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Horiuchi K, Kuno T, Takagi H, Egorova NN, Afezolli D. Predictive value of the G8 screening tool for postoperative complications in older adults undergoing cancer surgery: A systematic review and meta-analysis. J Geriatr Oncol 2024; 15:101656. [PMID: 37940482 DOI: 10.1016/j.jgo.2023.101656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Older adults with cancer who are being considered for cancer surgery are heterogenous, with variation in their physical, mental, and social baselines and risk of postoperative complications. Due in part to the complex nature of this population, the optimal preoperative evaluation method is not clearly defined. In this study we investigated whether geriatric-8 (G8), a screening tool for older patients with cancer that determines the need for a full geriatric assessment, is suitable for assessing the risk of postoperative complications in this population being considered for surgery. MATERIALS AND METHODS Studies that enrolled older patients undergoing cancer surgery and compared prevalence of postoperative complications in G8 "high" (≥15) patients and G8 "low" (<15) patients were identified using PubMed and EMBASE. A meta-analysis was conducted to calculate the risk ratio of postoperative complication rate. Postoperative mortality was systematically reviewed. RESULTS Eleven studies published between 2017 and 2022 were included in our analysis with a total of 2,691 older patients who underwent various types of cancer surgery and were characterized by their G8 scores: 1,255 G8 high (≥15) patients and 1,436 G8 low (<15) patients. G8 low patients had a significantly higher prevalence of postoperative complications than G8 high patients (risk ratio [95% confidence interval]: 1.56 [1.18-2.07], p = 0.002, I2 = 79%). DISCUSSION G8 can be an effective and efficient preoperative tool to assess risk of postoperative complications in older adults undergoing cancer surgery and identify potential need for further evaluation of an individual's risk with a comprehensive geriatric assessment.
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Affiliation(s)
- Kohei Horiuchi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA.
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizouka, Japan
| | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Debora Afezolli
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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2
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Bech D, Lietzen LW, Meldgaard P, Ryltoft AK, Ørum M. Diagnostic accuracy of the geriatric screening tools G8 and modified G8 in older patients with lung cancer: A diagnostic performance study. J Geriatr Oncol 2024; 15:101645. [PMID: 37903667 DOI: 10.1016/j.jgo.2023.101645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/30/2023] [Accepted: 10/03/2023] [Indexed: 11/01/2023]
Affiliation(s)
- Danny Bech
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark.
| | - Lone Winther Lietzen
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark; Aarhus University, Aarhus, Denmark
| | - Peter Meldgaard
- Aarhus University, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Marianne Ørum
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
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3
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Swartz K, Chapman A, Zhan T, Wen KY. Process evaluation of a G8 screening tool implementation in an outpatient oncology center. J Geriatr Oncol 2024; 15:101605. [PMID: 37633778 PMCID: PMC10843632 DOI: 10.1016/j.jgo.2023.101605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/18/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023]
Affiliation(s)
| | - Andrew Chapman
- Sidney Kimmel Cancer Center, Thomas Jefferson University, USA
| | - Tingting Zhan
- Sidney Kimmel Cancer Center, Thomas Jefferson University, USA
| | - Kuang-Yi Wen
- Sidney Kimmel Cancer Center, Thomas Jefferson University, USA
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Bakas AT, Polinder-Bos HA, Streng F, Mattace-Raso FUS, Ziere G, de Jong RJB, Sewnaik A. Frailty in Non-geriatric Patients With Head and Neck cancer. Otolaryngol Head Neck Surg 2023; 169:1215-1224. [PMID: 37264978 DOI: 10.1002/ohn.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/10/2023] [Accepted: 05/01/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Patients with head and neck cancer (HNC) are characterized by a poor lifestyle and comorbidity. The Geriatric 8 (G8) is an established screening tool to identify frail older patients with cancer. However, studies evaluating frailty in younger HNC patients are lacking. The aim of this study is to evaluate if the G8 can identify frailty and if it is related to mortality in younger HNC patients. STUDY DESIGN Case-control study design. SETTING Tertiary cancer center. METHODS We studied patients <70 years with HNC. Patients with G8 ≤ 14 were considered frail. Patients were matched to nonfrail (G8 > 14) control patients. Patients were matched according to sex, age, smoking, tumor location, and period of first consultation. Baseline health characteristics were compared between frail patients and nonfrail controls. Second, the treatment plan and adverse outcomes were compared. RESULTS Forty-five patients with G8 ≤ 14 were included and matched to 90 nonfrail controls. The median follow-up time was 357 days. Frail patients had a significantly lower body mass index and level of education, a worse World Health Organization performance status, and reported lower experienced overall health. 28.9% of the frail patients died after 1 year versus 10% of the nonfrail control patients (hazard ratio: 3.87 [95% confidence interval: 1.32-11.36], p = 0.014). CONCLUSION The G8 is a valid screening tool to identify frail patients in younger HNC patients.
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Affiliation(s)
- Ajay T Bakas
- Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Harmke A Polinder-Bos
- Department of Internal Medicine, Division of Geriatric Medicine, Rotterdam, The Netherlands
| | - Fleur Streng
- Department of Internal Medicine, Division of Geriatric Medicine, Rotterdam, The Netherlands
| | | | - Gijsbertus Ziere
- Department of Internal Medicine, Division of Geriatric Medicine, Rotterdam, The Netherlands
| | - Rob J Baatenburg de Jong
- Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Leo S, Marinelli F, Zurlo IV, Guarini V, Accettura C, Falco A, Leone S, Saracino V, Giudetti AM, Piscitelli P. Bioimpedentiometry parameters used as indicators of frailty and malnutrition: association between G8 score and Phase angle (PHA) in elderly cancer patients. Aging Clin Exp Res 2023; 35:2219-2225. [PMID: 37626230 DOI: 10.1007/s40520-023-02512-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 07/18/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Since the incidence of cancer increases with age, in older cancer patients important information may be missed without a Comprehensive Geriatric Assessment (CGA). On the other side, CGA is a time-consuming and complex instrument, so that Geriatric 8 (G8) has been proposed as a more feasible screening tool to identify patients who could benefit from a CGA evaluation. G8 consists of 8 questions (patient age + 7 items derived from the Mini Nutritional Assessment questionnaire). A G8 score ≤ 14 is considered associated with frailty and risk of malnutrition. Another screening test is Bioelectrical Impedance Analysis (Bioimpedentiometry, BIA), which enables to evaluate the nutritional status through a specific parameter known as Phase angle (PhA). This study is aimed at assessing the ability of G8 alone or in combination with PhA to detect elderly cancer patients at higher risk for malnutrition who cannot undergo immediate anticancer treatments. METHODS A total of 289 cancer patients (168 men and 121 women) aged ≥ 70 years old were enrolled and performed both G8 test, body mass index (BMI) and BIA assessments. A concurrent G8 score ≤ 14 and PhA < 5 defined subjects most exposed to the risk of malnutrition. RESULTS An association between BMI and G8 (p < 0.001, OR 1.54) and a clinically significant relationship between G8 and PhA (p = 0.013) were observed. CONCLUSION G8 can be used to identify patients at risk for malnutrition who would benefit from comprehensive CGA. The concurrent use of G8 and BIA presents a higher power in discriminating subjects at higher risk of malnutrition than a single test. This study suggests the need for routine assessment of nutritional status in cancer patients using combinations of methods, in order to implement strategies for individually-tailored care before starting any treatment.
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Affiliation(s)
- Silvana Leo
- Division of Oncology, Vito Fazzi Hospital, Lecce, Italy
| | - Fabiana Marinelli
- Department of Biological and Environmental Sciences and Technologies (DISTEBA), University of Salento, Lecce, Italy
| | | | | | | | | | - Stefania Leone
- Department of Biological and Environmental Sciences and Technologies (DISTEBA), University of Salento, Lecce, Italy
| | | | - Anna Maria Giudetti
- Department of Biological and Environmental Sciences and Technologies (DISTEBA), University of Salento, Lecce, Italy
| | - Prisco Piscitelli
- Division of Oncology, Vito Fazzi Hospital, Lecce, Italy.
- Department of Biological and Environmental Sciences and Technologies (DISTEBA), University of Salento, Lecce, Italy.
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Chon J, Timilshina N, AlMugbel F, Jin R, Monginot S, Tejero I, Breunis H, Alibhai SMH. Validity of a self-administered G8 screening test for older patients with cancer. J Geriatr Oncol 2023; 14:101553. [PMID: 37379768 DOI: 10.1016/j.jgo.2023.101553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/03/2023] [Accepted: 06/02/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION The Geriatric 8 (G8) is a brief cancer-specific tool which screens for patients who require a comprehensive geriatric assessment (CGA). The G8 test assesses patients on eight domains such as mobility, polypharmacy, age, and self-rated health. However, the current G8 requires a healthcare professional (nurse or physician) present to conduct the test, which limits its usefulness. The Self-G8 questionnaire (S-G8) is an adaptation of the original G8 test, assessing all the same domains, with questions modified to be appropriate for patients to self-complete. Our objective was to evaluate the performance of S-G8 compared to the G8 and CGA. MATERIALS AND METHODS The initial S-G8 was designed by our team through review of the literature and questionnaire design principles, and was optimized through feedback from patients over the age of 70. The questionnaire subsequently underwent further refinement after undergoing pilot testing (N = 14). The diagnostic accuracy of the final iteration of the S-G8 was evaluated along with the standard G8 in a prospective cohort study (N = 52) in an academic geriatric oncology clinic at the Princess Margaret Cancer Centre, Toronto, Canada. Psychometric characteristics were evaluated including internal consistency, sensitivity, and specificity compared to the G8 and to the CGA. RESULTS There was strong correlation between the G8 and S-G8 scores, with a Spearman correlation co-efficient of 0.76 (p < 0.001). Internal consistency was acceptable at 0.60. The frequency of abnormality (<14 score) for the G8 and S-G8 was 82.7% and 61.5%, respectively. The mean score for the original G8 and S-G8 was 11.9 and 13.5, respectively. The cut-off of 14 for the S-G8 yielded the best combination of sensitivity of 0.70 ± 0.07 and specificity of 0.78 ± 0.14 when compared to the G8. When compared to two or more abnormal domains on the CGA, the S-G8 performed at least as well as the G8 with a sensitivity of 0.77, specificity of 0.85, and a Youden's index of 0.62. DISCUSSION The S-G8 questionnaire appears to be an acceptable alternative to the original G8 in identifying older adults with cancer who will benefit from a CGA. Large scale testing is warranted.
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Affiliation(s)
- Joseph Chon
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Fahad AlMugbel
- Department of Medicine, University Health Network, Toronto, Canada
| | - Rana Jin
- Nursing, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Susie Monginot
- Nursing, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Isabel Tejero
- Department of Medicine, University Health Network, Toronto, Canada
| | | | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Canada.
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7
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Zhou X, Wang Y, Chen N, Pang B, Liu M, Cai K, Kobayashi N. Surveillance of Human Rotaviruses in Wuhan, China (2019-2022): Whole-Genome Analysis of Emerging DS-1-like G8P[8] Rotavirus. Int J Mol Sci 2023; 24:12189. [PMID: 37569563 PMCID: PMC10419309 DOI: 10.3390/ijms241512189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Group A rotaviruses (RVAs) are major etiologic agents of gastroenteritis in infants and young children worldwide. To study the prevalence and genetic characteristics of RVAs, a hospital-based surveillance study was conducted in Wuhan, China from June 2019 through May 2022. The detection rates of RVAs were 19.40% (142/732) and 3.51% (8/228) in children and adults, respectively. G9P[8] was the predominant genotype, followed by G8P[8] and G3P[8]. G8P[8] emerged and was dominant in the 2021-2022 epidemic season. The genome constellation of six G8P[8] strains was assigned to G8-P[8]-I2-R2-C2-M2-A2-N2-T2-E2-H2. Phylogenetic analysis revealed that the VP7, VP4, VP2, VP3, NSP1, NSP2, NSP3, and NSP5 genes of these G8P[8] strains clustered closely with those of the G8P[8] strains in Asia and were distant from those of the P[8] and G2P[4] strains simultaneously detected in Wuhan. In contrast, the VP1, VP6, and NSP4 genes were closely related to the typical G2P[4] rotavirus, including those of G2P[4] strains simultaneously detected in Wuhan. The detection rate of RVAs decreased in the COVID-19 pandemic era. It was deduced that the G8P[8] rotaviruses that emerged in China may be reassortants, carrying the VP6, VP1, and NSP4 genes derived from the G2P[4] rotavirus in the backbone of the neighboring DS-1-like G8P[8] strains represented by CAU17L-103.
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Affiliation(s)
- Xuan Zhou
- Division of Microbiology, Wuhan Center for Disease Control and Prevention, Wuhan 430024, China; (X.Z.); (B.P.); (M.L.)
| | - Yuanhong Wang
- Division of Microbiology, Wuhan Center for Disease Control and Prevention, Wuhan 430024, China; (X.Z.); (B.P.); (M.L.)
| | - Nan Chen
- Department of Aquatic Animal Medicine, College of Fisheries, Huazhong Agricultural University, Wuhan 430070, China;
| | - Beibei Pang
- Division of Microbiology, Wuhan Center for Disease Control and Prevention, Wuhan 430024, China; (X.Z.); (B.P.); (M.L.)
| | - Manqing Liu
- Division of Microbiology, Wuhan Center for Disease Control and Prevention, Wuhan 430024, China; (X.Z.); (B.P.); (M.L.)
| | - Kun Cai
- Institute of Health Inspection and Testing, Hubei Provincial Center for Disease Control and Prevention, Wuhan 430079, China;
| | - Nobumichi Kobayashi
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan;
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8
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Deldycke A, Denys H, Decruyenaere A, Velghe A, Naert E. Clinical decision-making in older patients with cancer: a cross-sectional single-centre study to assess the impact of clinical judgement and patient preferences. Acta Clin Belg 2023; 78:103-111. [PMID: 36879530 DOI: 10.1080/17843286.2022.2074702] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The heterogeneity in the population of older patients with cancer makes clinical decision-making difficult. We investigated the agreement between the G8 score and clinical judgment in frailty assessments, determined the impact of a life-expectancy calculator, and explored patient and caregiver preferences towards the treatment goal. METHODS Patients aged ≥75 years in need of new oncological treatment were prospectively enrolled between June 2020 and February 2021. Frailty was estimated by the oncologist and caregiver and compared to the G8 estimation. We examined whether the oncologist changed the fit/frail estimation based on life expectancy calculated using the ePrognosis tool. The main treatment goals, either longevity or quality of life (QoL), from the patient's and caregiver's perspective were noted and compared. RESULTS Forty-nine patients were included in the analysis. Comparison of the oncologist's and the caregiver's frailty estimation with the G8 assessment showed agreement and a Kappa coefficient of 58.3% (0.231) and 60% (0.255), respectively. The ePrognosis score and the odds of change in the frailty estimation by the oncologist showed no correlation. Regarding preferences, 28 (57.1%) and 17 (34.7%) patients and eighteen (47.3%) and seventeen (44.7%) caregivers chose longevity and QoL, respectively. The observed agreement and Kappa coefficient were 78.8% and 0.578. CONCLUSION Compared to the G8 assessment, frailty was underestimated by both oncologists and caregivers. Most of the patients chose longevity over QoL, and the preferences between the patient and the caregiver matched in the majority of cases.
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Affiliation(s)
- Annelies Deldycke
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Hannelore Denys
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Anja Velghe
- Geriatrics Department, Ghent University Hospital, Ghent, Belgium
| | - Eline Naert
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
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9
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Aksoy RA, Kaya V, Koca T, Korcum AF. The usefulness of the Geriatric-8 screening tool and basic laboratory parameters in older patients with non-small cell lung cancer. J Geriatr Oncol 2022; 13:1264-1267. [PMID: 35987893 DOI: 10.1016/j.jgo.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/13/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Rahmi Atil Aksoy
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey.
| | - Vildan Kaya
- Department of Radiation Oncology, Medstar Antalya Hospital, Antalya, Turkey; Antalya Bilim University, Antalya, Turkey
| | - Timur Koca
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Aylin Fidan Korcum
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
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Rier HN, Meinardi MC, van Rosmalen J, Westerweel PE, de Jongh E, Kitzen JJEM, van den Bosch J, Trajkovic M, Levin MD. Association Between Geriatric Assessment and Post-Chemotherapy Functional Status in Older Patients with Cancer. Oncologist 2022; 27:e878-e888. [PMID: 35861263 PMCID: PMC9632320 DOI: 10.1093/oncolo/oyac131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/15/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Maintaining functional status is among the most important patient-centered outcomes for older adults with cancer. This study investigated the association between comprehensive geriatric assessment (CGA) and progressive disease or decline of IADL-independence 1 year after chemotherapy, overall survival (OS), and premature termination of chemotherapy. CGA-based functional status and quality of life (QOL) 1 year after chemotherapy are also described. METHODS This prospective cohort study involved patients aged ≥65 years treated with chemotherapy for any cancer type. CGA and the G8-screening tool were performed before and after the completion of chemotherapy. Analyses were adjusted for tumor type and treatment intent: (a) indolent hematological malignancies, (b) aggressive hematological malignancies, c) solid malignancies treated with curative intent, and (d) solid malignancies treated with palliative intent. RESULTS All 291 included patients lived in The Netherlands; 193 (67.4%) lived fully independent prior to chemotherapy. The median age was 72 years; 164 (56.4%) were male. IADL independence, CGA-based functional status, and QOL were maintained in half of the patients 1 year after chemotherapy. An abnormal G8-score before chemotherapy was a higher risk for progressive disease or a decline of IADL-independence (OR 3.60, 95% CI, 1.98-6.54, P < .0001), prematurely terminated chemotherapy (OR 2.12, 95% CI, 1.24-3.65, P = .006), and shorter median OS (HR 1.71, 95% CI, 1.16-2.52, P = .007). The impact of an abnormal G8-score differed across tumor type (oncological or hematological) and treatment indication (adjuvant or palliative). CONCLUSION An abnormal G8 score before chemotherapy is associated with progressive disease and functional decline after chemotherapy and shorter median OS, especially in patients with solid malignancies.
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Affiliation(s)
- Hánah N Rier
- Corresponding author: Hánah N. Rier, MD, PhD, Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3314 AT Dordrecht, The Netherlands. Tel: +31 621645973;
| | - Marieke C Meinardi
- Department of Geriatric Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands,Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Peter E Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Eva de Jongh
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Jos J E M Kitzen
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Joan van den Bosch
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Marija Trajkovic
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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Traunero F, Claps F, Silvestri T, Mir MC, Ongaro L, Rizzo M, Piasentin A, Liguori G, Vedovo F, Celia A, Trombetta C, Pavan N. Reliable Prediction of Post-Operative Complications' Rate Using the G8 Screening Tool: A Prospective Study on Elderly Patients Undergoing Surgery for Kidney Cancer. J Clin Med 2022; 11:jcm11133785. [PMID: 35807070 PMCID: PMC9267910 DOI: 10.3390/jcm11133785] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 01/20/2023] Open
Abstract
In the last years the incidence of renal neoplasms has been steadily increasing, along with the average age of patients at the time of diagnosis. Surgical management for localized disease is becoming more challenging because of patients’ frailty. We conducted a multi-center prospective study to evaluate the role of the G8 as a screening tool in the assessment of intra and post-operative complications of elderly patients (≥70 y.o.) undergoing surgery for kidney cancer. A total of 162 patients were prospectively enrolled between January 2015 to January 2019 and divided into two study groups (frail vs. not-frail) according to their geriatric risk profile based on G8 score. Several factors (i.e., age, CCI, ASA score, preoperative anemia, RENAL score, surgical procedures, and techniques) were analyzed to identify whether any of them would configure as a statistically significant predictor of surgical complications. According to the G8 Score, 90 patients were included in the frail group. A total of 52 frail patients vs. 4 non-frail patients developed a postoperative complication of any kind (p < 0.001). Of these, 11 were major complications and all occurred in the frail group. Our results suggest that the G8 screening tool is an effective and useful instrument to predict the risk of overall complications in elderly patients prior to renal surgery.
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Affiliation(s)
- Fabio Traunero
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
- Correspondence: ; Tel.: +39-040-399-4293
| | - Francesco Claps
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Tommaso Silvestri
- Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, Italy; (T.S.); (A.C.)
| | - Maria Carmen Mir
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, 46009 Valencia, Spain;
| | - Luca Ongaro
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Michele Rizzo
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Andrea Piasentin
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Giovanni Liguori
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Francesca Vedovo
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, Italy; (T.S.); (A.C.)
| | - Carlo Trombetta
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Nicola Pavan
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
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12
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Fernández-Camacho E, Ferrer-Ramos C, Morilllo-Macías V, Rodríguez-Cordón M, Sánchez-Iglesias Á, Beato-Tortajada I, Francés-Muñoz A, Muelas-Soria R, Piquer-Camañes T, Santafé-Jiménez AI, Aznar-Tortonda V, Ferrer-Albiach C. The Impact of Frailty Screening on Radiation Treatment Modification. Cancers (Basel) 2022; 14:1072. [PMID: 35205820 DOI: 10.3390/cancers14041072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Care overburden makes it difficult to perform comprehensive geriatric assessments (CGAs) in oncology settings. We analyzed if screening tools modified radiotherapy in oncogeriatric patients. METHODS Patients ≥ 65 years, irradiated between December 2020 and March 2021 at the Hospital Provincial de Castellón, completed the frailty G8 and estimated survival Charlson questionnaires. The cohort was stratified between G8 score ≤ 14 (fragile) or >14 (robust); the cutoff point for the Charlson index was established at five. RESULTS Of 161 patients; 69.4% were male, the median age was 75 years (range 65-91), and the prevailing performance status (PS) was 0-1 (83.1%). Overall, 28.7% of the cohort were frail based on G8 scores, while the estimated survival at 10 years was 2.25% based on the Charlson test. The treatment administered changed up to 21% after frailty analysis. The therapies prescribed were 5.8 times more likely to be modified in frail patients based on the G8 test. In addition, patients ≥ 85 years (p = 0.01), a PS ≥ 2 (p = 0.008), and limited mobility (p = 0.024) were also associated with a potential change. CONCLUSIONS CGAs remain the optimal assessment tool in oncogeriatry. However, we found that the G8 fragility screening test, which is easier to integrate into patient consultations, is a reliable and efficient aid to rapid decision making.
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Krenzlin H, Jankovic D, Alberter C, Kalasauskas D, Westphalen C, Ringel F, Keric N. Frailty in Glioblastoma Is Independent From Chronological Age. Front Neurol 2021; 12:777120. [PMID: 34917020 PMCID: PMC8669893 DOI: 10.3389/fneur.2021.777120] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/01/2021] [Indexed: 01/12/2023] Open
Abstract
Objective: Treatment of glioblastoma in elderly patients is particularly challenging due to their general condition and comorbidities. Treatment decisions are often based on chronological age. Frailty screening tests promise an assessment tool to stratify geriatric patients and identify those at risk for an unfavorable outcome. This study aims to evaluate the impact of age and frailty on the surgical outcome and overall survival in geriatric patients with glioblastoma. Methods: Data acquisition was conducted as a single-center retrospective analysis. From January 1st 2015, and December 31st 2019, 104 glioblastoma patients over 70 years of age were included in our study. Demographic data, tumor size, Karnofsky Performance Score (KPS), and Eastern Cooperative Oncology Group Performance Status (ECOG), as well as treatment modalities, were assessed. The Geriatric 8 health status screening tool (G8) and Groningen Frailty Index (GFI) were compiled pre-and postoperatively. Results: The mean patient age was 76.86 ± 4.11 years. Forty-nine (47%) patients were female, 55 (53%) male. Sixty-seven patients underwent microsurgical tumor resection, 37 received tumor biopsy alone. Mean G8 on admission was 12.4 ± 2.0, mean GFI 5.0 ± 2.5. In our cohort, frailty was independent of patient age, tumor size, or localization. Frailty, defined by G8 and GFI, is associated with shorter overall survival (G8: p = 0.0035; GFI: p = 0.0136) and higher numbers of surgical complications (G8: p = 0.0326; GFI: p = 0.0388). Frailer patients are more likely to receive best supportive care (p = 0.004). Nevertheless, frailty did not affect adjuvant treatment decision-making toward either single-use of chemo- or radiation therapy, stratified treatment, or concomitant therapy. The surgical decision on the extent of resection was not based on pre-operative frailty. Conclusion: In our study, frailty is a predictor of poorer surgical outcomes, post-operative complications, and impaired overall survival independent of chronological age. Frailty screening tests offer an additional assessment tool to stratify geriatric patients with glioblastoma and identify those at risk for a detrimental outcome and thus should be implemented in therapeutic decision making.
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Affiliation(s)
- Harald Krenzlin
- Department of Neurosurgery, University Hospital Mainz, Mainz, Germany
| | - Dragan Jankovic
- Department of Neurosurgery, University Hospital Mainz, Mainz, Germany
| | | | | | | | - Florian Ringel
- Department of Neurosurgery, University Hospital Mainz, Mainz, Germany
| | - Naureen Keric
- Department of Neurosurgery, University Hospital Mainz, Mainz, Germany
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14
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Takahashi M, Sakamoto Y, Ohori H, Tsuji Y, Kuroki M, Kato S, Otsuka K, Komine K, Takahashi M, Takahashi S, Shirota H, Ouchi K, Takahashi Y, Imai H, Shibata H, Yoshioka T, Tanaka M, Yamaguchi H, Yamaguchi T, Shimodaira H, Ishioka C. Phase II study of trifluridine/tipiracil (TAS-102) therapy in elderly patients with colorectal cancer (T-CORE1401): geriatric assessment tools and plasma drug concentrations as possible predictive biomarkers. Cancer Chemother Pharmacol 2021; 88:393-402. [PMID: 34028598 DOI: 10.1007/s00280-021-04277-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/14/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE The current study aimed to determine the efficacy of trifluridine/tipiracil for elderly patients with advanced colorectal cancer. METHODS This single-arm, open-label, multicenter, phase II study included elderly patients aged 65 years or more who had fluoropyrimidine-refractory advanced colorectal cancer and received trifluridine/tipiracil (70 mg/m2, days 1-5 and 8-12, every 4 weeks). The primary endpoint was progression-free survival (PFS), while secondary endpoints included overall survival (OS), overall response rate (ORR), toxicities, association between efficacy and geriatric assessment scores, and association between toxicity and plasma drug concentrations. RESULTS A total of 30 patients with a mean age of 73 years were enrolled. Median PFS was 2.3 months (95% confidence interval, 1.9-4.3 months), while median OS was 5.7 months (95% confidence interval, 3.7-8.9 months). Patients had an ORR of 0%, with 57% having stable disease. Grade 4 neutropenia was observed in 13% of the patients. Patients with a higher G8 score (15 or more) showed longer PFS than those with a lower G8 score (median 4.6 vs. 2.0 months; p = 0.047). Moreover, patients with grade 3 or 4 neutropenia showed higher maximum trifluridine concentrations than those with grade 1 or 2 neutropenia (mean 2945 vs. 2107 ng/mL; p = 0.036). DISCUSSION The current phase II trial demonstrated that trifluridine/tipiracil was an effective and well-tolerated option for elderly patients with advanced colorectal cancer. Moreover, geriatric assessment tools and/or plasma drug concentration monitoring might be helpful in predicting the efficacy and toxicities in elderly patients receiving this drug. TRIAL REGISTRATION NUMBER UMIN000017589, 15/May/2015 (The University Hospital Medical Information Network).
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15
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Gomes F, Lorigan P, Woolley S, Foden P, Burns K, Yorke J, Blackhall F. A prospective cohort study on the safety of checkpoint inhibitors in older cancer patients - the ELDERS study. ESMO Open 2021; 6:100042. [PMID: 33516147 PMCID: PMC7844568 DOI: 10.1016/j.esmoop.2020.100042] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/06/2020] [Accepted: 12/20/2020] [Indexed: 11/30/2022] Open
Abstract
Objective Older cancer patients are underrepresented in the pivotal trials of checkpoint inhibitors (CPIs). This study aimed to investigate the impact of an ageing immune system on CPI-related toxicity and provide evidence for the role of geriatric assessments with CPI. Methods The ELDERS study is a prospective observational study with two cohorts: older (70+ years of age) and younger (<70 years of age). Patients with advanced/metastatic non-small-cell lung cancer or melanoma starting single-agent CPI were eligible. The older cohort was assessed for frailty with Geriatric-8 (G8) screening, which when positive (<15 points) was followed by a holistic set of geriatric assessments. Primary endpoint was the incidence of grade 3-5 immune-related adverse events (irAEs). Results One hundred and forty patients were enrolled with 43% being pretreated and pembrolizumab represented 92% of treatments on study. The older cohort had a significantly higher comorbidity burden (P < 0.001) and polypharmacy (P = 0.004). While 50% of older patients had a positive G8 screening, 60% on this frail subgroup had a performance status score of 0 or 1. There was no significant difference in the incidence of irAEs grade 3-5 between older and younger cohorts (18.6% versus 12.9%; odds ratio 1.55, confidence interval 95% 0.61-3.89; P = 0.353). Exposure to systemic steroids due to irAEs was numerically longer for older patients (22 versus 8 weeks; P = 0.208). A positive G8 screening predicted hospital admissions (P = 0.031) and risk of death (P = 0.01). Conclusions The use of CPI in older patients was not associated with more high-grade toxicity. The G8 screening identified a subgroup with higher risk of AEs and its implementation should be considered in the context of CPI. The ELDERS is the first prospective study designed to address the safety of immunotherapy in older cancer patients. Older cancer patients had no increased risk of high-grade toxicity with immunotherapy. Management of immune toxicity in older patients is often more challenging, particularly for those more vulnerable/frail. Geriatric assessments in the context of immunotherapy predict clinical outcomes. Comorbidity burden, polypharmacy and the G8 screening identified those with worst outcomes.
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Affiliation(s)
- F Gomes
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK; Patient-Centred Research Centre, The Christie NHS Foundation Trust, Manchester, UK.
| | - P Lorigan
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK; Division of Medical Sciences, University of Manchester, Manchester, UK
| | - S Woolley
- Research & Innovation Department, The Christie NHS Foundation Trust, Manchester, UK
| | - P Foden
- Data Analytics Department, The Christie NHS Foundation Trust, Manchester, UK
| | - K Burns
- Research & Innovation Department, The Christie NHS Foundation Trust, Manchester, UK
| | - J Yorke
- Patient-Centred Research Centre, The Christie NHS Foundation Trust, Manchester, UK; Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - F Blackhall
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK; Division of Medical Sciences, University of Manchester, Manchester, UK
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16
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Loi M, Comito T, Franzese C, Desideri I, Dominici L, Lo Faro L, Clerici E, Franceschini D, Baldaccini D, Badalamenti M, Reggiori G, Lobefalo F, Scorsetti M. Charlson comorbidity index and G8 in older old adult(≥80 years) hepatocellular carcinoma patients treated with stereotactic body radiotherapy. J Geriatr Oncol 2021; 12:1100-1103. [PMID: 33461945 DOI: 10.1016/j.jgo.2021.01.001] [Citation(s) in RCA: 3] [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: 07/25/2020] [Revised: 11/16/2020] [Accepted: 01/05/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Hepatocellular Carcinoma (HCC) is characterized, in Western countries, by higher incidence and mortality rates in the older adult population. In frail patients, limited therapeutic resources are available due to limited expected benefit concerning the risk of treatment-related toxicity. The aim of our study is to evaluate the role of Stereotactic Body Radiotherapy (SBRT) in the clinical management of older old adults (age ≥ 80 years) HCC patients and to identify predictors of efficacy and toxicity. MATERIAL AND METHODS Clinical and treatment-related data of older old adults HCC patients treated with SBRT at our institution were retrospectively reviewed. Statistical analysis was carried out to identify variables correlated with impaired outcome and toxicity. RESULTS Forty-two patients were included, accounting for 63 treated tumors. Median age was 85 (range 80-91) years. Median Charlson Comorbidity Index (CCI) and G8 scores were 10 (range 7-16) and 11 (range 8-14), respectively. SBRT was administered to a median BED10 of 103 Gy10. Median follow-up interval was 11 (range 3-40) months. Two years Local Control (LC), Progression-Free Survival (PFS), and Overall Survival (OS) were 93%, 31%, and 43%, respectively. Acute toxicity occurred in 28% (n = 13) of treatments. A G8 score > 10 was associated with improved survival (p = 0.045), while a CCI ≥10 was correlated with increased acute toxicity (p = 0.021). CONCLUSIONS SBRT is a safe and effective option in older old adults HCC patients. A comprehensive geriatric assessment (CGA) is advised before treatment decisions to select optimal candidates for SBRT.
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Affiliation(s)
- Mauro Loi
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy.
| | - Tiziana Comito
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Ciro Franzese
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy; Radiotherapy Department, University of Florence, Florence, Italy
| | - Isacco Desideri
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan Area, Italy
| | - Luca Dominici
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan Area, Italy
| | - Lorenzo Lo Faro
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Elena Clerici
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Davide Franceschini
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Davide Baldaccini
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Marco Badalamenti
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Giacomo Reggiori
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Francesca Lobefalo
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Marta Scorsetti
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy; Radiotherapy Department, University of Florence, Florence, Italy
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17
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Kubo T, Watanabe H, Ninomiya K, Kudo K, Minami D, Murakami E, Ochi N, Ninomiya T, Harada D, Yasugi M, Ichihara E, Ohashi K, Rai K, Fujiwara K, Hotta K, Tabata M, Maeda Y, Kiura K. Immune checkpoint inhibitor efficacy and safety in older non-small cell lung cancer patients. Jpn J Clin Oncol 2020; 50:1447-1453. [PMID: 32869100 DOI: 10.1093/jjco/hyaa152] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/11/2020] [Accepted: 07/28/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Immune checkpoint inhibitors offer longer survival than chemotherapy in several clinical trials for advanced non-small cell lung cancer. In subset analyses of clinical trials, immune checkpoint inhibitors extended survival in patients aged ≥65 years, but the effects in patients aged ≥75 years are controversial. We performed multicenter, collaborative and retrospective analyses of immune checkpoint inhibitor efficacy and safety in non-small cell lung cancer patients aged ≥75 years. METHODS We retrospectively studied 434 advanced non-small cell lung cancer patients who received immune checkpoint inhibitors from December 2015 to December 2017, and retrospectively applied the Geriatric (G) 8 screening tool with medical records. RESULTS Of the 434 patients who received immune checkpoint inhibitors, 100 were aged ≥75 years. Five patients with performance status 3 were omitted from the final analysis. Immune checkpoint inhibitors were given as a first-line treatment to 20 patients. The objective response rates, median progression-free survival rates and median survival times were 35.0%, 6.1 months and 10.7 months for first-line treatment, and 20.0%, 2.9 months and 14.7 months for second- or later-line treatments, respectively. The median modified G8 score was 11.0. The median survival time was longer in the high modified G8 (≥12.0) group than in the low modified G8 (≤11.0) group (18.7 vs. 8.7 months; P = 0.02). Likewise, the median survival time was 15.5 months (performance status 0-1) vs. 3.2 months (performance status 2) (P < 0.01). The grade ≥ 2 immune-related adverse events incidence was 36.8%. CONCLUSIONS In this study, immune checkpoint inhibitors were effective and tolerable for patients aged ≥75 years. The modified G8 screening tool and performance status were associated with the outcome of older non-small cell lung cancer patients treated with immune checkpoint inhibitors.
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Affiliation(s)
- Toshio Kubo
- Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan
| | - Hiromi Watanabe
- Allergy and Respiratory Medicine, Okayama University Hospital, Okayama
| | - Kiichiro Ninomiya
- Allergy and Respiratory Medicine, Okayama University Hospital, Okayama
| | - Kenichiro Kudo
- Respiratory Medicine, Iwakuni Medical Center, Iwakuni.,Respiratory Medicine, Okayama Medical Center, Okayama
| | | | - Etsuko Murakami
- Respiratory Medicine, Japanese Red Cross Society Himeji Hospital, Himeji
| | - Nobuaki Ochi
- General Internal Medicine 4, Kawasaki Medical School, Okayama
| | - Takashi Ninomiya
- Allergy and Respiratory Medicine, Okayama University Hospital, Okayama.,Health Service Center, Okayama University, Okayama
| | | | | | - Eiki Ichihara
- Allergy and Respiratory Medicine, Okayama University Hospital, Okayama
| | - Kadoaki Ohashi
- Allergy and Respiratory Medicine, Okayama University Hospital, Okayama
| | - Kammei Rai
- Allergy and Respiratory Medicine, Okayama University Hospital, Okayama.,Hospital-based Cancer registry division, Okayama University Hospital, Okayama
| | | | - Katsuyuki Hotta
- Allergy and Respiratory Medicine, Okayama University Hospital, Okayama.,Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama
| | - Masahiro Tabata
- Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan
| | - Yoshinobu Maeda
- Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Katsuyuki Kiura
- Allergy and Respiratory Medicine, Okayama University Hospital, Okayama
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Scheepers ERM, van der Molen LF, van den Bos F, Burgmans JP, van Huis-Tanja LH, Hamaker ME. The G8 frailty screening tool and the decision-making process in older breast cancer patients. Eur J Cancer Care (Engl) 2020; 30:e13357. [PMID: 33159382 DOI: 10.1111/ecc.13357] [Citation(s) in RCA: 4] [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: 05/22/2020] [Revised: 08/12/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the decision-making process in fit and frail older breast cancer patients. METHODS Breast cancer patients aged ≥70 years who completed the G8 frailty screening tool (G8) were included in this retrospective study. Socio-demographic and clinical characteristics were collected, as well as information from geriatric assessment (GA). Treatment decisions were compared with national guidelines. RESULTS Of 177 patients, 85 patients were considered fit by the G8 (G8-fit) and 92 patients frail (G8-frail). All G8-fit and 53 G8-frail were proposed for surgery. GA was performed in 34 patients (9 G8-fit; 25 G8-frail) of whom 16 (2 G8-fit;14 G8-frail) were considered frail (GA-frail). 28 out of these 34 patients were considered fit for surgery (including 11 GA-frail); their impairments were unlikely to interfere with surgery or life expectancy. Reasons for adjusting treatment were physical/cognitive condition and patient preference. Ultimately, 123 patients underwent surgery in accordance with guidelines (81 G8-fit;42 G8-frail, p < 0.001). Survival was reduced in G8-frail compared to G8-fit (p = 0.001), but G8 lost its association with mortality in multivariable survival analysis. Among patients undergoing surgery, no difference in mortality was seen between G8-fit and G8-frail (p = 0.996). CONCLUSION The G8 is associated with treatment decisions and did not affect survival in patients undergoing surgery. In the decision-making process, the G8 may help and estimates the need for adaptive care.
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Affiliation(s)
| | | | - Frederiek van den Bos
- Department of Geriatric Medicine, University Medical Centre, Utrecht, The Netherlands
| | | | | | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht, The Netherlands
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19
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Amzerin M, Layachi M, Bazine A, Aassab R, Arifi S, Benbrahim Z, Khmamouche MR, Kairouani M, Raiss H, Majid N, Ouaouch S, Ichou M, Afqir S, Mellas N, Fetohi M, Razine R, Errihani H. Cancer in Moroccan elderly: the first multicenter transverse study exploring the sociodemographic characteristics, clinical profile and quality of life of elderly Moroccan cancer patients. BMC Cancer 2020; 20:983. [PMID: 33046017 PMCID: PMC7552478 DOI: 10.1186/s12885-020-07458-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background Moroccan incidence of cancer is increasing with the lengthening of life expectancy. Data regarding elderly Moroccan cancer patients are lacking. In the context of our project aiming to develop an adapted version of the Comprehensive Geriatric Assessment CGA to the Moroccan population, we launched the first Moroccan multicenter transverse study to explore the characteristics of elderly Moroccan cancer patients. Methods The study was conducted in nine Moroccan medical oncology departments. Patients were enrolled over 4 months. Inclusion criteria were patients aged 65 years or over with verified solid cancer. The questionnaire included four sections: socio-demographic and economic data, clinical data, vulnerability and EORTC-QLQ C30. We explored the entire included population. Then, we compared the results according to age (65–70 years old and ≥ 71 years old) and sex. We also explored the correlation between G8 scores and the ability to practice religion as an indicator of fitness level. Results In total, 164 patients were enrolled. The mean age was 73.18 ± 6.01 years. The majority of patients were married, lived with their children and received their financial income from them. Fifteen percent of families asked to hide the diagnosis from the patient. Breast (23%), colorectal (15.9%) and lung (14%) cancers were the most frequent, and 83.5% had an abnormal G8. The majority of the patients were independent for basic daily activities. Female patients had poorer social and economic conditions. Abnormal G8 was correlated with religious practice and quality of life scores. Conclusion This is the first multicenter prospective study designed to collect data on the lifestyle and clinical profiles of elderly Moroccan cancer patients as an Arab and Muslim population. Our study shows that it is a well-cared-for population with strong social ties. However, there is deep economic vulnerability, especially among women, requiring urgent care. Religious practice is an important daily activity for our elderly patients and should be included in the Moroccan CGA.
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Affiliation(s)
- Mounia Amzerin
- Ahmad Bin Zayed Al Nahyan Center of Cancer Treatment, Department of Medical Oncology, Tangier, Morocco. .,Mohamed V University in Rabat, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco.
| | - Mohamed Layachi
- Mohamed VI University Hospital, Department of Medical Oncology, Marrakech, Morocco
| | - Aziz Bazine
- Moulay Ismail Military hospital, Department of Medical Oncology, Meknes, Morocco
| | - Rachid Aassab
- Hassan II Hospital, Department of Medical Oncology, Agadir, Morocco
| | - Samia Arifi
- Hassan II University Hospital, Department of Medical Oncology, Fez, Morocco
| | - Zineb Benbrahim
- Hassan II University Hospital, Department of Medical Oncology, Fez, Morocco
| | | | - Mouna Kairouani
- Hassan II Oncology Center, Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco
| | - Hanan Raiss
- Reginal Center of Oncology, Department of Medical Oncology, Al-Hoceima, Morocco
| | - Noura Majid
- Ibn Rochd University Hospital, Oncology Center, Department of Medical Oncology, Casablanca, Morocco
| | | | - Mohammed Ichou
- Mohamed V Military teaching Hospital, Department of Medical Oncology, Rabat, Morocco
| | - Said Afqir
- Hassan II Oncology Center, Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco
| | - Nawfal Mellas
- Hassan II University Hospital, Department of Medical Oncology, Fez, Morocco
| | - Mohamed Fetohi
- Moulay Ismail Military hospital, Department of Medical Oncology, Meknes, Morocco
| | - Rachid Razine
- Laboratory of Biostatistics, Epidemiology and Clinical Research, Mohammed V University in Rabat, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco.,Department of Public Health, University of Mohamed V Rabat, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco
| | - Hassan Errihani
- National Institute Of Oncology, Department of Medical Oncology, Mohamed V University in Rabat, Rabat, Morocco
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20
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Middelburg JG, Middelburg RA, van Zwienen M, Mast ME, Bhawanie A, Jobsen JJ, Rozema T, Maas H, Geijsen ED, van der Leest AH, van den Bongard DHJG, van Loon J, Budiharto T, Aarts MJ, Terhaard CHJ, Struikmans H. Impaired Geriatric 8 Score is Associated with Worse Survival after Radiotherapy in Older Patients with Cancer. Clin Oncol (R Coll Radiol) 2020; 33:e203-e210. [PMID: 32972801 DOI: 10.1016/j.clon.2020.09.002] [Citation(s) in RCA: 4] [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: 04/25/2020] [Revised: 08/11/2020] [Accepted: 09/04/2020] [Indexed: 12/12/2022]
Abstract
AIMS To investigate whether the Geriatric 8 (G8) score and the Timed Get Up and Go Test (TGUGT), together with clinical and demographic patient characteristics, are associated with survival and late toxicity after (chemo)radiation therapy, administered with curative intent in older patients with cancer. MATERIALS AND METHODS Four hundred and two patients aged ≥65 years (median age 72 years, range 65-96 years), diagnosed with either breast, non-small cell lung, prostate, head and neck, rectal or oesophageal cancer, and referred for curative (chemo)radiation therapy, took part in a multicentre prospective cohort study in eight radiotherapy centres in the Netherlands. The G8 and TGUGT scores were assessed before starting treatment. Other potential predictors and late toxicity were also recorded. Survival status and date of death, if applicable, were ascertained at the Dutch national death registry. RESULTS After 2.5 years, the overall survival was 83%. Survival was 87% for patients with high G8 scores and 55% for patients with low G8 scores (Log-rank P value < 0.0001). Survival was 77% for patients with good TGUGT results and 50% for patients with poor TGUGT results (Log-rank P value < 0.001). In multivariable analysis, in addition to age and type of primary tumour, the association of the G8 score with overall survival remained, with a hazard ratio of 2.1 (95% confidence interval 1.2-3.8) for low versus high scores. CONCLUSIONS G8 was associated with overall survival in older patients with cancer irradiated with curative intent. This association was independent of the predictive value of age and primary tumour.
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Affiliation(s)
- J G Middelburg
- Erasmus Medical Center, Radiotherapy, Rotterdam, the Netherlands.
| | - R A Middelburg
- Sanquin Research, Center for Clinical Transfusion Research, Leiden, the Netherlands; Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, the Netherlands
| | - M van Zwienen
- Erasmus Medical Center, Radiotherapy, Rotterdam, the Netherlands
| | - M E Mast
- Haaglanden Medical Center, Department of Radiotherapy, The Hague, the Netherlands
| | - A Bhawanie
- Medisch Spectrum Twente, Radiation Oncology, Enschede, the Netherlands
| | - J J Jobsen
- Medisch Spectrum Twente, Radiation Oncology, Enschede, the Netherlands
| | - T Rozema
- Institute Verbeeten, Radiotherapy, Tilburg, the Netherlands
| | - H Maas
- Elisabeth-Tweesteden Hospital, Department of Geriatric Medicine, Tilburg, the Netherlands
| | - E D Geijsen
- Academic Medical Center, Radiotherapy, Amsterdam, the Netherlands
| | - A H van der Leest
- University Medical Center Groningen, Radiotherapy, Groningen, the Netherlands
| | | | - J van Loon
- Maastricht University Medical Center, GROW-School for Oncology and Developmental Biology, Department of Radiation Oncology (Maastro Clinic), Maastricht, the Netherlands
| | - T Budiharto
- Catharina Ziekenhuis, Department of Radiotherapy, Eindhoven, the Netherlands
| | - M J Aarts
- Netherlands Comprehensive Cancer Organization IKNL, Netherlands Cancer Registry, Utrecht, the Netherlands
| | - C H J Terhaard
- University Medical Centre Utrecht, Department of Radiotherapy, Utrecht, the Netherlands
| | - H Struikmans
- Haaglanden Medical Center, Department of Radiotherapy, The Hague, the Netherlands
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Islam A, Hossain ME, Rostal MK, Ferdous J, Islam A, Hasan R, Miah M, Rahman M, Rahman MZ, Daszak P, Epstein JH. Epidemiology and Molecular Characterization of Rotavirus A in Fruit Bats in Bangladesh. Ecohealth 2020; 17:398-405. [PMID: 32876756 PMCID: PMC7464061 DOI: 10.1007/s10393-020-01488-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 07/07/2020] [Accepted: 07/28/2020] [Indexed: 05/06/2023]
Abstract
Rotavirus A (RVA) is the primary cause of acute dehydrating diarrhea in human and numerous animal species. Animal-to-human interspecies transmission is one of the evolutionary mechanisms driving rotavirus strain diversity in humans. We screened fresh feces from 416 bats (201 Pteropus medius, 165 Rousettus leschenaultii and 50 Taphozous melanopogon) for RVA using rRT-PCR. We detected a prevalence of 7% (95% CI 3.5-10.8) and 2% (95% CI 0.4-5.2) in P. medius and R. leschenaultii, respectively. We did not detect RVA in the insectivorous bat (T. melanopogon). We identified RVA strains similar to the human strains of G1 and G8 based on sequence-based genotyping, which underscores the importance of including wildlife species in surveillance for zoonotic pathogens to understand pathogen transmission and evolution better.
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Affiliation(s)
- Ariful Islam
- EcoHealth Alliance, 460 West 34th Street, Suite 17, New York, NY, 10001, USA
- Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Geelong, VIC, Australia
| | - Mohammad Enayet Hossain
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Melinda K Rostal
- EcoHealth Alliance, 460 West 34th Street, Suite 17, New York, NY, 10001, USA
| | - Jinnat Ferdous
- EcoHealth Alliance, 460 West 34th Street, Suite 17, New York, NY, 10001, USA
- Institute of Epidemiology, Disease Control and Research (IEDCR), Mohakhali, Dhaka, 1212, Bangladesh
| | - Ausraful Islam
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rashedul Hasan
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mojnu Miah
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafizur Rahman
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammed Ziaur Rahman
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Peter Daszak
- EcoHealth Alliance, 460 West 34th Street, Suite 17, New York, NY, 10001, USA
| | - Jonathan H Epstein
- EcoHealth Alliance, 460 West 34th Street, Suite 17, New York, NY, 10001, USA.
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22
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Kodama H, Hatakeyama S, Momota M, Togashi K, Hamaya T, Hamano I, Fujita N, Kojima Y, Okamoto T, Yoneyama T, Yamamoto H, Yoshikawa K, Yoneyama T, Hashimoto Y, Ohyama C. Effect of frailty and comorbidity on surgical contraindication in patients with localized prostate cancer (FRART-PC Study). Urol Oncol 2020; 39:191.e1-191.e8. [PMID: 32684512 DOI: 10.1016/j.urolonc.2020.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine how frailty and comorbidities affect surgical contraindication in patients with localized prostate cancer (CaP). MATERIALS AND METHODS We evaluated the effects of frailty in 479 patients with localized CaP who were treated with robot-assisted radical prostatectomy (RARP), or radiotherapy (RT) eligible for surgery (RT-nonfrail), or those with RT ineligible for surgery due to frailty or comorbidity (RT-frail) from February 2017 to April 2020. We retrospectively compared the geriatric 8 screening (G8) scores between patients with surgical indications (RARP and RT-nonfrail groups) and those with surgical contraindications (RT-frail group). The effect of G8 score in the RT-frail groups was investigated using multivariate logistic regression analysis. We developed and validated a nomogram for surgical contraindication in patients with localized CaP. RESULTS The median age of patients was 70 years. There were 256, 60, and 163 patients in the RARP, RT-nonfrail, and RT-frail, respectively. The G8 score in the RARP and RT-nonfrail groups was significantly higher than in the RT-frail group (15 vs. 14, respectively, P < 0.001). Age, comorbidities (cerebrocardiovascular disease or chronic respiratory disease), and G8 score were significantly associated with the RT-frail group. The nomogram showed that the area under the curve was 0.872 and 0.923 in the training and validation sets, respectively. The cutoff for surgical contraindication was >39.5%. CONCLUSIONS The G8 score and comorbidities have a significant effect on surgical contraindication in patients with localized CaP.
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Affiliation(s)
- Hirotake Kodama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Masaki Momota
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kyo Togashi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomoko Hamaya
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Itsuto Hamano
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuta Kojima
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Gogineni E, Rana Z, Wotman M, Karten J, Riegel A, Marrero M, Maduro L, Kamdar D, Frank D, Paul D, Seetharamu N, Ghaly M. Impact of stereotactic body radiation therapy on geriatric assessment and management for older patients with head and neck cancer using G8. J Geriatr Oncol 2020; 12:122-127. [PMID: 32593669 DOI: 10.1016/j.jgo.2020.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/06/2020] [Revised: 05/11/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Management of head and neck cancers (HNC) in older adults is a common but challenging clinical scenario. We assess the impact of Stereotactic Body Radiation Therapy (SBRT) on survival utilizing the Geriatric-8 (G8) questionnaire. MATERIALS AND METHODS 171 HNC patients, deemed medically unfit for definitive treatment, were treated with SBRT ± systemic therapy. G8 questionnaires were collected at baseline, at 4-6 weeks, and at 2-3 months post-treatment. Patients were stratified according to their baseline G8 score: <11 as 'vulnerable', 11-14 as 'intermediate', and >14 as 'fit'. Overall survival (OS) was assessed through univariate Kaplan Meier analysis. Repeated measures ANOVA was used to determine if baseline characteristics affected G8 score changes. RESULTS Median follow-up was seventeen months. 60% of patients presented with recurrent HNC, 30% with untreated HNC primaries, and 10% with metastatic non-HNC primaries. Median age was 75 years. Median Charlson Comorbidity Index score was 2. 51% of patients were 'vulnerable', 37% were 'intermediate', and 12% were 'fit' at baseline, with median survival of 13.2, 24.3, and 41.0 months, respectively (p = .004). Patients who saw a decrease in their follow-up G8 score (n = 69) had significantly lower survival than patients who had stable or increased follow-up G8 scores (n = 102), with median survival of 8.6 vs 36.0 months (p < .001). CONCLUSION The G8 questionnaire may be a useful tool in upfront treatment decision-making to predict prognosis and prevent older patients from receiving inappropriate anti-cancer treatment. Decline in follow-up G8 scores may also predict worse survival and aid in goals of care following treatment.
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Affiliation(s)
- Emile Gogineni
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Zaker Rana
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Michael Wotman
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Jessie Karten
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Adam Riegel
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Mihaela Marrero
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Luis Maduro
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Dev Kamdar
- Department of Otolarygology, Head / Neck Surgery, Northwell Health, Lake Success, NY, USA
| | - Douglas Frank
- Department of Otolarygology, Head / Neck Surgery, Northwell Health, Lake Success, NY, USA
| | - Doru Paul
- Department of Medical Oncology, Northwell Health, Lake Success, NY, USA
| | | | - Maged Ghaly
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA.
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Moutelíková R, Sauer P, Dvořáková Heroldová M, Holá V, Prodělalová J. Emergence of Rare Bovine-Human Reassortant DS-1-Like Rotavirus A Strains with G8P[8] Genotype in Human Patients in the Czech Republic. Viruses 2019; 11:v11111015. [PMID: 31683946 PMCID: PMC6893433 DOI: 10.3390/v11111015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 01/09/2023] Open
Abstract
Group A Rotaviruses (RVA) are the leading cause of acute gastroenteritis in children and a major cause of childhood mortality in low-income countries. RVAs are mostly host-specific, but interspecies transmission and reassortment between human and animal RVAs significantly contribute to their genetic diversity. We investigated the VP7 and VP4 genotypes of RVA isolated from 225 stool specimens collected from Czech patients with gastroenteritis during 2016–2019. The most abundant genotypes were G1P[8] (42.7%), G3P[8] (11.1%), G9P[8] (9.8%), G2P[4] (4.4%), G4P[8] (1.3%), G12P[8] (1.3%), and, surprisingly, G8P[8] (9.3%). Sequence analysis of G8P[8] strains revealed the highest nucleotide similarity of all Czech G8 sequences to the G8P[8] rotavirus strains that were isolated in Vietnam in 2014/2015. The whole-genome backbone of the Czech G8 strains was determined with the use of next-generation sequencing as DS-1-like. Phylogenetic analysis of all segments clustered the Czech isolates with RVA strains that were formerly described in Southeast Asia, which had emerged following genetic reassortment between bovine and human RVAs. This is the first time that bovine–human DS-1-like G8P[8] strains were detected at a high rate in human patients in Central Europe. Whether the emergence of this unusual genotype reflects the establishment of a new RVA strain in the population requires the continuous monitoring of rotavirus epidemiology.
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Affiliation(s)
| | - Pavel Sauer
- Institute of Microbiology, University Hospital Olomouc and Faculty of Medicine, Palacký University, 77900 Olomouc, Czech Republic.
| | - Monika Dvořáková Heroldová
- Microbiology Institute of Faculty of Medicine, Masaryk University Brno and University Hospital of St. Anne, 65691 Brno, Czech Republic.
| | - Veronika Holá
- Microbiology Institute of Faculty of Medicine, Masaryk University Brno and University Hospital of St. Anne, 65691 Brno, Czech Republic.
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Cuccia F, Mortellaro G, Mazzola R, Donofrio A, Valenti V, Tripoli A, Matranga D, Lo Casto A, Failla G, Di Miceli G, Ferrera G. Prognostic value of two geriatric screening tools in a cohort of older patients with early stage Non-Small Cell Lung Cancer treated with hypofractionated stereotactic radiotherapy. J Geriatr Oncol 2019; 11:475-481. [PMID: 31122872 DOI: 10.1016/j.jgo.2019.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 11/13/2018] [Revised: 03/16/2019] [Accepted: 05/02/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To investigate whether assessment with two geriatric screening tools shows a correlation with clinical outcomes of patients aged 65 years or more, with early-stage Non-Small Cell Lung Cancer (es-NSCLC) treated with hypofractionated stereotactic radiotherapy. METHODS From March 2014 to June 2018 we retrospectively evaluated 42 patients with stage I and II lung tumors. Patients were assessed with Charlson Comorbidity Index (CCI) and G8 screening tool. Median age was 74 years (range, 65-91). Stereotactic radiotherapy was performed with Helical Tomotherapy delivering 50-70 Gray (Gy) in 8-10 fractions. Toxicity was evaluated using Common Terminology Criteria for Adverse Events v4.0 criteria. RESULTS Median CCI and G8 scores were 6 (4-11) and 14 (12-17), respectively. With a median follow-up of 14 months (3-37), we observed: 3 cases of acute Grade 2 (G2) radiation pneumonitis, 1 late G2 non-cardiac chest pain, 1 late G2 dysphagia and 1 case of late G2 radiation pneumonitis. At statistical analysis, G8 scores ≤14 were significantly associated with late toxicity rates (p = .0073). Local failure was predictive of disease free survival and Overall Survival (p < .001 and p = .001). Death occurred in 12 patients, 6 for non-cancer related causes, with 1- and 2-yrs cancer specific survival rates of 94.8% and 90%, 1- and 2-yrs OS rates of 93% and 80%, respectively. CONCLUSIONS Our experience shows a correlation between G8 scores and late toxicity in older patients treated with stereotactic radiotherapy for lung cancer, suggesting the need for prospective studies evaluating its use for the identification of patients at higher risk of adverse events.
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Affiliation(s)
- Francesco Cuccia
- Radiation Oncology School, University of Palermo, Palermo, Italy; Radiation Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | - Gianluca Mortellaro
- Radiation Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | - Rosario Mazzola
- Department of Radiation Oncology, IRCCS, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Alessandra Donofrio
- Radiation Oncology School, University of Palermo, Palermo, Italy; Radiation Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | - Vito Valenti
- Radiation Oncology School, University of Palermo, Palermo, Italy; Radiation Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | - Antonella Tripoli
- Radiation Oncology School, University of Palermo, Palermo, Italy; Radiation Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | | | - Antonio Lo Casto
- Radiation Oncology School, University of Palermo, Palermo, Italy; Radiology Department, Di.Bi.Med., Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Giuseppe Failla
- Interventional Endoscopic Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | - Giuseppe Di Miceli
- Chest Surgery Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Giuseppe Ferrera
- Radiation Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy.
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Lucero Y, O'Ryan M, Liparoti G, Huerta N, Mamani N, Ramani S, Lagomarcino AJ, Del Canto F, Quense J. Predominance of Rotavirus G8P[8] in a City in Chile, a Country Without Rotavirus Vaccination. J Pediatr 2019; 204:298-300.e1. [PMID: 30297290 DOI: 10.1016/j.jpeds.2018.08.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/18/2018] [Revised: 07/27/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
Abstract
Rotavirus G8P[8] infection has been common in Africa, but rare in the Americas. Among 23 rotavirus episodes observed during 18 months of surveillance of 100 families in Chile, 11 (48%) were identified as G8P[8]. Genotypes from these strains shared >99% identity with rotavirus sequences described in Asia, and may be misclassified as mixed G8/G12.
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Affiliation(s)
- Yalda Lucero
- Microbiology and Mycology Program, ICBM, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Miguel O'Ryan
- Microbiology and Mycology Program, ICBM, Faculty of Medicine, University of Chile, Santiago, Chile; Millenium Institute of Immunology and Immunotherapy, University of Chile, Santiago, Chile.
| | - Giulia Liparoti
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Nicole Huerta
- Microbiology and Mycology Program, ICBM, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Nora Mamani
- Microbiology and Mycology Program, ICBM, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sasirekha Ramani
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX
| | - Anne J Lagomarcino
- Microbiology and Mycology Program, ICBM, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Felipe Del Canto
- Microbiology and Mycology Program, ICBM, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Jorge Quense
- Geography Institute, Pontificia Universidad Católica de Chile, Santiago, Chile
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Dottorini L, Catena L, Sarno I, Di Menna G, Marte A, Novelli E, Rusca C, Bajetta E. The role of Geriatric screening tool ( G8) in predicting side effect in older patients during therapy with aromatase inhibitor. J Geriatr Oncol 2018; 10:356-358. [PMID: 30333087 DOI: 10.1016/j.jgo.2018.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 06/22/2018] [Revised: 09/20/2018] [Accepted: 10/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Endocrine therapy is the main treatment in hormonosensitive breast cancer; the most frequent side effects are arthralgia, osteoporosis, depression, dyslipidemia and hypertension. G8 is a simple test developed to identify older patients who could benefit from a comprehensive geriatric assessment (CGA). The aim of this study is to evaluate the possible role of G8 in predicting side effects from treatment with aromatase inhibitor in women ≥65 years old. MATHERIAL AND METHOD Women ≥65 years old affected by breast cancer about to start a therapy with an aromatase inhibitor, in the adjuvant setting, were evaluated with the G8 tool. Patients were classified as "fit" with G8 score > 14 or "vulnerable" with G8 score ≤ 14; they then started treatment and clinical-instrumentalfollow-up. RESULTS From April 2016 to February 2018, 50 consecutive patients were screened. Median age was 75.1 (range 65-86). G8 identified 30 patients (60%) as "fit" (score > 14) and 20 (40%) as "vulnerable" (score ≤ 14). The grade of concordance between G8 score and the appearance/absence of adverse events were statistically significant (41/50 patients, 82%, p = 0.0002); sensitivity resulted in 78% and specificity was 81%; positive predictive value was 70% and negative predictive value was 87%. The most frequent adverse event was arthromyalgia. CONCLUSION The G8 screening tool has a potential role in predicting side effects during a treatment with aromatase inhibitor. G8 could be very useful in everyday clinical practice for this population.
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Affiliation(s)
| | - Laura Catena
- Institute of Oncology, Policlinico di Monza, Monza, Italy
| | - Italo Sarno
- Institute of Oncology, Policlinico di Monza, Monza, Italy
| | | | | | | | - Carmen Rusca
- Psychologist Consultant, Policlinico di Monza, Monza, Italy
| | - Emilio Bajetta
- Institute of Oncology, Policlinico di Monza, Monza, Italy
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de Thézy A, Lafargue A, d'Arailh L, Dijos M, Leroux L, Salles N, Rainfray M. Relevance of G8 scale in referring elderly patients with aortic stenosis requiring a TAVI for a geriatric consultation. ACTA ACUST UNITED AC 2017; 15:357-63. [PMID: 29187325 DOI: 10.1684/pnv.2017.0697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aortic stenosis (AS) may soon become a significant public health issue. Referring elderly suffering from aortic stenosis for a transcatheter aortic valve implantation (TAVI) versus surgical valve replacement might be difficult and requires a multidisciplinary staff. G8 is a geriatric screening scale for frailty, validated in oncogeriatry. We study sensibility and specificity of G8 used by cardiologists in comparison to a comprehensive geriatric assessment (CGA) performed by geriatrician. Prospective study, from February to July 2015, in Bordeaux university Hospital, France. Every elderly admitted for a TAVI had a G8 scale performed by cardiologist and CGA by a geriatrician in blind. Comorbidities were assessed using Cumulative Illness Rating Scale in his geriatric version (CIRS-G). CGA was abnormal if: MMSE <24/30 or GDS ≥7/15 or ADL ≤5/6 or IADL ≤7/8 or TUG ≥20 seconds or if malnutrition was noticed. G8 was abnormal if ≤14/17. We calculated sensibility, specificity, positive and negative predictive value in comparison to gold-standard CGA. 49 patients were included (55.1% women, mean age 84.8 years old). Nearly half of the patients (48.96%) had multiple comorbidities (CIRS G score >3 for at least three items excluding the cardiology item). 38 CGA were abnormal (77.55%) and 41 G8 (83.67%). G8 had a sensibility of 100% (IC 95% [0.9-1]), a specificity of 72.7% (IC 95% [0.43-0.9]), a positive predictive value of 92.6% and a negative prospective value of 100% (IC: 95%). G8 scale seems to be an efficient geriatric screening tool for frailty in elderly undergoing TAVI in comparison to CGA. Simple and useful, G8 scale could be performed by cardiologists in older patients with AS for identifying patients with a geriatric risk profile in consultation before surgery. Further studies with bigger samples are needed to confirm these results.
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Maebayashi T, Ishibashi N, Aizawa T, Sakaguchi M, Saito T, Kawamori J, Tanaka Y. Significance of stereotactic body radiotherapy in older patients with early stage non-small cell lung cancer. J Geriatr Oncol 2018; 9:594-9. [PMID: 29573969 DOI: 10.1016/j.jgo.2018.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/21/2018] [Accepted: 03/06/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Our aim was to investigate long-term treatment outcomes in older patients with early stage non-small cell lung cancer (NSCLC) and the presence or absence of therapeutic benefits, using the G8 screening tool. METHODS We retrospectively studied 43 older patients (median age 78 years, range 65-89 years) with stage I lung tumors (T1 and T2 tumors in 34 and 9 patients, respectively), who underwent stereotactic body radiotherapy (SBRT). This study assessed outcomes in a cohort of patients who received geriatric assessments, performed between 2004 and 2011, before the start of their SBRT regimen. Any questions asked to patients before undergoing treatment were applied to the G8 screening tool. RESULTS G8 scores ranged from 8 to 16 (median, 12) in all patients (n = 43), while G8 scores in the T1 and T2 groups ranged from 9 to 16 (median, 13) and 8 to 15 (median, 12), respectively. In patients with G8 scores ≤12, the 2-year and 5-year survival rates were 56.1% and 28% respectively, while the rates were 94.1% and 68.4%, respectively, in patients with G8 scores ≥13 (P = 0.0014). During long-term follow-up, 25.9% of the patients (n = 43) died of the primary disease, NSCLC, and 34.9% of patients died of other diseases or other types of cancer. CONCLUSION SBRT may be effective, even in older adults. Regardless of age, SBRT improved the long-term survival of patients only with G8 scores ≥13. The G8 screening tool may aid in determining whether older patients with comorbidities would benefit from SBRT.
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Battaglin F, Schirripa M, Buggin F, Pietrantonio F, Morano F, Boscolo G, Tonini G, Lutrino ES, Lucchetti J, Salvatore L, Passardi A, Cremolini C, Arnoldi E, Scartozzi M, Pella N, Boni L, Bergamo F, Zagonel V, Loupakis F, Lonardi S. The PANDA study: a randomized phase II study of first-line FOLFOX plus panitumumab versus 5FU plus panitumumab in RAS and BRAF wild-type elderly metastatic colorectal cancer patients. BMC Cancer 2018; 18:98. [PMID: 29370781 PMCID: PMC5784655 DOI: 10.1186/s12885-018-4001-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/17/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Few data are available regarding the treatment of metastatic colorectal cancer elderly patients with anti-EGFR agents in combination with chemotherapy. FOLFOX plus panitumumab is a standard first-line option for RAS wild-type metastatic colorectal cancer. Slight adjustments in chemo-dosage are commonly applied in clinical practice to elderly patients, but those modified schedules have never been prospectively tested. Clinical definition of elderly (≥70 years old) patients that may deserve a more or less intensive combination therapy is still debated. Several geriatric screening tools have been developed to predict survival and risk of toxicity from treatment. Among those, the G8 screening tool has been tested in cancer patients showing the strongest prognostic value for overall survival, while the CRASH score can stratify patients according to an estimated risk of treatment-related toxicities. METHODS The PANDA study is a prospective, open-label, multicenter, randomized phase II trial of first-line therapy with panitumumab in combination with dose-adjusted FOLFOX or with 5-fluorouracil monotherapy, in previously untreated elderly patients (≥70 years) with RAS and BRAF wild-type unresectable metastatic colorectal cancer. RAS and BRAF analyses are centralized. Geriatric assessment by means of G8 and CRASH score is planned at baseline and G8 will be re-evaluated at disease progression. The primary endpoint is duration of progression-free survival in both arms. Secondary endpoints include prospective evaluation of the prognostic role of G8 score and the correlation of CRASH risk categories with toxicity. DISCUSSION The PANDA study aims at exploring safety and efficacy of panitumumab in combination with FOLFOX or with 5FU/LV in elderly patients affected by RAS and BRAF wild-type metastatic colorectal cancer, to identify the most promising treatment strategy in this setting. Additionally, this is the first trial in which the prognostic role of the G8 score will be prospectively evaluated. Results of this study will drive further experimental developments for one or both combinations. TRIAL REGISTRATION PANDA is registered at Clinicaltrials.gov : NCT02904031 , July 11, 2016. PANDA is registered at EudraCT-No.: 2015-003888-10, September 3, 2015.
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Affiliation(s)
- Francesca Battaglin
- Istituto Oncologico Veneto - IRCCS, S.C. Oncologia Medica 1, Dipartimento di Oncologia Clinica e Sperimentale, Via Gattamelata, 64, 35128, Padova, Italy
| | - Marta Schirripa
- Istituto Oncologico Veneto - IRCCS, S.C. Oncologia Medica 1, Dipartimento di Oncologia Clinica e Sperimentale, Via Gattamelata, 64, 35128, Padova, Italy
| | - Federica Buggin
- Istituto Oncologico Veneto - IRCCS, S.C. Oncologia Medica 1, Dipartimento di Oncologia Clinica e Sperimentale, Via Gattamelata, 64, 35128, Padova, Italy
| | - Filippo Pietrantonio
- Fondazione IRCCS Istituto Nazionale Tumori, Dipartimento di Oncologia Medica, Via Venezian, 1, 20133, Milan, Italy
| | - Federica Morano
- Fondazione IRCCS Istituto Nazionale Tumori, Dipartimento di Oncologia Medica, Via Venezian, 1, 20133, Milan, Italy
| | - Giorgia Boscolo
- Azienda Unita Locale Socio-Sanitaria N°3 Serenissima - Distretto Mirano, Dolo, Noale - Dipartimento di Scienze Mediche, U.O.C. Oncologia ed Ematologia Oncologica, Via Don G. Sartor, 4, 30035, Mirano, VE, Italy
| | - Giuseppe Tonini
- Policlinico Universitario Campus Bio-Medico, U.O.C. Oncologia Medica, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Eufemia Stefania Lutrino
- Ospedale Senatore A. Perrino, U.O.C. Oncologia Medica, Strada Statale 7 (Appia), 72100, Brindisi, Italy
| | - Jessica Lucchetti
- U.O. Oncologia Medica, Dipartimento di Medicina, Ospedale Universitario Policlinico Tor Vergata, Università degli Studi di Roma Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Lisa Salvatore
- Oncologia, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Scuro, 10, 37134, Verona, Italy
| | - Alessandro Passardi
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), U.O. Oncologia Medica, Via P. Maroncelli, 40, 47014, Meldola, FC, Italy
| | - Chiara Cremolini
- Azienda Ospedaliero Universitaria Pisana, U.O. Oncologia Medica 2 Universitaria, Via Roma, 67, 56126, Pisa, Italy
| | - Ermenegildo Arnoldi
- ASST Papa Giovanni XXIII, U.O. Oncologia Medica, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Mario Scartozzi
- U.O. Oncologia Medica, Azienda Ospedaliero-Universitaria di Cagliari e Università di Cagliari, via Ospedale, 54, 09124, Cagliari, Italy
| | - Nicoletta Pella
- Azienda Sanitaria Universitaria Integrata di Udine, Dipartimento di Oncologia, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy
| | - Luca Boni
- Centro Coordinamento Sperimentazioni Cliniche - Istituto Toscano Tumori, Via Taddeo Alderotti, 26/N, 50139, Florence, Italy
| | - Francesca Bergamo
- Istituto Oncologico Veneto - IRCCS, S.C. Oncologia Medica 1, Dipartimento di Oncologia Clinica e Sperimentale, Via Gattamelata, 64, 35128, Padova, Italy
| | - Vittorina Zagonel
- Istituto Oncologico Veneto - IRCCS, S.C. Oncologia Medica 1, Dipartimento di Oncologia Clinica e Sperimentale, Via Gattamelata, 64, 35128, Padova, Italy
| | - Fotios Loupakis
- Istituto Oncologico Veneto - IRCCS, S.C. Oncologia Medica 1, Dipartimento di Oncologia Clinica e Sperimentale, Via Gattamelata, 64, 35128, Padova, Italy.
| | - Sara Lonardi
- Istituto Oncologico Veneto - IRCCS, S.C. Oncologia Medica 1, Dipartimento di Oncologia Clinica e Sperimentale, Via Gattamelata, 64, 35128, Padova, Italy.
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Pamoukdjian F, Liuu E, Caillet P, Gisselbrecht M, Herbaud S, Boudou-Rouquette P, Zelek L, Paillaud E. [Geriatric assessment and prognostic scores in older cancer patient: Additional support to the therapeutic decision?]. Bull Cancer 2017; 104:946-55. [PMID: 29150094 DOI: 10.1016/j.bulcan.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/25/2017] [Accepted: 10/03/2017] [Indexed: 01/10/2023]
Abstract
Cancer is a disease of the elderly as demonstrated by the epidemiological evolution of Western countries. Indeed, two third of cancers newly diagnosed occur over 65 years. However, older cancer patients have been often excluded from clinical trials in oncology and the extrapolation of cancer treatments in this population remains difficult in practice. Scientific societies recommend that a comprehensive geriatric assessment (CGA) be performed in patients aged 70 and over and selected using screening tools for frailty such as the G8 index. The CGA allows to detect aging-related vulnerabilities in various domains (comorbidities, polypharmacy, autonomy, nutrition, mobility, cognition, mood, social) and associated with adverse outcomes during cancer treatment (reduced overall survival, perioperative complications, toxicity-related chemotherapy). The CGA is allow to elaborate a personalized treatment plan in geriatric oncology. However, to date, no algorithms based on CGA is validated to guide therapeutic decision in geriatric oncology. The collaboration between geriatrician and oncologist remains essential to elaborate an appropriate therapeutic strategy and limit the situations of over- and under-treatment. This article presents the set of tools and scores used in geriatric oncology to guide the therapeutic decision.
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Souwer ETD, Verweij NM, van den Bos F, Bastiaannet E, Slangen RME, Steup WH, Hamaker ME, Portielje JEA. Risk stratification for surgical outcomes in older colorectal cancer patients using ISAR-HP and G8 screening tools. J Geriatr Oncol 2018; 9:110-4. [PMID: 29129470 DOI: 10.1016/j.jgo.2017.09.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/11/2017] [Accepted: 09/18/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Older patients are at risk for adverse outcomes after surgical treatment of cancer. Identifying patients at risk could affect treatment decisions and prevent functional decline. Screening tools are available to select patients for Geriatric Assessment. Until now their predictive value for adverse outcomes in older colorectal cancer patients has not been investigated. OBJECTIVE To study the predictive value of the Geriatric 8 (G8) and Identification of Seniors at Risk for Hospitalized Patients (ISAR-HP) screening tools for adverse outcomes after elective colorectal surgery in patients older than 70years. Primary outcomes were 30-day complication rates, secondary outcomes were the length of hospital stay and six-month mortality. STUDY DESIGN AND METHODS Multicentre cohort study from two hospitals in the Netherlands. Frail was defined as a G8 ≤14 and/or ISAR-HP ≥2. Odds ratio (OR) is given with 95% CI. RESULTS Overall, 139 patients (52%) out of 268 patients were included; 32 patients (23%) were ISAR-HP-frail, 68 (50%) were G8-frail, 20 were frail on both screening tools. Median age was 77.7years. ISAR-HP frail patients were at risk for 30-day complications OR 2.4 (CI 1.1-5.4, p=0.03), readmission OR 3.4 (1.1-11.0), cardiopulmonary complications OR 5.9 (1.6-22.6), longer hospital stay (10.3 versus 8.9day) and six-months mortality OR 4.9 (1.1-23.4). When ISAR-HP and G8 were combined OR increased for readmission, 30-day and six-months mortality. G8 alone had no predictive value. CONCLUSIONS ISAR-HP-frail patients are at risk for adverse outcomes after colorectal surgery. ISAR-HP combined with G8 has the strongest predictive value for complications and mortality. KEY POINTS Patients screening frail on ISAR-HP are at increased risk for morbidity and mortality. Screening results of G8 alone was not predictive for postoperative outcomes. Predictive value increased when G8 and ISAR-HP were combined.
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Takahashi K, Kobayashi J. Lessons from the Field Count more than Ever: The New Era of Global Health. Trop Med Health 2016; 43:243-5. [PMID: 26865827 PMCID: PMC4689607 DOI: 10.2149/tmh.2015-37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 11/17/2022] Open
Abstract
For many years, Japan has been silent on the achievements of Japan’s Overseas Development Assistance program including the health improvement of foreign countries. Japan’s contribution to global health communities through G8 process including Hashimoto Initiative is steadfast. On the other hand, in the field activity level, experts involved in ODA have not disclosed their achievements. However, the article by Wada et al., which describes the contents of TEN MR (Minimum Requirement), shed light on Japan’s silent ODA community by disclosing Japan’s achievements in global health by drawing lessons that may be applicable to other countries. Our future challenge in the global health will be how to synthesize actions that reflect the lessons learnt from the field and which show scientific evidence using established methods.
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Affiliation(s)
- Kenzo Takahashi
- Teikyo University Graduate School of Public Health; The Japan consortium for Global School Health Research
| | - Jun Kobayashi
- The University of Ryukyus, School of Health Sciences, Department of Global Community Health; The Japan consortium for Global School Health Research
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Agbemabiese CA, Nakagomi T, Doan YH, Nakagomi O. Whole genomic constellation of the first human G8 rotavirus strain detected in Japan. Infect Genet Evol 2015; 35:184-93. [PMID: 26275468 DOI: 10.1016/j.meegid.2015.07.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 12/25/2022]
Abstract
Human G8 Rotavirus A (RVA) strains are commonly detected in Africa but are rarely detected in Japan and elsewhere in the world. In this study, the whole genome sequence of the first human G8 RVA strain designated AU109 isolated in a child with acute gastroenteritis in 1994 was determined in order to understand how the strain was generated including the host species origin of its genes. The genotype constellation of AU109 was G8-P[4]-I2-R2-C2-M2-A2-N2-T2-E2-H2. Phylogenetic analyses of the 11 genome segments revealed that its VP7 and VP1 genes were closely related to those of a Hungarian human G8P[14] RVA strain and these genes shared the most recent common ancestors in 1988 and 1982, respectively. AU109 possessed an NSP2 gene closely related to those of Chinese sheep and goat RVA strains. The remaining eight genome segments were closely related to Japanese human G2P[4] strains which circulated around 1985-1990. Bayesian evolutionary analyses revealed that the NSP2 gene of AU109 and those of the Chinese sheep and goat RVA strains diverged from a common ancestor around 1937. In conclusion, AU109 was generated through genetic reassortment event where Japanese DS-1-like G2P[4] strains circulating around 1985-1990 obtained the VP7, VP1 and NSP2 genes from unknown ruminant G8 RVA strains. These observations highlight the need for comprehensive examination of the whole genomes of RVA strains of less explored host species.
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Affiliation(s)
- Chantal Ama Agbemabiese
- Department of Hygiene and Molecular Epidemiology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Toyoko Nakagomi
- Department of Hygiene and Molecular Epidemiology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yen Hai Doan
- Department of Hygiene and Molecular Epidemiology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Osamu Nakagomi
- Department of Hygiene and Molecular Epidemiology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
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