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Benderra MA, Paillaud E, Broussier A, Layese R, Tapia CM, Mebarki S, Boudou-Rouquette P, Laurent M, Piero M, Rollot-Trad F, Gligorov J, Caillet P, Canoui-Poitrïne F. Prediction of moderate and severe toxicities of chemotherapy in older patients with cancer: a propensity weighted analysis of ELCAPA cohort. Oncologist 2024:oyae157. [PMID: 38970398 DOI: 10.1093/oncolo/oyae157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/24/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Currently available predictive models for chemotherapy-related toxicity are not sufficiently discriminative in older patients with cancer and do not consider moderate toxicities. The purpose of this study was to identify factors associated with moderate and severe chemotherapy toxicities in older patients with cancer. MATERIALS AND METHODS Patients aged 70+ recruited in the prospective ELCAPA cohort were analyzed. A total of 837 patients with data on toxicities had received chemotherapy without other systemic treatment and were included between 2015 and 2022. To adjust for any imbalances in the distribution of covariates between patients receiving single-agent chemotherapy vs combination chemotherapy, we applied overlap weighting (a propensity-score-based technique). We used multinomial logistic regression. RESULTS Median (interquartile range) age was 81 (77-84). Forty-one percent experienced moderate toxicity, and 33% experienced severe toxicity. Hematologic toxicities accounted for 53% of severe toxicities and 66% of moderate toxicities. Age <80 years, cancer type, metastatic status, Eastern Cooperative Oncology Group performance status (ECOG-PS) >1, no cognitive impairment were associated with combination chemotherapy decision. In a univariate analysis with overlap weighting, no factors were associated with moderate toxicity. Hemoglobin < 0 g/dL and a CIRS-G score >12 were associated with severe toxicity. In a multivariate analysis, only hemoglobin < 10 g/dL was independently associated with severe toxicity, adjusted OR 2.96 (95% CI, 1.20-7.29). CONCLUSION By addressing indication bias for combination chemotherapy decision, only anemia and not cancer type, combination chemotherapy was predicting for severe chemotherapy-related toxicity in older patients with cancer. We did not find any predictors of moderate chemotherapy-related toxicity.
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Affiliation(s)
- Marc-Antoine Benderra
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopital Henri-Mondor, Public Health Department and Clinical Research Unit (URC Mondor), F-94010 Créteil, France
- Institut Universitaire de Cancérologie (IUC), AP-HP, Sorbonne Université, F-75013 Paris, France
| | - Elena Paillaud
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopital Européen Georges Pompidou, Paris Cancer Institute CARPEM, Department of Geriatrics, F-75015 Paris, France
| | - Amaury Broussier
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopitaux Henri Mondor/Emile Roux, Department of Geriatrics, F-94456 Limeil-Brevannes, France
| | - Richard Layese
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopital Henri-Mondor, Public Health Department and Clinical Research Unit (URC Mondor), F-94010 Créteil, France
| | - Claudia M Tapia
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
| | - Soraya Mebarki
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopital Européen Georges Pompidou, Paris Cancer Institute CARPEM, Department of Geriatrics, F-75015 Paris, France
| | - Pascale Boudou-Rouquette
- AP-HP, Hopital Cochin, Cancer Research for PErsonalized Medicine (CARPEM), Department of Medical Oncology, ARIANE Program, Paris Cité University, F-75015 Paris, France
| | - Marie Laurent
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopitaux Henri Mondor/Emile Roux, Department of Geriatrics, F-94456 Limeil-Brevannes, France
| | - Monica Piero
- AP-HP, Hopital Cochin, Cancer Research for PErsonalized Medicine (CARPEM), Department of Medical Oncology, ARIANE Program, Paris Cité University, F-75015 Paris, France
- Hopital Institut Curie, Unité d'oncogériatrie, Department of Supportive Care, F-92210 Saint-Cloud, France
| | - Florence Rollot-Trad
- Hopital Institut Curie, Unité d'oncogériatrie, Department of Supportive Care, F-92210 Saint-Cloud, France
| | - Joseph Gligorov
- Institut Universitaire de Cancérologie (IUC), AP-HP, Sorbonne Université, F-75013 Paris, France
- AP-HP, Hopital Tenon, Department of Medical Oncology, F-75020 Paris, France
| | - Philippe Caillet
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopital Européen Georges Pompidou, Paris Cancer Institute CARPEM, Department of Geriatrics, F-75015 Paris, France
| | - Florence Canoui-Poitrïne
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopital Henri-Mondor, Public Health Department and Clinical Research Unit (URC Mondor), F-94010 Créteil, France
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Gordon MJ, Duan Z, Zhao H, Nastoupil L, Iyer S, Ferrajoli A, Danilov AV, Giordano SH. Comparison of Comorbidity Models Within a Population-Based Cohort of Older Adults With Non-Hodgkin Lymphoma. JCO Clin Cancer Inform 2024; 8:e2300223. [PMID: 38684043 DOI: 10.1200/cci.23.00223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/25/2024] [Accepted: 03/08/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE Compare the association of individual comorbidities, comorbidity indices, and survival in older adults with non-Hodgkin lymphoma (NHL), including in specific NHL subtypes. METHODS Data source was SEER-Medicare, a population-based registry of adults age 65 years and older with cancer. We included all incident cases of NHL diagnosed during 2008-2017 who met study inclusion criteria. Comorbidities were classified using the three-factor risk estimate scale (TRES), Charlson comorbidity index (CCI), and National Cancer Institute (NCI) comorbidity index categories and weights. Overall survival (OS) and lymphoma-specific survival, with death from other causes treated as a competing risk, were estimated using the Kaplan-Meier method from time of diagnosis. Multivariable Cox models were constructed, and Harrel C-statistics were used to compare comorbidity models. A two-sided P value of <.05 was considered significant. RESULTS A total of 40,486 patients with newly diagnosed NHL were included. Patients with aggressive NHL had higher rates of baseline comorbidity. Despite differences in baseline comorbidity between NHL subtypes, cardiovascular, pulmonary, diabetes, and renal comorbidities were frequent and consistently associated with OS in most NHL subtypes. These categories were used to construct a candidate comorbidity score, the non-Hodgkin lymphoma 5 (NHL-5). Comparing three validated comorbidity scores, TRES, CCI, NCI, and the novel NHL-5 score, we found similar associations with OS and lymphoma-specific survival, which was confirmed in sensitivity analyses by NHL subtypes. CONCLUSION The optimal measure of comorbidity in NHL is unknown. Here, we demonstrate that the three-category TRES and five-category NHL-5 scores perform as well as the 14-16 category CCI and NCI scores in terms of association with OS and lymphoma-specific survival. These simple scores could be more easily used in clinical practice without prognostic loss.
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Affiliation(s)
- Max J Gordon
- Department of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
- National Cancer Institute, Lymphoid Malignancy Branch, Bethesda, MD
| | - Zhigang Duan
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Loretta Nastoupil
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Swaminathan Iyer
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alessandra Ferrajoli
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alexey V Danilov
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
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3
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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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Berendt J, Brunner S, Heckel M, Tewes M, Ostgathe C, Gahr S. Symptom burden and relief in palliative care units of German Comprehensive Cancer Center and other hospitals. J Cancer Res Clin Oncol 2024; 150:160. [PMID: 38532121 PMCID: PMC10965705 DOI: 10.1007/s00432-023-05557-6] [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: 07/03/2023] [Accepted: 11/27/2023] [Indexed: 03/28/2024]
Abstract
PURPOSE The National Hospice and Palliative Registry contains patient data from German hospice and palliative care facilities about symptoms. The aim of the study at hand is to differentiate symptom burden of patients in palliative care units between Comprehensive Cancer Center (CCC) and other hospitals regarding symptom burden and relief of patients in palliative care units. METHODS The registry analysis provided data of patients in palliative care units (2014-2018). We analyzed characteristic and symptom-related data on 18 symptoms, with considerable symptom-burdened patients (moderate or severe). We followed a cancer (yes/no) and facility-specific descriptive analysis (f, %, μ, Mdn, SD, V, r) using SPSS. RESULTS We evaluated 10,447 patient records (CCC: 4234 pts/non CCC 6,213 pts), 82% with a cancer diagnosis. For cancer patients, the mean age in CCC-affiliated palliative care units was 68 (SD 19-99) years, in others 73 (SD 23-104) years (p < 0.05; V = 0.2). The proportion of patients with significant symptom burden is lower in CCC-affiliated than in other palliative care units. The difference between facilities shows a significant weak effect in pain, vomiting and constipation, depressiveness, anxiety, and tension. The proportion of cases which symptom burden could be alleviated is higher in CCC-affiliated palliative care units with significant weak/medium effect in pain, nausea, vomiting, shortness of breath, constipation, wound care problems, depressiveness, anxiety, tension, confusion, and problems in organizing care. CONCLUSION We found differences in symptom burden and symptom relief between CCC-affiliated and other palliative care units. CCCs should continue to feel responsible for sharing knowledge about symptom relief, such as through standard operating procedures and education.
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Affiliation(s)
- Julia Berendt
- Department of Palliative Medicine and Comprehensive Cancer Center, CCC Erlangen-EMN, University Hospital Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
| | - Sarah Brunner
- Department of Palliative Medicine and Comprehensive Cancer Center, CCC Erlangen-EMN, University Hospital Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
- Medical Informatics and Communication Center and Comprehensive Cancer Center, CCC Erlangen-EMN, University Hospital Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Maria Heckel
- Department of Palliative Medicine and Comprehensive Cancer Center, CCC Erlangen-EMN, University Hospital Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Mitra Tewes
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine and Comprehensive Cancer Center, CCC Erlangen-EMN, University Hospital Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Susanne Gahr
- Department of Palliative Medicine and Comprehensive Cancer Center, CCC Erlangen-EMN, University Hospital Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
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Vargas A, Dutta P, Carpenter ES, Machicado JD. Endoscopic Ultrasound-Guided Ablation of Premalignant Pancreatic Cysts and Pancreatic Cancer. Diagnostics (Basel) 2024; 14:564. [PMID: 38473035 DOI: 10.3390/diagnostics14050564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
Pancreatic cancer is on the rise and expected to become the second leading cause of cancer-related death by 2030. Up to a one-fifth of pancreatic cancers may arise from mucinous pancreatic cysts, which are frequently present in the general population. Currently, surgical resection is the only curative approach for pancreatic cancer and its cystic precursors. However, only a dismal proportion of patients are eligible for surgery. Therefore, novel treatment approaches to treat pancreatic cancer and precancerous pancreatic cysts are needed. Endoscopic ultrasound (EUS)-guided ablation is an emerging minimally invasive method to treat pancreatic cancer and premalignant pancreatic cysts. Different ablative modalities have been used including alcohol, chemotherapy agents, and radiofrequency ablation. Cumulative data over the past two decades have shown that endoscopic ablation of mucinous pancreatic cysts can lead to cyst resolution in a significant proportion of the treated cysts. Furthermore, novel data are emerging about the ability to endoscopically ablate early and locally advanced pancreatic cancer. In this review, we aim to summarize the available data on the efficacy and safety of the different EUS-ablation modalities for the management of premalignant pancreatic cysts and pancreatic cancer.
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Affiliation(s)
- Alejandra Vargas
- Department of Medicine, Eastern Virginia Medical School, Norfolk, VA 23510, USA
| | - Priyata Dutta
- Department of Medicine, Trinity Health, Ann Arbor, MI 48197, USA
| | - Eileen S Carpenter
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jorge D Machicado
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI 48109, USA
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Dumont C, Aregui A, Hauchecorne M, Lefèvre M, Aussedat Q, Reignier PL, Gauthier H, Hennequin C, Fossey-Diaz V, Xylinas E, Pachev A, Desgrandchamps F, Masson-Lecomte A, Culine S. Safety and efficacy of preoperative chemotherapy for muscle-invasive bladder cancer in elderly patients. World J Urol 2023; 41:2715-2722. [PMID: 37555987 DOI: 10.1007/s00345-023-04561-2] [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: 06/06/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE This study aimed at describing the feasibility and oncological outcomes of standard cisplatin-based neoadjuvant chemotherapy (C-NAC) for muscle-invasive bladder cancer (MIBC) in patients aged ≥ 75 and assess the impact of baseline geriatric parameters. METHODS This retrospective study included patients with stage cT2-4NanyM0 MIBC aged 75 and older treated with ≥ 1 cycle of C-NAC from 2011 to 2021 at a high-volume academic center. Primary outcome was overall survival (OS). Secondary outcomes were chemotherapy feasibility (administration of ≥ 4 cycles), safety, and pathological downstaging. RESULTS Fifty-six patients were included. Median age was 79 (range 75-90). C-NAC regimen was ddMVAC in 41 patients and GC in 15. Seventy-three percent of patients received ≥ 4 cycles of C-NAC. Grade ≥ 3 toxicity was observed in 55% of patients. The febrile neutropenia rate was 7%. Thirty patients underwent cystectomy, and 13 underwent chemoradiotherapy. Three-year OS was 63%. Geriatric parameters polypharmacy, undernutrition, and age-adjusted Charlson comorbidity index ≥ 8 predicted worse OS. CONCLUSION Standard-of-care C-NAC and local treatments are feasible in selected elderly MIBC patients, with efficacy and safety findings similar to that observed in pivotal trials with younger patients. The prognostic impact of geriatric parameters underlines the need for specialized evaluation before treatment initiation.
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Affiliation(s)
- Clément Dumont
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France.
- Université Paris Cité, Paris, France.
| | - Amélie Aregui
- Oncogeriatrics Coordination Unit, AP-HP.Nord Université Paris Cité, Paris, France
| | - Mathilde Hauchecorne
- Oncogeriatrics Coordination Unit, AP-HP.Nord Université Paris Cité, Paris, France
| | - Madeleine Lefèvre
- Oncogeriatrics Coordination Unit, AP-HP.Nord Université Paris Cité, Paris, France
| | - Quiterie Aussedat
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France
| | - Pierre-Louis Reignier
- Urology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Hélène Gauthier
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France
| | - Christophe Hennequin
- Université Paris Cité, Paris, France
- Radiotherapy Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Virginie Fossey-Diaz
- Oncogeriatrics Coordination Unit, AP-HP.Nord Université Paris Cité, Paris, France
| | - Evanguelos Xylinas
- Université Paris Cité, Paris, France
- Urology Department, Bichat-Claude Bernard Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Atanas Pachev
- Radiology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - François Desgrandchamps
- Université Paris Cité, Paris, France
- Urology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Alexandra Masson-Lecomte
- Université Paris Cité, Paris, France
- Urology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Stéphane Culine
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France
- Université Paris Cité, Paris, France
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Chien LH, Tseng TJ, Chen TY, Chen CH, Chen CY, Jiang HF, Tsai FY, Ku HY, Jiang SS, Hsiung CA, Liu TW, Chang IS. Prevalence of comorbidities and their impact on survival among older adults with the five most common cancers in Taiwan: a population study. Sci Rep 2023; 13:6727. [PMID: 37185775 PMCID: PMC10130096 DOI: 10.1038/s41598-023-29582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 02/07/2023] [Indexed: 05/17/2023] Open
Abstract
Because of the cancer incidence increase and population aging in Taiwan, we aimed to assess the cancer prevalence, to summarize the comorbidities of older patients with the five most common cancers (i.e., breast, colorectal, liver, lung, and oral), and to develop a Taiwan cancer comorbidity index (TCCI) for studying their actual prognosis. The linkage of the Taiwan Cancer Registry, Cause of Death Database, and National Health Insurance Research Database was used. We followed the standard statistical learning steps to obtain a survival model with good discriminatory accuracy in predicting death due to noncancer causes, from which we obtained the TCCI and defined comorbidity levels. We reported the actual prognosis by age, stage, and comorbidity level. In Taiwan, cancer prevalence nearly doubled in 2004-2014, and comorbidities were common among older patients. Stage was the major predictor of patients' actual prognoses. For localized and regional breast, colorectal, and oral cancers, comorbidities correlated with noncancer-related deaths. Compared with the US, the chances of dying from comorbidities in Taiwan were lower and the chances of dying from cancer were higher for breast, colorectal, and male lung cancers. These actual prognoses could help clinicians and patients in treatment decision-making and help policymakers in resource planning.
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Affiliation(s)
- Li-Hsin Chien
- Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, 35053, Miaoli County, Taiwan
- Department of Applied Mathematics, Chung-Yuan Christian University, Chong-Li, Taiwan
| | - Tzu-Jui Tseng
- Center of Biomedical Resources, National Health Research Institutes, 35 Keyan Road, Zhunan, 35053, Miaoli County, Taiwan
- Department of Bachelor's Degree Program for Indigenous Peoples in Senior Health and Care Management, National Taitung University, 369 Section 2, University Road, Taitung City, Taitung County, 95092, Taiwan
- Master Program in Biomedicine, National Taitung University, 369 Section 2, University Road, Taitung City, 95092, Taitung County, Taiwan
| | - Tzu-Yu Chen
- Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, 35053, Miaoli County, Taiwan
| | - Chung-Hsing Chen
- National Institute of Cancer Research, National Health Research Institutes, 35 Keyan Road, Zhunan, 35053, Miaoli County, Taiwan
| | - Chia-Yu Chen
- National Institute of Cancer Research, National Health Research Institutes, 35 Keyan Road, Zhunan, 35053, Miaoli County, Taiwan
| | - Hsin-Fang Jiang
- Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, 35053, Miaoli County, Taiwan
| | - Fang-Yu Tsai
- National Institute of Cancer Research, National Health Research Institutes, 35 Keyan Road, Zhunan, 35053, Miaoli County, Taiwan
| | - Hsiu-Ying Ku
- National Institute of Cancer Research, National Health Research Institutes, 35 Keyan Road, Zhunan, 35053, Miaoli County, Taiwan
| | - Shih Sheng Jiang
- National Institute of Cancer Research, National Health Research Institutes, 35 Keyan Road, Zhunan, 35053, Miaoli County, Taiwan
| | - Chao A Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, 35053, Miaoli County, Taiwan
| | - Tsang-Wu Liu
- National Institute of Cancer Research, National Health Research Institutes, 35 Keyan Road, Zhunan, 35053, Miaoli County, Taiwan.
| | - I-Shou Chang
- National Institute of Cancer Research, National Health Research Institutes, 35 Keyan Road, Zhunan, 35053, Miaoli County, Taiwan.
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Wu J, Cui N, Li Z, Wu Y, Hao T, Li L. Clinical characteristics and survival outcomes in patients aged 75 years or older with advanced colorectal cancer treated using traditional Chinese medicine: an observational retrospective study. Front Pharmacol 2023; 14:1099659. [PMID: 37153772 PMCID: PMC10157214 DOI: 10.3389/fphar.2023.1099659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/12/2023] [Indexed: 05/10/2023] Open
Abstract
Limited evidence suggests that elderly patients with advanced colorectal cancer (ACRC) may benefit from traditional Chinese medicine (TCM). This study investigated the efficacy and safety of TCM in old ACRC patients treated in the Oncology Department of Xiyuan Hospital between January 2012 and December 2021. The clinical characteristics of these patients were retrospectively reviewed. Their progression-free survival (PFS) and total duration of TCM therapy (TTCM) were analyzed using the Kaplan-Meier curve. Forty-eight patients (F:M 13:35) with a mean age of 78.75 ± 2.99 years (range, 75-87) met the inclusion criteria. There were 18 cases of rectal cancer and 30 of colon cancer. The median PFS was 4 months (range, 1-26; 95% CI 3.26-4.73). The median TTCM was 5.5 months (range, 1-50; 95% CI 1.76-8.24). Subgroup analysis revealed that PFS and TTCM were shorter in patients with bone metastases and an ECOG performance status score of 2-3 (p < 0.05). No hematological toxicity or serious adverse reactions occurred during the study period. This real-world study demonstrates that TCM may be a potentially beneficial therapy for old ACRC patients, including when the ECOG performance status score is 2-3.
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Affiliation(s)
| | | | | | - Yu Wu
- *Correspondence: Yu Wu, , Tengteng Hao,
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Sass D, Vera E, Choi A, Acquaye A, Briceno N, Christ A, Grajkowska E, Jammula V, Levine J, Lindsley M, Reyes J, Roche K, Rogers JL, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Penas-Prado M, Pillai V, Polskin L, Theeler BJ, Wu J, Gilbert MR, Armstrong TS, Leeper H. Evaluation of the key geriatric assessment constructs in primary brain tumor population - a descriptive study. J Geriatr Oncol 2022; 13:1194-1202. [PMID: 36041994 DOI: 10.1016/j.jgo.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/04/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Despite an increasing aging population, older adults (≥ 65 years) with primary brain tumors (PBTs) are not routinely assessed for geriatric vulnerabilities. Recent reports of geriatric assessment (GA) in patients with glioblastomas demonstrated that GA may serve as a sensitive prognosticator of overall survival. Yet, current practice does not include routine evaluation of geriatric vulnerabilities and the relevance of GA has not been previously evaluated in broader cohorts of PBT patients. The objective of this descriptive study was to assess key GA constructs in adults with PBT dichotomized into older versus younger groups. MATERIALS AND METHODS A cross-sectional analysis of data collected from 579 participants with PBT recruited between 2016 and 2020, dichotomized into older (≥ 65 years, n = 92) and younger (≤ 64 years, n = 487) from an ongoing observational trial. GA constructs were evaluated using socio-demographic characteristics, Charlson Comorbidity Index (CCI), polypharmacy (>5 daily medications), Karnofsky Performance Status (KPS), Neurologic Function Score (NFS), and patient-reported outcome assessments including general health, functional status, symptom burden and interference, and mood. Descriptive statistics, t-tests, chi-square tests, and Pearson correlations were used to evaluate differences between age groups. RESULTS Older participants were more likely to have problems with mobility (58% vs. 44%), usual activities (64% vs 50%) and self-care (38% vs 26%) compared to the younger participants (odds ratios [ORs] = 1.3-1.4, ps < 0.05), while older participants were less likely to report feeling distressed (OR = 0.4, p < 0.05). Older participants also had higher CCI and were more likely to have polypharmacy (OR = 1.7, ps < 0.05). Increasing age strongly correlated with worse KPS score (r = -0.232, OR = 1.4, p < 0.001) and worse NFS (r = 0.210, OR = 1.5, p < 0.001). No differences were observed in overall symptom burden, symptom interference, and anxiety/depression scores. DISCUSSION While commonly used GA tools were not available, the study employed patient- and clinician-reported outcomes to identify potential future research directions for the use of GA in the broader neuro-oncology population. Findings illustrate missed opportunities in neuro-oncology practice and underscore the need for incorporation of GA into routine care of this population. Future studies are warranted to further evaluate the prognostic utility of GA and to better understand functional aging outcomes in this patient population.
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Affiliation(s)
- Dilorom Sass
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ewa Grajkowska
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Varna Jammula
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- Office of Information Technology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James L Rogers
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, MD, USA
| | - Eric Burton
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lily Polskin
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, MD, USA
| | - Brett J Theeler
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather Leeper
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Advances in Geriatric Oncology: Exploring Practical Ways to Optimize Treatment in Older Patients with Cancer. Cancers (Basel) 2022; 14:cancers14174129. [PMID: 36077666 PMCID: PMC9454997 DOI: 10.3390/cancers14174129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Cancer is a disease associated with aging, with patients over 70 accounting for 50% of newly diagnosed malignancies and 70% of all cancer deaths [...]
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