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Huang L, Zhang T, Wang K, Chang B, Fu D, Chen X. Postoperative Multimodal Analgesia Strategy for Enhanced Recovery After Surgery in Elderly Colorectal Cancer Patients. Pain Ther 2024:10.1007/s40122-024-00619-0. [PMID: 38836984 DOI: 10.1007/s40122-024-00619-0] [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: 04/24/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024] Open
Abstract
Enhanced Recovery After Surgery (ERAS) protocols have substantially proven their merit in diminishing recuperation durations and mitigating postoperative adverse events in geriatric populations undergoing colorectal cancer procedures. Despite this, the pivotal aspect of postoperative pain control has not garnered the commensurate attention it deserves. Typically, employing a multimodal analgesia regimen that weaves together nonsteroidal anti-inflammatory drugs, opioids, local anesthetics, and nerve blocks stands paramount in curtailing surgical complications and facilitating reduced convalescence within hospital confines. Nevertheless, this integrative pain strategy is not devoid of pitfalls; the specter of organ dysfunction looms over the geriatric cohort, rooted in the abuse of analgesics or the complex interplay of polypharmacy. Revolutionary research is delving into alternative delivery and release modalities, seeking to allay the inadvertent consequences of analgesia and thereby potentially elevating postoperative outcomes for the elderly post-colorectal cancer surgery populace. This review examines the dual aspects of multimodal analgesia regimens by comparing their established benefits with potential limitations and offers insight into the evolving strategies of drug administration and release.
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Affiliation(s)
- Li Huang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Tianhao Zhang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Kaixin Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Bingcheng Chang
- The Second Affiliated Hospital of Guizhou, University of Traditional Chinese Medicine, Guiyang, 550003, China
| | - Daan Fu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Ministry of Education, Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Wuhan, China.
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Ministry of Education, Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Wuhan, China.
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Agaciak M, Wassie MM, Simpson K, Cock C, Bampton P, Fraser R, Symonds EL. Surveillance colonoscopy findings in asymptomatic participants over 75 years of age. JGH Open 2024; 8:e13071. [PMID: 38699472 PMCID: PMC11062249 DOI: 10.1002/jgh3.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/06/2024] [Accepted: 04/12/2024] [Indexed: 05/05/2024]
Abstract
Background and Aim Surveillance colonoscopy for colorectal cancer (CRC) is generally not recommended beyond 75 years of age. The study determined incidence and predictors of advanced adenoma and CRC in older individuals undergoing surveillance colonoscopy. Methods This was a retrospective cohort study of asymptomatic older participants (≥75 years), enrolled in a South Australian CRC surveillance program who underwent colonoscopy (2015-2020). Clinical records were extracted for demographics, personal or family history of CRC, comorbidities, polypharmacy, and colonoscopy findings. The associations between clinical variables and advanced adenoma or CRC at surveillance were assessed with multivariable Poisson regression analysis. Results Totally 698 surveillance colonoscopies were analyzed from 574 participants aged 75-91 years (55.6% male). The incidence of CRC was 1.6% (11/698), while 37.9% (260/698) of procedures had advanced adenoma detected. Previous CRC (incidence rate ratio [IRR] 5.9, 95% CI 1.5-22.5), age ≥85 years (IRR 5.8, 95% CI 1.6-20.1) and active smoking (IRR 4.9, 95% CI 1.0-24.4) were independently associated with CRC diagnosis, while advanced adenoma at immediately preceding colonoscopy (IRR 1.6, 95% CI 1.3-2.0) and polypharmacy (IRR 1.2, 95% CI 1.0-1.5) were associated with advanced adenoma at surveillance colonoscopy in asymptomatic older participants (≥75 years). Conclusion Advanced neoplasia was found in more than one third of the surveillance procedures completed in this cohort. Continuation of surveillance beyond age 75 yeasrs may be considered in participants who have previous CRC or are active smokers (provided they are fit to undergo colonoscopy). In other cases, such as past advanced adenoma only, the need for ongoing surveillance should be considered alongside participant preference and health status.
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Affiliation(s)
- Madelyn Agaciak
- Department of Medicine, College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Molla M Wassie
- Flinders University, College of Medicine and Public HealthFlinders Health and Medical Research Institute, AdelaideBedford ParkSouth AustraliaAustralia
| | - Kalindra Simpson
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Charles Cock
- Flinders University, College of Medicine and Public HealthFlinders Health and Medical Research Institute, AdelaideBedford ParkSouth AustraliaAustralia
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Peter Bampton
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Robert Fraser
- Flinders University, College of Medicine and Public HealthFlinders Health and Medical Research Institute, AdelaideBedford ParkSouth AustraliaAustralia
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Erin L Symonds
- Flinders University, College of Medicine and Public HealthFlinders Health and Medical Research Institute, AdelaideBedford ParkSouth AustraliaAustralia
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
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Strobach D, Haimerl L, Mannell H, Stief CG, Karl A, Grimm T, Buchner A. The Characterization of Non-oncologic Chronic Drug Therapy in Bladder Cancer Patients and the Impact on Recurrence-Free and Cancer-Specific Survival: A Prospective Study. J Clin Med 2023; 12:6749. [PMID: 37959213 PMCID: PMC10648271 DOI: 10.3390/jcm12216749] [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: 09/14/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
We aimed to characterize non-oncologic chronic drug therapy of bladder cancer (BC) patients and evaluate a possible impact on recurrence-free (RFS) and cancer-specific survival (CSS). Patients with a first diagnosis (FD) of BC or radical cystectomy (RC) were included in a prospective, monocentric, observational study. Drugs and medical data was assessed at start and three-monthly for 24 months. Drugs were classified by anatomical-therapeutic-chemical code (ATC). Endpoints for outcome analysis were RFS and CSS in univariate (Kaplan-Meier curves and log-rank test, Cox regression for Hazard Ratio (HR)) and multivariate (Cox regression models) analyses. Of 113 patients, 52 had FD and 78 RC. Median age was 74 and 72 years, 83% and 82% were male. Drugs of 114 ATC classes were taken by 48 (92%) FD patients (median number 4.5/IQR 2-7.5) and 73 (94%) of RC patients (median 5/IQR 2-9). In univariate analysis (log-rank test (p)/Cox regression (HR, 95% CI, p)), polypharmacy (p = 0.036/HR = 2.83, 95% CI = 1.02-7.90, p = 0.047), calcium channel blockers (p = 0.046/HR = 2.47, 95% CI = 0.97-6.27, p = 0.057) and proton pump inhibitors (p = 0.015/HR = 3.16, 95% CI = 1.18-8.41, p = 0.022) had a significant negative impact on RFS in RC patients, statins (p = 0.025/HR = 0.14, 95% CI = 0.02-1.06, p = 0.057) a positive effect on RFS in FD patients, angiotensin-converting enzyme inhibitors (p = 0.008/HR = 10.74, 95% CI = 1.20-96.17, p = 0.034) and magnesium (p = 0.042/HR = 5.28, 95% CI = 0.88-31.59, p = 0.067) a negative impact on CSS in FD patients. In multivariate analysis, the only significant drug effects were the negative impact of angiotensin-converting enzyme inhibitors (HR = 15.20, 95% CI = 1.30-177.67, p = 0.030) and magnesium (HR = 22.87, 95% CI = 1.57-333.81), p = 0.022) on CSS in FD patients, and the positive impact of statins (HR = 0.12, 95% CI = 0.01-0.97, p = 0.047) on RFS in FD patients. Impact of non-oncologic drugs on RFS and CSS was small in this prospective study. Thus, appropriate treatment of comorbidities is encouraged.
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Affiliation(s)
- Dorothea Strobach
- Hospital Pharmacy and Doctoral Programm Clinical Pharmacy, LMU University Hospital, Marchioninistraße 15, 81377 Munich, Germany;
| | - Lisa Haimerl
- Hospital Pharmacy and Doctoral Programm Clinical Pharmacy, LMU University Hospital, Marchioninistraße 15, 81377 Munich, Germany;
| | - Hanna Mannell
- Physiology, Institute for Theoretical Medicine, Faculty of Medicine, University of Augsburg, Universitätsstraße 2, 86159 Augsburg, Germany;
| | - Christian G. Stief
- Department of Urology, LMU University Hospital, Marchioninistraße 15, 81377 Munich, Germany; (C.G.S.); (A.B.)
| | - Alexander Karl
- Department of Urology, Hospital Barmherzige Brüder, Romanstraße 93, 80639 Munich, Germany;
| | - Tobias Grimm
- Urology Practice Kaufbeuren, Gutenbergstraße 8, 87600 Kaufbeuren, Germany;
| | - Alexander Buchner
- Department of Urology, LMU University Hospital, Marchioninistraße 15, 81377 Munich, Germany; (C.G.S.); (A.B.)
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Galvin A, Amadéo B, Frasca M, Soubeyran P, Rondeau V, Delva F, Pérès K, Coureau G, Helmer C, Mathoulin-Pélissier S. Association between pre-diagnosis geriatric syndromes and overall survival in older adults with cancer (the INCAPAC study). J Geriatr Oncol 2023; 14:101539. [PMID: 37320933 DOI: 10.1016/j.jgo.2023.101539] [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: 12/01/2022] [Revised: 04/25/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Several population-based studies have reported disparities in overall survival (OS) among older patients with cancer. However, geriatric syndromes, known to be associated with OS in the geriatric population, were rarely studied. Thus, our aim was to identify the determinants of OS among French older adults with cancer, including geriatric syndromes before cancer diagnosis. MATERIALS AND METHODS Using cancer registries, we identified older subjects (≥65 years) with cancer in three French prospective cohort studies on aging from the Gironde department. Survival time was calculated from the date of diagnosis to the date of all-cause death or to the date of last follow-up, whichever came first. Demographic and socioeconomic characteristics, smoking status, self-rated health, cancer-related factors (stage at diagnosis, treatment), as well as geriatric syndromes (polypharmacy, activity limitation, depressive symptomatology, and cognitive impairment or dementia) were studied. Analyses were performed using Cox proportional hazard models for the whole population, then by age group (65-84 and 85+). RESULTS Among the 607 subjects included in the study, the median age at cancer diagnosis was 84 years. Smoking habits, activity limitations, cognitive impairment or dementia, advanced cancer stage and absence of treatment were significantly associated with lower OS in the analysis including the whole population. Women presented higher OS. Factors associated with OS differed by age group. Polypharmacy was inversely associated with OS in older adults aged 65-84 and 85 + . DISCUSSION Our findings support that geriatric assessment is needed to identify patients at higher risk of death and that an evaluation of activity limitation in older adults is essential. Improving early detection could enable interventions to address factors (activity limitations, cognitive impairment) associated with OS, potentially reducing disparities and lead to earlier palliative care.
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Affiliation(s)
- Angéline Galvin
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France.
| | - Brice Amadéo
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France
| | - Matthieu Frasca
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France
| | - Pierre Soubeyran
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Vinco team, UMR 1218, Bordeaux F-33000, France
| | - Virginie Rondeau
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Biostatistics team, UMR 1219, Bordeaux F-33000, France
| | - Fleur Delva
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France; Department of Public Health, Bordeaux University Hospital, Bordeaux F-3300, France
| | - Karine Pérès
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Sepia team, UMR 1219, Bordeaux F-33000, France
| | - Gaëlle Coureau
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France; Department of Public Health, Bordeaux University Hospital, Bordeaux F-3300, France
| | - Catherine Helmer
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Leha team, UMR 1219, Bordeaux F-33000, France
| | - Simone Mathoulin-Pélissier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France; Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonie, Comprehensive Cancer Center, Bordeaux F-33000, France
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Schöttker B, Chen LJ, Caspari R, Brenner H. Protocol of the optimal study: Optimization of polypharmacy in geriatric oncology - A randomized controlled trial. BMC Cancer 2023; 23:357. [PMID: 37072729 PMCID: PMC10111774 DOI: 10.1186/s12885-023-10812-7] [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: 02/15/2023] [Accepted: 04/05/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Polypharmacy is very common in older cancer patients and these patients are particularly vulnerable to drug-drug interactions and adverse drug reactions because they often receive chemotherapy and symptom-relieving agents. METHODS The primary aim of the randomized, controlled Optimization of Polypharmacy in Geriatric Oncology (OPTIMAL) trial is to test whether an advisory letter with the results of a comprehensive medication review conducted with the Fit fOR The Aged (FORTA) list to the caring physician in rehabilitation clinics improves the quality of life (QoL) of older cancer patients exposed to polypharmacy more than usual care. The FORTA list detects medication overuse, underuse, and potentially inappropriate drug use among older adults. In the oncology departments of approximately 10 German rehabilitation clinics, we aim to recruit 514 cancer patients (22 common cancers; diagnosis or recurrence requiring treatment in the last 5 years; all stages) who are ≥ 65 years old, regularly take ≥ 5 drugs, and have ≥ 1 medication-related problem. All necessary information about the patients will be provided to a pharmacist at the coordinating center (German Cancer Research Center, Heidelberg), who will perform randomization (1:1) and conduct the medication review with the FORTA list. For the intervention group only, the results are sent by letter to the treating physician in the rehabilitation clinics, who shall discuss medication changes with the patient at the discharge visit, as well as implement them afterwards and disclose them in the discharge letter to the general practitioner. The control group gets the usual care provided in German rehabilitation clinics, which usually does not include a comprehensive medication review but can include medication changes. Patients will be blinded, as they cannot know whether proposed medication changes were part of the study or part of usual care. Study physicians cannot be blinded. The primary endpoint will be the EORTC-QLQ-C30 global health status/QoL score, assessed via self-administered questionnaires 8 months after baseline. DISCUSSION If the planned study shows that a medication review with the FORTA list improves the QoL of older cancer patients in oncological rehabilitation more than usual care, it would provide the necessary evidence to translate the trial's findings into routine care. TRIAL REGISTRATION German Clinical Trials Register (DRKS): DRKS00031024.
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Affiliation(s)
- Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
| | - Li-Ju Chen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Reiner Caspari
- Rehabilitation Clinic Niederrhein, Hochstraße 13-19, 53474, Bad Neuenahr-Ahrweiler, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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Sadlonova M, Katz NB, Jurayj JS, Flores L, Celano CM, von Arnim CA, Silver JK. Surgical prehabilitation in older and frail individuals: a scoping review. Int Anesthesiol Clin 2023; 61:34-46. [PMID: 36815461 PMCID: PMC10006316 DOI: 10.1097/aia.0000000000000394] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Background: Older individuals who are scheduled for elective procedures often have co-morbidities at baseline and may be classified as frail. Both older age and frailty are associated with poor fitness and preoperative deconditioning, which can be predictors of postoperative complications. Prehabilitation aims to improve preoperative health in order to reduce complications and expedite postoperative recovery. To date, the effect of prehabilitation on improving outcomes in older and frail individuals is unclear, and the evidence in support of multi-modal treatments is evolving. Methods: In this scoping review, searches of PubMed and Cochrane Library between August 2012 and August 2022 were performed to identify studies investigating the efficacy of prehabilitation prior to surgical procedures. Results: A total of 36 articles were included in the review. Most of these examined the efficacy of unimodal (n=21) prehabilitation interventions, most commonly exercise therapy. Multimodal prehabilitation programs (n=15) included a variety of intervention components (e.g., exercise training, nutrition, psychological intervention or geriatric consultation). The most commonly studied populations were patients with gastrointestinal cancer (mostly colorectal cancer). Exercise therapy and multimodal interventions are likely to be of greatest impact on postoperative functional decline in patients awaiting total knee or hip arthroplasty, and cancer-related resection surgery (e.g., due to colorectal, gastric or lung cancer) in older and frail patients. Conclusions: Presurgical prehabilitation showed the potential to diminish postoperative outcomes in older and frail patients prior to surgery. However, adequately powered, randomized controlled, assessor blinded intervention trials demonstrating overall benefit of prehabilitation are needed. Aims This scoping review aims to summarize the current literature on the efficacy of prehabilitation in older and frail individuals who are undergoing surgical procedures in order to support clinical protocols and inform future research.
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Affiliation(s)
- Monika Sadlonova
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
- Department of Cardiovascular and Thoracic Surgery, University of Göttingen Medical Center, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Germany
| | - Nicole B. Katz
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Jane S. Jurayj
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Laura Flores
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Christopher M. Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, 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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Moodley Y, Govender K, van Wyk J, Reddy S, Ning Y, Wexner S, Stopforth L, Bhadree S, Naidoo V, Kader S, Cheddie S, Neugut AI, Kiran RP. Predictors of treatment refusal in patients with colorectal cancer: A systematic review. Semin Oncol 2022; 49:456-464. [PMID: 36754712 PMCID: PMC10023422 DOI: 10.1053/j.seminoncol.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/30/2023]
Abstract
This systematic review was conducted to investigate predictors of treatment refusal in colorectal cancer (CRC) patients. An understanding of these predictors would inform statistical models for the identification of high-risk patients who might benefit from interventions that seek to improve treatment compliance. We performed a search of PubMed and Scopus to identify potentially relevant studies on predictors of treatment refusal in CRC patients that were published between January 1, 2000 and December 31, 2021. We screened manuscripts using predefined eligibility criteria. Information on study design, study location, patient characteristics, treatments, rates and predictors of treatment refusal, and the impact of treatment refusal on mortality or survival were collected from eligible studies. Study quality was assessed using the Newcastle-Ottawa score. The overall findings of the review process were summarized using descriptive statistics and a narrative synthesis. A total of 13 studies were included in this review. Ten studies reported on refusal of CRC surgery, refusal rate: 0.25%-3.26%; three studies reported on chemotherapy refusal (one of which reported on both surgery and chemotherapy refusal), refusal rate: 7.8%-41.5%; and one study reported on refusal of any cancer treatment, refusal rate: 8.7%. The bulk of the published literature confirmed the harmful association between treatment refusal and poor survival outcomes in CRC patients. Frequently cited predictors of treatment refusal included patient demographic characteristics (age, race, gender), clinical characteristics (disease stage, comorbidity), and factors that impact access to cancer care services (healthcare insurance, facility level). Potentially high rates of treatment refusal pose a challenge to CRC control. This review has identified several factors which must be considered when attempting to reduce treatment refusal in CRC patients. Furthermore, these factors should be tested as components of predictive risk models for this important outcome.
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Affiliation(s)
- Yoshan Moodley
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Kumeren Govender
- Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Jacqueline van Wyk
- School of Clinical Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Department of Health Sciences Education, University of Cape Town, Cape Town, South Africa
| | - Seren Reddy
- Department of Electronic and Computer Engineering, Durban University of Technology, Durban, South Africa
| | - Yuming Ning
- Department of Surgery, Columbia University, New York, NY, USA
| | - Steven Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Laura Stopforth
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Shona Bhadree
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Vasudevan Naidoo
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Shakeel Kader
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Shalen Cheddie
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Alfred I Neugut
- Department of Medicine and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Ravi P Kiran
- Department of Surgery, Columbia University, New York, NY, USA
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Chen LJ, Nguyen TNM, Chang-Claude J, Hoffmeister M, Brenner H, Schöttker B. Incorporation of functional status, frailty, comorbidities, and co-medication in prediction models for colorectal cancer survival. Int J Cancer 2022; 151:539-552. [PMID: 35435251 DOI: 10.1002/ijc.34036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 11/08/2022]
Abstract
Limitations in functional status, frailty, multiple comorbidities, and co-medications are common among older colorectal cancer (CRC) patients. We investigated whether adding these factors could improve the predictive value of a reference model containing age, sex, tumor stage and location for prediction of 5-year overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), recurrence-free survival (RFS), and non-disease-specific survival (nDSS) for all CRC patients as well as for younger (<65 years) and older patients (≥65 years). Overall, 3,410 CRC patients from the DACHS study were analyzed and area under receiver operating characteristic curves (AUC) and net reclassification improvements (NRI) were assessed. In prediction of OS, the reference model plus functional status was identified as the best model among all CRC patients (AUC: 0.762) and younger CRC patients (AUC: 0.820). In older CRC patients, comorbidity should additionally be added (AUC: 0.747). For nDSS, the reference model plus comorbidity and frailty had the best predictive performance in all CRC patients (AUC: 0.776). For the outcomes DFS (AUC: 0. 727), DSS (AUC: 0. 838), and RFS (AUC: 0. 784), the reference model was already the best model in all CRC patients because no significant NRIs were observed. The pattern "The less CRC-specific the survival outcome and the older the CRC patients, the more relevant the inclusion of functional status, comorbidity, and frailty in CRC prognostic scores is" was observed. Thus, different nomograms for younger and older CRC patients for 1-, 3-, and 5-year OS prognosis estimation are being suggested.
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Affiliation(s)
- Li-Ju Chen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Thi Ngoc Mai Nguyen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Jenny Chang-Claude
- Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Cancer Epidemiology Group, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
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