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Kleven AG, Miaskowski C, Torstveit AH, Ritchie CS, Engh ME, Andersen E, Utne I. Quality of life of older gynecologic oncology patients at the initiation of chemotherapy. Nurs Open 2023; 10:6749-6757. [PMID: 37337353 PMCID: PMC10495706 DOI: 10.1002/nop2.1921] [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: 08/25/2022] [Revised: 05/14/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
AIM To evaluate older gynecologic oncology patients' quality of life (QOL) at the initiation of chemotherapy and compare their QOL scores with a female age-matched general population (GP) sample. DESIGN Cross-sectional. METHODS Older (n = 122) gynecologic oncology patients completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) that evaluates global health and five functional scales (range from 0 to 100). Differences in QOL scores between our sample and the GP were evaluated using one-sample t-tests and effect sizes were calculated using Cohen's d. RESULTS Patients' mean age was 70.7 years (±6.6). Mean scores for the function scales ranged from 58.5 (±31.1) for role function to 86.1 (±17.0) for cognitive function. Compared to the GP, our sample reported significantly lower scores for global health status, social, role and physical functioning, and a significantly higher score for cognitive functioning. No differences were found in emotional functioning scores. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Anne Grethe Kleven
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet ‐ Oslo Metropolitan UniversityOsloNorway
| | | | - Ann Helen Torstveit
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet ‐ Oslo Metropolitan UniversityOsloNorway
| | - Christine Seel Ritchie
- Division of Palliative Care and Geriatric MedicineMassachusetts General Hospital Mongan Institute Center for Aging and Serious IllnessBostonMassachusettsUSA
| | - Marie Ellström Engh
- Division Akershus University Hospital, Faculty of MedicineUniversity of OsloOsloNorway
- Department of Obstetrics and GynecologyAkershus University HospitalLørenskogNorway
| | - Elin Andersen
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet ‐ Oslo Metropolitan UniversityOsloNorway
| | - Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet ‐ Oslo Metropolitan UniversityOsloNorway
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2
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Janssen TL, de Vries J, Lodder P, Faes MC, Ho GH, Gobardhan PD, van der Laan L. The effects of elective aortic repair, colorectal cancer surgery and subsequent postoperative delirium on long-term quality of life, cognitive functioning and depressive symptoms in older patients. Aging Ment Health 2021; 25:896-905. [PMID: 32054299 DOI: 10.1080/13607863.2020.1725807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: This study aimed to demonstrate the impact of elective major abdominal surgery and subsequent postoperative delirium on quality of life (QOL; primary outcome), cognitive functioning and depressive symptoms (secondary outcomes) in older surgical patients.Method: A single-centre, longitudinal prospective cohort study was conducted between November 2015 and June 2018, including patients ≥70 years old who underwent surgery for colorectal cancer or an abdominal aortic aneurysm. They were followed-up at discharge and at 6 and 12 months postoperatively until June 2019. QOL was assessed with the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF). Cognitive functioning was measured with the Mini-Mental State Examination and depressive symptoms with the CES-D 16.Results: In all patients (n = 265), physical and psychological health were significantly lower at discharge compared to baseline (p < 0.001 for both domains). Physical health restored after 6 months, but psychological health remained decreased for the complete study period. Psychological, social and environmental QOL were significantly worse in patients with delirium compared to patients without (p = 0.001, p = 0.006 and p = 0.001 respectively). The cognitive functioning score was significantly lower at baseline in patients with delirium compared to those without (p = 0.006). Patients with delirium had a significantly higher CES-D 16 score compared to those without after 12 months (p = 0.027).Conclusion: Physical and psychological QOL were decreased in the early postoperative period. While physical health was restored after 6 and 12 months, psychological health remained decreased. After 12 months, postoperative delirium resulted in worse psychological, social and environmental QOL and more depressive symptoms. Decreased cognitive functioning may be a risk factor for delirium.
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Affiliation(s)
- Ties L Janssen
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Jolanda de Vries
- Department of Medical Psychology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Miriam C Faes
- Department of Geriatrics, Amphia Hospital, Breda, the Netherlands
| | - Gwan H Ho
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | | | - Lijckle van der Laan
- Department of Surgery, Amphia Hospital, Breda, the Netherlands.,Department of Cardiovascular Science, UZ Leuven, Leuven, Belgium
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3
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Crimmin J, Fulop T, Battisti NML. Biological aspects of aging that influence response to anticancer treatments. Curr Opin Support Palliat Care 2021; 15:29-38. [PMID: 33399393 DOI: 10.1097/spc.0000000000000536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Cancer is a disease of older adults, where fitness and frailty are a continuum. This aspect poses unique challenges to the management of cancer in this population. In this article, we review the biological aspects influencing the efficacy and safety of systemic anticancer treatments. RECENT FINDINGS The organ function decline associated with the ageing process affects multiple systems, including liver, kidney, bone marrow, heart, muscles and central nervous system. These can have a significant impact on the pharmacokinetics and pharmacodynamics of systemic anticancer agents. Comorbidities also represent a key aspect to consider in decision-making. Renal disease, liver conditions and cardiovascular risk factors are prevalent in this age group and may impact the risk of adverse outcomes in this setting. SUMMARY The systematic integration of geriatrics principles in the routine management of older adults with cancer is a unique opportunity to address the complexity of this population and is standard of care based on a wide range of benefits. This approach should be multidisciplinary and involve careful discussion with hospital pharmacists.
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Affiliation(s)
- Jane Crimmin
- Pharmacy, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Tamas Fulop
- Department of Medicine, Division of Geriatrics, Research Center on Aging, University of Sherbrooke, Faculty of Medicine and Health Sciences, Québec, Quebec, Canada
| | - Nicolò Matteo Luca Battisti
- Department of Medicine - Breast Unit, The Royal Marsden NHS Foundation Trust, Breast Cancer Research Division, The Institute of Cancer Research, Sutton, Surrey, UK
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4
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Ximenes CRC, Bergmann A, Lima JTDO, Cavalcanti AS, Britto MCAD, Mello MJG, Thuler LCS. Impact of age in health-related quality of life in older adults with cancer. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.5327/z2447-212320212000106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE: To evaluate the impact of age in health-related quality of life (HRQoL) in older adults with cancer. METHODS: This was a cross-sectional study of 608 older adults diagnosed with cancer. Age groups were considered an independent variable. For the analysis of HRQoL, the mean scores of age groups were compared by analysis of variance and the Scheffé comparison test. For measuring the association between age and HRQoL, we used simple and multiple linear regression analyses. RESULTS: Cognitive function showed the highest scores (average 87.94 ± 26.87), while physical function showed the lowest ones (68.04 ± 28.63). The highest symptom score was observed for financial difficulties (34.21 ± 39.06), followed by pain (29.47 ± 33.92) and insomnia (28.51 ± 37.03). After adjustment, we observed a decrease in physical function (p = 0.028) and an improvement in emotional function (p = 0.003) with increasing age. Conclusions: In older patients with cancer, age negatively impacted physical function and positively impacted emotional function.
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Affiliation(s)
| | - Anke Bergmann
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Brazil
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5
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Ximenes CRC, Bergmann A, Lima JTDO, Lima WRP, de Britto MC, de Mello MJG, Thuler LCS. Prospective Analysis of Health-Related Quality of Life in Older Adults With Cancer. J Patient Exp 2020; 7:1519-1525. [PMID: 33457609 PMCID: PMC7786648 DOI: 10.1177/2374373519889246] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate health-related quality of life (HRQoL) changes at 6 to 12 months after cancer diagnosis and to assess the impact of age in older adults with cancer. METHODS A cohort study using patients ≥60 years old diagnosed with cancer. Health-related quality of life scores were calculated according to the European Organisation for Research and Treatment of Cancer questionnaire. Student's t tests for paired samples and a binomial logistic regression were performed. RESULTS The study included 241 patients. At diagnosis, the affected HRQoL functions were physical and emotional functions, financial difficulties, pain, and insomnia. At follow-up, cognitive function (P < .001) and dyspnea (P = .004) worsened, while emotional function improved (P = .003). DISCUSSION At the 6 to 12 months of follow-up, older adult cancer patients showed worsening cognitive function and dyspnea and improved emotional function. These HRQoL changes were not associated with age.
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Affiliation(s)
| | - Anke Bergmann
- Research Center, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
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6
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Batra A, Rigo R, Sheka D, Cheung WY. Real-world evidence on adjuvant chemotherapy in older adults with stage II/III colon cancer. World J Gastrointest Oncol 2020; 12:604-618. [PMID: 32699576 PMCID: PMC7340998 DOI: 10.4251/wjgo.v12.i6.604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/08/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
Colon cancer represents one of the most common cancers diagnosed in older adults worldwide. The standard of care in resected stage II and stage III colon cancer continues to evolve. While there is unequivocal evidence to suggest both disease free and overall survival benefits with the use of combination chemotherapy in patients with stage III colon cancer, data regarding its use in patients with stage II colon cancer are less clear. Further, although colon cancer is a disease that affects older adults, there is considerable debate on the value of adjuvant chemotherapy in the aging population. In particular, many older patients are undertreated when compared to their younger counterparts. In this review, we will describe the clinical trials that contributed to the current adjuvant chemotherapy approach in colon cancer, discuss representation of older adults in trials and the specific challenges associated with the management of this sub-population, and highlight the role of comprehensive geriatric assessments. We will also review how real-world evidence complements the data gaps from clinical trials of early stage colon cancer.
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Affiliation(s)
- Atul Batra
- Department of Medicine, Tom Baker Cancer Centre, Calgary, Alberta T2N 1N4, Canada
| | - Rodrigo Rigo
- Department of Medicine, Tom Baker Cancer Centre, Calgary, Alberta T2N 1N4, Canada
| | - Dropen Sheka
- Department of Medicine, Tom Baker Cancer Centre, Calgary, Alberta T2N 1N4, Canada
| | - Winson Y Cheung
- Department of Oncology, University of Calgary, Calgary, Alberta T2N 4N2, Canada
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7
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Current Trends in Systemic Therapies in Elderly Patients With Metastatic Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2019. [DOI: 10.1007/s11888-019-00436-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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8
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McCleary NJ, Benson AB, Dienstmann R. Personalizing Adjuvant Therapy for Stage II/III Colorectal Cancer. Am Soc Clin Oncol Educ Book 2017; 37:232-245. [PMID: 28561714 DOI: 10.1200/edbk_175660] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This review focuses on three areas of interest with respect to the treatment of stage II and III colon and rectal cancer, including (1) tailoring adjuvant therapy for the geriatric population, (2) the controversy as to the optimal adjuvant therapy strategy for patients with locoregional rectal cancer and for patients with colorectal resectable metastatic disease, and (3) discussion of the microenvironment, molecular profiling, and the future of adjuvant therapy. It has become evident that age is the strongest predictive factor for receipt of adjuvant chemotherapy, duration of treatment, and risk of treatment-related toxicity. Although incorporating adjuvant chemotherapy for patients who have received neoadjuvant chemoradiation and surgery would appear to be a reasonable strategy to improve survivorship as an extrapolation from stage III colon cancer adjuvant trials, attempts at defining the optimal rectal cancer population that would benefit from adjuvant therapy remain elusive. Similarly, the role of adjuvant chemotherapy for patients after resection of metastatic colorectal cancer has not been clearly defined because of very limited data to provide guidance. An understanding of the biologic hallmarks and drivers of metastatic spread as well as the micrometastatic environment is expected to translate into therapeutic strategies tailored to select patients. The identification of actionable targets in mesenchymal tumors is of major interest.
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Affiliation(s)
- Nadine Jackson McCleary
- From the Dana-Farber Cancer Institute, Boston, MA; Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Oncology Data Science Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Sage Bionetworks, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Al B Benson
- From the Dana-Farber Cancer Institute, Boston, MA; Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Oncology Data Science Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Sage Bionetworks, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Rodrigo Dienstmann
- From the Dana-Farber Cancer Institute, Boston, MA; Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Oncology Data Science Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Sage Bionetworks, Fred Hutchinson Cancer Research Center, Seattle, WA
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9
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McNair AGK, Whistance RN, Forsythe RO, Rees J, Jones JE, Pullyblank AM, Avery KNL, Brookes ST, Thomas MG, Sylvester PA, Russell A, Oliver A, Morton D, Kennedy R, Jayne DG, Huxtable R, Hackett R, Dutton SJ, Coleman MG, Card M, Brown J, Blazeby JM. Synthesis and summary of patient-reported outcome measures to inform the development of a core outcome set in colorectal cancer surgery. Colorectal Dis 2015; 17:O217-29. [PMID: 26058878 PMCID: PMC4744711 DOI: 10.1111/codi.13021] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/05/2015] [Indexed: 12/14/2022]
Abstract
AIM Patient-reported outcome (PRO) measures (PROMs) are standard measures in the assessment of colorectal cancer (CRC) treatment, but the range and complexity of available PROMs may be hindering the synthesis of evidence. This systematic review aimed to: (i) summarize PROMs in studies of CRC surgery and (ii) categorize PRO content to inform the future development of an agreed minimum 'core' outcome set to be measured in all trials. METHOD All PROMs were identified from a systematic review of prospective CRC surgical studies. The type and frequency of PROMs in each study were summarized, and the number of items documented. All items were extracted and independently categorized by content by two researchers into 'health domains', and discrepancies were discussed with a patient and expert. Domain popularity and the distribution of items were summarized. RESULTS Fifty-eight different PROMs were identified from the 104 included studies. There were 23 generic, four cancer-specific, 11 disease-specific and 16 symptom-specific questionnaires, and three ad hoc measures. The most frequently used PROM was the EORTC QLQ-C30 (50 studies), and most PROMs (n = 40, 69%) were used in only one study. Detailed examination of the 50 available measures identified 917 items, which were categorized into 51 domains. The domains comprising the most items were 'anxiety' (n = 85, 9.2%), 'fatigue' (n = 67, 7.3%) and 'physical function' (n = 63, 6.9%). No domains were included in all PROMs. CONCLUSION There is major heterogeneity of PRO measurement and a wide variation in content assessed in the PROMs available for CRC. A core outcome set will improve PRO outcome measurement and reporting in CRC trials.
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Affiliation(s)
- A. G. K. McNair
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK,Severn School of SurgeryUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - R. N. Whistance
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK,Division of Surgery Head and NeckUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - R. O. Forsythe
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK,Division of Surgery Head and NeckUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - J. Rees
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK
| | - J. E. Jones
- Colorectal Cancer Patient RepresentativeNorth Bristol NHS TrustBristolUK
| | | | - K. N. L. Avery
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK
| | - S. T. Brookes
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK
| | - M. G. Thomas
- Colorectal Surgery UnitUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - P. A. Sylvester
- Colorectal Surgery UnitUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - A. Russell
- Colorectal Consumer Liaison GroupNational Cancer Research InstituteLondonUK
| | - A. Oliver
- Colorectal Consumer Liaison GroupNational Cancer Research InstituteLondonUK
| | - D. Morton
- Academic Department of SurgeryUniversity of BirminghamBirminghamUK
| | - R. Kennedy
- Department of SurgerySt Mark's Hospital and Academic InstituteHarrowUK
| | - D. G. Jayne
- Academic Surgical UnitSt James' University Hospital NHS TrustLeedsUK
| | - R. Huxtable
- Centre for Ethics in MedicineUniversity of BristolBristolUK
| | - R. Hackett
- Colorectal Network Site Specific GroupAvon, Somerset and Wiltshire Cancer ServicesBristolUK
| | - S. J. Dutton
- Centre for Statistics in Medicine and Oxford Clinical Trials Research UnitNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesUniversity of OxfordOxfordUK
| | - M. G. Coleman
- Department of Colorectal SurgeryPlymouth Hospitals NHS TrustPlymouthUK
| | - M. Card
- Colorectal Surgery UnitUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - J. Brown
- Clinical Trials Research UnitUniversity of LeedsLeedsUK
| | - J. M. Blazeby
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK,Division of Surgery Head and NeckUniversity Hospitals Bristol NHS Foundation TrustBristolUK
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10
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Shipp S, McKinstry C, Pearson E. The impact of colorectal cancer on leisure participation: A narrative study. Br J Occup Ther 2015. [DOI: 10.1177/0308022614562794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction The prevalence of cancer is increasing and, with enhanced early detection and treatment, survival rates have also improved. During cancer treatment and survivorship, occupational participation is significantly impacted, with leisure affected. This field has attracted limited research interest however, particularly involving men with colorectal cancer. Symptoms including cancer-related fatigue and pain may reduce ability to engage in usual leisure occupations. Method A qualitative narrative study was conducted to enhance understanding of leisure participation during and following cancer treatment. In-depth interviews were undertaken with four men with colorectal cancer attending for review at a specialist cancer centre. Audio-recorded interview data were transcribed verbatim and thematically analysed. Results All men interviewed reported significant disruption to their usual leisure occupations. Participants described participating in passive leisure occupations during treatment over more active or community-based occupations due to challenges such as having a colostomy bag and fatigue. The men described generally returning to their chosen leisure occupations and the significance this held for their wellbeing. Conclusion Given the impact of colorectal cancer on participation in leisure occupations for men, occupational therapists can assist these men to either resume previous leisure occupations or commence alternative leisure occupations to improve their quality of life.
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Affiliation(s)
- Sarah Shipp
- Occupational Therapist, Western Health, Department of Occupational Therapy, Footscray Hospital, Australia
| | - Carol McKinstry
- Senior Lecturer, La Trobe University, La Trobe Rural Health School, Bendigo, Australia
| | - Elizabeth Pearson
- PhD Candidate, La Trobe University, La Trobe Rural Health School, Bendigo, Australia
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11
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Quach C, Sanoff HK, Williams GR, Lyons JC, Reeve BB. Impact of colorectal cancer diagnosis and treatment on health-related quality of life among older Americans: a population-based, case-control study. Cancer 2014; 121:943-50. [PMID: 25377096 DOI: 10.1002/cncr.29125] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 10/05/2014] [Accepted: 10/07/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND Data on health-related quality of life (HRQoL) changes among Americans aged ≥65 following colorectal cancer (CRC) diagnosis and treatment are limited. This study compared HRQoL changes among CRC patients across stages from before to after diagnosis with matched noncancer controls. METHODS This population-based study used the Surveillance, Epidemiology, and End Results Medicare Health Outcomes Survey (MHOS) data set (1998-2007). Medicare Advantage beneficiaries diagnosed with CRC between their baseline and follow-up MHOS (n = 349) were matched to noncancer controls (n = 1745) using propensity scores. Mixed-effects analysis of covariance models estimated changes in HRQoL (measured by the Medical Outcomes Study Short Form-36/Veterans RAND 12-item Survey) and the ability to perform 6 activities of daily living (ADLs) between baseline and follow-up. Logistic regression models estimated odds ratios for ADL impairments and major depressive disorder (MDD) risk. RESULTS Mean time between CRC diagnosis and follow-up MHOS was 12.3 ± 9.8 months. Compared with controls, CRC patients had significantly lower scores in all physical and mental health domains at follow-up. The greatest decrements were observed in physical health and were largely driven by declines in the 6 months postdiagnosis and in stage III and IV patients. At follow-up, CRC patients had greater overall ADL impairment and difficulty with dressing, eating, and getting in/out of chairs. CRC patients, particularly stage IV patients, had greater odds of being at risk for MDD relative to controls. CONCLUSIONS This study further underscores the adverse effects of CRC on physical health and the need to support older Americans' basic self-care needs, with attention to later-stage patients' increased debility.
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Affiliation(s)
- Caroleen Quach
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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12
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Kent EE, Ambs A, Mitchell SA, Clauser SB, Smith AW, Hays RD. Health-related quality of life in older adult survivors of selected cancers: data from the SEER-MHOS linkage. Cancer 2014; 121:758-65. [PMID: 25369293 DOI: 10.1002/cncr.29119] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/29/2014] [Accepted: 09/18/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Research on health-related quality of life (HRQOL) among older adult cancer survivors is mostly confined to breast cancer, prostate cancer, colorectal cancer, and lung cancer, which account for 63% of all prevalent cancers. Much less is known about HRQOL in the context of less common cancer sites. METHODS HRQOL was examined with the 36-Item Short Form Health Survey, version 1, and the Veterans RAND 12-Item Health Survey in patients with selected cancers (kidney cancer, bladder cancer, pancreatic cancer, upper gastrointestinal cancer, cancer of the oral cavity and pharynx, uterine cancer, cervical cancer, thyroid cancer, melanoma, chronic leukemia, non-Hodgkin lymphoma, and multiple myeloma) and in individuals without cancer on the basis of data linked from the Surveillance, Epidemiology, and End Results cancer registry system and the Medicare Health Outcomes Survey. Scale scores, Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, and a utility metric (Short Form 6D/Veterans RAND 6D), adjusted for sociodemographic characteristics and other chronic conditions, were calculated. A 3-point difference in the scale scores and a 2-point difference in the PCS and MCS scores were considered to be minimally important differences. RESULTS Data from 16,095 cancer survivors and 1,224,549 individuals without a history of cancer were included. The results indicated noteworthy deficits in physical health status. Mental health was comparable, although scores for the Role-Emotional and Social Functioning scales were worse for patients with most types of cancer versus those without cancer. Survivors of multiple myeloma and pancreatic malignancies reported the lowest scores, with their PCS/MCS scores less than those of individuals without cancer by 3 or more points. CONCLUSIONS HRQOL surveillance efforts revealed poor health outcomes among many older adults and specifically among survivors of multiple myeloma and pancreatic cancer.
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Affiliation(s)
- Erin E Kent
- Applied Research Program, National Cancer Institute, Rockville, Maryland
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13
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Ward P, Hecht JR, Wang HJ, Dichmann R, Liem AK, Chan D, Patel R, Hu EH, Tchekmedyian NS, Wainberg ZA, Naeim A. Physical function and quality of life in frail and/or elderly patients with metastatic colorectal cancer treated with capecitabine and bevacizumab: An exploratory analysis. J Geriatr Oncol 2014; 5:368-75. [DOI: 10.1016/j.jgo.2014.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/16/2014] [Accepted: 05/31/2014] [Indexed: 12/14/2022]
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14
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Naeim A, Ward PR, Wang HJ, Dichmann R, Liem AKD, Chan D, Patel R, Hu EHL, Tchekmedyian NS, Wainberg ZA, Hecht JR. A phase II trial of frontline capecitabine and bevacizumab in poor performance status and/or elderly patients with metastatic colorectal cancer. J Geriatr Oncol 2013; 4:302-9. [PMID: 24472472 DOI: 10.1016/j.jgo.2013.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 05/02/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVES This study aims to determine the efficacy and tolerability of capecitabine (CAP) plus bevacizumab (BEV) as treatment for frontline metastatic colorectal cancer (mCRC) in frail and/or elderly patients. MATERIALS AND METHODS This was an open label, multi-site, single arm, phase II study in frontline mCRC. In this study, patients (pts) who were frail (ECOG 2) or older patients with ECOG 1 performance status (PS) received CAP (1000 mg/m(2) bid, 14 days of every 21 days) plus BEV (7.5mg/kg iv once every 21 days). The primary objective was progression free survival (PFS). Secondary objectives were overall response rate (ORR) and toxicity. RESULTS In terms of patients: 50 were enrolled; 5 withdrew consent prior to treatment; 45 were treated, and 41 were evaluable. The mean age was 75.9 (range 54-93) and 62% had an ECOG 2 PS. The median PFS was 6.87 months (95% CI, 5.1-11.5 months) and median overall survival was 12.7 months (95% CI, 6.9-12.7 months). The most common grades 3-4 toxicities were: diarrhea (17.8%), fatigue (13.3%), hand-foot syndrome (13.3%), dehydration (8.9%), hypertension (6.7%) and vomiting (6.7%). CONCLUSIONS The results of this trial support the use of CAP plus BEV as first-line treatment for frail/elderly patients with metastatic CRC. The ORR (40%) is comparable to pooled data in elderly on fluorouracil (5-FU)+BEV. The median PFS (7.2 months) in this study is slightly lower than that seen with 5-FU+BEV but this study had a high percentage of ECOG PS 2 patients. Side effects were manageable with no new safety signals.
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Affiliation(s)
- Arash Naeim
- David Geffen School of Medicine at University of California at Los Angeles, 10945 LeConte, Suite 2333 PVUB, Los Angeles, CA 90095, USA.
| | - Peter R Ward
- David Geffen School of Medicine at University of California at Los Angeles, 10945 LeConte, Suite 2333 PVUB, Los Angeles, CA 90095, USA
| | - Hei-Jing Wang
- David Geffen School of Medicine at University of California at Los Angeles, 10945 LeConte, Suite 2333 PVUB, Los Angeles, CA 90095, USA
| | - Richard Dichmann
- Translational Oncology Research International (TORI), Central Coast Medical Oncology, 220 S Palisade Dr Suite 204, Santa Maria, CA 93454, USA
| | - Andre K D Liem
- TORI, Pacific Shores Medical Group, 1043 Elm Avenue, Suite #104, Long Beach, CA 90813, USA
| | - David Chan
- TORI, Cancer Care Associates Medical Group, Inc., 514 North Prospect Ave., 4th Floor, Redondo Beach, CA 90277, USA
| | - Ravi Patel
- Pacific Care, Heritage Physician Network, 5925 Truxtun Extension Ste. A Bakersfield, CA 93309, USA
| | - Edward H L Hu
- Central Hematology Oncology, 707 S. Garfield Ave, Alhambra, CA 91801, USA
| | - Neres S Tchekmedyian
- Pacific Shores Med. Group, Long Beach Elm Office, 1043 Elm Avenue, Suite 104, Long Beach, CA 90813, USA
| | - Zev A Wainberg
- David Geffen School of Medicine at University of California at Los Angeles, 10945 LeConte, Suite 2333 PVUB, Los Angeles, CA 90095, USA
| | - J Randolph Hecht
- David Geffen School of Medicine at University of California at Los Angeles, 10945 LeConte, Suite 2333 PVUB, Los Angeles, CA 90095, USA
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15
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Macefield RC, Avery KNL, Blazeby JM. Integration of clinical and patient-reported outcomes in surgical oncology. Br J Surg 2012; 100:28-37. [PMID: 23165422 DOI: 10.1002/bjs.8989] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2012] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) provide information about the patient perspective and experience of undergoing surgery for cancer, but evidence suggests that they are not used widely to influence practice. This review considers key challenges and opportunities for using PROs effectively in gastrointestinal surgical oncology, drawing on principles learnt from surgical oncology in general. METHODS Systematic reviews of randomized controlled trials (RCTs) in surgical oncology reporting PROs as primary or secondary outcomes, and studies examining methods to communicate PRO information, were identified. Common themes are summarized and the future of PRO studies considered. RESULTS Reviews highlighted the need for improved design, conduct and reporting of PROs in RCTs in surgical oncology. Main issues related to the multiplicity of PRO measures hindering data synthesis and clinical understanding, problems with missing data risking bias, and limited integration of clinical and PRO data undermining the role of PRO data in practice. Reviews indicated that patients want PRO data to meet information needs and early work shows that graphically displayed PROs are understood by patients. CONCLUSION PROs have a role in the evaluation of surgical oncology, but increased consensus and collaboration between surgeons and methodologists is needed to improve the design, conduct and reporting of PROs with clinical outcomes in trials. Possible solutions include investing more effort and systematic thought into the PRO rationale in RCTs, the development and use of 'core outcome sets' with PROs, and implementation of the extension to the Consolidated Standards of Reporting Trials (CONSORT) guidelines for reporting PROs in RCTs.
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Affiliation(s)
- R C Macefield
- Academic Unit of Surgical Research, School of Social and Community Medicine, University of Bristol, UK
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16
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Honeybul S, Ho K, O'Hanlon S. Access to reliable information about long-term prognosis influences clinical opinion on use of lifesaving intervention. PLoS One 2012; 7:e32375. [PMID: 22384231 PMCID: PMC3285690 DOI: 10.1371/journal.pone.0032375] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 01/28/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Decompressive craniectomy has been traditionally used as a lifesaving rescue treatment in severe traumatic brain injury (TBI). This study assessed whether objective information on long-term prognosis would influence healthcare workers' opinion about using decompressive craniectomy as a lifesaving procedure for patients with severe TBI. METHOD A two-part structured interview was used to assess the participants' opinion to perform decompressive craniectomy for three patients who had very severe TBI. Their opinion was assessed before and after knowing the predicted and observed risks of an unfavourable long-term neurological outcome in various scenarios. RESULTS Five hundred healthcare workers with a wide variety of clinical backgrounds participated. The participants were significantly more likely to recommend decompressive craniectomy for their patients than for themselves (mean difference in visual analogue scale [VAS] -1.5, 95% confidence interval -1.3 to -1.6), especially when the next of kin of the patients requested intervention. Patients' preferences were more similar to patients who had advance directives. The participants' preferences to perform the procedure for themselves and their patients both significantly reduced after knowing the predicted risks of unfavourable outcomes, and the changes in attitude were consistent across different specialties, amount of experience in caring for similar patients, religious backgrounds, and positions in the specialty of the participants. CONCLUSIONS Access to objective information on risk of an unfavourable long-term outcome influenced healthcare workers' decision to recommend decompressive craniectomy, considered as a lifesaving procedure, for patients with very severe TBI.
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Affiliation(s)
- Stephen Honeybul
- Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Perth, Western Australia, Australia.
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17
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Trask PC, Blank TO, Jacobsen PB. Future perspectives on the treatment issues associated with cancer and aging. Cancer 2009; 113:3512-8. [PMID: 19058146 DOI: 10.1002/cncr.23940] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
For many older individuals, the decision to undergo treatment for cancer is viewed as a tradeoff between loss of function and extension of life: a decision that often is complicated by concomitant issues such as comorbid medical conditions, frailty, functional declines, family dynamics, and social and psychological issues. This poses several challenges and affords opportunities for healthcare professionals conducting research with older cancer patients who are undergoing treatment. The current article presents a summary of a roundtable discussion of the issues that face older individuals with cancer during the treatment phase of a cancer diagnosis. The issues covered include the importance of conducting thorough assessments, addressing methodological issues, differentiating age from cohort issues, reducing patient and healthcare provider misperceptions, and taking a multidisciplinary approach to care. To address the aforementioned issues, future research directions in the treatment phase of the cancer continuum should include encouraging transdisciplinary work; increasing age-related, behaviorally focused research that also is sensitive to differentiating age and cohort effects; understanding the impact of comorbidity; and separating out the influences of age, comorbidity, and performance status.
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Affiliation(s)
- Peter C Trask
- Global Outcomes Research, Pfizer, Inc., New London, Connecticut 06320, USA.
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18
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Fitzsimmons D, Gilbert J, Howse F, Young T, Arrarras JI, Brédart A, Hawker S, George S, Aapro M, Johnson CD. A systematic review of the use and validation of health-related quality of life instruments in older cancer patients. Eur J Cancer 2008; 45:19-32. [PMID: 18823775 DOI: 10.1016/j.ejca.2008.07.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 07/24/2008] [Indexed: 10/21/2022]
Abstract
AIM The aim of this paper is to systematically review the use and validation of HRQOL instruments in older cancer patients. METHOD A systematic review of 5 databases and 3 research registers identified studies reporting the use and validation of HRQOL instruments in cancer patients aged over 65 years from 1995 to mid 2007. RESULTS Thirty-one studies reported the use of HRQOL measures in older people, using a range of generic and disease-specific instruments. Little work was reported in patients aged over 80 years. All studies exhibited methodological limitations. Fourteen studies were identified with variable evidence on the psychometric properties and clinical usefulness of identified instruments. CONCLUSION Our review identified that the development, validation and use of HRQOL instruments often ignore the specific needs of older people. This review highlights the need for a HRQOL instrument specifically designed to capture the issues and concerns most relevant to older cancer patients.
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