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Tonorezos E, Devasia T, Mariotto AB, Mollica MA, Gallicchio L, Green P, Doose M, Brick R, Streck B, Reed C, de Moor JS. Prevalence of cancer survivors in the United States. J Natl Cancer Inst 2024; 116:1784-1790. [PMID: 39002121 PMCID: PMC11542986 DOI: 10.1093/jnci/djae135] [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: 02/12/2024] [Revised: 04/22/2024] [Accepted: 06/07/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND With aging of the population and improvements in diagnosis, treatment, and supportive care, the number of cancer survivors in the United States has increased; updated prevalence estimates are needed. METHODS Cancer prevalence on January 1, 2022, was estimated using the Prevalence Incidence Approach Model, utilizing incidence, survival, and mortality. Prevalence by age decade, sex, and time from diagnosis was calculated. The percentage of cancer survivors in the projected US population by age and sex was calculated as the ratio of the sex-specific projected prevalence to the sex-specific projected US population. RESULTS There were an estimated 18.1 million US cancer survivors as of January 1, 2022. From 2022 to 2030, the number of US cancer survivors is projected to increase to 21.6 million; by 2040, the number is projected to be 26 million. Long-term survivors are highly prevalent; in 2022, 70% of cancer survivors had lived 5 years or more after diagnosis, and 11% of cancer survivors had lived 25 years or more after diagnosis. Among all US females aged 40-54 years, 3.6% were cancer survivors; among females aged 65-74 years, 14.5% were cancer survivors; among females aged 85 years and older, 36.4% were cancer survivors. Among all US males aged 40-54 years, 2.1% were cancer survivors; among males aged 65-74 years, 16% were cancer survivors; and among those aged 85 years and older, 48.3% were cancer survivors. CONCLUSIONS Cancer survivors are growing in number. In the United States, most cancer survivors are long-term and very long-term survivors, representing a substantial proportion of the US population.
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Affiliation(s)
- Emily Tonorezos
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Theresa Devasia
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michelle A Mollica
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Lisa Gallicchio
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Paige Green
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michelle Doose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Rachelle Brick
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Brennan Streck
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - Crystal Reed
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Peng H, Wang M, Lu S, Liu J, Zhang Y, Fu Z, Li C, Huang Y, Guo J, Xu Z, Yang N. Enhanced recovery after surgery for percutaneous CT-guided microwave ablation of lung tumors: A single-center retrospective cohort study. J Cancer Res Ther 2024; 20:651-657. [PMID: 38687936 DOI: 10.4103/jcrt.jcrt_2017_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/24/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The feasibility and safety of enhanced recovery after surgery (ERAS) for percutaneous computed tomography (CT)-guided microwave ablation (MWA) for treating lung nodules remain unclear. METHODS AND MATERIALS A total of 409 patients with lung tumors treated at the Department of Thoracic Surgery, First Affiliated Hospital of Guangxi Medical University from August 2020 to May 2023 were enrolled. Perioperative data, including baseline characteristics, operation time, postoperative pain score (visual analog scale [VAS]), hospitalization expenses, postoperative complications, total hospital stay, and patient satisfaction, were observed and recorded. RESULTS No perioperative mortality occurred in either group and complete ablation was achieved in all patients. Patients in the ERAS group had significantly shorter hospital stays (P < 0.001), reduced operation times (P = 0.047), lower hospitalization expenses (P < 0.001), lower VAS scores (P < 0.001), and fewer complications (P = 0.047) compared with the traditional group. CONCLUSIONS ERAS for percutaneous CT-guided MWA (ERAA) is safe, effective, and feasible for the treatment of lung nodules.
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Affiliation(s)
- Huajian Peng
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
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Winer A, Dotan E. Treatment Paradigms for Older Adults with Pancreatic Cancer: a Nuanced Approach. Curr Treat Options Oncol 2021; 22:104. [PMID: 34596801 DOI: 10.1007/s11864-021-00892-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 02/08/2023]
Abstract
Pancreatic cancer is increasing in incidence in the USA. This disease disproportionately affects older adults, and as the percentage of adults > 65 years old increases with the aging of the baby boomers, the prevalence is expected to rise over the coming decade. These patients are often more susceptible to disease-related symptoms and have less ability to withstand both cancer and treatment-related side effects. Therefore, it is imperative that treating physicians thoughtfully consider their recommended treatment approach towards this vulnerable patient population. This review focuses on the current state of research of older adults with pancreatic adenocarcinoma, highlighting deficiencies in the representation of this patient population in clinical trials. It is vital that the treating physicians take a nuanced approach towards therapy of localized and metastatic disease in geriatric patients. A one size fits all treatment algorithm is no longer appropriate in any cancer patient, let alone the elders who are particularly vulnerable to developing treatment-related toxicities. To help guide therapy decisions, it is important to perform a comprehensive geriatric assessment which may uncover unexpected frailty and lead to a change in the recommended treatment approach. In this way, we can support older adults during therapy for this aggressive malignancy and provide optimal care.
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Affiliation(s)
- Arthur Winer
- Department of Medical Oncology, Inova Schar Cancer Institute, 8081 Innovation Park Drive, Fairfax, VA, 22031, USA.
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer, Philadelphia, PA, USA
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Lichtman SM, Cohen HJ, Muss H, Tew WP, Korc-Grodzicki B. From Assessment to Implementation and Beyond in Cancer and Aging Research. J Clin Oncol 2021; 39:2217-2225. [PMID: 34043443 PMCID: PMC8260919 DOI: 10.1200/jco.21.00317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Hyman Muss
- Department of Medicine and UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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5
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Dale W, Jacobsen PB, Mohile SG. Geriatric Oncology Comes of Age: Advancing the Science of Caring for Older Adults With Cancer. J Clin Oncol 2021; 39:2055-2057. [PMID: 34043451 DOI: 10.1200/jco.21.00887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- William Dale
- City of Hope National Medical Center, Duarte, CA
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Perioperative Geriatric Assessment as A Predictor of Long-Term Hepatectomy Outcomes in Elderly Patients with Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:cancers13040842. [PMID: 33671388 PMCID: PMC7922697 DOI: 10.3390/cancers13040842] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 02/06/2023] Open
Abstract
This retrospective study recorded pertinent baseline geriatric assessment variables to identify risk factors for recurrence-free survival (RFS) and overall survival (OS) after hepatectomy in 100 consecutive patients aged ≥70 years with hepatocellular carcinoma. Patients had geriatric assessments of cognition, nutritional and functional statuses, and comorbidity burden, both preoperatively and at six months postoperatively. The rate of change in each score between preoperative and postoperative assessments was calculated by subtracting the preoperative score from the score at six months postoperatively, then dividing by the score at six months postoperatively. Patients with score change ≥0 comprised the maintenance group, while patients with score change <0 comprised the reduction group. The change in Geriatric 8 (G8) score at six months postoperatively was the most significant predictive factor for RFS and OS among the tested geriatric assessments. Five-year RFS rates were 43.4% vs. 6.7% (maintenance vs. reduction group; HR, 0.19; 95%CI, 0.11-0.31; p < 0.001). Five-year OS rates were 73.8% vs. 17.8% (HR, 0.12; 95%CI, 0.06-0.25; p < 0.001). Multivariate Cox proportional hazards analysis showed that perioperative maintenance of G8 score was an independent prognostic indicator for both RFS and OS. Perioperative changes in G8 scores can help forecast postoperative long-term outcomes in these patients.
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7
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Pitchumoni CS. Colorectal Cancer. GERIATRIC GASTROENTEROLOGY 2021:1963-1989. [DOI: 10.1007/978-3-030-30192-7_80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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8
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Prevalence and predictors of depressive symptoms in older adults with cancer. J Geriatr Oncol 2020; 12:618-622. [PMID: 33357974 DOI: 10.1016/j.jgo.2020.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 10/29/2020] [Accepted: 12/11/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Older adults with cancer are at risk of developing depressive symptoms. However, little is known about the prevalence and predictors of depressive symptoms in older adults with cancer. MATERIALS AND METHODS This study examined the prevalence and predictors of depressive symptoms among older adults with cancer in the United States using the data from the 2012 and 2014 wave of the Health and Retirement Study. This analysis included 1799 older adults aged 65 and over with a self-reported diagnosis of cancer. Multivariate regression analysis was used to examine the predictors of depressive symptoms. The main predictors included age, gender, race, education, marital status, chronic conditions, and functional limitations. RESULTS Results revealed that the prevalence of depressive symptoms in older adults with cancer was 14.9%. Results of Poisson regression revealed that greater age, belonging to a race other than White or African American, not being married, presence of more chronic conditions, and higher levels of functional limitations were associated with higher levels of depressive symptoms. DISCUSSION The prevalence of depressive symptoms is high in older adults with cancer and several factors predict depressive symptoms in this population. Individuals who are at high risk of developing depressive symptoms should be identified and appropriate timely interventions should be initiated to reduce the rates of depressive symptoms in older adults with cancer.
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Bagayogo F, Le Berre M, Ruchon C, Denis JL, Lamothe L, Vedel I, Lapointe L. Caring for older cancer patients: A scoping review. Health Policy 2020; 124:1008-1016. [PMID: 32532568 DOI: 10.1016/j.healthpol.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 08/08/2019] [Accepted: 05/07/2020] [Indexed: 02/07/2023]
Abstract
There is a growing recognition among oncologists that older patients differ from other cancer patients. Older patients present age-specific issues affecting the prevention and management of their cancer. Over the years, this has led to the development of the discipline of geriatric oncology, which is the set of practices elaborated to evaluate, treat, follow-up and rehabilitate the population of older cancer patients. Geriatric oncology is still struggling to establish itself in healthcare settings managing older cancer patients. Efforts are currently being made to make it a recognized medical specialty. Health policy makers have to have a grasp of the evolution of this discipline because it concerns a fast growing segment of the cancer patient population. To shed light on the literature about this field, we undertook a scoping review in which we identified relevant studies; charted the data from the selected studies, collated, summarized and reported the results. From 2043 references initially identified, we included 92 articles in our scoping review and extracted data from 88 articles. The included articles were classified into three major categories, namely Advancing the discipline, Organization of care and Nursing and support services for patient and their caregivers. This review affords researchers and policy makers a foundation to help conduct many other conversations on each theme and sub-theme.
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Affiliation(s)
- Fatou Bagayogo
- York University School of Health Policy and Management, Canada.
| | - Mélanie Le Berre
- Lady Davis Institute of the Jewish General Hospital, 5858 Côte-des-Neiges road 3rd floor, H3S 1Z1, Montreal, Québec, Canada
| | - Christian Ruchon
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges road, 3rd floor, H3S 1Z1, Montreal, Québec, Canada
| | - Jean-Louis Denis
- School of Public Health, Université de Montréal (ESPUM), 7101 Parc Avenue, 3rd floor, offices 3014-8, H3N 1X9, Montreal, Québec, Canada; Research Center of the CHUM (CRCHUM), 900 Saint-Denis street, H2X 0A9, Montreal, Québec, Canada
| | - Lise Lamothe
- School of Public Health, Université de Montréal (ESPUM), 7101 Parc Avenue, 3rd floor, offices 3014-8, H3N 1X9, Montreal, Québec, Canada
| | - Isabelle Vedel
- Lady Davis Institute of the Jewish General Hospital, 5858 Côte-des-Neiges road 3rd floor, H3S 1Z1, Montreal, Québec, Canada; Department of Family Medicine, McGill University, 5858 Côte-des-Neiges road, 3rd floor, H3S 1Z1, Montreal, Québec, Canada
| | - Liette Lapointe
- Desautels Faculty of Management, McGill University, 1001 Sherbrooke Street West, Montreal, Quebec, H3A 1G5, Canada
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Fang CW, Chen CH, Muo CH, Wu SC. Risk of subsequent prostate cancer in peptic ulcer patients who received helicobacter pylori eradication therapy: an Asian population-based cohort study. BMC Urol 2020; 20:135. [PMID: 32867754 PMCID: PMC7461329 DOI: 10.1186/s12894-020-00706-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022] Open
Abstract
Background Studies have shown diverse results regarding the association between H. pylori (HP) infection and the risk of malignancy. There is accumulating evidence relating HP infection to urological diseases. We investigated whether there was an association between HP-infected peptic ulcers and the subsequent risk of prostate cancer. Methods We collected HP-infected male patients from 1998 to 2008 from the Longitudinal Health Insurance Database (LHID). HP-infected patients were identified as those who had a diagnosis of peptic ulcers upon admission and received HP eradication therapy within 1 year after diagnosis. The date of HP infection diagnosis upon admission was defined as the index date. Patients aged < 20 years or with a cancer history were excluded. For each HP-infected patient, we selected four males without peptic ulcers or a history of HP eradication in the LHID for the comparison cohort according to propensity score matching by age, index year, and comorbidity. The risk of prostate cancer and associated risk factors was assessed by Cox proportional hazard regression. Results A total of 2620 HP infection treatment patients and 10,480 matched comparisons were selected. There were 36 patients in the HP-infected treatment cohort and 117 patients in the comparison cohort with documented prostate cancer development (1.52 and 1.21 per 1000 person-years, respectively). Compared to the comparison cohort, the HP infection cohort had a 1.26-fold increased prostate cancer risk in the Cox models after adjusting for matched-pairs (95% CI = 0.87–1.34). There were no significant differences in subsequent prostate cancer development between HP-infected treatment patients and the comparison cohort. Conclusion Our findings showed no significant association between HP-infected peptic ulcers and the subsequent risk of prostate cancer. Further studies are warranted to investigate whether this observation is attributable to an HP eradication policy.
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Affiliation(s)
- Chu-Wen Fang
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Chun-Hao Chen
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Chi Wu
- School of medicine, China Medical University, Taichung, Taiwan. .,Trauma and Emergency Center, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, 404, Taiwan.
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Arsoniadis EG, Finlayson E, Potenti F. Is there a role for specialized geriatric centers in treating geriatric cancer patients? Eur J Surg Oncol 2020; 46:383-386. [PMID: 32005554 DOI: 10.1016/j.ejso.2019.12.012] [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: 05/09/2019] [Revised: 10/21/2019] [Accepted: 12/13/2019] [Indexed: 11/26/2022] Open
Abstract
As the population with colorectal cancer ages, the tailored approach required to manage older patients becomes all the more important for all providers and institutions treating colorectal cancer to adopt and improve the outcomes and well-being of this important and increasingly prevalent population. Joint guidelines from the American College of Surgeons and American Geriatric Association should be followed. Older cancer patients undergoing colorectal cancer surgery should be referred to centers with expertise in minimally invasive surgery. Likewise, older rectal cancer patients should be referred to centers with expertise in treating rectal cancer.
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Affiliation(s)
- Elliot G Arsoniadis
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA; Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA.
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Fabio Potenti
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
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Kitamura H, Nagashima F, Andou M, Furuse J. Feasibility of Continuous Geriatric Assessments as a Prognostic Indicator in Elderly People with Gastrointestinal Cancer. Intern Med 2020; 59:15-22. [PMID: 31484904 PMCID: PMC6995714 DOI: 10.2169/internalmedicine.2856-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 07/16/2019] [Indexed: 12/27/2022] Open
Abstract
Objective The feasibility of continuous geriatric assessments (GAs) has not been evaluated fully in elderly patients with cancer. We prospectively investigated this issue by administering a recommended-GA set (r-GA) repeatedly to patients undergoing chemotherapy for gastrointestinal cancer on an outpatient basis. Methods We administered the r-GA before chemotherapy and every two months thereafter. Continuous GAs was defined as the completion of at least two assessments, including the pre-treatment evaluation. The r-GA included the Barthel Index [Basic Activities of Daily Living (BADL)], Mini-Mental State Examination-Japanese (MMSE-J), Instrumental Activities of Daily Living (IADL) scale, Vitality Index (VI), and Geriatric Depression Scale-15. We also used the Vulnerable Elders Survey (VES)-13 to screen overall vulnerability. We analyzed the correlations between each baseline GA score and the overall survival (OS) and the association between the OS and changes in each patient's GA scores over time. Patients Patients ≥65 years of age who presented to our department for initial consultation were enrolled and followed between December 2012 and January 2017. Results Twenty-one elderly patients (median age, 76 years old) were enrolled. GAs were completed within 20 minutes. In an age- and performance status (PS)-adjusted Cox proportional hazards analysis, the baseline BADL, MMSE-J, and VI scores correlated significantly with the OS (p=0.012, p=0.032, and p=0.012, respectively). During the clinical course, decreases in the MMSE-J and VES-13 scores were correlated with the OS (p=0.022 and p=0.019, respectively). Conclusion Outpatient GA administration is feasible. Low baseline BADL, MMSE-J, and VI scores and decreased MMSE-J and VES-13 scores over time may prognosticate the OS.
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Affiliation(s)
- Hiroshi Kitamura
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Japan
| | - Fumio Nagashima
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Japan
| | - Masahiko Andou
- Center for Advanced Medicine and Clinical Research, Nagoya University, Japan
| | - Junji Furuse
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Japan
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Arraras JI, Asin G, Illarramendi JJ, Manterola A, Salgado E, Dominguez MA. The EORTC QLQ-ELD14 questionnaire for elderly cancer patients. Validation study for elderly Spanish breast cancer patients. Rev Esp Geriatr Gerontol 2019; 54:321-328. [PMID: 31266659 DOI: 10.1016/j.regg.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Quality of life (QoL) is a key outcome for elderly cancer patients. The EORTC has developed QLQ-ELD14, a questionnaire that assesses important age-specific issues for older patients with cancer. This study aims to validate QLQ-ELD14 for use with elderly Spanish breast cancer patients. MATERIALS AND METHODS A consecutive sample of breast cancer patients with localized disease (age ≥65) who had received surgery ≥5 years earlier, were disease-free, and may have received adjuvant treatments was included. Patients completed the QLQ-ELD14, QLQ-C30 and QLQ-BR23 questionnaires. A subsample of patients completed QLQ-ELD14 six months later. Psychometric evaluation of the structure, reliability and validity of QLQ-ELD14 was conducted. RESULTS 87 patients completed the first assessment and 30 the second. Multitrait scaling analysis showed that all items except two met the standards for convergent and divergent validity. Cronbach's coefficient met the 0.7 alpha criterion on all scales except worries about others. Areas of QLQ-ELD14 and QLQ-C30 whose contents are conceptually related correlated substantially (Spearman's Rho >0.40). Conversely, areas of QLQ-ELD14 that had less in common with those of QLQ-C30 and QLQ-BR23 had low correlations (Spearman's Rho <0.1). Differences in QLQ-ELD14 were found in groups based on age, disease duration, living arrangement, presence of limiting comorbidity, and level of performance status. Patients had a higher level of worries at the second assessment. CONCLUSIONS QLQ-ELD14 is a reliable and valid instrument when applied to a sample of Spanish patients. Our results are in line with those of other validation studies.
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Affiliation(s)
- Juan Ignacio Arraras
- Complejo Hospitalario de Navarra: Radiotherapeutic Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain; Complejo Hospitalario de Navarra: Medical Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain.
| | - Gemma Asin
- Complejo Hospitalario de Navarra: Radiotherapeutic Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - José Juan Illarramendi
- Complejo Hospitalario de Navarra: Medical Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Ana Manterola
- Complejo Hospitalario de Navarra: Radiotherapeutic Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Esteban Salgado
- Complejo Hospitalario de Navarra: Medical Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Miguel Angel Dominguez
- Complejo Hospitalario de Navarra: Radiotherapeutic Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
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Foley RA, Hurard LL, Anchisi A, Anchisi S. Rising to the medication's requirements: The experience of elderly cancer patients receiving palliative chemotherapy in the elective oncogeriatrics field. Soc Sci Med 2019; 242:112593. [PMID: 31629159 DOI: 10.1016/j.socscimed.2019.112593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 01/19/2023]
Abstract
A new subfield of oncology has emerged in the last twenty years to raise awareness and address the specific needs of elderly cancer patients, a population that was long neglected in oncology. We sought to understand the individual experiences, as well as moral and social implications of considering elderly cancer patients as "treatable". Following an anthropological critical interpretative approach focusing on practical and symbolic effects of chemotherapy in a rapidly evolving medical field, we conducted 20 semi-structured interviews and observations of medicine storage places at home among elderly cancer patients aged 70 and over in a clearly incurable situation receiving palliative chemotherapy. We used photographs representing paths as triggers in interviews, and compared the patients' views with those of 12 health professionals in oncology during a brief open-ended interview. Elderly cancer patients consider themselves to be survivors and fighters. Their long trajectory is a result of their successful struggle and tolerance of the treatments allowing them to carry on. They continually observe their physical ability and test their resistance, they resist complaining and are grateful to have cancer at a late stage of life. By highlighting their active life rather than the treatment inconveniences, they show they are "young elderly" persons, capable of keeping active physically. They are treated precisely because they demonstrated that they had the physical and moral capacity to take the hit of the chemotherapy to their bodies and had the will to fight. The development of oncogeriatrics has enabled the treatment of the fittest cancer patients over 70, but the ethical debate to treat some elderly patients and not others, and decisions of therapeutic abstention facing frail elderly cancer patients remains an issue rarely discussed. This aspect should not be eluded by the important progress achieved in medicine facing cancer.
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Affiliation(s)
- Rose-Anna Foley
- School of Health Sciences (HESAV), University of Applied Sciences and Arts, Western Switzerland (HES-SO), Lausanne, Switzerland; Department of Epidemiology and Health Services, Center for General Medicine and Public Health, Unisanté, University of Lausanne, Switzerland.
| | - Lucie Lechevalier Hurard
- School of Health Sciences (HESAV), University of Applied Sciences and Arts, Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Annick Anchisi
- School of Health Sciences (HESAV), University of Applied Sciences and Arts, Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Sandro Anchisi
- Oncology Service of the Hospital Center of Valais Romand (CHVR), Sion, Switzerland
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DuMontier C, Sedrak MS, Soo WK, Kenis C, Williams GR, Haase K, Harneshaug M, Mian H, Loh KP, Rostoft S, Dale W, Cohen HJ. Arti Hurria and the progress in integrating the geriatric assessment into oncology: Young International Society of Geriatric Oncology review paper. J Geriatr Oncol 2019; 11:203-211. [PMID: 31451439 DOI: 10.1016/j.jgo.2019.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/11/2019] [Accepted: 08/13/2019] [Indexed: 12/18/2022]
Abstract
Until recently, the progress in the diagnosis and management of cancer has not been matched by similar progress in the assessment of the increasing numbers of older and more complex patients with cancer. Dr. Arti Hurria identified this gap at the outset of her career, which she dedicated toward studying the geriatric assessment (GA) as an improvement over traditional methods used in oncology to assess vulnerability in older patients with cancer. This review documents the progress of the GA and its integration into oncology. First, we detail the GA's origins in the field of geriatrics. Next, we chronicle the early rise of geriatric oncology, highlighting the calls of early thought-leaders to meet the demands of the rapidly aging cancer population. We describe Dr. Hurria's early efforts toward meeting these calls though the implementation of the GA in oncology research. We then summarize some of the seminal studies constituting the evidence base supporting GA's implementation. Finally, we lay out the evolution of cancer-focused guidelines recommending the GA, concluding with future needs to advance the next steps toward more widespread implementation in routine cancer care. Throughout, we describe Dr. Hurria's vision and its execution in driving progress of the GA in oncology, from her fellowship training to her co-authored guidelines recommending GA for all older adults with cancer-published in the year of her untimely death.
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Affiliation(s)
- Clark DuMontier
- Brigham and Women's Hospital, Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States of America.
| | - Mina S Sedrak
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Wee Kheng Soo
- Eastern Health Clinical School, Monash University, 5 Arnold St, Box Hill, VIC, Australia; Department of Aged Medicine, Eastern Health, 8 Arnold St, Box Hill, VIC, Australia; Department of Cancer Services, Eastern Health, 8 Arnold St, Box Hill, VIC, Australia
| | - Cindy Kenis
- Department of General Medical Oncology and Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Grant R Williams
- Division of Hematology/Oncology, Geriatrics, and Palliative Care, Institute of Cancer Outcomes and Survivorship, O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, UK
| | - Kristen Haase
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, Canada
| | - Magnus Harneshaug
- The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, P.O. box 68, 2313 Ottestad, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 4956, Nydalen, 0424 Oslo, Norway
| | - Hira Mian
- Juravinski Cancer Center, Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Siri Rostoft
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - William Dale
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States of America
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Le Saux O, Falandry C, Gan HK, You B, Freyer G, Péron J. Changes in the Use of Comprehensive Geriatric Assessment in Clinical Trials for Older Patients with Cancer over Time. Oncologist 2019; 24:1089-1094. [PMID: 30710065 DOI: 10.1634/theoncologist.2018-0493] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/03/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The objective of this study was to describe the implementation of comprehensive geriatric assessment (CGA) in clinical trials dedicated to older patients before and after the creation of the International Society of Geriatric Oncology in the early 2000s. SUBJECTS, MATERIALS, AND METHODS All phase I, II, and III trials dedicated to the treatment of cancer among older patients published between 2001 and 2004 and between 2011 and 2014 were reviewed. We considered that a CGA was performed when the authors indicated an intention to do so in the Methods section of the article. We collected each geriatric domain assessed using a validated tool even in the absence of a clear CGA, including nutritional, functional, cognitive, and psychological status, comorbidity, comedication, overmedication, social status and support, and geriatric syndromes. RESULTS A total of 260 clinical trials dedicated to older patients were identified over the two time periods: 27 phase I, 193 phase II, and 40 phase III trials. CGA was used in 9% and 8% of phase II and III trials, respectively; it was never used in phase I trials. Performance status was reported in 67%, 79%, and 75% of phase I, II, and III trials, respectively. Functional assessment was reported in 4%, 11%, and 13% of phase I, II, and III trials, respectively. Between the two time periods, use of CGA increased from 1% to 11% (p = .0051) and assessment of functional status increased from 3% to 14% (p = .0094). CONCLUSION The use of CGA in trials dedicated to older patients increased significantly but remained insufficient. IMPLICATIONS FOR PRACTICE This article identifies the areas in which research efforts should be focused in order to offer physicians well-addressed clinical trials with results that can be extrapolated to daily practice.
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Affiliation(s)
- Olivia Le Saux
- Medical Oncology Department, Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
- Lyon 1 University, EMR 3738, Faculté de Médecine Lyon-Sud, Oullins, France
| | - Claire Falandry
- Geriatric Unit, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
- CarMen biomedical research laboratory (Cardiovascular diseases, Metabolism, diabetology and Nutrition) INSERM UMR 1060, Université de Lyon, Oullins, France
| | - Hui K Gan
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
- School of Cancer Medicine, La Trobe University, Heidelberg, Australia
- Department of Medicine, Melbourne University, Melbourne, Australia
| | - Benoit You
- Medical Oncology Department, Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
- Lyon 1 University, EMR 3738, Faculté de Médecine Lyon-Sud, Oullins, France
| | - Gilles Freyer
- Medical Oncology Department, Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
- Lyon 1 University, EMR 3738, Faculté de Médecine Lyon-Sud, Oullins, France
| | - Julien Péron
- Medical Oncology Department, Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
- Statistics unit, Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
- CNRS, UMR 5558 Biometry and Evolutionary Biology laboratory Université Lyon 1, Villeurbanne, France
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Atakul E, Akyar İ. Frailty Prevalence and Characteristics in Older Adults with Hematologic Cancer: a Descriptive Study. Asia Pac J Oncol Nurs 2019; 6:43-49. [PMID: 30599015 PMCID: PMC6287383 DOI: 10.4103/apjon.apjon_35_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective: This study investigated the prevalence of frailty in older patients with hematologic cancer and assessed the association between older patients’ characteristics and frailty. Methods: This descriptive study enrolled 90 older patients undergoing treatment for hematological malignancies at an oncology hospital. Frailty was assessed with the Edmonton Frailty Scale as not frail (0–4), apparently vulnerable (5–6), mildly frail (7–8), moderately frail (9–10), and severely frail (11–17). The association of frailty and older patient characteristics and diagnosis was assessed by logistic regression. Results: The prevalence of frailty (mild, moderately, and severely) was 42.2%, and “apparently vulnerable” frailty was 60%. The mean scale score was 5.59 ± 3.13. Frailty was more prevalent in patients who were ≥75 years of age, had ≥4 children, were diagnosed with leukemia, and were diagnosed for ≥2 years. Gender, diagnosis, and employment were factors associated with the presence of frailty. Female gender and lack of employment were factors associated with a high risk of frailty. A diagnosis of multiple myeloma was associated with a low risk of frailty. Conclusions: The prevalence of frailty was high in older patients. Female and unemployed patients were at high risk for frailty. Frailty characteristics of older patients with hematologic cancer highlighted the need for comprehensive geriatric assessment and frailty screening, provided prevalence and characteristics of frailty in this group of patients during treatment, and highlighted the need for holistic care approach.
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Affiliation(s)
- Esra Atakul
- Bone Marrow Transplantation Unit, Dr. Abdurrahman Yurtaslan Oncology Education and Training Hospital, Health Sciences University, Demetevler, Ankara, Turkey
| | - İmatullah Akyar
- Medical Nursing Department, Faculty of Nursing, Hacettepe University, Samanpazari, Ankara, Turkey
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Fang CW, Liao CH, Wu SC, Muo CH. Association of benign prostatic hyperplasia and subsequent risk of bladder cancer: an Asian population cohort study. World J Urol 2018; 36:931-938. [PMID: 29427001 DOI: 10.1007/s00345-018-2216-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/31/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Few studies discussed the link between benign prostatic hyperplasia (BPH) and bladder cancer. We performed this cohort study to investigate whether there is an association between BPH and subsequent risk of bladder cancer. METHODS We identified 35,092 study subjects including 17546 BPH patients and 17546 comparisons from the National Health Insurance database. The comparison cohort was frequency matched with age and index-year. We measured subsequent bladder cancer rates (per 1000 person-years) in two cohorts. Attributable risks (ARs) was calculated based on the bladder cancer rates in two cohorts. The hazard ratios (HRs) and 95% confidence intervals (CIs) for bladder cancer were estimated via Cox proportional hazard regression. RESULTS BPH patients had a higher bladder cancer rate than comparisons (AR = 0.81 per 1000 person-years) and exhibited 4.69- and 4.11-fold increases in bladder cancer risk in the crude and adjusted Cox models, respectively (95% CIs = 4.15-6.99 and 2.70-6.26). The AR was highest in patients aged 65-74 years old (AR = 1.33). BPH patients with chronic kidney disease were at an elevated bladder cancer risk. Regarding the association between bladder cancer and transurethral prostatectomy (TURP), BPH patients who underwent TURP were at a higher risk of bladder cancer (AR = 1.69; HR = 6.17, 95% CI = 3.68-10.3) than those who did not (AR = 0.69; HR = 3.73, 95% CI = 2.43-5.74). CONCLUSIONS In this study, BPH patients were found to have an increased risk of subsequent bladder cancer. Based on the limitations of retrospective nature, further studies are needed.
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Affiliation(s)
- Chu-Wen Fang
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Cheng-Hsi Liao
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Urology, Taichung Armed Forces General Hospital, Taichung, Taiwan
- National Defense Medical Center, Taipei, Taiwan
| | - Shih-Chi Wu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
- Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan.
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University and Hospital, No. 2, Yuh-Der Road, Taichung, 404, Taiwan
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Tjong MC, Menjak I, Trudeau M, Mehta R, Wright F, Leahey A, Ellis J, Gallagher D, Gibson L, Bristow B, Rice K, Szumacher E. The Perceptions and Expectations of Older Women in the Establishment of the Senior Women's Breast Cancer Clinic (SWBCC): a Needs Assessment Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:850-857. [PMID: 27142360 DOI: 10.1007/s13187-016-1042-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study explored older women's perceptions and expectations of the prospective Senior Women's Breast Cancer Clinic (SWBCC) at Sunnybrook Odette Cancer Centre (SOCC) in Toronto, Ontario, Canada. In our previous studies, older breast cancer patients had expressed a greater need for informational, decisional, and post-treatment support. This study also assessed women's perspectives on the involvement of geriatricians and incorporation of geriatric assessment in their cancer care. Twelve breast cancer patients aged 68 years or older who were treated at the SOCC participated in the study. We recorded and transcribed 11 interviews and analyzed them using qualitative thematic analysis methods to identify major themes; one interview was excluded due to recording defect. Eight major themes were identified: transportation issues, service, communication between patient and healthcare professionals, communication between healthcare professionals, support during treatment, support after treatment, informational resources, and patient suggestions. Important issues were raised by participants, such as difficulties in arranging transportation to the clinic, barriers in accessing family physician service, and communication breakdown that result in treatment delay and unaddressed complications. In conclusion, there were important gaps in the cancer care of older women with breast cancer that could be detected earlier and better addressed in the new multidisciplinary SWBCC. The participating women were highly supportive of the initiative and made several suggestions on how the clinic could better accommodate their specific needs during and after breast cancer treatment.
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Affiliation(s)
- Michael C Tjong
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ines Menjak
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Maureen Trudeau
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rajin Mehta
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frances Wright
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Angela Leahey
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Janet Ellis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Damian Gallagher
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Leslie Gibson
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Bonnie Bristow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Katie Rice
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ewa Szumacher
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
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20
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Le Saux O, Falandry C, Gan H, You B, Freyer G, Péron J. Changes in the use of end points in clinical trials for elderly cancer patients over time. Ann Oncol 2017; 28:2606-2611. [DOI: 10.1093/annonc/mdx354] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Baeza-Velasco C, Baguet F, Allart P, Aguerre C, Sultan S, Ninot G, Soubeyran P, Cousson-Gelie F. Major depressive disorder and associated factors in elderly patients with non-Hodgkin’s lymphoma. Health Psychol Behav Med 2016. [DOI: 10.1080/21642850.2016.1264879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Carolina Baeza-Velasco
- Institut de Psychologie, Université Paris Descartes, Sorbonne Paris Cité, Laboratoire de Psychopathologie et Processus de Santé EA, Paris, France
| | - Fanny Baguet
- Institut Régional du Cancer de Montpellier, Epidaure Pôle Prévention, Montpellier, France
- Université Montpellier 1 & 3, Laboratory Epsylon EA, Dynamics of Human Abilities and Health Behaviors, Montpellier, France
| | - Priscilla Allart
- Université de Bordeaux, Laboratoire Psychologie Santé et Qualité de Vie EA, Bordeaux, France
| | - Colette Aguerre
- Université François Rabelais, Laboratoire Psychologie des Ages de la Vie EA, Tours, France
| | - Serge Sultan
- Université de Montréal, CHU Sainte-Justine, QC, Canada
| | - Gregory Ninot
- Université Montpellier 1 & 3, Laboratory Epsylon EA, Dynamics of Human Abilities and Health Behaviors, Montpellier, France
| | - Pierre Soubeyran
- Departement d'Oncologie Médicale, Institut Bergonié, Bordeaux, France
| | - Florence Cousson-Gelie
- Institut Régional du Cancer de Montpellier, Epidaure Pôle Prévention, Montpellier, France
- Université Montpellier 1 & 3, Laboratory Epsylon EA, Dynamics of Human Abilities and Health Behaviors, Montpellier, France
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23
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Outcomes in elderly patients treated with a single-agent or combination regimen as first-line chemotherapy for recurrent or metastatic gastric cancer. Gastric Cancer 2015; 18:644-52. [PMID: 25098925 DOI: 10.1007/s10120-014-0405-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/13/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Palliative chemotherapy is used to prolong survival among elderly patients with inoperable gastric cancer (GC). We analyzed differences between single and combination first-line palliative chemotherapy among these patients. METHODS Included patients were >70 years old and were treated for GC at four clinical centers of the Catholic University of Korea. Baseline characteristics, the first-line chemotherapy regimen, treatment responses, toxicities, progression-free survival (PFS), and overall survival (OS) were evaluated. RESULTS Between 2005 and 2012, 178 > 70-year-old patients with GC received palliative chemotherapy using single or combination regimens. Median ages were 77 years (range 71-89) in the single regimen group (SG, 70 patients) and 73 years (range 71-81) in the combination group (CG, 108 patients). Patients in the SG received S-1 or capecitabine. The most common regimen in the CG was platinum combined with fluorouracil. The most common response in both groups was stable disease (SG, 45.7 %; CG, 48.1 %). In the SG and CG, median PFS times were 4.4 months (95 % confidence interval [CI] 2.85-5.95) and 4.1 months (95 % CI 2.62-5.57; P = 0.295), respectively; median OS times were 6.6 months (95 % CI 4.17-9.08) and 7.6 months (95 % CI 5.50-9.69; P = 0.782), respectively. Hematologic (P < 0.001) and non-hematologic toxicities (P < 0.001) were more frequent in the CG. The most common causes of chemotherapy cessation were disease progression in the SG and decreased performance status in the CG. CONCLUSIONS Single-agent treatment should be considered a first-line palliative chemotherapy option for elderly patients with GC.
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Vergnenegre A, Corre R, Lena H, Le Caer H. Management of elderly patients. Transl Lung Cancer Res 2015; 2:200-7. [PMID: 25806233 DOI: 10.3978/j.issn.2218-6751.2013.02.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 02/19/2013] [Indexed: 11/14/2022]
Abstract
SUMMARY Elderly patients are often excluded from clinical trials, yet more than two-thirds of patients diagnosed with lung cancer are over 65 years old. It is therefore important to develop specific tools and trials for this specific patient population. METHODS This chapter first examines the management specificities of elderly patients. Randomized trials specifically involving elderly patients are then described, and likely future developments are considered. RESULTS Older people have several specificities. In addition to traditional criteria such as age and performance status, other important factors include the number of comorbidities and age-related changes such as cognitive deficits and depression. Specific indices taking these factors into account have been published and validated. Single-agent therapy has been widely used to treat metastatic lung cancer in the elderly, following publication of negative results from randomized phase III trials of combination chemotherapy. Recently, however, a trial of doublet therapy gave positive results, in a subgroup of independent older patients. The benefit of patient selection based on a combination of these indices has been demonstrated in open-label and randomized trials. These results must now be confirmed in phase III trials including the use of tyrosine kinase inhibitors combined with chemotherapy. CONCLUSIONS Indices based on a combination of age-related factors, together with judicious use of biological markers, will further improve the prognosis of elderly lung cancer patients.
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Affiliation(s)
- Alain Vergnenegre
- Service de Pathologie Respiratoire, CHU - Limoges, France ; ; Groupe Français de Pneumo - Cancerologie (GFPC), France
| | - Romain Corre
- Groupe Français de Pneumo - Cancerologie (GFPC), France ; ; Service de Pneumologie CHU - Rennes, France
| | - Hervé Lena
- Groupe Français de Pneumo - Cancerologie (GFPC), France ; ; Service de Pneumologie CHU - Rennes, France
| | - Hervé Le Caer
- Groupe Français de Pneumo - Cancerologie (GFPC), France ; ; Service de Pneumologie CH - Draguignan, France
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Kaur I, Constance JE, Kosak KM, Spigarelli MG, Sherwin CMT. An extensive pharmacokinetic, metabolic and toxicological review of elderly patients under intensive chemotherapy for acute myeloid leukemia. Expert Opin Drug Metab Toxicol 2014; 11:53-65. [DOI: 10.1517/17425255.2015.972934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Imit Kaur
- 1University of Utah School of Medicine, Division of Clinical Pharmacology, Department of Pediatrics, 295 Chipeta Way, Salt Lake City, UT 84108, USA ;
| | - Jonathan E Constance
- 1University of Utah School of Medicine, Division of Clinical Pharmacology, Department of Pediatrics, 295 Chipeta Way, Salt Lake City, UT 84108, USA ;
| | - Ken M Kosak
- 2University of Utah, Division of Hematology and Hematologic Malignancies and Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Michael G Spigarelli
- 1University of Utah School of Medicine, Division of Clinical Pharmacology, Department of Pediatrics, 295 Chipeta Way, Salt Lake City, UT 84108, USA ;
| | - Catherine MT Sherwin
- 1University of Utah School of Medicine, Division of Clinical Pharmacology, Department of Pediatrics, 295 Chipeta Way, Salt Lake City, UT 84108, USA ;
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Ceresoli GL, Grosso F, Zucali PA, Mencoboni M, Pasello G, Ripa C, Degiovanni D, Simonelli M, Bruzzone A, Dipietrantonj C, Piccolini E, Beretta GD, Favaretto AG, Giordano L, Santoro A, Botta M. Prognostic factors in elderly patients with malignant pleural mesothelioma: results of a multicenter survey. Br J Cancer 2014; 111:220-6. [PMID: 24918816 PMCID: PMC4102949 DOI: 10.1038/bjc.2014.312] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 04/29/2014] [Accepted: 05/12/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The incidence of malignant pleural mesothelioma (MPM) in elderly patients is increasing. There are no specific guidelines for their management. METHODS The clinical records of elderly patients (⩾70 years old) with MPM referred from January 2005 to November 2011 to six Italian Centres were reviewed. Age, gender, histology, International Mesothelioma Interest Group (IMIG) stage, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), Charlson Comorbidity Index (CCI) and treatment modalities were analysed and correlated to overall survival (OS). RESULTS In total, 241 patients were identified. Charlson Comorbidity Index was ⩾1 in 92 patients (38%). Treatment was multimodality therapy including surgery in 18, chemotherapy alone in 180 (75%) and best supportive care in 43 cases (18%). Chemotherapy was mainly pemetrexed based. Median OS was 11.4 months. Non-epithelioid histology (HR 2.32; 95% CI 1.66-3.23, P<0.001), age ⩾75 years (HR 1.44; 95% CI 1.08-1.93, P=0.014), advanced (III-IV) stage (HR 1.47; 95% CI 1.09-1.98, P=0.011) and CCI⩾1 (HR 1.38; 95% CI 1.02-1.85, P=0.034) were associated to a shorter OS. Treatment with pemetrexed was associated with improved OS (HR 0.40; 95% CI 0.28-0.56, P<0.001). CONCLUSIONS Non-epithelioid histology, age ⩾75 years, advanced IMIG stage and presence of comorbidities according to CCI were significant prognostic factors in elderly patients with MPM. Treatment with pemetrexed-based chemotherapy was feasible in this setting. Prospective dedicated trials in MPM elderly patients selected according to prognostic factors including comorbidity scales are warranted.
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Affiliation(s)
- G L Ceresoli
- Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - F Grosso
- Oncology, Ospedale SS Antonio e Biagio, Alessandria, Italy
| | - P A Zucali
- Oncology, Humanitas Cancer Center, Rozzano (Milan), Italy
| | - M Mencoboni
- Oncology, Ospedale Villa Scassi, Sampierdarena, Genova, Italy
| | - G Pasello
- Oncology, Istituto Oncologico Veneto, Padova, Italy
| | - C Ripa
- Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - D Degiovanni
- Palliative Care Unit, Ospedale S. Spirito, Casale Monferrato, Italy
| | - M Simonelli
- Oncology, Humanitas Cancer Center, Rozzano (Milan), Italy
| | - A Bruzzone
- Oncology, Ospedale Villa Scassi, Sampierdarena, Genova, Italy
| | | | - E Piccolini
- Pneumology, Ospedale S. Spirito, Casale Monferrato, Italy
| | - G D Beretta
- Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | | | - L Giordano
- Biostatistic Unit, Humanitas Cancer Center, Rozzano (Milan), Italy
| | - A Santoro
- Oncology, Humanitas Cancer Center, Rozzano (Milan), Italy
| | - M Botta
- Oncology, Ospedale S. Spirito, Casale Monferrato, Italy
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Moy B, Flaig TW, Muss HB, Clark B, Tse W, Windham TC. Geriatric oncology for the 21st century: a call for action. J Oncol Pract 2014; 10:241-3. [PMID: 24781365 DOI: 10.1200/jop.2013.001333] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The recently released Institute of Medicine report further emphasizes the need for the oncology community to optimize care of older patients with cancer.
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Affiliation(s)
- Beverly Moy
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Colorado, Aurora, CO; University of North Carolina/Lineberger Comprehensive Cancer Center, Chapel Hill, NC; American Society of Clinical Oncology, Alexandria, VA; West Virginia University, Morgantown, WV; and Florida Hospital Memorial Medical Center, Daytona Beach, FL
| | - Thomas W Flaig
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Colorado, Aurora, CO; University of North Carolina/Lineberger Comprehensive Cancer Center, Chapel Hill, NC; American Society of Clinical Oncology, Alexandria, VA; West Virginia University, Morgantown, WV; and Florida Hospital Memorial Medical Center, Daytona Beach, FL
| | - Hyman B Muss
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Colorado, Aurora, CO; University of North Carolina/Lineberger Comprehensive Cancer Center, Chapel Hill, NC; American Society of Clinical Oncology, Alexandria, VA; West Virginia University, Morgantown, WV; and Florida Hospital Memorial Medical Center, Daytona Beach, FL
| | - Ben Clark
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Colorado, Aurora, CO; University of North Carolina/Lineberger Comprehensive Cancer Center, Chapel Hill, NC; American Society of Clinical Oncology, Alexandria, VA; West Virginia University, Morgantown, WV; and Florida Hospital Memorial Medical Center, Daytona Beach, FL
| | - William Tse
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Colorado, Aurora, CO; University of North Carolina/Lineberger Comprehensive Cancer Center, Chapel Hill, NC; American Society of Clinical Oncology, Alexandria, VA; West Virginia University, Morgantown, WV; and Florida Hospital Memorial Medical Center, Daytona Beach, FL
| | - T Christopher Windham
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Colorado, Aurora, CO; University of North Carolina/Lineberger Comprehensive Cancer Center, Chapel Hill, NC; American Society of Clinical Oncology, Alexandria, VA; West Virginia University, Morgantown, WV; and Florida Hospital Memorial Medical Center, Daytona Beach, FL
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Schmidt M, Neuner B, Kindler A, Scholtz K, Eckardt R, Neuhaus P, Spies C. Prediction of long-term mortality by preoperative health-related quality-of-life in elderly onco-surgical patients. PLoS One 2014; 9:e85456. [PMID: 24465568 PMCID: PMC3896375 DOI: 10.1371/journal.pone.0085456] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/05/2013] [Indexed: 12/28/2022] Open
Abstract
Objective Aim of this study was to evaluate the association between preoperative health-related quality of life (HRQoL) and mortality in a cohort of elderly patients (>65 years) with gastrointestinal, gynecological and genitourinary carcinomas. Design Prospective cohort pilot study. Setting Tertiary university hospital in Germany. Patients Between June 2008 and July 2010 and after ethical committee approval and written informed consent, 126 patients scheduled for onco-surgery were included. Prior to surgery as well as 3 and 12 months postoperatively all participants completed the EORTC-QLQ-C30 questionnaire (measuring self-reported health-related quality of life). Additionally, demographic and clinical data including the Mini Mental State Examination (MMSE) were collected. Surgery and anesthesia were conducted according to the standard operating procedures. Primary endpoint was the cumulative mortality rate over 12 months after one year. Changes in Quality of life were considered as secondary outcome. Results Mortality after one year was 28%. In univariable and multivariable logistic regression analysis baseline HRQoL self-reported cognitive function (OR per point: 0.98; CI 95% 0.96–0.99; p = 0.024) and higher symptom burden for appetite loss (per point: OR 1.02; CI 95% 1.00–1.03; p = 0.014) were predictive for long-term mortality. Additionally the MMSE as an objective measure of cognitive impairment (per point: OR 0.69; CI 95% 0.51–0.96; p = 0.026) as well as severity of surgery (OR 0.31; CI 95% 0.11–0.93; p = 0.036) were predictive for long-term mortality. Global health status 12 months after surgery was comparable to the baseline levels in survivors despite moderate impairments in other domains. Conclusion This study showed that objective and self-reported cognitive functioning together with appetite loss were prognostic for mortality in elderly cancer patients. In addition, impaired cognitive dysfunction and severity of surgery were predictive for one-year mortality whereas in this selected population scheduled for surgery age, gender, cancer site and metastases were not.
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Affiliation(s)
- Maren Schmidt
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Bruno Neuner
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Andrea Kindler
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Kathrin Scholtz
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Rahel Eckardt
- Charité Research Group on Geriatrics, Charité-University Medicine Berlin, Berlin, Germany
| | - Peter Neuhaus
- Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow, Charité-University Medicine Berlin, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlin, Germany
- * E-mail:
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Browner I, Smith T. Symptom assessment in elderly cancer patients receiving palliative care. Ann Oncol 2013; 24 Suppl 7:vii25-29. [DOI: 10.1093/annonc/mdt269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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International validation of the EORTC QLQ-ELD14 questionnaire for assessment of health-related quality of life elderly patients with cancer. Br J Cancer 2013; 109:852-8. [PMID: 23868003 PMCID: PMC3749575 DOI: 10.1038/bjc.2013.407] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/20/2013] [Accepted: 07/01/2013] [Indexed: 11/12/2022] Open
Abstract
Background: Older people represent the majority of cancer patients but their specific needs are often ignored in the development of health-related quality of life (HRQOL) instruments. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-ELD15 was developed to supplement the EORTC's core questionnaire, the QLQ-C30, for measuring HRQOL in patients aged >70 years in oncology studies. Methods: Patients (n=518) from 10 countries completed the QLQ-C30, QLQ-ELD15 and a debriefing interview. Eighty two clinically stable patients repeated the questionnaires 1 week later (test–retest analysis) and 107 others, with an expected change in clinical status, repeated the questionnaires 3 months later (response to change analysis, RCA). Results: Information from the debriefing interview, factor analysis and item response theory analysis resulted in the removal of one item (QLQ-ELD15→QLQ-ELD14) and revision of the proposed scale structure to five scales (mobility, worries about others, future worries, maintaining purpose and illness burden) and two single items (joint stiffness and family support). Convergent validity was good. In known-group comparisons, the QLQ-ELD14 differentiated between patients with different disease stage, treatment intention, number of comorbidities, performance status and geriatric screening scores. Test–retest and RCA analyses were equivocal. Conclusion: The QLQ-ELD14 is a validated HRQOL questionnaire for cancer patients aged ⩾70 years. Changes in elderly patients' self-reported HRQOL may be related to both cancer evolution and non-clinical events.
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Rao AV, Hurria A, Kimmick G, Pinheiro S, Seo PH. Geriatric oncology: past, present, future. J Oncol Pract 2013; 4:190-2. [PMID: 20856771 DOI: 10.1200/jop.0846001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Efforts to integrate geriatric oncology principles in the training of all medical oncologists are underway.
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Affiliation(s)
- Arati V Rao
- Duke University Medical Center, Durham, NC; City of Hope, Duarte CA; Miller School of Medicine, University of Miami, Miami, FL
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Focan C, Warzée E, Sondag C, Guillaume T. Evaluation of biological rhythms in elderly cancer patients. A complementary translational research within the frame of the trans-hospital pilot program of oncogeriatrics launched at CHC-Liège. PATHOLOGIE-BIOLOGIE 2013; 61:e33-e37. [PMID: 23102895 DOI: 10.1016/j.patbio.2011.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Thanks to the sponsoring of Belgian Cancer Plan, we have launched a trans-hospital project of oncogeriatrics implying any concerned actors from medical (oncology, geriatrics, various specialties) and paramedical staffs (nurses, physiotherapists, ergotherapists, dieteticians, social workers, psychologists…). We aim to recruit 300 consecutive patients aged over 70 and presenting with a new diagnosed cancer. They will benefit from both detailed Comprehensive Geriatrical (CGA) and Oncological (COA) assessments. A multidisciplinary concertation will try to define for each patient an individualized treatment planning taking into account CGA, CGO, co-morbidities, predictive indexes of chemotherapy toxicity (MAX2, i.e.). Detailed records will be obtained in collaboration with the data-management staff. Furthermore, a complementary translational research will include patients for a simple evaluation of their circadian rhythmicities through cortisol titration at 8a.m. and 4p.m. and actometry recordings of the rest-activity rhythms. Future steps could be developed aiming at the restoration of circadian structure disturbances with revalidation (physical exercise, tai-chi, yoga) and resynchronization (melatonin, hydrocortisone, bright light…) programs.
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Affiliation(s)
- C Focan
- CHC-Clinique Saint-Joseph, rue de Hesbaye, 75, 4000 Liège, Belgium.
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Cho YH, Kim SY, Hong Lee M, Yoo MW, Bang HY, Lee KY, Yoon SY. Comparative analysis of the efficacy and safety of chemotherapy with oxaliplatin plus fluorouracil/leucovorin between elderly patients over 65 years and younger patients with advanced gastric cancer. Gastric Cancer 2012; 15:389-95. [PMID: 22237658 DOI: 10.1007/s10120-011-0128-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 12/03/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND A chemotherapy regimen with oxaliplatin, fluorouracil, and leucovorin is commonly used to treat advanced gastric cancer (AGC). This study was designed to compare the efficacy and the safety of oxaliplatin plus fluorouracil/leucovorin administered biweekly (mFOLFOX6) between elderly patients aged over 65 years and younger counterparts with AGC. METHODS This analysis included 82 AGC patients (≥65:31, <65:51). Patients with previously untreated chemo-naïve advanced adenocarcinoma of the stomach received oxaliplatin 85 mg/m(2), 5-FU bolus 400 mg/m(2) on day 1 and 5-FU 1,500 mg/m(2), leucovorin 75 mg/m(2) 22 h infusion on days 1 and 2 every 2 weeks. The aim of the study was to compare efficacy and safety, including response rate (RR), progression-free survival (PFS), overall survival, and grade ≥3 adverse events, between patients aged ≥65 years and patients aged <65 years. RESULTS Median progression-free survival (PFS) was not significantly different between both groups (≥65: 5.8 months, <65: 5.7 months, respectively, HR 0.77, 95% CI: 0.44-1.16, P = 0.18). Median overall survival was not significantly different between both groups (≥65: 10.3 months, <65: 9.5 months HR 0.83, 95% CI: 0.50-1.37, P = 0.46). The rate of grade 3 or 4 neutropenia did not differ with age group (≥65: 51.6%, <65: 43.1%); nor did the rates of neutropenic fever (≥65: 16.1%, <65: 5.9%), and infection without neutropenia (≥65: 3.2%, <65: 3.9%). Rates of grade ≥3 toxicities such as thrombocytopenia, nausea/vomiting, or peripheral neuropathy were not significantly different between the two groups. CONCLUSIONS mFOLFOX6 maintains its efficacy and safety in elderly patients aged over 65 years in comparison with AGC patients aged <65 years. Its judicious use should be considered regardless of age.
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Affiliation(s)
- Yo Han Cho
- Department of Hemato-oncology, Konkuk University Medical Center, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Republic of Korea
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Kim ST, Park KH, Oh SC, Seo JH, Shin SW, Kim JS, Kim YH. Is chemotherapy in elderly patients with metastatic or recurrent gastric cancer as tolerable and effective as in younger patients? Asia Pac J Clin Oncol 2012; 8:194-200. [PMID: 22524579 DOI: 10.1111/j.1743-7563.2011.01501.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIM To analyze the chemotherapy regimens and outcomes of advanced gastric cancer (AGC) patients older than 70 years of age. METHODS Between May 2001 and October 2009, 1135 patients with metastatic or recurrent gastric cancer received palliative chemotherapy. Of these patients 56 (4.9%) were ≥70 years old and were analyzed retrospectively. RESULTS The median age at the time of first-line chemotherapy was 73 years (range, 70-85) and the median Charlson comorbidity index was 0 (0-5). In all 17 patients (30%) received surgery with curative or palliative intent; 43 (77%) were treated by doublet or triplet first-line chemotherapy regimens and 13 patients (23%) received single agent chemotherapy. Median progression-free survival for first-line chemotherapy was 3.97 months (95% CI 2.05-5.89) with an overall response rate of 26%. After the first-line chemotherapy, only 18 of 56 (32%) patients received second-line chemotherapy. The median overall survival (OS) was 12.4 months (95% CI 2.81-21.99). In multivariate analysis, receiving surgery and disease control for first-line chemotherapy were independent prognostic factors for increased OS for all 56 patients. CONCLUSION Patients older ≥70 years with metastatic or recurrent gastric cancer might achieve clinical benefit from chemotherapy. Receiving surgery and response of over more stable disease for first-line chemotherapy were independent prognostic factors for increased OS.
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Affiliation(s)
- Seung Tae Kim
- Divisions of Hematology-Oncology, Korea University College of Medicine, Seoul, South Korea
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Valentiny C, Kemmler G, Stauder R. Age, sex and gender impact multidimensional geriatric assessment in elderly cancer patients. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2011.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Bellury LM, Ellington L, Beck SL, Stein K, Pett M, Clark J. Elderly cancer survivorship: an integrative review and conceptual framework. Eur J Oncol Nurs 2011; 15:233-42. [PMID: 21530396 DOI: 10.1016/j.ejon.2011.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 03/22/2011] [Accepted: 03/25/2011] [Indexed: 12/27/2022]
Abstract
UNLABELLED The intersection of ageing and cancer in the phase of post-treatment survivorship represents a large and growing population with unique needs. PURPOSE The goal of this work is to review and integrate the current gerontology and oncology literature relevant to elderly cancer survivorship, to identify knowledge gaps and research opportunities and to propose a conceptual model to guide future research. The long-term, global goal is the prevention of morbidity and mortality in elderly cancer survivors by identification of vulnerable elders, maintenance of independence, tailoring of treatment, establishing intervention guidelines and planning for necessary resources within the entire trajectory of cancer survival for older survivors. METHODS Targeted and integrative review of selected literature from multiple disciplines. Search engines included PubMed, article reference lists and internet searches for epidemiological data (US Census, World Health Organization, American Cancer Society, Canadian Cancer Cancer Society, etc). RESULTS A conceptual model that incorporates the gerontologic, oncologic and personal characteristics of older cancer survivors is proposed that may provide a comprehensive approach by which to frame elderly survivorship research. CONCLUSION Cancer survivorship among the elderly is quantitatively and qualitatively different from cancer survivorship among other age groups. The current large numbers and predicted increase in elderly cancer survivors in the near future mandate attention to this population. Future research must consider the complexity of intersecting needs in the gero-oncology population.
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Wan-Chow-Wah D, Monette J, Monette M, Sourial N, Retornaz F, Batist G, Puts MT, Bergman H. Difficulties in decision making regarding chemotherapy for older cancer patients: A census of cancer physicians. Crit Rev Oncol Hematol 2011; 78:45-58. [DOI: 10.1016/j.critrevonc.2010.02.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 02/09/2010] [Accepted: 02/18/2010] [Indexed: 12/27/2022] Open
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Gribben JG. Chronic lymphocytic leukemia: planning for an aging population. Expert Rev Anticancer Ther 2011; 10:1389-94. [PMID: 20836674 DOI: 10.1586/era.10.127] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Chronic lymphocytic leukemia (CLL) remains incurable, but over the past decade there have been major advances in the understanding of the pathophysiology of CLL and in the treatment of this disease. This has led to greatly increased response rates and durations of response, as well as improved survival. CLL is a disease of the elderly and not all patients are eligible for the aggressive upfront chemoimmunotherapy regimens that are resulting in improved response rates and survival, so what is the optimal treatment approach for more frail elderly patients? It is highly likely that our treatment approaches will continue to evolve as the results of ongoing clinical trials are released. The age range of patients involved in clinical trials is not representative of this disease, and more research is required in patients who are representative of the majority of CLL patients seen in practice before we will see outcome improvements in these more elderly and often more frail patient populations.
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Affiliation(s)
- John G Gribben
- Barts Institute of Cancer, Barts and the London School of Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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Weinberger MI, Bruce ML, Roth AJ, Breitbart W, Nelson CJ. Depression and barriers to mental health care in older cancer patients. Int J Geriatr Psychiatry 2011; 26:21-6. [PMID: 21157847 PMCID: PMC3052769 DOI: 10.1002/gps.2497] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To review the literature on depression in cancer patients with a particular focus on depression assessment and barriers to mental health treatment in older cancer patients. DESIGN We conducted a review of the literature on depression and barriers to mental health treatment in older cancer patients. RESULTS Depression is prevalent in cancer patients. However, little is known about prevalence rates of depression in older adults with cancer, assessing depression in older cancer patients and barriers that impede proper mental health treatment in this sample. CONCLUSION Improved diagnostic clarity and a better understanding of barriers to mental health treatment can help clarify and facilitate mental health referrals and ultimately improve access to care among older cancer patients in need. Continuing to consider the complexities associated with diagnosing depression in older cancer patients is necessary. Further work may be needed to develop new diagnostic measures for such detection, determine the prevalence of depression among older cancer and ways in which to overcome barriers to mental health care.
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Affiliation(s)
- Mark I Weinberger
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10605, USA.
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Tang S, Morgan D, Winterbottom L, Kennedy H, Porock D, Cheung K. Optimising the care of primary breast cancer in older women—potential for a dedicated service. J Geriatr Oncol 2010. [DOI: 10.1016/j.jgo.2010.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Naeim A, Hurria A, Rao A, Cohen H, Heflin M, Seo P. The need for an aging and cancer curriculum for hematology/oncology trainees. J Geriatr Oncol 2010. [DOI: 10.1016/j.jgo.2010.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mohile SG, Kaur HP, Goldberg RM. Management of colon and rectal cancer in older adults. PRACTICAL GERIATRIC ONCOLOGY 2010:148-170. [DOI: 10.1017/cbo9780511763182.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Brunello A, Sandri R, Extermann M. Multidimensional geriatric evaluation for older cancer patients as a clinical and research tool. Cancer Treat Rev 2009; 35:487-92. [DOI: 10.1016/j.ctrv.2009.04.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Brunello A, Loaldi E, Balducci L. Dose adjustment and supportive care before and during treatment. Cancer Treat Rev 2009; 35:493-8. [DOI: 10.1016/j.ctrv.2009.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lichtman SM. Geriatric oncology: introduction. Curr Treat Options Oncol 2009; 10:141-3. [PMID: 19728103 DOI: 10.1007/s11864-009-0106-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stuart M Lichtman
- 65+ Clinical Geriatric Program, Memorial Sloan-Kettering Cancer Center, 650 Commack Road, Commack, NY 11725, USA.
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Goldzweig G, Andritsch E, Hubert A, Walach N, Perry S, Brenner B, Baider L. How relevant is marital status and gender variables in coping with colorectal cancer? A sample of middle-aged and older cancer survivors. Psychooncology 2009; 18:866-74. [DOI: 10.1002/pon.1499] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Six independent domains are defined by geriatric assessment in elderly cancer patients. Crit Rev Oncol Hematol 2009; 74:97-105. [PMID: 19520589 DOI: 10.1016/j.critrevonc.2009.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 04/24/2009] [Accepted: 04/29/2009] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Geriatric assessment (GA) must be integrated into treatment concepts for elderly cancer patients. Aim of this study was to assess the coverage of a large battery of GA instruments by determining the number of independent domains measured. METHODS Thirteen different GA scores were applied in 78 elderly tumor patients (mean age 72.9 years). Data were analyzed by exploratory factor analysis and substantiated by non-parametric correlation analyses. RESULTS Factor analysis yielded a six-factor solution explaining 77.1% of the total variance. The six domains identified may be described as general functioning in everyday life, health-related quality of life, co-morbidities, social support, cognition, and nutritional status. This factor structure was reasonably well confirmed by correlation analyses. Notably, WHO Performance Status, Karnofsky Index, VES-13 and PPT generally revealed high correlations with functional capacities, but only low correlations with comorbidities, social support, cognitive functioning or nutritional status. CONCLUSIONS From the six domains described a basis for efficient application of GA instruments in elderly cancer patients is worked out. The classical instruments WHO and KI as well as the screening scores VES-13 and PPT, while capturing physical functioning well, fail to cover several other important GA domains.
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Puts MTE, Girre V, Monette J, Wolfson C, Monette M, Batist G, Bergman H. Clinical experience of cancer specialists and geriatricians involved in cancer care of older patients: A qualitative study. Crit Rev Oncol Hematol 2009; 74:87-96. [PMID: 19427228 DOI: 10.1016/j.critrevonc.2009.04.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 03/31/2009] [Accepted: 04/08/2009] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Cancer is an important health problem in older persons. The aim of this study was to explore how cancer specialists and geriatricians manage the treatment of older patients with cancer. METHODS Interviews using semi-structured open-ended questions. SAMPLE physicians working in oncology and geriatric medicine at McGill affiliated hospitals. ANALYSIS Grounded-theory approach. RESULTS 24 cancer specialists and 17 geriatricians participated. There was considerable variability with regard to assessment, treatment plan, and follow-up care and little collaboration between both specialists. The cancer specialists have more older cancer patients in their practice and collaborate with geriatricians mostly to deal with complications of cancer treatment. However, both groups of specialists expressed a desire to collaborate more and had similar research priorities. CONCLUSIONS There was considerable variability in the management of older patients with cancer. Care for older patients with cancer might be improved by more collaboration between cancer specialists and geriatricians.
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Affiliation(s)
- M T E Puts
- Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada.
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Taylor JA, Kuchel GA. Bladder cancer in the elderly: clinical outcomes, basic mechanisms, and future research direction. NATURE CLINICAL PRACTICE. UROLOGY 2009; 6:135-44. [PMID: 19265855 PMCID: PMC2957872 DOI: 10.1038/ncpuro1315] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 01/19/2009] [Indexed: 12/16/2022]
Abstract
The association between aging and cancer is well exemplified by bladder cancer: with advancing age, the risk of developing bladder cancer increases, and patients' clinical presentation and outcomes worsen. Care for elderly patients with bladder cancer requires specific knowledge of many key geriatric clinical issues in order to determine optimal treatment plans. While numerous studies have tried to address the role of urologic intervention for elderly patients with bladder cancer, many studies fail to incorporate a component of true functional assessment. Evaluation tools that incorporate comorbidities, disabilities and functional status will need to be developed, as chronological age is a poor predictor of treatment outcomes. Additionally, further research is necessary to better understand the basic mechanisms that predispose elderly patients to develop this costly and life-threatening disease. This Review examines the current literature evaluating the clinical and mechanistic interactions between aging and bladder cancer, and suggests the formulation of a research agenda to address the issues raised.
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Affiliation(s)
- John A Taylor
- University of Connecticut Health Center, Farmington, CT 06030, USA.
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