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Austin CA, Seligman B, Shan-Bala S, Kuchel GA, Loh KP, Kistler CE, Batsis JA. Aging precisely: Precision medicine through the lens of an older adult. J Am Geriatr Soc 2024. [PMID: 38888213 DOI: 10.1111/jgs.19036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024]
Abstract
Precision medicine presents an opportunity to use novel, data-driven strategies to improve patient care. The field of precision medicine has undergone many advancements over the past few years. It has moved beyond incorporation of individualized genetic risk into medical decision-making to include multiple other factors such as unique social, demographic, behavioral, and clinical characteristics. Geriatric medicine stands to benefit heavily from the integration of precision medicine into its standard practices. Older adults, compared with other populations, have high clinical and biological heterogeneity that can alter the risks and benefits of different approaches to patient care. These factors have not been routinely considered previously by geriatricians. Yet, geriatricians' ability to address older adults' baseline heterogeneity is increasingly recognized as a cornerstone of delivering quality care in a geriatric medical practice. Given the shared focus of individualized decision-making, precision medicine is a natural fit for geriatric medicine. This manuscript provides, via cases and discussion, examples that illustrate how precision medicine can improve the care of our older patients today. We will share specific and existing tools and evidence, and review the existing multilevel barriers to further incorporate and implement these tools into clinical practice. We propose methods to address these barriers and to help realize the full potential of precision medicine for the care of older adults. We conclude with a brief discussion of potential future directions of research of precision medicine in the care of older adults.
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Affiliation(s)
- C Adrian Austin
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Benjamin Seligman
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Health Care System, Los Angeles, California, USA
- Division of Geriatric Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Sangeetha Shan-Bala
- Division of Geriatric Medicine, Department of Medicine, Inova Health System, Fairfax Medical Campus, Falls Church, Virginia, USA
| | - George A Kuchel
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA
| | - Chrissy E Kistler
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John A Batsis
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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Sedrak MS, Sun CL, Bae M, Freedman RA, Magnuson A, O'Connor T, Moy B, Wildes TM, Klepin HD, Chapman AE, Tew WP, Dotan E, Fenton MA, Kim H, Katheria V, Muss HB, Cohen HJ, Gross CP, Ji J. Functional decline in older breast cancer survivors treated with and without chemotherapy and non-cancer controls: results from the Hurria Older PatiEnts (HOPE) prospective study. J Cancer Surviv 2024:10.1007/s11764-024-01594-3. [PMID: 38678525 DOI: 10.1007/s11764-024-01594-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE This study aimed to assess whether physical functional decline in older women with early-stage breast cancer is driven by cancer, chemotherapy, or a combination of both. METHODS We prospectively sampled three groups of women aged ≥ 65: 444 with early-stage breast cancer receiving chemotherapy (BC Chemo), 98 with early-stage breast cancer not receiving chemotherapy (BC Control), and 100 non-cancer controls (NC Control). Physical function was assessed at two timepoints (T1 [baseline] and T2 [3, 4, or 6 months]) using the Physical Functioning Subscale (PF-10) of the RAND 36-item Short Form. The primary endpoint was the change in PF-10 scores from T1 to T2, analyzed continuously and dichotomously (Yes/No, with "yes" indicating a PF-10 decline > 10 points, i.e., a substantial and clinically meaningful difference). RESULTS Baseline PF-10 scores were similar across all groups. The BC Chemo group experienced a significant decline at T2, with a median change in PF-10 of -5 (interquartile range [IQR], -20, 0), while BC Control and NC Control groups showed a median change of 0 (IQR, -5, 5; p < 0.001). Over 30% of BC Chemo participants had a substantial decline in PF-10 vs. 8% in the BC Control and 5% in the NC Control groups (p < 0.001). CONCLUSION In this cohort of older adults with early-stage breast cancer, the combination of breast cancer and chemotherapy contributes to accelerated functional decline. Our findings reinforce the need to develop interventions aimed at preserving physical function, particularly during and after chemotherapy. IMPLICATIONS FOR CANCER SURVIVORS The high prevalence of accelerated functional decline in older women undergoing breast cancer chemotherapy underscores the urgency to develop interventions aimed at preserving physical function and improving health outcomes. CLINICAL TRIAL NCT01472094, Hurria Older PatiEnts (HOPE) with Breast Cancer Study.
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Affiliation(s)
- Mina S Sedrak
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
- Cancer & Aging Program, UCLA Health Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.
- UCLA David Geffen School of Medicine, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.
| | - Can-Lan Sun
- Department of Supportive Care, City of Hope, Duarte, CA, USA
- Center for Cancer and Aging, City of Hope, Duarte, CA, USA
| | - Marie Bae
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Tracey O'Connor
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Beverly Moy
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Tanya M Wildes
- Department of Medicine, Medical Center/Nebraska Medicine, University of Nebraska, Omaha, NE, USA
| | - Heidi D Klepin
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andrew E Chapman
- Department of Medical Oncology, Sidney Kimmel Cancer Center/Jefferson Health, Philadelphia, PA, USA
| | - William P Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Efrat Dotan
- Department of Hematology-Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Heeyoung Kim
- Department of Supportive Care, City of Hope, Duarte, CA, USA
- Center for Cancer and Aging, City of Hope, Duarte, CA, USA
| | - Vani Katheria
- Department of Supportive Care, City of Hope, Duarte, CA, USA
- Center for Cancer and Aging, City of Hope, Duarte, CA, USA
| | - Hyman B Muss
- Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Harvey J Cohen
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Cary P Gross
- Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - Jingran Ji
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA, USA
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Aleixo G, Lavelle MP, Sedhom R. Anthracyclines in Older Adults With Hodgkin Lymphoma: Too Much, Too Little? Getting it Just Right. JACC CardioOncol 2024; 6:214-216. [PMID: 38774015 PMCID: PMC11103025 DOI: 10.1016/j.jaccao.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024] Open
Affiliation(s)
- Gabriel Aleixo
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael P. Lavelle
- Department of Cardiology, Columbia University Medical Center, NewYork-Presbyterian, New York, New York, USA
| | - Ramy Sedhom
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ioffe D, Bhatia-Patel SC, Gandhi S, Hamad EA, Dotan E. Cardiovascular Concerns, Cancer Treatment, and Biological and Chronological Aging in Cancer: JACC Family Series. JACC CardioOncol 2024; 6:143-158. [PMID: 38774000 PMCID: PMC11103051 DOI: 10.1016/j.jaccao.2024.02.001] [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: 10/10/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 05/24/2024] Open
Abstract
Cardiovascular disease (CVD) and cancer are leading causes of death globally, particularly among the rapidly growing population of older adults (OAs). CVD is a leading cause of mortality among cancer survivors, often accelerated by cancer treatments associated with short- or long-term cardiotoxicity. Moreover, there is a dynamic relationship among CVD, cancer, and aging, characterized by shared risk factors and biological hallmarks, that plays an important role in caring for OAs, optimizing treatment approaches, and developing preventive strategies. Assessment of geriatric domains (eg, functional status, comorbidities, cognition, polypharmacy, nutritional status, social support, psychological well-being) is critical to individualizing treatment of OAs with cancer. The authors discuss considerations in caring for an aging population with cancer, including methods for the assessment of OAs with CVD and/or cardiovascular risk factors planned for cancer therapy. Multidisciplinary care is critical in optimizing patient outcomes and maintaining quality of life in this growing vulnerable population.
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Affiliation(s)
- Dina Ioffe
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | - Sakshi Gandhi
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Eman A. Hamad
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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Cil T, Boileau JF, Chia S, DeCoteau MJ, Jerzak KJ, Koch A, Nixon N, Quan ML, Roberts A, Brezden-Masley C. The Canadian Breast Cancer Symposium 2023 Meeting Report. Curr Oncol 2024; 31:1774-1802. [PMID: 38668038 PMCID: PMC11049169 DOI: 10.3390/curroncol31040135] [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: 01/05/2024] [Revised: 03/01/2024] [Accepted: 03/08/2024] [Indexed: 04/28/2024] Open
Abstract
On 15-16 June 2023, healthcare professionals and breast cancer patients and advocates from across Canada met in Toronto, Ontario, for the 2023 Canadian Breast Cancer Symposium (CBSC.). The CBSC. is a national, multidisciplinary event that occurs every 2 years with the goal of developing a personalized approach to the management of breast cancer in Canada. Experts provided state-of-the-art information to help optimally manage breast cancer patients, including etiology, prevention, diagnosis, experimental biology, and therapy of breast cancer and premalignant breast disease. The symposium also had the objectives of increasing communication and collaboration among breast cancer healthcare providers nationwide and providing a comprehensive and real-life review of the many facets of breast cancer. The sessions covered the patient voice, the top breast cancer papers from different disciplines in 2022, artificial intelligence in breast cancer, systemic therapy updates, the management of central nervous system metastases, multidisciplinary management of ductal carcinoma in situ, special populations, optimization-based individual prognostic factors, toxicity management of novel therapeutics, survivorship, and updates in surgical oncology. The key takeaways of these sessions have been summarized in this conference report.
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Affiliation(s)
- Tulin Cil
- Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (T.C.); (A.K.)
| | | | - Stephen Chia
- British Columbia Cancer Centre, University of British Columbia, Vancouver, BC V5Z 4E6, Canada;
| | - MJ DeCoteau
- Rethink Breast Cancer, Toronto, ON M4M 3G3, Canada;
| | - Katarzyna J. Jerzak
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.J.J.); (A.R.)
| | - Anne Koch
- Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (T.C.); (A.K.)
| | - Nancy Nixon
- Department of Surgery and Oncology, University of Calgary, Calgary, AB T2N 4Z6, Canada; (N.N.); (M.L.Q.)
| | - May Lynn Quan
- Department of Surgery and Oncology, University of Calgary, Calgary, AB T2N 4Z6, Canada; (N.N.); (M.L.Q.)
| | - Amanda Roberts
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.J.J.); (A.R.)
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Ji J, Bae M, Sun CL, Wildes TM, Freedman RA, Magnuson A, O’Connor T, Moy B, Klepin HD, Chapman AE, Tew WP, Dotan E, Fenton MA, Kim H, Katheria V, Gross CP, Cohen HJ, Muss HB, Sedrak MS. Falls prechemotherapy and toxicity-related hospitalization during adjuvant chemotherapy for breast cancer in older women: Results from the prospective multicenter HOPE trial. Cancer 2024; 130:936-946. [PMID: 37962093 PMCID: PMC10922500 DOI: 10.1002/cncr.35105] [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: 05/25/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Older women with breast cancer frequently experience toxicity-related hospitalizations during adjuvant chemotherapy. Although the geriatric assessment can identify those at risk, its use in clinic remains limited. One simple, low-cost marker of vulnerability in older persons is fall history. Here, the authors examined whether falls prechemotherapy can identify older women at risk for toxicity-related hospitalization during adjuvant chemotherapy for breast cancer. METHODS In a prospective study of women >65 years old with stage I-III breast cancer treated with adjuvant chemotherapy, the authors assessed baseline falls in the past 6 months as a categorical variable: no fall, one fall, and more than one fall. The primary end point was incident hospitalization during chemotherapy attributable to toxicity. Multivariable logistic regression was used to examine the association between falls and toxicity-related hospitalization, adjusting for sociodemographic, disease, and geriatric covariates. RESULTS Of the 497 participants, 60 (12.1%) reported falling before chemotherapy, and 114 (22.9%) had one or more toxicity-related hospitalizations. After adjusting for sociodemographic, disease, and geriatric characteristics, women who fell more than once within 6 months before chemotherapy had greater odds of being hospitalized from toxicity during chemotherapy compared to women who did not fall (50.0% vs. 20.8% experienced toxicity-related hospitalization, odds ratio, 4.38; 95% confidence interval, 1.66-11.54, p = .003). CONCLUSIONS In this cohort of older women with early breast cancer, women who experienced more than one fall before chemotherapy had an over 4-fold increased risk of toxicity-related hospitalization during chemotherapy, independent of sociodemographic, disease, and geriatric factors.
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Affiliation(s)
- Jingran Ji
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Marie Bae
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Can-Lan Sun
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Tanya M. Wildes
- Division of Hematology/ Oncology, University of Nebraska Medical Center/Nebraska Medicine, Omaha, NE
| | - Rachel A. Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Tracey O’Connor
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Beverly Moy
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Heidi D. Klepin
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Andrew E. Chapman
- Department of Medical Oncology, Sidney Kimmel Cancer Center/Jefferson Health, PA
| | - William P. Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Efrat Dotan
- Department of Hematology Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - Heeyoung Kim
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Vani Katheria
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Cary P. Gross
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Harvey J. Cohen
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Hyman B. Muss
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Mina S. Sedrak
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
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Bostel T, Nikolaidou E, Wollschläger D, Mayer A, Kaufmann J, Hopprich A, Rühle A, Grosu AL, Debus J, Fottner C, Moehler M, Grimminger P, Schmidberger H, Nicolay NH. Multicenter analysis on the value of standard (chemo)radiotherapy in elderly patients with locally advanced adenocarcinoma of the esophagus or gastroesophageal junction. Radiat Oncol 2024; 19:28. [PMID: 38433231 PMCID: PMC10910868 DOI: 10.1186/s13014-024-02414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND To assess the tolerability and oncological results of chemoradiation in elderly patients with locally advanced adenocarcinoma of the esophagus or gastroesophageal junction. METHODS This multi-center retrospective analysis included 86 elderly patients (≥ 65 years) with esophageal or gastroesophageal junction adenocarcinoma (median age 73 years; range 65-92 years) treated with definitive or neoadjuvant (chemo)radiotherapy. The treatment was performed at 3 large comprehensive cancer centers in Germany from 2006 to 2020. Locoregional control (LRC), progression-free survival (PFS), distant metastasis-free survival (DMFS), overall survival (OS), and treatment-associated toxicities according to CTCAE criteria v5.0 were analyzed, and parameters potentially relevant to patient outcomes were evaluated. RESULTS Thirty-three patients (38%) were treated with neoadjuvant chemoradiation followed by surgery, while the remaining patients received definitive (chemo)radiation. The delivery of radiotherapy without dose reduction was possible in 80 patients (93%). In 66 patients (77%), concomitant chemotherapy was initially prescribed; however, during the course of therapy, 48% of patients (n = 32) required chemotherapy de-escalation due to treatment-related toxicities and comorbidities. Twenty-nine patients (34%) experienced higher-grade acute toxicities and 14 patients (16%) higher-grade late toxicities. The 2-year LRC, DMFS, PFS, and OS amounted to 72%, 49%, 46%, and 52%, respectively. In multivariate analysis, neoadjuvant chemoradiation followed by surgery was shown to be associated with significantly better PFS (p = 0.006), DMFS (p = 0.006), and OS (p = 0.004) compared with all non-surgical treatments (pooled definitive radiotherapy and chemoradiation). No such advantage was seen over definitive chemoradiation. The majority of patients with neoadjuvant therapy received standard chemoradiotherapy without dose reduction (n = 24/33, 73%). In contrast, concurrent chemotherapy was only possible in 62% of patients undergoing definitive radiotherapy (n = 33/53), and most of these patients required dose-reduction or modification of chemotherapy (n = 23/33, 70%). CONCLUSIONS In our analysis, omission of chemotherapy or adjustment of chemotherapy dose during definitive radiotherapy was necessary for the overwhelming majority of elderly esophageal cancer patients not eligible for surgery, and hence resulted in reduced PFS and OS. Therefore, optimization of non-surgical approaches and the identification of potential predictive factors for safe administration of concurrent chemotherapy in elderly patients with (gastro)esophageal adenocarcinoma is required.
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Affiliation(s)
- Tilman Bostel
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
- German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center (Dkfz), Heidelberg, Germany.
- Radiological Institute Dr. Von Essen, Koblenz, Germany.
| | - Eirini Nikolaidou
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
- German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center (Dkfz), Heidelberg, Germany
- Department of Radiation Oncology, Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Wollschläger
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Arnulf Mayer
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
- German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center (Dkfz), Heidelberg, Germany
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Justus Kaufmann
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
- German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center (Dkfz), Heidelberg, Germany
| | - Anne Hopprich
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
- German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center (Dkfz), Heidelberg, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
- Cancer Center Central Germany (CCCG), Leipzig, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Fottner
- German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center (Dkfz), Heidelberg, Germany
- Department of Internal Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Markus Moehler
- German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center (Dkfz), Heidelberg, Germany
- Department of Internal Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Peter Grimminger
- German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center (Dkfz), Heidelberg, Germany
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
- German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center (Dkfz), Heidelberg, Germany
| | - Nils Henrik Nicolay
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
- Cancer Center Central Germany (CCCG), Leipzig, Germany
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Mac Eochagain C, Barrell A, Slavova-Boneva V, Murphy J, Pattwell M, Cumming J, Edmondson A, McGinn M, Kipps E, Milton M, Jethwa J, Ring A, Battisti NML. Implementation of a geriatric oncology service at the Royal Marsden Hospital. J Geriatr Oncol 2024; 15:101698. [PMID: 38219333 DOI: 10.1016/j.jgo.2023.101698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Despite significant evidence supporting the benefits of comprehensive oncogeriatric assessment in the management of older patients with cancer, the adoption of specialised geriatric oncology programs in the United Kingdom remains limited. Descriptions of clinic structure and models, patient demographics and baseline characteristics, resource utilisation, and predictors of resource utilisation are lacking in this population, which may complicate or impede the planning, resourcing, and development of further services in this subspecialty on a national and regional basis. MATERIALS AND METHODS Between November 2021 and April 2023, 244 patients commencing systemic anticancer treatment at the Royal Marsden Hospital, London underwent geriatric screening using the Senior Adult Oncology Programme-3 (SAOP3) screening tool. Baseline clinical factors (sex, age, Charlson Comorbidity Index score, Cumulative Illness Rating Scale-Geriatric [CIRS-G] score, Katz Index score, Barthel Index score, treatment intent, and Eastern Cooperative Oncology Group Performance Status [ECOG-PS]) were assessed as predictors of geriatric impairments and need for multidisciplinary referral and intervention using a negative binomial regression analysis. Referral rates to multidisciplinary teams were assessed against ECOG-PS score using point-biserial correlation, as well as against a historical control using descriptive statistics. RESULTS The median age of participants was 77; 75.8% were female. Breast cancer was the most prevalent diagnosis (61.9%). Most patients (67.6%) were undergoing treatment in the palliative setting. Two hundred eleven (86.5%) patients were identified as having at least one geriatric impairment. Six hundred forty-nine multidisciplinary referrals were made, of which 583 (86.7%) were accepted by the referred patient. Higher ECOG PS was positively associated with geriatric impairments in physiotherapy, occupational therapy, dietetics, pharmacy, and welfare rights domains, as well as with the overall number of geriatric impairments. DISCUSSION The Royal Marsden Senior Adult Oncology Programme represents the first geriatric oncology service in a tertiary cancer centre in the United Kingdom. Following implementation of SAOP3 screening, we observed a substantial increase in referrals to all multidisciplinary teams, suggestive of previously underrecognized needs among this population. The need for multidisciplinary intervention was strongly correlated with baseline ECOG-PS score, but not with other measured clinical variables, including comorbidity or functional indices.
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Affiliation(s)
- Colm Mac Eochagain
- Trinity St James' Cancer Institute, Dublin, Ireland; Royal Marsden Hospital, London, United Kingdom.
| | | | | | - Jane Murphy
- Royal Marsden Hospital, London, United Kingdom
| | | | | | | | | | - Emma Kipps
- Royal Marsden Hospital, London, United Kingdom
| | | | - Jo Jethwa
- Royal Marsden Hospital, London, United Kingdom
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McDeed AP, Van Dyk K, Zhou X, Zhai W, Ahles TA, Bethea TN, Carroll JE, Cohen HJ, Nakamura ZM, Rentscher KE, Saykin AJ, Small BJ, Root JC, Jim H, Patel SK, Mcdonald BC, Mandelblatt JS, Ahn J. Prediction of cognitive decline in older breast cancer survivors: the Thinking and Living with Cancer study. JNCI Cancer Spectr 2024; 8:pkae019. [PMID: 38556480 PMCID: PMC11031271 DOI: 10.1093/jncics/pkae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/27/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Abstract
PURPOSE Cancer survivors commonly report cognitive declines after cancer therapy. Due to the complex etiology of cancer-related cognitive decline (CRCD), predicting who will be at risk of CRCD remains a clinical challenge. We developed a model to predict breast cancer survivors who would experience CRCD after systematic treatment. METHODS We used the Thinking and Living with Cancer study, a large ongoing multisite prospective study of older breast cancer survivors with complete assessments pre-systemic therapy, 12 months and 24 months after initiation of systemic therapy. Cognition was measured using neuropsychological testing of attention, processing speed, and executive function (APE). CRCD was defined as a 0.25 SD (of observed changes from baseline to 12 months in matched controls) decline or greater in APE score from baseline to 12 months (transient) or persistent as a decline 0.25 SD or greater sustained to 24 months. We used machine learning approaches to predict CRCD using baseline demographics, tumor characteristics and treatment, genotypes, comorbidity, and self-reported physical, psychosocial, and cognitive function. RESULTS Thirty-two percent of survivors had transient cognitive decline, and 41% of these women experienced persistent decline. Prediction of CRCD was good: yielding an area under the curve of 0.75 and 0.79 for transient and persistent decline, respectively. Variables most informative in predicting CRCD included apolipoprotein E4 positivity, tumor HER2 positivity, obesity, cardiovascular comorbidities, more prescription medications, and higher baseline APE score. CONCLUSIONS Our proof-of-concept tool demonstrates our prediction models are potentially useful to predict risk of CRCD. Future research is needed to validate this approach for predicting CRCD in routine practice settings.
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Affiliation(s)
- Arthur Patrick McDeed
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
| | - Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Xingtao Zhou
- Georgetown University Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Department of Oncology and Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University, Washington, DC, USA
| | - Wanting Zhai
- Georgetown University Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Department of Oncology and Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University, Washington, DC, USA
| | - Tim A Ahles
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Traci N Bethea
- Georgetown University Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Department of Oncology and Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University, Washington, DC, USA
| | - Judith E Carroll
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Zev M Nakamura
- Department of Psychiatry, University of North Carolina–Chapel Hill, Chapel Hill, NC, USA
| | - Kelly E Rentscher
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew J Saykin
- Center for Neuroimaging and Indiana Alzheimer’s Disease Research Center, Department of Radiology and Imaging Sciences and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, and Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - James C Root
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heather Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, USA
| | - Sunita K Patel
- Outcomes Division, Population Sciences, City of Hope National Medical Center, Los Angeles, CA, USA
| | - Brenna C Mcdonald
- Center for Neuroimaging and Indiana Alzheimer’s Disease Research Center, Department of Radiology and Imaging Sciences and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jeanne S Mandelblatt
- Georgetown University Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Department of Oncology and Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University, Washington, DC, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
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10
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Dotan E, Lynch SM, Ryan JC, Mitchell EP. Disparities in care of older adults of color with cancer: A narrative review. Cancer Med 2024; 13:e6790. [PMID: 38234214 PMCID: PMC10905558 DOI: 10.1002/cam4.6790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/06/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024] Open
Abstract
This review describes the barriers and challenges faced by older adults of color with cancer and highlights methods to improve their overall care. In the next decade, cancer incidence rates are expected to increase in the United States for people aged ≥65 years. A large proportion will be older adults of color who often have worse outcomes than older White patients. Many issues contribute to racial disparities in older adults, including biological factors and social determinants of health (SDOH) related to healthcare access, socioeconomic concerns, systemic racism, mistrust, and the neighborhood where a person lives. These disparities are exacerbated by age-related challenges often experienced by older adults, such as decreased functional status, impaired cognition, high rates of comorbidities and polypharmacy, poor nutrition, and limited social support. Additionally, underrepresentation of both patients of color and older adults in cancer clinical research results in a lack of adequate data to guide the management of these patients. Use of geriatric assessments (GA) can aid providers in uncovering age-related concerns and personalizing interventions for older patients. Research demonstrates the ability of GA-directed care to result in fewer treatment-related toxicities and improved quality of life, thus supporting the routine incorporation of validated GA into these patients' care. GA can be enhanced by including evaluation of SDOH, which can help healthcare providers understand and address the needs of older adults of color with cancer who face disparities related to their age and race.
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Affiliation(s)
- Efrat Dotan
- Department of Hematology/OncologyFox Chase Cancer CenterPhiladelphiaPennsylvaniaUSA
| | | | | | - Edith P. Mitchell
- Clinical Professor of Medicine and Medical OncologySidney Kimmel Cancer Center at JeffersonPhiladelphiaPennsylvaniaUSA
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11
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Jackson EB, Curry L, Mariano C, Hsu T, Cook S, Pezo RC, Savard MF, Desautels DN, Leblanc D, Gelmon KA. Key Considerations for the Treatment of Advanced Breast Cancer in Older Adults: An Expert Consensus of the Canadian Treatment Landscape. Curr Oncol 2023; 31:145-167. [PMID: 38248095 PMCID: PMC10814011 DOI: 10.3390/curroncol31010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/04/2023] [Accepted: 12/23/2023] [Indexed: 01/23/2024] Open
Abstract
The prevalence of breast cancer amongst older adults in Canada is increasing. This patient population faces unique challenges in the management of breast cancer, as older adults often have distinct biological, psychosocial, and treatment-related considerations. This paper presents an expert consensus of the Canadian treatment landscape, focusing on key considerations for optimizing selection of systemic therapy for advanced breast cancer in older adults. This paper aims to provide evidence-based recommendations and practical guidance for healthcare professionals involved in the care of older adults with breast cancer. By recognizing and addressing the specific needs of older adults, healthcare providers can optimize treatment outcomes and improve the overall quality of care for this population.
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Affiliation(s)
- Emily B. Jackson
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Lauren Curry
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Caroline Mariano
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Tina Hsu
- The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada (M.-F.S.)
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Sarah Cook
- Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
- Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Rossanna C. Pezo
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada;
- Department of Medicine, Division of Medical Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Marie-France Savard
- The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada (M.-F.S.)
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Danielle N. Desautels
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Paul Albrechtsen Research Institute, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Dominique Leblanc
- Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC G1V 0A6, Canada
| | - Karen A. Gelmon
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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12
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Carrozzi A, Jin R, Monginot S, Puts M, Alibhai SMH. Defining an Abnormal Geriatric Assessment: Which Deficits Matter Most? Cancers (Basel) 2023; 15:5776. [PMID: 38136321 PMCID: PMC10742229 DOI: 10.3390/cancers15245776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
At present, there is no clear definition of what constitutes an abnormal geriatric assessment (GA) in geriatric oncology. Various threshold numbers of abnormal GA domains are often used, but how well these are associated with treatment plan modification (TPM) and whether specific GA domains are more important in this context remains uncertain. A retrospective review of the geriatric oncology clinic database at Princess Margaret Cancer Centre in Toronto, Canada, including new patients seen for treatment decision making from May 2015 to June 2022, was conducted. Logistic regression modelling was performed to determine the association between various predictor variables (including the GA domains and numerical thresholds) and TPM. The study cohort (n = 736) had a mean age of 80.7 years, 46.1% was female, and 78.3% had a VES-13 score indicating vulnerability (≥3). In the univariable analysis, the best-performing threshold number of abnormal domains based on area under the curve (AUC) was 4 (AUC 0.628). The best-performing multivariable model (AUC 0.704) included cognition, comorbidities, and falls risk. In comparison, the multivariable model with the sole addition of the threshold of 4 had an AUC of 0.689. Overall, an abnormal GA may be best defined as one with abnormalities in the domains of cognition, comorbidities, and falls risk. The optimal numerical threshold to predict TPM is 4.
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Affiliation(s)
- Anthony Carrozzi
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Rana Jin
- Department of Nursing, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Susie Monginot
- Department of Nursing, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Shabbir M. H. Alibhai
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
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13
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Ioffe D, Dotan E. Evidence-Based Care of Older Adults With Metastatic Colorectal Cancer: Insights From Landmark Clinical Trials. J Clin Oncol 2023; 41:5228-5236. [PMID: 37856768 PMCID: PMC10691792 DOI: 10.1200/jco.23.01337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/31/2023] [Accepted: 08/25/2023] [Indexed: 10/21/2023] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States with more than half of the patients diagnosed being older than 65 years, and an expected further increase in older adults (OA) diagnosed with this cancer in the coming years as the population ages. Prospective data guiding the management of older patients with metastatic CRC (mCRC) have been limited and treatment decisions for these patients are often guided by chronologic age, crude evaluation of performance status, and extrapolation from trials conducted in younger individuals. Recent evidence from randomized clinical trials specifically designed for OA supports treatment deintensification and dose modification to increase tolerability without compromising efficacy in older, frailer patients with mCRC. Additional studies support the incorporation of geriatric assessment (GA)-driven care to further improve the outcomes of OA with mCRC. Although the use of GA has not been validated in guiding specific treatment selection or modification for OA with mCRC, it provides a comprehensive and objective evaluation of a patient's functional status, comorbidities, risk of potential toxicities, effect on the quality of life, goals of care, and assists with personalizing therapy. With the increase in the number of OA we care for in our practices, it is time to stop extrapolating and define an evidence-based approach for this population that is based on data from prospective elderly specific clinical trials.
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Affiliation(s)
- Dina Ioffe
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA
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14
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Ozluk AA, Outlaw D, Akce M, Fowler ME, Hess DL, Giri S, Williams GR. Management of Older Adults With Colorectal Cancer: The Role of Geriatric Assessment. Clin Colorectal Cancer 2023; 22:390-401. [PMID: 37949790 PMCID: PMC11065137 DOI: 10.1016/j.clcc.2023.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/17/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
Older adults share a growing burden of cancer morbidity and mortality. This is present across the spectrum of oncologic diagnoses and is particularly true with colorectal cancer (CRC), where older adults continue to share the burden of diagnoses. However, optimal cancer treatment decision making in older adults remains a significant challenge, as the majority of previous clinical trials shaping the current treatment landscape have focused on younger patients, often with more robust performance status and fewer medical comorbid conditions. The heterogeneous aging process of older adults with CRC necessitates a personalized treatment approach, as approximately three-quarters of older adults with CRC also have a concominant geriatric syndrome and more than half of older adults with CRC are pre-frail or frail. Treatment decisions shoud be multifaceted, including consultation with the patient and their familes regarding their wishes, with consideration of the patient's quality of life, functional status, medical comorbid conditions, social support, and treatment toxicity risk. Geriatric assessment is a systematic and validated approach to assess an older adults's potential strengths and vulnerabilities, which can in turn be used to assist with comprehensive cancer care planning and support. In this review, we will summarize current treatment approaches for older adults with CRC, with a particular focus on the incorporation of the geriatric assessment.
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Affiliation(s)
- Ahmet Anil Ozluk
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Darryl Outlaw
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mehmet Akce
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mackenzie E Fowler
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Daniel L Hess
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Smith Giri
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
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15
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Shin IB, Han W, Lee HB, Kim HK, Moon HG. Life-Threatening Hematoma in an Elderly Breast Cancer Patient Undergoing Chemotherapy. J Breast Cancer 2023; 26:514-518. [PMID: 37704385 PMCID: PMC10625869 DOI: 10.4048/jbc.2023.26.e41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/26/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023] Open
Abstract
The use of neoadjuvant chemotherapy in older patients is increasing. However, chemotherapy should be administered considering the medical comorbidities of the patients and the toxicity of chemotherapeutic agents. Here, we present a case of abdominal wall hematoma with spontaneous inferior epigastric artery injury caused by coughing in a 70-year-old woman who was treated with neoadjuvant chemotherapy. Abdominal computed tomography demonstrated an abdominal wall hematoma with active bleeding. However, angiography with selective embolization of the right inferior epigastric artery and the right internal mammary artery was performed successfully. Scheduled chemotherapy was discontinued over concerns of rebleeding and breast-conserving surgery was performed. When deciding on chemotherapy for older patients, attention should be paid to the various complications.
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Affiliation(s)
- Ik Beom Shin
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
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16
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Laface C, Giuliani F, Melaccio A, Pappagallo MN, Santoro AN, Perrone M, De Santis P, Guarini C, Carrozzo D, Fedele P. The Treatment Landscape of Elderly Patients with Hormone Receptor-Positive Her2 Negative Advanced Breast Cancer: Current Perspectives and Future Directions. J Clin Med 2023; 12:6012. [PMID: 37762952 PMCID: PMC10532156 DOI: 10.3390/jcm12186012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/26/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Breast cancer (BC) in elderly women is an increasing health issue due to demographic changes. BC tends to present later and may receive less than standard treatment options. More often, BC in elderly patients is endocrine-positive (HR+). The treatment of elderly patients with metastatic BC (mBC) represents a therapeutic challenge. In recent years, the treatment landscape of patients that are HR+/Her2-negative has changed due to the introduction in clinical practice of new targeted drugs, which have improved patient outcomes. Elderly patients are a small percentage of all patients enrolled in clinical trials and, to date, there are no standardized guidelines that define the best treatment option for this patient population. This can lead to undertreatment or overtreatment, impacting patient morbidity and mortality. Geriatric Assessment tools to tailor the treatment in elderly patients are underused because they are long and difficult to apply in a busy routine clinical practice. For all these reasons, there is an urgent need to produce data about the best treatment for elderly patients with HR+ mBC. Herein, we report data from randomized clinical trials and real-world evidence on the therapeutic options for HR+ Her2-negative mBC elderly patients and explore future treatment directions.
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Affiliation(s)
- Carmelo Laface
- Medical Oncology, Dario Camberlingo Hospital, 72021 Francavilla Fontana, Italy (A.N.S.); (M.P.); (P.D.S.); (C.G.); (D.C.)
| | - Francesco Giuliani
- Medical Oncology, San Paolo Hospital, ASL Bari, 70123 Bari, Italy; (F.G.); (A.M.); (M.N.P.)
| | - Assunta Melaccio
- Medical Oncology, San Paolo Hospital, ASL Bari, 70123 Bari, Italy; (F.G.); (A.M.); (M.N.P.)
| | - Maria Nicla Pappagallo
- Medical Oncology, San Paolo Hospital, ASL Bari, 70123 Bari, Italy; (F.G.); (A.M.); (M.N.P.)
| | - Anna Natalizia Santoro
- Medical Oncology, Dario Camberlingo Hospital, 72021 Francavilla Fontana, Italy (A.N.S.); (M.P.); (P.D.S.); (C.G.); (D.C.)
| | - Martina Perrone
- Medical Oncology, Dario Camberlingo Hospital, 72021 Francavilla Fontana, Italy (A.N.S.); (M.P.); (P.D.S.); (C.G.); (D.C.)
| | - Pierluigi De Santis
- Medical Oncology, Dario Camberlingo Hospital, 72021 Francavilla Fontana, Italy (A.N.S.); (M.P.); (P.D.S.); (C.G.); (D.C.)
| | - Chiara Guarini
- Medical Oncology, Dario Camberlingo Hospital, 72021 Francavilla Fontana, Italy (A.N.S.); (M.P.); (P.D.S.); (C.G.); (D.C.)
| | - Daniela Carrozzo
- Medical Oncology, Dario Camberlingo Hospital, 72021 Francavilla Fontana, Italy (A.N.S.); (M.P.); (P.D.S.); (C.G.); (D.C.)
| | - Palma Fedele
- Medical Oncology, Dario Camberlingo Hospital, 72021 Francavilla Fontana, Italy (A.N.S.); (M.P.); (P.D.S.); (C.G.); (D.C.)
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17
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Record SM, Chanenchuk T, Parrish KM, Kaplan SJ, Kimmick G, Plichta JK. Prognostic Tools for Older Women with Breast Cancer: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1576. [PMID: 37763695 PMCID: PMC10534323 DOI: 10.3390/medicina59091576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Background: Breast cancer is the most common cancer in women, and older patients comprise an increasing proportion of patients with this disease. The older breast cancer population is heterogenous with unique factors affecting clinical decision making. While many models have been developed and tested for breast cancer patients of all ages, tools specifically developed for older patients with breast cancer have not been recently reviewed. We systematically reviewed prognostic models developed and/or validated for older patients with breast cancer. Methods: We conducted a systematic search in 3 electronic databases. We identified original studies that were published prior to 8 November 2022 and presented the development and/or validation of models based mainly on clinico-pathological factors to predict response to treatment, recurrence, and/or mortality in older patients with breast cancer. The PROBAST was used to assess the ROB and applicability of each included tool. Results: We screened titles and abstracts of 7316 records. This generated 126 studies for a full text review. We identified 17 eligible articles, all of which presented tool development. The models were developed between 1996 and 2022, mostly using national registry data. The prognostic models were mainly developed in the United States (n = 7; 41%). For the derivation cohorts, the median sample size was 213 (interquartile range, 81-845). For the 17 included modes, the median number of predictive factors was 7 (4.5-10). Conclusions: There have been several studies focused on developing prognostic tools specifically for older patients with breast cancer, and the predictions made by these tools vary widely to include response to treatment, recurrence, and mortality. While external validation was rare, we found that it was typically concordant with interval validation results. Studies that were not validated or only internally validated still require external validation. However, most of the models presented in this review represent promising tools for clinical application in the care of older patients with breast cancer.
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Affiliation(s)
- Sydney M. Record
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Tori Chanenchuk
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Kendra M. Parrish
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Gretchen Kimmick
- Duke Cancer Institute, Duke University, Durham, NC 27710, USA
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Jennifer K. Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
- Duke Cancer Institute, Duke University, Durham, NC 27710, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC 27710, USA
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18
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Trapani D, Jin Q, Block CC, Freedman RA, Lin NU, Tarantino P, Mittendorf EA, King TA, Lester SC, Brock JE, Tayob N, Bunnell CA, Tolaney SM, Burstein HJ. Identifying Patterns and Barriers in OncotypeDX Recurrence Score Testing in Older Patients With Early-Stage, Estrogen Receptor-Positive Breast Cancer: Implications for Guidance and Reimbursement. JCO Oncol Pract 2023; 19:560-570. [PMID: 37192427 DOI: 10.1200/op.22.00731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/16/2023] [Accepted: 03/13/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE To evaluate the clinical patterns of utilization of OncotypeDX Recurrence Score (RS) in early-stage, hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer (BC) at an academic center with previously established internal reflex testing guidelines. METHODS RS testing in accordance with preexisting reflex criteria and predictors of utilization outside of reflex criteria were retrospectively analyzed for the years 2019-2021 in a quality improvement evaluation. Patients were grouped according to OncotypeDX testing within (cohort A) or outside (cohort B) of predefined criteria which included a cap at age older than 65 years. RESULTS Of 1,687 patients whose tumors had RS testing, 1,087 were in cohort A and 600 in cohort B. In cohort B, nearly half of patients were older than 65 years (n = 279; IQR, 67-72 years). For patients older than 65 years, those with RS testing were younger (median age: 69 v 73 years), with higher grade cancers (G2-3: 84.9% v 54.7%) and were more likely to be treated with chemotherapy (15.4% v 4.1%). Issues for implementation of RS testing in older patients were identified, including potential structural barriers related to the current policy on the reimbursements of genomic tests. CONCLUSION Internal guidelines may facilitate standardized utilization of the RS in early-BC. Our data suggest that clinicians preferred broader utilization of RS across the age spectrum, with therapeutically important consequences. Modifying the current policy for reimbursement of RS testing and in internal reflexive testing criteria for those older than 65 years is warranted.
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Affiliation(s)
- Dario Trapani
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Qingchun Jin
- Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Caroline C Block
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Rachel A Freedman
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Nancy U Lin
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Paolo Tarantino
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Elizabeth A Mittendorf
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Tari A King
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Susan C Lester
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
- Breast Pathology, Brigham and Women's Hospital, Boston, MA
| | - Jane E Brock
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
- Breast Pathology, Brigham and Women's Hospital, Boston, MA
| | - Nabihah Tayob
- Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Craig A Bunnell
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Sara M Tolaney
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Harold J Burstein
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
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Extermann M, Al-Jumayli M, Sam C, Kish JA. Oncogeriatric Developments. Gerontology 2023; 69:1045-1055. [PMID: 37321185 DOI: 10.1159/000531559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
Cancer is a disease of aging and is rapidly becoming the number one cause of mortality in older people. Over their lifetime, one in two men and one in three women will develop a cancer, with half of the risk being beyond the age of seventy. Therefore, cancer is a problem frequently encountered by geriatricians. In this article, we review a few recent progresses that will be of interest to the geriatric community. First, we now have robust evidence that a comprehensive geriatric assessment and management change outcomes in older cancer patients, notably allowing decreased treatment toxicity, better treatment completion, and increased functional outcomes. In gastrointestinal cancers and breast cancer, several recent studies have addressed when treatment intensity can be decreased, and when it cannot. New treatments for acute myeloid leukemia are finally beginning to improve outcomes for older patients and such patients should be referred to oncologists for management. In prostate cancer, new imaging techniques (e.g., PSMA scan) and treatment options can allow better treatment targeting and spare some hormonal and chemotherapy toxicity. Finally, we review recent public policy efforts to address the epidemiologic wave of cancer in older patients on a global scale.
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Affiliation(s)
- Martine Extermann
- Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Christine Sam
- Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, Florida, USA
| | - Julie A Kish
- Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, Florida, USA
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20
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Brain EGC. Systemic Therapy in Older Patients With High-Risk Disease. Am Soc Clin Oncol Educ Book 2023; 43:e390456. [PMID: 37437232 DOI: 10.1200/edbk_390456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Adjuvant systemic treatments for older patients with breast cancer require constant dose or schedule adjustments of standards established for younger ones. This is mainly due to frailty that increases according to age (40%-50% of signals in all comers after age 70 years) and remains difficult to spot or diagnose accurately and therefore is often overlooked. Older patients are at higher risk to develop side effects whether under chemotherapy, optimized endocrine treatment, or targeted therapies. Pharmacokinetic reflects poorly functional reserves that reduce with aging and is therefore misleading. The demonstration of significant long-term benefits provided by adjuvant treatments is challenged by life expectancy, driven by multimorbidity status that increases with age, competing with cancer outcome. When geriatric assessment is incorporated into the multidisciplinary team, treatment decision process shows 30%-50% changes, de-escalating initial age-agnostic treatment choices in two of three cases. Finally, expectations from treatment vary over the years: In older ones, although not being exclusive, there is a general shift of preference for protecting functionality, cognitive functions, and independence, as summarized in quality of life that many systemic adjuvant treatment may jeopardize. These provocative considerations show importance to pay more attention to expectations expressed by older patients to limit gaps between what is thought by health care professionals as right, often on the basis of dose intensity models strongly engrained in oncology and that older patients may assess counterintuitively differently. The most achieved molecular testing to identify high-risk luminal tumors should be combined with determinant geriatric factors to bring relevant global information in the adjuvant setting for older patients.
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Alexander K, Hamlin PA, Tew WP, Trevino K, Tin AL, Shahrokni A, Meditz E, Boparai M, Amirnia F, Sun SW, Korc-Grodzicki B. Development and implementation of an interdisciplinary telemedicine clinic for older patients with cancer-Preliminary data. J Am Geriatr Soc 2023; 71:1638-1649. [PMID: 36744590 PMCID: PMC10175129 DOI: 10.1111/jgs.18267] [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: 11/14/2022] [Revised: 01/03/2023] [Accepted: 01/17/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Frailty assessment is an important marker of the older adult's fitness for cancer treatment independent of age. Pretreatment geriatric assessment (GA) is associated with improved mortality and morbidity outcomes but must occur in a time sensitive manner to be useful for cancer treatment decision making. Unfortunately, time, resources and other constraints make GA difficult to perform in busy oncology clinics. We developed the Cancer and Aging Interdisciplinary Team (CAIT) clinic model to provide timely GA and treatment recommendations independent of patient's physical location. METHODS The interdisciplinary CAIT clinic model was developed utilizing the surge in telemedicine during the COVID-19 pandemic. The core team consists of the patient's oncologist, geriatrician, registered nurse, pharmacist, and registered dietitian. The clinic's format is flexible, and the various assessments can be asynchronous. Patients choose the service method-in person, remotely, or hybrid. Based on GA outcomes, the geriatrician provides recommendations and arrange interventions. An assessment summary including life expectancy estimates and chemotoxicity risk calculator scores is conveyed to and discussed with the treating oncologist. Physician and patient satisfaction were assessed. RESULTS Between May 2021 and June 2022, 50 patients from multiple physical locations were evaluated in the CAIT clinic. Sixty-eight percent was 80 years of age or older (range 67-99). All the evaluations were hybrid. The median days between receiving a referral and having the appointment was 8. GA detected multiple unidentified impairments. About half of the patients (52%) went on to receive chemotherapy (24% standard dose, 28% with dose modifications). The rest received radiation (20%), immune (12%) or hormonal (4%) therapies, 2% underwent surgery, 2% chose alternative medicine, 8% were placed under observation, and 6% enrolled in hospice care. Feedback was extremely positive. CONCLUSIONS The successful development of the CAIT clinic model provides strong support for the potential dissemination across services and institutions.
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Affiliation(s)
- Koshy Alexander
- Memorial Sloan Kettering Cancer Center
- Weil Cornell Medical College
| | - Paul A Hamlin
- Memorial Sloan Kettering Cancer Center
- Weil Cornell Medical College
| | - William P Tew
- Memorial Sloan Kettering Cancer Center
- Weil Cornell Medical College
| | | | - Amy L Tin
- Memorial Sloan Kettering Cancer Center
| | - Armin Shahrokni
- Memorial Sloan Kettering Cancer Center
- Weil Cornell Medical College
| | | | | | - Farnia Amirnia
- Memorial Sloan Kettering Cancer Center
- Weil Cornell Medical College
| | - Sung Wu Sun
- Memorial Sloan Kettering Cancer Center
- Weil Cornell Medical College
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22
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Johns AC, Yang M, Wei L, Grogan M, Spakowicz D, Patel SH, Li M, Husain M, Kendra KL, Otterson GA, Rosko AE, Andersen BL, Carbone DP, Owen DH, Presley CJ. Risk Factors for Immune Checkpoint Inhibitor Immunotherapy Toxicity Among Older Adults with Cancer. Oncologist 2023:7135996. [PMID: 37085156 PMCID: PMC10400153 DOI: 10.1093/oncolo/oyad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/09/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES Immune checkpoint inhibitor immunotherapy (IO) is revolutionizing cancer care but can lead to significant toxicity. This study seeks to describe potential risk factors for immune-related adverse events (irAEs) specifically among older adults. MATERIALS AND METHODS This was a retrospective study at a single academic comprehensive cancer center based on chart review data abstracted by physicians. For patients aged ≥70 years, frequency, type, and grade of irAEs and their association with baseline patient demographics, comorbidities, mobility, and functional status were characterized using bivariate analysis. Based on those results, multivariable logistic regressions were constructed to model the association between these characteristics with any grade and grade 3 or higher irAEs. RESULTS Data were analyzed for 238 patients aged ≥70 years who received IO for mostly (≥90%) advanced cancer between 2011 and 2018. Thirty-nine percent of older adults experienced an irAE and 13% experienced one that was grade 3 or higher. In the multivariable analysis, depression was associated with an increased incidence of any grade irAE, while decreased life-space mobility was associated with an increased incidence of grade ≥3 irAEs. CONCLUSION Most characteristics of special interest among older adults, include fall risk, weight loss, cognitive limitations, and hearing loss, were not associated with irAEs in our study. However, decreased life-space mobility and depression are potential risk factors for IO toxicity among older adults with advanced cancer. Interventions designed to evaluate and mitigate modifiable risk factors for treatment-related toxicity are needed, and the results of this study may be useful for guiding those efforts.
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Affiliation(s)
- Andrew C Johns
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mike Yang
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Lai Wei
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Madison Grogan
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Daniel Spakowicz
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Sandipkumar H Patel
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mingjia Li
- Division of Hospital Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Marium Husain
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Kari L Kendra
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Gregory A Otterson
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Ashley E Rosko
- Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - David P Carbone
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Dwight H Owen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Brown L, Carr MJ, Sam C, Sun W, Whiting J, Kim Y, Lee MC. Tolerance and Outcomes of Neoadjuvant Chemotherapy in Geriatric Breast Cancer Patients. J Surg Res 2023; 283:329-335. [PMID: 36427442 DOI: 10.1016/j.jss.2022.10.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NAC) is an established treatment option for patients with human epidermal growth factor receptor 2-positive (Her2+) or triple-negative breast cancer (TNBC). However, the toxicities associated with NAC may lead to reduced tolerance in geriatric patients due to medical comorbidities. Our objective is to evaluate the tolerance and outcomes of NAC in geriatric patients with TNBC and Her2+ breast cancer. MATERIALS AND METHODS An institutional review board approved, retrospective study of 43 geriatric (≥70 y) and 103 non-geriatric (<70 y) patients with TNBC and Her2+ breast cancer was conducted. Demographic, comorbidity, treatment, and toxicity variables were collected. Log-rank tests and Cox regression visualized survival outcomes evaluated associations with clinical and demographic variables. Descriptive statistics were performed. RESULTS Following NAC, 30% geriatric patients had a pathologic complete response in the primary tumor, 54% had a partial response, and 16% had no response. Of the non-geriatric patients, 24% had a pathologic complete response, 64% had a partial response, and 12% showed no response. NAC-associated toxicities occurred in 81% of geriatric patients and 73% non-geriatric patients, with neutropenia occurring most frequently in both groups. Dose reduction and early discontinuation of NAC each occurred more frequently in the geriatric group (14%; 23%) than the non-geriatric group (7%; 6%). Higher post-treatment Eastern Cooperative Oncology Group scores were associated with worse overall survival and worse recurrence-free survival in both groups. CONCLUSIONS NAC was associated with reduced tumor and nodal stage in most geriatric patients; however, NAC-associated toxicities were common and led some patients to reduce or stop their NAC regimen prematurely.
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Affiliation(s)
- Lauren Brown
- USF Health Morsani College of Medicine, Tampa, Florida
| | - Michael J Carr
- Comprehensive Breast Program, Moffitt Cancer Center, Tampa, Florida
| | - Christine Sam
- Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, Florida
| | - Weihong Sun
- Comprehensive Breast Program, Moffitt Cancer Center, Tampa, Florida
| | - Junmin Whiting
- Department of Biostatistics & Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Youngchul Kim
- Department of Biostatistics & Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - M Catherine Lee
- Comprehensive Breast Program, Moffitt Cancer Center, Tampa, Florida.
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Yilmaz S, Koita F, Zittel J, Wells M, Mohile S, Wittink M, Kelly JM, Sedrak M, DeCaporale-Ryan L, DiGiovanni G, Magnuson A. The role of self-perceived age in older adults considering adjuvant chemotherapy. J Geriatr Oncol 2023; 14:101429. [PMID: 36682217 PMCID: PMC9974899 DOI: 10.1016/j.jgo.2023.101429] [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: 06/22/2022] [Revised: 11/21/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Aging-related concerns can increase the risk of treatment toxicities among older adults considering adjuvant chemotherapy. We previously demonstrated that older adults with cancer who reported feeling older than their chronological age (i.e., self-perceived age) were more likely to have aging-related concerns identified during a geriatric assessment. We explored how decisions about adjuvant chemotherapy vary with or are related to older adults' self-perceived age. MATERIALS AND METHODS We conducted a secondary analysis of a multi-phased feasibility pilot using semi-structured interviews that were conducted to explore the patient decision-making process for adjuvant chemotherapy. Interviews incorporated questions about chronological and perceived age as factors for decision-making. Patient eligibility for the study included (1) age ≥ 70 years and older, (2) a diagnosis of breast, colon, or lung cancer and considering adjuvant chemotherapy, and (3) able to read size 18 font in English. Interview data were analyzed using constant comparative method. RESULTS Twenty-one patients were enrolled. The mean chronological age was 78 years (range 71-91). The average perceived age of patients was 57 years (range 21-80). Eleven patients chose to receive treatment while ten patients did not. Aging-related themes illustrated that self-perceived age plays an important role when patients make decisions about adjuvant chemotherapy. More specifically, patients who reported their self-perceived age as younger than their chronological age also reported better perceived health status and chose to receive adjuvant chemotherapy. DISCUSSION Patients' experiences of aging and self-perceived age may have different implications for decision-making.
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Affiliation(s)
- Sule Yilmaz
- University of Rochester, Rochester, NY, United States of America.
| | - Fatoumata Koita
- State University of New York at Albany, Albany, NY, United States of America
| | - Jason Zittel
- University of Rochester, Rochester, NY, United States of America
| | - Megan Wells
- University of Rochester, Rochester, NY, United States of America
| | - Supriya Mohile
- University of Rochester, Rochester, NY, United States of America
| | - Marsha Wittink
- University of Rochester, Rochester, NY, United States of America
| | - J MacLaren Kelly
- University of Rochester, Rochester, NY, United States of America
| | - Mina Sedrak
- City of Hope, Duarte, CA, United States of America
| | | | - Grace DiGiovanni
- University of Rochester, Rochester, NY, United States of America
| | - Allison Magnuson
- University of Rochester, Rochester, NY, United States of America
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Adal O, Hiamanot Y, Zakir A, Regassa R, Gashaw A. Knowledge, Attitude, and Practice of Nurses Toward the Initial Managements of Acute Poisoning in Public Hospitals of Bahir Dar City, Northwest Ethiopia 2022: Cross-Sectional Study. SAGE Open Nurs 2023; 9:23779608231157307. [PMID: 36814459 PMCID: PMC9940229 DOI: 10.1177/23779608231157307] [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: 11/18/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction Poisoning is a common cause of medical visits and hospitalizations around the world. The knowledge, attitude, and practice of nurses in the management of acute poisoning are very poor in developing countries, such as Ethiopia. According to the previous study, 75% and 45% of nurses had unsatisfactory knowledge and practice, respectively. Objectives This study aimed to assess the knowledge, attitude, and practice of nurses toward the initial management of acute poisoning. Method An institution-based cross-sectional study design was used to recruit 422 nurses from public hospitals of Bahir Dar city in Ethiopia. A systematic random sampling method and an English version of self-administered questionnaires were used to collect the data. The data were entered into Epi Data and analyzed using SPSS version 25. Results The study recruited 422 nurses, with a response rate of 100%; 248 (58.8%) and 264 (62.2%) of the nurses had good knowledge and practice, respectively. Slightly more than half (57.6%) of the nurses had a positive attitude. Nurses who worked in an emergency and intensive care unit had twice the odds of having more knowledge and practice than those who worked in an outpatient department (AOR = 2.1, CI: (1.019, 4.540), p = 0.001). Nurses who have MSc degree were twice (AOR = 2.1, CI: (1.019, 4.540), p = 0.001) and three times (AOR = 3.1, CI: (1.012, 7.140), p = 0.002) to have good knowledge and practice than those who have a diploma. Conclusion Slightly more than half of nurses had good knowledge, practice, and a positive attitude. Educational status, working in an emergency department, and having training in poison management have been significantly associated with the knowledge and practice of nurses. The authors recommended that there is a need to empower the attitude, knowledge, and practice of nurses through consistent training, accessing, and updating guidelines (poisoning management protocol). The author also suggested that the poison management protocol be incorporated into the Ethiopian nursing curriculum (certificates).
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Affiliation(s)
- Ousman Adal
- Department of Emergency, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia,Ousman Adal, Department of Emergency, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia.
| | - Yigremew Hiamanot
- Department of Emergency, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abdulkadir Zakir
- Department of Emergency, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Redeat Regassa
- Department of Emergency, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Asnake Gashaw
- Department of Emergency, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Sedrak MS, Sun CL, Ji J, Cohen HJ, Gross CP, Tew WP, Klepin HD, Wildes TM, Dotan E, Freedman RA, O'Connor T, Chow S, Fenton MA, Moy B, Chapman AE, Dale W, Katheria V, Kuderer NM, Lyman GH, Magnuson A, Muss HB. Low-Intensity Adjuvant Chemotherapy for Breast Cancer in Older Women: Results From the Prospective Multicenter HOPE Trial. J Clin Oncol 2023; 41:316-326. [PMID: 36455189 PMCID: PMC9839299 DOI: 10.1200/jco.22.01440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Older women with high-risk early breast cancer (EBC) benefit from adjuvant chemotherapy, but their treatment is frequently complicated by toxic side effects, resulting in dose reductions and delays. This makes it challenging for oncologists to maintain a relative dose intensity (RDI) ≥ 85%, as recommended for optimal curative-intent treatment. Understanding which women are at risk of receiving suboptimal RDI may inform treatment discussions and guide early, targeted supportive care or geriatric comanagement interventions. METHODS This was a prespecified secondary analysis of the HOPE trial, which enrolled women age ≥ 65 years with EBC initiating neoadjuvant or adjuvant chemotherapy. RDI was calculated as the ratio of delivered to planned chemotherapy dose intensity. The primary outcome was low RDI, defined as RDI < 85%. Multivariable logistic regression with stepwise selection was used to evaluate the association between baseline variables (demographic, clinical, and geriatric assessment) and low RDI. Survival probability was estimated using the Kaplan-Meier method, and the log-rank test was used to compare overall survival. RESULTS Three hundred twenty-two patients (median age at diagnosis, 70 years; range, 65-86 years) were included. The median follow-up was 4 years. Sixty-six patients (21%) had a low RDI. Age ≥ 76 years (odds ratio [OR], 2.57; 95% CI, 1.12 to 5.91; P = .03), lower performance status (OR, 4.32; 95% CI, 1.98 to 9.42; P < .001), and use of anthracycline-based or cyclophosphamide, methotrexate, and fluorouracil regimens (OR, 3.47; 95% CI, 1.71 to 7.05; P < .001) were associated with low RDI. The 5-year overall survival probability was 0.80 versus 0.91 in patients with RDI < 85 versus ≥ 85%, respectively (log-rank P = .02). CONCLUSION One in five older patients with EBC treated with standard chemotherapy received low RDI and had inferior survival outcomes. Older patients at risk for low RDI should be identified and targeted upfront before initiating chemotherapy.
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Affiliation(s)
- Mina S. Sedrak
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Can-Lan Sun
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Supportive Care Medicine, City of Hope, Duarte, CA
| | - Jingran Ji
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Harvey J. Cohen
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Cary P. Gross
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - William P. Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heidi D. Klepin
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Tanya M. Wildes
- Department of Medical Oncology, Nebraska Medicine, Omaha, NE
| | - Efrat Dotan
- Department of Hematology Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Rachel A. Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Tracey O'Connor
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Selina Chow
- Department of Medicine, University of Chicago, Chicago, IL
| | | | - Beverly Moy
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Andrew E. Chapman
- Department of Medical Oncology, Sidney Kimmel Cancer Center/Jefferson Health, Philadelphia, PA
| | - William Dale
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Supportive Care Medicine, City of Hope, Duarte, CA
| | - Vani Katheria
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Supportive Care Medicine, City of Hope, Duarte, CA
| | | | - Gary H. Lyman
- Department of Medicine, University of Washington, Seattle, WA
| | - Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Hyman B. Muss
- Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Ji J, Sun CL, Cohen HJ, Synold T, Muss H, Sedrak MS. Inflammation and Clinical Decline After Adjuvant Chemotherapy in Older Adults With Breast Cancer: Results From the Hurria Older Patients Prospective Study. J Clin Oncol 2023; 41:307-315. [PMID: 36126235 PMCID: PMC9839275 DOI: 10.1200/jco.22.01217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/18/2022] [Accepted: 08/08/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Older breast cancer survivors are at increased risk of clinical decline after adjuvant chemotherapy. This study aimed to evaluate whether inflammatory markers assessed before adjuvant chemotherapy are associated with chemotherapy-induced clinical decline in a population of fit older adults with breast cancer. METHODS In a prospective study of women age ≥ 65 years with stage I-III breast cancer treated with chemotherapy, we measured interleukin-6 (IL-6) and C-reactive protein (CRP) prechemotherapy (T1). We assessed frailty status, using a Deficit Accumulation Index (DAI; categorized as robust, prefrail, and frail), at T1 and postchemotherapy (T2). The population of interest was robust women at T1. The primary outcome was chemotherapy-induced decline in frailty status, defined as decline in DAI from robust (T1) to prefrail or frail (T2). Multivariable logistic regression was used to examine the association between inflammatory markers and the primary outcome, adjusted for sociodemographic and clinical characteristics. RESULTS Of the 295 robust women at T1, 76 (26%) experienced chemotherapy-induced decline in frailty status, among whom 66% had high IL-6, 63% had high CRP, and 46% had high IL-6 and CRP at T1. After adjusting for sociodemographic and clinical characteristics, women with high IL-6 and CRP had a > three-fold (odds ratio, 3.52; 95% CI, 1.55 to 8.01; P = .003) odds of chemotherapy-induced decline in frailty status compared with women with low IL-6 and CRP. CONCLUSION In this cohort of older women with early breast cancer who were clinically fit before chemotherapy initiation, high IL-6 and CRP prechemotherapy were associated with chemotherapy-induced decline in frailty status independent of sociodemographic and clinical risk factors. Further research is needed to examine whether inflammatory markers can inform more personalized approaches to treating older breast cancer survivors.
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Affiliation(s)
- Jingran Ji
- City of Hope National Medical Center, Duarte, CA
| | - Can-Lan Sun
- City of Hope National Medical Center, Duarte, CA
| | | | | | - Hyman Muss
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Freedman RA, Li T, Sedrak MS, Hopkins JO, Tayob N, Faggen MG, Sinclair NF, Chen WY, Parsons HA, Mayer EL, Lange PB, Basta AS, Perilla-Glen A, Lederman RI, Wong A, Tiwari A, McAllister SS, Mittendorf EA, Miller PG, Gibson CJ, Burstein HJ. 'ADVANCE' (a pilot trial) ADjuVANt chemotherapy in the elderly: Developing and evaluating lower-toxicity chemotherapy options for older patients with breast cancer. J Geriatr Oncol 2023; 14:101377. [PMID: 36163163 PMCID: PMC10080267 DOI: 10.1016/j.jgo.2022.09.006] [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: 06/21/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Older adults with breast cancer receiving neo/adjuvant chemotherapy are at high risk for poor outcomes and are underrepresented in clinical trials. The ADVANCE (ADjuVANt Chemotherapy in the Elderly) trial evaluated the feasibility of two neo/adjuvant chemotherapy regimens in parallel-enrolling cohorts of older patients with human epidermal growth factor receptor 2-negative breast cancer: cohort 1-triple-negative; cohort 2-hormone receptor-positive. MATERIALS AND METHODS Adults age ≥ 70 years with stage I-III breast cancer warranting neo/adjuvant chemotherapy were enrolled. Cohort 1 received weekly carboplatin (area under the curve 2) and weekly paclitaxel 80 mg/m2 for twelve weeks; cohort 2 received weekly paclitaxel 80 mg/m2 plus every-three-weekly cyclophosphamide 600 mg/m2 over twelve weeks. The primary study endpoint was feasibility, defined as ≥80% of patients receiving ≥80% of intended weeks/doses of therapy. All dose modifications were applied per clinician discretion. RESULTS Forty women (n = 20 per cohort) were enrolled from March 25, 2019 through August 3, 2020 from three centers; 45% and 35% of patients in cohorts 1 and 2 were age > 75, respectively. Neither cohort achieved targeted thresholds for feasibility. In cohort 1, eight (40.0%) met feasibility (95% confidence interval [CI] = 19.1-63.9%), while ten (50.0%) met feasibility in cohort 2 (95% CI = 27.2-72.8). Neutropenia was the most common grade 3-4 toxicity (cohort 1-65%, cohort 2-55%). In cohort 1, 80% and 85% required ≥1 dose holds of carboplatin and/or paclitaxel, respectively. In cohort 2, 10% required dose hold(s) for cyclophosphamide and/or 65% for paclitaxel. DISCUSSION In this pragmatic pilot examining chemotherapy regimens in older adults with breast cancer, neither regimen met target goals for feasibility. Developing efficacious and tolerable regimens for older patients with breast cancer who need chemotherapy remains an important goal. CLINICALTRIALS gov Identifier: NCT03858322.
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Affiliation(s)
- Rachel A Freedman
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Tianyu Li
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mina S Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Judith O Hopkins
- Novant Health Cancer Institute / SCOR NCORP, Winston Salem, NC, USA
| | - Nabihah Tayob
- Harvard Medical School, Boston, MA, USA; Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Meredith G Faggen
- Dana-Farber Brigham Cancer Center at South Shore Hospital, South Weymouth, MA, USA
| | - Natalie F Sinclair
- Dana-Farber Brigham Cancer Center at Milford Regional Medical Center, Milford, MA, USA
| | - Wendy Y Chen
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Heather A Parsons
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Erica L Mayer
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Paulina B Lange
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ameer S Basta
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Ruth I Lederman
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrew Wong
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Abhay Tiwari
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Sandra S McAllister
- Harvard Medical School, Boston, MA, USA; Hematology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Stem Cell Institute, Cambridge, MA, USA; Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Elizabeth A Mittendorf
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter G Miller
- Harvard Medical School, Boston, MA, USA; Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA; Center for Cancer Research, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher J Gibson
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Harold J Burstein
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Huang WJ, Yuan JR, Zhang L, Wang W, Miao SD, Wang X, Wang RT. Albumin-bilirubin score predicts trastuzumab resistance in HER2-positive breast cancer. Cancer Biomark 2023; 38:425-432. [PMID: 37980647 DOI: 10.3233/cbm-230077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND The albumin-bilirubin (ALBI) score is a novel indicator of liver function. Some studies showed that the ALBI score was a predictive marker for the prognosis and efficacy of drug therapy in malignancies. We aimed to assess the predicted role of ALBI score in the sensitivity to therapy with trastuzumab in patients with human epidermal growth factor receptor 2 (HER2) positive breast cancer (BC). The clinical data of 226 HER2-positive BC patients at the Harbin Medical University Cancer Hospital from January 2017 and December 2018 were retrospectively collected. The ALBI score was calculated with serum albumin and bilirubin before diagnosis. The associations between ALBI score and trastuzumab resistance were analyzed by logistic regression analyses. The patients with trastuzumab resistance had higher ALBI scores compared with the patients without trastuzumab resistance. Moreover, there were weak correlations between the ALBI score and lymph node status (P= 0.093). In addition, multivariate analysis revealed that the ALBI score was an independent prognostic factor for trastuzumab resistance in HER2-positive BC. High ALBI score is associated with trastuzumab resistance in HER2-positive BC. Future studies are needed.
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Affiliation(s)
- Wen-Juan Huang
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jia-Rui Yuan
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Lei Zhang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Wen Wang
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Shi-Di Miao
- School of Computer Science and Technology, Harbin University of Science and Technology, Harbin, Heilongjiang, China
| | - Xin Wang
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Rui-Tao Wang
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
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Kimmick G, Sedrak MS, Williams G, McCleary NJ, Rosko AE, Berenberg JL, Freedman RA, Smith ML, Ahmed A, Muss HB, Chow S, Dale W. Infrastructure to Support Accrual of Older Adults to National Cancer Institute Clinical Trials. J Natl Cancer Inst Monogr 2022; 2022:151-158. [PMID: 36519814 PMCID: PMC9753220 DOI: 10.1093/jncimonographs/lgac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/30/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022] Open
Abstract
As part of ongoing efforts to meaningfully improve recruitment, enrollment, and accrual of older adults into cancer clinical trials, the National Cancer Institute (NCI) sponsored a workshop with experts across the country entitled Engaging Older Adults in the NCI Clinical Trials Network: Challenges and Opportunities. Three working groups, including Study Design, Infrastructure, and Stakeholders, were formed, who worked together to offer synergistic improvements in the system. Here, we summarize the workshop discussions of the Infrastructure Working Group, whose goal was to address infrastructural challenges, identify underlying resources, and offer solutions to facilitate accrual of older adults into cancer clinical trials. Based on preconference work and workshop discussions, four key recommendations to strengthen NCI infrastructure were proposed: 1) further centralize resources and expertise; 2) provide training for clinical research staff; (3) develop common data elements; and 4) evaluate what works and does not work. These recommendations provide a strategy to improve the infrastructure to enroll more older adults in cancer clinical trials.
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Affiliation(s)
- Gretchen Kimmick
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center/Duke Cancer Institute, Durham, NC, USA
| | - Mina S Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Grant Williams
- Institute for Cancer Outcomes & Survivorship and Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nadine J McCleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ashley E Rosko
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Jeffrey L Berenberg
- Department of Medicine, Division of Medical Oncology, Hawaii Minority Underserved National Cancer Institute Community Oncology Research Program, Honolulu, HI, USA
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Amina Ahmed
- Department of Obstetrics and Gynecology, Division of Gyn Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Selina Chow
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, USA
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Magnuson A, Van der Walde N, McKoy JM, Wildes TM, Wong ML, Le-Rademacher J, Little RF, Klepin HD. Integrating Geriatric Assessment Measures into National Cancer Institute Clinical Trials. J Natl Cancer Inst Monogr 2022; 2022:142-150. [PMID: 36519816 PMCID: PMC9949568 DOI: 10.1093/jncimonographs/lgac021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 12/23/2022] Open
Abstract
To improve the care of older adults with cancer, the traditional approach to clinical trial design needs to be reconsidered. Older adults are underrepresented in clinical trials with limited or no information on geriatric-specific factors, such as cognition or comorbidities. To address this knowledge gap and increase relevance of therapeutic clinical trial results to the real-life population, integration of aspects relevant to older adults is needed in oncology clinical trials. Geriatric assessment (GA) is a multidimensional tool comprising validated measures assessing specific health domains that are more frequently affected in older adults, including aspects related to physical function, comorbidity, medication use (polypharmacy), cognitive and psychological status, social support, and nutritional status. There are several mechanisms for incorporating either the full GA or specific GA measures into oncology therapeutic clinical trials to contribute to the overarching goal of the trial. Mechanisms include utilizing GA measures to better characterize the trial population, define trial eligibility, allocate treatment receipt within the context of the trial, develop predictive models for treatment outcomes, guide supportive care strategies, personalize care delivery, and assess longitudinal changes in GA domains. The objective of this manuscript is to review how GA measures can contribute to the overall goal of a clinical trial, to provide a framework to guide the selection and integration of GA measures into clinical trial design, and ultimately enable accrual of older adults to clinical trials by facilitating the design of trials tailored to older adults treated in clinical practice.
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Affiliation(s)
- Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA
| | - Noam Van der Walde
- Department of Radiation Oncology, West Cancer Center and Research Institute, University of Tennessee Health Science Center, Germantown, TN, USA
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tanya M Wildes
- Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine, Omaha, NE, USA
| | - Melisa L Wong
- Divisions of Hematology and Oncology and Geriatrics, Department of Internal Medicine, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | | | - Richard F Little
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Heidi D Klepin
- Correspondence to: Heidi D. Klepin, MD, MS, Section on Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA (e-mail: )
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Treatment discontinuation, patient-reported toxicities and quality-of-life by age following trastuzumab emtansine or paclitaxel/trastuzumab (ATEMPT). NPJ Breast Cancer 2022; 8:127. [PMID: 36450763 PMCID: PMC9712612 DOI: 10.1038/s41523-022-00495-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
In the ATEMPT trial, adjuvant trastuzumab emtansine (T-DM1) compared to paclitaxel plus trastuzumab (TH) for stage I HER2-positive breast cancer improved patient-reported outcomes (PROs), while maintaining excellent disease outcomes. We report treatment discontinuation and use multivariable models to compare, patient-reported toxicity and quality-of-life (QOL) by age (≤50, >50) and treatment arm at 18 months post-enrollment among 366 eligible participants randomized in a 3:1 ratio to T-DM1 or TH. T-DM1 discontinuation was higher among women >50 vs. ≤50 (23% vs. 9%, p = 0.003, Fisher's Exact test) with 4%, 8%, and 17% of older patients discontinuing treatment by 3, 6, and 9 months, respectively. Superior QOL with T-DM1 vs. TH was observed among women ≤50 with estimated mean difference of 6.48 (95% confidence interval (CI) 0.51-12.46) and driven by better social/family well-being and breast cancer-specific sub-scores. Among women >50, T-DM1 was associated with superior physical well-being and less activity impairment, with no differences in global QOL. Older women had decreased neuropathy with T-DM1 vs. TH. De-escalated treatment regimens for HER2 positive breast cancer may have age-varying impact on treatment tolerance, toxicities and subsequent QOL, which should be considered when selecting therapy options.Clinical Trial Registration: ClinicalTrials.gov, NCT01853748.
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Adjuvant trastuzumab without chemotherapy for treating early HER2-positive breast cancer in older patients: A propensity score-adjusted analysis of a prospective cohort study. Breast 2022; 66:245-254. [PMID: 36371994 PMCID: PMC9661716 DOI: 10.1016/j.breast.2022.10.017] [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: 09/24/2022] [Revised: 10/26/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To gauge the effects of treatment practices on prognosis for older patients with HER2-positive early breast cancer, particularly to determine whether adjuvant trastuzumab alone can offer benefit over no adjuvant therapy. This is a prospective cohort study which accompanies the RESPECT that is a randomized-controlled trial (RCT). METHODS Patients who declined the RCT were treated based on the physician's discretion. We studied the 1) trastuzumab-plus-chemotherapy group, 2) trastuzumab-monotherapy group, and 3) non-trastuzumab group (no therapy or anticancer therapy without trastuzumab). The primary endpoint was disease-free survival (DFS), which was compared using the propensity-score method. Relapse-free survival (RFS) and health-related quality of life (HRQoL) were assessed. RESULTS We enrolled 123 patients aged over 70 years (median: 74.5). Treatment categories were: trastuzumab-plus-chemotherapy group (n = 36, 30%), trastuzumab-monotherapy group (n = 52, 43%), and non-trastuzumab group (n = 32, 27%). The 3-year DFS was 96.7% in trastuzumab-plus-chemotherapy group, 89.2% in trastuzumab-monotherapy group, and 82.5% in non-trastuzumab group. DFS in non-trastuzumab group was lower than in trastuzumab-plus-chemotherapy and trastuzumab-monotherapy groups (propensity-adjusted hazard ratio; HR: 3.29; 95% CI: 1.15-9.39; P = 0.026). The RFS in non-trastuzumab group was lower than in trastuzumab-plus-chemotherapy and trastuzumab-monotherapy groups (propensity-adjusted HR = 7.80; 95% CI: 2.32-26.2, P < 0.0001). There were no significant intergroup differences in the proportions of patients showing HRQoL deterioration at 36 months (P = 0.717). CONCLUSION Trastuzumab-treated patients had better prognoses than patients not treated with trastuzumab without deterioration of HRQoL. Trastuzumab monotherapy could be considered for older patients who reject chemotherapy.
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Pichardo D, Michael R, Mercer M, Korina N, Onukwugha E. Utility of a Clinically Guided Data-Driven Approach for Predicting Breast Cancer Complications: An Application Using a Population-Based Claims Data Set. JCO Clin Cancer Inform 2022; 6:e2100191. [PMID: 36417684 DOI: 10.1200/cci.21.00191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE With earlier detection and an increasing number of breast cancer (BCa) survivors, more women are living with side effects of BCa treatment. A predictive approach to studying treatment-related adverse events (AEs) may generate proactive strategies; however, many studies are descriptive in nature. Focusing on short-term AEs, we determine the performance of prediction models of disease- or treatment-related AEs among women diagnosed with BCa. METHODS We used administrative claims data from the Blue Health Intelligence National Data Repository. The study sample included female individuals age 18 years and older who were diagnosed with BCa and received cancer-directed treatment between January 1, 2014, and August 1, 2019. Using the information available in the claims data, we constructed longitudinal patient histories and identified disease- and treatment-related AEs occurring within 6 months of treatment. The following prediction models were developed: logistic regression, Lasso regression, gradient boosted tree (GBT), and random forest (RF). We compared models using the area under the receiver operating characteristic curve and its CI, among other metrics. RESULTS Data were extracted for 267,473 members meeting study inclusion criteria. The area under the curve for the logistic regression model was 0.82 (0.82-0.86), compared with 0.89 (0.87-0.90) for the Lasso, 0.91 (0.89-0.93) for the GBT, and 0.90 (0.93-0.89) for the RF models. The sensitivity was 0.96 for the GBT, Lasso, and RF models, whereas the specificity was 0.42, 0.44, and 0.39 for the GBT, Lasso, and RF models, respectively. Positive predictive values were 0.96 across all three models. CONCLUSION Prediction models developed using big data methods and grounded in a clinically guided framework have the potential to reliably predict short-term treatment-related AEs among women diagnosed with BCa.
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Affiliation(s)
| | | | | | | | - Eberechukwu Onukwugha
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD
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澤木 正. [Management of systemic therapy in older adults with cancer]. Nihon Ronen Igakkai Zasshi 2022; 59:472-477. [PMID: 36476694 DOI: 10.3143/geriatrics.59.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Brown L, Naffouje SA, Sam C, Laronga C, Catherine Lee M. Neoadjuvant systemic therapy in geriatric breast cancer patients: a National Cancer Database (NCDB) analysis. Breast Cancer Res Treat 2022; 196:441-451. [PMID: 36207620 DOI: 10.1007/s10549-022-06751-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Neoadjuvant systemic therapy (NAST) can be an effective treatment option for patients with HER2 + or triple negative breast cancer (TNBC). However, its use in geriatric patients is largely understudied. Our aim is to investigate the effect of NAST in both septuagenarians and octogenarians with HER2 + or TNBC to better understand its role in the geriatric patient population. METHODS We utilized the National Cancer Database (NCDB) to analyze female patients with HER2 + or TNBC between 70 and 89 years. We compared the baseline demographic and clinical characteristics of septuagenarians and octogenarians using mixed-effect modeling for continuous variables and conditional logistic regressions for categorical variables. Overall survival (OS) between several subgroups was compared based on a propensity score model. Kaplan-Meier method was used to calculate OS between the subgroups, and log-rank test was used to compare OS results. RESULTS A total of 16,443 patients met inclusion/exclusion criteria, of which 92.9% had infiltrative ductal carcinoma and 73.5% were TNBC. Most patients received NAST as a first course of therapy (58.8%). Septuagenarians were more likely to receive NAST (65.9%), whereas octogenarians were more likely to receive upfront surgical resection (67.7%). Our analysis demonstrated OS benefit with NAST among patients who received surgical resection. However, in patients who received NAST, decline during therapy was associated with a significantly poorer OS outcomes in general. CONCLUSION When combined with surgical resection, NAST is an effective treatment option in both septuagenarians and octogenarians. Nonetheless, careful selection of NAST recipients in this population remains critical to optimize patient outcome.
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Affiliation(s)
- Lauren Brown
- USF Health Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Samer A Naffouje
- Department of Surgical Oncology, Moffitt Cancer Center, 12902 N. McKinley Drive, Tampa, FL, 33612, USA
| | - Christine Sam
- Senior Adult Oncology Program, Moffitt Cancer Center, 12902 N. McKinley Drive, Tampa, FL, 33612, USA
| | - Christine Laronga
- Comprehensive Breast Program, Moffitt Cancer Center, 12902 N. McKinley Drive, Tampa, FL, 33612, USA
| | - M Catherine Lee
- Comprehensive Breast Program, Moffitt Cancer Center, 12902 N. McKinley Drive, Tampa, FL, 33612, USA.
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Huang X, Shi Z, Mai J, Liu C, Liu C, Chen S, Lu H, Li Y, He B, Li J, Cun H, Han C, Chen X, Liang C, Liu Z. An MRI-based Scoring System for Preoperative Prediction of Axillary Response to Neoadjuvant Chemotherapy in Node-Positive Breast Cancer: A Multicenter Retrospective Study. Acad Radiol 2022:S1076-6332(22)00513-X. [DOI: 10.1016/j.acra.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/17/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022]
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Diefenhardt M, Martin D, Ludmir EB, Fleischmann M, Hofheinz RD, Ghadimi M, Kosmala R, Polat B, Friede T, Minsky BD, Rödel C, Fokas E. Development and Validation of a Predictive Model for Toxicity of Neoadjuvant Chemoradiotherapy in Rectal Cancer in the CAO/ARO/AIO-04 Phase III Trial. Cancers (Basel) 2022; 14:cancers14184425. [PMID: 36139585 PMCID: PMC9497244 DOI: 10.3390/cancers14184425] [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: 08/03/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background: There is a lack of predictive models to identify patients at risk of high neoadjuvant chemoradiotherapy (CRT)-related acute toxicity in rectal cancer. Patient and Methods: The CAO/ARO/AIO-04 trial was divided into a development (n = 831) and a validation (n = 405) cohort. Using a best subset selection approach, predictive models for grade 3−4 acute toxicity were calculated including clinicopathologic characteristics, pretreatment blood parameters, and baseline results of quality-of-life questionnaires and evaluated using the area under the ROC curve. The final model was internally and externally validated. Results: In the development cohort, 155 patients developed grade 3−4 toxicities due to CRT. In the final evaluation, 15 parameters were included in the logistic regression models using best-subset selection. BMI, gender, and emotional functioning remained significant for predicting toxicity, with a discrimination ability adjusted for overfitting of AUC 0.687. The odds of experiencing high-grade toxicity were 3.8 times higher in the intermediate and 6.4 times higher in the high-risk group (p < 0.001). Rates of toxicity (p = 0.001) and low treatment adherence (p = 0.007) remained significantly different in the validation cohort, whereas discrimination ability was not significantly worse (DeLong test 0.09). Conclusion: We developed and validated a predictive model for toxicity using gender, BMI, and emotional functioning. Such a model could help identify patients at risk for treatment-related high-grade toxicity to assist in treatment guidance and patient participation in shared decision making.
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Affiliation(s)
- Markus Diefenhardt
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt, Germany
- Frankfurt Cancer Institute, 60596 Frankfurt, Germany
- Correspondence: ; Tel.: +49-(0)69-63015130; Fax: +49-(0)69-63015091
| | - Daniel Martin
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt, Germany
- German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site, Frankfurt, 69120 Heidelberg, Germany
| | - Ethan B. Ludmir
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
| | - Maximilian Fleischmann
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt, Germany
| | - Ralf-Dieter Hofheinz
- Department of Medical Oncology, University Hospital Mannheim, 68167 Mannheim, Germany
| | - Michael Ghadimi
- Department of General and Visceral Surgery, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Rebekka Kosmala
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Bruce D. Minsky
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt, Germany
- Frankfurt Cancer Institute, 60596 Frankfurt, Germany
- German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site, Frankfurt, 69120 Heidelberg, Germany
| | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt, Germany
- Frankfurt Cancer Institute, 60596 Frankfurt, Germany
- German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site, Frankfurt, 69120 Heidelberg, Germany
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Clifton K, Gao F, Jabbari J, Van Aman M, Dulle P, Hanson J, Wildes TM. Loneliness, social isolation, and social support in older adults with active cancer during the COVID-19 pandemic. J Geriatr Oncol 2022; 13:1122-1131. [PMID: 36041993 PMCID: PMC9385725 DOI: 10.1016/j.jgo.2022.08.003] [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: 01/22/2022] [Revised: 06/09/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Abstract
Introduction The COVID-19 pandemic has had a considerable impact on mental health. The social distancing and stay-at-home orders have likely also impacted loneliness, social isolation, and social support. Older adults, particularly those with comorbidities such as cancer, have a greater potential to be impacted. Here we assessed loneliness, social isolation, and social support in older adults undergoing active cancer treatment during the pandemic. Materials and methods A mixed methods study in which quantitative data and qualitative response items were collected in parallel was conducted in 100 older adults with cancer. Participants completed a survey by telephone with a series of validated questionnaires to assess the domains of loneliness, social isolation, and social support as well as several open-ended questions. Baseline demographics and geriatric assessments were summarized using descriptive statistics. Bivariate associations between social isolation and loneliness and social support and loneliness were described using Spearman correlation coefficients. Conventional content analysis was performed on the open-ended questions. Results In a population of older adults with cancer, 3% were noted to be severely lonely, although 27% percent screened positive as having at least one indicator of loneliness by the University of California, Los Angeles (UCLA) Three Item Loneliness Scale. There was a significant positive correlation between loneliness and social isolation (r = +0.52, p < 0.05) as well as significant negative correlation between loneliness and social support (r = −0.49, p < 0.05). There was also a significant negative correlation between loneliness and emotional support (r = −0.43, p < 0.05). There was no significant association between loneliness and markers of geriatric impairments, including comorbidities, G8 score or cognition. Discussion Reassuringly, in this cohort we found relatively low rates of loneliness and social isolation and high rates of social support. Consistent with prior studies, loneliness, social isolation, and social support were found to be interrelated domains; however, they were not significantly associated with markers of geriatric impairments. Future studies are needed to study if cancer diagnosis and treatment may mediate changes in loneliness, social isolation, and social support in the context of the pandemic as well as beyond.
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Affiliation(s)
- Katherine Clifton
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America.
| | - Feng Gao
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - JoAnn Jabbari
- Goldfarb School of Nursing at Barnes-Jewish College, Saint Louis, MO, United States of America
| | - Mary Van Aman
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - Patricia Dulle
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - Janice Hanson
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - Tanya M Wildes
- Division of Hematology/Oncology, University of Nebraska Medical Center/Nebraska Medicine, Omaha NE, United States of America
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Munir A, Huws A, Khan S, Sharaiha Y, Holt S, Khawaja S. Geriatric assessment tool application in treatment recommendations for older women with breast cancer. Breast 2022; 63:101-107. [PMID: 35366503 PMCID: PMC8972005 DOI: 10.1016/j.breast.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Asma Munir
- Department of Breast Surgery, Prince Philip Hospital, Llanelli, UK.
| | - Anita Huws
- Department of Breast Surgery, Prince Philip Hospital, Llanelli, UK
| | - Sohail Khan
- Department of Breast Surgery, Prince Philip Hospital, Llanelli, UK
| | - Yousef Sharaiha
- Department of Breast Surgery, Prince Philip Hospital, Llanelli, UK
| | - Simon Holt
- Department of Breast Surgery, Prince Philip Hospital, Llanelli, UK
| | - Saira Khawaja
- Department of Breast Surgery, Prince Philip Hospital, Llanelli, UK
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Expert consensus to optimize the treatment of elderly patients with luminal metastatic breast cancer. Clin Transl Oncol 2022; 24:1033-1046. [PMID: 35103908 PMCID: PMC9107453 DOI: 10.1007/s12094-021-02766-8] [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: 10/18/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022]
Abstract
Most patients diagnosed with luminal metastatic breast cancer (MBC) who are seen in oncology consultations are elderly. MBC in elderly patients is characterized by a higher percentage of hormone receptor (HR) expression and a lower expression of human epidermal growth factor receptor 2 (HER2). The decision regarding which treatment to administer to these patients is complex due to the lack of solid evidence to support the decision-making process. The objective of this paper is to review the scientific evidence on the treatment of elderly patients with luminal MBC. For this purpose, the Oncogeriatrics Section of the Spanish Society of Medical Oncology (SEOM), the Spanish Breast Cancer Research Group (GEICAM) and the SOLTI Group appointed a group of experts who have worked together to establish consensus recommendations to optimize the treatment of this population. It was concluded that the chronological age of the patient alone should not guide therapeutic decisions and that a Comprehensive Geriatric Assessment (CGA) should be performed whenever possible before establishing treatment. Treatment selection for the elderly population should consider the patient’s baseline status, the expected benefit and toxicity of each treatment, and the impact of treatment toxicity on the patient’s quality of life and functionality.
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Dale W. Why Is Geriatric Assessment so Infrequently Used in Oncology Practices? The Ongoing Issue of Nonadherence to This Standard of Care for Older Adults With Cancer. JCO Oncol Pract 2022; 18:475-477. [PMID: 35544722 DOI: 10.1200/op.22.00197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- William Dale
- City of Hope National Medical Center, Duarte, CA
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Battisti NML, Arora SP. An overview of chemotherapy toxicity prediction tools in older adults with cancer: A young international society of geriatric oncology and nursing and allied health initiative. J Geriatr Oncol 2022; 13:521-525. [PMID: 34922885 PMCID: PMC11152042 DOI: 10.1016/j.jgo.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 11/11/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Nicolò Matteo Luca Battisti
- Department of Medicine - Breast Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom; Breast Cancer Research Division, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London SM2 5NG, United Kingdom.
| | - Sukeshi Patel Arora
- Division of Hematology/Oncology, Department of Medicine, Mays Cancer Center, University of Texas Health San Antonio, 7979 Wurzbach Rd., MC 8232, San Antonio, TX 78229, USA.
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Vargas A, Holub K, Biete A. Systemic inflammation in older patients with breast cancer: the missing point in geriatric evaluations to sharpen survival prediction. Clin Transl Oncol 2022; 24:1800-1808. [PMID: 35474170 DOI: 10.1007/s12094-022-02836-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast cancer (BC) prevalence steadily increases in older patients but their treatment is based on the geriatric evaluations of comorbidities and potential benefits proved in clinical trials with younger patients. The lack of better decision-making tools urges to promote the search for new prognostic markers. The association between inflammation, aging and cancer may be crucial for better treatment selection. We sought to analyze its impact on the survival of older BC patients, evaluating the interaction with age and comorbidities. METHODS We evaluated the relationship between inflammatory biomarkers at BC diagnosis (circulating blood cell counts and inflammatory indexes) and BC-related and not related mortality rate, evaluating the influence of comorbidities and age through the competitive risks assessment. RESULTS We analyzed 148 consecutive BC patients aged ≥ 70 years old, diagnosed with BC and regional lymph node metastases. After the median follow-up of 51.5 months, 59 patients died (28 due to breast cancer progression and 31 because of other causes). Increased levels of circulating monocytes, neutrophils and neutrophil-to-lymphocytes ratio and decreased level of eosinophils and eosinophil multiple by neutrophils-to-lymphocytes ratio were associated with higher probability of BC-related death but not with death related to other causes. CONCLUSION Our data suggest a role of inflammatory parameters as a possible prognostic tool in therapeutic decision-making process in older patients with BC, as increased level of inflammation was associated with cancer-specific mortality. Prospective studies may give the possibility of refining the geriatric evaluation for BC treatment in elderly.
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Affiliation(s)
- Andrés Vargas
- Radiation Oncology Department, Instituto de Radiomedicina (IRAM), Avenida Américo Vespucio 1314, Vitacura, 7630000, Santiago de Chile, Chile.
- Facultad de Medicina, Universidad Diego Portales, Santiago, Chile.
| | - Katarzyna Holub
- Facultat de Medicina, Universitat de Barcelona, C/Casanova 143, 08036, Barcelona, Spain
| | - Albert Biete
- Facultat de Medicina, Universitat de Barcelona, C/Casanova 143, 08036, Barcelona, Spain
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Sawaki M, Shimomura A, Shien T, Iwata H. Management of breast cancer in older patients. Jpn J Clin Oncol 2022; 52:682-689. [DOI: 10.1093/jjco/hyac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/28/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Japanese women have the highest life expectancy in the world and breast cancer is the most prevalent cancer among them. However, little data are available to support the evidence-based clinical management due to the fact that older adults are commonly excluded from most clinical trials. In Japan the rate of other cause of death in older patient was about a half, then we should consider whether or not breast cancer may affect the patient’s life expectancy to avoid either overtreatment or undertreatment. Although management principles in older patients may be similar with those of younger age, these differences would be caused by relatively short life expectancy, some comorbidity, drug interactions and low functional status. Then, their treatment needs to be individualized. To this end, employing a comprehensive geriatric assessment may be advantageous, which enables to evaluate patient vulnerability from several different aspects, to predict adverse events of chemotherapy and to identify geriatric problems in advance so that extra support and modified treatment can be provided. Before treatment we should assess the patient’s goals and values regarding the management of the cancer, especially on balancing survival benefit with immediate quality of life impairment due to anti-cancer therapy. In Japan Clinical Oncology Group (JCOG) , a randomized controlled trial for older patients with advanced stage HER2-positive breast cancer is ongoing as an inferiority design including geriatric assessment (JCOG1607, HARB TEA study). Best practice, current management and how to approach decision making in older patients with breast cancer are summarized.
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Affiliation(s)
- Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akihiko Shimomura
- Department of Breast and Medical Oncology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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Lemij AA, de Glas NA, Derks MGM, Bastiaannet E, Merkus JWS, Lans TE, van der Pol CC, van Dalen T, Vulink AJE, van Gerven L, Guicherit OR, Linthorst-Niers EMH, van den Bos F, Kroep JR, Liefers GJ, Portielje JEA. Discontinuation of adjuvant endocrine therapy and impact on quality of life and functional status in older patients with breast cancer. Breast Cancer Res Treat 2022; 193:567-577. [PMID: 35441273 PMCID: PMC9114046 DOI: 10.1007/s10549-022-06583-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/27/2022] [Indexed: 11/25/2022]
Abstract
Purpose Side effects are the main reason for discontinuation of adjuvant endocrine therapy in older adults. The aim of this study was to examine geriatric predictors of treatment discontinuation of adjuvant endocrine therapy within the first 2 years after initiation, and to study the association between early discontinuation and functional status and quality of life (QoL). Methods Patients aged ≥ 70 years with stage I–III breast cancer who received adjuvant endocrine therapy were included. The primary endpoint was discontinuation of endocrine therapy within 2 years. Risk factors for discontinuation were assessed using univariate logistic regression models. Linear mixed models were used to assess QoL and functional status over time. Results Overall, 258 patients were included, of whom 36% discontinued therapy within 2 years after initiation. No geriatric predictive factors for treatment discontinuation were found. Tumour stage was inversely associated with early discontinuation. Patients who discontinued had a worse breast cancer-specific QoL (b = − 4.37; 95% CI − 7.96 to − 0.78; p = 0.017) over the first 2 years, in particular on the future perspective subscale (b = − 11.10; 95% CI − 18.80 to − 3.40; p = 0.005), which did not recover after discontinuation. Treatment discontinuation was not associated with functional improvement. Conclusion A large proportion of older patients discontinue adjuvant endocrine treatment within 2 years after initiation, but geriatric characteristics are not predictive of early discontinuation of treatment. Discontinuation of adjuvant endocrine therapy did not positively affect QoL and functional status, which implies that the observed poorer QoL in this group is probably not caused by adverse effects of endocrine therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06583-7.
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Affiliation(s)
- Annelieke A Lemij
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Nienke A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marloes G M Derks
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos W S Merkus
- Department of Surgery, Haga Hospital, The Hague, The Netherlands
| | - Titia E Lans
- Department of Surgery, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | | | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - Annelie J E Vulink
- Department of Medical Oncology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Leander van Gerven
- Department of Internal Medicine, LangeLand Hospital, Zoetermeer, The Netherlands
| | - Onno R Guicherit
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - Frederiek van den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerrit Jan Liefers
- Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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VanderWalde N, Movsas B. Introduction: Personalization of Cancer Care for Older Adults. Semin Radiat Oncol 2022; 32:95-97. [DOI: 10.1016/j.semradonc.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Cancer is predominantly a disease of aging, and older adults represent the majority of cancer diagnoses and deaths. Older adults with cancer differ significantly from younger patients, leading to important distinctions in cancer treatment planning and decision-making. As a consequence, the field of geriatric oncology has blossomed and evolved over recent decades, as the need to bring personalized cancer care to older adults has been increasingly recognized and a focus of study. The geriatric assessment (GA) has become the cornerstone of geriatric oncology research, and the past year has yielded promising results regarding the implementation of GA into routine cancer treatment decisions and outcomes for older adults. In this article, we provide an overview of the field of geriatric oncology and highlight recent breakthroughs with the use of GA in cancer care. Further work is needed to continue to provide personalized, evidence-based care for each older adult with cancer.
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Chen M, Said NM, Rais NCM, Ho F, Ling N, Chun M, Ng YS, Eng WN, Yao Y, Korc-Grodzicki B, Pang A. Remaining agile in the COVID-19 pandemic healthcare landscape – How we adopted a hybrid telemedicine geriatric oncology care model in an academic tertiary cancer center. J Geriatr Oncol 2022; 13:856-861. [PMID: 35461791 PMCID: PMC9005364 DOI: 10.1016/j.jgo.2022.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/21/2022] [Accepted: 04/07/2022] [Indexed: 11/18/2022]
Abstract
Introduction The COVID-19 pandemic has impacted healthcare on an unprecedented scale, with healthcare resources being channeled into managing the devastating effects of the outbreak. Healthcare provision for vulnerable older adults has also been affected by lockdowns and suspension of selected medical services worldwide. In our tertiary cancer center, the National University Cancer Institute, Singapore (NCIS), our Geriatric Oncology (GO) service for older adults with cancer was halted for five months. In this paper, we describe the adoption of a hybrid telemedicine model by our GO service to continue care provision for older adults in the midst of the pandemic. Materials and Methods Comprehensive geriatric assessments (CGA) were done via telemedicine and virtual multidisciplinary discussions were held prior to the patients' clinic visits. A hybrid telemedicine consultation allowed geriatricians and oncologists, segregated in different sites during the pandemic, to provide a hybrid physical and video geriatric oncology consultation. Scheduled phone follow ups by GO nurses helped to monitor patients for treatment-related toxicities and geriatric syndromes. Results Two hundred fifty patients were enrolled in the program from July 2020 to August 2021. All were assessed with a CGA, with 240 receiving interventions in the one-stop clinic. The average amount of time spent per visit was shortened from four hours to two and a half hours with an average of three interventions on the same day, versus one previously. Of the patients who received interventions, 84.8% were satisfied with the hybrid telemedicine model and 80.8% of them had reported a maintained or improved quality of life after being enrolled in the program. Discussion Telemedicine has been widely adopted during the pandemic, but older adults with limited digital literacy may find it a challenge. Our hybrid telemedicine model has allowed us to continue to provide cancer care, identify issues brought about by social isolation, and render timely assistance. It has become imperative to adapt, prepare and plan for the challenges we may face amid the ongoing COVID-19 pandemic and similar future outbreaks. Only by doing so can we remain agile and resilient, to continue providing quality care to our older patients with cancer.
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Nanomedicine-Based Delivery Strategies for Breast Cancer Treatment and Management. Int J Mol Sci 2022; 23:ijms23052856. [PMID: 35269998 PMCID: PMC8911433 DOI: 10.3390/ijms23052856] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 12/12/2022] Open
Abstract
Breast cancer is one of the most common types of cancer among women globally. It is caused by mutations in the estrogen/progesterone receptors and conventional treatment methods are commonly utilized. About 70–80 percent of individuals with the early-stage non-metastatic disease may be cured. Conventional treatment is far less than the optimal ratio, as demonstrated through the high mortality rate of women with this cancer. However, conventional treatment methods like surgery, radiotherapy, and chemotherapy are not as effective as expected and lead to concerns about low bioavailability, low cellular uptake, emerging resistance, and adverse toxicities. A nanomedicine-based approach is a promising alternative for breast cancer treatment. The present era is witnessing rapid advancements in nanomedicine as a platform for investigating novel therapeutic applications and modern intelligent healthcare management strategies. This paper focuses on nanomedicine-based therapeutic interventions that are becoming more widely accepted for improving treatment effectiveness and reducing undesired side effects in breast cancer patients. By evaluating the state-of-the-art tools and taking the challenges involved into consideration, various aspects of the proposed nano-enabled therapeutic approaches have been discussed in this review.
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