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Jayani RV, Magnuson AM, Sun CL, Ma H, Tew WP, Mohile SG, Gajra A, Klepin HD, Gross CP, Muss HB, Chapman AE, Katheria V, Hurria A, Dale W. Association between a cognitive screening test and severe chemotherapy toxicity in older adults with cancer. J Geriatr Oncol 2020; 11:284-289. [PMID: 31813840 PMCID: PMC7054133 DOI: 10.1016/j.jgo.2019.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Cognitive impairment (CI) increases chemotherapy toxicity risk with need to understand this association utilizing publicly available short screening tools. We evaluated this utilizing a lower threshold on a short screening tool in older adults with cancer. MATERIALS AND METHODS We analyzed data from the Cancer and Aging Research Group (CARG) Chemotherapy Toxicity Risk tool (CARG score) development and validation cohorts (n = 703), which recruited adults age ≥ 65 with cancer from academic centers. Cognition was evaluated with the Blessed Orientation-Memory-Concentration test (BOMC). Patients with BOMC score ≥ 11 were excluded. Utilizing cut-points for older adults, we considered moderate BOMC scores (5-10) as potential CI. Logistic regression was used for analysis. RESULTS Patient baseline characteristics included: mean age 73; 85% white; 63% college or higher education; 250 (36%) potential CI; 385 (55%) severe toxicity. Patients with potential CI were more likely non-white (p ≤ 0.01) and to have high school or lower education (p ≤ 0.01) and high CARG score (p = 0.04). Potential CI was associated with increased severe toxicity risk (OR = 1.54, p ≤ 0.01). After adjusting for CARG score, this association became nonsignificant (OR = 1.35; p = 0.08). Among patients with lower education (n = 258; 36.7%), potential CI remained associated with severe toxicity, even after adjusting for CARG score (OR = 1.87, p = 0.03). CONCLUSIONS Our findings suggest potential cognitive impairment, defined by BOMC score 5-10, in older adults with cancer and lower education is associated with increased severe toxicity risk. Future studies are needed to validate these findings. Healthcare providers should consider cognitive testing before treatment for these vulnerable patients.
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Affiliation(s)
- Reena V Jayani
- Moffitt Cancer Center, Blood and Marrow Transplant and Cellular Immunotherapy Program, United States of America
| | - Allison M Magnuson
- University of Rochester Medical Center, Department of Medicine, United States of America
| | - Can-Lan Sun
- City of Hope National Medical Center, Department of Supportive Care Medicine, United States of America
| | - Huiyan Ma
- City of Hope National Medical Center, Department of Population Sciences, United States of America
| | - William P Tew
- Memorial Sloan Kettering Cancer Center, Department of Medicine, United States of America
| | - Supriya G Mohile
- University of Rochester Medical Center, Department of Medicine, United States of America
| | - Ajeet Gajra
- ICON Clinical Research, United States of America
| | - Heidi D Klepin
- Wake Forest School of Medicine, Department of Medicine, United States of America
| | - Cary P Gross
- Yale School of Medicine, Department of Internal Medicine, United States of America
| | - Hyman B Muss
- University of North Caroline School of Medicine, United States of America
| | - Andrew E Chapman
- Sidney Kimmel Cancer Center, Thomas Jefferson University, United States of America
| | - Vani Katheria
- City of Hope National Medical Center, Center for Cancer and Aging, United States of America
| | - Arti Hurria
- City of Hope National Medical Center, Center for Cancer and Aging, United States of America
| | - William Dale
- City of Hope National Medical Center, Department of Supportive Care Medicine, United States of America.
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Dunne RF, Roussel B, Culakova E, Pandya C, Fleming FJ, Hensley B, Magnuson AM, Loh KP, Gilles M, Ramsdale E, Maggiore RJ, Jatoi A, Mustian KM, Dale W, Mohile SG. Characterizing cancer cachexia in the geriatric oncology population. J Geriatr Oncol 2018; 10:415-419. [PMID: 30196027 DOI: 10.1016/j.jgo.2018.08.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/31/2018] [Accepted: 08/10/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Cancer cachexia, characterized by weight loss and sarcopenia, leads to a decline in physical function and is associated with poorer survival. Cancer cachexia remains poorly described in older adults with cancer. This study aims to characterize cancer cachexia in older adults by assessing its prevalence utilizing standard definitions and evaluating associations with components of the geriatric assessment (GA) and survival. MATERIALS AND METHODS Patients with cancer older than 65 years of age who underwent a GA and had baseline CT imaging were eligible in this cross-sectional study. Cancer cachexia was defined by the international consensus definition reported in 2011. Sarcopenia was measured using cross-sectional imaging and utilizing sex-specific cut-offs. Associations between cachexia, sarcopenia, and weight loss with survival and GA domains were explored. RESULTS Mean age of 100 subjects was 79.9 years (66-95) and 65% met criteria for cancer cachexia. Cachexia was associated with impairment in instrumental activities of daily living (IADL) (p = .017); no significant association was found between sarcopenia or weight loss and IADL impairment. Cachexia was significantly associated with poorer survival (median 1.0 vs 2.1 years, p = .011). CONCLUSIONS Cancer cachexia as defined by the international consensus definition is prevalent in older adults with cancer and is associated with functional impairment and decreased survival. Larger prospective studies are needed to further describe cancer cachexia in this population.
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Affiliation(s)
- Richard F Dunne
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States.
| | - Breton Roussel
- Department of Medicine, Brown University, Providence, RI, United States
| | - Eva Culakova
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States
| | - Chintan Pandya
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Fergal J Fleming
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Bradley Hensley
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Allison M Magnuson
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States
| | - Kah Poh Loh
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Maxence Gilles
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Erika Ramsdale
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States
| | - Ronald J Maggiore
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Aminah Jatoi
- Mayo Clinic, Department of Oncology, Rochester, MN, United States
| | - Karen M Mustian
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States
| | - William Dale
- City of Hope, Department of Supportive Care Medicine, Duarte, CA, United States
| | - Supriya G Mohile
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States
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Magnuson AM, Regan DP, Fouts JK, Booth AD, Dow SW, Foster MT. Diet-induced obesity causes visceral, but not subcutaneous, lymph node hyperplasia via increases in specific immune cell populations. Cell Prolif 2017; 50. [PMID: 28762561 DOI: 10.1111/cpr.12365] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/06/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The spatial proximity of adipose depots to secondary lymph nodes allows a unique relation between the two systems. Obesity, predominately visceral adiposity, links to numerous diseases; hence, we postulate that secondary lymphatics within this region contributes to disease risk. MATERIAL AND METHODS Male C57BL/6 mice were fed standard CHOW (18% kcal fat) or Western diet (45% kcal fat) for 7 weeks. Visceral and subcutaneous lymph nodes and associated adipose depots they occupy were excised. Lymph node morphology and resident immune cell populations were characterized via histopathology, immunofluorescence and flow cytometry. Adipose tissue immune cell populations were also characterized. RESULTS Obesity caused lymph node expansion, increased viable cell number and deviations in immune cell populations. These alterations were exclusive to visceral lymph nodes. Notably, pro-inflammatory antigen presenting cells and regulatory T cells increased in number in the visceral lymph node. Obesity, however, reduced T regulatory cells in visceral lymph nodes. The visceral adipose depot also had greater reactivity towards HFD than subcutaneous, with a greater percent of macrophages, dendritic and CD8+ T cells. Immune cell number, in both the visceral and subcutaneous, however decreased as adipose depots enlarged. CONCLUSION Overall, HFD has a greater influence on visceral cavity than the subcutaneous. In the visceral lymph node, but not subcutaneous, HFD-induced obesity decreased cell populations that suppressed immune function while increasing those that regulate/activate immune response.
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Affiliation(s)
- A M Magnuson
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, 80523, USA
| | - D P Regan
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, 80523, USA
| | - J K Fouts
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, 80523, USA
| | - A D Booth
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, 80523, USA
| | - S W Dow
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, 80523, USA
| | - M T Foster
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, 80523, USA
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Booth AD, Magnuson AM, Cox-York KA, Wei Y, Wang D, Pagliassotti MJ, Foster MT. Inhibition of adipose tissue PPARγ prevents increased adipocyte expansion after lipectomy and exacerbates a glucose-intolerant phenotype. Cell Prolif 2016; 50. [PMID: 27976431 DOI: 10.1111/cpr.12325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/05/2016] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Adipose tissue plays a fundamental role in glucose homeostasis. For example, fat removal (lipectomy, LipX) in lean mice, resulting in a compensatory 50% increase in total fat mass, is associated with significant improvement in glucose tolerance. This study was designed to further examine the link between fat removal, adipose tissue compensation and glucose homeostasis using a peroxisome proliferator-activated receptor γ (PPAR γ; activator of adipogenesis) knockout mouse. MATERIAL AND METHODS The study involved PPARγ knockout (FKOγ) or control mice (CON), subdivided into groups that received LipX or Sham surgery. We reasoned that as the ability of adipose tissue to expand in response to LipX would be compromised in FKOγ mice, so would improvements in glucose homeostasis. RESULTS In CON mice, LipX increased total adipose depot mass (~60%), adipocyte number (~45%) and changed adipocyte distribution to smaller cells. Glucose tolerance was improved (~30%) in LipX CON mice compared to Shams. In FKOγ mice, LipX did not result in any significant changes in adipose depot mass, adipocyte number or distribution. LipX FKOγ mice were also characterized by reduction of glucose tolerance (~30%) compared to shams. CONCLUSIONS Inhibition of adipose tissue PPARγ prevented LipX-induced increases in adipocyte expansion and produced a glucose-intolerant phenotype. These data support the notion that adipose tissue expansion is critical to maintain and/or improvement in glucose homeostasis.
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Affiliation(s)
- A D Booth
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, Colorado, USA
| | - A M Magnuson
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, Colorado, USA
| | - K A Cox-York
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, Colorado, USA
| | - Y Wei
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, Colorado, USA
| | - D Wang
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, Colorado, USA
| | - M J Pagliassotti
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, Colorado, USA
| | - M T Foster
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, Colorado, USA
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Cajander SC, Tina ET, Bäckman AB, Magnuson AM, Strålin KS, Söderquist BS, Källman JK. Expression of mRNA levels of HLA-DRA in relation to monocyte HLA-DR: a longitudinal sepsis study. Crit Care 2015. [PMCID: PMC4471361 DOI: 10.1186/cc14125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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