23.4%. Medical oncologists and physicians from medical specialties (p = 0.009) and those practicing in the south of Portugal (p = 0.054) were more likely to use geriatric assessment. Education and training in geriatric oncology was identified by 95.0% of respondents as an unmet need. The inquiries identified that geriatric assessment could be useful to define a therapeutic strategy (85.1%), detect frailty (77.5%), predict toxicity and improve quality of life (73.4%). Conclusions: There is a paucity of expertise and training in geriatric oncology in Portugal but an increasing perception of the value of geriatric assessment and the demand for education. In the next years, Portugal will progress in this area with the aid of the recently created Geriatric Oncology Working Group.
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Affiliation(s)
- Joana Marinho
- Medical Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
- Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), 4410-406 Vila Nova de Gaia, Portugal
- Correspondence: ; Tel.: +351934264447
| | - Sandra Custódio
- Medical Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
- Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), 4410-406 Vila Nova de Gaia, Portugal
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20
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Paillaud E, Brugel L, Bertolus C, Baron M, Bequignon E, Caillet P, Schouman T, Lacau Saint Guily J, Périé S, Bouvard E, Laurent M, Salvan D, Chaumette L, de Decker L, Piot B, Barry B, Raynaud-Simon A, Sauvaget E, Bach C, Bizard A, Bounar A, Minard A, Aziz B, Chevalier E, Chevalier D, Gaxatte C, Malard O, Liuu E, Lacour S, Gregoire L, Lafont C, Canouï-Poitrine F. Effectiveness of Geriatric Assessment-Driven Interventions on Survival and Functional and Nutritional Status in Older Patients with Head and Neck Cancer: A Randomized Controlled Trial (EGeSOR). Cancers (Basel) 2022; 14:cancers14133290. [PMID: 35805060 PMCID: PMC9265581 DOI: 10.3390/cancers14133290] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Due to population ageing, there is an increasing number of older patients with head and neck cancers (HNC). Management of HNCs is complex. This population may be frailer than other patients with solid cancer. The Geriatric Assessment (GA) is a multidimensional diagnostic and therapeutic tool focused on frailty to propose a coordinated treatment plan and long-term follow-up. Several trials assessed the efficacy of GA-driven interventions on diverse outcomes but no recent randomized controlled trial demonstrated the impact on mortality, functional, or nutritional status as a primary outcome in this particular population. This trial highlighted several difficulties in implementation of geriatric interventions and suggested that the assessment of other models as co-management with oncologists and/or experienced practice nurses could be useful in clinical routine practice. Abstract This study assesses the efficacy of Geriatric Assessment (GA)-driven interventions and follow-up on six-month mortality, functional, and nutritional status in older patients with head and neck cancer (HNC). HNC patients aged 65 years or over were included between November 2013 and September 2018 by 15 Ear, Nose, and Throat (ENT) and maxillofacial surgery departments at 13 centers in France. The study was of an open-label, multicenter, randomized, controlled, and parallel-group design, with independent outcome assessments. The patients were randomized 1:1 to benefit from GA-driven interventions and follow-up versus standard of care. The interventions consisted in a pre-therapeutic GA, a standardized geriatric intervention, and follow-up, tailored to the cancer-treatment plan for 24 months. The primary outcome was a composite criterion including six-month mortality, functional impairment (fall in the Activities of Daily Living (ADL) score ≥2), and weight loss ≥10%. Among the patients included (n = 499), 475 were randomized to the experimental (n = 238) or control arm (n = 237). The median age was 75.3 years [70.4–81.9]; 69.5% were men, and the principal tumor site was oral cavity (43.9%). There were no statistically significant differences regarding the primary endpoint (n = 98 events; 41.0% in the experimental arm versus 90 (38.0%); p = 0.53), or for each criterion (i.e., death (31 (13%) versus 27 (11.4%); p = 0.48), weight loss of ≥10% (69 (29%) versus 65 (27.4%); p = 0.73) and fall in ADL score ≥2 (9 (3.8%) versus 13 (5.5%); p = 0.35)). In older patients with HNC, GA-driven interventions and follow-up failed to improve six-month overall survival, functional, and nutritional status.
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Affiliation(s)
- Elena Paillaud
- IMRB, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Est Créteil, F-94010 Créteil, France; (P.C.); (M.L.); (C.L.); (F.C.-P.)
- Département de Gériatrie, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75015 Paris, France
- Correspondence: ; Tel.: +33-156-09-33-10
| | - Lydia Brugel
- Service d’ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Intercommunal de Créteil, F-94010 Créteil, France; (L.B.); (E.B.)
| | - Chloe Bertolus
- Service de Chirurgie Maxillo-Faciale, Sorbonne Université, Hôpital Pitié Salpétrière, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75013 Paris, France; (C.B.); (T.S.)
| | - Melany Baron
- Service de Soins de Suites et de Réadaptation Gériatrique, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance-Publique Hôpitaux de Paris (AP-HP), F-94205 Ivry sur Seine, France;
| | - Emilie Bequignon
- Service d’ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Intercommunal de Créteil, F-94010 Créteil, France; (L.B.); (E.B.)
| | - Philippe Caillet
- IMRB, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Est Créteil, F-94010 Créteil, France; (P.C.); (M.L.); (C.L.); (F.C.-P.)
- Département de Gériatrie, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75015 Paris, France
| | - Thomas Schouman
- Service de Chirurgie Maxillo-Faciale, Sorbonne Université, Hôpital Pitié Salpétrière, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75013 Paris, France; (C.B.); (T.S.)
| | - Jean Lacau Saint Guily
- Département d’ORL, Sorbonne Université, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75020 Paris, France; (J.L.S.G.); (S.P.)
- Département d’ORL, J Lacau St Guily Exerce à l’Hôpital-Fondation Rothschild, S Périé Exerce à la Clinique Hartmann, F-92200 Neuilly Sur Seine, France
| | - Sophie Périé
- Département d’ORL, Sorbonne Université, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75020 Paris, France; (J.L.S.G.); (S.P.)
- Département d’ORL, J Lacau St Guily Exerce à l’Hôpital-Fondation Rothschild, S Périé Exerce à la Clinique Hartmann, F-92200 Neuilly Sur Seine, France
| | - Eric Bouvard
- Service de Gériatrie, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75020 Paris, France;
| | - Marie Laurent
- IMRB, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Est Créteil, F-94010 Créteil, France; (P.C.); (M.L.); (C.L.); (F.C.-P.)
- Département de Gériatrie, Hôpital Henri-Mondor, Assistance-Publique Hôpitaux de Paris (AP-HP), F-94010 Créteil, France
| | - Didier Salvan
- Service ORL et Cervico-Facial, Centre Hospitalier Sud Francilien, F-91100 Corbeil-Essonnes, France;
| | - Laurence Chaumette
- Service de Court Sejour Gériatrique, Centre Hospitalier Sud Francilien, F-91100 Corbeil-Essonnes, France;
| | - Laure de Decker
- Service de Gériatrie, Centre Hospitalier Universitaire de Nantes, F-44093 Nantes, France;
| | - Benoit Piot
- Service de Chirurgie Maxillo-Faciale et Stomatologie, Centre Hospitalier Universitaire de Nantes, F-44093 Nantes, France;
| | - Beatrix Barry
- Service ORL et Chirurgie Cervico-Faciale, Université de Paris, Hôpital Bichat, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75018 Paris, France;
| | - Agathe Raynaud-Simon
- Service de Gériatrie, Université Paris Cité, Hôpital Bichat, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75018 Paris, France;
| | - Elisabeth Sauvaget
- Service ORL et Chirurgie Cervico-Faciale, Groupe Hospitalier Paris-Saint Joseph, F-75014 Paris, France;
| | | | - Antoine Bizard
- Unité de Gériatrie Aigue, Hôpital Foch, F-92150 Suresnes, France;
| | - Abderrahmane Bounar
- Unité de Gériatrie Aigue, Centre Hospitalier Intercommunal Villeneuve-Saint-Georges, F-94190 Villeneuve-Saint-Georges, France;
| | - Aurelien Minard
- Service de Gériatrie, Hôpital Léopold Bellan, F-75014 Paris, France;
| | - Bechara Aziz
- Service ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Intercommunal Villeneuve-Saint-Georges, F-94190 Villeneuve-Saint-Georges, France;
| | - Eric Chevalier
- Service ORL et Chirurgie Cervico-Faciale, Groupement Hospitalier Intercommunal Le Raincy-Montfermeil, F-93370 Montfermeil, France;
| | - Dominique Chevalier
- Service ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire de Lille, Hôpital Huriez, F-59000 Lille, France;
| | - Cedric Gaxatte
- Service de Médecine Gériatrique, Centre Hospitalier Universitaire de Lille, F-59000 Lille, France;
| | - Olivier Malard
- Service d’ORL et de Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire de Nantes, F-44093 Nantes, France;
| | - Evelyne Liuu
- Service de Gériatrie, Centre Hospitalier Universitaire de Poitiers, F-86021 Poitiers, France;
| | - Sandrine Lacour
- Centre de Recherche Clinique, Centre Hospitalier Intercommunal de Créteil, F-94010 Créteil, France;
| | - Laetitia Gregoire
- Unité de Recherche Clinique (URC-Mondor), Hôpital Henri-Mondor, AP-HP, F-94010 Créteil, France;
| | - Charlotte Lafont
- IMRB, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Est Créteil, F-94010 Créteil, France; (P.C.); (M.L.); (C.L.); (F.C.-P.)
- Service de Santé Publique, Hôpital Henri-Mondor, Assistance-Publique Hôpitaux de Paris (AP-HP), F-94010 Créteil, France
| | - Florence Canouï-Poitrine
- IMRB, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Est Créteil, F-94010 Créteil, France; (P.C.); (M.L.); (C.L.); (F.C.-P.)
- Service de Santé Publique, Hôpital Henri-Mondor, Assistance-Publique Hôpitaux de Paris (AP-HP), F-94010 Créteil, France
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21
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DuMontier C, Uno H, Hshieh T, Zhou G, Chen R, Magnavita ES, Mozessohn L, Javedan H, Stone RM, Soiffer RJ, Driver JA, Abel GA. Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies. Haematologica 2022; 107:1172-1180. [PMID: 34551505 PMCID: PMC9052912 DOI: 10.3324/haematol.2021.278802] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/03/2021] [Indexed: 02/02/2023] Open
Abstract
We conducted a randomized controlled trial in older adults with hematologic malignancies to determine the impact of geriatrician consultation embedded in our oncology clinic alongside standard care. From February 2015 to May 2018, transplant-ineligible patients aged ≥75 years who presented for initial consultation for lymphoma, leukemia, or multiple myeloma at Dana-Farber Cancer Institute (Boston, MA, USA) were eligible. Pre-frail and frail patients, classified based on phenotypic and deficit-accumulation approaches, were randomized to receive either standard oncologic care with or without consultation with a geriatrician. The primary outcome was 1-year overall survival. Secondary outcomes included unplanned care utilization within 6 months of follow-up and documented end-of-life (EOL) goals-of-care discussions. Clinicians were surveyed as to their impressions of geriatric consultation. One hundred sixty patients were randomized to either geriatric consultation plus standard care (n=60) or standard care alone (n=100). The median age of the patients was 80.4 years (standard deviation = 4.2). Of those randomized to geriatric consultation, 48 (80%) completed at least one visit with a geriatrician. Consultation did not improve survival at 1 year compared to standard care (difference: 2.9%, 95% confidence interval: -9.5% to 15.2%, P=0.65), and did not significantly reduce the incidence of emergency department visits, hospital admissions, or days in hospital. Consultation did improve the odds of having EOL goals-of-care discussions (odds ratio = 3.12, 95% confidence interval: 1.03 to 9.41) and was valued by surveyed hematologic-oncology clinicians, with 62.9%-88.2% of them rating consultation as useful in the management of several geriatric domains.
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Affiliation(s)
- Clark DuMontier
- Division of Aging, Brigham and Women's Hospital, Boston, MA; New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston
| | - Hajime Uno
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston
| | - Tammy Hshieh
- Division of Aging, Brigham and Women's Hospital, Boston, MA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - Guohai Zhou
- Division of Aging, Brigham and Women's Hospital, Boston
| | - Richard Chen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - Emily S Magnavita
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | | | | | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - Robert J Soiffer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - Jane A Driver
- Division of Aging, Brigham and Women's Hospital, Boston, MA; New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston
| | - Gregory A Abel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston.
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22
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Saur NM, Davis BR, Montroni I, Shahrokni A, Rostoft S, Russell MM, Mohile SG, Suwanabol PA, Lightner AL, Poylin V, Paquette IM, Feingold DL. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Perioperative Evaluation and Management of Frailty Among Older Adults Undergoing Colorectal Surgery. Dis Colon Rectum 2022; 65:473-488. [PMID: 35001046 DOI: 10.1097/dcr.0000000000002410] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Nicole M Saur
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bradley R Davis
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Isacco Montroni
- Department of Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Armin Shahrokni
- Department of Medicine/Geriatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marcia M Russell
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Pasithorn A Suwanabol
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Amy L Lightner
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Vitaliy Poylin
- Division of Gastrointestinal and Oncologic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ian M Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Daniel L Feingold
- Section of Colorectal Surgery, Rutgers University, New Brunswick, New Jersey
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Abstract
Cancer is predominantly a disease of aging, and older adults represent the majority of cancer diagnoses and deaths. Older adults with cancer differ significantly from younger patients, leading to important distinctions in cancer treatment planning and decision-making. As a consequence, the field of geriatric oncology has blossomed and evolved over recent decades, as the need to bring personalized cancer care to older adults has been increasingly recognized and a focus of study. The geriatric assessment (GA) has become the cornerstone of geriatric oncology research, and the past year has yielded promising results regarding the implementation of GA into routine cancer treatment decisions and outcomes for older adults. In this article, we provide an overview of the field of geriatric oncology and highlight recent breakthroughs with the use of GA in cancer care. Further work is needed to continue to provide personalized, evidence-based care for each older adult with cancer.
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24
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Gajra A, Jeune-Smith Y, Fortier S, Feinberg B, Phillips E, Balanean A, Klepin HD. The Use and Knowledge of Validated Geriatric Assessment Instruments Among US Community Oncologists. JCO Oncol Pract 2022; 18:e1081-e1090. [PMID: 35263162 DOI: 10.1200/op.21.00743] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The use of a standardized geriatric assessment (GA) to inform treatment decisions in older adults with cancer improves quality of life, reduces treatment-related toxicity, and is guideline-recommended. This study aimed to assess community oncologists' knowledge and utilization of GAs. METHODS Between September 2019 and February 2020, practicing US-based oncologists were invited to attend live meetings and complete web-based surveys designed to collect information on treatment decision making and various practice-based challenges in oncology care. RESULTS Among the 349 oncologists surveyed, 74% practiced in a community setting. Sixty percent did not use a formal GA to inform treatment decisions for any of their older patients; the most common reasons for not using a GA were "Too cumbersome to incorporate into routine practice" (44%) and "Adds no value beyond the comprehensive history and physical exam" (36%). Validated GA instruments used in routine clinical practice included: Mini-Mental State Exam (54%), Comprehensive Geriatric Assessment (23%), Cancer and Aging Research Group toxicity tool (12%), and Chemotherapy Risk Assessment Scale for High-Age Patients tool (9%). Nineteen percent of oncologists were not aware of any validated GA instruments. Eastern Cooperative Oncology Group performance status and comorbidities were the most frequently used assessment factors to inform treatment decisions (88% and 73%, respectively). CONCLUSION Many oncologists have not incorporated GA tools because of perceptions that GAs are difficult to implement or do not add any value. Increasing education of the benefits of GA-directed therapy could help to increase GA utilization among community oncologists.
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Affiliation(s)
- Ajeet Gajra
- Cardinal Health Specialty Solutions, Dublin, OH
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25
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Kobayashi LC, Westrick AC, Doshi A, Ellis KR, Jones CR, LaPensee E, Mondul AM, Mullins MA, Wallner LP. New directions in cancer and aging: State of the science and recommendations to improve the quality of evidence on the intersection of aging with cancer control. Cancer 2022; 128:1730-1737. [PMID: 35195912 PMCID: PMC9007869 DOI: 10.1002/cncr.34143] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/27/2021] [Accepted: 01/20/2022] [Indexed: 12/29/2022]
Abstract
Background The global population of older cancer survivors is growing. However, the intersections of aging‐related health risks across the cancer control continuum are poorly understood, limiting the integration of aging into cancer control research and practice. The objective of this study was to review the state of science and provide future directions to improve the quality of evidence in 6 priority research areas in cancer and aging. Methods The authors identified priority research areas in cancer and aging through an evidence‐based Research Jam process involving 32 investigators and trainees from multiple disciplines and research centers in aging and cancer; then, they conducted a narrative review of the state of the science and future directions to improve the quality of evidence in these research areas. Priority research areas were defined as those in which gaps in scientific evidence or clinical practice limit the health and well‐being of older adults with cancer. Results Six priority research areas were identified: cognitive and physical functional outcomes of older cancer survivors, sampling issues in studies of older cancer survivors, risk and resilience across the lifespan, caregiver support and well‐being, quality of care for older patients with cancer, and health disparities. Evidence in these areas could be improved through the incorporation of bias reduction techniques into longitudinal studies of older cancer survivors, novel data linkage, and improved representation of older adults in cancer research. Conclusions The priority research areas and methodologies identified here may be used to guide interdisciplinary research and improve the quality of evidence on cancer and aging. The population of older cancer survivors is growing, yet the effects of aging‐related health risks across the cancer control continuum remain poorly understood. This article identifies research areas that may be used to guide interdisciplinary research and improve the quality of evidence on cancer and aging.
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Affiliation(s)
- Lindsay C Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Ashly C Westrick
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Aalap Doshi
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan
| | - Katrina R Ellis
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.,University of Michigan School of Social Work, Ann Arbor, Michigan
| | - Carly R Jones
- University of Michigan School of Social Work, Ann Arbor, Michigan
| | - Elizabeth LaPensee
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan
| | - Alison M Mondul
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Megan A Mullins
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.,Center for Improving Patient and Population Health, University of Michigan, Ann Arbor, Michigan
| | - Lauren P Wallner
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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26
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Chapman AE, Elias R, Plotkin E, Lowenstein LM, Swartz K. Models of Care in Geriatric Oncology. J Clin Oncol 2021; 39:2195-2204. [PMID: 34043453 PMCID: PMC10476747 DOI: 10.1200/jco.21.00118] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 12/27/2022] Open
Affiliation(s)
- Andrew E. Chapman
- Department of Medical Oncology, Sidney Kimmel Cancer Center/Jefferson Health, Philadelphia, PA
| | - Rawad Elias
- Department of Medical Oncology, Hartford Healthcare Cancer Institute, Hartford, CT
| | - Elana Plotkin
- Provider Education, Association of Community Cancer Centers, Rockville, MD
| | - Lisa M. Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kristine Swartz
- Division of Geriatrics and Palliative Care, Department of Family and Community Medicine, Sidney Kimmel Medical College/Jefferson Health, Philadelphia, PA
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27
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Nipp RD, Subbiah IM, Loscalzo M. Convergence of Geriatrics and Palliative Care to Deliver Personalized Supportive Care for Older Adults With Cancer. J Clin Oncol 2021; 39:2185-2194. [PMID: 34043435 PMCID: PMC8260927 DOI: 10.1200/jco.21.00158] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/07/2021] [Accepted: 02/23/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- Ryan D. Nipp
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ishwaria M. Subbiah
- Department of Palliative, Rehabilitation and Integrative Medicine, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
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28
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DuMontier C, Fillmore NR, Yildirim C, Cheng D, La J, Orkaby AR, Charest B, Cirstea D, Yellapragada S, Gaziano JM, Do N, Brophy MT, Kim DH, Munshi NC, Driver JA. Contemporary Analysis of Electronic Frailty Measurement in Older Adults with Multiple Myeloma Treated in the National US Veterans Affairs Healthcare System. Cancers (Basel) 2021; 13:cancers13123053. [PMID: 34207459 PMCID: PMC8233717 DOI: 10.3390/cancers13123053] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 12/31/2022] Open
Abstract
Simple Summary Geriatric and frailty assessment are recommended for all older adults with cancer undergoing systemic therapy, but assessments remain difficult to scale. The aim of this study was to use an electronic frailty index based on data from administrative claims and electronic health records—the Veterans Affairs Frailty Index (VA-FI-10)—to estimate frailty and its impact on older United States (US) military veterans treated for multiple myeloma (MM) throughout the national VA Healthcare System. We found frailty to be prevalent and strongly associated with mortality and hospitalizations—independently of age, race, and MM stage. We also showed that changing the way in which the VA-FI-10 is measured affects its classification of frailty for individual veterans but not its association with mortality. These findings support the VA-FI-10’s use in research investigating outcomes in frail veterans treated with contemporary MM therapies. We provide further insights into the VA-FI-10’s potential use in clinical practice. Abstract Electronic frailty indices based on data from administrative claims and electronic health records can be used to estimate frailty in large populations of older adults with cancer where direct frailty measures are lacking. The objective of this study was to use the electronic Veterans Affairs Frailty Index (VA-FI-10)—developed and validated to measure frailty in the national United States (US) VA Healthcare System—to estimate the prevalence and impact of frailty in older US veterans newly treated for multiple myeloma (MM) with contemporary therapies. We designed a retrospective cohort study of 4924 transplant-ineligible veterans aged ≥ 65 years initiating MM therapy within VA from 2004 to 2017. Initial MM therapy was measured using inpatient and outpatient treatment codes from pharmacy data in the VA Corporate Data Warehouse. In total, 3477 veterans (70.6%) were classified as frail (VA-FI-10 > 0.2), with 1510 (30.7%) mildly frail (VA-FI-10 > 0.2–0.3), 1105 (22.4%) moderately frail (VA-FI-10 > 0.3–0.4), and 862 (17.5%) severely frail (VA-FI-10 > 0.4). Survival and time to hospitalization decreased with increasing VA-FI-10 severity (log-rank p-value < 0.001); the VA-FI-10 predicted mortality and hospitalizations independently of age, sociodemographic variables, and measures of disease risk. Varying data sources and assessment periods reclassified frailty severity for a substantial portion of veterans but did not substantially affect VA-FI-10’s association with mortality. Our study supports use of the VA-FI-10 in future research involving older veterans with MM and provides insights into its potential use in identifying frailty in clinical practice.
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Affiliation(s)
- Clark DuMontier
- New England Geriatrics Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA 02130, USA; (C.D.); (A.R.O.)
- Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Harvard Medical School, Boston, MA 02115, USA; (N.R.F.); (N.C.M.)
| | - Nathanael R. Fillmore
- Harvard Medical School, Boston, MA 02115, USA; (N.R.F.); (N.C.M.)
- VA Boston CSP Center, Boston, MA 02130, USA; (N.D.); (M.T.B.)
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA 02130, USA; (C.Y.); (J.L.); (B.C.)
- VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA;
| | - Cenk Yildirim
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA 02130, USA; (C.Y.); (J.L.); (B.C.)
- VA Boston Healthcare System, Boston, MA 02130, USA
| | - David Cheng
- Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Jennifer La
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA 02130, USA; (C.Y.); (J.L.); (B.C.)
- VA Boston Healthcare System, Boston, MA 02130, USA
| | - Ariela R. Orkaby
- New England Geriatrics Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA 02130, USA; (C.D.); (A.R.O.)
- Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Harvard Medical School, Boston, MA 02115, USA; (N.R.F.); (N.C.M.)
| | - Brian Charest
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA 02130, USA; (C.Y.); (J.L.); (B.C.)
- VA Boston Healthcare System, Boston, MA 02130, USA
| | - Diana Cirstea
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA;
| | - Sarvari Yellapragada
- Michael E. Debakey VA Medical Center and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA;
| | - John Michael Gaziano
- Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Harvard Medical School, Boston, MA 02115, USA; (N.R.F.); (N.C.M.)
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA 02130, USA; (C.Y.); (J.L.); (B.C.)
- VA Boston Healthcare System, Boston, MA 02130, USA
| | - Nhan Do
- VA Boston CSP Center, Boston, MA 02130, USA; (N.D.); (M.T.B.)
- Boston University School of Medicine, Boston, MA 02118, USA
| | - Mary T. Brophy
- VA Boston CSP Center, Boston, MA 02130, USA; (N.D.); (M.T.B.)
- Boston University School of Medicine, Boston, MA 02118, USA
| | - Dae H. Kim
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA 02131, USA;
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Nikhil C. Munshi
- Harvard Medical School, Boston, MA 02115, USA; (N.R.F.); (N.C.M.)
- VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA;
| | - Jane A. Driver
- New England Geriatrics Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA 02130, USA; (C.D.); (A.R.O.)
- Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Harvard Medical School, Boston, MA 02115, USA; (N.R.F.); (N.C.M.)
- Correspondence: ; Tel.: +1-857-364-2560
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29
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Rocque G, Wheeler S, Williams GR. The missing voice in multidisciplinary tumor boards. J Geriatr Oncol 2021; 12:1157-1158. [PMID: 33722503 DOI: 10.1016/j.jgo.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Gabrielle Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Stephanie Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA; Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, USA.
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30
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Di M, Huntington SF, Olszewski AJ. Challenges and Opportunities in the Management of Diffuse Large B-Cell Lymphoma in Older Patients. Oncologist 2020; 26:120-132. [PMID: 33230948 DOI: 10.1002/onco.13610] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
Most patients with diffuse large B-cell lymphoma (DLBCL) are diagnosed at age 60 years or older. Challenges to effective therapy among older individuals include unfavorable biologic features of DLBCL, geriatric vulnerabilities, suboptimal treatment selection, and toxicities of cytotoxic chemotherapy. Wider application of geriatric assessments may help identify fit older patients who benefit from standard immunochemotherapy without unnecessary dose reductions. Conversely, attenuated regimens may provide a better balance of risk and benefit for selected unfit or frail patients. Supportive care with the use of corticosteroid-based prephase, prophylactic growth factors, and early institution of supportive and palliative care can help maximize treatment tolerance. Several novel or emerging therapies have demonstrated favorable toxicity profiles, thus facilitating effective treatment for elderly patients. In the relapsed or refractory setting, patients who are not candidates for stem cell transplantation can benefit from newly approved options including polatuzumab vedotin-based combinations or tafasitamab plus lenalidomide, which may have higher efficacy and/or lower toxicity than historical chemotherapy regimens. Chimeric antigen receptor T-cell therapy has been successfully applied to older patients outside of clinical trials. In the first-line setting, emerging immunotherapy options (bispecific antibodies) and targeted therapies (anti-CD20 antibodies combined with lenalidomide and/or B-cell receptor inhibitors) may provide chemotherapy-free approaches for DLBCL. Enrolling older patients in clinical trials will be paramount to fully examine potential efficacy and toxicity of these strategies. In this review, we discuss recent advances in fitness stratification and therapy that have expanded curative options for older patients, as well as future opportunities to improve outcomes in this population. IMPLICATIONS FOR PRACTICE: Management of diffuse large B-cell lymphoma in older patients poses challenges due to aggressive disease biology and geriatric vulnerability. Although R-CHOP remains standard first-line treatment, geriatric assessment may help evaluate patients' fitness for immunochemotherapy. Corticosteroid prephase, prophylactic growth factors, and early palliative care can improve tolerance of treatment. Novel salvage options (polatuzumab vedotin-based combinations, tafasitamab plus lenalidomide) or chimeric antigen receptor T-cell therapy should be considered in the relapsed or refractory setting for patients ineligible for stem cell transplantation. Emerging immunotherapies (bispecific antibodies) and targeted therapies provide potential first-line chemotherapy-free approaches, which need to be rigorously assessed in clinical trials that involve geriatric patients.
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Affiliation(s)
- Mengyang Di
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Scott F Huntington
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Adam J Olszewski
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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