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Xu W, Yang H, Li W, Wang Y, Zhang X, Chen Y. The Impact of Frailty on Chemotherapy Outcomes in Patients With Digestive System Tumors: A Systematic Review and Meta-analysis. Cancer Nurs 2024:00002820-990000000-00261. [PMID: 38865649 DOI: 10.1097/ncc.0000000000001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
BACKGROUND The prevalence of patients with digestive system tumors has been high. In recent years, frailty has been considered to be associated with poor prognosis of digestive system tumors, but there are conflicting research results. A better understanding of the relationship between frailty and outcomes after chemotherapy can help advance the development of oncology care. OBJECTIVE The aim of this study was to evaluate the effects of prechemotherapy frailty on chemotherapy toxicity, overall mortality, unplanned hospitalization, and overall survival in patients with digestive system tumors. METHODS Up to April 2023, observational studies assessing the impact of frailty on chemotherapy outcomes in patients with digestive system tumors were collected through searching 10 online research databases. Two evaluators independently extracted literature based on the inclusion and exclusion criteria and evaluated the quality of the studies using the Newcastle-Ottawa Scale. RESULTS Eventually, 11 cohort studies encompassing 2380 patients were included. The meta-analysis revealed that the frail group exhibited an increased risk of overall mortality, with poorer overall survival than the nonfrail group. CONCLUSION Frailty increases the risk of chemotherapy-induced toxic effects, unplanned hospitalization, and death in patients. However, because of this study's limited number of participants, large-sample, multicenter studies to verify these findings are required. IMPLICATIONS FOR PRACTICE This study provides theoretical support for incorporating frailty assessment into the nursing evaluation of patients with digestive system tumors before chemotherapy. This integration aids in predicting patients at a high risk of chemotherapy toxicity, mortality, and unplanned hospitalization, therefore providing corresponding interventions in advance to reduce adverse outcomes.
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Affiliation(s)
- Weiyan Xu
- Author Affiliations: School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University (Miss Xu, Wang and Zhang); and Qilu Hospital of Shandong University (Mrs Yang, Mrs Li, and Mrs Chen), Jinan, China
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Guo Y, Miao X, Hu J, Chen L, Chen Y, Zhao K, Xu T, Jiang X, Zhu H, Xu X, Xu Q. Summary of best evidence for prevention and management of frailty. Age Ageing 2024; 53:afae011. [PMID: 38300725 DOI: 10.1093/ageing/afae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Frailty in older people can seriously affect their quality of life and increase the demand for long-term care and health care expenses. Aims of this study are to provide an evidence-based basis for clinical practice of frailty in older people by systematically searching for the best current evidence on interventions for the prevention and management of frailty. METHODS According to the '6S' evidence resource model, evidence retrieval is searched from the top-down and collected relevant guidelines, best practices, evidence summaries, systematic reviews and expert consensus. The retrieval time limit was from the database establishment to 20 March 2023. Two reviewers independently screened and evaluated the literature, and then extracted and summarised the evidence according to the JBI grading of evidence and recommendation system. RESULTS A total of 44 publications were finally included, including 12 guidelines, 5 best practices, 4 expert consensus, 5 evidence summaries and 18 systematic reviews. Through the induction and integration of the evidence, the evidence was finally summarised from eight aspects: frailty screening, frailty assessment, exercise intervention, nutrition intervention, multi-domain intervention, drug administration, social support and health education, and 43 best evidences were formed. CONCLUSIONS This study summarised the best evidence for the prevention and management of frailty from eight aspects, which can provide guidance for clinical or community medical staff to develop and apply frailty intervention and practice programmes for older people and improved the clinical outcome and quality of life of older people.
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Affiliation(s)
- Yinning Guo
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Xueyi Miao
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Jieman Hu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Li Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Yimeng Chen
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Kang Zhao
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Ting Xu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Xiaoman Jiang
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Hanfei Zhu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Xinyi Xu
- Faculty of Health, Queensland University of Technology, Brisbane 4059, Australia
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
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Risi E, Lisanti C, Vignoli A, Biagioni C, Paderi A, Cappadona S, Monte FD, Moretti E, Sanna G, Livraghi L, Malorni L, Benelli M, Puglisi F, Luchinat C, Tenori L, Biganzoli L. Risk assessment of disease recurrence in early breast cancer: A serum metabolomic study focused on elderly patients. Transl Oncol 2022; 27:101585. [PMID: 36403505 PMCID: PMC9676351 DOI: 10.1016/j.tranon.2022.101585] [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: 06/02/2022] [Revised: 10/28/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We previously showed that metabolomics predicts relapse in early breast cancer (eBC) patients, unselected by age. This study aims to identify a "metabolic signature" that differentiates eBC from advanced breast cancer (aBC) patients, and to investigate its potential prognostic role in an elderly population. METHODS Serum samples from elderly breast cancer (BC) patients enrolled in 3 onco-geriatric trials, were retrospectively analyzed via proton nuclear magnetic resonance (1H NMR) spectroscopy. Three nuclear magnetic resonance (NMR) spectra were acquired for each serum sample: NOESY1D, CPMG, Diffusion-edited. Random Forest (RF) models to predict BC relapse were built on NMR spectra, and resulting RF risk scores were evaluated by Kaplan-Meier curves. RESULTS Serum samples from 140 eBC patients and 27 aBC were retrieved. In the eBC cohort, median age was 76 years; 77% of patients had luminal, 10% HER2-positive and 13% triple negative (TN) BC. Forty-two percent of patients had tumors >2 cm, 43% had positive axillary nodes. Using NOESY1D spectra, the RF classifier discriminated free-from-recurrence eBC from aBC with sensitivity, specificity and accuracy of 81%, 67% and 70% respectively. We tested the NOESY1D spectra of each eBC patient on the RF models already calculated. We found that patients classified as "high risk" had higher risk of disease recurrence (hazard ratio (HR) 3.42, 95% confidence interval (CI) 1.58-7.37) than patients at low-risk. CONCLUSIONS This analysis suggests that a "metabolic signature", identified employing NMR fingerprinting, is able to predict the risk of disease recurrence in elderly patients with eBC independently from standard clinicopathological features.
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Affiliation(s)
- Emanuela Risi
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Camilla Lisanti
- Cro Aviano - National Cancer Institute - IRCCS, Medical Oncology and Cancer Prevention, Aviano, Italy
| | - Alessia Vignoli
- Magnetic Resonance Center (CERM), University of Florence, Sesto Fiorentino, Italy
| | | | - Agnese Paderi
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Silvia Cappadona
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Francesca Del Monte
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Erica Moretti
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Giuseppina Sanna
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Luca Livraghi
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Luca Malorni
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | | | - Fabio Puglisi
- Cro Aviano - National Cancer Institute - IRCCS, Medical Oncology and Cancer Prevention, Aviano, Italy
| | - Claudio Luchinat
- Magnetic Resonance Center (CERM), University of Florence, Sesto Fiorentino, Italy
| | - Leonardo Tenori
- Magnetic Resonance Center (CERM), University of Florence, Sesto Fiorentino, Italy
| | - Laura Biganzoli
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy,Corresponding author.
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Bandidwattanawong C, Kerkarchachai G. The benefits of G8 and VES-13 geriatric screening tools for older patients with advanced lung cancer. J Geriatr Oncol 2022; 13:1256-1259. [DOI: 10.1016/j.jgo.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/25/2022]
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Geriatric assessment-informed treatment decision making and downstream outcomes: what are the research priorities? Curr Opin Support Palliat Care 2022; 16:25-32. [DOI: 10.1097/spc.0000000000000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nagashima F, Furuse J. Treatments for elderly cancer patients and reforms to social security systems in Japan. Int J Clin Oncol 2022; 27:310-315. [PMID: 35098370 PMCID: PMC8801270 DOI: 10.1007/s10147-021-02099-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/28/2021] [Indexed: 11/05/2022]
Abstract
In Japan, the population aged 65 years and above accounts for 29% of the total population. Furthermore, the number of cancer patients among the elderly is increasing. Geriatric oncology is a discipline that deals with appropriate care for elderly cancer patients based on their characteristics. The International Society of Geriatric Oncology considers education, treatment, research, and partnership building areas of significance and priority for policy goals. In Japan, the Third Term of the Basic Plan to Promote Cancer Control is an initiative to improve the infrastructure and health services involved in cancer care. Content related to "cancer in the elderly" was added to establish guidelines for treating cancer in the elderly. Thus far, "Clinical Practice Guidelines of Cancer Drug Therapies for the Elderly" have been published. With the increasing age of the population, social security expenditures will increase substantially after the fiscal year 2022. Reforms to social security systems, such as pensions, medical care, and nursing care, are underway. It is important to enhance cooperation between oncology and geriatrics and to support cooperative systems among families and medical professionals to promote geriatric oncology. Since the working-age population and the total population have begun to decline, Japan is facing many challenges. As a leader of a super-aging society, Japan has the potential to share its experience on a global scale and address potential long-term outcomes.
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Affiliation(s)
- Fumio Nagashima
- Department of Medical Oncology, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Junji Furuse
- Department of Medical Oncology, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
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Hatta W, Gotoda T, Koike T, Uno K, Asano N, Imatani A, Masamune A. Is Additional Gastrectomy Required for Elderly Patients after Endoscopic Submucosal Dissection with Endoscopic Curability C-2 for Early Gastric Cancer? Digestion 2022; 103:83-91. [PMID: 34638125 DOI: 10.1159/000519514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/07/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND With the ongoing growth of the aged population, the number of elderly patients suffering from gastric cancer has increased in Japan. Since the frequency of lymph node metastasis (LNM) in patients after endoscopic submucosal dissection (ESD) with endoscopic curability (eCura) C-2 for early gastric cancer (EGC) is relative low, the following question can be raised: "Is additional gastrectomy required for elderly patients with such criteria for ESD?" SUMMARY For therapeutic decision-making after ESD with eCura C-2, the risk of all-cause mortality and impaired quality of life (QoL) should thus be evaluated. Risk stratification of LNM and gastric cancer-specific mortality was established by the eCura system; however, it remains unclear how much these categories and treatment selection affect all-cause mortality. The contribution of prognostic tools for predicting all-cause mortality was noted to vary across the studies of patients with EGC; thus, further studies that investigate comprehensive geriatric assessment (CGA) may be required. Regarding the QoL, studies on elderly patients remain to be lacking. Furthermore, one of the issues with CGA and QoL tools is that they are time consuming. Key Messages: Combined evaluation of risk stratification of gastric cancer-specific mortality by the eCura system and risk of nongastric cancer-related mortality and impaired QoL may be the current optimal method to decide treatment strategy after ESD with eCura C-2 for EGC among elderly patients. A large-scale prospective study that investigates CGA domains is required to identify predictors of all-cause mortality and impaired QoL, and a more easily usable tool should be developed.
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Affiliation(s)
- Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan,
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kaname Uno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoki Asano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Imatani
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Irelli A, Sirufo MM, Scipioni T, Aielli F, Martella F, Ginaldi L, Pancotti A, De Martinis M. The VES-13 and G-8 tools as predictors of toxicity associated with aromatase inhibitors in the adjuvant treatment of breast cancer in elderly patients: A single-center study. Indian J Cancer 2021; 0:319470. [PMID: 34380841 DOI: 10.4103/0019-509x.319470] [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: 11/04/2022]
Abstract
Background Adjuvant hormone treatment of postmenopausal breast cancer is mainly based on aromatase inhibitors. Adverse events associated with such class of drugs are particularly severe in elderly patients. Therefore, we investigated the possibility of ab initio predict which elderly patients could encounter toxicity. Methods In light of national and international oncological guidelines recommending the use of screening tests for multidimensional geriatric assessment in elderly patients aged ≥70 years and eligible for active cancer treatment, we assessed whether the Vulnerable Elder Survey (VES)-13 and the Geriatric (G)-8 could be predictors of toxicity associated with aromatase inhibitors. Seventy-seven consecutive patients aged ≥70 diagnosed with non-metastatic hormone-responsive breast cancer and therefore eligible for adjuvant hormone therapy with aromatase inhibitors, were screened with the VES-13 and the G-8, and underwent a six-monthly clinical and instrumental follow-up in our medical oncology unit, from September 2016 to March 2019 (30 months). Said patients were identified as vulnerable (VES-13 score ≥3 or G-8 score ≤14) and fit (VES-13 score <3 or G-8 score >14). The likelihood of experiencing toxicity is greater among vulnerable patients. Results The correlation between the VES-13 or the G-8 tools and the presence of adverse events is equal to 85.7% (p = 0.03). The VES-13 demonstrated 76.9% sensitivity, 90.2% specificity, 80.0% positive predictive value, 88.5% negative predictive value. The G-8 demonstrated 79.2% sensitivity, 88.7% specificity, 76% positive predictive value, 90.4% negative predictive value. Conclusion The VES-13 and the G-8 tools could be valuable predictors of the onset of toxicity associated with aromatase inhibitors in the adjuvant treatment of breast cancer in elderly patients aged ≥70.
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Affiliation(s)
- Azzurra Irelli
- Medical Oncology Unit, Department of Oncology, AUSL 04 Teramo, Italy
| | - Maria Maddalena Sirufo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy; Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, Italy
| | - Teresa Scipioni
- Medical Oncology Unit, Department of Oncology, AUSL 04 Teramo, Italy
| | - Federica Aielli
- Medical Oncology Unit, Department of Oncology, AUSL 04 Teramo, Italy
| | | | - Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy; Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, Italy
| | - Amedeo Pancotti
- Medical Oncology Unit, Department of Oncology, AUSL 04 Teramo, Italy
| | - Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy; Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, Italy
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Di Donato S, Vignoli A, Biagioni C, Malorni L, Mori E, Tenori L, Calamai V, Parnofiello A, Di Pierro G, Migliaccio I, Cantafio S, Baraghini M, Mottino G, Becheri D, Del Monte F, Miceli E, McCartney A, Di Leo A, Luchinat C, Biganzoli L. A Serum Metabolomics Classifier Derived from Elderly Patients with Metastatic Colorectal Cancer Predicts Relapse in the Adjuvant Setting. Cancers (Basel) 2021; 13:cancers13112762. [PMID: 34199435 PMCID: PMC8199587 DOI: 10.3390/cancers13112762] [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: 04/15/2021] [Revised: 05/14/2021] [Accepted: 05/29/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Around 30–40% of patients with early stage colorectal cancer (eCRC) experience relapse after surgery. Current recommendations for adjuvant therapy are based on suboptimal risk-stratification tools. In elderly patients, risk of relapse assessment is particularly important to ultimately avoid unnecessary chemotherapy-related toxicity in this frailer population. Serum metabolomics via NMR spectroscopy may improve risk stratification by identifying patients with residual micrometastases after surgery and thus at higher risk of relapse. We evaluated the serum metabolomic fingerprints of 94 elderly patients with eCRC (65 relapse free and 29 relapsed), and of 75 elderly patients with metastatic disease. Metabolomics efficiently discriminated patients with relapse-free eCRC from those with metastatic disease, correctly predicting relapse in 69% of relapsed eCRC patients. The metabolomic score was strongly and independently associated with prognosis. Our data suggest metabolomics as a valid addition to standard tools to refine risk stratification for eCRC and warrant further investigation. Abstract Adjuvant treatment for patients with early stage colorectal cancer (eCRC) is currently based on suboptimal risk stratification, especially for elderly patients. Metabolomics may improve the identification of patients with residual micrometastases after surgery. In this retrospective study, we hypothesized that metabolomic fingerprinting could improve risk stratification in patients with eCRC. Serum samples obtained after surgery from 94 elderly patients with eCRC (65 relapse free and 29 relapsed, after 5-years median follow up), and from 75 elderly patients with metastatic colorectal cancer (mCRC) obtained before a new line of chemotherapy, were retrospectively analyzed via proton nuclear magnetic resonance spectroscopy. The prognostic role of metabolomics in patients with eCRC was assessed using Kaplan–Meier curves. PCA-CA-kNN could discriminate the metabolomic fingerprint of patients with relapse-free eCRC and mCRC (70.0% accuracy using NOESY spectra). This model was used to classify the samples of patients with relapsed eCRC: 69% of eCRC patients with relapse were predicted as metastatic. The metabolomic classification was strongly associated with prognosis (p-value 0.0005, HR 3.64), independently of tumor stage. In conclusion, metabolomics could be an innovative tool to refine risk stratification in elderly patients with eCRC. Based on these results, a prospective trial aimed at improving risk stratification by metabolomic fingerprinting (LIBIMET) is ongoing.
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Affiliation(s)
- Samantha Di Donato
- Department of Medical Oncology, New Hospital of Prato S. Stefano, 59100 Prato, Italy; (L.M.); (E.M.); (V.C.); (A.P.); (G.D.P.); (F.D.M.); (E.M.); (A.M.); (A.D.L.); (L.B.)
- Correspondence: ; Tel.: +39-057-480-2520
| | - Alessia Vignoli
- Magnetic Resonance Center, University of Florence, 50019 Sesto Fiorentino, Italy; (A.V.); (L.T.); (C.L.)
- Department of Chemistry “Ugo Schiff”, University of Florence, 50019 Sesto Fiorentino, Italy
| | - Chiara Biagioni
- Bioinformatics Unit, Medical Oncology Department, New Hospital of Prato S. Stefano, 59100 Prato, Italy;
| | - Luca Malorni
- Department of Medical Oncology, New Hospital of Prato S. Stefano, 59100 Prato, Italy; (L.M.); (E.M.); (V.C.); (A.P.); (G.D.P.); (F.D.M.); (E.M.); (A.M.); (A.D.L.); (L.B.)
- “Sandro Pitigliani” Translational Research Unit, New Hospital of Prato, Stefano, 59100 Prato, Italy;
| | - Elena Mori
- Department of Medical Oncology, New Hospital of Prato S. Stefano, 59100 Prato, Italy; (L.M.); (E.M.); (V.C.); (A.P.); (G.D.P.); (F.D.M.); (E.M.); (A.M.); (A.D.L.); (L.B.)
| | - Leonardo Tenori
- Magnetic Resonance Center, University of Florence, 50019 Sesto Fiorentino, Italy; (A.V.); (L.T.); (C.L.)
- Department of Chemistry “Ugo Schiff”, University of Florence, 50019 Sesto Fiorentino, Italy
| | - Vanessa Calamai
- Department of Medical Oncology, New Hospital of Prato S. Stefano, 59100 Prato, Italy; (L.M.); (E.M.); (V.C.); (A.P.); (G.D.P.); (F.D.M.); (E.M.); (A.M.); (A.D.L.); (L.B.)
| | - Annamaria Parnofiello
- Department of Medical Oncology, New Hospital of Prato S. Stefano, 59100 Prato, Italy; (L.M.); (E.M.); (V.C.); (A.P.); (G.D.P.); (F.D.M.); (E.M.); (A.M.); (A.D.L.); (L.B.)
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Giulia Di Pierro
- Department of Medical Oncology, New Hospital of Prato S. Stefano, 59100 Prato, Italy; (L.M.); (E.M.); (V.C.); (A.P.); (G.D.P.); (F.D.M.); (E.M.); (A.M.); (A.D.L.); (L.B.)
| | - Ilenia Migliaccio
- “Sandro Pitigliani” Translational Research Unit, New Hospital of Prato, Stefano, 59100 Prato, Italy;
| | - Stefano Cantafio
- Department of Surgery, New Hospital of Prato S. Stefano, 59100 Prato, Italy; (S.C.); (M.B.)
| | - Maddalena Baraghini
- Department of Surgery, New Hospital of Prato S. Stefano, 59100 Prato, Italy; (S.C.); (M.B.)
| | - Giuseppe Mottino
- Department of Geriatrics, New Hospital of Prato S. Stefano, 59100 Prato, Italy; (G.M.); (D.B.)
| | - Dimitri Becheri
- Department of Geriatrics, New Hospital of Prato S. Stefano, 59100 Prato, Italy; (G.M.); (D.B.)
| | - Francesca Del Monte
- Department of Medical Oncology, New Hospital of Prato S. Stefano, 59100 Prato, Italy; (L.M.); (E.M.); (V.C.); (A.P.); (G.D.P.); (F.D.M.); (E.M.); (A.M.); (A.D.L.); (L.B.)
| | - Elisangela Miceli
- Department of Medical Oncology, New Hospital of Prato S. Stefano, 59100 Prato, Italy; (L.M.); (E.M.); (V.C.); (A.P.); (G.D.P.); (F.D.M.); (E.M.); (A.M.); (A.D.L.); (L.B.)
| | - Amelia McCartney
- Department of Medical Oncology, New Hospital of Prato S. Stefano, 59100 Prato, Italy; (L.M.); (E.M.); (V.C.); (A.P.); (G.D.P.); (F.D.M.); (E.M.); (A.M.); (A.D.L.); (L.B.)
- School of Clinical Sciences, Monash University, 3168 Clayton, Australia
| | - Angelo Di Leo
- Department of Medical Oncology, New Hospital of Prato S. Stefano, 59100 Prato, Italy; (L.M.); (E.M.); (V.C.); (A.P.); (G.D.P.); (F.D.M.); (E.M.); (A.M.); (A.D.L.); (L.B.)
| | - Claudio Luchinat
- Magnetic Resonance Center, University of Florence, 50019 Sesto Fiorentino, Italy; (A.V.); (L.T.); (C.L.)
- Department of Chemistry “Ugo Schiff”, University of Florence, 50019 Sesto Fiorentino, Italy
- Consorzio Interuniversitario Risonanze Magnetiche di Metallo Proteine (C.I.R.M.M.P.), 50019 Sesto Fiorentino, Italy
| | - Laura Biganzoli
- Department of Medical Oncology, New Hospital of Prato S. Stefano, 59100 Prato, Italy; (L.M.); (E.M.); (V.C.); (A.P.); (G.D.P.); (F.D.M.); (E.M.); (A.M.); (A.D.L.); (L.B.)
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Ono R, Makiura D, Nakamura T, Okumura M, Fukuta A, Saito T, Inoue J, Oshikiri T, Kakeji Y, Sakai Y. Impact of Preoperative Social Frailty on Overall Survival and Cancer-Specific Survival among Older Patients with Gastrointestinal Cancer. J Am Med Dir Assoc 2021; 22:1825-1830.e1. [PMID: 33932352 DOI: 10.1016/j.jamda.2021.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/24/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Frailty is a multidimensional syndrome. However, typical frailty scales used in oncology clinics assess physical impairment and/or malnutrition but do not consider the social domain. Our study aimed to clarify the relationship between preoperative social frailty and overall survival (OS) and cancer-specific survival (CSS) among older patients with gastrointestinal cancer. DESIGN This was a prospective cohort study. SETTING AND PARTICIPANTS This single-center study recruited 195 patients with gastrointestinal cancer scheduled for curative surgery and aged >60 years. METHODS The outcomes considered were the OS and CSS of surgery. Primary associated factors included frailty defined as a Geriatric 8 score ≤14; social frailty defined as 2 or more of the following-going out less frequently, rarely visiting friends, feeling unhelpful to friends or family, living alone, and not talking with someone daily, and combinations therein [no frailty without social frailty (-/-), frailty without social frailty (+/-), no frailty with social frailty (-/+), and frailty with social frailty (+/+)]. We used the Cox proportional hazards model and the Fine and Gray proportional subdistribution hazard model adjusting for confounding factors. RESULTS Of the 195 patients, 181 (mean age, 72.0 years) were included for analysis. The median follow-up time was 994 days. Social frailty (hazard ratio 3.10) and their combinations [6.35; frailty with social frailty (+/+) vs no frailty without social frailty (-/-)] were significant predictors of OS. Social frailty (subdistribution hazard ratio 3.23) and their combinations (7.57) were significant predictors of CSS. CONCLUSIONS AND IMPLICATIONS Preoperative social frailty is a predictor of OS and CSS in older patients with gastrointestinal cancer. Screening for social frailty, frailty, and their combinations in older patients with cancer is important.
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Affiliation(s)
- Rei Ono
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan.
| | - Daisuke Makiura
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Tetsu Nakamura
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Maho Okumura
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Akimasa Fukuta
- Division of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takashi Saito
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan; Division of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Junichiro Inoue
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Taro Oshikiri
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan; Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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11
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Almugbel FA, Timilshina N, AlQurini N, Loucks A, Jin R, Berger A, Romanovsky L, Puts M, Alibhai SMH. Role of the vulnerable elders survey-13 screening tool in predicting treatment plan modification for older adults with cancer. J Geriatr Oncol 2020; 12:786-792. [PMID: 33342723 DOI: 10.1016/j.jgo.2020.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Vulnerable Elders Survey (VES-13) is commonly used to identify older patients who may benefit from Comprehensive Geriatric Assessment (CGA) prior to cancer treatment. The optimal cut point of the VES-13 to identify those whose final oncologic treatment plan would change after CGA is unclear. We hypothesized that patients with high positive VES-13 scores (7-10)have a higher likelihood of a change in treatment compared to low positive scores (3-6). METHODS Retrospective review of a customized database of all patients seen for pre-treatment assessment in an academic geriatric oncology clinic from June 2015 to June 2019. Various VES-13 cut points were analyzed to identify those individuals whose treatment was modified after CGA. Area under the curve (AUC) was calculated and subgroups of patients treated locally or systemically were also examined to determine if performance varied by treatment modality. RESULTS We included 386 patients with mean age 81, 58% males. Gastrointestinal cancer was the most common site (31%) and 60% were planned to receive curative treatment. The final treatment plan was modified in 59% overall, with 52.7% modified with VES-13 scores 7-10, 50.8% with scores 3-6 and 28.1% with scores <3 (P = 0.002). VES-13 performance in predicting treatment modification was similar for cut points 3 (AUC 0.58), 4 (0.59), 5 (0.59), and 6 (0.59) and in those considering local treatment vs. chemotherapy. CONCLUSIONS A positive VES-13 score was associated with final oncologic treatment plan modification. A high positive score was not superior to the conventional cut point of ≥3.
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Affiliation(s)
- Fahad A Almugbel
- Medical Oncology Section, King Abdullah Center for Oncology and Liver Disease, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | - Naser AlQurini
- Fellowship Program, Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Canada
| | - Allison Loucks
- Princess Margaret Cancer Centre, University Health Network, Canada
| | - Rana Jin
- Princess Margaret Cancer Centre, University Health Network, Canada
| | - Arielle Berger
- Department of Medicine, University Health Network, Canada; Department of Medicine, University of Toronto, Canada
| | - Lindy Romanovsky
- Department of Medicine, University Health Network, Canada; Department of Medicine, University of Toronto, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Canada; Department of Medicine, University of Toronto, Canada.
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12
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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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13
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Battisti NML, McCartney A, Biganzoli L. The Conundrum of the Association of Chemotherapy With Survival Outcomes Among Elderly Patients With Curable Luminal Breast Cancer. JAMA Oncol 2020; 6:1535-1537. [DOI: 10.1001/jamaoncol.2020.2194] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nicolò Matteo Luca Battisti
- Department of Medicine–Breast Unit, The Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, United Kingdom
| | - Amelia McCartney
- “Sandro Pitigliani” Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Laura Biganzoli
- “Sandro Pitigliani” Medical Oncology Department, Hospital of Prato, Prato, Italy
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14
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Comprehensive geriatric assessment is an independent prognostic factor in older patients with metastatic renal cell cancer treated with first-line Sunitinib or Pazopanib: a single center experience. J Geriatr Oncol 2020; 12:290-297. [PMID: 32972885 DOI: 10.1016/j.jgo.2020.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/09/2020] [Accepted: 09/02/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is poor data on the prognostic role of Comprehensive Geriatric Assessment (CGA) in older patients with metastatic renal cell carcinoma (mRCC) treated with first line Tyrosine Kinase Inhibitors (TKIs). MATERIALS AND METHODS We retrospectively reviewed the clinical charts of mRCC patients older than 70 years treated at our Institute with first-line Sunitinib or Pazopanib for at least 6 months. Every patient received a CGA at baseline and was identified as fit, vulnerable or frail according to Balducci's Criteria. We then assessed the impact of CGA category on survival, disease control and tolerability of TKIs. RESULTS We identified 86 eligible patients. Median age: 74.5 years, 56% males; 45.4% were fit, 37.2% vulnerable and 17.4% frail at CGA. There were no significant differences in the rate of Grade (G)1-2 and G3-4 toxicities, dose reduction rates, PFS and OS between Sunitinib and Pazopanib. Fit, vulnerable and frail patients achieved significantly different median PFS (18.9 vs 11.2 vs 5.1 months; p < 0.001) and OS (35.5 vs 14.6 vs 10.9 months; p < 0.001). Patients categorized as fit had higher chance of receiving a second-line treatment (66.6% vs 28.9% in vulnerable/frail; p = 0.002). The incidence of G3/4 events was significantly lower in the fit subgroup (19% vs 45% in vulnerable/frail; p = 0.0025). CONCLUSIONS In our retrospective single-center experience, CGA could accurately discriminate patients with higher risk of experiencing G3/4 toxicities, shorter PFS, and lower chance of receiving a second line treatment. CGA strongly impacted on OS, independently from International mRCC Database Consortium (IMDC) classification.
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15
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Kenig J, Szabat K, Mituś J, Mituś-Kenig M, Krzeszowiak J. Usefulness of eight screening tools for predicting frailty and postoperative short- and long-term outcomes among older patients with cancer who qualify for abdominal surgery. Eur J Surg Oncol 2020; 46:2091-2098. [PMID: 32800399 DOI: 10.1016/j.ejso.2020.07.040] [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: 03/16/2020] [Revised: 07/13/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The aim of this study was to compare the ability of eight frailty screening scores to predict short- (30-day major morbidity and mortality), long-term outcomes (12-month mortality) and to compare their accuracy for predicting frailty among older patients with cancer undergoing elective abdominal surgery with curative intent. MATERIALS AND METHODS Consecutive patients aged ≥70 years were enrolled prospectively. The diagnostic performance of eight screening tests were evaluated: The Vulnerable Elderly Survey (VES-13), Triage Risk Screening Tool (TRST), Geriatric 8 (G8), Groningen Frailty Index (GFI), abbreviated Comprehensive Geriatric Assessment (aCGA), Rockwood, Balducci and Fried score. Frailty was defined based on the Geriatric Assessment (GA) with two (2ID) or three impaired domains (3ID). RESULTS The study included 269 consecutive patients; median age 78 (range 70-94) years. The prevalence of frailty based on the reference GA was: 40.9% (2ID), 34.2% (3ID) and using screening tools 40-75.5%. The area under the curve (AUC) for predicting the postoperative outcome was: 0.58-0.75 (30-day morbidity), 0.54-0.71 (30-day mortality) and 0.59-0.74 (12-month mortality), respectively, being the highest for the G8. The AUC for the frailty screening tests was: 0.67-0.85 (at the 2ID) and 0.63-0.83 (at the 3ID), being the highest for the aCGA. CONCLUSION The G8 was the best predictor of 30-day major morbidity, 30-day and 12-month mortality. It also had the highest sensitivity and negative predictive value in frailty screening, in case of both frailty definitions. In turn, the aCGA had the highest discriminatory ability in terms of frailty screening.
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Affiliation(s)
- Jakub Kenig
- Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Medical College, Krakow, Poland.
| | - Kinga Szabat
- Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy Mituś
- Centre of Oncology Maria Sklodowska Curie Memorial Institute, Department of Surgical Oncology Krakow, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Maria Mituś-Kenig
- Department of Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy Krzeszowiak
- Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Medical College, Krakow, Poland
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16
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Frailty and Vulnerability as Predictors of Chemotherapy Toxicity in Older Adults: A Longitudinal Study in Peru. J Nutr Health Aging 2020. [DOI: 10.1007/s12603-020-1504-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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17
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Poh AWY, Teo SP. Utility of Frailty Screening Tools in Older Surgical Patients. Ann Geriatr Med Res 2020; 24:75-82. [PMID: 32743327 PMCID: PMC7370792 DOI: 10.4235/agmr.20.0023] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 12/17/2022] Open
Abstract
Frailty is a loss of functional reserve that compromises a person's ability to cope with stressors such as surgery. Identifying and quantifying frailty may enable intensive rehabilitation interventions, caregiver support, or consideration of palliative care before surgery. This study describes the characteristics of five frailty screening tools, namely the Geriatric 8, Vulnerable Elders Survey-13, the Groningen Frailty Indicator, Edmonton Frailty Scale (EFS), and Clinical Frailty Scale. We further propose an approach incorporating a frailty scale into preoperative assessment, wherein older patients undergoing elective general surgery are screened using EFS, and frail patients are offered comprehensive geriatric assessment. The expected outcome is an individualized patient-centered care plan that will reduce frailty and optimize the patient's condition before surgery.
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Affiliation(s)
- Alicia Wan Yan Poh
- Department of Internal Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Brunei Darussalam
| | - Shyh Poh Teo
- Department of Internal Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Brunei Darussalam
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18
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Bréchemier D, Sourdet S, Girard P, Steinmeyer Z, Mourey L, Gérard S, Balardy L. Use of comprehensive geriatric assessment (CGA) to define frailty in geriatric oncology: Searching for the best threshold. Cross-sectional study of 418 old patients with cancer evaluated in the Geriatric Frailty Clinic (G.F.C.) of Toulouse (France). J Geriatr Oncol 2019; 10:944-950. [DOI: 10.1016/j.jgo.2019.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/15/2019] [Accepted: 03/17/2019] [Indexed: 12/12/2022]
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19
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Aubert CE, Fankhauser N, Marques-Vidal P, Stirnemann J, Aujesky D, Limacher A, Donzé J. Multimorbidity and healthcare resource utilization in Switzerland: a multicentre cohort study. BMC Health Serv Res 2019; 19:708. [PMID: 31623664 PMCID: PMC6798375 DOI: 10.1186/s12913-019-4575-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 09/30/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Multimorbidity is associated with higher healthcare resource utilization, but we lack data on the association of specific combinations of comorbidities with healthcare resource utilization. We aimed to identify the combinations of comorbidities associated with high healthcare resource utilization among multimorbid medical inpatients. METHODS We performed a multicentre retrospective cohort study including 33,871 multimorbid (≥2 chronic diseases) medical inpatients discharged from three Swiss hospitals in 2010-2011. Healthcare resource utilization was measured as 30-day potentially avoidable readmission (PAR), prolonged length of stay (LOS) and difference in median LOS. We identified the combinations of chronic comorbidities associated with the highest healthcare resource utilization and quantified this association using regression techniques. RESULTS Three-fourths of the combinations with the strongest association with PAR included chronic kidney disease. Acute and unspecified renal failure combined with solid malignancy was most strongly associated with PAR (OR 2.64, 95%CI 1.79;3.90). Miscellaneous mental health disorders combined with mood disorders was the most strongly associated with LOS (difference in median LOS: 17 days) and prolonged LOS (OR 10.77, 95%CI 8.38;13.84). The number of chronic diseases was strongly associated with prolonged LOS (OR 9.07, 95%CI 8.04;10.24 for ≥10 chronic diseases), and to a lesser extent with PAR (OR 2.16, 95%CI 1.75;2.65 for ≥10 chronic diseases). CONCLUSIONS Multimorbidity appears to have a higher impact on LOS than on PAR. Combinations of comorbidities most strongly associated with healthcare utilization included kidney disorders for PAR, and mental health disorders for LOS.
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Affiliation(s)
- Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland. .,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
| | | | - Pedro Marques-Vidal
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jérôme Stirnemann
- Department of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | | | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.,Division of General Medicine, BWH Hospitalist Service, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Internal Medicine, Hôpital neuchâtelois, Neuchâtel, Switzerland
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20
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Vernon TL, Rice AN, Titch JF, Hill BF, Muckler VC. Implementation of Vulnerable Elders Survey-13 Frailty Tool to Identify At-Risk Geriatric Surgical Patients. J Perianesth Nurs 2019; 34:911-918.e2. [PMID: 30910510 DOI: 10.1016/j.jopan.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/23/2019] [Accepted: 01/26/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE The primary purpose of this project was to preoperatively identify frail and vulnerable geriatric patients aged 65 or older using the Vulnerable Elders Survey (VES-13) tool, and to use those scores to assist with perioperative decision-making. DESIGN This feasibility study was implemented as a quality improvement initiative with a postimplementation group only. METHODS The VES-13 was introduced to the perioperative nursing staff and anesthesia providers and then added to the traditional preoperative assessment. The VES-13 scores were correlated to hospital length of stay, postanesthesia care unit stay, altered mental status, and morbidity. FINDINGS Increased identification of older adult surgical patients at risk for increased length of stay, altered mental status, and morbidity in the preoperative setting was not evident, although the VES-13 was effective in identifying functional deficits in the older adult surgical patient. CONCLUSIONS A detailed and comprehensive preoperative assessment remains the most efficient way to identify frail geriatric surgical patients.
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21
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Kirkhus L, Šaltytė Benth J, Grønberg BH, Hjermstad MJ, Rostoft S, Harneshaug M, Selbæk G, Wyller TB, Jordhøy MS. Frailty identified by geriatric assessment is associated with poor functioning, high symptom burden and increased risk of physical decline in older cancer patients: Prospective observational study. Palliat Med 2019; 33:312-322. [PMID: 30712456 PMCID: PMC6376598 DOI: 10.1177/0269216319825972] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Maintaining quality of life including physical functioning is highly prioritized among older cancer patients. Geriatric assessment is a recommended approach to identify patients with increased vulnerability to stressors (frailty). How frailty affects quality of life and physical functioning in older cancer patients has scarcely been investigated. AIM: Focusing on physical functioning and global quality of life, we investigated whether frailty identified by a geriatric assessment was associated with higher risk of quality-of-life deterioration during cancer treatment and follow-up. DESIGN: Prospective, observational study. Patients were classified as frail or non-frail by a modified geriatric assessment. Quality of life was measured using the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire at inclusion, 2, 4, 6 and 12 months. SETTING: Eight Norwegian outpatient cancer clinics. PARTICIPANTS: Patients ⩾70 years with solid tumours referred for palliative or curative systemic medical cancer treatment. RESULTS: Among 288 patients included, 140 (49%) were frail and 148 (51%) non-frail. Frail patients consistently reported poorer scores on all functioning and symptom scales. Independent of age, gender and major cancer-related factors, frail patients had significantly poorer physical functioning and global quality of life during follow-up, and opposed to non-frail patients they had both a clinically and statistically significant decline in physical functioning from baseline until 12 months. CONCLUSIONS: Geriatric assessment identifies frail patients with increased risk of physical decline, poor functioning and high symptom burden during and following cancer treatment. Frail patients should therefore receive early supportive or palliative care.
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Affiliation(s)
- Lene Kirkhus
- 1 Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,2 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- 1 Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,3 HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.,4 Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Bjørn Henning Grønberg
- 5 The Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,6 Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Marianne Jensen Hjermstad
- 7 European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Siri Rostoft
- 2 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,8 Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Magnus Harneshaug
- 1 Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,2 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Geir Selbæk
- 1 Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,9 Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,10 Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torgeir Bruun Wyller
- 2 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,8 Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Marit Slaaen Jordhøy
- 2 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,11 The Cancer Unit, Innlandet Hospital Trust, Hamar Hospital, Hamar, Norway
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22
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Ruiz J, Miller AA, Tooze JA, Crane S, Petty WJ, Gajra A, Klepin HD. Frailty assessment predicts toxicity during first cycle chemotherapy for advanced lung cancer regardless of chronologic age. J Geriatr Oncol 2018; 10:48-54. [PMID: 30005982 DOI: 10.1016/j.jgo.2018.06.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/13/2018] [Accepted: 06/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Improved assessment strategies are needed to individualize treatment for adults of all ages receiving palliative chemotherapy for non-small cell lung cancer (NSCLC). Our aim was to evaluate the utility of the Fried Frailty Index (FFI) and a cancer-specific geriatric assessment (GA) to predict chemotherapy toxicity and overall survival (OS). METHODS We conducted a multi-site pilot study of 50 patients with newly diagnosed advanced NSCLC, age ≥ 18 years. All participants received carboplatin AUC 6, paclitaxel 200 mg/m2 every 3 weeks. FFI and the GA were administered prior to chemotherapy. A GA toxicity risk score was calculated. Grade 3-5 toxicity was assessed during 1st two cycles of chemotherapy. OS was measured from chemotherapy initiation. Logistic regression and Cox proportional hazards models were fit to estimate the association between baseline characteristics and toxicity and OS respectively. RESULTS Among 50 participants, 48 received chemotherapy and were evaluable. The mean age was 68.5 y (range 42-86), 79% male, 85% KPS ≥80. The median OS was 8 months. Many (27%) met FFI criteria for frailty with ≥3 impairments. Impairments detected by the GA were common. In multivariable analyses both FFI ≥ 3 and GA toxicity risk score > 7 were independently associated with higher odds of toxicity (Odds ratio [OR] 7.0; 95% confidence interval [CI] 1.1-44.6 and OR 4.3; 95% CI 1.0-17.7, respectively) in first cycle chemotherapy. Neither score was associated with OS. CONCLUSIONS Frailty predicts chemotherapy toxicity during first cycle. Frailty assessment may inform toxicity risk regardless of chronologic age.
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Affiliation(s)
- Jimmy Ruiz
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA; W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC, USA
| | - Antonius A Miller
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA; W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC, USA
| | - Janet A Tooze
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sandrine Crane
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - William J Petty
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ajeet Gajra
- Department of Medicine, Syracuse VA Medical Center, Hematology/Oncology, Syracuse, NY USA
| | - Heidi D Klepin
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Mohile SG, Dale W, Somerfield MR, Schonberg MA, Boyd CM, Burhenn PS, Canin B, Cohen HJ, Holmes HM, Hopkins JO, Janelsins MC, Khorana AA, Klepin HD, Lichtman SM, Mustian KM, Tew WP, Hurria A. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol 2018; 36:2326-2347. [PMID: 29782209 DOI: 10.1200/jco.2018.78.8687] [Citation(s) in RCA: 868] [Impact Index Per Article: 144.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To provide guidance regarding the practical assessment and management of vulnerabilities in older patients undergoing chemotherapy. Methods An Expert Panel was convened to develop clinical practice guideline recommendations based on a systematic review of the medical literature. Results A total of 68 studies met eligibility criteria and form the evidentiary basis for the recommendations. Recommendations In patients ≥ 65 years receiving chemotherapy, geriatric assessment (GA) should be used to identify vulnerabilities that are not routinely captured in oncology assessments. Evidence supports, at a minimum, assessment of function, comorbidity, falls, depression, cognition, and nutrition. The Panel recommends instrumental activities of daily living to assess for function, a thorough history or validated tool to assess comorbidity, a single question for falls, the Geriatric Depression Scale to screen for depression, the Mini-Cog or the Blessed Orientation-Memory-Concentration test to screen for cognitive impairment, and an assessment of unintentional weight loss to evaluate nutrition. Either the CARG (Cancer and Aging Research Group) or CRASH (Chemotherapy Risk Assessment Scale for High-Age Patients) tools are recommended to obtain estimates of chemotherapy toxicity risk; the Geriatric-8 or Vulnerable Elders Survey-13 can help to predict mortality. Clinicians should use a validated tool listed at ePrognosis to estimate noncancer-based life expectancy ≥ 4 years. GA results should be applied to develop an integrated and individualized plan that informs cancer management and to identify nononcologic problems amenable to intervention. Collaborating with caregivers is essential to implementing GA-guided interventions. The Panel suggests that clinicians take into account GA results when recommending chemotherapy and that the information be provided to patients and caregivers to guide treatment decision making. Clinicians should implement targeted, GA-guided interventions to manage nononcologic problems. Additional information is available at www.asco.org/supportive-care-guidelines .
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Affiliation(s)
- Supriya G Mohile
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - William Dale
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Mark R Somerfield
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Mara A Schonberg
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Cynthia M Boyd
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Peggy S Burhenn
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Beverly Canin
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Harvey Jay Cohen
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Holly M Holmes
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Judith O Hopkins
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Michelle C Janelsins
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Alok A Khorana
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Heidi D Klepin
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Stuart M Lichtman
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Karen M Mustian
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - William P Tew
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Arti Hurria
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
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