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Oliveira RF, Oliveira AI, Cruz AS, Ribeiro O, Afreixo V, Pimentel F. Polypharmacy and drug interactions in older patients with cancer receiving chemotherapy: associated factors. BMC Geriatr 2024; 24:557. [PMID: 38918696 PMCID: PMC11201315 DOI: 10.1186/s12877-024-05135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Polypharmacy in older adults with cancer receiving chemotherapy leads to increased risks of drug interactions, translating in potential hazardous health outcomes. This study aims to assess the prevalence of polypharmacy, drug-drug interactions (DDIs), and severe-drug interactions (SDIs) in older patients with cancer. Antineoplastic agents (ANAs) involvement and possible risk contexts (comorbidities with cardiac risk, and high-risk medications) were also analysed. METHODS Observational study with older adults (≥ 65 years) diagnosed with cancer, who were treated with antineoplastic agents (ANAs); it was conducted in three hospitals from the north of Portugal. Data collection was obtained using self-reports and medical records. DDIs were identified and classified using Micromedex® software. Descriptive and association analyze statistics were performed. Statistical hypothesis tests with p value less than 0.05 were considered significant. All statistical procedures and analysis were performed with R version 4.1.3. RESULTS We enrolled 552 patients. Polypharmacy prevalence was 88.40%; 76.45% and 56.16% of the patients presented with DDIs and SDIs, respectively. SDIs with ANAs were found in 21.20% of the patients. High-risk medications were associated with a higher risk of polypharmacy, DDIs, and SDIs. Polypharmacy and DDIs were higher in patients with hypertension or diabetes. SDIs were higher in patients with diabetes. CONCLUSION Polypharmacy, potential DDIs and SDIs were highly prevalent in older adults with cancer. A careful review of the medication administered is necessary to decrease it. These findings warrant further research to optimize medication in this population and decrease problems related to medication, which may lead to emergency room visits and hospitalisations, compromising patient safety and/or ongoing treatments.
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Affiliation(s)
- Rita F Oliveira
- University of Aveiro, Aveiro, Portugal.
- ESS, Polytechnic of Porto, Porto, Portugal.
- Center for Health Technology and Services Researchat the Associate Laboratory RISE - Health Research Network (CINTESIS@RISE), Department of Education and Psychology, University of Aveiro (UA), Aveiro, Portugal.
| | - Ana I Oliveira
- REQUIMTE/LAQV, ESS, Polytechnic of Porto, Porto, Portugal
| | | | - Oscar Ribeiro
- Center for Health Technology and Services Researchat the Associate Laboratory RISE - Health Research Network (CINTESIS@RISE), Department of Education and Psychology, University of Aveiro (UA), Aveiro, Portugal
| | - Vera Afreixo
- Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics, University of Aveiro (UA), Aveiro, Portugal
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Santoro R, Goglia M, Brighi M, Curci FP, Amodio PM, Giannotti D, Goglia A, Mazzetti J, Antolino L, Bovino A, Zampaletta C, Levi Sandri GB, Ruggeri EM. Exploring 6 years of colorectal cancer surgery in rural Italy: insights from 648 consecutive patients unveiling successes and challenges. Updates Surg 2024; 76:963-974. [PMID: 38627306 PMCID: PMC11129985 DOI: 10.1007/s13304-024-01829-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: 01/02/2024] [Accepted: 03/12/2024] [Indexed: 05/28/2024]
Abstract
The multidisciplinary management of patients suffering from colorectal cancer (CRC) has significantly increased survival over the decades and surgery remains the only potentially curative option for it. However, despite the implementation of minimally invasive surgery and ERAS pathway, the overall morbidity and mortality remain quite high, especially in rural populations because of urban - rural disparities. The aim of the study is to analyze the characteristics and the surgical outcomes of a series of unselected CRC patients residing in two similar rural areas in Italy. A total of 648 consecutive patients of a median age of 73 years (IQR 64-81) was enrolled between 2017 and 2022 in a prospective database. Emergency admission (EA) was recorded in 221 patients (34.1%), and emergency surgery (ES) was required in 11.4% of the patients. Tumor resection and laparoscopic resection rates were 95.0% and 63.2%, respectively. The median length of stay was 8 days. The overall morbidity and mortality rates were 23.5% and 3.2%, respectively. EA was associated with increased median age (77.5 vs. 71 ys, p < 0.001), increased mean ASA Score (2.84 vs. 2.59; p = 0.002) and increased IV stage disease rate (25.3% vs. 11.5%, p < 0.001). EA was also associated with lower tumor resection rate (87.3% vs. 99.1%, p < 0.001), restorative resection rate (71.5 vs. 89.7%, p < 0.001), and laparoscopic resection rate (36.2 vs. 72.6%, p < 0.001). Increased mortality rates were associated with EA (7.2% vs. 1.2%, p < 0.001), ES (11.1% vs. 2.0%, p < 0.001) and age more than 80 years (5.8% vs. 1.9%, p < 0.001). In rural areas, high quality oncologic care can be delivered in CRC patients. However, the surgical outcomes are adversely affected by a still too high proportion of emergency presentation of elderly and frail patients that need additional intensive care supports beyond the surgical skill and alternative strategies for earlier detection of the disease.
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Affiliation(s)
- Roberto Santoro
- Unit of Oncologic and General Surgery, Belcolle District Hospital, Viterbo, Italy
| | - Marta Goglia
- Unit of Oncologic and General Surgery, Belcolle District Hospital, Viterbo, Italy.
- PhD in Training in Translational Medicine and Oncology, Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
| | - Manuela Brighi
- Unit of Oncologic and General Surgery, Belcolle District Hospital, Viterbo, Italy
| | - Fabio Pio Curci
- Unit of Oncologic and General Surgery, Belcolle District Hospital, Viterbo, Italy
| | - Pietro Maria Amodio
- Unit of Oncologic and General Surgery, Belcolle District Hospital, Viterbo, Italy
| | - Domenico Giannotti
- Unit of Oncologic and General Surgery, Belcolle District Hospital, Viterbo, Italy
| | - Angelo Goglia
- Unit of Oncologic and General Surgery, Belcolle District Hospital, Viterbo, Italy
| | - Jacopo Mazzetti
- Unit of Oncologic and General Surgery, Belcolle District Hospital, Viterbo, Italy
| | - Laura Antolino
- Unit of Oncologic and General Surgery, Belcolle District Hospital, Viterbo, Italy
| | - Antonio Bovino
- Unit of Oncologic and General Surgery, Belcolle District Hospital, Viterbo, Italy
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Ioffe D, Bhatia-Patel SC, Gandhi S, Hamad EA, Dotan E. Cardiovascular Concerns, Cancer Treatment, and Biological and Chronological Aging in Cancer: JACC Family Series. JACC CardioOncol 2024; 6:143-158. [PMID: 38774000 PMCID: PMC11103051 DOI: 10.1016/j.jaccao.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 05/24/2024] Open
Abstract
Cardiovascular disease (CVD) and cancer are leading causes of death globally, particularly among the rapidly growing population of older adults (OAs). CVD is a leading cause of mortality among cancer survivors, often accelerated by cancer treatments associated with short- or long-term cardiotoxicity. Moreover, there is a dynamic relationship among CVD, cancer, and aging, characterized by shared risk factors and biological hallmarks, that plays an important role in caring for OAs, optimizing treatment approaches, and developing preventive strategies. Assessment of geriatric domains (eg, functional status, comorbidities, cognition, polypharmacy, nutritional status, social support, psychological well-being) is critical to individualizing treatment of OAs with cancer. The authors discuss considerations in caring for an aging population with cancer, including methods for the assessment of OAs with CVD and/or cardiovascular risk factors planned for cancer therapy. Multidisciplinary care is critical in optimizing patient outcomes and maintaining quality of life in this growing vulnerable population.
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Affiliation(s)
- Dina Ioffe
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | - Sakshi Gandhi
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Eman A. Hamad
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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Doi A, Mizukami T, Takeda H, Umemoto K, Arai H, Horie Y, Izawa N, Ogura T, Sunakawa Y. Clinical utility of geriatric assessment tools in older patients with gastrointestinal cancer. Front Oncol 2023; 13:1110236. [PMID: 37324017 PMCID: PMC10264801 DOI: 10.3389/fonc.2023.1110236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Background Geriatric 8 (G8) and instrumental activities of daily living (IADL) are recommended to predict overall survival (OS) or risk of serious adverse events (SAEs) in older cancer patients. However, the clinical utility is relatively unknown in older patients suffering malnutrition with gastrointestinal (GI) cancer, including gastric cancer (GC) and pancreatic cancer (PC). Materials and methods We retrospectively included patients aged ≥65 years with GC, PC, and colorectal cancer (CRC) who received a G8 questionnaire at first visit from April 2018 to March 2020. The associations between G8/IADL and safety or OS were assessed in patients with advanced/unresectable tumors. Results Of 207 patients (median age: 75 years), the median G8 score was 10.5 and normal G8 score rate was 6.8%. Both the median G8 score and normal G8 (>14) score rate numerically increased in the order of GC < PC < CRC. There was no clear association between the G8 standard cutoff value of 14 and SAEs or OS. However, OS was significantly longer in patients with G8 >11 than in those with G8 ≤11 (19.3 vs. 10.5 months, p = 0.0017). Furthermore, OS was significantly better in patients with normal IADL than in those with abnormal IADL (17.6 vs. 11.4 months, p = 0.049). Conclusion The G8 cutoff value of 14 would not be clinically useful in patients with GI cancer for predicting OS or SAEs; however, the cutoff value of 11 and IADL may be useful to predict OS for older patients with GI cancers including GC and PC.
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Affiliation(s)
- Ayako Doi
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
| | - Takuro Mizukami
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
- Nippon Telegraph and Telephone Corporation (NTT) Medical Center Tokyo, Department of Medical Oncology, Tokyo, Japan
| | - Hiroyuki Takeda
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
| | - Kumiko Umemoto
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
| | - Hiroyuki Arai
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
| | - Yoshiki Horie
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
| | - Naoki Izawa
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
| | - Takashi Ogura
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
- Kawasaki Municipal Tama Hospital, Department of Clinical Oncology, Kawasaki, Japan
| | - Yu Sunakawa
- St. Marianna University School of Medicine, Department of Clinical Oncology, Kawasaki, Japan
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Ioffe D, Dotan E. Guidance for Treating the Older Adults with Colorectal Cancer. Curr Treat Options Oncol 2023; 24:644-666. [PMID: 37052812 DOI: 10.1007/s11864-023-01071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 04/14/2023]
Abstract
OPINION STATEMENT The need for evidence-based data in the rapidly growing group of older patients is vast and more elderly-specific studies are desperately needed, for which there is clear demand from both patients and providers. Notably, many of the studies discussed in this review included unplanned subset analyses based on age and/or were not originally stratified by age; therefore, these data, particularly overall survival data, need to be interpreted with some caution as they may not be statistically valid based on the initial trial design and statistical plan. As we await data from ongoing elderly-specific trials, our recommendation for managing older patients with CRC should include geriatric screening tools (e.g., CSGA, VES-13, G8, CARG, CRASH) to help guide treatment adjustments for improved tolerability without sacrificing efficacy. For patients with a positive screen for significant geriatric concerns, a full geriatric assessment is recommended to guide treatment approach and supportive care. Prior data support the use of all approved medications for CRC in older adults who are fit; however, treatment breaks and dose attenuation with potential escalation are reasonable options for these patients. Ultimately, management decisions in the care of older adults with mCRC must be made through shared decision-making with the patient with consideration for the patient's functional status, comorbidities, goals of care, social support, as well as potential toxicities and possible effect on QoL.
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Affiliation(s)
- Dina Ioffe
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
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Dotan E, Catalano P, Lenchik L, Boutin R, Yao X, Marques HS, Ioffe D, Zhen DB, Li D, Wagner LI, Simon MA, Wong TZ, O'Dwyer PJ. The GIANT trial (ECOG-ACRIN EA2186) methods paper: A randomized phase II study of gemcitabine and nab-paclitaxel compared with 5-fluorouracil, leucovorin, and liposomal irinotecan in older patients with treatment-naïve metastatic pancreatic cancer - defining a new treatment option for older vulnerable patients. J Geriatr Oncol 2023; 14:101474. [PMID: 36963200 PMCID: PMC10425127 DOI: 10.1016/j.jgo.2023.101474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/06/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Pancreatic cancer is the fourth leading cause of cancer-related death in the US with an increasing incidence in older adults (OA) over age 70. There are currently no treatment guidelines for OA with metastatic pancreatic cancer (mPCA) and selecting a chemotherapy regimen for these patients is subjective, based largely on chronologic age and performance status (PS). Geriatric screening tools provide a more objective and accurate evaluation of a patient's overall health but have not yet been validated in patient selection for mPCA treatment. This study aims to elucidate the optimal chemotherapy treatment of vulnerable OA with mPCA and understand the geriatric factors that affect outcomes in this population. METHODS/DESIGN The GIANT (ECOG-ACRIN EA2186) study is multicenter, randomized phase II trial enrolling patients over age 70 with newly diagnosed mPCA. This study utilizes a screening geriatric assessment (GA) which characterizes patients as fit, vulnerable, or frail. Patients with mild abnormalities in functional status and/or cognition, moderate comorbidities, or over age 80 are considered vulnerable. Enrolled patients are randomized to one of two dose-reduced treatment regimens (gemcitabine/nab-paclitaxel every other week, or dose-reduced 5-fluoruracil (5FU)/ liposomal irinotecan (nal-IRI) every other week). GA and quality of life (QoL) evaluations are completed prior to treatment initiation and at each disease evaluation. Overall survival (OS) is the primary endpoint, with secondary endpoints including progression free survival (PFS) and objective response rate (ORR). Enrolled patients will be stratified by age (70-74 vs ≥75) and ECOG PS (0-1 vs 2). Additional endpoints of interest for OA include evaluation of risk factors identified through GA, QoL evaluation, and toxicities of interest for older adults. Correlative studies include assessment of pro-inflammatory biomarkers of aging in the blood (IL-6, CRP) and imaging evaluation of sarcopenia as predictors of treatment tolerance. DISCUSSION The GIANT study is the first randomized, prospective national trial evaluating vulnerable OA with mPCA aimed at developing a tailored treatment approach for this patient population. This trial has the potential to establish a new way of objectively selecting vulnerable OA with mPCA for modified treatment and to establish a new standard of care in this growing patient population. TRIAL REGISTRATION This trial is registered with ClinicalTrial.gov Identifier NCT04233866.
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Affiliation(s)
- Efrat Dotan
- Department of Hematology and Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA.
| | - Paul Catalano
- Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Robert Boutin
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Xin Yao
- ThedaCare Regional Cancer Center-Appelton, WI, USA
| | - Helga S Marques
- Department of Biostatistics and Center for Statistical Sciences, Brown University, Providence, RI, USA
| | - Dina Ioffe
- Department of Hematology and Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - David B Zhen
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA; Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Daneng Li
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Lynne I Wagner
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Center for Health Equity Transformation, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Terence Z Wong
- Department of Radiology, Division of Nuclear Medicine and Radiotheranostics, Duke University Medical Center, Durham, NC, USA
| | - Peter J O'Dwyer
- University of Pennsylvania and Abramson Cancer Center, Philadelphia, PA, USA
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Lin Y, Xu Y, Wang C, Song Y, Xu Y, Zhang X, Huang X, Sun Q. Geriatric assessment for older patients with breast cancer: A single-institution study. Front Oncol 2023; 13:1031682. [PMID: 36910654 PMCID: PMC9996328 DOI: 10.3389/fonc.2023.1031682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Although geriatric assessment (GA) has been used for a long time in the field of geriatrics and internal medicine, there are few studies on its application in the field of breast surgery. Therefore, the utility of specific GA domains for the assessment of older patients with breast cancer remains unclear. The aim of the present study was to evaluate the association between specific GA domains and the survival rate of older patients with breast cancer. Methods We used the database of Peking Union Medical College Hospital to identify older patients who were newly diagnosed with breast cancer between 2012 and 2018 and retrospectively analysed the data of 541 patients aged ≥65 years. Patients with metastatic cancer and those with missing vital status data were excluded. The primary outcomes were overall survival (OS) and breast cancer-specific survival. The GA domains used in this study included functional status, comorbidities, and psychological state. Multivariate regression analysis was used to estimate hazard ratios for these three domains. Results After a median follow-up of 72 months, we observed a significant relationship between functional impairment and mortality (adjusted HR: 3.06, 95% confidence interval [CI]: 1.83-5.10, P<0.001). Similarly, patients with severe comorbidities (adjusted HR: 2.35; 95% CI: 1.16-4.75, P=0.017) and an impaired psychological state (adjusted HR: 2.82, 95% CI: 1.45-5.50, P=0.002) showed worse OS rates. Accordingly, addition of the three GA domains to the basic model, which included age, tumour stage, lymph node stage, and intrinsic molecular subtype as baseline variables, yielded higher C-statistics for mortality analysis (from 0.713 to 0.740). Conclusion To our knowledge, this is the first study to include specific GA domains in a prognostic model for older patients with breast cancer in China. Three domains, namely functional status, comorbidities, and psychological state, should be considered for survival analyses in this particular population. The full model including these three GA domains may be more accurate in predicting the survival of older patients with breast cancer.
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Affiliation(s)
- Yan Lin
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Ying Xu
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Changjun Wang
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Yu Song
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Yali Xu
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Xiaohui Zhang
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Xin Huang
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Qiang Sun
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
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Park SY, Kim Y, Hong H. Patient-reported distress and problems among elderly patients with hematological malignancy in Korea. Support Care Cancer 2022; 30:9019-9027. [PMID: 35948847 DOI: 10.1007/s00520-022-07315-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Treatment for hematological malignancies (HMs) and functional decline associated with age can cause distress in elderly patients with HMs. However, information about the nature and effects of distress in this population is scarce. Therefore, this study examined the level of distress, its source, and the practical/familial/physical/emotional problems among elderly patients with HMs. METHODS We conducted a cross-sectional study of patients with HMs aged ≥ 65 years who visited an outpatient clinic at a tertiary medical center in Korea between November 2019 and March 2020. Patient-reported distress and problems were measured using the distress thermometer (DT) and 39-item Problem List by the National Comprehensive Cancer Network. Descriptive statistics, χ2 test or Fisher's exact test, and multivariate logistic regression analyses were conducted (N = 132). RESULTS In total, 62.1% of patients had moderate to severe distress (DT score ≥ 4), experiencing an average of nine problems. Significant sources of distress on multivariate logistic analysis included problems with transportation, depression, and constipation, accounting for 47% of distress variance. Most patients had physical (97.0%) or emotional problems (79.5%). Among these, fatigue (60.6%), worry (59.8%), tingling (59.8%), difficulty with mobility (47.0%), and memory/concentration (40.2%) were the most frequently reported problems. CONCLUSIONS Elderly patients with HMs have a high burden of distress, which is affected by different sources, compared with younger patients with solid tumors. Thus, in this population, assessment and management of distress need to be conducted considering the unique features of their source and burden. Further research on distress should consider the cancer type and population age.
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Affiliation(s)
- Sun-Young Park
- Graduate School, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.,Division of New Health Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, 400 Neungdong-ro, Gwangjin-gu, Seoul, 04554, Korea
| | - Yoonjoo Kim
- Department of Nursing, College of Healthcare Sciences, Far East University, Eumseong-gun, Chungcheongbuk-do, Seoul, South Korea, 27601
| | - Hyunju Hong
- National Cancer Center, 323 Ilsan-ro, Goyang-si, Gyeonggi-do, 10408, Korea.
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Osaki K, Morishita S, Takami S, Sakai Y, Kamimura A, Shindo A, Kawata E. Quality of life of patients with hematological malignancies and factors affecting health state utility values. Support Care Cancer 2022; 30:5319-5327. [PMID: 35278136 DOI: 10.1007/s00520-022-06958-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 03/07/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE It is well studied that physical function and social background affect the quality of life (QoL) of cancer patients. However, differences in QoL by age and factors affecting health state utility values (HSUV) of patients with hematological malignancies have not yet been sufficiently investigated. Our aim is to investigate the factors that affect QoL and HSUV in such patients. METHODS A total of 32 patients with hematological malignancies on outpatient chemotherapy were included. QoL and HSUV were evaluated using the EuroQol-5 Dimension 5-level (EQ-5D-5L). Physical function was assessed using grip strength, knee extension strength, 6-min walking distance, and Short Physical Performance Battery (SPPB). Fatigue was assessed using Brief Fatigue Inventory (BFI), and nutritional status was assessed using Mini Nutritional Assessment-Short Form (MNA-SF). RESULTS In the EQ-5D-5L, a high percentage of the patients were aware of mobility problems and pain/discomfort, and mobility problems were more common in the older-aged group (≥ 65 years old, n = 16) than in the middle-aged group (< 65 years old, n = 16). In addition, the older-aged group showed lower HSUV and physical function. SPPB (β = 0.38, p < 0.01), BFI (β = - 0.58, p < 0.01), and MNA-SF (β = 0.29, p = 0.02) were independent factors affecting HSUV (adjusted R2 = 0.65, p < 0.01). BFI was correlated with HSUV in both older and middle-aged groups. CONCLUSION Comprehensive supports, to improve lower extremity function, fatigue, and nutritional status, are required to augment QoL and HSUV in patients with hematological malignancies.
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Affiliation(s)
- Keiichi Osaki
- Department of Rehabilitation, Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
| | - Shinichiro Morishita
- Department of Physical Therapy, School of Health Sciences, Fukushima Medical University, 10-6 Sakaemachi, Fukushima, Fukushima, 960-8516, Japan.
| | - Suzuho Takami
- Department of Rehabilitation, Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
| | - Yuki Sakai
- Department of Rehabilitation, Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
| | - Akiho Kamimura
- Department of Rehabilitation, Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
| | - Atsushi Shindo
- Department of Rehabilitation, Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
| | - Eri Kawata
- Department of Hematology, Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
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Fasano M, D’Onofrio I, Belfiore MP, Angrisani A, Caliendo V, Della Corte CM, Pirozzi M, Facchini S, Caterino M, Guida C, Nardone V, Reginelli A, Cappabianca S. Head and Neck Squamous Cell Carcinoma in Elderly Patients: Role of Radiotherapy and Chemotherapy. Cancers (Basel) 2022; 14:cancers14030472. [PMID: 35158740 PMCID: PMC8833743 DOI: 10.3390/cancers14030472] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 01/01/2023] Open
Abstract
Simple Summary The focus of this review deals with the management of elderly patients with head and neck squamous cell carcinoma, discussing the role of clinical management, geriatric evaluation and therapeutic approaches (radiation therapy and systemic therapies). Abstract Head and neck squamous cell carcinomas (HNSCC) constitute the sixth most common malignancy worldwide, with approximately 25–40% of the diagnosed patients older than 70 years. HNSCC patients are often frail and frequently have multiple comorbidities due to their unhealthy lifestyle, and evidence suggests that older patients may receive less aggressive and suboptimal treatment than younger patients with the same disease status. The aim of this review is to depict and summarize the evidence regarding the different strategies that can be used in the clinical management of elderly HNSCC patients. Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. This paper contains a narrative report and a critical discussion of clinical approaches in the context of elderly HNSCC.
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Affiliation(s)
- Morena Fasano
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Ida D’Onofrio
- Unit of Radiation Oncology, Ospedale del Mare, ASL Napoli 1 Centro, 80147 Naples, Italy; (I.D.); (C.G.)
| | - Maria Paola Belfiore
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Antonio Angrisani
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Valentina Caliendo
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Carminia Maria Della Corte
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Mario Pirozzi
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Sergio Facchini
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Marianna Caterino
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Cesare Guida
- Unit of Radiation Oncology, Ospedale del Mare, ASL Napoli 1 Centro, 80147 Naples, Italy; (I.D.); (C.G.)
| | - Valerio Nardone
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
- Correspondence: ; Tel.: +39-0815-664-179
| | - Alfonso Reginelli
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Salvatore Cappabianca
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
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11
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González Serrano A, Martínez Tapia C, de la Taille A, Mongiat-Artus P, Irani J, Bex A, Paillaud E, Audureau E, Barnay T, Laurent M, Canouï-Poitrine F. Adherence to Treatment Guidelines and Associated Survival in Older Patients with Prostate Cancer: A Prospective Multicentre Cohort Study. Cancers (Basel) 2021; 13:4694. [PMID: 34572921 PMCID: PMC8468518 DOI: 10.3390/cancers13184694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 02/02/2023] Open
Abstract
The guidelines on prostate cancer treatment in older men recommend evaluating the patient's underlying health status before treatment selection. We aimed to evaluate the frequency of a guideline-discordant treatment (GDT), identify factors associated with GDT, and assess the relationship between GDT and overall survival. We studied patients with prostate cancer aged 70 or older included in the ELCAPA cohort between 2010 and 2019. Multivariable logistic regression assessed GDT-associated factors. The restricted mean survival time (RMST) assessed the 24- and 36-month OS using stabilized inverse probability of treatment weighting of propensity scores. We included 356 patients (median age: 81 years), and 164 (46%) received a GDT (95% confidence interval (CI) = (41-51%)). Patients with metastases were less likely to receive a GDT (adjusted odds ratio (95% CI) = 0.34 (0.17-0.69); p = 0.003). After weighting, the RMST at 24 months was shorter in the GDT group (13.9 months, vs. 17 months for compliant treatments; difference (95% CI): -3.1 months (-5.3, -1.0); p = 0.004). RMST at 36 months was 18.5 months, vs. 21.8 months (difference: -3.3 months (-6.7, 0.0); p = 0.053). GDT is common in older patients with prostate cancer and especially those with non-metastatic disease. GDT was associated with worse survival, independently of health status and tumour characteristics.
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Affiliation(s)
- Adolfo González Serrano
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
| | - Claudia Martínez Tapia
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
| | - Alexandre de la Taille
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
- Department of Urology, AP-HP, Hôpital Henri Mondor, F-94010 Creteil, France
| | - Pierre Mongiat-Artus
- Université de Paris, INSERM UMR_S1165, F-75010 Paris, France;
- Department of Urology, AP-HP, Hôpital Saint Louis, F-75010 Paris, France
| | - Jacques Irani
- Faculty of Medicine, Université Paris Saclay, F-94270 Le Kremlin-Bicêtre, France;
- Department of Urology, AP-HP, Hôpital Bicêtre, F-94270 Le Kremlin-Bicêtre, France
| | - Axel Bex
- Division of Surgery and Interventional Science, University College London, London NW3 2QG, UK;
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
- Department of Geriatrics, Paris Cancer Institute CARPEM, AP-HP, Hôpital Européen Georges Pompidou, F-75006 Paris, France
- Faculty of Health, Univeristé de Paris, F-75006 Paris, France
| | - Etienne Audureau
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
- Department of Public Health, AP-HP, Hôpital Henri Mondor, F-94010 Creteil, France
| | - Thomas Barnay
- ERUDITE Research Unit, Univ Paris Est Creteil, F-94010 Créteil, France;
| | - Marie Laurent
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
- Department of Internal Medicine and Geriatrics, AP-HP, Hôpital Henri Mondor, F-94010 Creteil, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
- Department of Public Health, AP-HP, Hôpital Henri Mondor, F-94010 Creteil, France
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12
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Bellieni A, Fusco D, Sanchez AM, Franceschini G, Di Capua B, Allocca E, Di Stasio E, Marazzi F, Tagliaferri L, Masetti R, Bernabei R, Colloca GF. Different Impact of Definitions of Sarcopenia in Defining Frailty Status in a Population of Older Women with Early Breast Cancer. J Pers Med 2021; 11:jpm11040243. [PMID: 33810556 PMCID: PMC8066315 DOI: 10.3390/jpm11040243] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 12/23/2022] Open
Abstract
Sarcopenia is a geriatric syndrome characterized by losses of quantity and quality of skeletal muscle, which is associated with negative outcomes in older adults and in cancer patients. Different definitions of sarcopenia have been used, with quantitative data more frequently used in oncology, while functional measures have been advocated in the geriatric literature. Little is known about the correlation between frailty status as assessed by comprehensive geriatric assessment (CGA) and sarcopenia in cancer patients. We retrospectively analyzed data from 96 older women with early breast cancer who underwent CGAs and Dual X-ray Absorptiometry (DXA) scans for muscle mass assessment before cancer treatment at a single cancer center from 2016 to 2019 to explore the correlation between frailty status as assessed by CGA and sarcopenia using different definitions. Based on the results of the CGA, 35 patients (36.5%) were defined as frail. Using DXA Appendicular Skeletal Mass (ASM) or the Skeletal Muscle Index (SMI=ASM/height^2), 41 patients were found to be sarcopenic (42.7%), with no significant difference in prevalence between frail and nonfrail subjects. Using the European Working Group on Sarcopenia in Older People (EWGSOP2) definition of sarcopenia (where both muscle function and mass are required), 58 patients were classified as "probably" sarcopenic; among these, 25 were sarcopenic and 17 "severely" sarcopenic. Only 13 patients satisfied both the requirements for being defined as sarcopenic and frail. Grade 3-4 treatment-related toxicities (according to Common Terminology Criteria for Adverse Events) were more common in sarcopenic and frail sarcopenic patients. Our data support the use of a definition of sarcopenia that includes both quantitative and functional data in order to identify frail patients who need tailored treatment.
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Affiliation(s)
- Andrea Bellieni
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.B.); (B.D.C.)
| | - Domenico Fusco
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.B.); (B.D.C.)
- Correspondence: ; Tel.: +39-063-0151
| | - Alejandro Martin Sanchez
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.M.S.); (G.F.); (R.M.)
| | - Gianluca Franceschini
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.M.S.); (G.F.); (R.M.)
| | - Beatrice Di Capua
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.B.); (B.D.C.)
| | - Elena Allocca
- Istituto per la Sicurezza Sociale, 47890 Cailungo, Città di San Marino, San Marino;
| | - Enrico Di Stasio
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Fabio Marazzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.M.); (L.T.); (G.F.C.)
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.M.); (L.T.); (G.F.C.)
| | - Riccardo Masetti
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.M.S.); (G.F.); (R.M.)
| | | | - Giuseppe Ferdinando Colloca
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.M.); (L.T.); (G.F.C.)
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13
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van Holstein Y, van Deudekom FJ, Trompet S, Postmus I, Uit den Boogaard A, van der Elst MJT, de Glas NA, van Heemst D, Labots G, Altena M, Slingerland M, Liefers GJ, van den Bos F, van der Bol JM, Blauw GJ, Portielje JEA, Mooijaart SP. Design and rationale of a routine clinical care pathway and prospective cohort study in older patients needing intensive treatment. BMC Geriatr 2021; 21:29. [PMID: 33413165 PMCID: PMC7791733 DOI: 10.1186/s12877-020-01975-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Treatment decisions concerning older patients can be very challenging and individualised treatment plans are often required in this very heterogeneous group. In 2015 we have implemented a routine clinical care pathway for older patients in need of intensive treatment, including a comprehensive geriatric assessment (CGA) that was used to support clinical decision making. An ongoing prospective cohort study, the Triaging Elderly Needing Treatment (TENT) study, has also been initiated in 2016 for participants in this clinical care pathway, to study associations between geriatric characteristics and outcomes of treatment that are relevant to older patients. The aim of this paper is to describe the implementation and rationale of the routine clinical care pathway and design of the TENT study. METHODS A routine clinical care pathway has been designed and implemented in multiple hospitals in the Netherlands. Patients aged ≥70 years who are candidates for intensive treatments, such as chemotherapy, (chemo-)radiation therapy or major surgery, undergo frailty screening based on the Geriatric 8 (G-8) questionnaire and the Six-Item Cognitive Impairment Test (6CIT). If screening reveals potential frailty, a CGA is performed. All patients are invited to participate in the TENT study. Clinical data and blood samples for biomarker studies are collected at baseline. During follow-up, information about treatment complications, hospitalisations, functional decline, quality of life and mortality is collected. The primary outcome is the composite endpoint of functional decline or mortality at 1 year. DISCUSSION Implementation of a routine clinical care pathway for older patients in need of intensive treatment provides the opportunity to study associations between determinants of frailty and outcomes of treatment. Results of the TENT study will support individualised treatment for future patients. TRIAL REGISTRATION The study is retrospectively registered at the Netherlands Trial Register (NTR), trial number NL8107 . Date of registration: 22-10-2019.
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Affiliation(s)
- Yara van Holstein
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, PO box 9600, 2300 RC, Leiden, The Netherlands.
| | - Floor J van Deudekom
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, PO box 9600, 2300 RC, Leiden, The Netherlands
| | - Stella Trompet
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, PO box 9600, 2300 RC, Leiden, The Netherlands
| | - Iris Postmus
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, PO box 9600, 2300 RC, Leiden, The Netherlands
| | - Anna Uit den Boogaard
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, PO box 9600, 2300 RC, Leiden, The Netherlands
| | - Marjan J T van der Elst
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, PO box 9600, 2300 RC, Leiden, The Netherlands
| | - Nienke A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Diana van Heemst
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, PO box 9600, 2300 RC, Leiden, The Netherlands
| | - Geert Labots
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
| | - Mariëtte Altena
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerrit Jan Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederiek van den Bos
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, PO box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Gerard J Blauw
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, PO box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Simon P Mooijaart
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, PO box 9600, 2300 RC, Leiden, The Netherlands
- Institute for Evidence-based Medicine in Old Age (IEMO), Leiden, The Netherlands
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14
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Navarrete-Reyes AP, Animas-Mijangos K, Gómez-Camacho J, Juárez-Carrillo Y, Torres-Pérez AC, Cataneo-Piña DJ, Negrete-Najar JP, Soto-Perez-de-Celis E. Geriatric principles for patients with cancer. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.5327/z2447-212320212100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cancer is primarily a disease of older persons. Given the heterogeneity of aging, physiological age, rather than chronological age, better expresses the cumulative effect of environmental, medical, and psychosocial stressors, which modifies life expectancy. Comprehensive geriatric assessment, a tool that helps ascertain the physiological age of older individuals, is the gold standard for assessing older adults with cancer. Several international organizations recommend using the geriatric assessment domains to identify unrecognized health problems that can interfere with treatment and predict adverse health-related outcomes, aiding complex treatment decision making. More recently, it has been shown that geriatric assessment-guided interventions improve quality of life and mitigate treatment toxicity without compromising survival. In this review, we discuss the role of comprehensive geriatric assessment in cancer care for older adults and provide the reader with useful information to assess potential treatment risks and benefits, anticipate complications, and plan interventions to better care for older people with cancer.
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15
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Lu X, Li X, Ling H, Gong Y, Guo L, He M, Sun H, Hu X. Nomogram for Predicting Breast Cancer-Specific Mortality of Elderly Women with Breast Cancer. Med Sci Monit 2020; 26:e925210. [PMID: 32920589 PMCID: PMC7510685 DOI: 10.12659/msm.925210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The objectives of this study were to evaluate the cumulative incidence of breast cancer-specific death (BCSD) and other cause-specific death in elderly patients with breast cancer (BC) and to develop an individualized nomogram for estimating BCSD. Material/Methods Data were retrieved from the Surveillance, Epidemiology, and End Results program. A total of 25 241 patients older than 65 years with stage I–III BC diagnosed between 2004 and 2008 was included in the study cohort. We used the cumulative incidence function (CIF) to describe the cause-specific mortality and Gray’s test to compare the differences in CIF among the groups. Fine and Gray’s proportional subdistribution hazard model was applied to validate the independent prognostic factors, upon which the competing-risks nomogram and web-based calculator was built. The performance of the nomogram was assessed with the C-indexes and calibration plot diagrams. Results After data screening, 25 241 cases were included for statistical analysis. In the training cohort, the 5-, 8-, and 10-year cumulative incidence of BCSD was 5.7, 8.1, and 9.1%, respectively. Ten independent prognostic factors associated with BCSD were identified. The C-index of the nomogram was 0.818 (0.804–0.831) in the training cohort and 0.808 (0.783–0.833) in the validation cohort. Calibration plot diagrams showed near-ideal consistency between the predicted probabilities and actual observations. Conclusions We built a reliable dynamic nomogram for predicting BCSD in elderly patients, and this individualized predictive tool is favorable for risk classification and complex personalized treatment decision making in clinical practice.
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Affiliation(s)
- Xunxi Lu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China (mainland).,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (mainland)
| | - Xiaoguang Li
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China (mainland)
| | - Hong Ling
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China (mainland).,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (mainland)
| | - Yue Gong
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China (mainland).,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (mainland)
| | - Linwei Guo
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China (mainland).,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (mainland)
| | - Min He
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China (mainland).,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (mainland)
| | - Hefen Sun
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China (mainland).,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (mainland)
| | - Xin Hu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China (mainland).,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (mainland)
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16
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Liuu E, Saulnier PJ, Gand E, Ragot S, Valero S, Jamet A, Hadjadj S, Paccalin M. Frailty and diabetes status in older patients with cancer: impact on mortality in the ANCRAGE cohort. Aging Clin Exp Res 2020; 32:1809-1819. [PMID: 31898171 DOI: 10.1007/s40520-019-01362-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/21/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Frailty, diabetes and cancer are associated with aging, but the relationship between these conditions is not well defined. AIMS We studied older patients with cancer from the prospective single-center cohort ANCRAGE (ANalyses of CanceR in AGEd) aiming to determine the impact of type 2 diabetes (T2D) and its vascular complications (VC) on frailty and adverse outcomes (mortality, unplanned readmission) during follow-up. METHODS Analysis of cohort patients ≥ 75 years, included between 2009 and 2017, who underwent a comprehensive geriatric assessment (CGA). Variables of interest were history of T2D and VC, tumor site and metastatic status, CGA including eight domains (social environment, functional status, mobility, nutrition, mood, cognition, polypharmacy and comorbidities) and frailty. RESULTS Among 1092 patients (47% female, mean age 82 ± 5 years), 219 (20%) had a reported diagnosis of T2D at baseline including 152 (69%) with VC. The most common tumor sites were prostate (15%), breast (15%), skin (12%), and colorectum (11%); 29% of patients had a metastatic disease. Frailty was highly prevalent (84%). During follow-up (median of 15.3 months), 653 (60%) patients died (60% no T2D, 43% T2D without VC, 66% with VC). After adjustment for age, gender and metastatic status, diabetics with VC had a higher risk of all-cause death (aHR1.89, 1.24-2.86, p = 0.004). Death was more frequently due to a non-cancer cause (p < 0.001). No difference in unplanned readmissions was observed in the three groups. Frailty was an independent risk factor for mortality and unplanned readmissions (p < 0.001 both). CONCLUSION In older cancer patients from the prospective ANCRAGE cohort, all-cause mortality was significantly higher in frail patients and those with complicated T2D, a finding questioning the quality of care management in such vulnerable patients, and stimulating further research in this multidisciplinary field.
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17
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de Boer AZ, van de Water W, Bastiaannet E, de Glas NA, Kiderlen M, Portielje JEA, Extermann M. Early stage breast cancer treatment and outcome of older patients treated in an oncogeriatric care and a standard care setting: an international comparison. Breast Cancer Res Treat 2020; 184:519-526. [PMID: 32813120 PMCID: PMC7599178 DOI: 10.1007/s10549-020-05860-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022]
Abstract
Introduction Since older patients with breast cancer are underrepresented in clinical trials, an oncogeriatric approach is advocated to guide treatment decisions. However, the effect on outcomes is unclear. The aim of this study was to compare treatments and outcomes between patients treated in an oncogeriatric and a standard care setting. Methods Patients aged ≥ 70 years with early stage breast cancer were included. The oncogeriatric cohort comprised unselected patients from the Moffitt Cancer Center, and the standard cohort patients from a Dutch population-based cohort. Cox models were used to characterize the influence of care setting on recurrence risk and overall mortality. Results Overall, 268 patients were included in the oncogeriatric and 1932 patients in the standard cohort. Patients in the oncogeriatric cohort were slightly younger, had more comorbidity, and received more adjuvant endocrine therapy and chemotherapy. Oncogeriatric care was associated with a lower risk of recurrence, which remained significant after adjustment for patient and tumour characteristics [hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.44–0.99]. Oncogeriatric care was also associated with a lower overall mortality, which also remained significant after adjustment for patient and tumour characteristics (HR 0.69, 95% CI 0.55–0.87). Conclusions Patients treated in the oncogeriatric care setting had a lower risk of recurrence, which may be explained by more systemic treatment. Overall mortality was also lower, but other explanations besides care setting could not be ruled out as the cohorts had different patient profiles. Future studies need to clarify the impact of an oncogeriatric approach on outcomes. Electronic supplementary material The online version of this article (10.1007/s10549-020-05860-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Z de Boer
- Department of Surgery, Leiden University Medical Center, Location J10-71, Postzone K6-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Willemien van de Water
- Department of Surgery, Leiden University Medical Center, Location J10-71, Postzone K6-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Location J10-71, Postzone K6-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mandy Kiderlen
- Department of Radiotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Martine Extermann
- Department of Senior Adult Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Olin RL, Fretham C, Pasquini MC, Arora M, Bhatt VR, Derman B, Giralt SA, Huang LW, Koll T, Lee SM, Lin RJ, Pang L, Popat UR, Weisdorf DJ, Artz A. Geriatric assessment in older alloHCT recipients: association of functional and cognitive impairment with outcomes. Blood Adv 2020; 4:2810-2820. [PMID: 32574365 PMCID: PMC7322958 DOI: 10.1182/bloodadvances.2020001719] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/19/2020] [Indexed: 01/01/2023] Open
Abstract
Use of allogeneic hematopoietic cell transplantation (alloHCT) is increasing in older patients with hematologic malignancies. Studies suggest that geriatric assessment (GA), incorporating functional measures such as instrumental activities of daily living (IADL), delineates subtle age-related impairments that enhance risk-stratification. The objective of this multi-institutional retrospective study was to evaluate the prognostic utility of GA metrics collected pre-alloHCT. Eligibility criteria included age ≥50 and pre-alloHCT GA inclusive of at least IADL. Beyond IADL, additional geriatric metrics were collected where available and included Medical Outcomes Study Physical Health score (MOS-PH), Timed Up and Go (TUG), and cognition by Blessed Orientation Memory Concentration (BOMC). Three hundred thirty subjects were included, with a median age of 63 (range 50 to 77). Impairments were frequent: 36% had at least 1 IADL impairment; 14% had TUG ≥13.5 seconds; and 17% had cognitive impairment (BOMC ≥ 7). Median MOS-PH score was 80. IADL and age were not significantly associated with nonrelapse mortality (NRM) or overall survival (OS). In multivariate analysis, only impaired cognition and Hematopoietic Cell Transplant-Comorbidity Index score ≥3 showed an independent association with 1-year NRM (subdistribution hazard ratio [SHR], 2.36; P = .01; and SHR, 2.19; P = .009, respectively). Cognitive impairment independently conferred inferior 1-year OS (hazard ratio, 1.94; P = .01). In a preplanned subgroup analysis in 224 patients aged ≥60 years, cognitive impairment remained the sole GA metric predictive of NRM (2-year NRM: SHR, 2.72; P = .007). These data suggest that cognitive impairment elevates risk of post-alloHCT NRM in older patients.
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Affiliation(s)
- Rebecca L Olin
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Caitrin Fretham
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, MN
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Mukta Arora
- Division of Hematology, Oncology, and Transplant, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Vijaya R Bhatt
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Benjamin Derman
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Sergio A Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Li-Wen Huang
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
- Division of Hematology/Oncology, Department of Medicine, Veterans Affairs Medical Center, San Francisco, CA
| | - Thuy Koll
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Sang Mee Lee
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Richard J Lin
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Uday R Popat
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, TX; and
| | - Daniel J Weisdorf
- Division of Hematology, Oncology, and Transplant, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA
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Bitas C, Jones S, Singh HK, Ramirez M, Siegler E, Glesby M. Adherence to Recommendations from Comprehensive Geriatric Assessment of Older Individuals with HIV. J Int Assoc Provid AIDS Care 2020; 18:2325958218821656. [PMID: 30798675 PMCID: PMC6430118 DOI: 10.1177/2325958218821656] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This retrospective cohort study sought to assess the effectiveness of comprehensive geriatric assessment (CGA) for older patients at an HIV clinic in a large US city. We systematically reviewed medical records of all patients who underwent CGA from June 2013 to July 2017. In addition, physicians and social workers completed an anonymous survey about the impact of CGA on their patients. For the 76 patients (median age 67.2; Q1, Q3 = 60.9, 72.6) seen by geriatricians at the clinic, there were 184 recommendations, 54 instances of counseling, and 11 direct actions. Overall adherence to recommendations was 32.8%, 34.9% for patient-directed, and 31.7% for provider-directed recommendations. No demographic or CGA variables were associated with adherence. Despite this lack of adherence, surveyed providers reported that they usually or always followed recommendations; the most frequently cited barrier to implementation was lack of feasibility. Further research will be needed to determine how CGA can improve outcomes for this population.
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Affiliation(s)
- Christiana Bitas
- 1 Department of Obstetrics and Gynecology, Tufts University Medical Center, Boston, MA, USA
| | - Sian Jones
- 2 Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Harjot Kaur Singh
- 2 Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Mildred Ramirez
- 3 Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA.,4 Research Division, Hebrew Home at Riverdale, RiverSpring Health, Riverdale, NY, USA
| | - Eugenia Siegler
- 3 Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Marshall Glesby
- 2 Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
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Abstract
Frailty is defined as a reduced physiologic reserve vulnerable to external stressors. For older individuals, frailty plays a decisive role in increasing adverse health outcomes in most clinical situations. Many tools or criteria have been introduced to define frailty in recent years, and the definition of frailty has gradually converged into several consensuses. Frail older adults often have multi-domain risk factors in terms of physical, psychological, and social health. Comprehensive geriatric assessment (CGA) is the process of identifying and quantifying frailty by examining various risky domains and body functions, which is the basis for geriatric medicine and research. CGA provides physicians with information on the reversible area of frailty and the leading cause of deterioration in frail older adults. Therefore frailty assessment based on understanding CGA and its relationship with frailty, can help establish treatment strategies and intervention in frail older adults. This review article summarizes the recent consensus and evidence of frailty and CGA.
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Affiliation(s)
- Heayon Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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21
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Mongiat-Artus P, Paillaud E, Albrand G, Caillet P, Neuzillet Y. [Evaluation of the elderly patient with cancer]. Prog Urol 2019; 29:807-827. [PMID: 31771766 DOI: 10.1016/j.purol.2019.08.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To explain the notion of frailty, then to explain how crucial is the detection of frailty detection in the elderly patient, and, in cases of suspected frailty, how crucial is the need for geriatric assessment. To describe (i) how this assessment of the elderly cancer patient is performed, (ii) how the results of this geriatric assessment must drive the decision making, and (iii) the role of the geriatrician in the care pathway. METHOD Bibliographic research from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as on the websites of scientific geriatric societies, from the National Cancer Institute using the following keywords: elderly, geriatrics, cancer, frailty, assessment, decision making. RESULTS The goal of frailty detection is to optimize care, to maintain the independence and the survival of the patient. The prevalence of frailty increases with the age and the diagnosis of cancer. Detection of frailty in the elderly patient with cancer is performed using the G8 questionnaire recommended by the INCa. In case of anomaly or clinical justification, the patient receives a geriatric assessment, which is a multidimensional and multidisciplinary procedure. The clinician can call on the UCOG of the region in which he practices. The relevance of medical decisions will be based on the results of this geriatric assessment. The geriatrician plays a crucial role and will be involved throughout the care. CONCLUSION The detection of frailty in the elderly patient with cancer is obligatory. Consecutive geriatric assessment can be performed by the UCOG of the region. The results of the geriatric assessment must serve as a basis for any therapeutic decision making and the preservation of the independence of the patient must remain the priority.
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Affiliation(s)
- P Mongiat-Artus
- Inserm UMR_S1165, service d'urologie, unité de chirurgie et d'anesthésie ambulatoires, hôpital Saint-Louis, université Paris Diderot, université de Paris, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
| | - E Paillaud
- EA 7376 épidémiologie clinique et vieillissement, service de gériatrie, unité d'onco-gériatrie et UCOG - Paris-Ouest, hôpital européen Georges-Pompidou, université René-Descartes, université de Paris, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - G Albrand
- Service de gériatrie et UCOG - IR, AuRA Ouest-Guyane, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | - P Caillet
- Service de gériatrie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94000 Créteil, France
| | - Y Neuzillet
- Service d'urologie, hôpital Foch, université de Versailles - Saint-Quentin-en-Yvelines, 92150 Suresnes, France
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22
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Mariano C, Jamal R, Bains P, Hejazi S, Chao L, Wan J, Ho J. Utility of a chemotherapy toxicity prediction tool for older patients in a community setting. ACTA ACUST UNITED AC 2019; 26:234-239. [PMID: 31548802 DOI: 10.3747/co.26.4869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Expert groups have recommended incorporation of a geriatric assessment into clinical practice for older patients starting oncologic therapy. However, that practice is not standard primarily because of resource limitations. In the present study, we evaluated the effect on treatment decisions by oncologists in the community oncology setting of a brief geriatric assessment tool that estimates risk of toxicity. Methods This prospective longitudinal study in 5 community oncology practices in British Columbia involved patients 70 years of age and older starting a new cytotoxic chemotherapy regimen. Clinical personnel completed a brief validated geriatric assessment tool-the Cancer and Aging Research Group chemotherapy toxicity tool (carg-tt)-that estimates the risk of grade 3 or greater toxicity in older patients. Physicians were asked if the carg-tt changed their treatment plan or prompted extra supports. Patients were followed to assess the incidence of toxicity during treatment. Results The study enrolled 199 patients between July 2016 and February 2018. Mean age was 77 years. Treatment was palliative in 61.4% of the group. Compared with physician judgment, the carg-tt predicted higher rates of toxicity. In 5 patients, treatment was changed based on the carg-tt. In 38.5% of the patients, data from the tool prompted extra supports. Within the first 3 cycles of treatment, 21.3% of patients had experienced grade 3 or greater toxicity. Conclusions This study demonstrates that use of a brief geriatric assessment tool is possible in a broad community oncology practice. The tool modified the oncologist's supportive care plan for a significant number of older patients undertaking cytotoxic chemotherapy.
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Affiliation(s)
- C Mariano
- Department of Medicine and Medical Oncology, Royal Columbian Hospital, New Westminster, BC
| | - R Jamal
- University of British Columbia, Vancouver, BC
| | - P Bains
- Department of Medicine and Medical Oncology, Lions Gate Hospital, North Vancouver, BC
| | - S Hejazi
- Department of Evaluation and Research Services, Fraser Health Authority, Surrey, BC
| | - L Chao
- Department of Medicine and Medical Oncology, Lions Gate Hospital, Richmond, BC
| | - J Wan
- Department of Pharmacy, Royal Columbian Hospital, New Westminster, BC
| | - J Ho
- Department of Medicine and Medical Oncology, Lions Gate Hospital, Richmond, BC
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23
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Overcash J, Ford N, Kress E, Ubbing C, Williams N. Comprehensive Geriatric Assessment as a Versatile Tool to Enhance the Care of the Older Person Diagnosed with Cancer. Geriatrics (Basel) 2019; 4:geriatrics4020039. [PMID: 31238518 PMCID: PMC6630523 DOI: 10.3390/geriatrics4020039] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/14/2019] [Accepted: 06/20/2019] [Indexed: 12/27/2022] Open
Abstract
The comprehensive geriatric assessment (CGA) is a versatile tool for the care of the older person diagnosed with cancer. The purpose of this article is to detail how a CGA can be tailored to Ambulatory Geriatric Oncology Programs (AGOPs) in academic cancer centers and to community oncology practices with varying levels of resources. The Society for International Oncology in Geriatrics (SIOG) recommends CGA as a foundation for treatment planning and decision-making for the older person receiving care for a malignancy. A CGA is often administered by a multidisciplinary team (MDT) composed of professionals who provide geriatric-focused cancer care. CGA can be used as a one-time consult for surgery, chemotherapy, or radiation therapy providers to predict treatment tolerance or as an ongoing part of patient care to manage malignant and non-malignant issues. Administrative support and proactive infrastructure planning to address scheduling, referrals, and provider communication are critical to the effectiveness of the CGA.
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Affiliation(s)
- Janine Overcash
- The College of Nursing, The Ohio State University, 1585 Neil Ave, Newton Hall, Columbus, OH 43201, USA.
| | - Nikki Ford
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Elizabeth Kress
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Caitlin Ubbing
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Nicole Williams
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
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24
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Gonçalves SEAB, Ribeiro AAF, Hirose EY, Santos FPDS, Ferreira FM, Koch LDOM, Tanaka M, de Souza MS, Souza PMR, Gonçalves TJM, Pereira AZ. Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly. EINSTEIN-SAO PAULO 2019; 17:eAE4340. [PMID: 31116236 PMCID: PMC6533077 DOI: 10.31744/einstein_journal/2019ae4340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 09/05/2018] [Indexed: 12/20/2022] Open
Abstract
The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly was elaborated by nutritionists, nutrologists and hematologists physicians from 15 Brazilians reference centers in hematopoietic stem cell transplantation, in order to emphasize the importancy of nutritional status and the body composition during the treatment, as well as the main characteristics related to patient's nutritional assessment. Establishing the consensus, we intended to improve and standardize the nutritional therapy during the hematopoietic stem cell transplantation. The Consensus was approved by the Brazilian Society of Bone Marrow Transplantation.
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Affiliation(s)
| | - Andreza Alice Feitosa Ribeiro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Centro de Transplante de Medula Óssea, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | - Márcia Tanaka
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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25
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Al-Mansour Z, Pang L, Bathini V. Novel Cancer Therapeutics in Geriatrics: What is Unique to the Aging Patient? Drugs Aging 2019; 36:1-11. [PMID: 30478744 DOI: 10.1007/s40266-018-0619-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
With the worldwide trend of aging populations, the number of older adults who develop and survive cancer is likely to increase. In the last decade, oncology drug development has shifted away from conventional chemotherapeutics towards agents that can 'target' a driver mutation of a specific cancer or 'unleash' the patient's native immune system to attack the cancer-so-called molecularly targeted therapies and immunotherapeutics. The basic algorithms of cancer treatment in elderly patients are essentially the same as in younger patients; however, one needs to pay exceptional attention to the effects of co-morbidities, interaction with other drugs, and the organ function reserve of an older individual before determining his/her 'eligibility' for a specific cancer treatment modality. Despite the growing evidence of safety and effectiveness of combination chemotherapy in fit elderly patients, the data are still lacking concerning the use of currently approved targeted agents and immunotherapies. The current evidence, though limited, suggests reasonable tolerability with comparable efficacy in patients > 65 years old treated with immune-based therapies to that in younger controls; however, it is unclear if this leads to significant patient-relevant gains such as improved survival with an acceptable quality of life. Nonetheless, these newer agents remain better tolerated than cytotoxic chemotherapy in clinical practice, particularly in older patients. Alternatively, a personalized approach for elderly patients with consideration of the incidence and management of adverse effects, as well as strategies for optimizing efficacy in the context of an aging immune system, would be of utmost value in our aging cancer population. Future trials should also explore immune markers to predict response to these therapeutics in elderly patients, taking into consideration the effects of immunosenescence and immune modulation in aging hosts.
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Affiliation(s)
- Zeina Al-Mansour
- Division of Hematology/Oncology, University of Massachusetts School of Medicine, Office #S5-726, 55 Lake Ave N, Worcester, MA, 01655, USA.
| | - Linda Pang
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Venu Bathini
- University of Massachusetts School of Medicine, Worcester, MA, USA
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26
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Le Saux O, Falandry C, Gan HK, You B, Freyer G, Péron J. Changes in the Use of Comprehensive Geriatric Assessment in Clinical Trials for Older Patients with Cancer over Time. Oncologist 2019; 24:1089-1094. [PMID: 30710065 DOI: 10.1634/theoncologist.2018-0493] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/03/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The objective of this study was to describe the implementation of comprehensive geriatric assessment (CGA) in clinical trials dedicated to older patients before and after the creation of the International Society of Geriatric Oncology in the early 2000s. SUBJECTS, MATERIALS, AND METHODS All phase I, II, and III trials dedicated to the treatment of cancer among older patients published between 2001 and 2004 and between 2011 and 2014 were reviewed. We considered that a CGA was performed when the authors indicated an intention to do so in the Methods section of the article. We collected each geriatric domain assessed using a validated tool even in the absence of a clear CGA, including nutritional, functional, cognitive, and psychological status, comorbidity, comedication, overmedication, social status and support, and geriatric syndromes. RESULTS A total of 260 clinical trials dedicated to older patients were identified over the two time periods: 27 phase I, 193 phase II, and 40 phase III trials. CGA was used in 9% and 8% of phase II and III trials, respectively; it was never used in phase I trials. Performance status was reported in 67%, 79%, and 75% of phase I, II, and III trials, respectively. Functional assessment was reported in 4%, 11%, and 13% of phase I, II, and III trials, respectively. Between the two time periods, use of CGA increased from 1% to 11% (p = .0051) and assessment of functional status increased from 3% to 14% (p = .0094). CONCLUSION The use of CGA in trials dedicated to older patients increased significantly but remained insufficient. IMPLICATIONS FOR PRACTICE This article identifies the areas in which research efforts should be focused in order to offer physicians well-addressed clinical trials with results that can be extrapolated to daily practice.
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Affiliation(s)
- Olivia Le Saux
- Medical Oncology Department, Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
- Lyon 1 University, EMR 3738, Faculté de Médecine Lyon-Sud, Oullins, France
| | - Claire Falandry
- Geriatric Unit, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
- CarMen biomedical research laboratory (Cardiovascular diseases, Metabolism, diabetology and Nutrition) INSERM UMR 1060, Université de Lyon, Oullins, France
| | - Hui K Gan
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
- School of Cancer Medicine, La Trobe University, Heidelberg, Australia
- Department of Medicine, Melbourne University, Melbourne, Australia
| | - Benoit You
- Medical Oncology Department, Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
- Lyon 1 University, EMR 3738, Faculté de Médecine Lyon-Sud, Oullins, France
| | - Gilles Freyer
- Medical Oncology Department, Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
- Lyon 1 University, EMR 3738, Faculté de Médecine Lyon-Sud, Oullins, France
| | - Julien Péron
- Medical Oncology Department, Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
- Statistics unit, Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
- CNRS, UMR 5558 Biometry and Evolutionary Biology laboratory Université Lyon 1, Villeurbanne, France
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Looijaard SMLM, Slee-Valentijn MS, Groeneveldt LN, Deeg DJH, Huisman M, Maier AB. Do older individuals who are diagnosed with cancer have worse physical performance prior to diagnosis compared to matched controls? A longitudinal cohort study. BMC Geriatr 2018; 18:166. [PMID: 30021524 PMCID: PMC6052670 DOI: 10.1186/s12877-018-0850-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 06/27/2018] [Indexed: 12/25/2022] Open
Abstract
Background Impaired physical performance is highly prevalent in older cancer patients and is associated with cancer-related outcomes such as mortality and chemotherapy-related toxicity. Physical performance might already decline prior to the cancer diagnosis due to undiagnosed disease. This study aimed to assess whether the physical performance of community-dwelling individuals prior to cancer diagnosis is worse compared to matched controls who are not diagnosed with cancer. Methods The study sample was selected from the Longitudinal Aging Study Amsterdam, a longitudinal study on a nationally representative sample of the Dutch older population. Physical performance of initially cancer-free individuals aged 55–84 years who were diagnosed with cancer during 10 or 20 years of follow-up was compared to the physical performance of controls who were not diagnosed with cancer. For controls, the physical performance measurements of the cycle with a median age closest to the cancer group were used. The time interval between physical performance measurements and the report of cancer was 2 to 4 years. Groups were compared using logistic and linear regression analysis. Results The study sample included 1735 individuals with a median age of 68.7 [interquartile range 63.3–76.4] years. During follow-up, 414 (23.9%) individuals were diagnosed with cancer. Handgrip strength, gait speed, chair stand ability, chair stand test time and ability to put on and take off a cardigan did not differ between groups. Individuals prior to cancer diagnosis were more likely to complete the tandem balance test. Conclusions Physical performance of individuals 2 to 4 years prior to report of cancer diagnosis is not lower compared to controls. This suggests that physical performance may not be influenced by cancer before diagnosis.
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Affiliation(s)
- S M L M Looijaard
- Section of Gerontology and Geriatrics, Department of Internal Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - M S Slee-Valentijn
- Center of Excellence in Geriatric Rehabilitation, Cordaan, Box 1103, 1000 BC, Amsterdam, the Netherlands
| | - L N Groeneveldt
- Section of Gerontology and Geriatrics, Department of Internal Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - D J H Deeg
- Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - M Huisman
- Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Department of Sociology, Vrije Universiteit Amsterdam, Van der Boechorstraat 7, 1081 BT, Amsterdam, The Netherlands
| | - A B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, City & Royal Park Campus, 34-54 Poplar Road, Parkville, Melbourne, Victoria, 3052, Australia.
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Soto-Perez-de-Celis E, Sun CL, Tew WP, Mohile SG, Gajra A, Klepin HD, Owusu C, Gross CP, Muss HB, Lichtman SM, Chapman AE, Cohen HJ, Dale W, Kim H, Fernandes S, Katheria V, Hurria A. Association between patient-reported hearing and visual impairments and functional, psychological, and cognitive status among older adults with cancer. Cancer 2018; 124:3249-3256. [PMID: 29797664 DOI: 10.1002/cncr.31540] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/09/2018] [Accepted: 04/13/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hearing and visual impairments are common among community-dwelling older adults, and are associated with psychological, functional, and cognitive deficits. However, to the authors' knowledge, little is known regarding their prevalence among older patients with cancer. METHODS The current study was a secondary analysis combining 2 prospective cohorts of adults aged ≥65 years with solid tumors who were receiving chemotherapy. The authors assessed the association between patient-reported hearing and/or visual impairment (defined as fair/poor grading by self-report) and physical function, instrumental activities of daily living (IADLs), anxiety, depression, and cognition. Descriptive analyses were conducted to summarize patient and treatment characteristics. One-way analysis of variance and chi-square tests were conducted as appropriate to examine differences between patients with and without sensory impairments. Logistic regression was used to analyze associations between sensory impairments and outcomes. RESULTS Among 750 patients with a median age of 72 years who had solid tumors (29% with breast/gynecological tumors, 28% with lung tumors, and 27% with gastrointestinal tumors), approximately 18% reported hearing impairment alone, 11% reported visual impairment alone, and 7% reported dual sensory impairment. Hearing impairment was associated with IADL dependence (odds ratio [OR], 1.9), depression (OR, 1.6), and anxiety (OR, 1.6). Visual impairment was associated with IADL dependence (OR, 1.9), poor physical function (OR, 1.9), and depression (OR, 2.5). Dual impairment was associated with IADL dependence (OR, 2.8), anxiety (OR, 2.3), depression (OR, 2.5), and cognitive impairment (OR, 3.2). CONCLUSIONS Sensory impairment is common among older adults with cancer. Patients with sensory impairment are more likely to have functional, psychological, and cognitive deficits. Interventions aimed at improving the vision and hearing of older adults with cancer should be studied. Cancer 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Enrique Soto-Perez-de-Celis
- Cancer and Aging Research Program, City of Hope, Duarte, California.,Department of Geriatrics, Salvador Zubiran National Institute of Medical Science and Nutrition, Mexico City, Mexico
| | - Can-Lan Sun
- Cancer and Aging Research Program, City of Hope, Duarte, California
| | - William P Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Supriya Gupta Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Ajeet Gajra
- ICON Clinical Research, North Wales, Pennsylvania
| | - Heidi D Klepin
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Cynthia Owusu
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Cary Philip Gross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Hyman B Muss
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Stuart M Lichtman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew E Chapman
- Jefferson Senior Adult Oncology Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Harvey Jay Cohen
- Center for the Study of Aging & Human Development, Duke University Medical Center, Durham, North Carolina
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, California
| | - Heeyoung Kim
- Cancer and Aging Research Program, City of Hope, Duarte, California
| | - Simone Fernandes
- Cancer and Aging Research Program, City of Hope, Duarte, California
| | - Vani Katheria
- Cancer and Aging Research Program, City of Hope, Duarte, California
| | - Arti Hurria
- Cancer and Aging Research Program, City of Hope, Duarte, California
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Mohile SG, Dale W, Somerfield MR, Schonberg MA, Boyd CM, Burhenn PS, Canin B, Cohen HJ, Holmes HM, Hopkins JO, Janelsins MC, Khorana AA, Klepin HD, Lichtman SM, Mustian KM, Tew WP, Hurria A. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol 2018; 36:2326-2347. [PMID: 29782209 DOI: 10.1200/jco.2018.78.8687] [Citation(s) in RCA: 878] [Impact Index Per Article: 146.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To provide guidance regarding the practical assessment and management of vulnerabilities in older patients undergoing chemotherapy. Methods An Expert Panel was convened to develop clinical practice guideline recommendations based on a systematic review of the medical literature. Results A total of 68 studies met eligibility criteria and form the evidentiary basis for the recommendations. Recommendations In patients ≥ 65 years receiving chemotherapy, geriatric assessment (GA) should be used to identify vulnerabilities that are not routinely captured in oncology assessments. Evidence supports, at a minimum, assessment of function, comorbidity, falls, depression, cognition, and nutrition. The Panel recommends instrumental activities of daily living to assess for function, a thorough history or validated tool to assess comorbidity, a single question for falls, the Geriatric Depression Scale to screen for depression, the Mini-Cog or the Blessed Orientation-Memory-Concentration test to screen for cognitive impairment, and an assessment of unintentional weight loss to evaluate nutrition. Either the CARG (Cancer and Aging Research Group) or CRASH (Chemotherapy Risk Assessment Scale for High-Age Patients) tools are recommended to obtain estimates of chemotherapy toxicity risk; the Geriatric-8 or Vulnerable Elders Survey-13 can help to predict mortality. Clinicians should use a validated tool listed at ePrognosis to estimate noncancer-based life expectancy ≥ 4 years. GA results should be applied to develop an integrated and individualized plan that informs cancer management and to identify nononcologic problems amenable to intervention. Collaborating with caregivers is essential to implementing GA-guided interventions. The Panel suggests that clinicians take into account GA results when recommending chemotherapy and that the information be provided to patients and caregivers to guide treatment decision making. Clinicians should implement targeted, GA-guided interventions to manage nononcologic problems. Additional information is available at www.asco.org/supportive-care-guidelines .
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Affiliation(s)
- Supriya G Mohile
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - William Dale
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Mark R Somerfield
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Mara A Schonberg
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Cynthia M Boyd
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Peggy S Burhenn
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Beverly Canin
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Harvey Jay Cohen
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Holly M Holmes
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Judith O Hopkins
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Michelle C Janelsins
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Alok A Khorana
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Heidi D Klepin
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Stuart M Lichtman
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Karen M Mustian
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - William P Tew
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Arti Hurria
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
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Xue DD, Cheng Y, Wu M, Zhang Y. Comprehensive geriatric assessment prediction of postoperative complications in gastrointestinal cancer patients: a meta-analysis. Clin Interv Aging 2018; 13:723-736. [PMID: 29731614 PMCID: PMC5927346 DOI: 10.2147/cia.s155409] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Gastrointestinal cancer is an age-associated disease, and geriatric patients are mostly likely to suffer from postoperative complications. Some studies indicated that comprehensive geriatric assessment (CGA) could predict postoperative complications in gastrointestinal cancer patients. However, the evidence is mixed. Objective This study aimed to conduct a meta-analysis to identify the effectiveness of CGA for predicting postoperative complications in gastrointestinal cancer patients. Methods The Joanna Briggs Institute Library, Cochrane Library, PubMed, Embase, Web of Science, CINAHL Complete and four Chinese databases were searched for studies published up to March 2017. Two reviewers independently screened literature, extracted data and assessed the quality of included studies. RevMan5.3 was used for meta-analysis or only descriptive analysis. Results Six studies were included, with 1,037 participants in total. In all, 13 components of CGA were identified, among which comorbidity (Charlson Comorbidity Index [CCI] ≥3; odds ratio [OR]=1.31, 95% CI [1.06, 1.63], P=0.01), polypharmacy (≥5 drugs/day; OR=1.30, 95% CI [1.04, 1.61], P=0.02) and activities of daily living (ADL) dependency (OR=1.69, 95% CI [1.20, 2.38], P=0.003) were proven relevant to the prediction of postoperative complications. No conclusive relationship was established between instrumental activities of daily living (IADL) dependency (OR=1.18, 95% CI [0.73, 1.91], P=0.51), Mini-Mental State Examination (MMSE; OR=1.13, 95% CI [0.91, 1.41], P=0.27), potential malnutrition (OR=1.07, 95% CI [0.87, 1.31], P=0.54), malnutrition (OR=1.26, 95% CI [0.80, 1.99], P=0.32), Geriatric Depression Scale (GDS; OR=1.18, 95% CI [0.90, 1.55], P=0.24) and postoperative complications. Conclusion Comorbidity (CCI ≥3), polypharmacy (≥5 drugs/day) and ADL dependency were predictive factors for postoperative complications in gastrointestinal cancer patients; the results of other geriatric instruments were not conclusive, pointing to insufficient studies and requirement of more original investigations.
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Affiliation(s)
- Dan-Dan Xue
- Nursing Department, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China.,School of Nursing, Fudan University, Shanghai, People's Republic of China
| | - Yun Cheng
- Nursing Department, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
| | - Mei Wu
- School of Nursing, Fudan University, Shanghai, People's Republic of China
| | - Yan Zhang
- Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
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31
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Ferrat E, Bastuji-Garin S, Paillaud E, Caillet P, Clerc P, Moscova L, Gouja A, Renard V, Attali C, Breton JL, Audureau E. Efficacy of nurse-led and general practitioner-led comprehensive geriatric assessment in primary care: protocol of a pragmatic three-arm cluster randomised controlled trial (CEpiA study). BMJ Open 2018; 8:e020597. [PMID: 29654038 PMCID: PMC5898323 DOI: 10.1136/bmjopen-2017-020597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Older patients raise therapeutic challenges, because they constitute a heterogeneous population with multimorbidity. To appraise this complexity, geriatricians have developed a multidimensional comprehensive geriatric assessment (CGA), which may be difficult to apply in primary care settings. Our primary objective was to compare the effect on morbimortality of usual care compared with two complex interventions combining educational seminars about CGA: a dedicated geriatric hotline for general practitioners (GPs) and CGA by trained nurses or GPs. METHODS AND ANALYSIS The Clinical Epidemiology and Ageing study is an open-label, pragmatic, multicentre, three-arm, cluster randomised controlled trial comparing two intervention groups and one control group. Patients must be 70 years or older with a long-term illness or with unscheduled hospitalisation in the past 3 months (750 patients planned). This study involves volunteering GPs practising in French primary care centres, with randomisation at the practice level. The multifaceted interventions for interventional arms comprise an educational interactive multiprofessional seminar for GPs and nurses, a geriatric hotline dedicated to GPs in case of difficulties and the performance of a CGA updated to primary care. The CGA is systematically performed by a nurse in arm 1 but is GP-led on a case-by-case basis in arm 2. The primary endpoint is a composite criterion comprising overall death, unscheduled hospitalisations, emergency admissions and institutionalisation within 12 months after inclusion. Intention-to-treat analysis will be performed using mixed-effects logistic regression models, with adjustment for potential confounders. ETHICS AND DISSEMINATION The protocol was approved by an appropriate ethics committee (CPP Ile-de-France IV, Paris, France, approval April 2015;15 664). This study is conducted according to principles of good clinical practice in the context of current care and will provide useful knowledge on the clinical benefits achievable by CGA in primary care. TRIAL REGISTRATION NUMBER NCT02664454; Pre-results.
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Affiliation(s)
- Emilie Ferrat
- Université Paris-EstCréteil (UPEC), DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology andAgeing Unit), Créteil, France
- Université Paris-Est Créteil (UPEC), School ofMedicine, Primary Care Department, Créteil, France
| | - Sylvie Bastuji-Garin
- Université Paris-EstCréteil (UPEC), DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology andAgeing Unit), Créteil, France
- AP-HP, Hôpital Henri-Mondor, Department of PublicHealth, Créteil, France
- AP-HP, Hôpital Henri-Mondor, Clinical Research Unit(URC Mondor), Créteil, France
| | - Elena Paillaud
- Université Paris-EstCréteil (UPEC), DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology andAgeing Unit), Créteil, France
- AP-HP, HôpitalHenri-Mondor, Geriatric Department, Créteil, France
| | - Philippe Caillet
- Université Paris-EstCréteil (UPEC), DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology andAgeing Unit), Créteil, France
- AP-HP, HôpitalHenri-Mondor, Geriatric Department, Créteil, France
| | - Pascal Clerc
- Université Paris-EstCréteil (UPEC), DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology andAgeing Unit), Créteil, France
- Université de Versailles - saint Quentin en Yvelines, School of Medicine, Primary Care Department, Montigny-le-Bretonneux, France
| | - Laura Moscova
- Université Paris-Est Créteil (UPEC), School ofMedicine, Primary Care Department, Créteil, France
| | - Amel Gouja
- AP-HP, Hôpital Henri-Mondor, Clinical Research Unit(URC Mondor), Créteil, France
| | - Vincent Renard
- Université Paris-EstCréteil (UPEC), DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology andAgeing Unit), Créteil, France
- Université Paris-Est Créteil (UPEC), School ofMedicine, Primary Care Department, Créteil, France
| | - Claude Attali
- Université Paris-EstCréteil (UPEC), DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology andAgeing Unit), Créteil, France
- Université Paris-Est Créteil (UPEC), School ofMedicine, Primary Care Department, Créteil, France
| | - Julien Le Breton
- Université Paris-EstCréteil (UPEC), DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology andAgeing Unit), Créteil, France
- Université Paris-Est Créteil (UPEC), School ofMedicine, Primary Care Department, Créteil, France
| | - Etienne Audureau
- Université Paris-EstCréteil (UPEC), DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology andAgeing Unit), Créteil, France
- AP-HP, Hôpital Henri-Mondor, Department of PublicHealth, Créteil, France
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Bridges J, Lucas G, Wiseman T, Griffiths P. Workforce characteristics and interventions associated with high-quality care and support to older people with cancer: a systematic review. BMJ Open 2017; 7:e016127. [PMID: 28760795 PMCID: PMC5642668 DOI: 10.1136/bmjopen-2017-016127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To provide an overview of the evidence base on the effectiveness of workforce interventions for improving the outcomes for older people with cancer, as well as analysing key features of the workforce associated with those improvements. DESIGN Systematic review. METHODS Relevant databases were searched for primary research, published in English, reporting on older people and cancer and the outcomes of interventions to improve workforce knowledge, attitudes or skills; involving a change in workforce composition and/or skill mix; and/or requiring significant workforce reconfiguration or new roles. Studies were also sought on associations between the composition and characteristics of the cancer care workforce and older people's outcomes. A narrative synthesis was conducted and supported by tabulation of key study data. RESULTS Studies (n=24) included 4555 patients aged 60+ from targeted cancer screening to end of life care. Interventions were diverse and two-thirds of the studies were assessed as low quality. Only two studies directly targeted workforce knowledge and skills and only two studies addressed the nature of workforce features related to improved outcomes. Interventions focused on discrete groups of older people with specific needs offering guidance or psychological support were more effective than those broadly targeting survival outcomes. Advanced Practice Nursing roles, voluntary support roles and the involvement of geriatric teams provided some evidence of effectiveness. CONCLUSIONS An array of workforce interventions focus on improving outcomes for older people with cancer but these are diverse and thinly spread across the cancer journey. Higher quality and larger scale research that focuses on workforce features is now needed to guide developments in this field, and review findings indicate that interventions targeted at specific subgroups of older people with complex needs, and that involve input from advanced practice nurses, geriatric teams and trained volunteers appear most promising.
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Affiliation(s)
- Jackie Bridges
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex
| | - Grace Lucas
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Theresa Wiseman
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- The Royal Marsden NHS Foundation Trust
| | - Peter Griffiths
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex
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Abstract
As the number of older patients with cancer is increasing, oncology disciplines are faced with the challenge of managing patients with multiple chronic conditions who have difficulty maintaining independence, who may have cognitive impairment, and who also may be more vulnerable to adverse outcomes. National and international societies have recommended that all older patients with cancer undergo geriatric assessment (GA) to detect unaddressed problems and introduce interventions to augment functional status to possibly improve patient survival. Several predictive models have been developed, and evidence has shown correlation between information obtained through GA and treatment-related complications. Comprehensive geriatric evaluations and effective interventions on the basis of GA may prove to be challenging for the oncologist because of the lack of the necessary skills, time constraints, and/or limited available resources. In this article, we describe how the Geriatrics Service at Memorial Sloan Kettering Cancer Center approaches an older patient with colon cancer from presentation to the end of life, show the importance of GA at the various stages of cancer treatment, and how predictive models are used to tailor the treatment. The patient's needs and preferences are at the core of the decision-making process. Development of a plan of care should always include the patient's preferences, but it is particularly important in the older patient with cancer because a disease-centered approach may neglect noncancer considerations. We will elaborate on the added value of co-management between the oncologist and a geriatric nurse practitioner and on the feasibility of adapting elements of this model into busy oncology practices.
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Affiliation(s)
| | - Soo Jung Kim
- Memorial Sloan Kettering Cancer Center, New York, NY
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Gladman JR. Delivering comprehensive geriatric assessment in new settings: advice for frontline clinicians. J R Coll Physicians Edinb 2016; 46:174-179. [PMID: 27959354 DOI: 10.4997/jrcpe.2016.309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Over the decades, as the principles of comprehensive geriatric assessment have been established, there have been attempts to apply its principles to settings other than acute hospital medical wards or the general communitydwelling older population, for example, to other settings where older people with infirmity are found. The purpose of this paper is to describe and reflect upon the application of and evidence for comprehensive geriatric assessment in these new settings and give some advice to clinicians about how to optimise their contributions to these processes. I will state my advice having first discussed intermediate care, emergency surgery (hip fracture), elective surgery, dementia and delirium care, emergency care, cancer care, and the care of residents of care homes (mindful of the irony of calling the latter a new setting, given that geriatric medicine originated in long term care).
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Affiliation(s)
- J R Gladman
- JRF Gladman, Division of Rehabilitation and Ageing, B Floor Medical School, Queen's Medical Centre, Nottingham NG7 2UH, UK, E-mail
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Abstract
OPINION STATEMENT Lung cancer is the leading cause of cancer-related deaths worldwide. In the USA, ≈60 % of lung cancer cases are diagnosed in elderly patients (≥65 years of age). However, elderly patients are underrepresented in clinical studies, leading to a paucity of evidence to guide treatment decisions. Several treatment barriers exist in elderly patients, including comorbidities and poor performance status. In addition, lack of reliable geriatric assessment tools and physician reluctance to treat may contribute to undertreatment in this population. For decades, systemic chemotherapy for elderly patients with advanced non-small cell lung cancer (NSCLC) was either omitted or given as monotherapy, frequently with significant dose reductions, potentially compromising the efficacy of these therapies. Recent analyses of elderly subgroups from multiple clinical trials provide evidence for improved outcomes associated with platinum-based doublet chemotherapies vs monotherapy. Moreover, in the new era of precision medicine, molecularly targeted therapies and more recently immune-targeting therapies (anti-PD-1 and anti-PD-L1 agents) exhibit relatively milder toxicities but superior clinical outcomes in subgroups of patients compared with conventional cytotoxic chemotherapies. Further clinical trials will be needed to confirm similar safety and efficacy profiles of these therapeutic approaches in the elderly compared with their younger counterparts. In this article, we review available evidence from clinical studies and also present expert consensus on the management of NSCLC in the elderly, including treatment in the adjuvant setting and treatment of advanced disease. Screening tools, such as the Comprehensive Geriatric Assessment, that help to identify the right population of elderly patients suitable for systemic treatment are also discussed.
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Gajra A, Anand A, Loh KP, Mohile S. Treatment dilemma in the care of older adults with advanced lung cancer. J Thorac Dis 2016; 8:E1497-E1500. [PMID: 28066642 DOI: 10.21037/jtd.2016.11.73] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ajeet Gajra
- Hematology-Oncology, Upstate Cancer Center, SUNY Upstate Medical University, Syracuse, NY13210, USA
| | - Ankit Anand
- Hematology-Oncology, Upstate Cancer Center, SUNY Upstate Medical University, Syracuse, NY13210, USA
| | - Kah Poh Loh
- Hematology Oncology, James P Wilmot Cancer Institute, University of Rochester, Rochester, NY 14642, USA
| | - Supriya Mohile
- Hematology Oncology, James P Wilmot Cancer Institute, University of Rochester, Rochester, NY 14642, USA
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Brady C, O'Connor K, Power DG. Androgen Deprivation Therapy and Risk of Alzheimer's Disease: Importance of Holistic Geriatric Oncology Assessment. J Clin Oncol 2016; 34:2803-4. [PMID: 27298422 DOI: 10.1200/jco.2016.67.8169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Derek G Power
- Cork University Hospital and Mercy University Hospital, Cork, Ireland
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Jonna S, Chiang L, Liu J, Carroll MB, Flood K, Wildes TM. Geriatric assessment factors are associated with mortality after hospitalization in older adults with cancer. Support Care Cancer 2016; 24:4807-13. [PMID: 27465048 DOI: 10.1007/s00520-016-3334-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/10/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Survival in older adults with cancer varies given differences in functional status, comorbidities, and nutrition. Prediction of factors associated with mortality, especially in hospitalized patients, allows physicians to better inform their patients about prognosis during treatment decisions. Our objective was to analyze factors associated with survival in older adults with cancer following hospitalization. METHODS Through a retrospective cohort study, we reviewed 803 patients who were admitted to Barnes-Jewish Hospital's Oncology Acute Care of Elders (OACE) unit from 2000 to 2008. Data collected included geriatric assessments from OACE screening questionnaires as well as demographic and medical history data from chart review. The primary end point was time from index admission to death. The Cox proportional hazard modeling was performed. RESULTS The median age was 72.5 years old. Geriatric syndromes and functional impairment were common. Half of the patients (50.4 %) were dependent in one or more activities of daily living (ADLs), and 74 % were dependent in at least one instrumental activity of daily living (IADLs). On multivariate analysis, the following factors were significantly associated with worse overall survival: male gender; a total score <20 on Lawton's IADL assessment; reason for admission being cardiac, pulmonary, neurologic, inadequate pain control, or failure to thrive; cancer type being thoracic, hepatobiliary, or genitourinary; readmission within 30 days; receiving cancer treatment with palliative rather than curative intent; cognitive impairment; and discharge with hospice services. CONCLUSIONS In older adults with cancer, certain geriatric parameters are associated with shorter survival after hospitalization. Assessment of functional status, necessity for readmission, and cognitive impairment may provide prognostic information so that oncologists and their patients make more informed, individualized decisions.
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Affiliation(s)
- Sushma Jonna
- Department of Medicine, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8056, St Louis, MO, 63110, USA
| | - Leslie Chiang
- University of California San Diego, San Diego, CA, USA
| | - Jingxia Liu
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO, USA
| | - Maria B Carroll
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - Kellie Flood
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tanya M Wildes
- Department of Medicine, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8056, St Louis, MO, 63110, USA.
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Ferrat E, Audureau E, Paillaud E, Liuu E, Tournigand C, Lagrange JL, Canoui-Poitrine F, Caillet P, Bastuji-Garin S. Four Distinct Health Profiles in Older Patients With Cancer: Latent Class Analysis of the Prospective ELCAPA Cohort. J Gerontol A Biol Sci Med Sci 2016; 71:1653-1660. [PMID: 27006079 DOI: 10.1093/gerona/glw052] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 03/01/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Several studies have evaluated the independent prognostic value of impairments in single geriatric-assessment (GA) components in elderly cancer patients. None identified homogeneous subgroups. Our aims were to identify such subgroups based on combinations of GA components and to assess their associations with treatment decisions, admission, and death. METHODS We prospectively included 1,021 patients aged ≥70 years who had solid or hematologic malignancies and who underwent a GA in one of two French teaching hospitals. Two geriatricians independently selected candidate GA parameters for latent class analysis, which was then performed on the 821 cases without missing data. Age, gender, tumor site, metastatic status, and inpatient versus outpatient status were used as active covariates and predictors of class membership. Outcomes were cancer treatment decisions, overall 1-year mortality, and 6-month unscheduled admissions. Sensitivity analyses were performed on the overall population of 1,021 patients and on 375 newly enrolled patients. RESULTS We identified four classes: relatively healthy (LC1, 28%), malnourished (LC2, 36%), cognitive and mood impaired (LC3, 15%), and globally impaired (LC4, 21%). Tumor site, metastatic status, age, and in/outpatient status independently predicted class membership (p < .001). In adjusted pairwise comparisons, compared to LC1, the three other LCs were associated with higher risks of palliative treatment, death, and unscheduled admission (p ≤ .05). LC4 was associated with 1-year mortality and palliative treatment compared to LC2 and LC3 (p ≤ .05). CONCLUSION We identified four health profiles that may help physicians select cancer treatments and geriatric interventions. Researchers may find these profiles useful for stratifying patients in clinical trials.
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Affiliation(s)
- Emilie Ferrat
- Clinical Epidemiology and Ageing (CEpiA) Unit EA 7376, Université Paris Est (UPEC), A-TVB DHU, IMRB, F-94010 Créteil, France. .,Primary Care Department, Faculté de médecine, Université Paris Est, UPEC, F-94010 Créteil France
| | - Etienne Audureau
- Clinical Epidemiology and Ageing (CEpiA) Unit EA 7376, Université Paris Est (UPEC), A-TVB DHU, IMRB, F-94010 Créteil, France.,Department of Public Health, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France
| | - Elena Paillaud
- Clinical Epidemiology and Ageing (CEpiA) Unit EA 7376, Université Paris Est (UPEC), A-TVB DHU, IMRB, F-94010 Créteil, France.,Unité de coordination en oncogériatrie (UCOG), AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France
| | - Evelyne Liuu
- Unité de coordination en oncogériatrie (UCOG), AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France
| | - Christophe Tournigand
- Department of Medical Oncology, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France.,Université Paris Est (UPEC), Early detection of Colon Cancer using Molecular Markers and Microbiota (EC2M3) Unit EA7375, UPEC, F-94010 Créteil, France
| | - Jean-Leon Lagrange
- Department of Radiation Oncology, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France
| | - Florence Canoui-Poitrine
- Clinical Epidemiology and Ageing (CEpiA) Unit EA 7376, Université Paris Est (UPEC), A-TVB DHU, IMRB, F-94010 Créteil, France.,Department of Public Health, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France
| | - Philippe Caillet
- Clinical Epidemiology and Ageing (CEpiA) Unit EA 7376, Université Paris Est (UPEC), A-TVB DHU, IMRB, F-94010 Créteil, France.,Unité de coordination en oncogériatrie (UCOG), AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France
| | - Sylvie Bastuji-Garin
- Clinical Epidemiology and Ageing (CEpiA) Unit EA 7376, Université Paris Est (UPEC), A-TVB DHU, IMRB, F-94010 Créteil, France.,Department of Public Health, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France.,Clinical Research Unit (URC Mondor), AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France
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40
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Martinez-Tapia C, Canoui-Poitrine F, Bastuji-Garin S, Soubeyran P, Mathoulin-Pelissier S, Tournigand C, Paillaud E, Laurent M, Audureau E. Optimizing the G8 Screening Tool for Older Patients With Cancer: Diagnostic Performance and Validation of a Six-Item Version. Oncologist 2016; 21:188-95. [PMID: 26764250 DOI: 10.1634/theoncologist.2015-0326] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/27/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A multidimensional geriatric assessment (GA) is recommended in older cancer patients to inventory health problems and tailor treatment decisions accordingly but requires considerable time and human resources. The G8 is among the most sensitive screening tools for selecting patients warranting a full GA but has limited specificity. We sought to develop and validate an optimized version of the G8. PATIENTS AND METHODS We used a prospective cohort of cancer patients aged ≥ 70 years referred to geriatricians for GA (2007-2012: n = 729 [training set]; 2012-2014: n = 414 [validation set]). Abnormal GA was defined as at least one impaired domain across seven validated tests. Multiple correspondence analysis, multivariate logistic regression, and bootstrapped internal validation were performed sequentially. RESULTS The final model included six independent predictors for abnormal GA: weight loss, cognition/mood, performance status, self-rated health status, polypharmacy (≥ 6 medications per day), and history of heart failure/coronary heart disease. For the original G8, sensitivity was 87.2% (95% confidence interval, 84.3-89.7), specificity 57.7% (47.3-67.7), and area under the receiver-operating characteristic curve (AUROC) 86.5% (83.5-89.6). The modified G8 had corresponding values of 89.2% (86.5-91.5), 79.0% (69.4-86.6), and 91.6% (89.3; 93.9), with higher AUROC values for all tumor sites and stable properties on the validation set. CONCLUSION A modified G8 screening tool exhibited better diagnostic performance with greater uniformity across cancer sites and required only six items. If these features are confirmed in other settings, the modified tool may facilitate selection for a full GA in older patients with cancer. IMPLICATIONS FOR PRACTICE Several screening tools have been developed to identify older patients with cancer likely to benefit from a complete geriatric assessment, but none combines appropriate sensitivity and specificity. Based on a large prospective cohort study, an optimized G8 tool was developed, combining a systematic statistical approach with expert judgment to ensure optimal discriminative power and clinical relevance. The improved screening tool achieves high sensitivity, high specificity, better homogeneity across cancer types, and greater parsimony with only six items needed, facilitating selection for a full geriatric assessment.
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Affiliation(s)
| | - Florence Canoui-Poitrine
- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), IMRB, A-TVB DHU Public Health Department, Assistance Publique Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France
| | - Sylvie Bastuji-Garin
- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), IMRB, A-TVB DHU Public Health Department, Assistance Publique Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France Clinical Research Unit (URC Mondor), Assistance Publique Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France
| | - Pierre Soubeyran
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France Université de Bordeaux, Bordeaux, France
| | - Simone Mathoulin-Pelissier
- INSERM U897, CIC-EC07, ISPED, Université de Bordeaux, France Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France
| | - Christophe Tournigand
- EC2M3 Unit, VIC DHU, Université Paris Est (UPE) Department of Medical Oncology Assistance Publique Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France
| | - Elena Paillaud
- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), IMRB, A-TVB DHU Internal Medicine and Geriatric Department, Assistance Publique Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France
| | - Marie Laurent
- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), IMRB, A-TVB DHU Internal Medicine and Geriatric Department, Assistance Publique Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France
| | - Etienne Audureau
- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), IMRB, A-TVB DHU Public Health Department, Assistance Publique Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France
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Brunello A, Fontana A, Zafferri V, Panza F, Fiduccia P, Basso U, Copetti M, Lonardi S, Roma A, Falci C, Monfardini S, Cella A, Pilotto A, Zagonel V. Development of an oncological-multidimensional prognostic index (Onco-MPI) for mortality prediction in older cancer patients. J Cancer Res Clin Oncol 2016; 142:1069-77. [PMID: 26758276 PMCID: PMC4828483 DOI: 10.1007/s00432-015-2088-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/23/2015] [Indexed: 01/06/2023]
Abstract
Purpose A
multidimensional prognostic index (MPI) based on a comprehensive geriatric assessment (CGA) has been developed and validated in independent cohorts of older patients demonstrating good accuracy in predicting one-year mortality. The aim of this study was to develop a cancer-specific modified MPI (Onco-MPI) for mortality prediction in older cancer patients. Methods We enrolled 658 new cancer subjects ≥70 years (mean age 77.1 years, 433 females, 65.8 %) attending oncological outpatient services from September 2004 to June 2011. The Onco-MPI was calculated according to a validated algorithm as a weighted linear combination of the following CGA domains: age, sex, basal and instrumental activities of daily living, Eastern Cooperative Oncology Group performance status, mini-mental state examination, body mass index, Cumulative Illness Rating Scale, number of drugs and the presence of caregiver. Cancer sites (breast 46.5 %, colorectal 21.3 %, lung 6.4 %, prostate 5.5 %, urinary tract 5.0 %, other 15.3 %) and cancer stages (I 37 %, II 22 %, III 19 %, IV 22 %) were also included in the model. All-cause mortality was recorded. Three grades of severity of the Onco-MPI score (low risk: 0.0–0.46, medium risk: 0.47–0.63, high risk: 0.64–1.0) were calculated using RECPAM method. Discriminatory power and calibration were assessed by estimating survival C-indices, along with 95 % confidence interval (CI) and the survival-based Hosmer–Lemeshow (HL) measures. Results One-year mortality incidence rate was 17.4 %. A significant difference in mortality rates was observed in Onco-MPI low risk compared to medium- and high-risk patients (2.1 vs. 17.7 vs. 80.8 %, p < 0.0001). The discriminatory power of one-year mortality prediction of the Onco-MPI was very good (survival C-index 0.87, 95 % CI 0.84–0.90) with an excellent calibration (HL p value 0.854). Conclusion Onco-MPI appears to be a highly accurate and well-calibrated predictive tool for one-year mortality in older cancer patients that can be useful for clinical decision making in this age group.
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Affiliation(s)
- Antonella Brunello
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy.
| | - Andrea Fontana
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Valeria Zafferri
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - Francesco Panza
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.,Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Pasquale Fiduccia
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - Umberto Basso
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | | | - Sara Lonardi
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - Anna Roma
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - Cristina Falci
- Medical Oncology 2, Istituto Oncologico Veneto IOV- IRCCS, Padua, Italy
| | | | - Alberto Cella
- Department of OrthoGeriatrics, Rehabilitation and Stabilization, Frailty Area, NR-HS Galliera Hospital, Genoa, Italy
| | - Alberto Pilotto
- Department of OrthoGeriatrics, Rehabilitation and Stabilization, Frailty Area, NR-HS Galliera Hospital, Genoa, Italy.,Geriatrics Unit, Azienda ULSS 16, S Antonio Hospital, Padua, Italy
| | - Vittorina Zagonel
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
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Korc-Grodzicki B, Holmes HM, Shahrokni A. Geriatric assessment for oncologists. Cancer Biol Med 2015; 12:261-74. [PMID: 26779363 PMCID: PMC4706523 DOI: 10.7497/j.issn.2095-3941.2015.0082] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 10/21/2015] [Indexed: 01/18/2023] Open
Abstract
The world is experiencing aging of its population. Age-specific incidence rates of cancer are higher and cancer is now recognized as a part of aging. Treating older patients can be challenging. The clinical behavior of some tumors changes with age and the aging process itself brings physiological changes leading to decline in the function of organs. It is essential to identify those patients with longer life expectancy, potentially more likely to benefit from aggressive treatment vs. those that are more vulnerable to adverse outcomes. A primary determination when considering therapy for an older cancer patient is a patient's physiologic, rather than chronologic age. In order to differentiate amongst patients of the same age, it is useful to determine if a patient is fit or frail. Frail older adults have multiple chronic conditions and difficulties maintaining independence. They may be more vulnerable to therapy toxicities, and may not have substantial lasting benefits from therapy. Geriatric assessment (GA) may be used as a tool to determine reversible deficits and devise treatment strategies to mitigate such deficits. GA is also used in treatment decision making by clinicians, helping to risk stratify patients prior to potentially high-risk therapy. An important practical aspect of GA is the feasibility of incorporating it into a busy oncology practice. Key considerations in performing the GA include: available resources, patient population, GA tools to use, and who will be responsible for using the GA results and develop care plans. Challenges in implementing GA in clinical practice will be discussed.
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Affiliation(s)
- Beatriz Korc-Grodzicki
- 1 Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, USA ; 2 Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Holly M Holmes
- 1 Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, USA ; 2 Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Armin Shahrokni
- 1 Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, USA ; 2 Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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Rudek MA, Graham RA, Ratain MJ. Harmonization of Renal Function Assessment Is Needed During Early Clinical Development of Oncology Drugs. J Clin Oncol 2015; 34:103-4. [PMID: 26628472 DOI: 10.1200/jco.2015.64.2553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Canoui-Poitrine F, Reinald N, Laurent M, Guery E, Caillet P, David JP, Tournigand C, Lagrange JL, Bastuji-Garin S, Lemogne C, Paillaud E. Geriatric assessment findings independently associated with clinical depression in 1092 older patients with cancer: the ELCAPA Cohort Study. Psychooncology 2015; 25:104-11. [PMID: 26123351 DOI: 10.1002/pon.3886] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/04/2015] [Accepted: 05/26/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We aim to assess the prevalence and associated factors of clinical depression in older patients with cancer. METHODS We studied a prospective cohort of cancer patients aged ≥ 70 years and referred to geriatric oncology clinics between 2007 and 2012. A multidimensional geriatric assessment was performed before choosing the cancer-treatment strategy. Clinical depression was diagnosed by senior geriatricians by a semi-structured interview. It encompassed criteria of the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) and of the International Classification of Diseases (10th edition). Multivariate logistic regression was performed. RESULTS Of 1121 consecutive patients, 1092 had available data (mean age, 80.4 years; women, 48.8%; metastases, 51.3%; cancer location: colorectal 21.1%, breast 16.8%, kidney, bladder or urinary tract 14.0%, and prostate 11.4%). The overall prevalence of clinical depression was 28.4% (95% confidence interval, 25.7-31.2). Factors independently associated with clinical depression by multivariate analysis adjusting for all following factors plus gender, and metastasis were impaired mobility (adjusted odds ratio [aOR], 2.35; 1.59-3.46), impaired functional status defined as Eastern Cooperative Oncology Group Performance Status ≥ 2 (aOR, 2.39; 1.66-3.43) or as activities of daily living < 6 (aOR, 2.43; 1.73-3.41), inpatient status (aOR, 1.68; 1.20-2.37), inadequate social support (aOR, 1.66; 1.16-2.37), cognitive impairment (aOR, 1.76; 1.24-2.49), polypharmacy defined as five or more non-antidepressant drugs (aOR, 1.65; 1.14-2.38), multimorbidity (aOR additional CIRS-G point , 1.08; 1.04-1.12), and cancer-related pain (aOR, 1.76; 1.26-2.46). CONCLUSION In older patients with as-yet untreated cancer at various sites and stages, clinical depression was highly prevalent. Clinical depression was independently associated with several geriatric assessment findings (impaired mobility and function, inadequate social support, cognitive impairment, polypharmacy, and multimorbidity) independently from gender, tumor site, and metastatic status.
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Affiliation(s)
- Florence Canoui-Poitrine
- APHP, Hôpital Henri-Mondor, Service de Santé Publique, F-94000, Créteil, France.,Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France
| | - Nicoleta Reinald
- Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France.,APHP, Hôpital Henri-Mondor, Département de Gériatrie, Unité de Coordination en Onco-Gériatrie UCOG Sud Val-de-Marne, F-94000, Créteil, France
| | - Marie Laurent
- Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France.,APHP, Hôpital Henri-Mondor, Département de Gériatrie, Unité de Coordination en Onco-Gériatrie UCOG Sud Val-de-Marne, F-94000, Créteil, France
| | - Esther Guery
- APHP, Hôpital Henri-Mondor, Service de Santé Publique, F-94000, Créteil, France.,Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France.,APHP, Hôpital Henri-Mondor, Unité de Recherche Clinique (URC-Mondor), F-94000, Créteil, France
| | - Philippe Caillet
- Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France.,APHP, Hôpital Henri-Mondor, Département de Gériatrie, Unité de Coordination en Onco-Gériatrie UCOG Sud Val-de-Marne, F-94000, Créteil, France
| | - Jean-Philippe David
- Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France.,APHP, Hôpital Emile-Roux, Département de Gériatrie, F-94450, Limeil-Brévannes, France
| | - Christophe Tournigand
- APHP, Hôpital Henri-Mondor, Service d'Oncologie Médicale, F-94010, Créteil, France.,Université Paris Est, UPEC, DHU VIC, unité EC2M3, F-94000, Créteil, France
| | - Jean-Leon Lagrange
- APHP, Hôpital Henri-Mondor, Service de Radiothérapie, F-94000, Créteil, France.,Université Paris Est, UPEC, Faculté de Médecine, F-94000, Créteil, France
| | - Sylvie Bastuji-Garin
- APHP, Hôpital Henri-Mondor, Service de Santé Publique, F-94000, Créteil, France.,Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France.,APHP, Hôpital Henri-Mondor, Unité de Recherche Clinique (URC-Mondor), F-94000, Créteil, France
| | - Cedric Lemogne
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,APHP, Hôpitaux Universitaires Paris Ouest, Service de Psychiatrie de l'adulte et du sujet âgé, F-75015, Paris, France.,Inserm, U894, Centre Psychiatrie et Neurosciences, F-75015, Paris, France
| | - Elena Paillaud
- Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France.,APHP, Hôpital Henri-Mondor, Département de Gériatrie, Unité de Coordination en Onco-Gériatrie UCOG Sud Val-de-Marne, F-94000, Créteil, France
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Naruishi K, Kunita A, Kubo K, Nagata T, Takashiba S, Adachi S. Predictors of improved functional outcome in elderly inpatients after rehabilitation: a retrospective study. Clin Interv Aging 2014; 9:2133-41. [PMID: 25584025 PMCID: PMC4264602 DOI: 10.2147/cia.s73388] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose The number of elderly inpatients has been steadily increasing worldwide. However, the ability to predict the degree of improvement of functional capacity after comprehensive examination of elderly inpatients is still lacking. The purpose of this study was to investigate the predictors of improved functional outcome after rehabilitation of elderly inpatients. Methods We performed a retrospective cohort study with 1,079 patients (age <70 years: N=331, age ≥70 years: N=748) who had been admitted to Tottori Municipal Hospital. Functional Independence Measure (FIM) scores were measured both at admission and discharge to calculate FIM gain and efficiency. Of these patients, 262 patients had oral examinations on admission. The Mann–Whitney U-test or chi-square test was used for statistical analyses. Conditional logistic regression analysis was used to compute the odds ratio (OR) and 95% confidence interval (CI). Cut-off values of FIM scores to determine if elderly inpatients were able to return home after discharge were determined using a receiver operating characteristic curve. Results FIM scores, including FIM gain and efficiency, of elderly patients were significantly lower than those of middle-aged patients. Inability to close the lips and dysfunctional tongue movement, but not the loss of teeth, were correlated with a reduced improvement of FIM scores. Cognitive impairment and aspiration pneumonia, but not cerebrovascular disease, were also correlated with a reduced improvement of FIM scores. Interestingly, FIM scores were significantly lower in patients with both cerebrovascular disease and a loss of posterior occlusion. Factors shown to have a significant impact on the improvement of FIM scores included the stable posterior occlusion (OR: 2.23, 95% CI: 1.2–4.1), closed lips (OR: 5.15, 95% CI: 2.3–11.7), functional tongue movement (OR: 5.74, 95% CI: 3.0–11.0), presence of cognitive impairment (OR: 0.31, 95% CI: 0.17–0.49), and presence of aspiration pneumonia (OR: 0.27, 95% CI: 0.15–0.51). Conclusion Age and disorder of oral function may be significant predictors of improved functional capacity after rehabilitation for elderly inpatients.
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Affiliation(s)
- Koji Naruishi
- Division of Local Care Center, Tottori Municipal Hospital, Tottori, Japan ; Department of Periodontics and Endodontics, Okayama University Hospital, Okayama, Japan
| | - Akiko Kunita
- Division of Rehabilitation, Tottori Municipal Hospital, Tottori, Japan
| | - Katsuyuki Kubo
- Division of Local Care Center, Tottori Municipal Hospital, Tottori, Japan ; Department of Periodontics and Endodontics, Okayama University Hospital, Okayama, Japan
| | - Toshihiko Nagata
- Department of Periodontology and Endodontology, Institute of Health Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Shogo Takashiba
- Department of Periodontics and Endodontics, Okayama University Hospital, Okayama, Japan ; Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Seiji Adachi
- Division of Local Care Center, Tottori Municipal Hospital, Tottori, Japan
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