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Caba Y, Dharmarajan K, Gillezeau C, Ornstein KA, Mazumdar M, Alpert N, Schwartz RM, Taioli E, Liu B. The Impact of Dementia on Cancer Treatment Decision-Making, Cancer Treatment, and Mortality: A Mixed Studies Review. JNCI Cancer Spectr 2021; 5:pkab002. [PMID: 34056540 PMCID: PMC8152697 DOI: 10.1093/jncics/pkab002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/21/2020] [Accepted: 11/16/2020] [Indexed: 11/12/2022] Open
Abstract
Dementia and cancer occur commonly in older adults. Yet, little is known about the effect of dementia on cancer treatment and outcomes in patients diagnosed with cancer, and no guidelines exist. We performed a mixed studies review to assess the current knowledge and gaps on the impact of dementia on cancer treatment decision-making, cancer treatment, and mortality. A search in PubMed, Medline, and PsycINFO identified 55 studies on older adults with a dementia diagnosis before a cancer diagnosis and/or comorbid cancer and dementia published in English from January 2004 to February 2020. We described variability using range in quantitative estimates, ie, odds ratios (ORs), hazard ratios (HRs), and risk ratios (RR) when appropriate and performed narrative review of qualitative data. Patients with dementia were more likely to receive no curative treatment (including hospice or palliative care) (OR, HR, and RR range = 0.40-4.4, n = 8), while less likely to receive chemotherapy (OR and HR range = 0.11-0.68, n = 8), radiation (OR range = 0.24-0.56, n = 2), and surgery (OR range = 0.30-1.3, n = 4). Older adults with cancer and dementia had higher mortality than those with cancer alone (HR and OR range = 0.92-5.8, n = 33). Summarized findings from qualitative studies consistently revealed that clinicians, caregivers, and patients tended to prefer less aggressive care and gave higher priority to quality of life over life expectancy for those with dementia. Current practices in treatment-decision making for patients with both cancer and dementia are inconsistent. There is an urgent need for treatment guidelines for this growing patient population that considers patient and caregiver perspectives.
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Affiliation(s)
- Yaelin Caba
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kavita Dharmarajan
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christina Gillezeau
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Healthcare Delivery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naomi Alpert
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rebecca M Schwartz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Emanuela Taioli
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Zavaroni M, Oudé-Engberink A, Antoine V. French general practitioners' attitude towards breast cancer in older women: A qualitative study. J Geriatr Oncol 2021; 12:1076-1084. [PMID: 34045153 DOI: 10.1016/j.jgo.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/02/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In France, general practitioners (GPs) are usually the first-line healthcare contact for breast cancer (BC) screening/diagnosis in older women, information about therapies, access to cancer specialists, management of comorbidities and follow-up. GPs' practices may influence the factors involved in the unfavorable prognosis of BC in older patients: delay in diagnosis, insufficiently active treatment and the impact of associated morbidities. OBJECTIVE The aim of this study was to explore GPs' experience, to understand the factors which shape their care of older women with BC and to identify ways in which this care might be improved. METHOD This was a two-part qualitative study among GPs following COREQ guidelines. We analysed themes arising from group and semi-directive personal interviews. RESULTS GPs had diverse attitudes caused by 1/ the GPs' professional values, in response to their mission for local referral, their overall knowledge of the patient's context and wishes; 2/ the impact of comorbidities; 3/ the GPs' own experiences (confrontation with the disease, emotional ties established with the patient, embarrassment about examinations); 4/ prejudicial connotations (therapies judged as being too aggressive). GPs expressed interest for training, for inclusion in a coordinated multidisciplinary organisation with oncologists and geriatricians, confirming the GP's position (to better inform their patients, participate in the therapeutic decision and ensure the continuity of care). CONCLUSION To improve their care of older patients with BC, GPs would welcome improved relationships with geriatricians and oncologists, more information support and a more clearly defined role in the geriatric oncology care pathway.
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Affiliation(s)
- Marine Zavaroni
- Department of Geriatric Medicine, CHU Nimes, Univ Montpellier, Nîmes, France
| | - Agnès Oudé-Engberink
- Department of General Medicine, Univ Montpellier, Montpellier, France; CEPS platform, site Saint-Charles, 34000 Montpellier, France; Maison de santé pluri-professionnelle universitaire Avicenne, 2 rue Ibn Sinai dit Avicenne, 66300 Cabestany, France; Institut Desbrest d'Epidemiologie et de Sante Publique, IDESP UMR UA11 INSERM - Univ. Montpellier, Montpellier, France
| | - Valéry Antoine
- Department of Geriatric Medicine, CHU Nimes, Univ Montpellier, Nîmes, France; Institut Desbrest d'Epidemiologie et de Sante Publique, IDESP UMR UA11 INSERM - Univ. Montpellier, Montpellier, France.
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