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Obama K, Fujimori M, Boku N, Matsuoka A, Mori K, Okizaki A, Miyaji T, Okamura M, Majima Y, Goto S, Shimazu T, Uchitomi Y. Shared decision-making support program for older patients with advanced cancer using a question prompt list and geriatric assessment: A pilot randomized controlled trial. J Geriatr Oncol 2024; 15:101778. [PMID: 38704911 DOI: 10.1016/j.jgo.2024.101778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/10/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Older patients with cancer are less likely to express their treatment preferences than younger patients. Question prompt lists (QPLs) facilitate communication between patients and physicians. Geriatric assessment (GA) is recommended when older patients with cancer make treatment decisions. This study estimated the effect size of a shared decision-making (SDM) support program combining QPLs with GA in terms of patients' subjective evaluation of the SDM process for a future definitive randomized controlled trial. We also evaluated the number and quality of aging-related communication during consultations, and feasibility and acceptability of the study for exploratory purposes. MATERIALS AND METHODS This is a pilot study with randomized allocation and blind evaluation. Patients aged 65 years or older at the National Cancer Center Hospital, Tokyo, Japan, scheduled to discuss the changes of their treatment, were randomly assigned in a 1:1 ratio to the SDM support program or usual care. This program consisted of 30-60 min of face-to-face coaching, with QPLs and GA provided before the coaching. As the primary endpoint, the decisional conflict scores given by the patients immediately after the consultation were compared between the two groups. For the secondary endpoints, the number and quality of aging-related communications during the consultations were assessed by evaluators (blinded) using audio-recordings. Adherence, burden, and usefulness were assessed for evaluating feasibility and acceptability of the SDM support program. RESULTS Forty patients were enrolled. All patients completed the GA questionnaire, for which 70% did not require any individual assistance. Answering the questionnaires took approximately 11 min. The decisional conflict scores were mean [standard deviation (SD)]: 19.3 [10.8] vs. 18.0 [11.1] (effect size: Cohen's d = 0.12) for the SDM support program and usual care groups, respectively. The number of aging-related communications during the consultation for the new treatment was higher in the SDM support program group than the usual care (mean [SD]: 3.3 [1.2] vs. 2.2 [1.5], effect size: cohen's d = 1.32). Patients felt that the SDM support program was useful but not burdensome or difficult. DISCUSSION The SDM support program was considered useful and feasible for older patients and able to facilitate communication regarding aging-related concerns. TRIAL REGISTRATION NUMBER The study protocol was registered on September 23, 2020, in the UMIN Clinical Trials Registry (UMIN000041867).
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Affiliation(s)
- Kyoko Obama
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Maiko Fujimori
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan.
| | - Narikazu Boku
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Ayumu Matsuoka
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Keita Mori
- Department of Biostatistics, Clinical Research Center, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Ayumi Okizaki
- Innovation Center for Supportive, Palliative, and Psychosocial Care, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Tempei Miyaji
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan; Innovation Center for Supportive, Palliative, and Psychosocial Care, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Masako Okamura
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Yoshiyuki Majima
- NPO Pancreatic Cancer Action Network Japan, Sodegaura, Chiba, Japan
| | - Shinichi Goto
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Taichi Shimazu
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Yosuke Uchitomi
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan; Innovation Center for Supportive, Palliative, and Psychosocial Care, National Cancer Center, Chuo-ku, Tokyo, Japan
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Sattar S, Haase KR, Puts M, Iddrisu M, Chalchal H, Souied O, Alibhai SMH, Ahmed S. Oncology care providers' perceptions and anticipated barriers regarding the use of geriatric assessment in routine clinic practice: A mixed-methods study. J Geriatr Oncol 2024; 15:101768. [PMID: 38626515 DOI: 10.1016/j.jgo.2024.101768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/16/2024] [Accepted: 04/08/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Geriatric assessment (GA) is currently not a standard of cancer care across Canada. In the Canadian province of Saskatchewan, there are no known formal geriatric teams in outpatient oncology settings. Therefore, it is not known whether, how, and to what extent GA is performed in oncology clinics, or what supports are needed to carry out a GA. The objective of this study was to explore Saskatchewan oncology care providers' knowledge, perceptions, and practices regarding GA, and their perceived barriers to implementing formal GA. MATERIALS AND METHODS In this mixed-methods study, oncology physicians and nurses within the Saskatchewan Cancer Agency (SCA) were invited to participate in an anonymous survey and individual open-ended interview. Quantitative survey data were analyzed using descriptive statistics; free-text responses provided in the survey were summarized. Data from interviews were analyzed using thematic analysis. RESULTS A total of 19 physicians and 30 clinic nurses participated in the survey (response rate: 24% [physicians] and 38.0% [nurses]). In terms of cancer treatment and management, the majority (74% of physicians and 62% of nurses) stated considerations for older adults are different than younger patients. More than half (53% of physicians and 58% of nurses) reported making treatment and management decisions primarily based on judgement versus validated tools. For physicians whose practices involve prescribing chemotherapy (16/19), 75% rarely or never use validated tools (e.g., CARG, CRASH) to assess risk of chemotoxicity for older patients. Lack of time and supporting staff and feeling unsure as to where to refer older patients for help or follow-up were the most commonly voiced anticipated barriers to implementing GA. Two physicians and six nurses (n = 8) participated in the open-ended interviews. Main themes included: (1) tension between knowing the importance of GA versus capacity and (2) buy-in. DISCUSSION Our findings review barriers and opportunities for implementing GA in oncology care in Saskatchewan and provides foundational knowledge to inform efforts to promote personalized medicine and to optimize cancer care for older adults with cancer in this region.
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Affiliation(s)
- Schroder Sattar
- College of Nursing, University of Saskatchewan, Saskatoon, Canada.
| | - Kristen R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, Canada; BC Cancer Research Institute, Vancouver, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Mohammed Iddrisu
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Haji Chalchal
- College of Medicine, University of Saskatchewan, Saskatoon, Canada; Saskatchewan Cancer Agency, Canada
| | - Osama Souied
- College of Medicine, University of Saskatchewan, Saskatoon, Canada; Saskatchewan Cancer Agency, Canada
| | - Shabbir M H Alibhai
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON M5G 2C4, Canada; Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON M5S 3H2, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Ste. 425, Toronto, ON M5T 3M6, Canada
| | - Shahid Ahmed
- College of Medicine, University of Saskatchewan, Saskatoon, Canada; Saskatchewan Cancer Agency, Canada
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Sedrak MS, Sun CL, Bae M, Freedman RA, Magnuson A, O'Connor T, Moy B, Wildes TM, Klepin HD, Chapman AE, Tew WP, Dotan E, Fenton MA, Kim H, Katheria V, Muss HB, Cohen HJ, Gross CP, Ji J. Functional decline in older breast cancer survivors treated with and without chemotherapy and non-cancer controls: results from the Hurria Older PatiEnts (HOPE) prospective study. J Cancer Surviv 2024:10.1007/s11764-024-01594-3. [PMID: 38678525 DOI: 10.1007/s11764-024-01594-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE This study aimed to assess whether physical functional decline in older women with early-stage breast cancer is driven by cancer, chemotherapy, or a combination of both. METHODS We prospectively sampled three groups of women aged ≥ 65: 444 with early-stage breast cancer receiving chemotherapy (BC Chemo), 98 with early-stage breast cancer not receiving chemotherapy (BC Control), and 100 non-cancer controls (NC Control). Physical function was assessed at two timepoints (T1 [baseline] and T2 [3, 4, or 6 months]) using the Physical Functioning Subscale (PF-10) of the RAND 36-item Short Form. The primary endpoint was the change in PF-10 scores from T1 to T2, analyzed continuously and dichotomously (Yes/No, with "yes" indicating a PF-10 decline > 10 points, i.e., a substantial and clinically meaningful difference). RESULTS Baseline PF-10 scores were similar across all groups. The BC Chemo group experienced a significant decline at T2, with a median change in PF-10 of -5 (interquartile range [IQR], -20, 0), while BC Control and NC Control groups showed a median change of 0 (IQR, -5, 5; p < 0.001). Over 30% of BC Chemo participants had a substantial decline in PF-10 vs. 8% in the BC Control and 5% in the NC Control groups (p < 0.001). CONCLUSION In this cohort of older adults with early-stage breast cancer, the combination of breast cancer and chemotherapy contributes to accelerated functional decline. Our findings reinforce the need to develop interventions aimed at preserving physical function, particularly during and after chemotherapy. IMPLICATIONS FOR CANCER SURVIVORS The high prevalence of accelerated functional decline in older women undergoing breast cancer chemotherapy underscores the urgency to develop interventions aimed at preserving physical function and improving health outcomes. CLINICAL TRIAL NCT01472094, Hurria Older PatiEnts (HOPE) with Breast Cancer Study.
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Affiliation(s)
- Mina S Sedrak
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
- Cancer & Aging Program, UCLA Health Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.
- UCLA David Geffen School of Medicine, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.
| | - Can-Lan Sun
- Department of Supportive Care, City of Hope, Duarte, CA, USA
- Center for Cancer and Aging, City of Hope, Duarte, CA, USA
| | - Marie Bae
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Tracey O'Connor
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Beverly Moy
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Tanya M Wildes
- Department of Medicine, Medical Center/Nebraska Medicine, University of Nebraska, Omaha, NE, USA
| | - Heidi D Klepin
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andrew E Chapman
- Department of Medical Oncology, Sidney Kimmel Cancer Center/Jefferson Health, Philadelphia, PA, USA
| | - William P Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Efrat Dotan
- Department of Hematology-Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Heeyoung Kim
- Department of Supportive Care, City of Hope, Duarte, CA, USA
- Center for Cancer and Aging, City of Hope, Duarte, CA, USA
| | - Vani Katheria
- Department of Supportive Care, City of Hope, Duarte, CA, USA
- Center for Cancer and Aging, City of Hope, Duarte, CA, USA
| | - Hyman B Muss
- Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Harvey J Cohen
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Cary P Gross
- Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - Jingran Ji
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA, USA
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Rosko AE, Elsaid MI, Woyach J, Islam N, Lepola N, Urrutia J, Christian LM, Presley C, Mims A, Burd CE. Determining the relationship of p16 INK4a and additional molecular markers of aging with clinical frailty in hematologic malignancy. J Cancer Surviv 2024:10.1007/s11764-024-01591-6. [PMID: 38678524 DOI: 10.1007/s11764-024-01591-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Older adults with hematologic malignancies (HM) have unique challenges due to age and fitness. The primary aim of this pilot study was to benchmark the ability of multiple biomarkers of aging (p16, epigenetic clocks, T cell gene expression profiles, and T cell receptor excision circles (TREC) to identify frailty as measured by a clinical impairment index (I2) in patients with HM. METHODS 70 patients newly diagnosed with HM had peripheral blood T lymphocytes (PBTL) analyzed for p16INK4a expression using the OSU_Senescence Nanostring CodeSet. PBTL epigenetic age was measured using 7 epigenetic clocks, and TREC were quantified by qRT-PCR. A composite clinical impairment index (I2) was generated by combining values from 11 geriatric metrics (Independent Activities of Daily Living (iADL), physical health score, Short Physical Performance Battery (SPPB), Body Mass Index (BMI), Eastern Cooperative Oncology Group (ECOG) performance status, self-reported KPS, Blessed Orientation Memory Concentration (BOMC), polypharmacy, Mental Health Inventory (MHI)-17, Medical Outcomes Study (MOS) subscales). Clinical frailty was defined as a score of 7 or greater on the I2. RESULTS Age-adjusted p16INK4a was similar in newly diagnosed patients and healthy controls (p > 0.1). PBTL p16INK4a levels correlated positively with the Hannum [r = 0.35, 95% CI (0.09-0.75); p adj. = 0.04] and PhenoAge [r = 0.37, 95% CI (0.11-0.59); p adj. = 0.04] epigenetic clocks. The discrimination ability of the I2 model was calculated using the area under the receiver operating characteristic curve (AUC). After adjusting for chronologic age and disease group, baseline p16INK4a [AUC = 0.76, 95% CI (0.56-0.98); p = 0.01], Hannum [AUC = 0.70, 95% CI (0.54-0.85); p = 0.01], PhenoAge [AUC = 0.71, 95% CI (0.55-0.86); p = 0.01], and DunedinPACE [AUC = 0.73, 95% CI (0.57-0.88); p = < 0.01] measures showed the greatest potential to identify clinical frailty using the I2. CONCLUSIONS Our pilot data suggest that multiple blood-based aging biomarkers have potential to identify frailty in older adults with HM. IMPLICATIONS FOR CANCER SURVIVORS We developed the I2 index to quantify impairments across geriatric domains and discovered that PBTL p16, Hannum, PhenoAge, and DunedinPACE are promising indicators of frailty in HM.
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Affiliation(s)
- Ashley E Rosko
- Division of Hematology, The Ohio State University, Columbus, OH, USA.
- James Comprehensive Cancer Center, 300 West 10th Ave, Columbus, Ohio, 43210, United States.
| | - Mohamed I Elsaid
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
- Division of Medical Oncology, The Ohio State University, Columbus, OH, USA
| | - Jennifer Woyach
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Nowshin Islam
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Noah Lepola
- Departments of Molecular Genetics, Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
| | - Jazmin Urrutia
- Departments of Molecular Genetics, Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
| | - Lisa M Christian
- Department of Psychiatry and Behavioral Health, Institute for Behavioral Medicine Research, The Ohio State University, Columbus, OH, USA
| | - Carolyn Presley
- Division of Medical Oncology, The Ohio State University, Columbus, OH, USA
| | - Alice Mims
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Christin E Burd
- Departments of Molecular Genetics, Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
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Soto-Perez-de-Celis E, Dale W, Katheria V, Kim H, Fakih M, Chung VM, Lim D, Mortimer J, Cabrera Chien L, Charles K, Roberts E, Vazquez J, Moreno J, Lee T, Fernandes Dos Santos Hughes S, Sedrak MS, Sun CL, Li D. Outcome prioritization and preferences among older adults with cancer starting chemotherapy in a randomized clinical trial. Cancer 2024. [PMID: 38630903 DOI: 10.1002/cncr.35333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Older adults with cancer facing competing treatments must prioritize between various outcomes. This study assessed health outcome prioritization among older adults with cancer starting chemotherapy. METHODS Secondary analysis of a randomized trial addressing vulnerabilities in older adults with cancer. Patients completed three validated outcome prioritization tools: 1) Health Outcomes Tool: prioritizes outcomes (survival, independence, symptoms) using a visual analog scale; 2) Now vs. Later Tool: rates the importance of quality of life at three times-today versus 1 or 5 years in the future; and 3) Attitude Scale: rates agreement with outcome-related statements. The authors measured the proportion of patients prioritizing various outcomes and evaluated their characteristics. RESULTS A total of 219 patients (median [range] age 71 [65-88], 68% with metastatic disease) were included. On the Health Outcomes Tool, 60.7% prioritized survival over other outcomes. Having localized disease was associated with choosing survival as top priority. On the Now vs. Later Tool, 50% gave equal importance to current versus future quality of life. On the Attitude Scale, 53.4% disagreed with the statement "the most important thing to me is living as long as I can, no matter what my quality of life is"; and 82.2% agreed with the statement "it is more important to me to maintain my thinking ability than to live as long as possible". CONCLUSION Although survival was the top priority for most participants, some older individuals with cancer prioritize other outcomes, such as cognition and function. Clinicians should elicit patient-defined priorities and include them in decision-making.
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Affiliation(s)
- Enrique Soto-Perez-de-Celis
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - William Dale
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Vani Katheria
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Heeyoung Kim
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Marwan Fakih
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | - Vincent M Chung
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | - Dean Lim
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | - Joanne Mortimer
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | | | | | - Elsa Roberts
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Jessica Vazquez
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Jeanine Moreno
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Ty Lee
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | | | - Mina S Sedrak
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Can-Lan Sun
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Daneng Li
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
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Matsunuma S, Koshiishi T, Sunaga S, Otsuka K, Okumura E, Yoshimoto K, Jimbo H. Evaluation of high-dose methotrexate completion for primary central nervous system lymphoma using modified Geriatric 8 for functional assessment: A retrospective descriptive study. J Geriatr Oncol 2024; 15:101704. [PMID: 38245426 DOI: 10.1016/j.jgo.2024.101704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 11/21/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024]
Affiliation(s)
- Satoru Matsunuma
- Department of Pharmacy, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0988, Japan.
| | - Toru Koshiishi
- Department of Pharmacy, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0988, Japan.
| | - Shigeki Sunaga
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0988, Japan.
| | - Kunitoshi Otsuka
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0988, Japan.
| | - Eitaro Okumura
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0988, Japan.
| | - Koichi Yoshimoto
- Department of Pharmacy, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0988, Japan.
| | - Hiroyuki Jimbo
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0988, Japan.
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Stueger A, Joerger M, De Nys K. Geriatric evaluation methods in oncology and their use in clinical studies: A systematic literature review. J Geriatr Oncol 2024; 15:101684. [PMID: 38072709 DOI: 10.1016/j.jgo.2023.101684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/04/2023] [Accepted: 12/01/2023] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Therapeutic options in oncology keep on expanding. Nonetheless, older adults are underrepresented in clinical trials and those enrolled often have a better health status than their average peers, resulting in a lack of representative evidence for this heterogenous population. The inclusion of older patients and a uniform categorization of "frailty" is becoming increasingly urgent. Standardized tools could contribute to the quality and comparability of clinical trials and facilitate clinical decisions. The aim of this literature review was to elaborate an overview of the use of geriatric evaluation (GE) methods in clinical cancer research. MATERIALS AND METHODS We performed a literature review of the PubMed database. Clinical pharmacotherapy studies that applied or evaluated a clearly defined system for the GE of oncological patients were included. Data retrieved encompassed the applied GE method(s), cancer type(s), and pharmacotherapy investigated, the number of included patients, study type, year of publication, as well as the primary purpose of the GE. The GEs used most frequently were depicted in more depth. RESULTS In this literature review, 103 publications were selected for inclusion. The biggest proportion of studies (36%, n = 34) used clearly defined, but not previously validated, GE methods (study-specific GE). Standardized GE methods encountered in at least five publications were the G8 screening test (applied in 18% of included studies, n = 17), the Balducci score (7%, n = 7), and a geriatric assessment based on Hurria (5%, n = 5). The primary purpose of GE was predominantly an appraisal of its potential role in pharmacotherapy optimization. The GE also served as baseline and outcome measure, inclusion/exclusion criterion, factor for stratified randomization, and to determine treatment allocation. DISCUSSION The wide range of GE methods used across studies make direct comparisons difficult, and many methods are poorly characterized and/or not previously validated. The further inclusion of representative older patients in clinical trials combined with the use of a standardized GE could help clinicians in the decision-making process.
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Affiliation(s)
- Amelie Stueger
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland.
| | - Markus Joerger
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland; Department of Oncology and Hematology, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9000 St. Gallen, Switzerland.
| | - Katelijne De Nys
- Palliativzentrum, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9000 St. Gallen, Switzerland; KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, ON2 Herestraat 49 - box 424, BE-3000 Leuven, Belgium.
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Fowler ME, Harmon C, Sharafeldin N, Baker E, Oates G, Nassel A, Clausing D, Giri S, Williams GR. The association between food access and frailty among older adults with gastrointestinal malignancies-The CARE Registry. Cancer 2024; 130:1083-1091. [PMID: 38059840 PMCID: PMC10939932 DOI: 10.1002/cncr.35144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/04/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Food access is associated with higher gastrointestinal (GI) cancer mortality; however, its association with frailty, which is a predictor of premature mortality among older adults with cancer, is less understood. METHODS The authors included 880 adults aged 60 years and older who were recently diagnosed with GI cancers and were undergoing self-reported geriatric assessment at their first prechemotherapy visit to the University of Alabama at Birmingham oncology clinic. Food access was measured using the 2019 US Department of Agriculture Economic Research Service designation low-income, low-access (LILA), classifying census tracts based on income and/or access to food stores at various distances. The primary outcome was frailty on the CARE (Cancer and Aging Resilience Evaluation) Frailty Index, a composite of the proportion of impaired geriatric assessment measures. The authors examined the LILA-frailty association with modified Poisson regression accounting for census-tract clustering. RESULTS The median patient age was 69 years, 58.1% were men, 22.5% were non-Hispanic Black, 29.2% had colorectal cancer, 28.0% had pancreatic cancer, 70.1% presented with stage III/IV disease, and 34.9% were frail. A higher proportion in LILA areas were non-Hispanic Black (44.1% vs. 10.8%; p < .001) and had less education (high school or less: 48.1% vs. 37.9%; p = .020). Adjusting for age, race and ethnicity, sex, cancer type and stage, and education, an LILA designation was associated with 58% greater odds of worsening frailty status (95% confidence interval, 1.18-2.12). An analysis of LILA subcategories revealed that associations were maintained across all LILA measures. CONCLUSIONS Poor food access was associated with a greater risk of frailty among newly diagnosed older adults with GI cancers before they received systemic treatment. Intervening on local food access, particularly in LILA areas, may be a target for improving rates of frailty and promoting health equity in this population.
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Affiliation(s)
- Mackenzie E. Fowler
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christian Harmon
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Noha Sharafeldin
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Baker
- Department of Sociology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabriela Oates
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ariann Nassel
- Lister Hill Center for Health Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel Clausing
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smith Giri
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grant R. Williams
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- DCH Health System, Tuscaloosa, AL, USA
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9
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Fowler ME, Murdaugh D, Harmon C, Al-Obaidi M, Sharafeldin N, Bhatia S, Giri S, Williams GR. Longitudinal changes in patient-reported cognitive complaints among older adults with gastrointestinal malignancies - results from the Cancer and Aging Resilience Evaluation (CARE) Registry. J Cancer Surviv 2024; 18:521-530. [PMID: 36114326 PMCID: PMC10020125 DOI: 10.1007/s11764-022-01254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Longitudinal change in patient-reported cognitive complaints (CC) in older adults with cancer is poorly understood. The purpose of this study was to evaluate early longitudinal CC and predictors among older adults with cancer. METHODS We examined early CC change on the PROMIS® Short Form4a Cognitive Function among adults ≥ 60 years with GI cancer enrolled in the Cancer and Aging Resilience Evaluation (CARE) undergoing geriatric assessment (GA) at baseline and one 3-6-month follow-up. Multivariable linear regression examined associations of demographics, socioeconomics, GA domains, baseline cognitive score, and treatment toxicities on follow-up cognitive score. Bayesian analysis of covariance (ANCOVA) determined best fitting model. RESULTS A total of 218 participants were included. The median follow-up was 3.7 months, the mean age was 69.2 ± 7.1, and 57.3% were male. The most common cancer was colorectal (30.7%) with most stage III/IV (73.7%). About half (51.8%) had stable cognition baseline to follow-up (follow-up t-score ± 5 points of baseline), 20.6% improved (≥ 5 increase), and 27.5% declined (≥ 5 decrease). After adjustment, there were no significant baseline predictors of follow-up cognitive t-score. Baseline t-score was the best-fitting predictor of follow-up t-score. CONCLUSIONS In this first study, examining early change in CC among older adults with cancer, ~ 28% exhibited cognitive decline. Baseline cognition is the most important early predictor of follow-up cognition. Longer follow-up is needed to identify long-term predictors of CC change in cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Cognitive decline, even early, may occur in many older adults with cancer. Baseline and regular follow-up assessments of cognitive symptoms are an important component of survivorship care.
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Affiliation(s)
- Mackenzie E Fowler
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Donna Murdaugh
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christian Harmon
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Noha Sharafeldin
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pediatrics, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smith Giri
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grant R Williams
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
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10
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Ji J, Bae M, Sun CL, Wildes TM, Freedman RA, Magnuson A, O’Connor T, Moy B, Klepin HD, Chapman AE, Tew WP, Dotan E, Fenton MA, Kim H, Katheria V, Gross CP, Cohen HJ, Muss HB, Sedrak MS. Falls prechemotherapy and toxicity-related hospitalization during adjuvant chemotherapy for breast cancer in older women: Results from the prospective multicenter HOPE trial. Cancer 2024; 130:936-946. [PMID: 37962093 PMCID: PMC10922500 DOI: 10.1002/cncr.35105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Older women with breast cancer frequently experience toxicity-related hospitalizations during adjuvant chemotherapy. Although the geriatric assessment can identify those at risk, its use in clinic remains limited. One simple, low-cost marker of vulnerability in older persons is fall history. Here, the authors examined whether falls prechemotherapy can identify older women at risk for toxicity-related hospitalization during adjuvant chemotherapy for breast cancer. METHODS In a prospective study of women >65 years old with stage I-III breast cancer treated with adjuvant chemotherapy, the authors assessed baseline falls in the past 6 months as a categorical variable: no fall, one fall, and more than one fall. The primary end point was incident hospitalization during chemotherapy attributable to toxicity. Multivariable logistic regression was used to examine the association between falls and toxicity-related hospitalization, adjusting for sociodemographic, disease, and geriatric covariates. RESULTS Of the 497 participants, 60 (12.1%) reported falling before chemotherapy, and 114 (22.9%) had one or more toxicity-related hospitalizations. After adjusting for sociodemographic, disease, and geriatric characteristics, women who fell more than once within 6 months before chemotherapy had greater odds of being hospitalized from toxicity during chemotherapy compared to women who did not fall (50.0% vs. 20.8% experienced toxicity-related hospitalization, odds ratio, 4.38; 95% confidence interval, 1.66-11.54, p = .003). CONCLUSIONS In this cohort of older women with early breast cancer, women who experienced more than one fall before chemotherapy had an over 4-fold increased risk of toxicity-related hospitalization during chemotherapy, independent of sociodemographic, disease, and geriatric factors.
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Affiliation(s)
- Jingran Ji
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Marie Bae
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Can-Lan Sun
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Tanya M. Wildes
- Division of Hematology/ Oncology, University of Nebraska Medical Center/Nebraska Medicine, Omaha, NE
| | - Rachel A. Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Tracey O’Connor
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Beverly Moy
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Heidi D. Klepin
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Andrew E. Chapman
- Department of Medical Oncology, Sidney Kimmel Cancer Center/Jefferson Health, PA
| | - William P. Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Efrat Dotan
- Department of Hematology Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - Heeyoung Kim
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Vani Katheria
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Cary P. Gross
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Harvey J. Cohen
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Hyman B. Muss
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Mina S. Sedrak
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
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11
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Jensen CE, Deal AM, Nyrop KA, Logan M, Mangieri NJ, Strayhorn MD, Miller J, Muss HB, Lichtman EI, Rubinstein SM, Tuchman SA. Geriatric assessment-guided interventions for older adults with multiple myeloma: A feasibility and acceptability study. J Geriatr Oncol 2024; 15:101680. [PMID: 38104482 PMCID: PMC10922464 DOI: 10.1016/j.jgo.2023.101680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/11/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Geriatric assessment (GA)-guided supportive care programs have been successful in improving treatment outcomes for older adults with solid-organ cancers. This study aimed to evaluate the feasibility of a GA-guided supportive care program among older adults treated for multiple myeloma (MM). MATERIALS AND METHODS The study utilized an existing registry of adults with plasma cell disorders at the University of North Carolina. Patients with MM, aged 60 or older, and having a GA-identified deficit in one or more problem area were offered referrals to supportive care resources during routine visits. Problem areas included physical function deficits, polypharmacy, and anxiety or depression. Patients with physical function deficits were offered referral to physical therapy (PT), those with polypharmacy to an Oncology Clinical Pharmacist Practitioner (CPP), and those with mental health symptoms to the Comprehensive Cancer Support Program (CCSP). RESULTS Of the 58 individuals identified as having at least one deficit on the GA, PT was the most commonly identified relevant resource (79%), followed by CPP visits (57%). Among individuals that were offered referral(s) to at least one new supportive care resource, the acceptance rate was 50%. Referral acceptance rates were highest among those recommended for a CPP visit (55% of those approached) and lowest for CCSP (0%). DISCUSSION The study examined the feasibility and acceptability of a referral program for supportive care resources among older adults with MM who have deficits on GA. The most commonly identified deficit was physical functioning, followed by polypharmacy and mental health. The study found that physical interventions and referrals to CPPs were the most accepted interventions. However, the low proportion of patients who accepted physical therapy referrals indicates the need for tailored and more personalized approaches. Further research is needed to explore the feasibility and impact of supportive care referral programs for older adults with MM.
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Affiliation(s)
- Christopher E Jensen
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Physicians Office Building, CB# 7305, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Kirsten A Nyrop
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA; Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Physicians Office Building, CB# 7305, Chapel Hill, NC 27599, USA.
| | - Maya Logan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Nicholas J Mangieri
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Martha D Strayhorn
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Jordan Miller
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA; Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Physicians Office Building, CB# 7305, Chapel Hill, NC 27599, USA.
| | - Eben I Lichtman
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Physicians Office Building, CB# 7305, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Samuel M Rubinstein
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Physicians Office Building, CB# 7305, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Sascha A Tuchman
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Physicians Office Building, CB# 7305, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
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12
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Piercey O, Wong HL, Leung C, To YH, Heong V, Lee M, Tie J, Steel M, Yeung JM, McCormick J, Gibbs P, Wong R. Adjuvant Chemotherapy for Older Patients With Stage III Colorectal Cancer: A Real-World Analysis of Treatment Recommendations, Treatment Administered and Impact on Cancer Recurrence. Clin Colorectal Cancer 2024; 23:95-103.e3. [PMID: 38242766 DOI: 10.1016/j.clcc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/23/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND A substantial proportion of patients with stage III colorectal cancer (CRC) are older than 70 years. Optimal adjuvant chemotherapy (AC) for older patients (OP) continues to be debated, with subgroup analyses of randomized trials not demonstrating a survival benefit from the addition of oxaliplatin to a fluoropyrimidine backbone. PATIENTS AND METHODS We analyzed the multisite Australian ACCORD registry, which prospectively collects patient, tumor and treatment data along with long term clinical follow-up. We compared OP (≥70) with stage III CRC to younger patients ([YP] <70), including the proportion recommended AC and any reasons for not prescribing AC. AC administration, regimen choice, completion rates, and survival outcomes were also examined. RESULTS One thousand five hundred twelve patients enrolled in the ACCORD registry from 2005 to 2018 were included. Median follow-up was 57.0 months. Compared to the 827 YP, the 685 OP were less likely to be offered AC (71.5% vs. 96.5%, P < .0001) and when offered, were more likely to decline treatment (15.1% vs. 2.8%, P < .0001). Ultimately, 60.0% of OP and 93.7% of YP received AC (P < .0001). OP were less likely to receive oxaliplatin (27.5% vs. 84.7%, P < .0001) and to complete AC (75.9% vs. 85.7%, P < .0001). The probability of remaining recurrence-free was significantly higher in OP who received AC compared to those not treated (HR 0.73, P = .04) but not significantly improved with the addition of oxaliplatin (HR 0.75, P = .18). CONCLUSION OP were less likely than YP to receive AC. Receipt of AC reduced recurrences in OP, supporting its use, although no significant benefit was observed from the addition of oxaliplatin.
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Affiliation(s)
- Oliver Piercey
- Peter MacCallum Cancer Centre, Melbourne, Australia; The University of Melbourne, Parkville, Australia.
| | - Hui-Li Wong
- Peter MacCallum Cancer Centre, Melbourne, Australia; The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Clara Leung
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Yat Hang To
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Valerie Heong
- The University of Melbourne, Parkville, Australia; The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Margaret Lee
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Eastern Health, Box Hill, Australia; Western Health, St Albans, Australia; Monash University, Eastern Health Clinical School, Box Hill, Australia
| | - Jeanne Tie
- Peter MacCallum Cancer Centre, Melbourne, Australia; The University of Melbourne, Parkville, Australia; The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | | | - Justin M Yeung
- The University of Melbourne, Parkville, Australia; Western Health, St Albans, Australia
| | - Jacob McCormick
- Peter MacCallum Cancer Centre, Melbourne, Australia; Melbourne Health, Parkville, Australia
| | - Peter Gibbs
- The University of Melbourne, Parkville, Australia; The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Western Health, St Albans, Australia
| | - Rachel Wong
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Eastern Health, Box Hill, Australia; Monash University, Eastern Health Clinical School, Box Hill, Australia
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13
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Garg T, Frank K, Johns A, Rabinowitz K, Danella JF, Kirchner HL, Nielsen ME, McMullen CK, Murphy TE, Cohen HJ. Geriatric assessment-derived deficit accumulation and patient-reported treatment burden in older adults with bladder cancer. J Am Geriatr Soc 2024; 72:490-502. [PMID: 37974546 PMCID: PMC10922080 DOI: 10.1111/jgs.18676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/02/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND When a person's workload of healthcare exceeds their resources, they experience treatment burden. At the intersection of cancer and aging, little is known about treatment burden. We evaluated the association between a geriatric assessment-derived Deficit Accumulation Index (DAI) and patient-reported treatment burden in older adults with early-stage, non-muscle-invasive bladder cancer (NMIBC). METHODS We conducted a cross-sectional survey of older adults with NMIBC (≥65 years). We calculated DAI using the Cancer and Aging Research Group's geriatric assessment and measured urinary symptoms using the Urogenital Distress Inventory-6 (UDI-6). The primary outcome was Treatment Burden Questionnaire (TBQ) score. A negative binomial regression with LASSO penalty was used to model TBQ. We further conducted qualitative thematic content analysis of responses to an open-ended survey question ("What has been your Greatest Challenge in managing medical care for your bladder cancer") and created a joint display with illustrative quotes by DAI category. RESULTS Among 119 patients, mean age was 78.9 years (SD 7) of whom 56.3% were robust, 30.3% pre-frail, and 13.4% frail. In the multivariable model, DAI and UDI-6 were significantly associated with TBQ. Individuals with DAI above the median (>0.18) had TBQ scores 1.94 times greater than those below (adjusted IRR 1.94, 95% CI 1.33-2.82). Individuals with UDI-6 greater than the median (25) had TBQ scores 1.7 times greater than those below (adjusted IRR 1.70, 95% CI 1.16-2.49). The top 5 themes in the Greatest Challenge question responses were cancer treatments (22.2%), cancer worry (19.2%), urination bother (18.2%), self-management (18.2%), and appointment time (11.1%). CONCLUSIONS DAI and worsening urinary symptoms were associated with higher treatment burden in older adults with NMIBC. These data highlight the need for a holistic approach that reconciles the burden from aging-related conditions with that resulting from cancer treatment.
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Affiliation(s)
- Tullika Garg
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Katie Frank
- Biostatistics Core, Geisinger, Danville, PA
- Department of Population Health Sciences, Geisinger, Danville, PA
| | - Alicia Johns
- Biostatistics Core, Geisinger, Danville, PA
- Department of Population Health Sciences, Geisinger, Danville, PA
| | | | | | | | - Matthew E. Nielsen
- Department of Urology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
- Departments of Epidemiology and Health Policy & Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC
| | | | - Terrence E. Murphy
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Harvey J. Cohen
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
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14
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Galvin A, Soubeyran P, Brain E, Cheung KL, Hamaker ME, Kanesvaran R, Mauer M, Mohile S, Montroni I, Puts M, Rostoft S, Wildiers H, Mathoulin-Pélissier S, Bellera C. Assessing patient-reported outcomes (PROs) and patient-related outcomes in randomized cancer clinical trials for older adults: Results of DATECAN-ELDERLY initiative. J Geriatr Oncol 2024; 15:101611. [PMID: 37679204 DOI: 10.1016/j.jgo.2023.101611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/01/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
As older adults with cancer are underrepresented in randomized clinical trials (RCT), there is limited evidence on which to rely for treatment decisions for this population. Commonly used RCT endpoints for the assessment of treatment efficacy are more often tumor-centered (e.g., progression-free survival). These endpoints may not be as relevant for the older patients who present more often with comorbidities, non-cancer-related deaths, and treatment toxicity. Moreover, their expectation and preferences are likely to differ from younger adults. The DATECAN-ELDERLY initiative combines a broad expertise, in geriatric oncology and clinical research, with interest in cancer RCT that include older patients with cancer. In order to guide researchers and clinicians coordinating cancer RCT involving older patients with cancer, the experts reviewed the literature on relevant domains to assess using patient-reported outcomes (PRO) and patient-related outcomes, as well as available tools related to these domains. Domains considered relevant by the panel of experts when assessing treatment efficacy in RCT for older patients with cancer included functional autonomy, cognition, depression and nutrition. These were based on published guidelines from international societies and from regulatory authorities as well as minimum datasets recommended to collect in RCT including older adults with cancer. In addition, health-related quality of life, patients' symptoms, and satisfaction were also considered by the panel. With regards to tools for the assessment of these domains, we highlighted that each tool has its own strengths and limitations, and very few had been validated in older adults with cancer. Further studies are thus needed to validate these tools in this specific population and define the minimum clinically important difference to use when developing RCTs in this population. The selection of the most relevant tool should thus be guided by the RCT research question, together with the specific properties of the tool.
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Affiliation(s)
- Angéline Galvin
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France
| | - Pierre Soubeyran
- Univ. Bordeaux, Inserm, UMR 1312, SIRIC BRIO, France; Department of medical oncology, Bergonie Institute, Comprehensive Cancer Center, Bordeaux, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie/Saint-Cloud, Saint-Cloud, France
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht/ Zeist/Doorn, Zeist, the Netherlands
| | | | - Murielle Mauer
- Statistics Department, European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Supriya Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Isacco Montroni
- Division of Colorectal Surgery, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven Cancer Institute, Belgium
| | - Simone Mathoulin-Pélissier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France; INSERM CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - Carine Bellera
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France; INSERM CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, F-33000 Bordeaux, France.
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15
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Patel I, Winer A. Assessing Frailty in Gastrointestinal Cancer: Two Diseases in One? Curr Oncol Rep 2024; 26:90-102. [PMID: 38180691 DOI: 10.1007/s11912-023-01483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/06/2024]
Abstract
PURPOSEOF REVIEW This review examines the challenges of treating gastrointestinal cancer in the aging population, focusing on the importance of frailty assessment. Emphasized are the rise in gastrointestinal cancer incidence in older adults, advances in frailty assessments for patients with gastrointestinal cancer, the development of novel frailty markers, and a summary of recent trials. RECENT FINDINGS Increasing evidence suggests that the use of a Comprehensive Geriatric Assessment (CGA) to identify frail older adults and individualize cancer care leads to lower toxicity and improved quality of life outcomes. However, the adoption of a full CGA prior to chemotherapy initiation in older cancer patients remains low. Recently, new frailty screening tools have emerged, including assessments designed to specifically predict chemotherapy-related adverse events. Additionally, frailty biomarkers have been developed, such as blood tests like IL-6 and performance tracking through physical activity monitors. The relevance of nutrition and muscle mass is discussed. Highlights from recent trials suggest the feasibility of successfully identifying patients most at risk of serious adverse events. There have been promising developments in identifying novel frailty markers and methods to screen for frailty in the older adult population. Further prospective trials that focus on and address the needs of the geriatric population for early identification of frailty in cancer care, facilitating a more tailored treatment approach. Practicing oncologists should select a frailty assessment to implement into their routine practice and adjust treatment accordingly.
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Affiliation(s)
- Ishan Patel
- Inova Schar Cancer Institute, 8081 Innovation Park Drive, Falls Church, Falls Church, VA, 22031, USA.
| | - Arthur Winer
- Inova Schar Cancer Institute, 8081 Innovation Park Drive, Falls Church, Falls Church, VA, 22031, USA
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16
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Hess DL, Fowler ME, Harmon C, Giri S, Williams GR. Anxiety is Associated With Geriatric Assessment Impairments and Reduced Quality of Life Among Older Adults With Colorectal Cancer: Results From the CARE Registry. Clin Colorectal Cancer 2023; 22:383-389. [PMID: 37743126 PMCID: PMC10956033 DOI: 10.1016/j.clcc.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/13/2023] [Accepted: 08/02/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) preferentially affects older adults. Modifiable factors, such as anxiety, can be measured as part of cancer-specific geriatric assessments (GA) completed prior to the start of treatment. We hypothesized that anxiety is prevalent among older adults with CRC and is associated with increased depression, increased frailty, and impaired health-related quality of life (HRQOL). PATIENTS AND METHODS Patients ≥60 years old with newly diagnosed CRC completed a cancer-specific GA called the Cancer and Aging Resilience Evaluation (CARE). Between September 2017 and February 2023, we analyzed patients with CRC who had not yet received any systemic treatment. Anxiety was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety 4-item short form and reported as t-scores. We used modified Poisson models with robust variance estimation to assess for differences in the prevalence of depression, frailty, and impaired HRQOL. RESULTS We analyzed 277 older adults with CRC. The median age of the study sample was 68 years. 57% were male, 72% were non-Hispanic White, and most had advanced CRC (35% stage III and 39% stage IV). Moderate/severe anxiety was present in 17% of older adults with newly diagnosed CRC. In adjusted models, as compared to patients without moderate/severe anxiety, patients with moderate/severe anxiety had significantly increased risk of depression (prevalence ratio [PR] 7.60, CI 4.90-11.78), frailty (PR 4.93, CI 3.01-8.07), impaired physical HRQOL (PR 3.57, CI 2.03-6.28), and impaired mental HRQOL (PR 3.82, CI 2.12-6.89). CONCLUSION Among older adults with CRC, anxiety is associated with increased depression and frailty as well as reduced HRQOL.
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Affiliation(s)
- Daniel L Hess
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mackenzie E Fowler
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Christian Harmon
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Smith Giri
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL; Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Grant R Williams
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL; Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
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Ozluk AA, Outlaw D, Akce M, Fowler ME, Hess DL, Giri S, Williams GR. Management of Older Adults With Colorectal Cancer: The Role of Geriatric Assessment. Clin Colorectal Cancer 2023; 22:390-401. [PMID: 37949790 PMCID: PMC11065137 DOI: 10.1016/j.clcc.2023.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/17/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
Older adults share a growing burden of cancer morbidity and mortality. This is present across the spectrum of oncologic diagnoses and is particularly true with colorectal cancer (CRC), where older adults continue to share the burden of diagnoses. However, optimal cancer treatment decision making in older adults remains a significant challenge, as the majority of previous clinical trials shaping the current treatment landscape have focused on younger patients, often with more robust performance status and fewer medical comorbid conditions. The heterogeneous aging process of older adults with CRC necessitates a personalized treatment approach, as approximately three-quarters of older adults with CRC also have a concominant geriatric syndrome and more than half of older adults with CRC are pre-frail or frail. Treatment decisions shoud be multifaceted, including consultation with the patient and their familes regarding their wishes, with consideration of the patient's quality of life, functional status, medical comorbid conditions, social support, and treatment toxicity risk. Geriatric assessment is a systematic and validated approach to assess an older adults's potential strengths and vulnerabilities, which can in turn be used to assist with comprehensive cancer care planning and support. In this review, we will summarize current treatment approaches for older adults with CRC, with a particular focus on the incorporation of the geriatric assessment.
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Affiliation(s)
- Ahmet Anil Ozluk
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Darryl Outlaw
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mehmet Akce
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mackenzie E Fowler
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Daniel L Hess
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Smith Giri
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
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Nakamura ZM, Small BJ, Zhai W, Ahles TA, Ahn J, Artese AL, Bethea TN, Breen EC, Cohen HJ, Extermann M, Graham D, Irwin MR, Isaacs C, Jim HSL, Kuhlman KR, McDonald BC, Patel SK, Rentscher KE, Root JC, Saykin AJ, Tometich DB, Van Dyk K, Zhou X, Mandelblatt JS, Carroll JE. Depressive symptom trajectories in older breast cancer survivors: the Thinking and Living with Cancer Study. J Cancer Surviv 2023:10.1007/s11764-023-01490-2. [PMID: 37924476 PMCID: PMC11068856 DOI: 10.1007/s11764-023-01490-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE To identify trajectories of depressive symptoms in older breast cancer survivors and demographic, psychosocial, physical health, and cancer-related predictors of these trajectories. METHODS Recently diagnosed nonmetastatic breast cancer survivors (n = 272), ages 60-98 years, were evaluated for depressive symptoms (Center for Epidemiological Studies Depression Scale, CES-D; scores ≥16 suggestive of clinically significant depressive symptoms). CES-D scores were analyzed in growth-mixture models to determine depression trajectories from baseline (post-surgery, pre-systemic therapy) through 3-year annual follow-up. Multivariable, multinomial logistic regression was used to identify baseline predictors of depression trajectories. RESULTS Survivors had three distinct trajectories: stable (84.6%), emerging depressive symptoms (10.3%), and recovery from high depressive symptoms at baseline that improved slowly over time (5.1%). Compared to stable survivors, those in the emerging (OR = 1.16; 95% CI = 1.08-1.23) or recovery (OR = 1.26; 95% CI = 1.15-1.38) groups reported greater baseline anxiety. Greater baseline deficit accumulation (frailty composite measure) was associated with emerging depressive symptoms (OR = 3.71; 95% CI = 1.90-7.26). Less social support at baseline (OR = 0.38; 95% CI = 0.15-0.99), but greater improvement in emotional (F = 4.13; p = 0.0006) and tangible (F = 2.86; p = 0.01) social support over time, was associated with recovery from depressive symptoms. CONCLUSIONS Fifteen percent of older breast cancer survivors experienced emerging or recovery depressive symptom trajectories. Baseline anxiety, deficit accumulation, and lower social support were associated with worse outcomes. IMPLICATIONS FOR CANCER SURVIVORS Our results emphasize the importance of depression screening throughout the course of cancer care to facilitate early intervention. Factors associated with depressive symptoms, including lower levels of social support proximal to diagnosis, could serve as intervention levers.
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Affiliation(s)
- Zev M Nakamura
- Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, Campus Box #7160, Chapel Hill, NC, 27599, USA.
| | - Brent J Small
- School of Aging Studies, University of South Florida, and Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Ashley L Artese
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Traci N Bethea
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Elizabeth C Breen
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Martine Extermann
- Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Deena Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Michael R Irwin
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Claudine Isaacs
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kate R Kuhlman
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychological Science, University of California, Irvine, CA, USA
- Institute for Interdisciplinary Salivary Bioscience Research, School of Social Ecology, University of California, Irvine, CA, USA
| | - Brenna C McDonald
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sunita K Patel
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Kelly E Rentscher
- Department of Psychiatry and Behavioral Medicine, MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Danielle B Tometich
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Jeanne S Mandelblatt
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Judith E Carroll
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
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Jamy OH, Kasner M, Wall S, Ingram S, Dent D'A, Dudley WN, Dudley L, Scott JM, Wujcik D. Integrating electronic geriatric assessment and frailty screening for adults with acute myeloid leukemia to drive personalized treatment decisions. Leuk Res 2023; 134:107393. [PMID: 37801913 DOI: 10.1016/j.leukres.2023.107393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/10/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Abstract
PURPOSE Evidenced based guidelines for patients with Acute Myeloid Leukemia (AML) acknowledge increasing importance of frailty assessment when deciding on treatment, yet comprehensive geriatric assessment (GA) results are not easily incorporated into clinic workflows and the electronic health record. This study assessed the feasibility of electronic GA use in a real-world environment. METHODS Patients with AML, ≥ 60 years and at a treatment decision-making point were recruited at three academic institutions. An electronic GA (eGA) was completed by patients prior to starting treatment. Results were immediately available on a dashboard. Data on feasibility, useability and acceptability of the intervention were collected immediately after the clinical visit. Patients completed follow up surveys at 3 months and chart reviews were done to capture treatment and toxicities. RESULTS 77 patients were enrolled with a median age of 71 years (range=61-88). The eGA results were 25 fit (31.0 %), 22 (32.0 %) intermediate, and 23 (31.0 %) frail. There was 62.7 % (n = 47) provider concordance with the eGA result and 27 (36.0 %) post visit reports indicated that the eGA results influenced the treatment decision. On average, patients completed the surveys unassisted in 16.24 min and providers reviewed the dashboard in 3.5 min. CONCLUSION Patients easily completed an eGA prior to starting treatment. Results were reviewed by the physician and considered in the decision for optimal treatment. One third of physician reports indicated the results were used to inform the treatment decision. Feasibility of completing the eGA in the clinic without workflow disruption and utility of the results was demonstrated.
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Affiliation(s)
- Omer Hassan Jamy
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Margaret Kasner
- Chief Leukemia Section, Division of Hematologic Malignancies and HSCT, Thomas Jefferson University, Philadelphia, PA, United States
| | - Sarah Wall
- Division of Hematology, Ohio State University, Columbus, OH, United States
| | - Stacey Ingram
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - D 'Ambra Dent
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - William N Dudley
- Piedmont Research Strategies, Inc, Greensboro, NC, United States
| | - Leah Dudley
- Piedmont Research Strategies, Inc, Greensboro, NC, United States
| | - Julie M Scott
- Director of Clinical Operations, Carevive Systems, Inc, Miami, FL, United States
| | - Debra Wujcik
- Director of Research, Carevive Systems, Inc, Miami, FL, United States.
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20
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Huang LW, Shi Y, Andreadis C, Logan AC, Mannis GN, Smith CC, Gaensler KML, Martin TG, Damon LE, Boscardin WJ, Steinman MA, Olin RL. Association of geriatric measures and global frailty with cognitive decline after allogeneic hematopoietic cell transplantation in older adults. J Geriatr Oncol 2023; 14:101623. [PMID: 37678052 PMCID: PMC11101048 DOI: 10.1016/j.jgo.2023.101623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 04/18/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Allogeneic hematopoietic cell transplantation (alloHCT) is increasingly offered to older adults, and its potential impact on cognition in this population is understudied. This work aims to evaluate the ability of cancer-specific geriatric assessments (cGA) and a global frailty index based on accumulation of deficits identified in the cGA to predict the risk of cognitive decline after alloHCT in older adults. MATERIALS AND METHODS AlloHCT recipients aged 50 years or older completed a cGA, including a cognitive evaluation by the Blessed Orientation Memory Concentration (BOMC) test, at baseline prior to alloHCT and then at 3, 6, and 12 months after transplant. Baseline frailty was assessed using a deficit accumulation frailty index (DAFI) calculated from the cGA. A multinomial logit model was used to examine the association between predictors (individual cGA measures, DAFI) and the following three outcomes: alive with stable or improved cognition, alive with cognitive decline, and deceased. In post-hoc analyses, analysis of variance was used to compare BOMC scores at baseline, 3, 6, and 12 months across frailty categories. RESULTS In total, 148 participants were included, with a median age of 62 (range 50-76). At baseline, 12% had cognitive impairment; at one year, 29% of survivors had improved BOMC scores, 33% had stable BOMC, and 37% had worse BOMC. Prior to transplant, 25% were pre-frail and 11% were frail. Individual baseline cGA measures were not associated with cognitive change at one year as assessed by BOMC. Adjusting for age, sex, and education, those who were frail at baseline were 7.4 times as likely to develop cognitive decline at one year than those who were non-frail, although this finding did not reach statistical significance (95% confidence interval [CI] 0.74-73.8, p = 0.09). The probability of being alive with stable/improved cognition at 12 months for the non-frail, pre-frail, and frail groups was 43%, 34%, and 8%, respectively. DISCUSSION Baseline geriatric measures and frailty were not significantly associated with cognitive change as assessed by BOMC in adults aged 50 or older after alloHCT. However, the study was underpowered to detect clinically meaningful differences, and future work to elucidate potential associations between frailty and cognitive outcomes is warranted.
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Affiliation(s)
- Li-Wen Huang
- San Francisco VA Health Care System, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
| | - Ying Shi
- San Francisco VA Health Care System, San Francisco, CA, USA; Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
| | - Charalambos Andreadis
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Aaron C Logan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Gabriel N Mannis
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Catherine C Smith
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Karin M L Gaensler
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Thomas G Martin
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Lloyd E Damon
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - W John Boscardin
- San Francisco VA Health Care System, San Francisco, CA, USA; Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Michael A Steinman
- San Francisco VA Health Care System, San Francisco, CA, USA; Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca L Olin
- San Francisco VA Health Care System, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
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21
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Harmon C, Fowler M, Giri S, Tucker A, Al-Obaidi M, Rocque G, Zubkoff L, Rogers LQ, Wildes TM, Pergolotti M, Outlaw D, Shelby E, El-Rayes B, Akce M, Bhatia S, Williams GR. Implementation of the Web-Enabled Cancer & Aging Resilience Evaluation (WeCARE) in an outpatient oncology setting. J Geriatr Oncol 2023; 14:101644. [PMID: 37806291 PMCID: PMC10895518 DOI: 10.1016/j.jgo.2023.101644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Although geriatric assessments (GAs) are recommended for use in older adults with cancer, their integration into oncology practice remain suboptimal. Here, we report our experience integrating web-enabled GA (WeCARE) into oncology practice as an augmented delivery method and provider interface format to overcome implementation barriers. MATERIALS AND METHODS Older patients (≥60 years) with a gastro-intestinal (GI) malignancy presenting for an initial visit to medical oncology clinic at a single institution between December 7, 2021 and October 10, 2022 were contacted by staff two days in advance of their visits and sent a link to the WeCARE GA, rather than the paper version used previously. Results were directly embedded into the medical record. We describe our initial implementation outcomes and the results of a provider usability survey. RESULTS Of 266 eligible patients, 221 (83.1%) were successfully contacted by telephone and 200 (75.2%) completed the WeCARE prior to their appointment. More than one phone call was required to make contact for 35.7% of patients, with a mean duration of phone conversation of 2.8 min. Most patients preferred email delivery to text (63% vs 31%); 4.5% were unable to access surveys due to inadequate technology, and 25.7% brought up additional logistical concerns. Among GI oncology providers surveyed, all six found the WeCARE tool and dashboard acceptable, appropriate, and feasible. However, only a third of providers often or always used the dashboard to inform treatment decisions and guide interventions. DISCUSSION With nearly three-quarters of patients completing the WeCARE prior to their visits with minimal staff support and time required, this method of administration may be a viable format to overcome barriers to GA implementation. Additional work is needed to integrate the results meaningfully into clinical practice.
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Affiliation(s)
- Christian Harmon
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mackenzie Fowler
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smith Giri
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Abigail Tucker
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabrielle Rocque
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lisa Zubkoff
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laura Q Rogers
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tanya M Wildes
- Division of Hematology/Oncology, University of Nebraska Medical Center/Nebraska Medicine, Omaha, NE, USA
| | | | - Darryl Outlaw
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emily Shelby
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bassel El-Rayes
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mehmet Akce
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grant R Williams
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
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Jensen-Battaglia M, Mohammed M, Loh KP, Wells M, Tylock R, Ramsdale E, Canin B, Geer J, O'Rourke MA, Liu JJ, Seplaki CL, Mohile SG, Wildes TM. Modifiable fall risk factors among older adults with advanced cancer: Secondary analysis of a cluster-randomized clinical trial. J Geriatr Oncol 2023; 14:101650. [PMID: 37897888 PMCID: PMC10872468 DOI: 10.1016/j.jgo.2023.101650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/28/2023] [Accepted: 10/12/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION Older adults with cancer have unique fall risk factors related to their disease and treatment such as polypharmacy and neurotoxic treatments. In this secondary analysis, we identified modifiable risk factors associated with future falls among older adults with advanced cancers. MATERIALS AND METHODS Data were from the COACH study (ClinicalTrials.gov: NCT02107443; PI: Mohile). Patients were age ≥ 70, had stage III/IV solid tumor or lymphoma, ≥1 geriatric assessment impairment, and were receiving palliative intent treatment. Falls were self-reported at baseline (in the past six months), four to six weeks, three months, and six months. We generated inverse probability weights to account for mortality-related loss to follow-up and applied these in generalized linear mixed models to estimate incidence rate ratios. RESULTS Of 541 patients (mean age: 77, standard deviation [SD]: 5.27), 140 (26%) reported prior falls at baseline, and 467 (86%) had falls data for ≥1 follow-up timepoint. Of those, 103 (22%) reported at least one fall during the follow-up period, and 112 (24%) had incomplete follow-up due to death. In fully adjusted models, prior falls and impaired Timed Up and Go score were associated with higher incidence of falls over 6 months. DISCUSSION We identified several potentially modifiable fall risk factors in older adults with advanced cancers. Future studies should consider ways to integrate fall risk assessment into ongoing cancer care and intervene to reduce falls in this population.
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Affiliation(s)
- Marielle Jensen-Battaglia
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Mostafa Mohammed
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Megan Wells
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Rachael Tylock
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Erika Ramsdale
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Beverly Canin
- SCOREboard Advisory Group, University of Rochester Medical Center, Rochester, NY, USA
| | - Jodi Geer
- Metro Minnesota Community Oncology Research Program, St. Louis Park, MN, USA.
| | - Mark A O'Rourke
- NCORP of the Carolinas (Prisma Health NCORP), Greenville, SC, USA.
| | | | - Christopher L Seplaki
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Supriya G Mohile
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Tanya M Wildes
- University of Nebraska Medical Center/Nebraska Medicine, Omaha, NE, USA.
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García-Baztán A, Oteiza-Olaso J, Gonzales-Montejo NJ, Ramón-Espinoza MF, Tamayo-Rodríguez I, Martínez-Velilla N, Viguria-Alegria MC. Treatment Individualization in Diffuse Large B-Cell Lymphoma: Is Frailty Enough for Old Adults? An Original Article. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e348-e359. [PMID: 37487908 DOI: 10.1016/j.clml.2023.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Toxicity risk evaluation based on frailty assessment is recommended for treatment individualization in old adults with diffuse large B-cell lymphoma (DLBCL). However, no specific assessment method to guide decision-making has been established yet. Here, we implement a therapeutic algorithm based on the information obtained in an updated comprehensive geriatric assessment (CGA) to assess the value that other prognostic factors add to frailty. MATERIAL AND METHODS We prospectively recruited 31 patients aged 70 or older recently diagnosed with DLBCL. Standard dose regimen R-CHOP and dose-attenuated R-miniCHOP were the therapeutic options. A CGA-based algorithm was used for the initial treatment recommendation. The sample was compared according to frailty and treatment allocation to describe baseline differential characteristics and treatment tolerance. RESULTS Mean age was 79 (SD: 5.5) and 45.1% were above 80. Half of the patients (51.6%) were frail; their survival was inferior to that observed in fit adults (p: .034). The mean Short Physical Performance Battery (SPPB) score of patients responding to therapy was higher than non-responders´ media (8.6 vs. 5.9; p: .022). However, when RCHOP was allocated to high functional patients within fit and frail groups, no differences in survival were found compared to R-miniCHOP. The prevalence of toxic events was higher with the standard regimen in fit (p: .054) and frail patients (p: 0.016). CONCLUSIONS The combination of frailty and physical performance assessment in an algorithm is a promising method to guide the decision-making process in old adults with DLBCL. SPPB might complete frailty predictive information on toxicity risk.
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Affiliation(s)
| | - Julio Oteiza-Olaso
- Universidad Pública de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain; Department of Medicine, Hospital Universitario de Navarra, Pamplona, Spain
| | | | | | - Ibai Tamayo-Rodríguez
- Division of Methodology, Biomedical Research Centre of the Government of Navarra (Navarrabiomed). Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
| | - Nicolás Martínez-Velilla
- Department of Geriatrics, Hospital Universitario de Navarra, Pamplona, Spain; Universidad Pública de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain; Biomedical Research Centre of the Government of Navarra (Navarrabiomed), Pamplona, Navarra, Spain
| | - Mari Cruz Viguria-Alegria
- Universidad Pública de Navarra, Pamplona, Spain; Department of Hematology, Hospital Universitario de Navarra, Pamplona, Spain
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García-Baztán A, Viguria-Alegria MC, Ramón-Espinoza MF, Tamayo-Rodríguez I, Gonzales-Montejo NJ, Martínez-Velilla N, Oteiza-Olaso J. Hand grip strength, short physical performance battery, and gait speed: key tools for function in Non-Hodgkin Lymphoma. Ann Hematol 2023; 102:2823-2834. [PMID: 37566279 DOI: 10.1007/s00277-023-05397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
This study aimed to determine which performance assessment tools included in Comprehensive Geriatric Assessment (CGA) are the most sensitive for the functional approach in the initial evaluation and during the therapy of old adults diagnosed with Diffuse Large B-Cell Lymphoma (DLBCL). We prospectively recruited 31 patients aged 70 years or older presenting for an initial consultation in the Hematology Clinic of a tertiary hospital. We implemented an updated physical performance evaluation as part of CGA at baseline and during treatment. Baseline characteristics of the sample were compared according to age, Geriatric 8 (G8), frailty, Short Physical Performance Battery (SPPB), and sarcopenia measured by hand grip strength (HGS). Functional changes were monitored during the treatment period using HGS, gait speed (GS) and SPPB. The mean age was 79.0 (5.5) years and 51.6% of the sample was frail; 65,5% were treated with standard chemotherapy and 35,5% with a therapeutic regimen with attenuated doses. All the assessment tools included in CGA found functional differences at baseline when the sample was stratified and compared according to frailty, sarcopenia, and SPPB, but not according to G8 score and age. Only SPPB was able to detect functional differences between groups stratified by age at baseline. GS was the only score that identified clinically significant functional changes during the treatment. In conclusion, HGS and SPPB are appropriate performance scores to complete the functional approach in the initial hematologic evaluation, and GS is a promising option to detect functional decline during therapy in old adults with DLBCL.
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Affiliation(s)
| | - Mari Cruz Viguria-Alegria
- Department of Hematology, Hospital Universitario de Navarra, Pamplona, Spain
- Universidad Pública de Navarra, Pamplona, Spain
| | | | - Ibai Tamayo-Rodríguez
- Division of Methodology, Biomedical Research Centre of the Government of Navarra (Navarrabiomed), Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Red de Investigación en Cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS), Pamplona, Spain
| | | | - Nicolás Martínez-Velilla
- Department of Geriatrics, Hospital Universitario de Navarra, Pamplona, Spain
- Universidad Pública de Navarra, Pamplona, Spain
- Biomedical Research Centre of the Government of Navarra (Navarrabiomed), Pamplona, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - Julio Oteiza-Olaso
- Universidad Pública de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
- Department of Medicine, Hospital Universitario de Navarra, Pamplona, Spain
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Dale W, Klepin HD, Williams GR, Alibhai SMH, Bergerot C, Brintzenhofeszoc K, Hopkins JO, Jhawer MP, Katheria V, Loh KP, Lowenstein LM, McKoy JM, Noronha V, Phillips T, Rosko AE, Ruegg T, Schiaffino MK, Simmons JF, Subbiah I, Tew WP, Webb TL, Whitehead M, Somerfield MR, Mohile SG. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Update. J Clin Oncol 2023; 41:4293-4312. [PMID: 37459573 DOI: 10.1200/jco.23.00933] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE To update the ASCO guideline (2018) on the practical assessment and management of age-associated vulnerabilities in older patients undergoing systemic cancer therapy. METHODS An Expert Panel conducted a systematic review to identify relevant randomized clinical trials (RCTs), systematic reviews, and meta-analyses from January 2016 to December 2022. RESULTS A total of 26 publications met eligibility criteria and form the evidentiary basis for the update. RECOMMENDATIONS The Expert Panel reiterates its overarching recommendation from the prior guideline that geriatric assessment (GA), including all essential domains, should be used to identify vulnerabilities or impairments that are not routinely captured in oncology assessments for all patients over 65 years old with cancer. Based on recently published RCTs demonstrating significantly improved clinical outcomes, all older adults with cancer (65+ years old) receiving systemic therapy with GA-identified deficits should have GA-guided management (GAM) included in their care plan. GAM includes using GA findings to inform cancer treatment decision-making as well as to address impairments through appropriate interventions, counseling, and/or referrals. A GA should include high priority aging-related domains known to be associated with outcomes in older adults with cancer: physical and cognitive function, emotional health, comorbid conditions, polypharmacy, nutrition, and social support. Clinical adaptation of the GA based on patient population, resources, and time is appropriate.The Panel recommends the Practical Geriatric Assessment as one option for this purpose (https://old-prod.asco.org/sites/new-www.asco.org/files/content-files/practice-patients/documents/2023-PGA-Final.pdf; https://youtu.be/jnaQIjOz2Dw; https://youtu.be/nZXtwaGh0Z0).Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
- William Dale
- City of Hope National Medical Center, Duarte, CA
| | - Heidi D Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | | | | | | | | | | | | | - Vani Katheria
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Kah Poh Loh
- University of Rochester Medical Center, Rochester, NY
| | | | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Tanyanika Phillips
- Department of Medical Oncology & Therapeutics Research, City of Hope Cancer Center, Duarte, CA
| | - Ashley E Rosko
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Tracy Ruegg
- WellStar School of Nursing, Kennesaw State University, Kennesaw, GA
| | | | | | | | - William P Tew
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tracy L Webb
- Wake Forest University Health Sciences, Winston Salem, NC
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Clausing D, Fowler ME, Harmon C, Tucker A, Outlaw D, Akce M, El-Rayes B, Giri S, Williams GR. Association of emotional support with quality of life, mental health, and survival in older adults with gastrointestinal malignancies-Results from the CARE registry. Cancer Med 2023; 12:19102-19111. [PMID: 37644881 PMCID: PMC10557900 DOI: 10.1002/cam4.6477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Emotional support (ES) is the most frequently reported support need among older adults with cancer. Yet, the association of ES with cancer outcomes is largely unknown. This study examined the association of ES with health-related quality of life (HRQoL), mental health, and survival among older adults with gastrointestinal (GI) malignancies. METHODS We included newly diagnosed older adults (≥60 years) with GI cancer undergoing self-reported geriatric assessment at their first clinic visit. ES was measured using an adaptation of the Medical Outcomes Study (dichotomized adequate ES vs. inadequate ES). Outcomes included physical and mental HRQoL, anxiety, depression, and survival. Multivariable linear regression evaluated the association between ES and HRQoL scores. Multivariable logistic regression evaluated the association of ES with anxiety and depression. All models were adjusted for age at geriatric assessments, race, sex, and cancer type/stage. RESULTS 795 participants were included. Median patient age was 68 years (IQR: 64-74), 58% were male, and most cancers were either colorectal (37.9%) or pancreatic (30.8%). Most (77.6%) had adequate ES. Patients with inadequate ES were more likely to be Black (31.5 vs. 20.8%, p = 0.005), disabled (24.1 vs. 10.4%, p < 0.001), widowed/divorced (54.2 vs. 24.8%, p < 0.001) and had lower physical and mental HRQoL t-scores (Physical β: -3.35, 95% CI: -5.25, -1.46; Mental β: -2.46, 95% CI: -4.11, -0.81) and higher odds of depression (aOR: 2.22, CI: 1.34-3.69). This study found no difference between those with adequate ES versus inadequate ES in the proportion of deaths within 1 year of diagnosis (24.3% vs. 24.2%, p = 0.966), or within 2 years of diagnosis (32.4% vs. 33.2%, p = 0.126). CONCLUSIONS Older adults with inadequate ES have worse physical and mental HRQoL and higher odds of depression compared to those with adequate ES.
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Affiliation(s)
- Daniel Clausing
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mackenzie E Fowler
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christian Harmon
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Abigail Tucker
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Darryl Outlaw
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mehmet Akce
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bassel El-Rayes
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Smith Giri
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Grant R Williams
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Williams GR, Hopkins JO, Klepin HD, Lowenstein LM, Mackenzie A, Mohile SG, Somerfield MR, Dale W. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Questions and Answers. JCO Oncol Pract 2023; 19:718-723. [PMID: 37459585 DOI: 10.1200/op.23.00263] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 09/14/2023] Open
Affiliation(s)
| | | | - Heidi D Klepin
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | | | - Amy Mackenzie
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | | | - William Dale
- City of Hope National Medical Center, Duarte, CA
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Johnson PC, Woyach JA, Ulrich A, Marcotte V, Nipp RD, Lage DE, Nelson AM, Newcomb RA, Rice J, Lavoie MW, Ritchie CS, Bartlett N, Stephens DM, Ding W, Owen C, Stone R, Ruppert AS, Mandrekar SJ, Byrd JC, El-Jawahri A, Le-Rademacher J, Rosko A. Geriatric assessment measures are predictive of outcomes in chronic lymphocytic leukemia. J Geriatr Oncol 2023; 14:101538. [PMID: 37329769 PMCID: PMC10599966 DOI: 10.1016/j.jgo.2023.101538] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/05/2023] [Accepted: 05/25/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Chronic lymphocytic leukemia (CLL) commonly affects older adults. However, few studies have examined the relationship between baseline geriatric domains and clinical outcomes in this population. Here, we aim to evaluate the use of a comprehensive geriatric assessment in older (>65 years) untreated patients with CLL to predict outcomes. MATERIALS AND METHODS We conducted a planned analysis of 369 patients with CLL age 65 or older treated in a phase 3 randomized trial of bendamustine plus rituximab versus ibrutinib plus rituximab versus ibrutinib alone (A041202). Patients underwent evaluations of geriatric domains including functional status, psychological status, social activity, cognition, social support, and nutritional status. We examined associations among baseline geriatric domains with grade 3+ adverse events using multivariable logistic regression and overall survival (OS) and progression-free survival (PFS) using multivariable Cox regression models. RESULTS In this study, the median age was 71 years (range: 65-87). In the combined multivariable model, the following geriatric domains were significantly associated with PFS: Medical Outcomes Study (MOS) - social activities survey score (hazard ratio [HR] [95% confidence interval (CI)] 0.974(0.961, 0.988), p = 0.0002) and nutritional status (≥5% weight loss in the preceding six months: (HR [95% CI] 2.717[1.696, 4.354], p < 0.001). MOS - social activities score [HR (95% CI) 0.978(0.958, 0.999), p = 0.038] was associated with OS. No geriatric domains were significantly associated with toxicity. There were no statistically significant interactions between geriatric domains and treatment. DISCUSSION Geriatric domains of social activity and nutritional status were associated with OS and/or PFS in older adults with CLL. These findings highlight the importance of assessing geriatric domains to identify high-risk patients with CLL who may benefit from additional support during treatment.
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Affiliation(s)
- P Connor Johnson
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jennifer A Woyach
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | - Angela Ulrich
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Veronique Marcotte
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Ryan D Nipp
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Daniel E Lage
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashley M Nelson
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard A Newcomb
- Dana-Farber/Partners CancerCare, Harvard Medical School, Boston, MA, USA
| | - Julia Rice
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Nancy Bartlett
- Washington University - Siteman Cancer Center, St. Louis, MO, USA
| | | | | | - Carolyn Owen
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Richard Stone
- Dana-Farber/Partners CancerCare, Harvard Medical School, Boston, MA, USA
| | - Amy S Ruppert
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - John C Byrd
- University of Cincinnati, Cincinnati, OH, USA
| | - Areej El-Jawahri
- Dana-Farber/Partners CancerCare, Harvard Medical School, Boston, MA, USA
| | | | - Ashley Rosko
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Raz DJ, Kim JY, Erhunwmunesee L, Hite S, Varatkar G, Sun V. The value of perioperative physical activity in older patients undergoing surgery for lung cancer. Expert Rev Respir Med 2023; 17:691-700. [PMID: 37668168 DOI: 10.1080/17476348.2023.2255133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/24/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION With a median age at diagnosis of 70, lung cancer represents an enormous public health problem among older Americans. An estimated 19,000 people age 65 and older undergo lung cancer surgery annually in the US. Older adults undergoing lung cancer surgery are often frail with limited physiologic reserves, multi-morbidities, and functional impairments. Physical function, dyspnea, and quality of life return to baseline slower in older adults compared with younger adults after lung surgery. AREAS COVERED In this review, we summarize available data about perioperative physical activity interventions that may improve outcomes for older adults undergoing lung cancer surgery. We also review the limitations of existing studies and discuss emerging data on the roles of telehealth and family caregiver inclusion in peri-operative physical activity interventions. EXPERT OPINION We propose that future perioperative physical activity interventions in older adults undergoing lung cancer surgery should include a comprehensive geriatric assessment to guide personalized interventions. Interventions should be conceptually based, with a focus on enhancing self-efficacy, motivation, and adherence through classic behavior change strategies that are proven to impact outcomes. Finally, interventions should be designed with attention to feasibility and scalability. Exercise programs delivered via telehealth (telephone or tele-video) may improve access and convenience for patients.
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Affiliation(s)
- Dan J Raz
- Department of Surgery, City of Hope, CA, USA
| | - Jae Y Kim
- Department of Surgery, City of Hope, CA, USA
| | - Loretta Erhunwmunesee
- Department of Surgery, City of Hope, CA, USA
- Department of Population Sciences, City of Hope, CA, USA
| | - Sherry Hite
- Department of Rehabilitation, City of Hope, CA, USA
| | | | - Virginia Sun
- Department of Surgery, City of Hope, CA, USA
- Department of Population Sciences, City of Hope, CA, USA
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Arora SP, Puts M. Lessons learned from organizing International Society of Geriatric Oncology (SIOG) geriatric assessment workshops. J Geriatr Oncol 2023; 14:101528. [PMID: 37230931 PMCID: PMC11147499 DOI: 10.1016/j.jgo.2023.101528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Sukeshi Patel Arora
- Division of Hematology/Oncology, Department of Medicine, Mays Cancer Center, University of Texas Health San Antonio, 7979 Wurzbach Rd., MC 8232, San Antonio, TX 78229, USA.
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College street suite 130, Toronto M5P1T8, ON, Canada.
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Graham LS, Lin JK, Lage DE, Kessler ER, Parikh RB, Morgans AK. Management of Prostate Cancer in Older Adults. Am Soc Clin Oncol Educ Book 2023; 43:e390396. [PMID: 37207299 DOI: 10.1200/edbk_390396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The majority of men with prostate cancer are diagnosed when they are older than 65 years; however, clinical trial participants are disproportionately younger and more fit than the real-world population treated in typical clinical practices. It is, therefore, unknown whether the optimal approach to prostate cancer treatment is the same for older men as it is for younger and/or more fit men. Short screening tools can be used to efficiently assess frailty, functional status, life expectancy, and treatment toxicity risk. These risk assessment tools allow for targeted interventions to increase a patient's reserve and improve treatment tolerance, potentially allowing more men to experience the benefit of the significant recent treatment advances in prostate cancer. Treatment plans should also take into consideration each patient's individual goals and values considered within their overall health and social context to reduce barriers to care. In this review, we will discuss evidence-based risk assessment and decision tools for older men with prostate cancer, highlight intervention strategies to improve treatment tolerance, and contextualize these tools within the current treatment landscape for prostate cancer.
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Affiliation(s)
- Laura S Graham
- Division of Medical Oncology, University of Colorado, Aurora, CO
| | - John K Lin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Ravi B Parikh
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Coporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
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Hsu T, Elias R, Swartz K, Chapman A. Developing Sustainable Cancer and Aging Programs. Am Soc Clin Oncol Educ Book 2023; 43:e390980. [PMID: 37155945 DOI: 10.1200/edbk_390980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Geriatric assessment (GA) has been shown to decrease toxicity from systemic therapy, improve completion of chemotherapy, and reduce hospitalizations in older adults with cancer. Given the aging of the cancer population, this has the potential to have a positive impact on the care of a large swath of patients seen. Despite endorsement by several international societies, including the American Society of Clinical Oncology, uptake of GA has been low. Lack of knowledge, time, and resources has been cited as reasons for this. Although challenges to developing and implementing a cancer and aging program vary depending on the health care context, GA is adaptable to every health care context from low- to high-resource settings, as well as those in which geriatric oncology is a well-established or just emerging field. We provide an approach for clinicians and administrators to develop, implement, and sustain aging and cancer programs in a doable and sustainable way.
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Affiliation(s)
- Tina Hsu
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Rawad Elias
- Hartford HealthCare Cancer Institute, Hartford, CT
- University of Connecticut School of Medicine, Farmington, CT
| | - Kristine Swartz
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Jefferson Health, Philadelphia, PA
| | - Andrew Chapman
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Jefferson Health, Philadelphia, PA
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Fowler ME, Kenzik KM, Al-Obaidi M, Harmon C, Giri S, Arora S, Stephenson C, Khushman M, Outlaw D, Bhatia S, Williams GR. Rural-urban disparities in mortality and geriatric assessment among older adults with cancer: The cancer & aging resilience evaluation (CARE) registry. J Geriatr Oncol 2023; 14:101505. [PMID: 37087962 PMCID: PMC10207384 DOI: 10.1016/j.jgo.2023.101505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/13/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Rural-urban disparities persist in cancer mortality, despite improvement in cancer screening and treatment. Although older adults represent the majority of cancer cases and are over-represented in rural areas, few studies have explored rural-urban disparities in mortality and age-related impairments among older adults with cancer. MATERIALS AND METHODS We included 962 newly-diagnosed older adults (≥60 years) with cancer who underwent geriatric assessment (GA) at their first pre-chemotherapy visit to an academic medical center in the Southeastern United States. We used Rural-Urban Commuting Area (RUCA) codes to classify residence at time of diagnosis into urban and rural areas. We used one-year survival and pre-treatment frailty as outcomes. We used Cox proportional hazards regression to evaluate the association between residence and one-year mortality, and logistic regression to evaluate the association between residence and pre-treatment frailty. All tests were two-sided. RESULTS Median age at GA was 68.0 (interquartile rage [IQR]: 64.0, 74.0) years; most had colorectal cancer (24.3%) with advanced stage (III/IV 73.2%) disease. Overall, 11.4% resided in rural and 88.6% in urban areas. Rural areas had a higher proportion of White and less educated participants. After adjustment for age, sex, race, education, employment status, and cancer type/stage, rural residence was associated with higher hazard of one-year mortality (hazard ratio [HR] = 1.78, 95% confidence interval [CI] = 1.23, 2.57) compared to urban residence. Frailty was an effect modifier of this association (HROverall = 1.83, 95% CI = 1.27, 2.57; HRFrail = 2.05, 95% CI = 1.23, 3.41; HRNot Frail = 1.55, 95% CI = 0.90, 2.68). DISCUSSION Among older adults with newly diagnosed cancer, rural residence was associated with reduced one-year survival, particularly among frail older adults. The rural-urban disparities observed in the current study may be due to frailty in conjunction with disparities in social determinants of health across rural and urban areas. Future studies should focus on understanding and intervening on underlying causes of these disparities.
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Affiliation(s)
- Mackenzie E Fowler
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA.
| | - Kelly M Kenzik
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA.
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA.
| | - Christian Harmon
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA.
| | - Smith Giri
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA.
| | - Sankalp Arora
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA.
| | | | - Moh''d Khushman
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA.
| | - Darryl Outlaw
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA.
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA; Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Building, Birmingham, AL 35233-1771, USA.
| | - Grant R Williams
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA.
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Ioffe D, Dotan E. Guidance for Treating the Older Adults with Colorectal Cancer. Curr Treat Options Oncol 2023; 24:644-666. [PMID: 37052812 DOI: 10.1007/s11864-023-01071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 04/14/2023]
Abstract
OPINION STATEMENT The need for evidence-based data in the rapidly growing group of older patients is vast and more elderly-specific studies are desperately needed, for which there is clear demand from both patients and providers. Notably, many of the studies discussed in this review included unplanned subset analyses based on age and/or were not originally stratified by age; therefore, these data, particularly overall survival data, need to be interpreted with some caution as they may not be statistically valid based on the initial trial design and statistical plan. As we await data from ongoing elderly-specific trials, our recommendation for managing older patients with CRC should include geriatric screening tools (e.g., CSGA, VES-13, G8, CARG, CRASH) to help guide treatment adjustments for improved tolerability without sacrificing efficacy. For patients with a positive screen for significant geriatric concerns, a full geriatric assessment is recommended to guide treatment approach and supportive care. Prior data support the use of all approved medications for CRC in older adults who are fit; however, treatment breaks and dose attenuation with potential escalation are reasonable options for these patients. Ultimately, management decisions in the care of older adults with mCRC must be made through shared decision-making with the patient with consideration for the patient's functional status, comorbidities, goals of care, social support, as well as potential toxicities and possible effect on QoL.
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Affiliation(s)
- Dina Ioffe
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
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Pathi N, Parikh PM, Banerjee J, Tilak TVSVGK, Prem NN, Pillai A. Unmet Needs in Geriatric Oncology. South Asian J Cancer 2023; 12:221-227. [PMID: 37969679 PMCID: PMC10635778 DOI: 10.1055/s-0043-1771441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Nikhil PathiIndia's population is aging, with the number of people aged 60 and over projected to reach 340 million by 2050. This is expected to lead to an increase in the number of older adults with cancer. Geriatric oncology is a rapidly growing field in India that is facing several challenges. Some of these include inadequate access to cancer screening and early detection programs in elderly, leading to late diagnoses and poor outcomes, lack of specialized geriatric oncology services, cancer-specific treatment guidelines and protocols in elderly, limited availability of treatment options due to accessibility, finances and other logistic issues, lack of trained healthcare professionals with expertise in geriatric oncology, lack of awareness, and access to early integrated palliative care services. There are several challenges faced by elderly in this journey like financial dependency, social isolation, difficulty in transportation to healthcare for treatments, and psychosocial aspects attributed to cancer. Awareness about availability of resources, patient assistance programs to reduce financial burdens, education campaigns, use of telemedicine and telehealth services to bypass transportation issues in remote and underserved areas, and integration of geriatric oncology into mainstream oncology services might be some solutions. Additionally, there is a need for more research on the unique characteristics and needs of older cancer patients in India, as well as the development of culturally appropriate interventions to address these needs. Development of India-specific geriatric assessment scales encompassing medical, psychosocial, and functional problems in elderly identifies areas of vulnerability. A multidisciplinary team-based decision-making is required at various levels. There is a need for increased investment in geriatric oncology research, training, and integrated palliative care services in India. Geriatric oncology is slowly being recognized as a separate subspeciality and more geriatric oncology centers and clinics are being set up in major cities in India that should be the way forward.
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Affiliation(s)
- Nikhil Pathi
- Department of Medical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Purvish Mahendra Parikh
- Department of Clinical Hematology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Joyita Banerjee
- Department of Geriatric Medicine, Venu Geriatric Services, New Delhi, India
| | - TVSVGK Tilak
- Department of Geriatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Anupa Pillai
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Dotan E, Catalano P, Lenchik L, Boutin R, Yao X, Marques HS, Ioffe D, Zhen DB, Li D, Wagner LI, Simon MA, Wong TZ, O'Dwyer PJ. The GIANT trial (ECOG-ACRIN EA2186) methods paper: A randomized phase II study of gemcitabine and nab-paclitaxel compared with 5-fluorouracil, leucovorin, and liposomal irinotecan in older patients with treatment-naïve metastatic pancreatic cancer - defining a new treatment option for older vulnerable patients. J Geriatr Oncol 2023; 14:101474. [PMID: 36963200 PMCID: PMC10425127 DOI: 10.1016/j.jgo.2023.101474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/06/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Pancreatic cancer is the fourth leading cause of cancer-related death in the US with an increasing incidence in older adults (OA) over age 70. There are currently no treatment guidelines for OA with metastatic pancreatic cancer (mPCA) and selecting a chemotherapy regimen for these patients is subjective, based largely on chronologic age and performance status (PS). Geriatric screening tools provide a more objective and accurate evaluation of a patient's overall health but have not yet been validated in patient selection for mPCA treatment. This study aims to elucidate the optimal chemotherapy treatment of vulnerable OA with mPCA and understand the geriatric factors that affect outcomes in this population. METHODS/DESIGN The GIANT (ECOG-ACRIN EA2186) study is multicenter, randomized phase II trial enrolling patients over age 70 with newly diagnosed mPCA. This study utilizes a screening geriatric assessment (GA) which characterizes patients as fit, vulnerable, or frail. Patients with mild abnormalities in functional status and/or cognition, moderate comorbidities, or over age 80 are considered vulnerable. Enrolled patients are randomized to one of two dose-reduced treatment regimens (gemcitabine/nab-paclitaxel every other week, or dose-reduced 5-fluoruracil (5FU)/ liposomal irinotecan (nal-IRI) every other week). GA and quality of life (QoL) evaluations are completed prior to treatment initiation and at each disease evaluation. Overall survival (OS) is the primary endpoint, with secondary endpoints including progression free survival (PFS) and objective response rate (ORR). Enrolled patients will be stratified by age (70-74 vs ≥75) and ECOG PS (0-1 vs 2). Additional endpoints of interest for OA include evaluation of risk factors identified through GA, QoL evaluation, and toxicities of interest for older adults. Correlative studies include assessment of pro-inflammatory biomarkers of aging in the blood (IL-6, CRP) and imaging evaluation of sarcopenia as predictors of treatment tolerance. DISCUSSION The GIANT study is the first randomized, prospective national trial evaluating vulnerable OA with mPCA aimed at developing a tailored treatment approach for this patient population. This trial has the potential to establish a new way of objectively selecting vulnerable OA with mPCA for modified treatment and to establish a new standard of care in this growing patient population. TRIAL REGISTRATION This trial is registered with ClinicalTrial.gov Identifier NCT04233866.
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Affiliation(s)
- Efrat Dotan
- Department of Hematology and Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA.
| | - Paul Catalano
- Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Robert Boutin
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Xin Yao
- ThedaCare Regional Cancer Center-Appelton, WI, USA
| | - Helga S Marques
- Department of Biostatistics and Center for Statistical Sciences, Brown University, Providence, RI, USA
| | - Dina Ioffe
- Department of Hematology and Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - David B Zhen
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA; Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Daneng Li
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Lynne I Wagner
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Center for Health Equity Transformation, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Terence Z Wong
- Department of Radiology, Division of Nuclear Medicine and Radiotheranostics, Duke University Medical Center, Durham, NC, USA
| | - Peter J O'Dwyer
- University of Pennsylvania and Abramson Cancer Center, Philadelphia, PA, USA
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Tse N, Parks RM, Holmes HM, Cheung KL. The Association Between Medication Use in Older Women with Early-Stage Operable Primary Breast Cancer and Decision Regarding Primary Treatment. Oncologist 2023; 28:e128-e135. [PMID: 36718086 PMCID: PMC10020815 DOI: 10.1093/oncolo/oyac278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/14/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Polypharmacy is one factor contributing to increased mortality, hospitalization, and adverse drug reactions in older adults. The aim of this study was to measure the prevalence of polypharmacy in a cohort of older women with early-stage operable primary breast cancer and the relationship of polypharmacy to primary treatment decision and functional status. METHODS A total of 139 patients with a new diagnosis of early-stage operable primary breast cancer proven histologically were recruited as part of a prospective study. The average age was 77 years. Assessment using a cancer-specific Comprehensive Geriatric Assessment (CGA) tool was conducted within 6 weeks of diagnosis of breast cancer. Association was determined between number of medications and treatment decision and physical status as measured by the CGA outcomes. Additional analysis was performed to determine the associations above with polypharmacy defined by ≥5 daily medications, and if cardiovascular-related diseases have a role in the treatment decision. RESULTS Polypharmacy was present in 48% of patients (n = 139). CGA determined that polypharmacy was associated with greater comorbidity (P < .001), reduced physical status rated by physicians (P = .009) and patients (P = .019), and reduced ability to perform activities of instrumental ADLs (P = .008). Similar findings were present in the analysis of cardiovascular-related diseases. CONCLUSIONS This work suggests that patients with polypharmacy are more likely to be frail. The number of medications could help us screen patients who should go on to receive full CGA.
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Affiliation(s)
- Natalie Tse
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
| | - Ruth M Parks
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, University of Texas Health Science Center, McGovern Medical School, Houston, TX, USA
| | - Kwok-Leung Cheung
- Corresponding author: Kwok-Leung Cheung, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, DE22 3DT, UK. Telephone: +44(0)1332 724881;
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Singhal S, Walter LC, Smith AK, Loh KP, Cohen HJ, Zeng S, Shi Y, Boscardin WJ, Presley CJ, Williams GR, Magnuson A, Mohile SG, Wong ML. Change in four measures of physical function among older adults during lung cancer treatment: A mixed methods cohort study. J Geriatr Oncol 2023; 14:101366. [PMID: 36058839 PMCID: PMC9974579 DOI: 10.1016/j.jgo.2022.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Functional outcomes during non-small cell lung cancer (NSCLC) treatment are critically important to older adults. Yet, data on physical function and which measures best capture functional change remain limited. MATERIALS AND METHODS This multisite, mixed methods cohort study recruited adults ≥65 years with advanced NSCLC starting systemic treatment (i.e., chemotherapy, immunotherapy, and/or targeted therapy) with non-curative intent. Participants underwent serial geriatric assessments prior to starting treatment and at one, two, four, and six months, which included the Karnofsky Performance Scale (KPS, range: 0-100%), instrumental activities of daily living (IADL, range: 0-14), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Physical Functioning subscale (EORTC QLQ-C30 PF, range: 0-100), and Life-Space Assessment (LSA, range: 0-120). For all measures, higher scores represent better functioning. In a qualitative substudy, 20 patients completed semi-structured interviews prior to starting treatment and at two and six months to explore how treatment affected their daily functioning. We created joint displays for each interview participant that integrated their longitudinal KPS, IADL, EORTC QLQ-C30 PF, and LSA scores with patient quotes describing their function. RESULTS Among 87 patients, median age was 73 years (range 65-96). Mean pretreatment KPS score was 79% (standard deviation [SD] 13), EORTC QLQ-C30 PF was 69 (SD 23), and LSA was 67 (SD 28); median IADL was 13 (interquartile range [IQR] 10-14). At two months after treatment initiation, 70% of patients experienced functional decline on at least one measure, with only 13% of these patients recovering at six months. At two and six months, decline in LSA was the most common (48% and 35%, respectively). Joint displays revealed heterogeneity in how well each quantitative measure of physical function captured the qualitative patient experience. DISCUSSION Functional decline during NSCLC treatment is common among older adults. LSA is a useful measure to detect subtle functional decline that may be missed by other measures. Given heterogeneity in how well each quantitative measure captures changes in physical function, there is value to including more than one functional measure in geriatric oncology research studies.
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Affiliation(s)
- Surbhi Singhal
- Division of Medical Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Louise C Walter
- Division of Geriatrics, University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Alexander K Smith
- Division of Geriatrics, University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Kah Poh Loh
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Harvey Jay Cohen
- Center for the Study of Aging & Human Development and Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Sandra Zeng
- Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Ying Shi
- Division of Geriatrics, University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - W John Boscardin
- Division of Geriatrics, University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Grant R Williams
- Divisions of Hematology/Oncology and Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Allison Magnuson
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Melisa L Wong
- Division of Geriatrics, University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
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Tejero I, Timilshina N, Jin R, Monginot S, Berger A, Romanovsky L, Alibhai SMH. Impact of patients' sex in assessments and treatment recommendations in an older adult cancer clinic. J Geriatr Oncol 2023; 14:101412. [PMID: 36509671 DOI: 10.1016/j.jgo.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION In multiple settings, sex disparities have been seen in diagnosis, treatment, and outcomes. This study sought to determine whether there are sex differences in a geriatric oncology clinic concerning results of the comprehensive geriatric assessment (CGA) and treatment recommendations. MATERIALS AND METHODS This is a retrospective cohort study including patients ≥65 years old referred for consultation on cancer treatment decision-making who underwent a CGA between July 2015 and December 2020, in a single Canadian academic geriatric oncology (GO) clinic. We examined differences by sex, stratified by disease site, stage, treatment intent, CGA results by domain, final treatment plan, and referrals for abnormal CGA findings. Differences were assessed using chi-square, Fisher's exact, or t-test as appropriate. Multivariate logistic regression was performed to examine whether sex impacted recommendations to reduce treatment intensity. RESULTS In the study period, 328 patients were assessed in the GO clinic (mean age 81 years). The most common cancer types were gastrointestinal (42.1%), hematologic (18.3%), and head and neck (17.3%). More males than females were assessed in the GO clinic (62.2% versus 37.8%, respectively). This proportion did not change over time (p = 0.58). The GO clinic recommended to reduce treatment intensity in 140 cases (42.7%), with no difference between sexes in adjusted models (43.6% of females and 42.2% of males, p = 0.80). There were no differences in any CGA domain by sex. There were also no differences in referrals made by the GO clinic to optimize abnormal CGA domains by sex. DISCUSSION Sex itself did not impact treatment decision-making, nor referrals to optimize abnormal CGA domains in our GO clinic using CGA-based care.
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Affiliation(s)
- Isabel Tejero
- Division of Geriatric Medicine and General Internal Medicine, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Narhari Timilshina
- Division of Geriatric Medicine and General Internal Medicine, Department of Medicine, University Health Network, Toronto, Ontario, 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
| | - Arielle Berger
- Division of Geriatric Medicine and General Internal Medicine, Department of Medicine, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Lindy Romanovsky
- Division of Geriatric Medicine and General Internal Medicine, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Division of Geriatric Medicine and General Internal Medicine, Department of Medicine, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
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Verduzco-Aguirre HC, Navarrete-Reyes AP, Negrete-Najar JP, Soto-Pérez-de-Celis E. [Cancer in older adults in Latin America: interdisciplinary cooperation between oncology and geriatrics]. Rev Salud Publica (Bogota) 2023; 22:337-345. [PMID: 36753161 DOI: 10.15446/rsap.v22n3.84617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/30/2020] [Indexed: 12/24/2022] Open
Abstract
Latin America, like the rest of the world, is currently facing the consequences of population aging. Among these consequences is a rise in incidence in malignant neoplasms among older adults, with an anticipated increase in oncologic health service requirements in this population. Geriatric oncology is a recently created discipline which integrates geriatric principles into oncology care to offer older adults with cancer individualized treatments. This multidisciplinary approach is now recommended as part of routine oncology care by international associations. Although several geriatric oncology clinical, educational and research initiatives exist in Latin America, the number and availability of specialized facilities and personnel is limited in comparison to those in high-income regions. In this manuscript, we review international recommendations for the implementation of geriatric oncology principles into routine clinical practice, describe resources available for geriatric oncology in Latin America, and provide recommendations to improve multidisciplinary care for older adults with cancer in the region.
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Affiliation(s)
- Haydeé C Verduzco-Aguirre
- HV: MD. Esp. Oncología Médica. Departamento de Hemato-Oncología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Ciudad de México, México.
| | - Ana P Navarrete-Reyes
- AN: MD. Esp. Geriatría. Servicio de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Ciudad de México, México.
| | - Juan P Negrete-Najar
- JN: MD. Esp. Geriatría. Servicio de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Ciudad de México, México.
| | - Enrique Soto-Pérez-de-Celis
- ES: Esp. Oncología Médica. Investigador en Ciencias Médicas "D". Maestro en Ciencias Médicas. Servicio de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Ciudad de México, México.
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Tack L, Schofield P, Boterberg T, Chandler R, Parris CN, Debruyne PR. Practical Implementation of the Comprehensive Geriatric Assessment to Optimise Care for Older Adults with Cancer. Geriatrics (Basel) 2023; 8:geriatrics8010018. [PMID: 36826360 PMCID: PMC9957492 DOI: 10.3390/geriatrics8010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
Whilst cancer remains a very serious health problem at any stage, cancer combined with increasing age creates an even more challenging situation for health care providers [...].
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Affiliation(s)
- Laura Tack
- Department of Medical Oncology, Kortrijk Cancer Centre, General Hospital Groeninge, 8500 Kortrijk, Belgium
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Patricia Schofield
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Tom Boterberg
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Rebecca Chandler
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Chelmsford CM1 1SQ, UK
| | - Christopher N. Parris
- Medical Technology Research Centre (MTRC), School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Philip R. Debruyne
- Department of Medical Oncology, Kortrijk Cancer Centre, General Hospital Groeninge, 8500 Kortrijk, Belgium
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
- Medical Technology Research Centre (MTRC), School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge CB1 1PT, UK
- Correspondence:
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Sedrak MS, Sun CL, Ji J, Cohen HJ, Gross CP, Tew WP, Klepin HD, Wildes TM, Dotan E, Freedman RA, O'Connor T, Chow S, Fenton MA, Moy B, Chapman AE, Dale W, Katheria V, Kuderer NM, Lyman GH, Magnuson A, Muss HB. Low-Intensity Adjuvant Chemotherapy for Breast Cancer in Older Women: Results From the Prospective Multicenter HOPE Trial. J Clin Oncol 2023; 41:316-326. [PMID: 36455189 PMCID: PMC9839299 DOI: 10.1200/jco.22.01440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Older women with high-risk early breast cancer (EBC) benefit from adjuvant chemotherapy, but their treatment is frequently complicated by toxic side effects, resulting in dose reductions and delays. This makes it challenging for oncologists to maintain a relative dose intensity (RDI) ≥ 85%, as recommended for optimal curative-intent treatment. Understanding which women are at risk of receiving suboptimal RDI may inform treatment discussions and guide early, targeted supportive care or geriatric comanagement interventions. METHODS This was a prespecified secondary analysis of the HOPE trial, which enrolled women age ≥ 65 years with EBC initiating neoadjuvant or adjuvant chemotherapy. RDI was calculated as the ratio of delivered to planned chemotherapy dose intensity. The primary outcome was low RDI, defined as RDI < 85%. Multivariable logistic regression with stepwise selection was used to evaluate the association between baseline variables (demographic, clinical, and geriatric assessment) and low RDI. Survival probability was estimated using the Kaplan-Meier method, and the log-rank test was used to compare overall survival. RESULTS Three hundred twenty-two patients (median age at diagnosis, 70 years; range, 65-86 years) were included. The median follow-up was 4 years. Sixty-six patients (21%) had a low RDI. Age ≥ 76 years (odds ratio [OR], 2.57; 95% CI, 1.12 to 5.91; P = .03), lower performance status (OR, 4.32; 95% CI, 1.98 to 9.42; P < .001), and use of anthracycline-based or cyclophosphamide, methotrexate, and fluorouracil regimens (OR, 3.47; 95% CI, 1.71 to 7.05; P < .001) were associated with low RDI. The 5-year overall survival probability was 0.80 versus 0.91 in patients with RDI < 85 versus ≥ 85%, respectively (log-rank P = .02). CONCLUSION One in five older patients with EBC treated with standard chemotherapy received low RDI and had inferior survival outcomes. Older patients at risk for low RDI should be identified and targeted upfront before initiating chemotherapy.
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Affiliation(s)
- Mina S. Sedrak
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Can-Lan Sun
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Supportive Care Medicine, City of Hope, Duarte, CA
| | - Jingran Ji
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Harvey J. Cohen
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Cary P. Gross
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - William P. Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heidi D. Klepin
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Tanya M. Wildes
- Department of Medical Oncology, Nebraska Medicine, Omaha, NE
| | - Efrat Dotan
- Department of Hematology Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Rachel A. Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Tracey O'Connor
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Selina Chow
- Department of Medicine, University of Chicago, Chicago, IL
| | | | - Beverly Moy
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Andrew E. Chapman
- Department of Medical Oncology, Sidney Kimmel Cancer Center/Jefferson Health, Philadelphia, PA
| | - William Dale
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Supportive Care Medicine, City of Hope, Duarte, CA
| | - Vani Katheria
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Supportive Care Medicine, City of Hope, Duarte, CA
| | | | - Gary H. Lyman
- Department of Medicine, University of Washington, Seattle, WA
| | - Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Hyman B. Muss
- Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Freedman RA, Li T, Sedrak MS, Hopkins JO, Tayob N, Faggen MG, Sinclair NF, Chen WY, Parsons HA, Mayer EL, Lange PB, Basta AS, Perilla-Glen A, Lederman RI, Wong A, Tiwari A, McAllister SS, Mittendorf EA, Miller PG, Gibson CJ, Burstein HJ. 'ADVANCE' (a pilot trial) ADjuVANt chemotherapy in the elderly: Developing and evaluating lower-toxicity chemotherapy options for older patients with breast cancer. J Geriatr Oncol 2023; 14:101377. [PMID: 36163163 PMCID: PMC10080267 DOI: 10.1016/j.jgo.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Older adults with breast cancer receiving neo/adjuvant chemotherapy are at high risk for poor outcomes and are underrepresented in clinical trials. The ADVANCE (ADjuVANt Chemotherapy in the Elderly) trial evaluated the feasibility of two neo/adjuvant chemotherapy regimens in parallel-enrolling cohorts of older patients with human epidermal growth factor receptor 2-negative breast cancer: cohort 1-triple-negative; cohort 2-hormone receptor-positive. MATERIALS AND METHODS Adults age ≥ 70 years with stage I-III breast cancer warranting neo/adjuvant chemotherapy were enrolled. Cohort 1 received weekly carboplatin (area under the curve 2) and weekly paclitaxel 80 mg/m2 for twelve weeks; cohort 2 received weekly paclitaxel 80 mg/m2 plus every-three-weekly cyclophosphamide 600 mg/m2 over twelve weeks. The primary study endpoint was feasibility, defined as ≥80% of patients receiving ≥80% of intended weeks/doses of therapy. All dose modifications were applied per clinician discretion. RESULTS Forty women (n = 20 per cohort) were enrolled from March 25, 2019 through August 3, 2020 from three centers; 45% and 35% of patients in cohorts 1 and 2 were age > 75, respectively. Neither cohort achieved targeted thresholds for feasibility. In cohort 1, eight (40.0%) met feasibility (95% confidence interval [CI] = 19.1-63.9%), while ten (50.0%) met feasibility in cohort 2 (95% CI = 27.2-72.8). Neutropenia was the most common grade 3-4 toxicity (cohort 1-65%, cohort 2-55%). In cohort 1, 80% and 85% required ≥1 dose holds of carboplatin and/or paclitaxel, respectively. In cohort 2, 10% required dose hold(s) for cyclophosphamide and/or 65% for paclitaxel. DISCUSSION In this pragmatic pilot examining chemotherapy regimens in older adults with breast cancer, neither regimen met target goals for feasibility. Developing efficacious and tolerable regimens for older patients with breast cancer who need chemotherapy remains an important goal. CLINICALTRIALS gov Identifier: NCT03858322.
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Affiliation(s)
- Rachel A Freedman
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Tianyu Li
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mina S Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Judith O Hopkins
- Novant Health Cancer Institute / SCOR NCORP, Winston Salem, NC, USA
| | - Nabihah Tayob
- Harvard Medical School, Boston, MA, USA; Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Meredith G Faggen
- Dana-Farber Brigham Cancer Center at South Shore Hospital, South Weymouth, MA, USA
| | - Natalie F Sinclair
- Dana-Farber Brigham Cancer Center at Milford Regional Medical Center, Milford, MA, USA
| | - Wendy Y Chen
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Heather A Parsons
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Erica L Mayer
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Paulina B Lange
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ameer S Basta
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Ruth I Lederman
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrew Wong
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Abhay Tiwari
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Sandra S McAllister
- Harvard Medical School, Boston, MA, USA; Hematology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Stem Cell Institute, Cambridge, MA, USA; Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Elizabeth A Mittendorf
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter G Miller
- Harvard Medical School, Boston, MA, USA; Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA; Center for Cancer Research, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher J Gibson
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Harold J Burstein
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Kimmick G, Sedrak MS, Williams G, McCleary NJ, Rosko AE, Berenberg JL, Freedman RA, Smith ML, Ahmed A, Muss HB, Chow S, Dale W. Infrastructure to Support Accrual of Older Adults to National Cancer Institute Clinical Trials. J Natl Cancer Inst Monogr 2022; 2022:151-158. [PMID: 36519814 PMCID: PMC9753220 DOI: 10.1093/jncimonographs/lgac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/30/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022] Open
Abstract
As part of ongoing efforts to meaningfully improve recruitment, enrollment, and accrual of older adults into cancer clinical trials, the National Cancer Institute (NCI) sponsored a workshop with experts across the country entitled Engaging Older Adults in the NCI Clinical Trials Network: Challenges and Opportunities. Three working groups, including Study Design, Infrastructure, and Stakeholders, were formed, who worked together to offer synergistic improvements in the system. Here, we summarize the workshop discussions of the Infrastructure Working Group, whose goal was to address infrastructural challenges, identify underlying resources, and offer solutions to facilitate accrual of older adults into cancer clinical trials. Based on preconference work and workshop discussions, four key recommendations to strengthen NCI infrastructure were proposed: 1) further centralize resources and expertise; 2) provide training for clinical research staff; (3) develop common data elements; and 4) evaluate what works and does not work. These recommendations provide a strategy to improve the infrastructure to enroll more older adults in cancer clinical trials.
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Affiliation(s)
- Gretchen Kimmick
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center/Duke Cancer Institute, Durham, NC, USA
| | - Mina S Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Grant Williams
- Institute for Cancer Outcomes & Survivorship and Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nadine J McCleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ashley E Rosko
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Jeffrey L Berenberg
- Department of Medicine, Division of Medical Oncology, Hawaii Minority Underserved National Cancer Institute Community Oncology Research Program, Honolulu, HI, USA
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Amina Ahmed
- Department of Obstetrics and Gynecology, Division of Gyn Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Selina Chow
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, USA
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Magnuson A, Van der Walde N, McKoy JM, Wildes TM, Wong ML, Le-Rademacher J, Little RF, Klepin HD. Integrating Geriatric Assessment Measures into National Cancer Institute Clinical Trials. J Natl Cancer Inst Monogr 2022; 2022:142-150. [PMID: 36519816 PMCID: PMC9949568 DOI: 10.1093/jncimonographs/lgac021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 12/23/2022] Open
Abstract
To improve the care of older adults with cancer, the traditional approach to clinical trial design needs to be reconsidered. Older adults are underrepresented in clinical trials with limited or no information on geriatric-specific factors, such as cognition or comorbidities. To address this knowledge gap and increase relevance of therapeutic clinical trial results to the real-life population, integration of aspects relevant to older adults is needed in oncology clinical trials. Geriatric assessment (GA) is a multidimensional tool comprising validated measures assessing specific health domains that are more frequently affected in older adults, including aspects related to physical function, comorbidity, medication use (polypharmacy), cognitive and psychological status, social support, and nutritional status. There are several mechanisms for incorporating either the full GA or specific GA measures into oncology therapeutic clinical trials to contribute to the overarching goal of the trial. Mechanisms include utilizing GA measures to better characterize the trial population, define trial eligibility, allocate treatment receipt within the context of the trial, develop predictive models for treatment outcomes, guide supportive care strategies, personalize care delivery, and assess longitudinal changes in GA domains. The objective of this manuscript is to review how GA measures can contribute to the overall goal of a clinical trial, to provide a framework to guide the selection and integration of GA measures into clinical trial design, and ultimately enable accrual of older adults to clinical trials by facilitating the design of trials tailored to older adults treated in clinical practice.
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Affiliation(s)
- Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA
| | - Noam Van der Walde
- Department of Radiation Oncology, West Cancer Center and Research Institute, University of Tennessee Health Science Center, Germantown, TN, USA
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tanya M Wildes
- Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine, Omaha, NE, USA
| | - Melisa L Wong
- Divisions of Hematology and Oncology and Geriatrics, Department of Internal Medicine, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | | | - Richard F Little
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Heidi D Klepin
- Correspondence to: Heidi D. Klepin, MD, MS, Section on Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA (e-mail: )
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The Interplay between Age and Viral Status in EBV-Related Nasopharyngeal and HPV-Related Oropharyngeal Carcinoma Patients. Cancers (Basel) 2022; 14:cancers14246170. [PMID: 36551656 PMCID: PMC9777049 DOI: 10.3390/cancers14246170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/08/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
Background. The aim of this work was to analyze the interplay between age and viral status on the outcomes in loco-regionally advanced oropharyngeal and nasopharyngeal cancer patients treated with radiotherapy and different chemotherapy combinations. Methods. A retrospective (2006−2017) analysis was performed on non-metastatic loco-regionally advanced oropharyngeal (both HPV+ and HPV−) and EBV+ nasopharyngeal cancer patients (young: <65 years vs. elderly: ≥65 years) treated with radiotherapy with or without chemotherapy. The impact of age and viral status on overall (OS) and disease-free survival (DFS) were studied with multivariable models, which were adjusted for smoking, stage, comorbidities, chemotherapy dose intensity and treatment strategy. Results. We analyzed 324 patients (146 HPV+ oropharynx, 63 HPV−, 115 nasopharynx). Elderly patients had more comorbidities, and received less intensive treatments when compared to younger subjects. Although OS and DFS were shorter in older patients, after adjustment for stage, smoking, comorbidities, treatment strategy and dose intensity, no significant differences in terms of survival were observed according to age (65 vs. 50 years of age: HR 1.89, 95% CI 0.45−7.84 for HPV+ OPC; HR 0.91, 95% CI 0.29−2.89 for HPV− OPC; HR 1.99, 95% CI 0.9−4.39 for NPC; p = 0.395). Conclusions. Several potential age-related (comorbidities, treatment intensity) and disease-related (stage) confounding factors play a prognostic role with differential impacts on both virus and non-virus-related tumors. In HPV+ oropharyngeal cancer and in EBV+ nasopharyngeal cancer patients, age should be considered as the expression of an array of host- and tumor-related features rather than an independent prognostic factor.
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Arora S, Fowler ME, Harmon C, Al-Obaidi M, Outlaw D, Hollis R, Gbolahan O, Khushman M, Giri S, Williams GR. Differences in Pretreatment Frailty Across Gastrointestinal Cancers in Older Adults: Results From the Cancer and Aging Resilience Evaluation Registry. JCO Oncol Pract 2022; 18:e1796-e1806. [PMID: 36075013 PMCID: PMC9653204 DOI: 10.1200/op.22.00270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/08/2022] [Accepted: 08/04/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Frailty predicts poor outcomes in older adults with cancer, but how it differs between different cancer types is unknown. We examined differences in pretreatment frailty between colorectal (CRC), pancreatic, and hepatobiliary cancers. METHODS We included older adults age 60 years or older with the above cancer types enrolled in the Cancer and Aging Resilience Evaluation registry. Frailty was defined using a 44-item Cancer and Aging Resilience Evaluation frailty index constructed on the basis of the principles of deficit accumulation (including several geriatric assessment impairments encompassing malnutrition, functional status, comorbidities, anxiety, depression, cognitive complaints, health-related quality of life, falls, ability to walk one block, interference in social activities, and polypharmacy). Multivariable logistic regression models were used to examine the adjusted odds ratio (aOR) of frailty between cancer types. RESULTS A total of 505 patients were included (mean age 70 years, 59% male): 211 (41.8%) CRC, 178 (35.2%)pancreatic cancer, and 116 (23.0%) hepatobiliary cancer. Patients with pancreatic cancer had the highest prevalence of frailty (23.3% CRC, 40.6% pancreatic, 34.3% hepatobiliary; P = .001). Both pancreatic (aOR, 2.18; 95% CI, 1.38 to 3.45), and hepatobiliary cancer (aOR, 1.73; 95% CI, 1.03 to 2.93) were independently associated with higher odds of frailty relative to CRC. Frailty was driven by higher rates of malnutrition and instrumental activities of daily living impairments in patients with pancreatic cancer and higher number of comorbidities in patients with hepatobiliary cancer. CONCLUSION Older adults with pancreatic and hepatobiliary cancers are at high-risk of pretreatment frailty. Early interventions to improve nutritional and functional status and optimization of comorbidities may help improve outcomes.
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Affiliation(s)
- Sankalp Arora
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Christian Harmon
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Darryl Outlaw
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Robert Hollis
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Olumide Gbolahan
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, GA
| | - Moh'd Khushman
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Smith Giri
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Grant R. Williams
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
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Kitamura H, Nakazawa J, Nagashima F, Andou M, Furuse J. The Prognostic Utility of a Geriatric Assessment for Patients with Pancreatic Cancer Receiving Gemcitabine-based Chemotherapy: A Prospective Observational Study. Intern Med 2022. [PMID: 36223928 DOI: 10.2169/internalmedicine.9689-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To evaluate the effect of a pretreatment geriatric assessment on the clinical outcomes in older patients with unresectable or recurrent pancreatic ductal adenocarcinoma (PDAC) scheduled to receive gemcitabine (GEM)/GEM+nab-paclitaxel (GnP). Patients Older patients with unresectable PDAC scheduled to receive GEM/GnP who visited Kyorin University Hospital and cooperating institutions were enrolled and followed from April 2015 to March 2020. The maximum observation period was two years. All patients underwent a cancer-specific geriatric assessment (CSGA) and optional geriatric assessment (GA) before treatment initiation and two months after the start of treatment. The patients' background characteristics, tumor progression, tumor site, and regimen (GEM/GnP) were examined in a Cox proportional hazards model. The relationship between the overall survival (OS) and GA score was also determined. Eligible patients (age ≥70 years old with histopathologically confirmed unresectable or recurrent PDAC) were scheduled to receive first-line chemotherapy. Results The performance status (PS) and activities of daily living (ADL)/instrumental ADL (IADL) scores at baseline correlated with the OS. Furthermore, even in cases with normal baseline values, lower Frontal Assessment Battery scores and higher Geriatric Depression Scale-Short Form scores after treatment initiation were significantly correlated with OS. Conclusion The baseline PS, ADL, and IADL may be prognostic factors in older PDAC patients. In addition, a normal frontal lobe function and depression scores prior to treatment initiation that rapidly worsened during treatment were independently associated with a reduced OS. Selecting appropriate interventions and improving the therapeutic environment may prolong the OS in such patients.
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Affiliation(s)
- Hiroshi Kitamura
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Japan
| | - Junichi Nakazawa
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Fumio Nagashima
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Japan
| | - Masahiko Andou
- Center for Advanced Medicine and Clinical Research, Nagoya University, Japan
| | - Junji Furuse
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Japan
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Jensen-Battaglia M, Lei L, Xu H, Loh KP, Wells M, Tylock R, Ramsdale E, Kleckner AS, Mustian KM, Dunne RF, Kehoe L, Bearden J, Burnette BL, Whitehead M, Mohile SG, Wildes TM. Communication About Fall Risk in Community Oncology Practice: The Role of Geriatric Assessment. JCO Oncol Pract 2022; 18:e1630-e1640. [PMID: 35984998 PMCID: PMC9835996 DOI: 10.1200/op.22.00173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/12/2022] [Accepted: 07/06/2022] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Falls are a modifiable source of morbidity for older adults with cancer, yet are underassessed in oncology practice. In this secondary analysis of a nationwide cluster-randomized controlled trial, we examined characteristics associated with patient-oncologist conversations about falls, and whether oncologist knowledge of geriatric assessment (GA) resulted in more conversations. METHODS Eligible patients (ClinicalTrials.gov identifier: NCT02107443) were age ≥ 70 years, had stage III/IV solid tumor or lymphoma, were being treated with noncurative treatment intent, and ≥ 1 GA domain impairment. Patients in both arms underwent GA. At practices randomly assigned to the intervention arm, oncologists were provided a GA summary with management recommendations. In both arms, patients had one clinical encounter audio-recorded, transcribed, and coded to categorize whether a conversation about falls occurred. Generalized linear mixed models adjusted for arm, practice site, and other important covariates were used to generate proportions and odds ratios (ORs) from the full sample. RESULTS Of 541 patients (intervention N = 293 and usual care N = 248, mean age: 77 years, standard deviation: 5.3), 528 had evaluable audio recordings. More patients had conversations about falls in the intervention versus usual care arm (61.3% v 10.3%, P < .001). Controlling for the intervention and practice site, history of falls (OR, 2.1; 95% CI, 1.3 to 3.6; P = .005) and impaired physical performance (OR, 4.7; 95% CI, 1.7 to 12.8; P = .002) were significantly associated with patient-oncologist conversations about falls. CONCLUSION GA intervention increased conversations about falls. History of falls and impaired physical performance were associated with patient-oncologist conversations about falls in community oncology practice.
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Affiliation(s)
- Marielle Jensen-Battaglia
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | - Huiwen Xu
- Department of Preventive Medicine and Population Health and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
| | - Kah Poh Loh
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Megan Wells
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Rachael Tylock
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Erika Ramsdale
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Amber S. Kleckner
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland Baltimore, Baltimore, MD
| | - Karen M. Mustian
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Richard F. Dunne
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Lee Kehoe
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | | | - Brian L. Burnette
- Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI
| | - Mary Whitehead
- SCOREboard Advisory Group, University of Rochester Medical Center, Rochester, NY
| | - Supriya G. Mohile
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
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Zurlo IV, Pozzo C, Strippoli A, Mignogna S, Basso M, Vivolo R, Trovato G, Ciaburri M, Morelli F, Bria E, Leo S, Tortora G. Safety and Efficacy of a First-Line Chemotherapy Tailored by G8 Score in Elderly Metastatic or Locally Advanced Gastric and Gastro-Esophageal Cancer Patients: A Real-World Analysis. Geriatrics (Basel) 2022; 7:geriatrics7050107. [PMID: 36286210 PMCID: PMC9601931 DOI: 10.3390/geriatrics7050107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/12/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Gastric (GC) and gastro-esophageal cancer (GEC) are common neoplasms in the elderly. However, in clinical practice, the correct strategy for elderly patients who might benefit from chemotherapy (CT) is unknown. Prospective data are still poor. In this context, we performed a retrospective analysis of GC patients aged ≥75 years and treated at our institutions. Material and Methods: We retrospectively analyzed 90 patients with confirmed metastatic GC or GEC, treated with an upfront CT. Inclusion criteria were patients aged ≥75 years, PS 0−2, normal bone marrow/liver/renal function and no major comorbidities. All patients received a G8 score, and some patients with G8 ≤14 received a comprehensive geriatric assessment (CGA). The primary goal was to perform a safety evaluation based on the incidence of adverse events (AE), and the secondary goal was to determine the efficacy (PFS and OS). The chi-square test and the Kaplan−Meier method were used to estimate the outcomes. The statistical significance level was set at p < 0.05. Results: Toxicity rates were quite low: G1/G2 (51.1%) and G3/G4 (25.5%). No toxic deaths were reported. The median PFS was 6.21 months and the median OS 11 months. The G8 score and PS ECOG significantly influenced both PFS and OS. A statistically significant correlation among G8, weight loss, hypoalbuminemia and risk of G3/G4 adverse events was also found. Conclusion: Our research on selected elderly patients did not detect broad differences of efficacy and tolerability compared to a young population. Our study, although retrospective and small-sized, showed that G8 score might be an accurate tool to identify elderly GC/GEC patients who could be safely treated with CT, further recognizing patients who could receive a doublet CT and who may require a single agent chemotherapy or a baseline dose reduction.
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Affiliation(s)
- Ina Valeria Zurlo
- Medical Oncology Unit, “Vito Fazzi” Hospital, 73100 Lecce, Italy
- Correspondence:
| | - Carmelo Pozzo
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Antonia Strippoli
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | | | - Michele Basso
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Raffaella Vivolo
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Giovanni Trovato
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Michele Ciaburri
- Geriatric Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Franco Morelli
- Medical Oncology Unit, Gemelli Molise, 86100 Campobasso, Italy
| | - Emilio Bria
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Silvana Leo
- Medical Oncology Unit, “Vito Fazzi” Hospital, 73100 Lecce, Italy
| | - Giampaolo Tortora
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
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