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Conti C, Paillaud E, Laurent M, Poisson J, Boudou-Rouquette P, Frelaut M, Gay P, Canovas J, Caillet P, Mebarki S, Broussier A, Canouï-Poitrine F. Prognostic impact of neurocognitive disorders in older patients with cancer: the ELCAPA prospective cohort study. J Nutr Health Aging 2024; 28:100215. [PMID: 38518539 DOI: 10.1016/j.jnha.2024.100215] [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: 01/29/2024] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE To assess the prognostic value of neurocognitive disorder (NCD) for 12 month-overall mortality in patients aged 70 or more with a solid cancer. DESIGN prospective, observational, multicenter cohort. SETTING AND PARTICIPANTS We analyzed data from the ELCAPA longitudinal multicenter observational cohort of patients aged 70 or over, referred for a geriatric assessment (GA) before a new cancer treatment modality between January 31st, 2007, and December 29th, 2017. We defined the baseline NCD in four classes: no NCD, mild NCD, moderate NCD, and major NCD, based on the Mini-Mental State Examination (MMSE) score, memory complaint, and the Instrumental Activities of Daily Living (IADL) score. STATISTICAL METHODS We compared the baseline characteristics of patients according to NCD classes, globally and by pairs (with Bonferroni' correction). Prognosis value of NCD classes were analysed by using univariable and then multivariable 12 month survival analysis with age as time-variable and with and without adjustement for the treatment strategy (curative, palliative or exclusive supportive care). RESULTS 2784 patients with solid-cancer were included, with a median [interquartile range] age of 82 [78;86]. 36% of the patients were free of NCD, 34% had a mild NCD, 17% had a moderate NCD, and 13% had a major NCD. We identified the following independent prognostic factors for 12 month-overall mortality: NCD (adjusted hazard ratio (aHR) [95% confidence interval (CI)] for a major NCD = 1.54 [1.19-1.98] (p < 0.001), type of cancer, metastatic status, inpatient consultation, poor general health (assessed as the level of fatigue and Eastern Cooperative Oncology Group performance status [ECOG-PS]), greater weight loss, palliative treatment, and exclusive supportive care. Additional adjustment for the treatment strategy did not greatly change the strength of the association of a major NCD with 12 month-overall mortality (HR [95%CI] = 1.78 [1.39-2.29] (p < 0.001). CONCLUSION Our results suggest that the presence of a major NCD has direct prognostic value (independently of other geriatric factors, the type of cancer and the treatment strategy) in older patients with a solid cancer.
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Affiliation(s)
- Catherine Conti
- AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France; Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France.
| | - Elena Paillaud
- AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France; Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France
| | - Marie Laurent
- Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France; AP-HP, Hopital Henri-Mondor, Department of Internal Medicine and Geriatrics, F-94010 Creteil, France
| | - Johanne Poisson
- AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France; Université Paris-Cité, Center for Research on Inflammation, Inserm U1149, F-75018 Paris, France
| | | | | | - Pierre Gay
- AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France
| | - Johanna Canovas
- AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France
| | - Philippe Caillet
- AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France; Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France
| | - Soraya Mebarki
- AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France
| | - Amaury Broussier
- Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France; AP-HP, Hôpitaux Henri-Mondor/Emile Roux, Department of Geriatrics, F-94456 Limeil-Brevannes, F-94000 Créteil, France
| | - Florence Canouï-Poitrine
- Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France; AP-HP, Hopital Henri-Mondor, Public Health Departement, F-94010 Creteil, France
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Ramsdale E, Mohamed M, Holmes HM, Zubkoff L, Bauer J, Norton SA, Mohile S. Decreasing polypharmacy in older adults with cancer: A pilot cluster-randomized trial protocol. J Geriatr Oncol 2024; 15:101687. [PMID: 38302299 PMCID: PMC10923001 DOI: 10.1016/j.jgo.2023.101687] [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: 09/08/2023] [Revised: 11/02/2023] [Accepted: 12/07/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Polypharmacy is prevalent in older adults with cancer and associated with multiple adverse outcomes. A single-site, cluster-randomized clinical trial will enroll older adults with cancer and polypharmacy starting chemotherapy and will assess the effectiveness and feasibility of deprescribing interventions by comparing two arms: a pharmacist-led deprescribing intervention and a patient educational brochure. MATERIALS AND METHODS The study will be conducted in two phases. In phase I, focus groups and semi-structured individual interviews will guide adaptation of deprescribing interventions for the oncology clinic (phase Ia), and eight patients will undergo the pharmacist-led deprescribing intervention with iterative adaptations (phase Ib). In phase II, a pilot cluster-randomized trial (n = 72) will compare a pharmacist-led deprescribing intervention with a patient education brochure, with treating oncologists as the cluster. Both efficacy (relative dose intensity of planned chemotherapy, potentially inappropriate medications successfully deprescribed, chemotherapy toxicity, functional status, hospitalizations, falls, and symptoms) and implementation outcomes (barriers and facilitators) will be assessed. DISCUSSION This study is anticipated to provide pilot data to inform a nationwide randomized clinical trial of deprescribing in older adults starting cancer treatment. The cluster randomization is intended to provide an initial estimate for the intervention effect as well as oncologists' intra-class correlation coefficient. Deprescribing interventions may improve outcomes in older adults starting cancer treatment, but these interventions are understudied in this population, and it is unknown how best to implement them into oncology practice. The results of this trial will inform the design of large, randomized phase III trials of deprescribing. CLINICALTRIALS gov Identifier:NCT05046171. Date of registration: September 16, 2021.
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Affiliation(s)
- Erika Ramsdale
- James P. Wilmot Cancer Center, University of Rochester Medical Center, NY, USA.
| | - Mostafa Mohamed
- James P. Wilmot Cancer Center, University of Rochester Medical Center, NY, USA
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, McGovern Medical School, TX, USA
| | - Lisa Zubkoff
- Department of Medicine, University of Alabama at Birmingham, AL, USA
| | - Jessica Bauer
- James P. Wilmot Cancer Center, University of Rochester Medical Center, NY, USA
| | - Sally A Norton
- School of Nursing, University of Rochester Medical Center, NY, USA
| | - Supriya Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical Center, NY, USA
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Han CJ, Rosko AE, Spakowicz DJ, Hammer MJ, Von Ah D. Associations of frailty with symptoms, and HRQOL in older cancer survivors after cancer treatments: a systematic review and meta-analyses. Qual Life Res 2024; 33:583-598. [PMID: 37897643 DOI: 10.1007/s11136-023-03537-4] [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: 10/03/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE Frailty in older adult cancer survivors after cancer treatments is associated with various health outcomes. However, there is less agreement on how frailty affects symptoms and health-related quality of life (HRQOL). This systematic review and meta-analysis aimed to evaluate the current literature on frailty, symptoms, and HRQOL, as well as the associations of frailty with these factors in older adult cancer survivors with chemotherapy. METHODS A review was conducted on peer-reviewed publications from 2008 to 2023, using seven electronic databases. Meta-analyses were performed using random effects models to determine pooled effect estimates for frailty prevalence, symptom severity, and HRQOL scores. RESULTS A total of 26 studies involving older cancer survivors were included in the analysis. Most of these studies were conducted in Western countries and focused on White survivors, particularly those with breast cancer. The mean pooled prevalence of frailty was 43.5%. Among frail survivors, the most common symptoms reported after cancer treatments were pain (36.4%), neuropathy (34.1%), and fatigue (21.3%). Frailty was associated with higher pooled mean symptom severity (B = 1.23, p = 0.046) and lower functional HRQOL (B = - 0.31, p = 0.051, with marginal significance) after cancer treatments. CONCLUSION Frail older cancer survivors are at high risk of adverse symptoms and poor HRQOL after cancer treatment. Further research on screening for frailty is needed to prevent older adults from developing worse symptoms burden and maintain HRQOL. It is also essential to understand the mechanisms of the associations between frailty, symptoms and HRQOL in this population.
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Affiliation(s)
- Claire J Han
- Center for Healthy Aging, Self-Management and Complex Care, College of Nursing Columbus, The Ohio State University, Office 377, Newton Hall, 1585 Neil Avenue, Columbus, OH, 43210, USA.
- Cancer Survivorship and Control Survivorship, Ohio State University-James: Cancer Treatment and Research Center, Columbus, OH, USA.
| | - Ashley E Rosko
- Division of Hematology, The Ohio State University-James: Cancer Treatment and Research Center, Columbus, OH, USA
| | - Daniel J Spakowicz
- Division of Medical Oncology, Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Marilyn J Hammer
- Dana-Farber Cancer Institute, and Member of the Faculty, Medical Oncology Harvard Medical School, Boston, MA, USA
| | - Diane Von Ah
- Center for Healthy Aging, Self-Management and Complex Care, College of Nursing Columbus, The Ohio State University, Office 377, Newton Hall, 1585 Neil Avenue, Columbus, OH, 43210, USA
- Cancer Survivorship and Control Survivorship, Ohio State University-James: Cancer Treatment and Research Center, Columbus, OH, USA
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Mohamed MR, Rich DQ, Seplaki C, Lund JL, Flannery M, Culakova E, Magnuson A, Wells M, Tylock R, Mohile SG. Primary Treatment Modification and Treatment Tolerability Among Older Chemotherapy Recipients With Advanced Cancer. JAMA Netw Open 2024; 7:e2356106. [PMID: 38358742 PMCID: PMC10870189 DOI: 10.1001/jamanetworkopen.2023.56106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/21/2023] [Indexed: 02/16/2024] Open
Abstract
Importance Older adults with advanced cancer are less likely to tolerate treatment with cytotoxic chemotherapy compared with younger patients due to their aging-related conditions. Hence, oncologists sometimes opt to employ primary treatment modifications (deviation from standard of care) during the first cycle of chemotherapy. Objective To examine the association between primary treatment modification and treatment tolerability in older adults with advanced cancer who were starting new palliative chemotherapy regimens. Design, Setting, and Participants This cohort study was a secondary analysis of the GAP70+ (Geriatric Assessment Intervention for Reducing Toxicity in Older Patients with Advanced Cancer) trial, which was conducted between July 2014 and March 2019. The GAP70+ trial included patients aged 70 years or older who had advanced (ie, incurable) cancer, had 1 or more geriatric assessment domain impairments, and planned to start a new palliative chemotherapy regimen. Data analysis was conducted in November 2022. Exposures Receipt of standard-of-care chemotherapy regimens vs primary treatment modification defined as any change from National Comprehensive Cancer Network guidelines or published clinical trials (eg, primary dose reduction, schedule change). Main Outcomes and Measures Tolerability outcomes were assessed within 3 months of treatment. These outcomes included the following: (1) any grade 3 to 5 toxic effect, according to the National Cancer Institute Common Terminology Criteria for Adverse Events; (2) patient-reported functional decline, defined as the development of worse dependency in activities of daily living using scale scores; and (3) a composite adverse outcome (an end point that combined toxic effects, functional decline, and 6-month overall survival). Multivariable cluster-weighted generalized estimating equation models examined the association between primary treatment modification and outcomes adjusting for covariates. Results This study included 609 patients with a mean (SD) age of 77.2 (5.2) years; more than half (333 [54.7%]) were men. Race and ethnicity was available for 607 patients: 39 (6.4%) were Black, 539 (88.5%) were non-Hispanic White, and 29 (4.8%) were of other race or ethnicity. Nearly half (281 [46.1%]) received a primary modified treatment regimen. The most common cancer types were gastrointestinal cancer (228 [37.4%]) and lung cancer (174 [28.6%]). In multivariable analysis, primary treatment modification was associated with a reduced risk of grade 3 to 5 toxic effects (relative risk [RR], 0.85 [95% CI, 0.77-0.94]) and functional decline (RR, 0.80 [95% CI, 0.67-0.95]). Patients who received primary treatment modification had 32.0% lower odds of having a worse composite adverse outcome (odds ratio, 0.68 [95% CI, 0.48-0.97]). Conclusions and Relevance In this cohort study, primary treatment modification was associated with improved tolerability of chemotherapeutic regimens among older adults with advanced cancer and aging-related conditions. These findings may help optimize cancer treatment dosing in older adults with advanced cancer and aging-related conditions.
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Affiliation(s)
- Mostafa R. Mohamed
- Division of Hematology/Oncology, James P. Wilmot Cancer Institute, Department of Medicine, University of Rochester, Rochester, New York
| | - David Q. Rich
- Department of Public Health, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Christopher Seplaki
- Department of Public Health, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jennifer L. Lund
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Marie Flannery
- University of Rochester School of Nursing, Rochester, New York
| | - Eva Culakova
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Allison Magnuson
- Division of Hematology/Oncology, James P. Wilmot Cancer Institute, Department of Medicine, University of Rochester, Rochester, New York
| | - Megan Wells
- Division of Hematology/Oncology, James P. Wilmot Cancer Institute, Department of Medicine, University of Rochester, Rochester, New York
| | - Rachael Tylock
- Division of Hematology/Oncology, James P. Wilmot Cancer Institute, Department of Medicine, University of Rochester, Rochester, New York
| | - Supriya G. Mohile
- Division of Hematology/Oncology, James P. Wilmot Cancer Institute, Department of Medicine, University of Rochester, Rochester, New York
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Hamacher R, Liu X, Schuler MK, Hentschel L, Schöffski P, Kopp HG, Bauer S, Kasper B, Lindner L, Chemnitz JM, Crysandt M, Stein A, Steffen B, Richter S, Egerer G, Ivanyi P, Kunitz A, Grünwald V. A post hoc analysis of the EPAZ trial: The role of geriatric variables in elderly soft tissue sarcoma patients on toxicity and outcome. Eur J Cancer 2023; 181:145-154. [PMID: 36657323 DOI: 10.1016/j.ejca.2022.12.012] [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: 09/19/2022] [Revised: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The EPAZ study (NCT01861951) showed recently that pazopanib was non-inferior to doxorubicin in patients ≥60 years treated in first line for advanced soft tissue sarcoma . The current post-hoc analysis aimed to assess the prognostic impact of frailty. METHODS Geriatric assessments were evaluated at baseline. Age >75 years, liposarcoma, ECOG = 2, G8 ≤14, instrumental activities of daily living (IADL) ≥1 and Charlson Comorbidity Index ≥2 were tested for their impact on progression-free survival (PFS), overall survival (OS), CTCAE grade 3/4 adverse events (AEs) or serious AEs (SAEs), using univariate and multivariate analysis models. RESULTS univariate analysis showed an increased risk of grade 3/4 AEs and SAEs for ECOG = 2, G8 score ≤14 or IADL ≥1, independent of treatment. The multivariate analysis exhibited for pazopanib a significantly reduced risk for grade 3/4 AEs (HR 0.53; p = 0.033), and in patients with G8 ≤14 an increased risk for SAEs (HR 2.67; p = 0.011). In the multivariate analysis, G8 ≤14 was a negative prognostic factor for PFS (HR 1.82; p = 0.009) and IADL ≥1 for OS (HR 2.02; p = 0.007). ECOG = 2 was the strongest negative predictor for PFS (HR 4.39; p = 0.001) and OS (HR 3.74; p = 0.004). Neither age nor Charlson Comorbidity Index showed any impact on PFS, OS, incidence of grade 3/4 AEs or SAEs. CONCLUSIONS This post hoc analysis demonstrated that age is not a denominator for outcome or toxicity in elderly patients with soft tissue sarcoma . Instead, geriatric and functional assessments should be used to counsel patients and tailor therapy to individual needs. Moreover, pazopanib has a reduced risk for grade 3/4 AEs compared to doxorubicin.
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Affiliation(s)
- Rainer Hamacher
- Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Xiaofei Liu
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Markus K Schuler
- Division of Hematology, Oncology and Stem Cell Transplantation, Medical Clinic I, Department of Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Leopold Hentschel
- National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus, Dresden, Germany
| | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Hans-Georg Kopp
- Robert Bosch Centrum für Tumorerkrankungen Stuttgart, Stuttgart, Germany
| | - Sebastian Bauer
- Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Bernd Kasper
- Sarcoma Unit, Mannheim University Medical Center, Mannheim, Germany
| | - Lars Lindner
- Department of Medicine III, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Jens-Markus Chemnitz
- Community Hospital Middle Rine, Middle Rine, Germany; Department of Hematology, Oncology, Clinical Infectious Diseases, Clinical Immunology, Hemostaseology and Medical Intensive Care, University Hospital Cologne, Cologne, Germany
| | - Martina Crysandt
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Alexander Stein
- University Hospital Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | | | - Stephan Richter
- National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Philipp Ivanyi
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Medical School Hannover, Hannover, Germany
| | - Annegret Kunitz
- Vivantes Clinic Berlin-Spandau, Berlin-Spandau, Germany; Department of Hematology, Oncology and Tumor Immunology, University Hospital Charite, Berlin, Germany
| | - Viktor Grünwald
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany; Interdisciplinary Genitourinary Oncology at the West-German Cancer Center, Clinic for Internal Medicine (Tumor Research) and Clinic for Urology, University Hospital Essen, Essen, Germany.
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Management and Outcomes of Older Patients (Age ≥ 70 Years) with Advanced Soft Tissue Sarcoma and Role of Geriatric Assessment and Oncological Multidimensional Prognostic Index (Onco-MPI) in a Real-World Setting. Cancers (Basel) 2023; 15:cancers15041043. [PMID: 36831386 PMCID: PMC9953908 DOI: 10.3390/cancers15041043] [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: 11/13/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
Background: Incidences of soft tissue sarcomas (STS) steadily increase with age. Yet, despite the high prevalence in advanced age, older patients (pts) are underrepresented in sarcoma clinical trials and evidence-based guidelines for chemotherapy are lacking. International oncological societies suggest using geriatric tools to evaluate older patients with cancer to optimise treatment indication. Comprehensive geriatric assessment (CGA) is a multidimensional assessment of older subjects, based on which pts can be classified as fit, vulnerable or frail. Onco-MPI (multidimensional prognostic index) is a CGA-based score which also considers tumour characteristics, classifying pts into three risk groups of death at one year: high-risk, intermediate-risk and low-risk. Methods: This is a single-centre retrospective study which aims at describing real-word management and outcomes of older pts with advanced stage STS and at assessing the ability of CGA and onco-MPI to predict survival in these pts. Consecutive pts with advanced stage STS aged 70 years or older and treated at the Istituto Oncologico Veneto from January 2009 to June 2020 were retrieved from a prospectively maintained database. Pts' demographics, CGA assessments and tumour characteristics were analysed. Statistical analysis was performed with R version 3.4.3 Results: Out of 101 pts, with a median age of 77 years, 76 received chemotherapy (75.3%), which was anthracycline-based for 46 pts (60.5%). Anthracyclines were used in a higher proportion in fit pts (58.9% fit vs. 45.1% vulnerable vs. 12.5% frail pts). Frail pts and pts in the onco-MPI high-risk group experienced a higher rate of chemotherapy-related toxicities. Median OS was 13.8 months (95% CI 11.3-17.7 months). According to CGA, the median OS was 19.53 months (95% CI 15.23-36.8) for fit pts, 12.83 months (95% CI 9.7-17.5) for vulnerable and 7.75 months (95% CI 2.73-30) for frail pts (p = 0.005). Onco-MPI confirmed a predictive value for 1-year survival with intermediate risk pts not reaching a median OS at 1 year, and high-risk pts having a median one-year OS of 11.5 months (95%CI 9.7-NA), p = 0.02. In multivariate analysis, onco-MPI and CGA were associated with survival (high risk onco-MPI: HR 5.5, 95%CI 1.25-24.7 p = 0.02; fitness at CGA HR 0.552 95% 0.314-0.973; p = 0.040) as well as chemotherapy use (HR 0.24, 95% CI 0.11-0.51, p < 0.005). Conclusions: Both CGA and onco-MPI retain prognostic value for survival in pts with metastatic STS. Pts frail/vulnerable at CGA and pts within the onco-MPI high risk category should be offered an oncogeriatric management approach in order to optimise treatment-related survival and reduce toxicity.
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Shah HP, Cohen O, Sukys J, Dibble J, Mehra S. The impact of frailty on adjuvant treatment in patients with head and neck free flap reconstruction-A retrospective study using two independent frailty scores. Oral Oncol 2022; 132:106006. [PMID: 35835056 DOI: 10.1016/j.oraloncology.2022.106006] [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: 02/04/2022] [Revised: 05/17/2022] [Accepted: 06/27/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Reconstructive surgery may result in prolonged postoperative recovery, especially in frail patients, which in turn may impact delivery of adjuvant therapy. To date, no studies have investigated potential associations between frailty and adjuvant treatment delivery after reconstructive surgery. We examine the impact of frailty on time to initiation, duration, and completion of adjuvant treatment after reconstructive surgery for head and neck cancers (HNCs). METHODS A retrospective review of patients who underwent free flap reconstruction for HNC at a single institution from 2015 to 2021 and received adjuvant radiation was performed. Frailty was assessed using two independent scales: the 11-item modified frailty index (mFI) score and binary Johns Hopkins Adjusted Clinical Groups (ACG) frailty indicator. Timely adjuvant initiation (within six weeks of surgery), duration of adjuvant treatment, and completion were compared between frail and non-frail patients. RESULTS Of the 163 patients included for analysis, 52 (31.9%) were identified as frail by the ACG indicator and 24 (14.7%) were identified as frail with an mFI score ≥ 3. Frail patients (mFI score ≥ 3) were significantly less likely than non-frail patients to initiate adjuvant treatment within six weeks (OR:0.21, CI:0.04-0.85, p = 0.046). Frailty designated by either frailty scale was not significantly associated with adjuvant treatment duration. Likelihood of adjuvant treatment completion was significantly lower for frail compared to non-frail patients by both scales: ACG indicator (OR 0.02, CI:9.05 × 10-4-0.25, p = 0.007) and mFI score ≥ 3 (OR:0.01, CI:6.85 × 10-4-0.13, p = 0.007). CONCLUSIONS Frailty is associated with decreased likelihood of timely adjuvant treatment initiation and completion in patients with HNCs after free flap reconstruction.
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Affiliation(s)
- Hemali P Shah
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Oded Cohen
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Jordan Sukys
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Jacqueline Dibble
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Saral Mehra
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA.
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Frelaut M, Aupomerol M, Degousée L, Scotté F. [The place of support care]. SOINS. GERONTOLOGIE 2022; 27:21-29. [PMID: 36280368 DOI: 10.1016/j.sger.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Supportive care, in the context of breast cancer in the elderly, is part of standard oncogeriatric care. Nevertheless, the multidisciplinary reinforcement of the different transversal teams can support the global approach, that is essential to the quality of care and the life course. Evaluation is the basis of this management. As a result of this evaluation, the approach to sexual health is a novelty that is often insufficiently considered with elderly patients suffering from breast malignancy.
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Affiliation(s)
| | - Marion Aupomerol
- Service de pathologie mammaire et de gynécologie, département de médecine oncologique
| | - Lena Degousée
- Service de pathologie mammaire et de gynécologie, département de médecine oncologique
| | - Florian Scotté
- DIOPP, Gustave-Roussy, 114 rue Édouard-Vaillant, 94805 Villejuif, France.
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Ortland I, Mendel Ott M, Kowar M, Sippel C, Ko YD, Jacobs AH, Jaehde U. Medication risks in older patients (70 +) with cancer and their association with therapy-related toxicity. BMC Geriatr 2022; 22:716. [PMID: 36042410 PMCID: PMC9429305 DOI: 10.1186/s12877-022-03390-z] [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: 04/30/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background To evaluate medication-related risks in older patients with cancer and their association with severe toxicity during antineoplastic therapy. Methods This is a secondary analysis of two prospective, single-center observational studies which included patients ≥ 70 years with cancer. The patients’ medication lists were investigated regarding possible risks: polymedication (defined as the use of ≥ 5 drugs), potentially inappropriate medication (PIM), and relevant potential drug-drug interactions (rPDDI). The risks were analyzed before and after start of cancer therapy. Severe toxicity during antineoplastic therapy was captured from medical records according to the Common Terminology Criteria for Adverse Events (CTCAE). The association between grade ≥ 3 toxicity and medication risks was evaluated by univariate as well as multivariate regression adjusted by ECOG and age. Results The study cohort comprised 136 patients (50% female, mean age 77 years, 42% hematological malignancies). Before the start of cancer therapy, patients took on average 5 drugs as long-term medication and 52% of patients were exposed to polymedication. More than half of patients used at least one PIM. Approximately one third of patients exhibited rPDDI. The prevalence of medication risks increased after start of cancer therapy. rPDDI were significantly associated with severe overall toxicity (OR, 5.07; p = 0.036; 95% Confidence Interval (CI) 1.11–23.14; toxicity in patients with rPDDI 94.1% (32/34) vs 75.9% (60/79) in patients without rPDDI) and hematological toxicity (OR, 3.95; p = 0.010; 95% CI 1.38–11.29; hematological toxicity in patients with rPDDI 85.3% (29/34) vs 59.5% (47/79) in patients without rPDDI). In the multivariate analysis adjusted by ECOG and age, only the association for rPDDI with hematological toxicity remained statistically significant (OR, 4.51; p = 0.007; 95% CI 1.52–13.38). These findings should be further investigated in larger studies. Conclusion Medication risks are common in older patients with cancer and might be associated with toxicity. This raises the need for tailored interventions to ensure medication safety in this patient cohort. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03390-z.
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Affiliation(s)
- Imke Ortland
- Institute of Pharmacy, Department of Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany
| | - Monique Mendel Ott
- Institute of Pharmacy, Department of Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany
| | - Michael Kowar
- Department of Geriatrics and Neurology, Johanniter Hospital Bonn, Johanniterstr. 1-3, 53113, Bonn, Germany
| | - Christoph Sippel
- Department of Oncology and Hematology, Johanniter Hospital Bonn, Johanniterstr. 1-3, 53113, Bonn, Germany
| | - Yon-Dschun Ko
- Department of Oncology and Hematology, Johanniter Hospital Bonn, Johanniterstr. 1-3, 53113, Bonn, Germany
| | - Andreas H Jacobs
- Department of Geriatrics and Neurology, Johanniter Hospital Bonn, Johanniterstr. 1-3, 53113, Bonn, Germany
| | - Ulrich Jaehde
- Institute of Pharmacy, Department of Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany.
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10
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Zuccarino S, Monacelli F, Antognoli R, Nencioni A, Monzani F, Ferrè F, Seghieri C, Antonelli Incalzi R. Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review. Cancers (Basel) 2022; 14:cancers14133235. [PMID: 35805005 PMCID: PMC9265029 DOI: 10.3390/cancers14133235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary The Comprehensive Geriatric Assessment is a multidimensional and multidisciplinary evaluation designed for elderly patients with the goal of structuring tailored care and follow-up. Despite the known benefits of this approach, the Comprehensive Geriatric Assessment is not universally applied to elderly cancer patients due to economic and practical barriers. This narrative review aims to investigate the cost-effectiveness of the Comprehensive Geriatric Assessment adopted in geriatric oncology. The results revealed a lack of research on the topic, but recurrent cost-saving effects of this approach in geriatric oncology settings were highlighted—suggesting a positive cost-effectiveness ratio. Further structured research with comprehensive economic evaluations is needed to confirm these findings. Abstract The Comprehensive Geriatric Assessment (CGA) and the corresponding geriatric interventions are beneficial for community-dwelling older persons in terms of reduced mortality, disability, institutionalisation and healthcare utilisation. However, the value of CGA in the management of older cancer patients both in terms of clinical outcomes and in cost-effectiveness remains to be fully established, and CGA is still far from being routinely implemented in geriatric oncology. This narrative review aims to analyse the available evidence on the cost-effectiveness of CGA adopted in geriatric oncology, identify the relevant parameters used in the literature and provide recommendations for future research. The review was conducted using the PubMed and Cochrane databases, covering published studies without selection by the publication year. The extracted data were categorised according to the study design, participants and measures of cost-effectiveness, and the results are summarised to state the levels of evidence. The review conforms to the SANRA guidelines for quality assessment. Twenty-nine studies out of the thirty-seven assessed for eligibility met the inclusion criteria. Although there is a large heterogeneity, the overall evidence is consistent with the measurable benefits of CGA in terms of reducing the in-hospital length of stay and treatment toxicity, leaning toward a positive cost-effectiveness of the interventions and supporting CGA implementation in geriatric oncology clinical practice. More research employing full economic evaluations is needed to confirm this evidence and should focus on CGA implications both from patient-centred and healthcare system perspectives.
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Affiliation(s)
- Sara Zuccarino
- Management and Health Laboratory, Institute of Management–Department Embeds, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy; (F.F.); (C.S.)
- Correspondence: (S.Z.); (F.M.); (R.A.I.)
| | - Fiammetta Monacelli
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, 16132 Genoa, Italy; (F.M.); (A.N.)
- IRCSS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Rachele Antognoli
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, 56126 Pisa, Italy;
| | - Alessio Nencioni
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, 16132 Genoa, Italy; (F.M.); (A.N.)
- IRCSS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, 56126 Pisa, Italy;
- Correspondence: (S.Z.); (F.M.); (R.A.I.)
| | - Francesca Ferrè
- Management and Health Laboratory, Institute of Management–Department Embeds, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy; (F.F.); (C.S.)
| | - Chiara Seghieri
- Management and Health Laboratory, Institute of Management–Department Embeds, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy; (F.F.); (C.S.)
| | - Raffaele Antonelli Incalzi
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University, 00128 Rome, Italy
- Correspondence: (S.Z.); (F.M.); (R.A.I.)
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11
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de Vries J, Poelman A, Sidorenkov G, Festen S, de Bock GH, Langendijk JA, van der Laan BFAM, Steenbakkers RJHM, Halmos GB. The association of frailty and outcomes of geriatric assessment with acute radiation-induced toxicity in patients with head and neck cancer. Oral Oncol 2022; 130:105933. [PMID: 35665634 DOI: 10.1016/j.oraloncology.2022.105933] [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: 04/13/2022] [Accepted: 05/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Geriatric impairments and frailty are highly prevalent in patients with head and neck cancer (HNC). This study investigated the association of frailty and outcomes of geriatric assessment (GA) with radiation-induced toxicity (RIT) in patients undergoing (chemo)radiotherapy ((C)RT) for HNC. MATERIALS AND METHODS Between October 2014 and April 2016, patients with HNC were prospectively included in OncoLifeS, an institutional data-biobank. Before treatment initiation, patients underwent GA and frailty screening (Groningen Frailty Indicator and Geriatric 8). The main outcome of this study was RIT (weight loss, mucositis, salivary gland inflammation, oral pain, sore throat, hoarseness, dry mouth, dysgeusia, dysphagia and general pain) according to the common terminology criteria of adverse events (CTCAE) version 4.0. Linear mixed models were performed, to analyse factors associated with increasing mean RIT over time during the treatment period. RESULTS 160 patients were included. 114 (71.3%) were male and the mean age was 66.1 years. Age ≥ 65 (β = 0.03(95 %CI = 0.01;0.05), p = 0.01), regional RT (β = 0.05(95 %CI = 0.02;0.09), p = 0.004), and concurrent chemotherapy (β = 0.04(95 %CI = 0.02;0.07), p = 0.001), were independent factors associated with increasing toxicity during the 7-week treatment period, adjusted for relevant covariates. None of the single items of GA, as well as the frailty screening instruments, were associated with increasing RIT. CONCLUSION In this study, frailty and GA were not associated with additional RIT during treatment. These results suggest that (C)RT is equally tolerated in frail and non-frail patients, with respect to acute RIT. RT could be a suitable alternative to surgery in selected frail patients.
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Affiliation(s)
- Julius de Vries
- University of Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, Groningen, the Netherlands.
| | - Anouk Poelman
- University of Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Grigory Sidorenkov
- University of Groningen, Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Suzanne Festen
- University of Groningen, University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Geertruida H de Bock
- University of Groningen, Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Johannes A Langendijk
- University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, the Netherlands
| | - Bernard F A M van der Laan
- University of Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, Groningen, the Netherlands; Haaglanden Medical Center, Department of Otorhinolaryngology, Head and Neck Surgery, The Hague, the Netherlands
| | - Roel J H M Steenbakkers
- University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, the Netherlands
| | - Gyorgy B Halmos
- University of Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, Groningen, the Netherlands
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12
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Lemij AA, de Glas NA, Derks MGM, Bastiaannet E, Merkus JWS, Lans TE, van der Pol CC, van Dalen T, Vulink AJE, van Gerven L, Guicherit OR, Linthorst-Niers EMH, van den Bos F, Kroep JR, Liefers GJ, Portielje JEA. Discontinuation of adjuvant endocrine therapy and impact on quality of life and functional status in older patients with breast cancer. Breast Cancer Res Treat 2022; 193:567-577. [PMID: 35441273 PMCID: PMC9114046 DOI: 10.1007/s10549-022-06583-7] [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: 02/24/2022] [Accepted: 03/27/2022] [Indexed: 11/25/2022]
Abstract
Purpose Side effects are the main reason for discontinuation of adjuvant endocrine therapy in older adults. The aim of this study was to examine geriatric predictors of treatment discontinuation of adjuvant endocrine therapy within the first 2 years after initiation, and to study the association between early discontinuation and functional status and quality of life (QoL). Methods Patients aged ≥ 70 years with stage I–III breast cancer who received adjuvant endocrine therapy were included. The primary endpoint was discontinuation of endocrine therapy within 2 years. Risk factors for discontinuation were assessed using univariate logistic regression models. Linear mixed models were used to assess QoL and functional status over time. Results Overall, 258 patients were included, of whom 36% discontinued therapy within 2 years after initiation. No geriatric predictive factors for treatment discontinuation were found. Tumour stage was inversely associated with early discontinuation. Patients who discontinued had a worse breast cancer-specific QoL (b = − 4.37; 95% CI − 7.96 to − 0.78; p = 0.017) over the first 2 years, in particular on the future perspective subscale (b = − 11.10; 95% CI − 18.80 to − 3.40; p = 0.005), which did not recover after discontinuation. Treatment discontinuation was not associated with functional improvement. Conclusion A large proportion of older patients discontinue adjuvant endocrine treatment within 2 years after initiation, but geriatric characteristics are not predictive of early discontinuation of treatment. Discontinuation of adjuvant endocrine therapy did not positively affect QoL and functional status, which implies that the observed poorer QoL in this group is probably not caused by adverse effects of endocrine therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06583-7.
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Affiliation(s)
- Annelieke A Lemij
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Nienke A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marloes G M Derks
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos W S Merkus
- Department of Surgery, Haga Hospital, The Hague, The Netherlands
| | - Titia E Lans
- Department of Surgery, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | | | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - Annelie J E Vulink
- Department of Medical Oncology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Leander van Gerven
- Department of Internal Medicine, LangeLand Hospital, Zoetermeer, The Netherlands
| | - Onno R Guicherit
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - Frederiek van den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerrit Jan Liefers
- Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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13
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Htoo PT, Measer G, Orr R, Bohn J, Sorbello A, Francis H, Dutcher SK, Cosgrove A, Carruth A, Toh S, Cocoros NM. Evaluating Confounding Control in Estimations of Influenza Antiviral Effectiveness in Electronic Health Plan Data. Am J Epidemiol 2022; 191:908-920. [PMID: 35106530 DOI: 10.1093/aje/kwac020] [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] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 01/17/2022] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Observational studies of oseltamivir use and influenza complications could suffer from residual confounding. Using negative control risk periods and a negative control outcome, we examined confounding control in a health-insurance-claims-based study of oseltamivir and influenza complications (pneumonia, all-cause hospitalization, and dispensing of an antibiotic). Within the Food and Drug Administration's Sentinel System, we identified individuals aged ≥18 years who initiated oseltamivir use on the influenza diagnosis date versus those who did not, during 3 influenza seasons (2014-2017). We evaluated primary outcomes within the following 1-30 days (the primary risk period) and 61-90 days (the negative control period) and nonvertebral fractures (the negative control outcome) within days 1-30. We estimated propensity-score-matched risk ratios (RRs) per season. During the 2014-2015 influenza season, oseltamivir use was associated with a reduction in the risk of pneumonia (RR = 0.72, 95% confidence interval (CI): 0.70, 0.75) and all-cause hospitalization (RR = 0.54, 95% CI: 0.53, 0.55) in days 1-30. During days 61-90, estimates were near-null for pneumonia (RR = 1.04, 95% CI: 0.95, 1.15) and hospitalization (RR = 0.94, 95% CI: 0.91, 0.98) but slightly increased for antibiotic dispensing (RR = 1.14, 95% CI: 1.08, 1.21). The RR for fractures was near-null (RR = 1.09, 95% CI: 0.99, 1.20). Estimates for the 2016-2017 influenza season were comparable, while the 2015-2016 season had conflicting results. Our study suggests minimal residual confounding for specific outcomes, but results differed by season.
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14
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The Impact of Cognitive Impairment on Treatment Toxicity, Treatment Completion, and Survival among Older Adults Receiving Chemotherapy: A Systematic Review. Cancers (Basel) 2022; 14:cancers14061582. [PMID: 35326733 PMCID: PMC8946153 DOI: 10.3390/cancers14061582] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Although cognitive impairment is common among older adults, the relationship between cognitive impairment and its effect on cancer outcomes is unclear. We conducted a systematic review of the literature to examine how toxicity risk, treatment completion, and survival may be impacted by chemotherapy in patients exhibiting evidence of cognitive impairment. Despite an absence of clear parallels between the severity of cognitive impairment and cancer outcomes, we found statistically significant relationships with survival in several studies and with toxicity in one study. An overall lack of robust evidence indicates the need for further research on the role of cognitive impairment in predicting survival, treatment completion, and toxicity among older adults receiving chemotherapy. Abstract Cognitive impairment (CI) is common among older adults with cancer, but its effect on cancer outcomes is not known. This systematic review sought to identify research investigating clinical endpoints (toxicity risk, treatment completion, and survival) of chemotherapy treatment in those with baseline CI. A systematic search of five databases (inception to March 2021) was conducted. Eligible studies included randomized trials, prospective studies, and retrospective studies in which the sample or a subgroup were older adults (aged ≥ 65) screened positive for CI prior to receiving chemotherapy. Risk of bias assessment was performed using the Quality in Prognosis Studies (QUIPS) tool. Twenty-three articles were included. Sample sizes ranged from n = 31 to 703. There was heterogeneity of cancer sites, screening tools and cut-offs used to ascertain CI, and proportion of patients with CI within study samples. Severity of CI and corresponding proportion of each level within study samples were unclear in all but one study. Among studies investigating CI in a qualified multivariable model, statistically significant findings were found in 4/6 studies on survival and in 1/1 study on nonhematological toxicity. The lack of robust evidence indicates a need for further research on the role of CI in predicting survival, treatment completion, and toxicity among older adults receiving chemotherapy, and the potential implications that could shape treatment decisions.
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15
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The Impact of Frailty Screening on Radiation Treatment Modification. Cancers (Basel) 2022; 14:cancers14041072. [PMID: 35205820 PMCID: PMC8870720 DOI: 10.3390/cancers14041072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Care overburden makes it difficult to perform comprehensive geriatric assessments (CGAs) in oncology settings. We analyzed if screening tools modified radiotherapy in oncogeriatric patients. METHODS Patients ≥ 65 years, irradiated between December 2020 and March 2021 at the Hospital Provincial de Castellón, completed the frailty G8 and estimated survival Charlson questionnaires. The cohort was stratified between G8 score ≤ 14 (fragile) or >14 (robust); the cutoff point for the Charlson index was established at five. RESULTS Of 161 patients; 69.4% were male, the median age was 75 years (range 65-91), and the prevailing performance status (PS) was 0-1 (83.1%). Overall, 28.7% of the cohort were frail based on G8 scores, while the estimated survival at 10 years was 2.25% based on the Charlson test. The treatment administered changed up to 21% after frailty analysis. The therapies prescribed were 5.8 times more likely to be modified in frail patients based on the G8 test. In addition, patients ≥ 85 years (p = 0.01), a PS ≥ 2 (p = 0.008), and limited mobility (p = 0.024) were also associated with a potential change. CONCLUSIONS CGAs remain the optimal assessment tool in oncogeriatry. However, we found that the G8 fragility screening test, which is easier to integrate into patient consultations, is a reliable and efficient aid to rapid decision making.
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16
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Yekedüz E, Aktaş EG, Köksoy EB, Doğan N, Ürün Y, Utkan G. The prognostic role of polypharmacy in metastatic colorectal cancer patients treated with regorafenib. Future Oncol 2022; 18:1067-1076. [PMID: 35109668 DOI: 10.2217/fon-2021-1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate polypharmacy (PP) in patients with metastatic colorectal cancer receiving regorafenib. Methods: Patients with metastatic colorectal cancer receiving regorafenib were included and divided into two categories by their PP status: PP- (<5 regular drug use/day) and PP+ (≥5 regular drug use/day). Results: 80 patients were included. 31 (38.7%) patients had PP. The median number of drugs used was three and seven in PP- and PP+ patients, respectively. Antiemetics (26.5%) and antacids (48.4%) were the most common drugs used by PP- and PP+ patients, respectively. In multivariate analysis, the risk of death was higher in PP+ patients (hazard ratio: 2.1; 95% CI: 1.2-3.7; p = 0.005). Conclusion: PP was an independent prognostic factor for overall survival in patients with metastatic colorectal cancer receiving regorafenib.
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Affiliation(s)
- Emre Yekedüz
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, 06590, Turkey.,Ankara University Cancer Research Institute, Ankara, 06590, Turkey
| | - Elif Gizem Aktaş
- Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, 06590, Turkey
| | - Elif Berna Köksoy
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, 06590, Turkey.,Ankara University Cancer Research Institute, Ankara, 06590, Turkey
| | - Neslihan Doğan
- Medical Oncology Clinic, Prof Dr A İlhan Özdemir Training and Research Hospital, Giresun University, Giresun, 28100, Turkey
| | - Yüksel Ürün
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, 06590, Turkey.,Ankara University Cancer Research Institute, Ankara, 06590, Turkey
| | - Güngör Utkan
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, 06590, Turkey.,Ankara University Cancer Research Institute, Ankara, 06590, Turkey
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17
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Muzyka M, Tagliafico L, Serafini G, Baiardini I, Braido F, Nencioni A, Monacelli F. Neuropsychiatric Disorders and Frailty in Older Adults over the Spectrum of Cancer: A Narrative Review. Cancers (Basel) 2022; 14:258. [PMID: 35008421 PMCID: PMC8796027 DOI: 10.3390/cancers14010258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The interplay between different neuropsychiatric conditions, beyond dementia, in the presence of a diagnosis of cancer in older adults may mediate patients' fitness and cancer-related outcomes. Here, we aimed to investigate the presence of depression, sleep disturbances, anxiety, attitude, motivation, and support in older adults receiving a diagnosis of cancer and the dimension of frailty in order to understand the magnitude of the problem. METHODS This review provides an update of the state of the art based on references from searches of PubMed between 2000 and June 2021. RESULTS The evidence obtained underscored the tight association between frailty and unfavorable clinical outcomes in older adults with cancer. Given the intrinsic correlation of neuropsychiatric disorders with frailty in the realm of cancer survivorship, the evidence showed they might have a correlation with unfavorable clinical outcomes, late-life geriatric syndromes and higher degree of frailty. CONCLUSIONS The identification of common vulnerabilities among neuropsychiatric disorders, frailty, and cancer may hold promise to unmask similar shared pathways, potentially intercepting targeted new interventions over the spectrum of cancer with the delivery of better pathways of care for older adults with cancer.
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Affiliation(s)
- Mariya Muzyka
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Luca Tagliafico
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Gianluca Serafini
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
| | - Ilaria Baiardini
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
| | - Fulvio Braido
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Alessio Nencioni
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Fiammetta Monacelli
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
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18
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Crouch A, Champion V, Von Ah D. Cognitive Dysfunction in Older Breast Cancer Survivors: An Integrative Review. Cancer Nurs 2022; 45:E162-E178. [PMID: 34870942 PMCID: PMC8649173 DOI: 10.1097/ncc.0000000000000896] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Approximately 60% of the more than 3.8 million breast cancer survivors (BCSs) living in the United States are 60 years or older. Breast cancer survivors experience many symptoms including cognitive dysfunction; however, little is known regarding how age affects these symptoms. OBJECTIVE This integrative review was conducted to synthesize the literature on cognitive dysfunction in older BCSs. The purpose was to (1) describe the prevalence of objective and subjective cognitive dysfunctions and (2) examine factors associated with cognitive dysfunction in older BCSs. METHODS Whittemore and Knafl's integrative review methodology was used to examine cognitive dysfunction in BCSs 60 years or older. RESULTS Twelve quantitative studies were included. Up to 41% of older BCSs experienced cognitive dysfunction on neuropsychological examination, and up to 64% reported cognitive dysfunction on subjective measures pretreatment. Approximately half of older BCSs experienced cognitive decline from pretreatment to posttreatment regardless of cognitive measure. The domains most impacted were memory, executive functioning, and processing speed. Objective and subjective cognitive dysfunctions were associated with age, comorbidities, chemotherapy receipt, sleep, neuropsychological symptom cluster, frailty, and quality of life. CONCLUSIONS Cognitive dysfunction among older BCSs was common both prior to and following treatment. Cognitive dysfunction was associated with multiple factors that are compounded in the aging population and could be detrimental to quality of life and independent living. IMPLICATIONS TO PRACTICE Early assessment and intervention by healthcare providers, including nurses, for cognitive dysfunction in older BCSs are essential. Future research should focus on evidence-based interventions for cognitive dysfunction incorporating the unique needs of older BCSs.
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Affiliation(s)
- Adele Crouch
- Author Affiliation: Indiana University School of Nursing, Indianapolis
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19
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Ho YW, Tang WR, Chen SY, Lee SH, Chen JS, Hung YS, Chou WC. Association of frailty and chemotherapy-related adverse outcomes in geriatric patients with cancer: a pilot observational study in Taiwan. Aging (Albany NY) 2021; 13:24192-24204. [PMID: 34747717 PMCID: PMC8610137 DOI: 10.18632/aging.203673] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/28/2021] [Indexed: 12/27/2022]
Abstract
Background: With the rapid growth of the elderly population and the increasing incidence of cancer, an increasing number of geriatric patients are receiving cancer treatment, making the selection of appropriate treatment an important issue. Increasing studies have confirmed that frailty can predict adverse outcomes in geriatric patients with cancer after treatment, but local data from Taiwan are lacking. Therefore, this study aimed to investigate the correlation between frailty and chemotherapy-related adverse outcomes in geriatric patients with cancer. Material and Methods: A total of 234 geriatric patients aged ≥65 years with cancer receiving chemotherapy were enrolled during the study period of September 2016 to November 2018. The collected data included: patients’ basic demographics and Comprehensive Geriatric Assessment (CGA) before treatment, chemotherapy-related adverse outcomes, unexpected hospitalizations, and emergency department visits within 3 months of treatment. We investigated the association between frailty and chemotherapy-related adverse outcomes in geriatric patients with cancer using the chi-square test and logistic regression analysis. Results: The prevalence of frailty in geriatric patients with cancer was 58.1%. Age, marital status, main caregiver, cancer type, and Eastern Cooperative Oncology Group performance status, and physical fitness were factors associated with frailty. Frail geriatric patients with cancer were at higher risk of chemotherapy-related adverse outcomes, such as grades 3–4 thrombocytopenia (odds ratio [OR] = 11.13, p = 0.021) and grades 3–4 hyponatremia (OR = 12.03, p = 0.017), than non-frail patients, and they were at increased risk of unexpected hospitalizations (OR = 2.15, p = 0.025) and emergency department visits (OR = 1.99, p = 0.039). Conclusions: Frailty is a common problem in geriatric patients with cancer and significantly impacts chemotherapy-related adverse outcomes. Our findings suggest that geriatric patients with cancer should undergo frail assessment prior to chemotherapy as a reference to guide future treatment decisions.
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Affiliation(s)
- Ya-Wen Ho
- Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Woung-Ru Tang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ying Chen
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hui Lee
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Chang Gung University of Science and Technology, Cardinal Tien Junior College of Healthcare and Management, Taoyuan, Taiwan
| | - Jen-Shi Chen
- Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shin Hung
- Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
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20
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The prevalence of frailty among breast cancer patients: a systematic review and meta-analysis. Support Care Cancer 2021; 30:2993-3006. [PMID: 34694496 DOI: 10.1007/s00520-021-06641-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Coexistence of frailty and breast cancer (BC) is related to a higher risk of hospitalization, mortality, and falls. Given the potential reversibility of frailty, investigating its epidemiology in BC is of great importance. However, estimates of the prevalence of frailty in BC patients vary considerably. We synthesized the existing body of literature on the prevalence of frailty among BC patients. METHODS We searched English databases (Cochrane Library, PubMed, Medline, CINAHL, Embase, Scopus, and Web of Science) and Chinese databases (CNKI, WanFang, CBM, and VIP database) from the inception to April 15, 2021, and collected observational studies about the prevalence of frailty among BC patients. The robustness of the pooled estimates was validated by analysis of different subgroups, meta-regression, and sensitivity. All data were analyzed using Stata 15.1. RESULTS In total, 4645 articles were screened and data from 24 studies involving 13,510 subjects were used in the meta-analysis. The prevalence of frailty among BC patients in individual studies varied from 5 to 71%. The pooled prevalence of frailty was 43% (95% confidence intervals (CI): 36% to 50%, I2 = 98.4%, P < 0.05). Subgroup analyses revealed that the therapeutic method, frailty scales, age, frailty stage, regions, publication years, and study quality were associated with the prevalence of frailty among BC patients. CONCLUSIONS The prevalence of frailty among BC patients was relatively high, and the conditions of BC treatment can increase the risk of frailty. Understanding the effects of frailty on BC, especially in elderly patients, can provide the healthcare personnel with the theoretical basis for patients' management and treatment.
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21
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Chen LJ, Trares K, Laetsch DC, Nguyen TNM, Brenner H, Schöttker B. Systematic Review and Meta-Analysis on the Associations of Polypharmacy and Potentially Inappropriate Medication With Adverse Outcomes in Older Cancer Patients. J Gerontol A Biol Sci Med Sci 2021; 76:1044-1052. [PMID: 32459845 DOI: 10.1093/gerona/glaa128] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Both polypharmacy and potentially inappropriate medication (PIM) intake are highly prevailing in older cancer patients. However, only studies on the association of polypharmacy and postoperative complications have been meta-analyzed previously. METHODS A systematic review and a meta-analysis of prospective/retrospective observational studies reporting associations of polypharmacy or PIM with at least one out of five predefined adverse health outcomes in a population of older cancer patients (≥60 years) were carried out. PubMed and Web of Science were used to search for relevant studies published between January 1991 and March 2020. Data were pooled by adopting a random-effects model. RESULTS Overall, 42 publications were included in the systematic review. Meta-analyses could be performed on 39 studies about polypharmacy and 13 studies about PIM. Polypharmacy was found to be statistically significantly associated with all-cause mortality (risk ratio [95% confidence interval]: 1.37 [1.25-1.50]), hospitalization (1.53 [1.37-1.71]), treatment-related toxicity (1.22 [1.01-1.47]), and postoperative complications (1.73 [1.36-2.20]). The association of polypharmacy with prolongation of hospitalization was not statistically significant at the p < .05 significance level (1.62 [0.98-2.66]). With respect to PIM, a statistically significant association with all-cause mortality (1.43 [1.08-1.88]) was observed but not with other adverse outcomes. CONCLUSIONS Polypharmacy was found to be associated with several adverse outcomes and PIM use with all-cause mortality in older cancer patients. However, these results should be interpreted with caution because about three-quarters of the studies identified did not adjust for comorbidity and are prone to confounding by indication.
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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, Germany
| | - Kira Trares
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Germany
| | - Dana Clarissa Laetsch
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 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, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Germany
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22
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Flannery MA, Culakova E, Canin BE, Peppone L, Ramsdale E, Mohile SG. Understanding Treatment Tolerability in Older Adults With Cancer. J Clin Oncol 2021; 39:2150-2163. [PMID: 34043433 PMCID: PMC8238902 DOI: 10.1200/jco.21.00195] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 01/03/2023] Open
Affiliation(s)
- Marie A. Flannery
- University of Rochester Medical Center, School of Nursing, Rochester, NY
| | - Eva Culakova
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Beverly E. Canin
- SCOREboard Stakeholder Advisory Group, University of Rochester Medical Center, Rochester, NY
| | - Luke Peppone
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Erika Ramsdale
- Department of Medicine, University of Rochester, Rochester, NY
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23
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Makihara K, Shimeda Y, Matsumura T. Influence of Concomitant Polypharmacy on Docetaxel-induced Febrile Neutropenia. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:135-141. [PMID: 35399310 DOI: 10.21873/cdp.10018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/31/2021] [Indexed: 01/18/2023]
Abstract
Background/Aim Docetaxel (DTX) is metabolized by liver cytochromes P450 (CYP) 3A4 (CYP3A4) and 3A5 (CYP3A5) CYP3A4 activity is considered the main factor affecting the effectiveness in DTX clearance. We, therefore, explored the association between DTX-induced febrile neutropenia (FN) and concomitant polypharmacy involving CYP3A4 inhibitors in cancer patients. Patients and Methods Among patients who received docetaxel, we compared the number of concomitant medications between patients with and without FN, and risk factors associated with FN were identified. Results The total number of concomitant CYP3A4 inhibitors and substrates used was significantly higher in patients with FN [mean: 2.1 (95% confidence interval (CI)=1.5-2.9)] than in those without FN [mean: 1.4 (95% CI=1.0-1.8)] (p=0.01). The only risk factor for FN was the use of ≥2 concomitant CYP3A4 inhibitors and substrates in total (OR=4.82, 95% CI=1.77-14.1; p=0.002). Conclusion Polypharmacy involving CYP3A4 inhibitors and substrates increases the risk of DTX-induced FN.
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Affiliation(s)
- Katsuya Makihara
- Department of Pharmacy, Yodogawa Christian Hospital, Osaka, Japan
| | - Yuka Shimeda
- Department of Pharmacy, Yodogawa Christian Hospital, Osaka, Japan
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24
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Hoon SN, Lau PK, White AM, Bulsara MK, Banks PD, Redfern AD. Capecitabine for hormone receptor-positive versus hormone receptor-negative breast cancer. Cochrane Database Syst Rev 2021; 5:CD011220. [PMID: 34037241 PMCID: PMC8150746 DOI: 10.1002/14651858.cd011220.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Retrospective analyses suggest that capecitabine may carry superior activity in hormone receptor-positive relative to hormone receptor-negative metastatic breast cancer. This review examined the veracity of that finding and explored whether this differential activity extends to early breast cancer. OBJECTIVES To assess effects of chemotherapy regimens containing capecitabine compared with regimens not containing capecitabine for women with hormone receptor-positive versus hormone receptor-negative breast cancer across the three major treatment scenarios: neoadjuvant, adjuvant, metastatic. SEARCH METHODS On 4 June 2019, we searched the Cochrane Breast Cancer Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5) in the Cochrane Library; MEDLINE; Embase; the World Health Organization International Clinical Trials Registry Platform; and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials looking at chemotherapy regimens containing capecitabine alone or in combination with other agents versus a control or similar regimen without capecitabine for treatment of breast cancer at any stage. The primary outcome measure for metastatic and adjuvant trials was overall survival (OS), and for neoadjuvant studies pathological complete response (pCR). DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias and certainty of evidence using the GRADE approach. Hazard ratios (HRs) were derived for time-to-event outcomes, and odds ratios (ORs) for dichotomous outcomes, and meta-analysis was performed using a fixed-effect model. MAIN RESULTS We included 26 studies with outcome data by hormone receptor: 12 metastatic studies (n = 4325), 6 neoadjuvant trials (n = 3152), and 8 adjuvant studies (n = 13,457). Capecitabine treatment was added in several different ways across studies. These could be classified as capecitabine alone compared to another treatment, capecitabine substituted for part of the control chemotherapy, and capecitabine added to control chemotherapy. In the metastatic setting, the effect of capecitabine was heterogenous between hormone receptor-positive and -negative tumours. For OS, no difference between capecitabine-containing and non-capecitabine-containing regimens was observed for all participants taken together (HR 1.01, 95% confidence interval (CI) 0.98 to 1.05; 12 studies, 4325 participants; high-certainty evidence), for those with hormone receptor-positive disease (HR 0.93, 95% CI 0.84 to 1.04; 7 studies, 1834 participants; high-certainty evidence), and for those with hormone receptor-negative disease (HR 1.00, 95% CI 0.88 to 1.13; 8 studies, 1577 participants; high-certainty evidence). For progression-free survival (PFS), a small improvement was seen for all people (HR 0.89, 95% CI 0.82 to 0.96; 12 studies, 4325 participants; moderate-certainty evidence). This was largely accounted for by a moderate improvement in PFS for inclusion of capecitabine in hormone receptor-positive cancers (HR 0.82, 95% CI 0.73 to 0.91; 7 studies, 1594 participants; moderate-certainty evidence) compared to no difference in PFS for hormone receptor-negative cancers (HR 0.96, 95% CI 0.83 to 1.10; 7 studies, 1122 participants; moderate-certainty evidence). Quality of life was assessed in five studies; in general there did not seem to be differences in global health scores between the two treatment groups at around two years' follow-up. Neoadjuvant studies were highly variable in design, having been undertaken to test various experimental regimens using pathological complete response (pCR) as a surrogate for disease-free survival (DFS) and OS. Across all patients, capecitabine-containing regimens resulted in little difference in pCR in comparison to non-capecitabine-containing regimens (odds ratio (OR) 1.12, 95% CI 0.94 to 1.33; 6 studies, 3152 participants; high-certainty evidence). By subtype, no difference in pCR was observed for either hormone receptor-positive (OR 1.22, 95% CI 0.76 to 1.95; 4 studies, 964 participants; moderate-certainty evidence) or hormone receptor-negative tumours (OR 1.28, 95% CI 0.61 to 2.66; 4 studies, 646 participants; moderate-certainty evidence). Four studies with 2460 people reported longer-term outcomes: these investigators detected no difference in either DFS (HR 1.02, 95% CI 0.86 to 1.21; high-certainty evidence) or OS (HR 0.97, 95% CI 0.77 to 1.23; high-certainty evidence). In the adjuvant setting, a modest improvement in OS was observed across all participants (HR 0.89, 95% CI 0.81 to 0.98; 8 studies, 13,547 participants; moderate-certainty evidence), and no difference in OS was seen in hormone receptor-positive cancers (HR 0.86, 95% CI 0.68 to 1.09; 3 studies, 3683 participants), whereas OS improved in hormone receptor-negative cancers (HR 0.72, 95% CI 0.59 to 0.89; 5 studies, 3432 participants). No difference in DFS or relapse-free survival (RFS) was observed across all participants (HR 0.93, 95% CI 0.86 to 1.01; 8 studies, 13,457 participants; moderate-certainty evidence). As was observed for OS, no difference in DFS/RFS was seen in hormone receptor-positive cancers (HR 1.03, 95% CI 0.91 to 1.17; 5 studies, 5604 participants; moderate-certainty evidence), and improvements in DFS/RFS with inclusion of capecitabine were observed for hormone receptor-negative cancers (HR 0.74, 95% CI 0.64 to 0.86; 7 studies, 3307 participants; moderate-certainty evidence). Adverse effects were reported across all three scenarios. When grade 3 or 4 febrile neutropenia was considered, no difference was seen for capecitabine compared to non-capecitabine regimens in neoadjuvant studies (OR 1.31, 95% CI 0.97 to 1.77; 4 studies, 2890 participants; moderate-certainty evidence), and a marked reduction was seen for capecitabine in adjuvant studies (OR 0.55, 95% CI 0.47 to 0.64; 5 studies, 8086 participants; moderate-certainty evidence). There was an increase in diarrhoea and hand-foot syndrome in neoadjuvant (diarrhoea: OR 1.95, 95% CI 1.32 to 2.89; 3 studies, 2686 participants; hand-foot syndrome: OR 6.77, 95% CI 4.89 to 9.38; 5 studies, 3021 participants; both moderate-certainty evidence) and adjuvant trials (diarrhoea: OR 2.46, 95% CI 2.01 to 3.01; hand-foot syndrome: OR 13.60, 95% CI 10.65 to 17.37; 8 studies, 11,207 participants; moderate-certainty evidence for both outcomes). AUTHORS' CONCLUSIONS In summary, a moderate PFS benefit by including capecitabine was seen only in hormone receptor-positive cancers in metastatic studies. No benefit of capecitabine for pCR was noted overall or in hormone receptor subgroups when included in neoadjuvant therapy. In contrast, the addition of capecitabine in the adjuvant setting led to improved outcomes for OS and DFS in hormone receptor-negative cancer. Future studies should stratify by hormone receptor and triple-negative breast cancer (TNBC) status to clarify the differential effects of capecitabine in these subgroups across all treatment scenarios, to optimally guide capecitabine inclusion.
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Affiliation(s)
- Siao-Nge Hoon
- Medical Oncology Department, St John of God Midland, Perth, Australia
- Medical Oncology Department, Sir Charles Gairdner Hospital, Perth, Australia
| | - Peter Kh Lau
- Medical Oncology Department, Sir Charles Gairdner Hospital, Perth, Australia
- Medical Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alison M White
- Murdoch Community Hospice, St John of God Hospital Murdoch, Perth, Australia
- Palliative Care Department, Royal Perth Hospital, Perth, Australia
| | - Max K Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Patricia D Banks
- Medical Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Medical Oncology Department, University Hospital Geelong, Geelong, Australia
| | - Andrew D Redfern
- School of Medicine, University of Western Australia, Perth, Australia
- Medical Oncology Department, Fiona Stanley Hospital, Perth, Australia
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25
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Guven DC, Kavgaci G, Aktepe OH, Yildirim HC, Sahin TK, Aksoy S, Erman M, Kilickap S, Yalcin S. The burden of polypharmacy and drug-drug interactions in older cancer patients treated with immunotherapy. J Oncol Pharm Pract 2021; 28:785-793. [PMID: 33878976 DOI: 10.1177/10781552211012038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Polypharmacy is a common problem in older cancer patients, although the data about polypharmacy and potentially inappropriate prescription practices is limited in patients treated with immune checkpoint inhibitors (ICIs). Therefore, we aimed to evaluate the polypharmacy frequency and drug-drug interactions in older cancer patients (≥65 years) treated with ICIs. METHODS A total of 70 geriatric patients with advanced cancer were included. The polypharmacy was defined as regular use of 5 or more drugs. The START/STOPP Criteria Version 2 was used for the potentially inappropriate medications (PIM) and potential prescription omissions (PPO). The Medscape Drug Interaction Checker was used for potential drug-drug interactions. RESULTS The patients had a median of 6 regular drugs, and polypharmacy was present in 77.1%. The polypharmacy risk was significantly increased in patients over 75 years of age (p = 0.028) and with opioid use (p = 0.048). The 50% of patients had category D or X interactions. Patients with higher Charlson Comorbidity Index had significantly increased risk for drug interactions (CCI ≤10 vs. >10, p = 0.017). The PIMs were present in 44.3% and the PPOs in 68.6% of the patients. While the overall survival and immune related adverse events were similar according to polypharmacy, in patients using seven or more drugs, the acute kidney injury risk was increased (HR: 4.667, p = 0.038). CONCLUSION In this study, we observed a high rate of polypharmacy and inappropriate prescription practices in ICI-treated patients. These issues pointed out the need for improved general medical care and attention for better comedication management in ICI-treated patients.
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Affiliation(s)
- Deniz C Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Gozde Kavgaci
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Oktay H Aktepe
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Hasan C Yildirim
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Taha K Sahin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Saadettin Kilickap
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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26
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Stormoen DR, Baeksted C, Taarnhøj GA, Johansen C, Pappot H. Patient reported outcomes interfering with daily activities in prostate cancer patients receiving antineoplastic treatment. Acta Oncol 2021; 60:419-425. [PMID: 33641578 DOI: 10.1080/0284186x.2021.1881818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Patient-reported outcome (PRO) can give information to caregivers and doctors about adverse effects and give real-world data on symptom burden for patients during treatment. We here report PROs from patients with metastatic castration resistant prostate cancer (mCRPC) receiving oncological treatment. Our findings are compared with adverse events from published findings in relevant registration studies and we discuss possible applications by looking at the level of interference with usual or daily activities. MATERIAL AND METHODS An electronic PRO-Common Terminology Criteria for Adverse Events (ePRO-CTCAE) questionnaire, with 41 items corresponding to 22 symptoms/adverse events associated with the treatment regimens commonly used for mCRPC, were collected from 54 patients with mCRPC receiving medical oncological treatment. Eleven symptoms attributing interference with usual or daily living were selected and stratified by antineoplastic treatment administered. The responses were pooled and compared with data from relevant registration studies for docetaxel, cabazitaxel, radium-223 and abiraterone. RESULTS 168 questionnaires were completed, and among responses from patients receiving docetaxel, 89% of responses shows that fatigue interfered with their usual or daily activities to some degree and 22% to a high or very high degree. In the registration study for docetaxel fatigue is reported with 53% for all grades and 5% for grade 3 or above. For cabazitaxel, radium-223 and abiraterone the percentage of responses with interference of daily activities from fatigue range from 58% to 82%. Between four and six of the eleven chosen PRO-CTCAE symptoms are not reported in the registration studies as common side effects. CONCLUSION PRO may help inform caregivers about symptoms not previously reported, interfering with usual or daily activities but also point to the use of this information to inform new patients. This may help clinicians and patients decide a treatment plan with an acceptable benefit-to-harm ratio.
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Affiliation(s)
- Dag Rune Stormoen
- Department of Oncology, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | | | - Gry Assam Taarnhøj
- Department of Oncology, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Department of Oncology, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
- The Danish Cancer Society, Copenhagen, Denmark
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
- The Danish Cancer Society, Copenhagen, Denmark
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27
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Nguyen NP, Baumert BG, Oboite E, Motta M, Appalanaido GK, Arenas M, Lara PC, Bonet M, Zamagni A, Vuong T, Popescu T, Karlsson U, Trigo L, Sun Myint A, Thariat J, Vinh-Hung V. Immunotherapy and Radiotherapy for Older Cancer Patients during the COVID-19 Era: Proposed Paradigm by the International Geriatric Radiotherapy Group. Gerontology 2021; 67:379-385. [PMID: 33784693 PMCID: PMC8089416 DOI: 10.1159/000514451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Older cancer patients with locally advanced or metastatic disease may benefit from chemotherapy alone or combined with radiotherapy. However, chemotherapy is often omitted either because of physician bias or because of its underlying comorbidity, thus compromising their survival. The coronavirus disease 19 (COVID-19) pandemic is compounding this issue because of the fear of immunosuppression induced by chemotherapy on the elderly which makes them more vulnerable to the virus. SUMMARY Immunotherapy has less effect on the patient bone marrow compared to chemotherapy. The potential synergy between radiotherapy and immunotherapy may improve local control and survival for older patients with selected cancer. Preliminary data are encouraging because of better survival and local control in diseases which are traditionally resistant to radiotherapy and chemotherapy such as melanoma and renal cell carcinoma. Key Message: We propose a new paradigm combining immunotherapy at a reduced dose and/or extended dosing intervals and hypofractionated radiotherapy for older patients with selected cancer which needs to be tested in future clinical trials.
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Affiliation(s)
- Nam Phong Nguyen
- Department of Radiation Oncology, Howard University, Washington, District of Columbia, USA
| | - Brigitta G. Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Eromosele Oboite
- Department of Radiation Oncology, Howard University, Washington, District of Columbia, USA
| | - Micaela Motta
- Department of Radiation Oncology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Meritxell Arenas
- Department of Radiation Oncology, Sant Joan de Reus University, University Rovira I Virgili, Tarragona, Spain
| | - Pedro Carlos Lara
- Department of Radiation Oncology, Fernando Pessoa Canarias Las Palmas University, Las Palmas, Spain
| | - Marta Bonet
- Department of Radiation Oncology, Arnau de Villanova University Hospital, Lleida, Spain
| | - Alice Zamagni
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, and Department of Experimental, Diagnostic, and Specialty Medicine, -DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy
| | - Te Vuong
- Department of Radiation Oncology, McGill University, Montreal, Québec, Canada
| | - Tiberiu Popescu
- Department of Radiation Oncology, Amethyst Radiotherapy Center, Cluj, Romania
| | - Ulf Karlsson
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, District of Columbia, USA
| | - Lurdes Trigo
- Service of Brachytherapy, Instituto Portugues de Oncologia Francisco Martins Porto E.P.E., Porto, Portugal
| | - Arthur Sun Myint
- Department of Radiation Oncology, Clatterbridge Cancer Center, Liverpool, United Kingdom
| | - Juliette Thariat
- Department of Radiation Oncology, Baclesse Cancer Center, Caen, France
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, University Hospital of Martinique, Martinique, France
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Berben L, Floris G, Wildiers H, Hatse S. Cancer and Aging: Two Tightly Interconnected Biological Processes. Cancers (Basel) 2021; 13:1400. [PMID: 33808654 PMCID: PMC8003441 DOI: 10.3390/cancers13061400] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
Age is one of the main risk factors of cancer; several biological changes linked with the aging process can explain this. As our population is progressively aging, the proportion of older patients with cancer is increasing significantly. Due to the heterogeneity of general health and functional status amongst older persons, treatment of cancer is a major challenge in this vulnerable population. Older patients often experience more side effects of anticancer treatments. Over-treatment should be avoided to ensure an optimal quality of life. On the other hand, under-treatment due to fear of toxicity is a frequent problem and can lead to an increased risk of relapse and worse survival. There is a delicate balance between benefits of therapy and risk of toxicity. Robust biomarkers that reflect the body's biological age may aid in outlining optimal individual treatment regimens for older patients with cancer. In particular, the impact of age on systemic immunity and the tumor immune infiltrate should be considered, given the expanding role of immunotherapy in cancer treatment. In this review, we summarize current knowledge concerning the mechanistic connections between aging and cancer, as well as aging biomarkers that could be helpful in the field of geriatric oncology.
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Affiliation(s)
- Lieze Berben
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, 3000 Leuven, Belgium;
| | - Giuseppe Floris
- Department of Pathology, University Hospitals Leuven, 3000 Leuven, Belgium;
- Laboratory of Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
| | - Hans Wildiers
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, 3000 Leuven, Belgium;
- Department of General Medical Oncology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Sigrid Hatse
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, 3000 Leuven, Belgium;
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Ertl SW, Heuer HC, Stahl MK. How an Oncologist's Intuition Compares to a Geriatric Assessment. Oncol Res Treat 2021; 44:1-8. [PMID: 33535207 DOI: 10.1159/000513737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND A geriatric assessment (GA) is recommended before treating older cancer patients. The goal of this study was to investigate if the additional information from a GA and discussion by a multidisciplinary board (MB) change the treatment recommendations. PATIENTS AND METHODS Older cancer patients (n = 421) were prospectively assessed by an oncologist for eligibility for chemotherapy. A multidimensional GA was performed and a discussion about each patient was held by a MB including a geriatrician. Differences between the judgment made by the oncologist, that of the MB, and the Balducci classification were examined. A statistical model of the MB decision-making process was established and evaluated. RESULTS The treating oncologist and the MB judged 12 and 15% of the patients as frail, 41 and 38% as vulnerable, and 46 and 47% as fit. Overall, 83% agreement was observed. Based on the Balducci classification, 55% of the patients were frail, 30% were vulnerable, and 15% were fit. Only 34% of congruency with the oncologist's judgment was observed. In a 2-stage logistics model, activities of daily living and the Mini-Mental-State Examination (MMSE) proved most suitable for identifying frail patients. Tinetti's test, age, Charlson Comorbidity Index, living alone, the MMSE, and the Mini-Nutritional Assessment fitted best to distinguish between vulnerable and fit. CONCLUSIONS Regarding the decision of systemic treatment for older patients, the judgment by an experienced oncologist was comparable to that of an MB and both were significantly different from the Balducci classification. For some patients, the additional discussion of GA data in an MB may change treatment decisions.
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Barlow A, Prusak ES, Barlow B, Nightingale G. Interventions to reduce polypharmacy and optimize medication use in older adults with cancer. J Geriatr Oncol 2021; 12:863-871. [PMID: 33353854 DOI: 10.1016/j.jgo.2020.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/22/2020] [Accepted: 12/10/2020] [Indexed: 02/07/2023]
Abstract
The use of polypharmacy and potentially inappropriate medications (PIMs) is an increasingly common, concerning public health issue in older adults, and a concurrent cancer diagnosis only further escalates the prevalence and complexity. Polypharmacy and PIM use has been associated with negative patient outcomes, including falls, chemotherapy toxicities and other adverse events, postoperative complications, frailty, functional impairment, and shortened survival. Despite the recognition of the harms, the prevalence of polypharmacy and PIM use continues to rise due to a lack of standardized identification and intervention methods. Efforts to reduce the prevalence have included use of explicit PIM screening tools (e.g., Beers criteria), comprehensive medication reviews, and deprescribing algorithms. However, these efforts are not widespread and the research on the effectiveness of such interventions is limited. To better understand what is known, this paper summarized available studies evaluating the effect of interventions on reducing the burden of polypharmacy/PIMs and provided recommendations to guide further practice models to reduce the negative consequences associated with polypharmacy and PIM use. Furthermore, we aim to establish a framework for clinical practice and to highlight areas for future intervention-based research to improve outcomes for older adults with cancer.
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Affiliation(s)
- Ashley Barlow
- Department of Pharmacy, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Brooke Barlow
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA
| | - Ginah Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA.
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31
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Sgnaolin V, Sgnaolin V, Schneider RH. Implicações da avaliação geriátrica ampla na qualidade de vida em pessoas idosas com câncer: uma revisão integrativa. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2021. [DOI: 10.1590/1981-22562021024.200297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Resumo A avaliação geriátrica ampla (AGA) melhora a qualidade do cuidado das pessoas idosas com câncer, pois permite a identificação de problemas geriátricos e fragilidades que tenham implicações na saúde do indivíduo. Apesar dos benefícios da AGA, dificuldades relacionadas ao tempo e gastos com essa ferramenta limitam sua implantação na prática. O objetivo desta revisão é avaliar a relação entre a AGA e a qualidade de vida (QV) de pessoas idosas com câncer, através de uma revisão integrativa da literatura. Foi realizada uma busca por artigos nas bases de dados PubMed, MEDLINE, IBECS e LILACS, publicados entre 2015 e 2020, que abordassem as implicações da AGA na QV de pessoas idosas com câncer e, dos 298 estudos encontrados, 21 foram selecionados para análise. Esses demonstraram que a AGA desempenha função importante ao identificar pessoas idosas com maior risco de comprometimento da QV durante a evolução da neoplasia e do tratamento oncológico, bem como ao orientar a indicação de intervenções geriátricas específicas que previnam a deterioração da QV. Assim, a presente revisão destaca a importância da avaliação integral das pessoas idosas com câncer que, através de diferentes âmbitos, sejam prognósticos ou intervencionistas, desenvolve um papel fundamental na preservação da QV dessa população. Compreende-se a necessidade de desenvolver estratégias para incorporação da AGA no cuidado das pessoas idosas com câncer.
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Affiliation(s)
- Valéria Sgnaolin
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brasil; Hospital Mãe de Deus, Brasil
| | - Vanessa Sgnaolin
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brasil
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Navarrete-Reyes AP, Animas-Mijangos K, Gómez-Camacho J, Juárez-Carrillo Y, Torres-Pérez AC, Cataneo-Piña DJ, Negrete-Najar JP, Soto-Perez-de-Celis E. Geriatric principles for patients with cancer. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.5327/z2447-212320212100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cancer is primarily a disease of older persons. Given the heterogeneity of aging, physiological age, rather than chronological age, better expresses the cumulative effect of environmental, medical, and psychosocial stressors, which modifies life expectancy. Comprehensive geriatric assessment, a tool that helps ascertain the physiological age of older individuals, is the gold standard for assessing older adults with cancer. Several international organizations recommend using the geriatric assessment domains to identify unrecognized health problems that can interfere with treatment and predict adverse health-related outcomes, aiding complex treatment decision making. More recently, it has been shown that geriatric assessment-guided interventions improve quality of life and mitigate treatment toxicity without compromising survival. In this review, we discuss the role of comprehensive geriatric assessment in cancer care for older adults and provide the reader with useful information to assess potential treatment risks and benefits, anticipate complications, and plan interventions to better care for older people with cancer.
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Haase KR, Kain D, Merchant S, Booth C, Koven R, Brundage M, Galica J. Older survivors of cancer in the COVID-19 pandemic: Reflections and recommendations for future care. J Geriatr Oncol 2020; 12:461-466. [PMID: 33303410 PMCID: PMC7713572 DOI: 10.1016/j.jgo.2020.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/13/2020] [Accepted: 11/30/2020] [Indexed: 02/08/2023]
Abstract
Purpose Although the year after cancer treatment is challenging for all cancer survivors, older adults (≥60 years) face additional challenges due to age-related decline and high rates of comorbidity. There is a paucity of research on how health service interruptions from the COVID-19 pandemic have impacted the experience of older cancer survivors. In this study we explore older cancer survivors' reflections on the pandemic and their suggestions for future care delivery when traditionally offered resources are not available. Methods We conducted 1:1 telephone interviews with adults 60 years and older previously diagnosed with breast and colorectal cancer and recently (≤12 months) discharged from their cancer care team. We analyzed the data using descriptive thematic analysis. Results The mean sample (n = 30) age was 72.1 years (SD 5.8, Range 63–83) of whom 57% identified as female. Participants described personal and societal implications of the pandemic. that affected their ability to navigate social support, and public and clinical landscapes. These reflections informed their suggestions for future health care delivery, such as how they could have been better prepared to self-manage their post-cancer treatment journey. Participants recommendations were grouped into four sub-themes: 1) enhanced baseline information; 2) facilitate caregiver support and engagement; 3) greater technology integration; and 4) sustained use and public appreciation of personal protective equipment. Conclusion Older cancer survivors appreciate the needed shift to virtual appointments and services during the COVID-19 pandemic. Specific strategies to bolster older adults existing strengths and improve their readiness to engage in these measures are critical.
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Affiliation(s)
- Kristen R Haase
- School of Nursing, Faculty of Applied Science, The University of British Columbia, Canada.
| | - Danielle Kain
- Division of Palliative Medicine, Departments of Medicine and Oncology, School of Medicine, Queen's University, Canada
| | - Shaila Merchant
- Division of General Surgery and Surgical Oncology, Queen's University, Canada
| | - Christopher Booth
- Canada Research Chair in Population Cancer Care; Principal Investigator, Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Canada; Cancer Centre of Southeastern Ontario, Canada; Departments of Oncology and Medicine, School of Medicine, Queen's University, Canada
| | - Rachel Koven
- Division of Cancer Care & Epidemiology, Queen's Cancer Research Institute, Canada
| | - Michael Brundage
- Department of Oncology, School of Medicine, Queen's University, Canada; Department of Public Health Sciences, School of Medicine, Queen's University, Canada; Kingston Regional Cancer Centre, Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Canada
| | - Jacqueline Galica
- Division of Cancer Care & Epidemiology, Queen's Cancer Research Institute, Canada; School of Nursing, Queen's University, Canada
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34
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Kadambi S, Loh KP, Dunne R, Magnuson A, Maggiore R, Zittel J, Flannery M, Inglis J, Gilmore N, Mohamed M, Ramsdale E, Mohile S. Older adults with cancer and their caregivers - current landscape and future directions for clinical care. Nat Rev Clin Oncol 2020; 17:742-755. [PMID: 32879429 PMCID: PMC7851836 DOI: 10.1038/s41571-020-0421-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 12/13/2022]
Abstract
Despite substantial improvements in the outcomes of patients with cancer over the past two decades, older adults (aged ≥65 years) with cancer are a rapidly increasing population and continue to have worse outcomes than their younger counterparts. Managing cancer in this population can be challenging because of competing health and ageing-related conditions that can influence treatment decision-making and affect outcomes. Geriatric screening tools and comprehensive geriatric assessment can help to identify patients who are most at risk of poor outcomes from cancer treatment and to better allocate treatment for these patients. The use of evidence-based management strategies to optimize geriatric conditions can improve communication and satisfaction between physicians, patients and caregivers as well as clinical outcomes in this population. Clinical trials are currently underway to further determine the effect of geriatric assessment combined with management interventions on cancer outcomes as well as the predictive value of geriatric assessment in the context of treatment with contemporary systemic therapies such as immunotherapies and targeted therapies. In this Review, we summarize the unique challenges of treating older adults with cancer and describe the current guidelines as well as investigational studies underway to improve the outcomes of these patients.
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Affiliation(s)
- Sindhuja Kadambi
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA.
| | - Kah Poh Loh
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Richard Dunne
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Allison Magnuson
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Ronald Maggiore
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Jason Zittel
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Marie Flannery
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Julia Inglis
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Nikesha Gilmore
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Mostafa Mohamed
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Erika Ramsdale
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Supriya Mohile
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA.
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Abstract
The number of older adults with cancer is growing in the United States, and there is a relative paucity of data relating the presence of frailty with its outcomes of interest. The authors present the surgical oncology, radiation oncology, and medical oncology literature with respect to the presence of frailty in older adults with cancer. More research is needed to understand how the presence of frailty should be used by surgical, radiation, and medical oncologists to guide patient counseling and treatment planning.
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Affiliation(s)
- Christina A Minami
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Breast Oncology Program, Dana-Farber Cancer Institute, 450 Brookline Avenue, Yawkey 1274, Boston, MA 02215, USA
| | - Zara Cooper
- Division of Trauma, Burn, and Critical Care, Department of Surgery, Brigham and Women's Hospital, 1620 Tremont Street, Suite 2-016, Boston, MA 02120, USA.
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36
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Grünwald V, Karch A, Schuler M, Schöffski P, Kopp HG, Bauer S, Kasper B, Lindner LH, Chemnitz JM, Crysandt M, Stein A, Steffen B, Richter S, Egerer G, Ivanyi P, Zimmermann S, Liu X, Kunitz A. Randomized Comparison of Pazopanib and Doxorubicin as First-Line Treatment in Patients With Metastatic Soft Tissue Sarcoma Age 60 Years or Older: Results of a German Intergroup Study. J Clin Oncol 2020; 38:3555-3564. [DOI: 10.1200/jco.20.00714] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Doxorubicin is a standard of care in patients with advanced, inoperable soft tissue sarcoma (STS). We tested whether pazopanib has efficacy comparable to that of doxorubicin in elderly patients with STS and offers superior tolerability for hematologic toxicity. PATIENTS AND METHODS Patients age 60 years or older without previous systemic treatment for progressive advanced or metastatic STS who had Eastern Cooperative Oncology Group performance status of 0 to 2 and adequate organ function were included. Treatment consisted of pazopanib 800 mg once per day or doxorubicin 75 mg/m2 once every 3 weeks (≤ 6 cycles) after being randomly assigned in a 2:1 ratio. Noninferiority was assumed for progression-free survival (PFS), if the upper limit of the 95% CI for the hazard ratio (HR) was less than 1.8. Neutropenia and febrile neutropenia were key secondary end points. The European Organisation for Research and Treatment of Cancer (30-item) Quality of Life Questionnaire and geriatric assessment were used to measure patient-reported outcomes. Cox regression analysis and Kaplan-Meier curves were used for analysis. RESULTS Pazopanib and doxorubicin were given to 81 and 39 patients, respectively. The median age was 71 years (range, 60-88 years). PFS was noninferior (HR, 1.00; 95% CI, 0.65 to 1.53) and the incidence of grade 4 neutropenia and febrile neutropenia favored pazopanib. Objective response rates for pazopanib and doxorubicin were 12.3% and 15.4%, respectively. Overall survival did not differ significantly between arms (HR, 1.08; 95% CI, 0.68 to 1.72; P = .735). Geriatric assessment revealed 2 or more comorbidities in 15.8% of the patients and impairment of activities of daily living in 28.3% of patients. CONCLUSION Pazopanib was noninferior to doxorubicin, rendering pazopanib a putative therapeutic option in the first-line treatment of STS in patients age 60 years or older. The distinct adverse event profile may be used to counsel patients and tailor therapy to individual needs.
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Affiliation(s)
- Viktor Grünwald
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Medical School Hannover, Hannover, Germany
- Interdisciplinary Genitourinary Oncology at the West-German Cancer Center, Clinic for Internal Medicine (Tumor Research) and Clinic for Urology, University Hospital Essen, Essen, Germany
| | - Annika Karch
- Institute for Biostatistics, Medical School Hannover, Hannover, Germany
| | | | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hans-Georg Kopp
- Robert Bosch Centrum für Tumorerkrankungen Stuttgart, Stuttgart, Germany
| | - Sebastian Bauer
- Clinic for Internal Medicine (Tumor Research), University Hospital Essen, Essen, Germany
| | - Bernd Kasper
- Sarcoma Unit, Mannheim University Medical Center, Mannheim, Germany
| | - Lars H. Lindner
- Department of Medicine III, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Jens-Marcus Chemnitz
- Community Hospital Middle Rine, Middle Rine, Germany
- Department of Hematology, Oncology, Clinical Infectious Diseases, Clinical Immunology, Hemostaseology and Medical Intensive Care, University Hospital Cologne, Cologne, Germany
| | | | - Alexander Stein
- University Hospital Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | | | - Stephan Richter
- University Hospital Carl Gustav Carus, University Cancer Center/Medical Department I, Dresden, Germany
| | | | - Philipp Ivanyi
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Medical School Hannover, Hannover, Germany
| | | | - Xiaofei Liu
- Institute for Biostatistics, Medical School Hannover, Hannover, Germany
| | - Annegret Kunitz
- Vivantes Clinic Berlin-Spandau, Berlin-Spandau, Germany
- Department of Hematology, Oncology and Tumor Immunology, University Hospital Charite, Berlin, Germany
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Abd Allah ES, Gad HMM, Abdel-Aziz HR. Nutritional Status and Its Contributing Factors among Older Adults with Cancer Receiving Chemotherapy. Clin Nurs Res 2020; 29:650-658. [PMID: 32755230 DOI: 10.1177/1054773820947953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study aimed to assess nutritional status and its contributing factors among older adults with cancer receiving chemotherapy so, a descriptive study design was used. The study was conducted at Zagazig University Hospitals, Egypt. The study's sample was selected purposively which composed of 194 older adults. Nutritional status was measured by the Arabic version of the Mini-Nutritional Assessment (MNA). Contributing factors were identified by examining the relationship of nutritional status with demographic and clinical variables. Study results revealed that 33% of the older patients were malnourished and 51.5% were at risk for malnutrition. Statistically significant relations were found between nutritional status and advanced age, illiteracy, insufficient monthly income, comorbidities, cancer stage four at diagnosis, and receiving ≥4 chemotherapy cycles. High prevalence of malnutrition and many contributing factors were identified among older patients with cancer receiving chemotherapy. So, continuous malnutrition screening along chemotherapy courses with special concern for contributing factors assessed in this study is recommended.
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Affiliation(s)
- Eman Shokry Abd Allah
- Professor of Community Health Nursing and Gerontological Nursing, Gerontological Nursing Department, Faculty of Nursing, Zagazig University, Egypt
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Morishima T, Sato A, Nakata K, Miyashiro I. Geriatric assessment domains to predict overall survival in older cancer patients: An analysis of functional status, comorbidities, and nutritional status as prognostic factors. Cancer Med 2020; 9:5839-5850. [PMID: 32618120 PMCID: PMC7433808 DOI: 10.1002/cam4.3205] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 12/14/2022] Open
Abstract
Cancer treatments for older patients must account for heterogeneity in health and functional status. Guidelines advocate the use of geriatric assessments (GAs), but comprehensive assessments are laborious and the utility of specific GA domains remains unclear. The identification of specific domains as prognostic factors may support survival predictions and treatment decisions. We aimed to evaluate the associations between several GA domains and overall survival in older cancer patients. We linked cancer registry data and administrative claims data from cancer patients residing in Osaka Prefecture, Japan. The subjects were patients aged ≥70 years who received a diagnosis of gastric, colorectal, or lung cancer between 2010 and 2014 at 36 designated cancer care hospitals. The following three GA domains were assessed at cancer diagnosis: functional status through activities of daily living (ADL), comorbidities, and nutritional status through body mass index. Cox proportional hazards models were constructed for the three cancer types to estimate each domain's prognostic effect while adjusting for gender, age, and cancer stage. Adjusted hazard ratios (HRs) for all-cause mortality were calculated. We identified 5,559, 4,746, and 4,837 patients with gastric, colorectal, and lung cancer respectively. ADL impairment (HRs: 1.39-3.34, 1.64-2.86, and 1.24-3.21 for gastric, colorectal, and lung cancer, respectively), comorbidities (1.32-1.58, 1.33-1.97, and 1.19-1.29 for gastric, colorectal, and lung cancer, respectively), and underweight (1.36, 1.51, and 1.54 for gastric, colorectal, and lung cancer, respectively) were significantly associated with poorer overall survival. In contrast, overweight was significantly associated with improved overall survival (HRs: 0.82 and 0.89 for gastric and lung cancer respectively). The addition of the three domains increased the models' C-statistics (0.816 to 0.836, 0.764 to 0.787, and 0.759 to 0.783 for gastric, colorectal, and lung cancer respectively). Incorporating these factors into initial patient evaluations during diagnosis may aid prognostic predictions and treatment strategies in geriatric oncology.
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Affiliation(s)
| | - Akira Sato
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Kayo Nakata
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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van Winden MEC, Garcovich S, Peris K, Colloca G, de Jong EMGJ, Hamaker ME, van de Kerkhof PCM, Lubeek SFK. Frailty screening in dermato-oncology practice: a modified Delphi study and a systematic review of the literature. J Eur Acad Dermatol Venereol 2020; 35:95-104. [PMID: 32403174 PMCID: PMC7818261 DOI: 10.1111/jdv.16607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022]
Abstract
Background Appropriate management and prevention of both under‐ and overtreatment in older skin cancer patients can be challenging. It could be helpful to incorporate frailty screening in dermato‐oncology care, since frailty is associated with adverse health outcomes. Objectives This study aimed to identify and prioritize the requirements a frailty screening tool (FST) should fulfil in dermato‐oncology practice and to select the best existing FST(s) for this purpose. Methods A modified two‐round Delphi procedure was performed among 50 Italian and Dutch specialists and patients to review and prioritize a list of potential FST requirements, using a 5‐point Likert scale. Consensus was defined as a mean score of ≥4.0. A systematic literature search was performed to identify existing multidomain FSTs, which were then assessed on the requirements resulting from the modified Delphi procedure. Results Consensus was achieved on evaluation of comorbidities (4.3 ± 0.7), polypharmacy (4.0 ± 0.9) and cognition (4.1 ± 0.8). The FST should have appropriate measurement properties (4.0 ± 1.0), be quickly executed (4.2 ± 0.7), clinically relevant (4.3 ± 0.7), and both easily understandable (4.1 ± 1.2) and interpretable (4.3 ± 0.7). Of the 26 identified FSTs, four evaluated the content‐related domains: the Geriatric‐8 (G8), the modified Geriatric‐8 (mG8), the Groningen Frailty Indicator (GFI) and the Senior Adult Oncology Program 2 (SAOP2) screening tool. Of these, the G8 was the most extensively studied FST, with the best psychometric properties and execution within 5 min. Conclusions The G8 appears the most suitable FST for assessing frailty in older adults with skin cancer, although clinical studies assessing its use in a dermato‐oncology population are needed to further assess whether or not frailty in this particular patient group is associated with relevant outcomes (e.g. complications and mortality), as seen in previous studies in other medical fields.
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Affiliation(s)
- M E C van Winden
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Garcovich
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - K Peris
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Colloca
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M E Hamaker
- Department of Geriatrics, Diakonessenhuis, Zeist, The Netherlands
| | - P C M van de Kerkhof
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S F K Lubeek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Le Bon P, Solem-Laviec H, Devoueize I, Despres N, Grellard JM, Danet S, Clarisse B, Lequesne J, Beauplet B. Geriatric phone follow-up in the management of older patients treated for cancer: Telog study results. J Geriatr Oncol 2020; 11:951-959. [DOI: 10.1016/j.jgo.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/05/2019] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
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Narasimhulu DM, McGree ME, Weaver AL, Jatoi A, LeBrasseur NK, Glaser GE, Langstraat CL, Block MS, Kumar A. Frailty is a determinant of suboptimal chemotherapy in women with advanced ovarian cancer. Gynecol Oncol 2020; 158:646-652. [PMID: 32518016 DOI: 10.1016/j.ygyno.2020.05.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/27/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the relationship between frailty and chemotherapy delivery among women with epithelial ovarian cancer (EOC). METHODS We included women who underwent primary debulking surgery (PDS) for stage IIIC/IV EOC between 1/2/2003 and 12/30/2011, received adjuvant chemotherapy at our institution, and had data available to calculate a frailty deficit index. Frailty was defined as a frailty deficit index ≥0.15. Relative dose intensity (RDI) of chemotherapy was calculated as the percentage of the standard dose that was administered, and compared between frail and non-frail using the Wilcoxon rank-sum test. RESULTS Failure to receive chemotherapy following PDS was twice as common among frail vs. non-frail women (26.7% vs 14.2%, p = 0.001). Of the 169 women who received chemotherapy at our institution, 17.2% (29/169) were frail. Frail women were older (mean, 67.9 vs 62.3 years, p = 0.01), had higher BMI (mean, 29.6 vs 25.7 kg/m2, p = 0.003), and were less likely to complete 6 cycles of chemotherapy (75.9 vs. 93.6%, p = 0.008). Using an RDI cutoff of 85%, frail women were less likely to have adequate doses of carboplatin (15.8 vs. 66.2%, p < 0.001) and paclitaxel (57.9 vs. 80.5%, p = 0.07) despite no differences in dose delays (34.5 vs. 42.1%), dose reductions (65.5 vs. 68.6%), and severe neutropenia (44.8 vs. 39.3%). After adjusting for age, frailty was associated with shorter progression-free (HR 1.58, 95% CI: 0.99-2.50) and overall survival (HR 2.14, 95% CI: 1.35-3.41). CONCLUSION Frail women with EOC were less likely to receive chemotherapy or the optimal dose of chemotherapy after PDS despite no evidence of treatment-related toxicity. Frail EOC patients demonstrated shorter progression-free and overall survival. Further studies are needed to explore the association between frailty, chemotherapy, and survival.
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Affiliation(s)
- Deepa Maheswari Narasimhulu
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Michaela E McGree
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Amy L Weaver
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Aminah Jatoi
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Nathan K LeBrasseur
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Gretchen E Glaser
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States; Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Carrie L Langstraat
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States; Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Matthew S Block
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States; Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States.
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The influence of polypharmacy, potentially inappropriate medications, and drug interactions on treatment completion and prognosis in older patients with ovarian cancer. J Geriatr Oncol 2020; 11:593-602. [DOI: 10.1016/j.jgo.2019.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/07/2019] [Accepted: 12/16/2019] [Indexed: 12/27/2022]
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Managing older patients with cancer. JAAPA 2020; 33:31-34. [PMID: 32345946 DOI: 10.1097/01.jaa.0000657188.98965.ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
With the growing population of adults over age 70 years, clinicians must know how to care appropriately for the increasing number of older patients with cancer. Although older adults have higher rates of surgical complications and chemotherapy-related toxicity, they should not be excluded from treatment opportunities based on age alone. Rather, patients should be assessed for fitness, or functional age, for a more accurate estimation of how they will tolerate treatment. This article discusses considerations clinicians should take into account when developing effective treatment plans that do not compromise quality of life for older patients with cancer.
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Dhakal P, Lyden E, Muir KLE, Al-Kadhimi ZS, Koll T, Maness LJ, Gundabolu K, Bhatt VR. Prevalence and effects of polypharmacy on overall survival in acute myeloid leukemia. Leuk Lymphoma 2020; 61:1702-1708. [DOI: 10.1080/10428194.2020.1737687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Prajwal Dhakal
- Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE, USA
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Elizabeth Lyden
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kate-Lynn E. Muir
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Zaid S. Al-Kadhimi
- Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE, USA
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Thuy Koll
- Department of Internal Medicine, Division of Geriatrics and Gerontology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lori J. Maness
- Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE, USA
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Krishna Gundabolu
- Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE, USA
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Vijaya Raj Bhatt
- Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE, USA
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
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Abstract
Improvements in breast cancer (BC) mortality rates have not been seen in the older adult community, and the fact that older adults are more likely to die from their cancer than younger women establishes a major health disparity. Studies have identified that despite typically presenting with more favorable histology, older women present with more advanced disease, which may be related in part to delayed diagnosis. This is supported by examination of screening practices in older adults. Older women have a worse prognosis than younger women in both early stage disease, and more advanced and metastatic disease. Focus on the treatment of older adults has often concentrated on avoiding overtreatment, but in fact undertreatment may be one reason for the age-related differences in outcomes, and treatments need to be individualized for every older adult, and take into account patient preferences and functional status and not chronologic age alone. Given the aging population in the US, identifying methods to improve early diagnosis in this population and identify additional factors will be important to reducing this age-related disparity.
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Mohamed MR, Ramsdale E, Loh KP, Arastu A, Xu H, Obrecht S, Castillo D, Sharma M, Holmes HM, Nightingale G, Juba KM, Mohile SG. Associations of Polypharmacy and Inappropriate Medications with Adverse Outcomes in Older Adults with Cancer: A Systematic Review and Meta-Analysis. Oncologist 2020; 25:e94-e108. [PMID: 31570516 PMCID: PMC6964156 DOI: 10.1634/theoncologist.2019-0406] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Polypharmacy (PP) and potentially inappropriate medications (PIM) are highly prevalent in older adults with cancer. This study systematically reviews the associations of PP and/or PIM with outcomes and, through a meta-analysis, obtains estimates of postoperative outcomes associated with PP in this population. MATERIALS AND METHODS We searched PubMed, Embase, Web of Science, and Cochrane Register of Clinical Trials using standardized terms for concepts of PP, PIM, and cancer. Eligible studies included cohort studies, cross-sectional studies, meta-analyses, and clinical trials which examined outcomes associated with PP and/or PIM and included older adults with cancer. A random effects model included studies in which definitions of PP were consistent to examine the association of PP with postoperative complications. RESULTS Forty-seven articles met the inclusion criteria. PP was defined as five or more medications in 57% of the studies. Commonly examined outcomes included chemotherapy toxicities, postoperative complications, functional decline, hospitalization, and overall survival. PP was associated with chemotherapy toxicities (4/9 studies), falls (3/3 studies), functional decline (3/3 studies), and overall survival (2/11 studies). A meta-analysis of four studies indicated an association between PP (≥5 medications) and postoperative complications (overall odds ratio, 1.3; 95% confidence interval [1.3-2.8]). PIM was associated with adverse outcomes in 3 of 11 studies. CONCLUSION PP is associated with postoperative complications, chemotherapy toxicities, and physical and functional decline. Only three studies showed an association between PIM and outcomes. However, because of inconsistent definitions, heterogeneous populations, and variable study designs, these associations should be further investigated in prospective studies. IMPLICATIONS FOR PRACTICE Polypharmacy and potentially inappropriate medications (PIM) are prevalent in older adults with cancer. This systematic review summarizes the associations of polypharmacy and PIM with health outcomes in older patients with cancer. Polypharmacy and PIM have been associated with postoperative complications, frailty, falls, medication nonadherence, chemotherapy toxicity, and mortality. These findings emphasize the prognostic importance of careful medication review and identification of PIM by oncology teams. They also underscore the need to develop and test interventions to address polypharmacy and PIM in older patients with cancer, with the goal of improving outcomes in these patients.
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Affiliation(s)
- Mostafa R. Mohamed
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Erika Ramsdale
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Asad Arastu
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Huiwen Xu
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
- Department of Public Health, University of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Spencer Obrecht
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Daniel Castillo
- MLIS‐Miner Library, University of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Manvi Sharma
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, UniversityMississippiUSA
| | - Holly M. Holmes
- The University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Ginah Nightingale
- Department of Pharmacy Practice, Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Katherine M. Juba
- Department of Pharmacy, University of Rochester Medical CenterRochesterNew YorkUSA
- Department of Pharmacy Practice, Wegmans School of PharmacyRochesterNew YorkUSA
| | - Supriya G. Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
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Jauhari Y, Gannon MR, Dodwell D, Horgan K, Tsang C, Clements K, Medina J, Tang S, Pettengell R, Cromwell DA. Addressing frailty in patients with breast cancer: A review of the literature. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:24-32. [PMID: 31439357 DOI: 10.1016/j.ejso.2019.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/12/2019] [Indexed: 11/25/2022]
Abstract
Various studies have documented variation in the management of older patients with breast cancer, and some of this variation stems from different approaches to balancing the expected benefit of different treatments, with the ability of patients to tolerate them. Frailty is an emerging concept that can help to make clinical decisions for older patients more consistent, not least by providing a measure of 'biological' ageing. This would reduce reliance on 'chronological' age, which is not a reliable guide for decisions on the appropriate breast cancer care for older patients. This article examines the potential of frailty assessment to inform on breast cancer treatments. Overall, the current evidence highlights various benefits from implementing comprehensive geriatric assessment and screening for frailty in breast cancer patients. This includes a role in supporting the selection of appropriate therapies and improving physical fitness prior to treatment. However, there are challenges in implementing routine frailty assessments in a breast cancer service. Studies have used a diverse array of frailty assessment instruments, which hampers the generalisability of research findings. Consequently, a number of issues need to be addressed to clearly establish the optimal timing of frailty assessment and the role of geriatric medicine specialists in the breast cancer care pathway.
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Affiliation(s)
- Yasmin Jauhari
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; St George's University of London, London, UK.
| | - Melissa Ruth Gannon
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kieran Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | - Carmen Tsang
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Karen Clements
- Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, UK
| | - Jibby Medina
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Sarah Tang
- Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, UK
| | - Ruth Pettengell
- Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, UK
| | - David Alan Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Perspectives on geriatric oncology research presented at the 2019 ESMO Congress. J Geriatr Oncol 2019; 11:543-548. [PMID: 31831360 DOI: 10.1016/j.jgo.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/03/2019] [Indexed: 11/20/2022]
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Hong S, Lee JH, Chun EK, Kim KI, Kim JW, Kim SH, Lee YG, Hwang IG, Kim JY, Koh SJ, Ko YH, Shin SH, Woo IS, Kim TY, Baek JY, Kim HJ, Kim HJ, Lee MA, Kwon JH, Hong YS, Ryoo HM, Kim JH. Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy. Oncologist 2019; 25:e502-e511. [PMID: 32162799 DOI: 10.1634/theoncologist.2019-0085] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 10/14/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Polypharmacy is an important issue in the care of older patients with cancer, as it increases the risk of unfavorable outcomes. We estimated the prevalence of polypharmacy, potentially inappropriate medication (PIM) use, and drug-drug interactions (DDIs) in older patients with cancer in Korea and their associations with clinical outcomes. SUBJECTS, MATERIALS, AND METHODS This was a secondary analysis of a prospective observational study of geriatric patients with cancer undergoing first-line palliative chemotherapy. Eligible patients were older adults (≥70 years) with histologically diagnosed solid cancer who were candidates for first-line palliative chemotherapy. All patients enrolled in this study received a geriatric assessment (GA) at baseline. We reviewed the daily medications taken by patients at the time of GA before starting chemotherapy. PIMs were assessed according to the 2015 Beers criteria, and DDIs were assessed by a clinical pharmacist using Lexi-comp Drug Interactions. We evaluated the association between polypharmacy and clinical outcomes including treatment-related toxicity, and hospitalization using logistic regression and Cox regression analyses. RESULTS In total, 301 patients (median age 75 years; range, 70-93) were enrolled; the most common cancer types were colorectal cancer (28.9%) and lung cancer (24.6%). Mean number of daily medications was 4.7 (±3.1; range, 0-14). The prevalence of polypharmacy (≥5 medications) was 45.2% and that of excessive polypharmacy (≥10 medications) was 8.6%. PIM use was detected in 137 (45.5%) patients. Clinically significant DDIs were detected in 92 (30.6%) patients. Polypharmacy was significantly associated with hospitalization or emergency room (ER) visits (odds ratio: 1.73 [1.18-2.55], p < .01). Neither polypharmacy nor PIM use showed association with treatment-related toxicity. CONCLUSION Polypharmacy, PIM use, and potential major DDIs were prevalent in Korean geriatric patients with cancer. Polypharmacy was associated with a higher risk of hospitalization or ER visits during the chemotherapy period. IMPLICATIONS FOR PRACTICE This study, which included 301 older Korean patients with cancer, highlights the increased prevalence of polypharmacy in this population planning to receive palliative chemotherapy. The prevalence of polypharmacy and excessive polypharmacy was 45.2% and 8.6%, respectively. The prescription of potentially inappropriate medications (PIMs) was detected in 45.5% and clinically significant drug-drug interaction in 30.6% of patients. Given the association of polypharmacy with increased hospitalization or emergency room visits, this study points to the need for increased awareness and intervention to minimize polypharmacy in the geriatric cancer population undergoing chemotherapy. Moreover, specific criteria for establishing PIMs should be adopted for the treatment of older adults with cancer.
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Affiliation(s)
- Soojung Hong
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Ju Hyun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Eun Kyeong Chun
- Department of Pharmacy, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - In Gyu Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, College of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Yoon Ho Ko
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Seong Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Pusan, Republic of Korea
| | - In Sook Woo
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Yeon Baek
- Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Hyun Jung Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Hyo Jung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Myung Ah Lee
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Yong Sang Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hun-Mo Ryoo
- Department of Internal Medicine, Daegu Catholic University Hospital, Daegu Catholic University College of Medicine, Daegu, Republic of Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Caring for the Older Person Who Is Diagnosed with Cancer: a Toolbox for the Geriatric Nurse. CURRENT GERIATRICS REPORTS 2019. [DOI: 10.1007/s13670-019-00305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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