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Waaijer MEC, Lemij AA, de Boer AZ, Bastiaannet E, van den Bos F, Derks MGM, Kroep JR, Liefers GJ, Portielje JEA, de Glas NA. The impact of geriatric characteristics and comorbidities on distant metastases and other cause mortality in older women with non-metastatic breast cancer treated with primary endocrine therapy. Breast Cancer Res Treat 2023; 201:471-478. [PMID: 37479944 PMCID: PMC10460719 DOI: 10.1007/s10549-023-07029-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/28/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION In recent years, primary surgical treatment of older women with non-metastatic breast cancer has decreased in favor of primary endocrine therapy (PET). PET can be considered in women with a remaining life expectancy of less than five years. The aim of this study was to (1) assess the risk of distant metastases and other cause mortality over ten years in women aged 65 and older with stage I-III breast cancer treated with PET, (2) whether this was associated with geriatric characteristics and comorbidities and to (3) describe the reasons on which the choice for PET was made. METHODS Women were included from the retrospective FOCUS cohort, which comprises all incident women diagnosed with breast cancer aged 65 or older between January 1997 and December 2004 in the Comprehensive Cancer Center Region West in the Netherlands. We selected women (N = 257) with stage I-III breast cancer and treated with PET from this cohort. Patient characteristics (including comorbidity, polypharmacy, walking, cognitive and sensory impairment), treatment and tumor characteristics were retrospectively extracted from charts. Outcomes were distant metastasis and other cause mortality. Cumulative incidences were calculated using the Cumulative Incidence for Competing Risks method (CICR); and subdistribution hazard ratios (SHR) were tested between groups based on age, geriatric characteristics and comorbidity with the Fine and Gray model. RESULTS Women treated with PET were on average 84 years old and 41% had one or more geriatric characteristics. Other cause mortality exceeded the cumulative incidence of distant metastasis over ten years (83 versus 5.6%). The risk of dying from another cause further increased in women with geriatric characteristics (SHR 2.06, p < 0.001) or two or more comorbidities (SHR 1.72, p < 0.001). Often the reason for omitting surgery was not recorded (52.9%), but if recorded surgery was omitted mainly at the patient's request (18.7%). DISCUSSION This study shows that the cumulative incidence of distant metastasis is much lower than other cause mortality in older women with breast cancer treated with PET, especially in the presence of geriatric characteristics or comorbidities. This confirms the importance of assessment of geriatric characteristics to aid counseling of older women.
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Affiliation(s)
- M E C Waaijer
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - A A Lemij
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - A Z de Boer
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - E Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - F van den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - M G M Derks
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - J R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - G J Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - N A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands.
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Esbenshade AJ, Lu L, Friedman DL, Oeffinger KC, Armstrong GT, Krull KR, Neglia JP, Leisenring WM, Howell R, Partin R, Sketch A, Robison LL, Ness KK. Accumulation of Chronic Disease Among Survivors of Childhood Cancer Predicts Early Mortality. J Clin Oncol 2023:JCO2202240. [PMID: 37216619 DOI: 10.1200/jco.22.02240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 03/07/2023] [Accepted: 04/05/2023] [Indexed: 05/24/2023] Open
Abstract
PURPOSE Cancer survivors develop cancer and treatment-related morbidities at younger than normal ages and are at risk for early mortality, suggestive of an aging phenotype. The Cumulative Illness Rating Scale for Geriatrics (CIRS-G) is specifically designed to describe the accumulation of comorbidities over time with estimates of severity such as total score (TS) which is a sum of possible conditions weighted by severity. These severity scores can then be used to predict future mortality. METHODS CIRS-G scores were calculated in cancer survivors and their siblings from Childhood Cancer Survivor Study cohort members from two time points 19 years apart and members of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. CIRS-G metrics were analyzed using Cox proportional hazards regression to determine subsequent mortality risk. RESULTS In total, 14,355 survivors with a median age of 24 (IQR, 18-30) years and 4,022 siblings with a median age of 26 (IQR, 19-33) years provided baseline data; 6,138 survivors and 1,801 siblings provided follow-up data. Cancer survivors had higher median baseline TS than siblings at baseline (5.75 v 3.44) and follow-up (7.76 v 4.79), all P < .01. The mean increase in TS from baseline to follow-up was significantly steeper in cancer survivors (2.89 males and 3.18 females) vs. siblings (1.79 males and 1.69 females) and NHANES population (2.0 males and 1.94 females), all P < .01. Every point increase in baseline TS increased hazard for death by 9% (95% CI, 8 to 10) among survivors. CONCLUSION Application of a geriatric rating scale to characterize disease supports the hypothesis that morbidity accumulation is accelerated in young adult survivors of childhood cancer when compared with siblings and the general population.
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Affiliation(s)
- Adam J Esbenshade
- Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Lu Lu
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Debra L Friedman
- Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | | | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN
| | - Joseph P Neglia
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Wendy M Leisenring
- Clincal Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Rebecca Howell
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX
| | - Robyn Partin
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Amy Sketch
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
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Zang Z. The care types choice in filial culture: A cross-sectional study of disabled elderly in China. Front Public Health 2022; 10:954035. [PMID: 36148366 PMCID: PMC9485573 DOI: 10.3389/fpubh.2022.954035] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/02/2022] [Indexed: 01/24/2023] Open
Abstract
For the past few decades, studies of care types choice have been restricted to the scope of individual characteristics and health status. Meanwhile, the historiography of the research largely ignores the role of filial culture within China. This study sets out to examine the influence of the factors in the cultural context of filial piety on the choice of care types for older people with disability in China. According to the characteristics of filial culture, the factors influencing the choice of care type for the older people in China are summarized as family endowment and support. The study concludes that gender, residence, living alone or not, family income, real estate, pension and community service have momentous effects on the choice of care type of older people with disability; informal care has a substitutive effect on formal care. The research was based on cross-sectional data of CLHLS 2018 and utilized binary logistic regression analysis to compare the factors influencing the choice of old disabled people between formal and informal care. The study implies that in the context of filial culture, the older people's choice of care types is affected by family endowment and community service supply for the older people in China. In the background of filial culture, the government should give informal care official support such as cash and services, so as to change its attribute of private domain of it and enhance the quality of long-term care.
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Affiliation(s)
- Zheng Zang
- School of Marxism, Soochow University, Suzhou, China,Soochow University Base, Jiangsu Research Centre for Socialist Theory System With Chinese Characteristics, Suzhou, China,*Correspondence: Zheng Zang
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NLR and CRP to albumin ratio as a predictor of in-hospital mortality in the geriatric ED patients. Am J Emerg Med 2021; 44:50-55. [PMID: 33578332 DOI: 10.1016/j.ajem.2021.01.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION We aimed to investigate the role of neutrophil to lymphocyte ratio (NLR) and the C-Reactive Protein/Albumin Ratio (CAR), which are obtained from the first laboratory values of the elderly patients at admission to the emergency department (ED), in predicting in-hospital mortality. METHODS This retrospective observational study includes the patients aged 65 and above who applied to the emergency department for two months. The patients' neutrophil, lymphocyte, C-reactive protein (CRP), albumin, NLR and CAR values were recorded. Statistical analysis of NLR and CAR values was performed according to in-hospital mortality and ED outcome. RESULTS 784 patients were included in the statistical analysis of the study. Increased NLR (8.82 (4.16-16.63), 4.76 (2.62-8.56), p˂0.001) and increased CAR (21.39 (6.02-55.07), 4.82 (1.17-17.03), p < 0.001) values were found to be statistically significant in the group with mortality compared to the group without mortality. Increased NLR (AUC: 0.642) and increased CAR (AUC: 0.723) were a predictor of in-hospital mortality. It was found that in-hospital mortality risk in patients with concurrent high NLR and CAR values (CAR˃12.3, NLR˃7.1) was 9.87 times more than the patients with concurrent low NLR and CAR values (CAR<12.3, NLR < 7.1). NLR and CAR values of the patients hospitalized in intensive care and service (NLR 7.21 (4.07-13.36), 5.77 (3.45-11.22); CAR 12.65 (2.79-36.8), 9.56 (1.74-33.97)) were found to be statistically significantly higher than those who were discharged (NLR 3.64 (2.26-7.02); CAR 2.88 (0.9-10.59)). CONCLUSION According to our results, the concurrent high levels of NLR and CAR values were found to be more effective in predicting in-hospital mortality compared to a separate evaluation.
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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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González Cervantes JJ, Mascarós Martínez JM, Arana E. Administration of iodinated contrast: What is the risk in cancer patients? Eur J Cancer Care (Engl) 2020; 30:e13351. [PMID: 33135211 DOI: 10.1111/ecc.13351] [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: 02/20/2020] [Revised: 06/20/2020] [Accepted: 09/10/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Despite the association between intravenous contrast and kidney injury, few studies exist in oncology. Our objective was to estimate kidney outcomes following iodinated contrast-enhanced computed tomography (CECT) in cancer patients, and to evaluate whether self-assessment questionnaires can identify kidney injury risk factors. METHODS This prospective observational study included 289 patients who underwent a CECT scan between March and May 2017 in a hospital setting. All patients completed the modified European Society of Urogenital Radiology (ESUR) questionnaire and had an estimated glomerular filtration rate (eGFR) >30 ml/min/1.73 m2 on the day of the examination. Outcomes were followed for 4 months. Univariate and logistic regression analyses were carried out. RESULTS In the logistic regression analysis, the only variables statistically associated with deterioration in the eGFR were age, (odds ratio (OR) = 1.091, p = 0.003), female sex, (OR 0.22, p = 0.020) and arterial hypertension (AH), (OR = 3.57, p = 0.019). Regarding exitus, only the group with a worse eGFR was close to predictive statistical significance (OR = 2.48, p = 0.09). CONCLUSIONS The administration of iodinated contrast in cancer patients was not associated with an increase in kidney outcomes. Risk factors in these patients were age, sex and AH.
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Affiliation(s)
- Jose Javier González Cervantes
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, España.,Servicio de Radiología, Instituto Valenciano de Oncología. (FIVO), Valencia, España
| | | | - Estanislao Arana
- Servicio de Radiología, Instituto Valenciano de Oncología. (FIVO), Valencia, España
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Yamada SI, Kurita H, Nakano R, Ohta R, Akita D, Hashidume M, Morishita K, Kondo E, Sakai H. Treatment strategies for and outcomes of older patients with oral squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:322-329. [PMID: 32102767 DOI: 10.1016/j.oooo.2019.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/17/2019] [Accepted: 10/09/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate factors that have a significant impact on decision making regarding treatment strategies and on the resultant outcomes in older patients with oral squamous cell carcinoma (OSCC). STUDY DESIGN To define fit, vulnerable, and frail patients, as well as treatment strategies/outcomes, in patients 75 years of age and older with primary OSCC were retrospectively reviewed from the medical records. RESULTS Among patients with stage I and II tumors, those with a Geriatric 8 (G8) score of 11.5 or greater had favorable outcomes and those with a score less than 11.5 had acceptable outcomes (5-year self-reliance [SR] rates: 80.8 and 53.5%, respectively). Among patients with stage III and IV tumors, those with the Eastern Cooperative Oncology Group-Performance status (ECOG-PS) score less than 2 and/or a G8 score 11.5 or greater mainly received standard therapy, had favorable outcomes (5-year SR rate: 66.7%). The 5-year SR rates of stage IV patients with an ECOG-PS score 2 or greater and those with a G8 score less than 11.5 were poor regardless of any treatment strategy. Although the 5-year SR rate of patients with standard therapy was 73.4%, that of patients receiving other curative therapies was 0%. CONCLUSIONS In patients with stage III/IV, ECOG-PS 2 or greater, and/or G8 score less than 11.5, treatment was difficult, and the prognosis was poor.
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Affiliation(s)
- Shin-Ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Ryoko Nakano
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ryosuke Ohta
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Daisuke Akita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masao Hashidume
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kota Morishita
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Eiji Kondo
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hironori Sakai
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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van Walree IC, Scheepers E, van Huis-Tanja L, Emmelot-Vonk MH, Bellera C, Soubeyran P, Hamaker ME. A systematic review on the association of the G8 with geriatric assessment, prognosis and course of treatment in older patients with cancer. J Geriatr Oncol 2019; 10:847-858. [DOI: 10.1016/j.jgo.2019.04.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/17/2019] [Accepted: 04/20/2019] [Indexed: 12/13/2022]
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Yamada SI, Hasegawa T, Okuyama K, Yamakawa N, Okura M, Hashidume M, Yanamoto S, Akashi M, Kirita T, Umeda M, Kurita H. Clinical significance of the G8 screening tool in elderly patients with oral squamous cell carcinoma. Clin Oral Investig 2019; 24:1953-1961. [PMID: 31410674 DOI: 10.1007/s00784-019-03056-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/05/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The present study investigated the clinical significance of the G8 screening tool in elderly oral squamous cell carcinoma (OSCC) patients using a multicenter analysis. MATERIALS AND METHODS The medical records of 438 primary OSCC patients aged 75 years and older were retrospectively reviewed. To examine the clinical significance of the G8 screening tool in elderly OSCC patients, self-reliance (SR) rates and prognostic factors were statistically analyzed. RESULTS The mean score of the G8 screening tool was 10.9 ± 2.93. The SR cut-off value of the G8 score was 9.5 in a receiver operating characteristic curve analysis. Five-year overall survival rates were 40.1% in patients with a G8 score < 9.5 and 58.4% in those with a G8 score ≥ 9.5 (p < 0.01). Five-year cancer-specific rates were 34.3% in patients with a G8 score < 9.5 and 55.7% in those with a G8 score ≥ 9.5 (p < 0.01). Five-year SR rates were 40.7% in patients with a G8 score < 9.5 and 55.3% in those with a G8 score ≥ 9.5 (p < 0.05). A multivariate analysis identified an advanced age (≥ 80 vs < 80; HR, 1.437; 95%CI, 1.181-1.843; p < 0.01), poorer ECOG-PS (2-4 vs 0-1; HR, 1.560; 95%CI, 1.14-2.106; p < 0.01), and standard treatment (non-standard therapy vs standard therapy; HR, 0.598; 95%CI, 0.405-0.910; p < 0.05) as significant independent prognostic factors for SR. A lower G8 score was associated with poorer SR (≥ 9.5 vs < 9.5; HR, 0.765; 95%CI, 0.575-1.034; p = 0.081). CONCLUSION The clinical significance of the G8 score for elderly OSCC patients was demonstrated and its combination with ECOG-PS may be useful for assessing their prognoses.
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Affiliation(s)
- Shin-Ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan.
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kohei Okuyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuhiro Yamakawa
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Masaya Okura
- The 1st Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Masao Hashidume
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
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Salazar AS, Recinos LM, Mian HS, Stoll C, Simon LE, Sekhon S, Colditz GA, Wildes TM. Geriatric Assessment and Frailty Scores Predict Mortality in Myeloma: Systematic Review and Meta-analysis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:488-496.e6. [DOI: 10.1016/j.clml.2019.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022]
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Overcash J. Comprehensive Geriatric Assessment: Interprofessional Team Recommendations for Older Adult Women With Breast Cancer. Clin J Oncol Nurs 2019; 22:304-315. [PMID: 29781467 DOI: 10.1188/18.cjon.304-315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Geriatric oncology incorporates comprehensive geriatric assessment (CGA) and traditional oncology care. OBJECTIVES The aims are to identify limitations reflected by mean scores on the CGA instruments and describe the CGA recommendations documented in the medical record. METHODS CGA was administered and consisted of the Timed Up and Go Test, the Activities of Daily Living Scale, the Instrumental Activities of Daily Living Scale, grip strength, falls, pain, the Brief Fatigue Inventory, the Pittsburgh Sleep Quality Index, the Geriatric Depression Scale, the Mini-Cog, and the Mini Nutritional Assessment. CGA recommendations were obtained from the medical record. Descriptive statistics were used to analyze the data. FINDINGS Most recommendations were for general cancer treatment, followed by fall referral/education.
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Predictive value of each geriatric assessment domain for older patients with cancer: A systematic review. J Geriatr Oncol 2019; 10:859-873. [PMID: 30926250 DOI: 10.1016/j.jgo.2019.02.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/23/2019] [Accepted: 02/14/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND A geriatric assessment (GA) is increasingly used to help guide treatment decisions in older patients with cancer. However, there is no consensus regarding which domains should be included in the GA. In addition, the field of geriatric oncology moves very fast and as a result many new studies have been published since the last review in 2015. Therefore, the objective of this systematic review is to evaluate which domains of the GA could predict patient-related treatment outcomes of older patients with cancer and thereby should be included in a GA. METHODS A systematic literature search was performed for publications in English or Dutch between September 2006 and July 2017 addressing the association between individual domains of the GA and mortality, postoperative complications, or systemic treatment-related outcomes in older patients with cancer. RESULTS Eight different domains were evaluated in 46 publications, namely functional status, nutritional status, cognition, mood, physical function, fatigue, social support, and falls. All eight domains were predictive for at least one of the investigated outcomes but the results were quite variable across studies. Physical function and nutritional status were the domains most often associated with mortality and systemic treatment-related outcomes, and the domain physical function was most often associated with postoperative complications. CONCLUSION Overall, this review demonstrates that the GA should minimally consist of physical function and nutritional status, when the aim is to predict patients-related outcomes of older patients with cancer, although the results are quite heterogeneous. For the other domains, the findings are too inconsistent to draw conclusions about their overall predictive ability.
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Prediction of postoperative delirium by comprehensive geriatric assessment among elderly patients with hip fracture. Ir J Med Sci 2019; 188:1311-1315. [PMID: 30915678 DOI: 10.1007/s11845-019-02011-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 03/20/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of this study is to investigate whether the preoperative comprehensive geriatric assessment (CGA) would predict postoperative delirium (POD) in elderly patients with hip fracture. METHODS This is an observational study, performed in a tertiary hospital from June 2014 to May 2018, which enrolled patients with hip fracture aged over 65 years. The comprehensive geriatric assessment for recruited patients was carried out before surgery. POD was recorded prospectively until discharge. Delirium was diagnosed according to the Confusion Assessment Method (CAM) algorithm. RESULTS POD occurred in 22.09% of the 507 patients who underwent hip surgery. The Barthel index, Mini-Mental State Examination (MMSE), instrumental activities of daily living (IADL), vitality index, and Geriatric Depression Scale (GDS) results were related to the occurrence of POD. All of them were independent factors related to the occurrence of POD after adjusting other traditional risk factors. CONCLUSIONS The comprehensive geriatric assessment before hip fracture surgery can predict the occurrence of POD in elderly patients.
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Edwards BJ, Zhang X, Sun M, Song J, Khalil P, Karuturi MS, Pang L, Geng Y, Dinney CP, Valero V, Champlin RE, Tripathy D. Overall survival in older patients with cancer. BMJ Support Palliat Care 2018; 10:25-35. [PMID: 30244203 DOI: 10.1136/bmjspcare-2018-001516] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/06/2018] [Accepted: 08/01/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVES A growing number of patients with cancer are older adults. We sought to identify the predictors for overall survival (OS) in older adults with solid tumour and haematological malignancies between January 2013 and December 2016. METHODS Retrospective cohort study. A comprehensive geriatric assessment was performed, with a median follow-up of 12.8 months. ANALYSIS univariate and multivariate Cox proportional hazards regression analysis. RESULTS In this study, among the 455 patients with last follow-up date or date of death, 152 (33.4%) died during the follow-up. The median follow-up is 12.8 months (range 0.2-51.1 months) and the median OS is 20.5 months (range 0.3-44.5 months). Among all older patients with cancer, predictors of OS included male gender, cancer stage, malnutrition, history of smoking, heavy alcohol use, frailty, weight loss, major depression, low body weight and nursing home residence. Traditional performance scores (Eastern Cooperative Oncology Group (ECOG) and Karnofsky Performance Scale (KPS)) were predictors of OS. Independent predictors included age >85 years and haematological malignancies. Among solid tumours (n=311) in addition to the above predictors, comorbidity, gait speed and vitamin D deficiency were associated with OS. CONCLUSIONS We identified specific geriatric factors associated with OS in older patients with cancer, and comparable in predictive ability to traditional performance scores such as KPS and ECOG. Prospective studies will be necessary to confirm our findings.
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Affiliation(s)
- Beatrice J Edwards
- Geriatrics and Extended Care, Central Texas Veterans Healthcare System, Temple, Texas, USA
| | - Xiaotao Zhang
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ming Sun
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juhee Song
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peter Khalil
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Meghan Sri Karuturi
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Linda Pang
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yunlong Geng
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Colin P Dinney
- Department of Urologic Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Richard E Champlin
- Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debasish Tripathy
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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15
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Polypharmacy in Older Adults with Cancer: Evaluating Polypharmacy as Part of the Geriatric Assessment. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0221-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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16
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Farag S, van Coevorden F, Sneekes E, Grunhagen DJ, Reyners AKL, Boonstra PA, van der Graaf WT, Gelderblom HJ, Steeghs N. Elderly patients with gastrointestinal stromal tumour (GIST) receive less treatment irrespective of performance score or comorbidity - A retrospective multicentre study in a large cohort of GIST patients. Eur J Cancer 2017; 86:318-325. [PMID: 29073582 DOI: 10.1016/j.ejca.2017.09.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Although gastrointestinal stromal tumours (GIST) predominantly occur in older patients, data on treatment patterns in elderly GIST patients are scarce. METHODS Patients registered in the Dutch GIST Registry (DGR) from January 2009 until December 2016 were included. Differences in treatment patterns between elderly (≥75 years) and younger patients were compared. Multivariate analyses were conducted using logistic regression. RESULTS Data of 145 elderly and 665 non-elderly patients were registered (median age 78 and 60 years respectively). In elderly patients, performance score (WHO-PS) and age-adjusted Charlson comorbidity index (ACCI) were significantly higher (p < 0.05; p < 0.001), and albumin level significantly lower (p = 0.04). Hundred-and-nine (75.2%) elderly and 503 (75.6%) non-elderly patients had only localised disease. Surgery was performed in 57% of elderly versus 84% of non-elderly patients (p = 0.003, OR: 0.26, 95% CI: 0.11-0.63). No differences in surgery outcome or complications were found. Thirty-eight percent of elderly with an indication for adjuvant treatment did receive imatinib versus 68% of non-elderly (p = 0.04, OR: 0.47, 95% CI: 0.23-0.95). Thirty-six elderly and 162 non-elderly patients had metastatic disease. Palliative imatinib was equally given (mean dose 400 mg) and adverse events were mostly minor (p = 0.71). In elderly, drug-related toxicity was in 32.7% reason to discontinue imatinib versus 5.1% in non-elderly (p = 0.001, OR 13.5, 95% CI: 2.8-65.0). Median progression-free survival (PFS) was 24 months in elderly and 33 months in non-elderly (p = 0.10). Median overall survival (OS) was 34 months and 59 months respectively (p = 0.01). CONCLUSIONS Elderly GIST patients with localised disease receive less surgery and adjuvant treatment, irrespective of comorbidity and performance score. Drug-related toxicity results more often in treatment discontinuation. This possibly results in poor outcome.
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Affiliation(s)
- Sheima Farag
- Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Frits van Coevorden
- Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, Department of Surgical Oncology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Esther Sneekes
- Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Dirk J Grunhagen
- Erasmus MC - Cancer Institute, Department of Medical Oncology, Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Anna K L Reyners
- University Medical Centre Groningen, Department of Medical Oncology, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Pieter A Boonstra
- University Medical Centre Groningen, Department of Medical Oncology, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Winette T van der Graaf
- The Radboud University Medical Center, Department of Medical Oncology, PO Box 9101, 6500 HB Nijmegen, The Netherlands; The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Fullham Road, London, UK
| | - Hans J Gelderblom
- Leiden University Medical Center, Department of Medical Oncology, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Neeltje Steeghs
- Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
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17
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Miaskowski C, Wong ML, Cooper BA, Mastick J, Paul SM, Possin K, Steinman M, Cataldo J, Dunn LB, Ritchie C. Distinct Physical Function Profiles in Older Adults Receiving Cancer Chemotherapy. J Pain Symptom Manage 2017; 54:263-272. [PMID: 28716620 PMCID: PMC5610084 DOI: 10.1016/j.jpainsymman.2017.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/01/2017] [Accepted: 07/07/2017] [Indexed: 02/07/2023]
Abstract
CONTEXT Although physical function is an important patient outcome, little is known about changes in physical function in older adults receiving chemotherapy (CTX). OBJECTIVES Identify subgroups of older patients based on changes in their level of physical function; determine which demographic and clinical characteristics were associated with subgroup membership; and determine if these subgroups differed on quality-of-life (QOL) outcomes. METHODS Latent profile analysis was used to identify groups of older oncology patients (n = 363) with distinct physical function profiles. Patients were assessed six times over two cycles of CTX using the Physical Component Summary score from the Short Form 12. Differences, among the groups, in demographic and clinical characteristics and QOL outcomes were evaluated using parametric and nonparametric tests. RESULTS Three groups of older oncology patients with distinct functional profiles were identified: Well Below (20.4%), Below (43.8%), and Above (35.8%) normative Physical Component Summary scores. Characteristics associated with membership in the Well Below class included the following: lower annual income, a higher level of comorbidity, being diagnosed with depression and back pain, and lack of regular exercise. Compared with the Above class, patients in the other two classes had significantly poorer QOL outcomes. CONCLUSION Almost 65% of older oncology patients reported significant decrements in physical function that persisted over two cycles of CTX. Clinicians can assess for those characteristics associated with poorer functional status to identify high-risk patients and initiate appropriate interventions.
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Affiliation(s)
| | - Melisa L Wong
- School of Medicine, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Katherine Possin
- School of Medicine, University of California, San Francisco, California, USA
| | - Michael Steinman
- School of Medicine, University of California, San Francisco, California, USA
| | - Janine Cataldo
- School of Nursing, University of California, San Francisco, California, USA
| | - Laura B Dunn
- School of Medicine, Stanford University, Palo Alto, California, USA
| | - Christine Ritchie
- School of Medicine, University of California, San Francisco, California, USA
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18
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Takahashi M, Takahashi M, Komine K, Yamada H, Kasahara Y, Chikamatsu S, Okita A, Ito S, Ouchi K, Okada Y, Imai H, Saijo K, Shirota H, Takahashi S, Mori T, Shimodaira H, Ishioka C. The G8 screening tool enhances prognostic value to ECOG performance status in elderly cancer patients: A retrospective, single institutional study. PLoS One 2017. [PMID: 28640844 PMCID: PMC5480957 DOI: 10.1371/journal.pone.0179694] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Some elderly cancer patients, even with good Eastern Cooperative Oncology Group performance status (ECOG-PS), have poor survival outcomes and cannot tolerate standard therapy. Few studies have detailed the associations between the G8 screening tool, ECOG-PS, and overall survival (OS) in such patients. Methods Cancer patients, aged 70 years or older, were assessed for G8 and classified into three groups according to their G8 score: <11 as the low score group, 11–14 as the intermediate score group, and >14 as the high score group. We retrospectively analyzed the association between G8 score and OS in all patients and for each ECOG-PS-categorized group. Results Out of 264 enrolled patients, most patients (87%) with solid tumor were categorized as TNM stage IV. ECOG-PS was 0 or 1 in 215 patients and ≥2 in 48; there was missing data for one patient. Among all patients, the low score group with a median OS of 7.7 months survived significantly less than both the high score group with a median OS of 25.6 months [Hazard ratio (HR) 3.48; 95% confidence interval (CI), 1.96–6.63; p < 0.0001] and the intermediate score group with a median of 15.6 months (HR 1.83; 95% CI, 1.28–2.65; p < 0.001). In the multivariate analysis, TNM stage and G8 score were independent prognostic factors for OS. When patients with an ECOG-PS of 0 or 1 were analyzed, patients with a lower G8 score showed significantly shorter OS than patients with a higher score when any two groups were compared. Conclusion This novel classification of the G8 score contributes to prompt identification of patients with poor prognosis and improved the prognostic value of ECOG-PS. Using G8 with ECOG-PS may be helpful in deciding treatment for elderly patients with advanced cancer.
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Affiliation(s)
- Masahiro Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Masanobu Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Keigo Komine
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Hideharu Yamada
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Yuki Kasahara
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Sonoko Chikamatsu
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Akira Okita
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Shukuei Ito
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Kota Ouchi
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Yoshinari Okada
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Hiroo Imai
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Ken Saijo
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Hidekazu Shirota
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
| | - Shin Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Takahiro Mori
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
| | - Hideki Shimodaira
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Chikashi Ishioka
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
- * E-mail:
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19
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Zulfiqar AA, Sui Seng X, Gillibert A, Kadri N, Doucet J. Anemia and frailty in the elderly hospitalized in an acute unit: Preliminary results. Eur J Intern Med 2017; 38:e8-e9. [PMID: 27829532 DOI: 10.1016/j.ejim.2016.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 01/31/2023]
Abstract
Anemia is a frequent reason for hospitalization in acute geriatric units. The elderly are particularly susceptible and can condition the prognosis in cases of poor tolerance. The main objective is to research the link between anemia and weakness according to FRIED.
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Affiliation(s)
| | - Xavier Sui Seng
- Geriatric Department, University Hospital of Rouen, 76000 Rouen, France.
| | - André Gillibert
- Pharmacovigilance Unit, University Hospital of Rouen, France.
| | - Nadir Kadri
- Geriatric Department, University Hospital of Rouen, 76000 Rouen, France.
| | - Jean Doucet
- Geriatric Department, University Hospital of Rouen, 76000 Rouen, France.
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