Systemic therapy for elderly patients with gastrointestinal cancer

Systemic therapy in stage IV pancreatic cancer: a population-based analysis using the National Cancer Data Base

BACKGROUND

Pancreatic cancer accounts for approximately 7% of all cancer deaths. More than half of all pancreatic cancers are stage IV at diagnosis, where systemic chemotherapy is used with the goal of life prolongation as well as palliation. The patient characteristics and health system factors that drive the use of systemic therapy are unknown.

METHOD

This is a retrospective study of stage IV pancreatic cancer patients (n = 140,210) diagnosed between 2000 and 2011 in the NCDB. NCDB contains approximately 70% of new cancer diagnosis from more than 1500 accredited cancer programs in the United States and Puerto Rico. Chi-squared test was used to determine any differences in characteristics of patients who did or did not receive systemic therapy.

RESULTS

Our study demonstrated that only 49.1% of stage IV pancreatic cancer patients received systemic therapy. The use of systemic therapy is significantly lower in female, African American/Hispanic, patients older than 40 years, those without insurance or with Medicare and Medicaid, higher Charlson Comorbidity Score, poor economic and educational status and in nonacademic centers.

CONCLUSIONS

This is the largest study to evaluate the determinants of systemic therapy use in stage IV pancreatic cancer. The use of systemic therapy was significantly lower in patients older than 40 years, lower educational status, nonprivate insurance and with higher Charlson Comorbidity Scores. In addition, the use of systemic therapy was lower with female sex, African Americans/Hispanic, and lower socio-economic status. Understanding the barriers in the use of systemic therapy as well as appropriate utilization of systemic therapy can both optimize cancer care.

A clinical psychologist's perspective of mental disorders in patients of 70 years of age or more, who underwent digestive tract cancer surgeries

Introduction

Behavioural and psychological disorders in surgical patients treated for malignant diseases are not always adequately appreciated and often neglected. However, they are very important in the therapeutic process because they may severely disturb physical and psychological rehabilitation, the patient’s effective struggle with malignancy, environmental relationships and quality of life. Professional preoperative psychological assessment is necessary to facilitate therapy for malignant diseases in those patients who are specifically exposed to a severely stressful situation.

Aim

To investigate the incidence of depression, hallucinations and anxiety in patients undergoing surgery for malignancy of the digestive tract. The influence of those disorders on the period of hospitalisation, cooperation with medical staff and postoperative quality of life was analysed.

Material and methods

A routine program of psychological and psychiatric care for patients with malignancy, who undergo extensive surgical procedures, was implemented in our department several years ago. The program allows for identification of patients with a high risk of psychiatric disorders to provide them with special psychological support. Sixty-nine patients with advanced malignancy were followed after the surgery between 2009 and 2010. All were examined by a professional psychologist. A QLQ C-30 (EORTC) questionnaire was used to assess the quality of life.

Results

Psychotic disorders were present in 53.6% of examined patients. Depression was dominating (57%), followed by anxiety (28%) and hallucinations (15%). The mean hospital stay was different between those, respectively, with and without psychotic disorders (17 days vs. 15 days). Quality of life index for patients at risk was 3.8 vs. 5.1 for more psychologically stable patients.

Conclusions

Approximately 50% of patients undergoing surgery for malignant diseases develop severe psychotic disorders in the postoperative period. Preoperative psychological assessment seems to be extremely useful in providing adequate postoperative psychological support for individual patients.