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Shimaoka H, Yoshida Y, Yamada T, Shimokoube H, Aisu N, Ogawa S, Tamura K, Hasegawa S. Distribution of Geriatric 8 screening tool scores in elderly and non-elderly patients with cancer. Int J Clin Oncol 2025; 30:457-468. [PMID: 39775670 DOI: 10.1007/s10147-024-02688-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Accepted: 12/29/2024] [Indexed: 01/11/2025]
Abstract
INTRODUCTION Population aging and increased cancer incidence have made the treatment of cancer in older individuals an increasingly important issue. Geriatric 8 (G8) is a screening tool developed to identify patients who would benefit most from a comprehensive geriatric assessment (GA). Previous G8 studies have involved older patients, but the age-related significance and usefulness of G8 is unknown. In this study, G8 screening was administered to patients who were 30 years of age or over with cancer to examine a G8 score in each 10 years age group and its correlation with other GA tools. MATERIALS AND METHODS The study was conducted at Fukuoka University Hospital from January 2020 to March 2022 and enrolled 715 patients aged ≥ 30 years undergoing surgery for primary gastrointestinal cancer or malignant disease. The relationship between age, G8, instrumental activities of daily living (IADL), activities of daily living (ADL), and the Charlson Comorbidity Index (CCI) was investigated. RESULTS The median age of the patients was 69 years (34-98 years). Functional disability in ADLs was present in 43 patients (6%) and in IADLs in 72 patients (10.1%). The mean G8 score by age group was 13.7, 13.1, 13.3, 13.3, 12.4, 11.3, and 9.25 for ages 30-39, 40-49, 50-59, 60-69, 70-79, 80-89, and 90-100 years, respectively. For each of the ADL/IADL items, the group with functional disability had significantly lower G8 scores than the group without functional disability (p < 0.001). The relationship between the G8 score and CCI by age group showed that the G8 score decreased as the CCI score increased. Assessments divided into age groups of 65, 70, and 75 years showed significant differences between groups for most ADL/IADL items and G8 scores, even when divided by age 65. DISCUSSION G8 scores were lower in patients with ADL/IADL disabilities and decreased with age in both the presence and absence of disabilities. The G8 total score decreased significantly after the age of 70 years. Performing G8 in patients < 65 years of age does not decrease sensitivity; however, the functional decline is so slight that it appears reasonable to restrict G8 screening to patients ≥ 65 years of age.
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Affiliation(s)
- Hideki Shimaoka
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Yoichiro Yoshida
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan.
- Department of Medical Informatics and Digital Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan.
| | - Teppei Yamada
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Hisaaki Shimokoube
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Naoya Aisu
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Shinichiro Ogawa
- Department of Medical Informatics and Digital Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Kazuo Tamura
- Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
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Van Rickstal R, Van den Block L, Decoster L, Ritchie C, Wyn Griffiths A, Gilissen J. How oncologists assess and consider cognition in clinical decision-making with older adults. J Geriatr Oncol 2025:102204. [PMID: 39955220 DOI: 10.1016/j.jgo.2025.102204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 12/05/2024] [Accepted: 02/07/2025] [Indexed: 02/17/2025]
Affiliation(s)
- Romy Van Rickstal
- End-of-life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lore Decoster
- Division of Medical Oncology, University Hospital Brussels & Vrije Universiteit Brussel, Brussels, Belgium
| | - Christine Ritchie
- Atlantic Fellows for Equity in Brain Health, Global Brain Health Institute (GBHI), University San Francisco California (UCSF), San Francisco, CA, USA; The Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA; Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital (MGH), Boston, MA, USA
| | - Alys Wyn Griffiths
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Joni Gilissen
- End-of-life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Division of Medical Oncology, University Hospital Brussels & Vrije Universiteit Brussel, Brussels, Belgium; Research Centre Care in Connection, Karel de Grote University of Applied Sciences and Arts, Antwerp, Belgium.
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Wingfield SA. The role of geriatric assessment in the care of older adults undergoing urologic cancer surgery. Curr Opin Urol 2024; 34:438-443. [PMID: 39113607 DOI: 10.1097/mou.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2024]
Abstract
PURPOSE OF REVIEW Older adults undergoing urologic cancer surgery have unique needs and require unique risk assessment and management. This review will discuss recent literature on brief screening tools to identify high risk older adults in the preoperative period and the role of comprehensive geriatric assessment (CGA) in identifying and addressing geriatric vulnerabilities for older adults undergoing urologic cancer surgery. RECENT FINDINGS Frailty screening tools such as the G8 can be used to identify patients who are at an increased risk of adverse postoperative outcomes such as postoperative complications and prolonged length of stay. CGA can provide more detailed information about geriatric syndromes prior to urologic cancer surgery. SUMMARY Screening tools for geriatric vulnerabilities and CGA are valuable tools for the urologist in identifying high-risk older adults, counseling patients on perioperative risk and addressing vulnerabilities prior to surgery. Making health system-wide changes can allow this optimal practice to reach more older surgical patients.
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Affiliation(s)
- Sarah A Wingfield
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Teraishi F, Shoji R, Kondo Y, Kagawa S, Tamura R, Matsuoka Y, Morimatsu H, Mitsuhashi T, Fujiwara T. Comprehensive geriatric assessment as an indicator of postoperative recovery in older patients with colorectal cancer. J Geriatr Oncol 2024; 15:101837. [PMID: 39054156 DOI: 10.1016/j.jgo.2024.101837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 07/09/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Fuminori Teraishi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Minimally Invasive Therapy Center, Okayama University Hospital, Okayama, Japan.
| | - Ryohei Shoji
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshitaka Kondo
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shunsuke Kagawa
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Rie Tamura
- Perioperative Management Center, Okayama University Hospital, Okayama, Japan
| | - Yoshikazu Matsuoka
- Perioperative Management Center, Okayama University Hospital, Okayama, Japan
| | - Hiroshi Morimatsu
- Perioperative Management Center, Okayama University Hospital, Okayama, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Minimally Invasive Therapy Center, Okayama University Hospital, Okayama, Japan
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Baltussen JC, Cárdenas-Reyes P, Chavarri-Guerra Y, Ramirez-Fontes A, Morales-Alfaro A, Portielje JEA, Ramos-Lopez WA, Rosado-Canto V, Soto-Perez-de-Celis E. Time toxicity among older patients with cancer treated with palliative systemic therapy. Support Care Cancer 2024; 32:621. [PMID: 39212749 DOI: 10.1007/s00520-024-08844-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE The time toxicity of anticancer therapy, defined as days spent with healthcare contact during treatment, represents a critical but understudied outcome. This study aims to quantify time toxicity among older patients with cancer receiving palliative systemic treatment. METHODS All patients aged ≥ 65 years with metastatic cancer receiving cytotoxic chemotherapy, immunotherapy, or targeted therapy at a single center in Mexico were selected from a prospective patient navigation cohort. Patients completed a baseline assessment, including the G8 screening and quality of life measures. Physical healthcare contact days within the first 6 months were extracted from medical records and divided by days alive during the same period. Beta regression models were used to identify predictors of time toxicity. RESULTS We identified 158 older patients (median age 71 years); 86% received cytotoxic chemotherapy. Seventy-three percent had an impaired G8 score and were considered vulnerable/frail. Six-month overall survival was 74%. Within the first 6 months, patients spent a mean of 21% (95% confidence interval (CI) 19-23%) of days with healthcare contact. Concurrent radiotherapy (odds ratio (OR) 1.55; 95%CI 1.21-1.97), cytotoxic chemotherapy versus targeted therapy (OR 1.64; 95%CI 1.13-2.37), and an impaired G8 (OR 1.27; 95%CI 1.01-1.60) were associated with increased time toxicity. CONCLUSION Older adults with metastatic cancer spend 1 in 5 days with healthcare contact during treatment, with a higher burden of time toxicity for patients receiving radiotherapy or cytotoxic chemotherapy and those with potential frailty. These findings underscore the importance of informing patients about their expected healthcare contact days within the context of a limited life expectancy.
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Affiliation(s)
- Joosje C Baltussen
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Paula Cárdenas-Reyes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Yanin Chavarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Andrea Ramirez-Fontes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Andrea Morales-Alfaro
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | | | - Wendy A Ramos-Lopez
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Valentina Rosado-Canto
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico.
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Yajima S, Masuda H. The significance of G8 and other geriatric assessments in urologic cancer management: A comprehensive review. Int J Urol 2024; 31:607-615. [PMID: 38402450 DOI: 10.1111/iju.15432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
In urologic oncology, which often involves older patients, it is important to consider how to manage their care appropriately. Geriatric assessment (GA) is a method that can address the specific needs of older cancer patients. The GA encompasses various assessment domains, but these domains exhibit variations across the literature. Some of the common items include functional ability, nutrition, comorbidities, cognitive ability, psychosocial disorders, polypharmacy, social and financial support, falls/imbalance, and vision/hearing. Despite the diversity of domains, there is limited consensus on reliable measurement methods. This review discusses the role of GA in managing urologic cancer in unique scenarios, such as those necessitating temporary or permanent urinary catheters or stomas due to urinary diversion. A comprehensive GA is time and human-resource-intensive in real-world clinical practice. Hence, simpler tools such as the Geriatric-8 (G8), capable of identifying high-risk patients requiring a detailed GA, are also under investigation in various contexts. Therefore, we conducted a systematic literature review on the G8. Our findings indicate that patients with low G8 scores encounter difficulties with stoma self-care after urinary diversion and have higher risks of urinary tract infections and ileus after radical cystectomy. The utilization of G8 as a screening tool for urologic cancer patients may facilitate the delivery of appropriate and personalized treatment and care.
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Affiliation(s)
- Shugo Yajima
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| | - Hitoshi Masuda
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
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Diaz FC, Hamparsumian A, Loh KP, Verduzco-Aguirre H, Abdallah M, Williams GR, Hsu T, Soto-Perez-de-Celis E, Elias R. Geriatric Oncology: A 5-Year Strategic Plan. Am Soc Clin Oncol Educ Book 2024; 44:e100044. [PMID: 38709980 PMCID: PMC11463154 DOI: 10.1200/edbk_100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
The increasing rate of the older adult population across the world over the next 20 years along with significant developments in the treatment of oncology will require a more granular understanding of the older adult population with cancer. The ASCO Geriatric Oncology Community of Practice (COP) herein provides an outline for the field along three fundamental pillars: education, research, and implementation, inspired by ASCO's 5-Year Strategic Plan. Fundamental to improving the understanding of geriatric oncology is research that intentionally includes older adults with clinically meaningful data supported by grants across all career stages. The increased knowledge base that is developed should be conveyed among health care providers through core competencies for trainees and continuing education for practicing oncologists. ASCO's infrastructure can serve as a resource for fellowship programs interested in acquiring geriatric oncology content and provide recommendations on developing training pathways for fellows interested in pursuing formalized training in geriatrics. Incorporating geriatric oncology into everyday practice is challenging as each clinical setting has unique operational workflows with barriers that limit implementation of valuable geriatric tools such as Geriatric Assessment. Partnerships among experts in quality improvement from the ASCO Geriatric Oncology COP, the Cancer and Aging Research Group, and ASCO's Quality Training Program can provide one such venue for implementation of geriatric oncology through a structured support mechanism. The field of geriatric oncology must continue to find innovative strategies using existing resources and partnerships to address the pressing needs of the older adult population with cancer to improve patient outcomes.
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Affiliation(s)
- Fernando C Diaz
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
- Division of Geriatrics, University of North Carolina, Chapel Hill, NC
| | - Anahid Hamparsumian
- Geriatric Research Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Haydeé Verduzco-Aguirre
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Maya Abdallah
- Section of Hematology/Oncology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA
| | - Grant R Williams
- Lewis and Faye Manderson Cancer Center at DCH Regional Medical Center, Tuscaloosa, AL
- Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Tina Hsu
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rawad Elias
- Division of Hematology-Oncology, UMass Chan Medical School-Baystate, Springfield, MA
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