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van Deudekom FJ, Klop HG, Hartgrink HH, Boonstra JJ, Lips IM, Slingerland M, Mooijaart SP. Functional and cognitive impairment, social functioning, frailty and adverse health outcomes in older patients with esophageal cancer, a systematic review. J Geriatr Oncol 2018; 9:560-568. [PMID: 29680585 DOI: 10.1016/j.jgo.2018.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 12/11/2017] [Revised: 01/26/2018] [Accepted: 03/28/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Older patients with esophageal cancer are at high risk of adverse health outcomes, but the association of geriatric assessment with adverse health outcomes in these patients has not been systematically evaluated. The aim of this systematic review was to study the association of functional and cognitive impairment, social environment and frailty with adverse health outcomes in patients diagnosed with esophageal cancer. METHODS We searched Pubmed, Embase, Web of Science and Cochrane Library for original studies reporting on associations of functional or cognitive impairment, social environment and frailty with adverse outcomes (mortality, functional or cognitive decline, adverse events during treatment, prolonged length of hospitalization (LOS) and health related quality of life (HRQoL)) after follow-up in patients with esophageal cancer. RESULTS Of 1.391 identified citations, nineteen articles were included that reported on 53 associations. The median sample size of the included studies was 110 interquartile range (IQR 91-359). Geriatric conditions were prevalent: between 14 and 67% of the included participants were functionally impaired, around 42% had depressive symptoms and between 5 and 23% did not have a partner. In nineteen of 53 (36%) associations functional or cognitive impairment or frailty were significant associated with adverse health outcomes, but the studies were small. In four out of six (67%) associations with the largest sample size (n ≥ 359), functional impairment or social environment were significant associated with adverse health outcomes. CONCLUSION Functional and cognitive impairment, depression and social isolation are prevalent in patients with esophageal cancer, and associate with adverse health outcomes. Geriatric measurements may guide decision-making and customize treatments, but more large studies are needed to explore the clinical usability.
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Affiliation(s)
- Floor J van Deudekom
- Department of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands.
| | - Henk G Klop
- Department of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands
| | - Henk H Hartgrink
- Department of Surgery, Leiden University Medical Center, The Netherlands
| | - Jurjen J Boonstra
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
| | - Irene M Lips
- Department of Radiation Oncology, Leiden University Medical Center, The Netherlands
| | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands; Institute for Evidence-based Medicine in Old Age (IEMO), Leiden, The Netherlands
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de Gelder J, Haenen E, Lucke JA, Klop HG, Blomaard LC, Smit RAJ, Mesri K, de Groot B, Fogteloo AJ, Anten S, Blauw GJ, Mooijaart SP. Optimising the ISAR-HP to screen efficiently for functional decline in older patients. Neth J Med 2017; 75:379-385. [PMID: 29219810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The Identification of Seniors At Risk-Hospitalised Patients (ISAR-HP) has recently been included in guidelines as a frailty indicator to identify patients for comprehensive geriatric assessment. Previous studies showed that the conventional cut-off score incorrectly classifies a high percentage of patients as high risk. We aimed to optimise the predictive value of ISAR-HP by using different cut-offs in older acutely hospitalised patients. METHODS A prospective follow-up study was performed in two Dutch hospitals. Acutely hospitalised patients aged ≥ 70 years were included. Demographics, illness severity parameters, geriatric measurements and the ISAR-HP scores were obtained at baseline. The primary outcome was a combined end point of functional decline or mortality during 90-day follow-up. RESULTS In total 765 acutely hospitalised older patients were included, with a median age of 79 years, of whom 276 (36.1%) experienced functional decline or mortality. The conventional ISAR-HP cut-off of ≥ 2 assigned 432/765 patients (56.5%) as high risk, with a positive predictive value (PPV) of 0.49 (95%CI 0.45-0.54) and a negative predictive value of 0.81 (95%CI 0.76-0.85). Thus, 51% of those whom the ISAR-HP denoted as high risk did not experience the outcome of interest. Raising the cut-off to ≥ 4 assigned 205/765 patients (26.8%) as high risk, with a marginally increased PPV to 0.55 (95%CI 0.48-0.62). CONCLUSION The ISAR-HP with the conventional cut-off of ≥ 2 incorrectly identifies a large group of patients at high risk for functional decline or mortality and raising the cut-off to 4 only marginally improved performance. Caution is warranted to ensure efficient screening and follow-up interventions.
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Affiliation(s)
- J de Gelder
- Department of Internal Medicine - section of geriatrics, Leiden University Medical Center, Leiden, the Netherlands
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Hoeke G, Wang Y, van Dam AD, Mol IM, Gart E, Klop HG, van den Berg SM, Pieterman EH, Princen HMG, Groen AK, Rensen PCN, Berbée JFP, Boon MR. Atorvastatin accelerates clearance of lipoprotein remnants generated by activated brown fat to further reduce hypercholesterolemia and atherosclerosis. Atherosclerosis 2017; 267:116-126. [PMID: 29121499 DOI: 10.1016/j.atherosclerosis.2017.10.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/02/2017] [Accepted: 10/25/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Activation of brown adipose tissue (BAT) reduces both hyperlipidemia and atherosclerosis by increasing the uptake of triglyceride-derived fatty acids by BAT, accompanied by formation and clearance of lipoprotein remnants. We tested the hypothesis that the hepatic uptake of lipoprotein remnants generated by BAT activation would be accelerated by concomitant statin treatment, thereby further reducing hypercholesterolemia and atherosclerosis. METHODS APOE*3-Leiden.CETP mice were fed a Western-type diet and treated without or with the selective β3-adrenergic receptor (AR) agonist CL316,243 that activates BAT, atorvastatin (statin) or both. RESULTS β3-AR agonism increased energy expenditure as a result of an increased fat oxidation by activated BAT, which was not further enhanced by statin addition. Accordingly, statin treatment neither influenced the increased uptake of triglyceride-derived fatty acids from triglyceride-rich lipoprotein-like particles by BAT nor further lowered plasma triglyceride levels induced by β3-AR agonism. Statin treatment increased the hepatic uptake of the formed cholesterol-enriched remnants generated by β3-AR agonism. Consequently, statin treatment further lowered plasma cholesterol levels. Importantly, statin, in addition to β3-AR agonism, also further reduced the atherosclerotic lesion size as compared to β3-AR agonism alone, without altering lesion severity and composition. CONCLUSIONS Statin treatment accelerates the hepatic uptake of remnants generated by BAT activation, thereby increasing the lipid-lowering and anti-atherogenic effects of BAT activation in an additive fashion. We postulate that, in clinical practice, combining statin treatment with BAT activation is a promising new avenue to combat hyperlipidemia and cardiovascular disease.
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Affiliation(s)
- Geerte Hoeke
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands.
| | - Yanan Wang
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands; Dept. of Pediatrics, University Medical Center Groningen, Groningen, The Netherlands
| | - Andrea D van Dam
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Isabel M Mol
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Eveline Gart
- The Netherlands Organization of Applied Scientific Research (TNO) - Metabolic Health Research, Gaubius Laboratory, Leiden, The Netherlands
| | - Henk G Klop
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Susan M van den Berg
- Dept. of Medical Biochemistry, Subdivision of Experimental Vascular Biology, Academic Medical Center, Amsterdam, The Netherlands
| | - Elsbet H Pieterman
- The Netherlands Organization of Applied Scientific Research (TNO) - Metabolic Health Research, Gaubius Laboratory, Leiden, The Netherlands
| | - Hans M G Princen
- The Netherlands Organization of Applied Scientific Research (TNO) - Metabolic Health Research, Gaubius Laboratory, Leiden, The Netherlands
| | - Albert K Groen
- Dept. of Pediatrics, University Medical Center Groningen, Groningen, The Netherlands; Dept. of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Patrick C N Rensen
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jimmy F P Berbée
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Mariëtte R Boon
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
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