1
|
Geng J, Li R, Wang X, Xu R, Liu J, Jiang H, Wang G, Hesketh T. Eliciting Older Cancer Patients' Preferences for Follow-Up Care to Inform a Primary Healthcare Follow-Up Model in China: A Discrete Choice Experiment. THE PATIENT 2024:10.1007/s40271-024-00697-4. [PMID: 38702574 DOI: 10.1007/s40271-024-00697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND OBJECTIVES Increasing longevity and advances in treatment have increased the cancer burden in the elderly, resulting in complex follow-up care needs; however, in China, little is known about the follow-up care preferences of these patients. This study quantified older cancer patients' preferences for follow-up care and examined the trade-offs they are willing to make to accept an alternative follow-up model. METHODS A discrete choice experiment was conducted among inpatients aged over 60 years with breast, prostate, or colorectal cancer, at two large tertiary hospitals in Nantong, China. Preference weights for follow-up care were estimated using mixed logit analysis. Subgroup analysis and latent class analysis were used to explore preference heterogeneity. RESULTS Complete results were obtained from 422 patients (144 with breast cancer, 133 with prostate cancer, 145 with colorectal cancer), with a mean age of 70.81 years. Older cancer patients stated a preference for follow-up by specialists over primary healthcare (PHC) providers ( β = -1.18, 95% confidence interval -1.40 to -0.97). The provider of follow-up care services was the most valued attribute among patients with breast cancer (relative importance [RI] 37.17%), while remote contact services were prioritized by patients with prostate (RI 43.50%) and colorectal cancer (RI 33.01%). The uptake rate of an alternative care model integrating PHC increased compared with the baseline setting when patients were provided with preferred services (continuity of care, individualized care plans, and remote contact services). CONCLUSION To encourage older cancer patients to use PHC-integrated follow-up care, alternative follow-up care models need to be based on patients' preferences before introducing them as a routine option.
Collapse
Affiliation(s)
- Jiawei Geng
- Center for Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Institute of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, China
| | - Ran Li
- Center for Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Insititute of Global Health, University College London, London, UK
| | - Xinyu Wang
- School of Public Health, Nantong University, Nantong, China
| | - Rongfang Xu
- Department of Nursing, Affiliated Cancer Hospital of Nantong University, Nantong, China
| | - Jibin Liu
- Institute of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, China
| | - Haiyan Jiang
- Department of Health Management, Affiliated Hospital of Nantong University, Nantong, China
| | - Gaoren Wang
- Institute of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, China.
| | - Therese Hesketh
- Center for Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China.
- Insititute of Global Health, University College London, London, UK.
| |
Collapse
|
2
|
Aleixo G, Lavelle MP, Sedhom R. Anthracyclines in Older Adults With Hodgkin Lymphoma: Too Much, Too Little? Getting it Just Right. JACC CardioOncol 2024; 6:214-216. [PMID: 38774015 PMCID: PMC11103025 DOI: 10.1016/j.jaccao.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024] Open
Affiliation(s)
- Gabriel Aleixo
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael P. Lavelle
- Department of Cardiology, Columbia University Medical Center, NewYork-Presbyterian, New York, New York, USA
| | - Ramy Sedhom
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
3
|
Leung B, Pilleron S, Bastiaannet E, Coombs LA, Jin R, Kantilal K, Kantilal K, Kenis C, Kobekyaa F, Kosmari L, Krok-Schoen JL, Li J, Mac Eochagain C, Newton L, Ruegg T, Stolz-Baskett P, Zhao Y, Bradley C, Puts M, Haase KR. Cancer treatment-related decision-making among culturally and linguistically diverse older adults with cancer: A scoping review by the International Society of Geriatric Oncology Nursing and Allied Health Interest Group. J Geriatr Oncol 2023; 14:101607. [PMID: 37633779 DOI: 10.1016/j.jgo.2023.101607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/06/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION Countries with large economies are observing a growing number of culturally and linguistically diverse (CALD) older adults, many of whom will be affected by cancer. Little is known about the experiences and factors that influence cancer treatment decision-making in this population. The purposes of this scoping review are: (1) to summarize the published literature on cancer treatment-related decision-making with this population; and (2) to identify potential differences in how cancer treatment decisions are made compared to non-CALD older adults with cancer. MATERIALS AND METHODS We conducted a scoping review following Arksey and O'Malley and Levac methods, Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review Guidelines. We conducted a comprehensive multidatabase search, screening 1,139 titles/abstracts. Following data abstraction, we analyzed the data using tabular and narrative summary. RESULTS We extracted data from six studies that met the inclusion criteria: four quantitative and two qualitative; five from the United States and one from Canada. Three themes were identified: (1) barriers to decision-making, (2) the influence of family and friends on decisionmaking, and (3) differences in uptake and types of treatment received between CALD and non-CALD older adults. DISCUSSION This comprehensive review of treatment decision-making among CALD older adults with cancer highlights the paucity of research in this area. The findings are limited to North American populations and may not represent experiences in other regions of the world. Future research should focus on studying their treatment-related decision-making experiences to improve the quality of care for this vulnerable population.
Collapse
Affiliation(s)
- Bonnie Leung
- Department of Medical Oncology, BC Cancer, Vancouver, Canada; Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, Canada.
| | - Sophie Pilleron
- Ageing, Cancer, and Disparities Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Esther Bastiaannet
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Lorinda A Coombs
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - Rana Jin
- Princess Margaret Cancer Centre, Toronto, Canada
| | - Kavita Kantilal
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Kumud Kantilal
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Cindy Kenis
- Department of General Medical Oncology and Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
| | - Francis Kobekyaa
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - Jessica L Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, USA
| | - Juan Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | | | - Lorelei Newton
- School of Nursing, University of Victoria, Victoria, Canada
| | | | - Petra Stolz-Baskett
- Institute of Nursing, Zurich University of Applied Sciences SHAW, Winterthur, Switzerland; School of Nursing, Midwifery & Health Practice, Te Herenga Waka/Victoria University of Wellington, Wellington, New Zealand
| | - Yue Zhao
- Department of General, Visceral, Tumor and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Cara Bradley
- Dr. John Archer Library, University of Regina, Regina, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Kristen R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, Canada
| |
Collapse
|
4
|
Schiaffino MK, Schumacher JR, Nalawade V, Nguyen PTN, Yakuta M, Gilbert PE, Dale W, Murphy JD, Moore AA. The disproportionate burden of Alzheimer's disease and related dementias (ADRD) in diverse older adults diagnosed with cancer. J Geriatr Oncol 2023; 14:101610. [PMID: 37666209 PMCID: PMC11086668 DOI: 10.1016/j.jgo.2023.101610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/26/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Older adults living with Alzheimer's disease and related dementias (ADRD) who are then diagnosed with cancer are an understudied population. While the role of cognitive impairment during and after cancer treatment have been well-studied, less is understood about patients who are living with ADRD and then develop cancer. The purpose of this study is to contribute evidence about our understanding of this vulnerable population. MATERIALS AND METHODS This was a retrospective cohort study of a linked, representative family of databases of cancer registries and Medicare administrative claims that make up the SEER-Medicare database. Older adults ages 68 and older with a first primary cancer type: breast, cervical, colorectal, lung, oral, or prostate were eligible for inclusion (N = 337,932). Prevalence estimates of ADRD across cancer types and a 5% non-cancer comparison sample were compared by patient factors. RESULTS The overall prevalence of patients who had an ADRD diagnosis anytime in the three years prior to their cancer diagnosis was 5.6%. Patients with ADRD were more likely to be female, older (over age 75), a racial/ethnic minority, single, with multiple chronic conditions, and a tumor diagnosed early (stage I) or were unstaged. Black patients with colorectal and oral cancer had the highest and second highest prevalence of ADRD compared to White patients (13.46% vs 7.95% and 12.64% vs 7.82% respectively, p < .0001). We observed the highest prevalence of ADRD among Black patients for breast (11.85%), cervical (11.98%), lung (8.41%), prostate (4.83), and the 5% sample (9.50%, p > .0001). DISCUSSION The higher prevalence of ADRD among Black and Latine older adults with cancer not only aligns with the trend observed in our non-cancer comparison sample, but also, these findings demonstrate the compounded risk experienced by minoritized older adults over the life course. The greater than expected prevalence of patients with ADRD who go on to develop cancer demonstrates better assessment of cognition is urgently needed. Accurate identification of these vulnerable populations is critical to improve assessment, care coordination, and address inequities in screening and treatment planning.
Collapse
Affiliation(s)
- Melody K Schiaffino
- School of Public Health, San Diego State University, San Diego, CA, USA; Center for Health Equity, Education, and Research, School of Medicine, UC San Diego, La Jolla, CA, USA; Division of Radiation Medicine and Applied Sciences, School of Medicine, UC San Diego, La Jolla, CA, USA; Division of Geriatrics, Gerontology, and Palliative Medicine, UC San Diego, CA, USA.
| | - Jessica R Schumacher
- Department of Surgery, School of Medicine, UNC Chapel Hill, Chapel Hill, NC, USA.
| | - Vinit Nalawade
- Division of Radiation Medicine and Applied Sciences, School of Medicine, UC San Diego, La Jolla, CA, USA.
| | - Phuong Thi Ngoc Nguyen
- Interdisciplinary Graduate Program in Informatics, University of Iowa, Iowa City, IA, USA.
| | - Melissa Yakuta
- San Diego Health and Human Services Agency, San Diego, CA, USA.
| | - Paul E Gilbert
- Department of Psychology, San Diego State University, San Diego, CA, USA.
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, USA.
| | - James D Murphy
- Center for Health Equity, Education, and Research, School of Medicine, UC San Diego, La Jolla, CA, USA; Division of Radiation Medicine and Applied Sciences, School of Medicine, UC San Diego, La Jolla, CA, USA.
| | - Alison A Moore
- Division of Geriatrics, Gerontology, and Palliative Medicine, UC San Diego, CA, USA.
| |
Collapse
|
5
|
Mensah ABB, Mikare M, Mensah KB, Okyere J, Amaniampong EM, Poku AA, Apiribu F, Lamptey JNC. Impact of cancer diagnosis and treatment: a qualitative analysis of strains, resources and coping strategies among elderly patients in a rural setting in Ghana. BMC Geriatr 2023; 23:540. [PMID: 37670259 PMCID: PMC10481500 DOI: 10.1186/s12877-023-04248-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 08/21/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Rurality is fraught with numerous difficulties including a lack of advanced health facilities to provide health services, and an absence of specialist cancer services, and qualified personnel, among others. These factors exacerbate the challenges of elderly patients diagnosed with cancer and further pose limitations to activities/instrumental activities of daily living. Yet, there is limited scholarship on the strains that affect elderly patients diagnosed with cancer and the resources that helps them to overcome them. This study explores the strains, resources, and coping strategies of elderly patients diagnosed with cancer and undergoing treatment in rural Ghana. METHODS An exploratory, descriptive qualitative design was adopted. Purposive sampling was used to recruit 20 individuals to participate in in-depth interviews. The collected data was analysed inductively using Collaizi's framework. QSR NVivo-12 was used in managing the data. RESULTS The results were grouped into two main categories, namely: strains and resources. Within the category of strains, three main themes with their corresponding sub-themes emerged: cancer-related strains (systemic side effects from treatment, altered physical appearance and body image, and experience of pain), elderly strains (altered functional ability, limited social interactions and participation, psycho-emotional reactions, limited/restricted economic participation, and financial strains), and health system strains (negative attitude and insensitive communication, delay in diagnosis, lack of geriatric oncology care, lack of community-based specialist cancer centre and long travel distance to access care, and limited availability of essential cancer medicines and other radiations services). Four types of resources were available to cancer patients: personal resources, family resources, community resources, and healthcare systems resources. CONCLUSION In conclusion, elderly patients diagnosed with cancer experience physical, economic, psychological, and emotional strains that threaten their health and well-being. However, they are able to leverage family, community, and health system-related resources to navigate through the strains. There is, therefore, a need to expand advanced health facilities with geriatric oncology units and specialists to improve access to cancer care in rural areas. The government needs to assist elderly persons with costs associated with their diagnosis and treatment through the expansion of the National Health Insurance Scheme to include this as part of the benefits package.
Collapse
Affiliation(s)
- Adwoa Bemah Boamah Mensah
- School of Nursing & Midwifery, College of Health Sciences, Private Mail bag, Kwame Nkrumah University of Science and Technology, University Post Office, Kumasi, Ghana.
| | - Maurice Mikare
- School of Nursing & Midwifery, College of Health Sciences, Private Mail bag, Kwame Nkrumah University of Science and Technology, University Post Office, Kumasi, Ghana
- Nursing and Midwifery Training College - Zuarungu, P. O. Box 660, Bolgatanga, Ghana
| | - Kofi Boamah Mensah
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, University Post Office, Private Mail bag, Kumasi, Ghana
| | - Joshua Okyere
- School of Nursing & Midwifery, College of Health Sciences, Private Mail bag, Kwame Nkrumah University of Science and Technology, University Post Office, Kumasi, Ghana
- Department of Population and Health, University of Cape Coast, University Post Office, Cape Coast, Ghana
| | - Er-Menan Amaniampong
- School of Nursing & Midwifery, College of Health Sciences, Private Mail bag, Kwame Nkrumah University of Science and Technology, University Post Office, Kumasi, Ghana
- Department of Sociology and Social Work, Faculty of Social Sciences, College of Humanities and Social Sciences, Kwame Nkrumah University of Science and Technology, University Post Office, Private Mail bag, Kumasi, Ghana
| | - Abena Agyekum Poku
- School of Nursing & Midwifery, College of Health Sciences, Private Mail bag, Kwame Nkrumah University of Science and Technology, University Post Office, Kumasi, Ghana
- Department of Komfo Anokye Teaching Hospital, P. O. Box, 1934, Kumasi, Ghana
| | - Felix Apiribu
- School of Nursing & Midwifery, College of Health Sciences, Private Mail bag, Kwame Nkrumah University of Science and Technology, University Post Office, Kumasi, Ghana
| | - Joe-Nat Clegg Lamptey
- Department of Surgery, University of Ghana Medical School, University of Ghana, Accra, Ghana
- Korle-Bu Teaching Hospital, Accra, Ghana
| |
Collapse
|
6
|
Galvin A, Amadéo B, Frasca M, Soubeyran P, Rondeau V, Delva F, Pérès K, Coureau G, Helmer C, Mathoulin-Pélissier S. Association between pre-diagnosis geriatric syndromes and overall survival in older adults with cancer (the INCAPAC study). J Geriatr Oncol 2023; 14:101539. [PMID: 37320933 DOI: 10.1016/j.jgo.2023.101539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/25/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Several population-based studies have reported disparities in overall survival (OS) among older patients with cancer. However, geriatric syndromes, known to be associated with OS in the geriatric population, were rarely studied. Thus, our aim was to identify the determinants of OS among French older adults with cancer, including geriatric syndromes before cancer diagnosis. MATERIALS AND METHODS Using cancer registries, we identified older subjects (≥65 years) with cancer in three French prospective cohort studies on aging from the Gironde department. Survival time was calculated from the date of diagnosis to the date of all-cause death or to the date of last follow-up, whichever came first. Demographic and socioeconomic characteristics, smoking status, self-rated health, cancer-related factors (stage at diagnosis, treatment), as well as geriatric syndromes (polypharmacy, activity limitation, depressive symptomatology, and cognitive impairment or dementia) were studied. Analyses were performed using Cox proportional hazard models for the whole population, then by age group (65-84 and 85+). RESULTS Among the 607 subjects included in the study, the median age at cancer diagnosis was 84 years. Smoking habits, activity limitations, cognitive impairment or dementia, advanced cancer stage and absence of treatment were significantly associated with lower OS in the analysis including the whole population. Women presented higher OS. Factors associated with OS differed by age group. Polypharmacy was inversely associated with OS in older adults aged 65-84 and 85 + . DISCUSSION Our findings support that geriatric assessment is needed to identify patients at higher risk of death and that an evaluation of activity limitation in older adults is essential. Improving early detection could enable interventions to address factors (activity limitations, cognitive impairment) associated with OS, potentially reducing disparities and lead to earlier palliative care.
Collapse
Affiliation(s)
- Angéline Galvin
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France.
| | - Brice Amadéo
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France
| | - Matthieu Frasca
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France
| | - Pierre Soubeyran
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Vinco team, UMR 1218, Bordeaux F-33000, France
| | - Virginie Rondeau
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Biostatistics team, UMR 1219, Bordeaux F-33000, France
| | - Fleur Delva
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France; Department of Public Health, Bordeaux University Hospital, Bordeaux F-3300, France
| | - Karine Pérès
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Sepia team, UMR 1219, Bordeaux F-33000, France
| | - Gaëlle Coureau
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France; Department of Public Health, Bordeaux University Hospital, Bordeaux F-3300, France
| | - Catherine Helmer
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Leha team, UMR 1219, Bordeaux F-33000, France
| | - Simone Mathoulin-Pélissier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France; Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonie, Comprehensive Cancer Center, Bordeaux F-33000, France
| |
Collapse
|
7
|
Viteri Malone MA, Cabrera Chien L, Pergolotti M, Canin B, Battisti NML, Krok-Schoen JL, Kaur A, BrintzenhofeSzoc K, Plotkin E, Boehmer LM, Shahrokni A. Evolving oncology care for older adults: Trends in telemedicine use after one year of caring for older adults with cancer during COVID-19. J Geriatr Oncol 2023; 14:101497. [PMID: 37328358 PMCID: PMC10264234 DOI: 10.1016/j.jgo.2023.101497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 03/06/2023] [Accepted: 03/31/2023] [Indexed: 06/18/2023]
Affiliation(s)
| | | | | | - Beverly Canin
- Cancer and Aging Research Group Author Institution is Unverified, USA
| | | | | | | | | | | | | | | |
Collapse
|
8
|
The Role of Nurse on the Treatment Decision Support for Older People with Cancer: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11040546. [PMID: 36833079 PMCID: PMC9956907 DOI: 10.3390/healthcare11040546] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Background: The number of older adults with cancer is increasing worldwide. The role of nurses in supporting patients' decision-making is expanding, as this process is fraught with complexity and uncertainty due to comorbidities, frailty, cognitive decline, etc., in older adults with cancer. The aim of this review was to examine the contemporary roles of oncology nurses in the treatment decision-making process in older adults with cancer. Methods: A systematic review of PubMed, CINAHL, and PsycINFO databases was conducted in accordance with PRISMA guidelines. Results: Of the 3029 articles screened, 56 full texts were assessed for eligibility, and 13 were included in the review. We identified three themes regarding nurses' roles in the decision-making process for older adults with cancer: accurate geriatric assessments, provision of available information, and advocacy. Nurses conduct geriatric assessments to identify geriatric syndromes, provide appropriate information, elicit patient preferences, and communicate efficiently with patients and caregivers, promoting physicians. Time constraints were cited as a barrier to fulfilling nurses' roles. Conclusions: The role of nurses is to elicit patients' broader health and social care needs to facilitate patient-centered decision-making, respecting their preferences and values. Further research focusing on the role of nurses that considers diverse cancer types and healthcare systems is needed.
Collapse
|
9
|
An evaluation of the Index4 tool for chemotherapy toxicity prediction in cancer patients older than 70 years old. Sci Rep 2023; 13:1082. [PMID: 36658198 PMCID: PMC9852555 DOI: 10.1038/s41598-023-28309-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Chemotherapy, although beneficial for improving outcomes in both localized and metastatic cancers, may be associated with significant adverse effects, especially for patients with decreased functional reserves. Prediction of patients who will not tolerate well chemotherapy treatment may help in modifying treatment plans and in reallocating resources to vulnerable patients. One hundred seventeen consecutive cancer patients over the age of 70 scheduled for chemotherapy treatment in a single cancer center were included in the study. Prediction of adverse chemotherapy outcomes were calculated using a prediction tool proposed and validated from the Cancer and Aging Research Group (CARG) and a prediction tool proposed by us, called Index4. The 2 tools were compared for their ability to predict grade 3 and 4 toxicities, Emergency Department (ED) and hospital admissions and chemotherapy discontinuation. The accuracy of both predictive tools was suboptimal. A high CARG score had a sensitivity of 46.3% and a specificity of 82% and an Index4 of 1 or above had a sensitivity of 53.7% and a specificity of 60% in predicting grade 3-4 adverse effects. The performance of the 2 tools in predicting ED and hospital admissions and chemotherapy discontinuation was comparable. An Index4 score of 0 was superior in predicting absence of grade 3-4 toxicities than a low CARG score (p = 0.002, McNemar's test). The CARG tool for chemotherapy adverse effect prediction in geriatric cancer patients and the Index4 were able to predict adverse outcomes with moderate accuracy. Given its ease of calculation Index4 may be an alternative to CARG tool, suitable for a busy oncology practice.
Collapse
|
10
|
Lee W, Cheng SJ, Grant SJ, Marcum ZA, Devine B. Use of geriatric assessment in cancer clinical trials: A systematic review. J Geriatr Oncol 2022; 13:907-913. [PMID: 35550351 PMCID: PMC10129289 DOI: 10.1016/j.jgo.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/17/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Older adults are underrepresented in cancer clinical trials despite accounting for most of the disease burden. Geriatric assessment (GA) could be used in clinical trials of cancer drugs for older adults to improve the clinical evidence for cancer drug use among older adults. OBJECTIVE To examine patterns of use of GA in cancer clinical trials. METHODS We undertook a systematic review of the studies reporting use of GA in a clinical trial setting for all cancer types and published between January 2010 and January 2020. Characteristics of GA use were extracted for each study, along with study phase, cancer type, and participant age (PROSPERO: CRD42020170584). RESULTS We identified 320 studies and 63 studies met the final inclusion criteria. Among 74 purposes of GA use, the most common was to examine the association between impairments in GA domains and clinical outcomes (28/74, 38%). Among 258 GA domains assessed across 63 studies, physical status (59/258, 23%) and comorbidities (50/258, 19%) were most often evaluated. There was significant heterogeneity in the instruments used to assess physical function (n = 16) and mood disorders (n = 7). Most studies were phase 2 (32/63, 51%). CONCLUSIONS GA is most often used in clinical trial settings to examine associations between GA-identified deficits and clinical outcomes. Significant heterogeneity exists in the GA instruments used across trials. Comprehensive and consistent incorporation of GA into future cancer clinical trial designs could help collect more older adult-specific clinical information and adjust trial eligibility criteria to increase representation by older adults.
Collapse
Affiliation(s)
- Woojung Lee
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, USA.
| | - Spencer J Cheng
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, USA
| | - Shakira J Grant
- Department of Medicine, Division of Hematology, The University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, USA
| | - Zachary A Marcum
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, USA
| | - Beth Devine
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, USA
| |
Collapse
|
11
|
Zuccarino S, Monacelli F, Antognoli R, Nencioni A, Monzani F, Ferrè F, Seghieri C, Antonelli Incalzi R. Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review. Cancers (Basel) 2022; 14:cancers14133235. [PMID: 35805005 PMCID: PMC9265029 DOI: 10.3390/cancers14133235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary The Comprehensive Geriatric Assessment is a multidimensional and multidisciplinary evaluation designed for elderly patients with the goal of structuring tailored care and follow-up. Despite the known benefits of this approach, the Comprehensive Geriatric Assessment is not universally applied to elderly cancer patients due to economic and practical barriers. This narrative review aims to investigate the cost-effectiveness of the Comprehensive Geriatric Assessment adopted in geriatric oncology. The results revealed a lack of research on the topic, but recurrent cost-saving effects of this approach in geriatric oncology settings were highlighted—suggesting a positive cost-effectiveness ratio. Further structured research with comprehensive economic evaluations is needed to confirm these findings. Abstract The Comprehensive Geriatric Assessment (CGA) and the corresponding geriatric interventions are beneficial for community-dwelling older persons in terms of reduced mortality, disability, institutionalisation and healthcare utilisation. However, the value of CGA in the management of older cancer patients both in terms of clinical outcomes and in cost-effectiveness remains to be fully established, and CGA is still far from being routinely implemented in geriatric oncology. This narrative review aims to analyse the available evidence on the cost-effectiveness of CGA adopted in geriatric oncology, identify the relevant parameters used in the literature and provide recommendations for future research. The review was conducted using the PubMed and Cochrane databases, covering published studies without selection by the publication year. The extracted data were categorised according to the study design, participants and measures of cost-effectiveness, and the results are summarised to state the levels of evidence. The review conforms to the SANRA guidelines for quality assessment. Twenty-nine studies out of the thirty-seven assessed for eligibility met the inclusion criteria. Although there is a large heterogeneity, the overall evidence is consistent with the measurable benefits of CGA in terms of reducing the in-hospital length of stay and treatment toxicity, leaning toward a positive cost-effectiveness of the interventions and supporting CGA implementation in geriatric oncology clinical practice. More research employing full economic evaluations is needed to confirm this evidence and should focus on CGA implications both from patient-centred and healthcare system perspectives.
Collapse
Affiliation(s)
- Sara Zuccarino
- Management and Health Laboratory, Institute of Management–Department Embeds, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy; (F.F.); (C.S.)
- Correspondence: (S.Z.); (F.M.); (R.A.I.)
| | - Fiammetta Monacelli
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, 16132 Genoa, Italy; (F.M.); (A.N.)
- IRCSS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Rachele Antognoli
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, 56126 Pisa, Italy;
| | - Alessio Nencioni
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, 16132 Genoa, Italy; (F.M.); (A.N.)
- IRCSS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, 56126 Pisa, Italy;
- Correspondence: (S.Z.); (F.M.); (R.A.I.)
| | - Francesca Ferrè
- Management and Health Laboratory, Institute of Management–Department Embeds, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy; (F.F.); (C.S.)
| | - Chiara Seghieri
- Management and Health Laboratory, Institute of Management–Department Embeds, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy; (F.F.); (C.S.)
| | - Raffaele Antonelli Incalzi
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University, 00128 Rome, Italy
- Correspondence: (S.Z.); (F.M.); (R.A.I.)
| |
Collapse
|
12
|
Letica-Kriegel AS, Tin AL, Nash GM, Benfante NE, McNeil N, Vickers AJ, Bochner B, Donat SM, Goh A, Dalbagni G, Donahue T, Cha EK, Pietzak E, Herr H, Korc-Grodzicki B, Shahrokni A. Feasibility of a geriatric comanagement (GERICO) pilot program for patients 75 and older undergoing radical cystectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1427-1432. [DOI: 10.1016/j.ejso.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
|
13
|
Okawa S, Tabuchi T, Nakata K, Morishima T, Koyama S, Odani S, Miyashiro I. Surgical volume threshold to improve 3-year survival in designated cancer care hospitals in 2004-2012 in Japan. Cancer Sci 2022; 113:1047-1056. [PMID: 34985172 PMCID: PMC8898718 DOI: 10.1111/cas.15264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 12/12/2022] Open
Abstract
In Japan, cancer care hospitals designated by the national government have a surgical volume requirement of 400 annually, which is not necessarily defined based on patient outcomes. This study aimed to estimate surgical volume thresholds that ensure optimal 3‐year survival for three periods. In total, 186 965 patients who had undergone surgery for solid cancers in 66 designated cancer care hospitals in Osaka between 2004 and 2012 were examined using data from a population‐based cancer registry. These hospitals were categorized by the annual surgical volume of each 50 surgeries (eg, 0‐49, 50‐99, and so on). Using multivariable Cox proportional hazard regression, we estimated the adjusted 3‐year survival probability per surgical volume category for 2004‐2006, 2007‐2009, and 2010‐2012. Using the joinpoint regression model that computes inflection points in a linear relationship, we estimated the points at which the trend of the association between surgical volume and survival probability changes, defining them as surgical volume thresholds. The adjusted 3‐year survival ranges were 71.7%‐90.0%, 68.2%‐90.0%, and 79.2%‐90.3% in 2004‐2006, 2007‐2009, and 2010‐2012, respectively. The surgical volume thresholds were identified at 100‐149 in 2004‐2006 and 2007‐2009 and 200‐249 in 2010‐2012. The extents of change in the adjusted 3‐year survival probability per increase of 50 surgical volumes were +4.00%, +6.88%, and +1.79% points until the threshold and +0.41%, +0.30%, and +0.11% points after the threshold in 2004‐2006, 2007‐2009, and 2010‐2012, respectively. The existing surgical volume requirements met our estimated thresholds. Surgical volume thresholds based on the association with patient survival may be used as a reference to validate the surgical volume requirement.
Collapse
Affiliation(s)
- Sumiyo Okawa
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan.,Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Kayo Nakata
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | - Shihoko Koyama
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Satomi Odani
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| |
Collapse
|
14
|
Brautigam L, Hill NL. Promoting Cognitive Health in Older Adult Cancer Survivors. J Gerontol Nurs 2022; 48:2-4. [PMID: 34978497 DOI: 10.3928/00989134-20211206-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Nikki L Hill
- Ross and Carol Nese College of Nursing Carol A. Nese Early Career Professor in Nursing, Associate Director, Center of Geriatric Nursing Excellence The Pennsylvania State University University Park, Pennsylvania
| |
Collapse
|
15
|
Poruk KE, Shahrokni A, Brennan MF. Surgical resection for intraductal papillary mucinous neoplasm in the older population. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 48:1293-1299. [PMID: 34887167 PMCID: PMC10091239 DOI: 10.1016/j.ejso.2021.12.001] [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: 07/31/2021] [Revised: 10/27/2021] [Accepted: 12/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgery for intraductal papillary mucinous neoplasm (IPMN) in older adults requires a careful balance of risk and benefit. We sought to analyze patient outcomes in the older individuals after pancreatic resection for IPMN. METHODS Retrospective analysis of a prospectively maintained database was performed for patients 65 years or older undergoing IPMN resection between January 1, 2012 and December 31, 2017. Statistical analysis was performed based on age and Memorial Sloan Kettering Frailty Index (MSKFI) score. RESULTS 148 patients underwent resection of an IPMN, including five patients who required two operations for recurrent disease. Median age at surgery was 74 (range, 65-90 years), and 52% were male. Most patients underwent pancreaticoduodenectomy (53%) or distal pancreatectomy/splenectomy (35%). An associated adenocarcinoma was seen on pathology for 56 patients (37%). Median hospital length of stay was 7 days (range, 4-46 days). Grade 3 or higher post-operative complications on the Clavien-Dindo classification scale were seen in 20%. No patient died within 30-days. Patient outcomes were evaluated by age, split at age ≥75 (considered "elderly"), and separately by MSKFI score. No differences in post-operative morbidity or mortality was seen when stratified by age (65 - 74 vs > 75 years) or by MSKFI frailty score. CONCLUSION Pancreatic resection can be safely performed in selected patients 65 years and older with low morbidity and mortality. More analysis is needed to determine if MSKFI score is a useful predictor of complications in older individuals.
Collapse
Affiliation(s)
- Katherine E Poruk
- Department of Surgery, The Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA.
| | - Armin Shahrokni
- Department of Geriatrics, The Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA.
| | - Murray F Brennan
- Department of Surgery, The Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| |
Collapse
|
16
|
Mohamed MR, Kyi K, Mohile SG, Xu H, Culakova E, Loh KP, Flannery M, Obrecht S, Ramsdale E, Patil A, Dunne RF, DiGiovanni G, Hezel A, Burnette B, Desai N, Giguere J, Magnuson A. Prevalence of and factors associated with treatment modification at first cycle in older adults with advanced cancer receiving palliative treatment. J Geriatr Oncol 2021; 12:1208-1213. [PMID: 34272204 DOI: 10.1016/j.jgo.2021.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/09/2021] [Accepted: 06/18/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Treatment toxicities are common in older adults with cancer and consequently, treatment modifications are sometimes considered. We evaluated the prevalence and factors associated with treatment modifications at the first cycle in older patients receiving palliative systemic treatment. METHODS Patients (n = 369) from the GAP 70+ Trial (NCT02054741; PI: Mohile) usual care arm were included. Enrolled patients were aged 70+ with advanced cancer and ≥ 1 Geriatric Assessment (GA) domain impairment. Treatment modification was defined as any change from National Comprehensive Cancer Network guidelines or published clinical trials. Baseline variables included: 1) sociodemographic factors; 2) clinical variables; 3) GA domains; and 4) physician beliefs about life expectancy. Bivariate analyses and multivariable cluster-weighted generalized estimating equation model were conducted to assess the association of baseline variables with cycle 1 treatment modifications. RESULTS Mean age was 77.2 years (range: 70-94); 62% had lung or gastrointestinal cancers, and 35% had treatment modifications at cycle 1. Increasing age by one year (odds ratio (OR) 1.1, 95% confidence interval [CI] 1.0-1.2), receipt of ≥second line of chemotherapy (OR 1.8, CI 1.1-3.0), functional impairment (OR 1.6, CI 1.1-2.3) and income ≤$50,000 (OR 1.7, CI 1.1-2.4) were independently associated with a higher likelihood of cycle 1 treatment modification. CONCLUSION Treatment modifications occurred in 35% of older adults with advanced cancer at cycle 1. Increasing age, receipt of ≥second line of chemotherapy, functional impairment, and lower income were independently associated with treatment modifications. These findings emphasize the need for evidence-based regimens in older adults with cancer and GA impairments.
Collapse
Affiliation(s)
- Mostafa R Mohamed
- James P Wilmot Cancer Institute, University of Rochester, New York, USA; Department of Public Health Sciences, University of Rochester, New York, USA
| | - Kaitlin Kyi
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Supriya G Mohile
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Huiwen Xu
- Department of Surgery, Cancer Control, University of Rochester, New York, USA
| | - Eva Culakova
- Department of Surgery, Cancer Control, University of Rochester, New York, USA
| | - Kah Poh Loh
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Marie Flannery
- School of Nursing, University of Rochester, New York, USA
| | - Spencer Obrecht
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Erika Ramsdale
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Amita Patil
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Richard F Dunne
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Grace DiGiovanni
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Aram Hezel
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Brian Burnette
- Cancer Research of Wisconsin and Northern Michigan, NCORP, USA
| | | | | | - Allison Magnuson
- James P Wilmot Cancer Institute, University of Rochester, New York, USA.
| |
Collapse
|
17
|
Chesney TR, Coburn N, Mahar AL, Davis LE, Zuk V, Zhao H, Hsu AT, Wright F, Haas B, Hallet J. All-Cause and Cancer-Specific Death of Older Adults Following Surgery for Cancer. JAMA Surg 2021; 156:e211425. [PMID: 33978695 PMCID: PMC8117065 DOI: 10.1001/jamasurg.2021.1425] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/14/2021] [Indexed: 12/30/2022]
Abstract
Importance Cancer care has inherent complexities in older adults, including balancing risks of cancer and noncancer death. A poor understanding of cause-specific outcomes may lead to overtreatment and undertreatment. Objective To examine all-cause and cancer-specific death throughout 5 years for older adults after cancer resection. Design, Setting, and Participants This population-based cohort study was conducted in Ontario, Canada, using the administrative databases stored at ICES (formerly the Institute for Clinical Evaluative Sciences). All adults 70 years or older who underwent resection for a new diagnosis of cancer between January 1, 2007, and December 31, 2017, were included. Patients were followed up until death or censored at date of last contact of December 31, 2018. Exposures Cancer resection. Main Outcome and Measures Using a competing risks approach, the cumulative incidence of cancer and noncancer death was estimated and stratified by important prognostic factors. Multivariable subdistribution hazard models were fit to explore prognostic factors. Results Of 82 037 older adults who underwent surgery (all older than 70 years; 52 119 [63.5%] female), 16 900 of 34 044 deaths (49.6%) were cancer related at a median (interquartile range) follow-up of 46 (23-80) months. At 5 years, estimated cumulative incidence of cancer death (20.7%; 95% CI, 20.4%-21.0%) exceeded noncancer death (16.5%; 95% CI, 16.2%-16.8%) among all patients. However, noncancer deaths exceeded cancer deaths starting at 3 years after surgery in breast, prostate, and melanoma skin cancers, patients older than 85 years, and those with frailty. Cancer type, advancing age, and frailty were independently associated with cause-specific death. Conclusions and Relevance At the population level, the relative burden of cancer deaths exceeds noncancer deaths for older adults selected for surgery. No subgroup had a higher burden of noncancer death early after surgery, even in more vulnerable patients. This cause-specific overall prognosis information should be used for patient counseling, to assess patterns of over- or undertreatment in older adults with cancer at the system level, and to guide targets for system-level improvements to refine selection criteria and perioperative care pathways for older adults with cancer.
Collapse
Affiliation(s)
- Tyler R. Chesney
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, St Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Natalie Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, Sunnybrook Health Sciences Centre–Odette Cancer Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Alyson L. Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Victoria Zuk
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Amy T. Hsu
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Frances Wright
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, Sunnybrook Health Sciences Centre–Odette Cancer Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Barbara Haas
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, Sunnybrook Health Sciences Centre–Odette Cancer Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, Sunnybrook Health Sciences Centre–Odette Cancer Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| |
Collapse
|
18
|
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: 1.7] [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
| | | | | |
Collapse
|
19
|
Afonso AM, Sastow D, Cadwell JB, Downey RJ, Fischer GW, Shahrokni A. Intraoperative haemodynamics and postoperative intensive care unit admission in older patients with cancer. J Perioper Pract 2021; 32:301-309. [PMID: 34134558 DOI: 10.1177/17504589211012351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Research on the impact of various intraoperative haemodynamic variables on the incidence of postoperative ICU admission among older patients with cancer is limited. In this study, the relationship between intraoperative haemodynamic status and postoperative intensive care unit admission among older patients with cancer is explored. METHODS Patients aged ≥75 who underwent elective oncologic surgery lasting ≥120min were analysed. Chi-squared and t-tests were used to assess the associations between intraoperative variables with postoperative intensive care unit admission. Multivariable regressions were used to analyse potential predict risk factors for postoperative intensive care unit admission. RESULTS Out of 994 patients, 48 (4.8%) were admitted to the intensive care unit within 30 days following surgery. Intensive care unit admission was associated with the presence of ≥4 comorbid conditions, intraoperative blood loss ≥100mL, and intraoperative tachycardia and hypertensive urgency. On multivariable analysis, operation time ≥240min (Odds Ratio [OR] = 2.29, p = 0.01), and each minute spent with intraoperative hypertensive urgency (OR = 1.06, p = 0.01) or tachycardia (OR = 1.01, p = 0.002) were associated with postoperative intensive care unit admission. CONCLUSION Intraoperative hypertensive urgency and tachycardia were associated with postoperative intensive care unit admission in older patients undergoing cancer surgery.
Collapse
Affiliation(s)
- Anoushka M Afonso
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Dahniel Sastow
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Joshua B Cadwell
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Robert J Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Gregory W Fischer
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Armin Shahrokni
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| |
Collapse
|
20
|
Galica J, Liu Z, Kain D, Merchant S, Booth C, Koven R, Brundage M, Haase KR. Coping during COVID-19: a mixed methods study of older cancer survivors. Support Care Cancer 2021; 29:3389-3398. [PMID: 33404813 PMCID: PMC7786158 DOI: 10.1007/s00520-020-05929-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Older cancer survivors are among the most vulnerable to the negative effects of COVID-19 and may need specific survivorship supports that are unavailable/restricted during the pandemic. The objective of this study was to explore how older adults (≥ 60 years) who were recently (≤ 12 months) discharged from the care of their cancer team were coping during the pandemic. METHODS We used a convergent mixed method design (QUAL+quan). Quantitative data were collected using the Brief-COPE questionnaire. Qualitative data were collected using telephone interviews to explore experiences and strategies for coping with cancer-related concerns. RESULTS The mean sample age (n = 30) was 72.1 years (SD 5.8, range 63-83) of whom 57% identified as female. Participants' Brief-COPE responses indicated that they commonly used acceptance (n = 29, 96.7%), self-distraction (n = 28, 93.3%), and taking action (n = 28, 93.3%) coping strategies. Through our descriptive thematic analysis, we identified three themes: (1) drawing on lived experiences, (2) redeploying coping strategies, and (3) complications of cancer survivorship in a pandemic. Participants' coping strategies were rooted in experiences with cancer, other illnesses, life, and work. Using these strategies during the pandemic was not new-they were redeployed and repurposed-although using them during the pandemic was sometimes complicated. These data were converged to maximize interpretation of the findings. CONCLUSIONS Study findings may inform the development or enhancement of cancer and non-cancer resources to support coping, particularly using remote delivery methods within and beyond the pandemic. Clinicians can engage a strengths-based approach to support older cancer survivors as they draw from their experiences, which contain a repository of potential coping skills.
Collapse
Affiliation(s)
- Jacqueline Galica
- School of Nursing, Queen's University, Kingston, Canada.
- Division of Cancer Care & Epidemiology, Queen's Cancer Research Institute, Kingston, Canada.
| | - Ziwei Liu
- School of Nursing, Queen's University, Kingston, Canada
| | - Danielle Kain
- Division of Palliative Medicine, Departments of Medicine and Oncology, School of Medicine, Queen's University, Kingston, Canada
| | - Shaila Merchant
- Division of General Surgery and Surgical Oncology, Queen's University, Kingston, Canada
| | - Christopher Booth
- Division of Cancer Care & Epidemiology, Queen's Cancer Research Institute, Kingston, Canada
- Cancer Centre of Southeastern Ontario, Kingston, Canada
- Department of Oncology, School of Medicine, Queen's University, Kingston, Canada
| | - Rachel Koven
- Division of Cancer Care & Epidemiology, Queen's Cancer Research Institute, Kingston, Canada
| | - Michael Brundage
- Division of Cancer Care & Epidemiology, Queen's Cancer Research Institute, Kingston, Canada
- Cancer Centre of Southeastern Ontario, Kingston, Canada
- Department of Oncology, School of Medicine, Queen's University, Kingston, Canada
- Department of Public Health Sciences, School of Medicine, Queen's University, Kingston, Canada
| | - Kristen R Haase
- School of Nursing, Faculty of Applied Science, The University of British Columbia, Vancouver, Canada
| |
Collapse
|
21
|
Chua IS, Gaziel-Yablowitz M, Korach ZT, Kehl KL, Levitan NA, Arriaga YE, Jackson GP, Bates DW, Hassett M. Artificial intelligence in oncology: Path to implementation. Cancer Med 2021; 10:4138-4149. [PMID: 33960708 PMCID: PMC8209596 DOI: 10.1002/cam4.3935] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/21/2022] Open
Abstract
In recent years, the field of artificial intelligence (AI) in oncology has grown exponentially. AI solutions have been developed to tackle a variety of cancer‐related challenges. Medical institutions, hospital systems, and technology companies are developing AI tools aimed at supporting clinical decision making, increasing access to cancer care, and improving clinical efficiency while delivering safe, high‐value oncology care. AI in oncology has demonstrated accurate technical performance in image analysis, predictive analytics, and precision oncology delivery. Yet, adoption of AI tools is not widespread, and the impact of AI on patient outcomes remains uncertain. Major barriers for AI implementation in oncology include biased and heterogeneous data, data management and collection burdens, a lack of standardized research reporting, insufficient clinical validation, workflow and user‐design challenges, outdated regulatory and legal frameworks, and dynamic knowledge and data. Concrete actions that major stakeholders can take to overcome barriers to AI implementation in oncology include training and educating the oncology workforce in AI; standardizing data, model validation methods, and legal and safety regulations; funding and conducting future research; and developing, studying, and deploying AI tools through multidisciplinary collaboration.
Collapse
Affiliation(s)
- Isaac S Chua
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michal Gaziel-Yablowitz
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Zfania T Korach
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kenneth L Kehl
- Harvard Medical School, Boston, MA, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Gretchen P Jackson
- IBM Watson Health, Cambridge, MA, USA.,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael Hassett
- Harvard Medical School, Boston, MA, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
22
|
Saldivar RT, Tew WP, Shahrokni A, Nelson J. Goals of care conversations and telemedicine. J Geriatr Oncol 2021; 12:995-999. [PMID: 33619000 DOI: 10.1016/j.jgo.2021.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/11/2021] [Indexed: 11/16/2022]
Abstract
Rapid expansion of telemedicine is one of the transformative healthcare consequences of the COVID pandemic. As a result, telemedicine has allowed clinicians to address the needs of older adults with cancer, who faced the highest risks from COVID, while maintaining safety at home. In light of the COVID experience, which is an important source of learning, this article provides guidance on approaches to enhance telemedicine-enabled supportive care for the geriatric cancer patient.
Collapse
Affiliation(s)
| | - William P Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Armin Shahrokni
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Judith Nelson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
23
|
Skaansar O, Tverdal C, Rønning PA, Skogen K, Brommeland T, Røise O, Aarhus M, Andelic N, Helseth E. Traumatic brain injury-the effects of patient age on treatment intensity and mortality. BMC Neurol 2020; 20:376. [PMID: 33069218 PMCID: PMC7568018 DOI: 10.1186/s12883-020-01943-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/29/2020] [Indexed: 12/21/2022] Open
Abstract
Background Ageing is associated with worse treatment outcome after traumatic brain injury (TBI). This association may lead to a self-fulfilling prophecy that affects treatment efficacy. The aim of the current study was to evaluate the role of treatment bias in patient outcomes by studying the intensity of diagnostic procedures, treatment, and overall 30-day mortality in different age groups of patients with TBI. Methods Included in this study was consecutively admitted patients with TBI, aged ≥ 15 years, with a cerebral CT showing intracranial signs of trauma, during the time-period between 2015–2018. Data were extracted from our prospective quality control registry for admitted TBI patients. As a measure of management intensity in different age groups, we made a composite score, where placement of intracranial pressure monitor, ventilator treatment, and evacuation of intracranial mass lesion each gave one point. Uni- and multivariate survival analyses were performed using logistic multinomial regression. Results A total of 1,571 patients with TBI fulfilled the inclusion criteria. The median age was 58 years (range 15–98), 70% were men, and 39% were ≥ 65 years. Head injury severity was mild in 706 patients (45%), moderate in 437 (28%), and severe in 428 (27%). Increasing age was associated with less management intensity, as measured using the composite score, irrespective of head injury severity. Multivariate analyses showed that the following parameters had a significant association with an increased risk of death within 30 days of trauma: increasing age, severe comorbidities, severe TBI, Rotterdam CT-score ≥ 3, and low management intensity. Conclusion The present study indicates that the management intensity of hospitalised patients with TBI decreased with advanced age and that low management intensity was associated with an increased risk of 30-day mortality. This suggests that the high mortality among elderly TBI patients may have an element of treatment bias and could in the future be limited with a more aggressive management regime.
Collapse
Affiliation(s)
- Ola Skaansar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Cathrine Tverdal
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | | | - Karoline Skogen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Tor Brommeland
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Olav Røise
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Mads Aarhus
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Eirik Helseth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
24
|
Shahrokni A, Vishnevsky BM, Jang B, Sarraf S, Alexander K, Kim SJ, Downey R, Afonso A, Korc-Grodzicki B. Geriatric Assessment, Not ASA Physical Status, Is Associated With 6-Month Postoperative Survival in Patients With Cancer Aged ≥75 Years. J Natl Compr Canc Netw 2020; 17:687-694. [PMID: 31200361 DOI: 10.6004/jnccn.2018.7277] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/17/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The American Society of Anesthesiologists physical status (ASA PS) classification system is the most common method of assessing preoperative functional status. Comprehensive geriatric assessment (CGA) has been proposed as a supplementary tool for preoperative assessment of older adults. The goal of this study was to assess the correlation between ASA classification and CGA deficits among oncogeriatric patients and to determine the association of each with 6-month survival. PATIENTS AND METHODS Oncogeriatric patients (aged ≥75 years) who underwent preoperative CGA in an outpatient geriatric clinic at a single tertiary comprehensive cancer center were identified. All patients underwent surgery, with a hospital length of stay (LOS) ≥1 day and at least 6 months of follow-up. ASA classifications were obtained from preoperative anesthesiology notes. Preoperative CGA scores ranged from 0 to 13. Six-month survival was assessed using the Social Security Death Index. RESULTS In total, 81 of the 980 patients (8.3%) included in the study cohort died within 6 months of surgery. Most patients were classified as ASA PS III (85.4%). The mean number of CGA deficits for patients with PS II was 4.03, PS III was 5.15, and PS IV was 6.95 (P<.001). ASA classification was significantly associated with age, preoperative albumin level, hospital LOS, and 30-day intensive care unit (ICU) admissions. On multivariable analysis, 6-month mortality was associated with number of CGA deficits (odds ratio [OR], 1.14 per each unit increase in CGA score; P=.01), 30-day ICU admissions (OR, 2.77; P=.003), hospital LOS (OR, 1.03; P=.02), and preoperative albumin level (OR, 0.36; P=.004). ASA classification was not associated with 6-month mortality. CONCLUSIONS Number of CGA deficits was strongly associated with 6-month mortality; ASA classification was not. Preoperative CGA elicits critical information that can be used to enhance the prediction of postoperative outcomes among older patients with cancer.
Collapse
Affiliation(s)
- Armin Shahrokni
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Brian Jang
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Saman Sarraf
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Koshy Alexander
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Soo Jung Kim
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Anoushka Afonso
- Department of Anesthesiology & Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Beatriz Korc-Grodzicki
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
25
|
Haase K, Drury A, Puts M. Supportive Care and eHealth: A Narrative Review of Technologies, Interventions, and Opportunities for Optimizing Care in Patients With Cancer. Clin J Oncol Nurs 2020; 24:32-41. [DOI: 10.1188/20.cjon.s1.32-41] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
26
|
Liu J, Gutierrez E, Tiwari A, Padam S, Li D, Dale W, Pal SK, Stewart D, Subbiah S, Bosserman LD, Presant C, Phillips T, Yap K, Hill A, Bhatt G, Yeon C, Cianfrocca M, Yuan Y, Mortimer J, Sedrak MS. Strategies to Improve Participation of Older Adults in Cancer Research. J Clin Med 2020; 9:jcm9051571. [PMID: 32455877 PMCID: PMC7291007 DOI: 10.3390/jcm9051571] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 02/02/2023] Open
Abstract
Cancer is a disease associated with aging. As the US population ages, the number of older adults with cancer is projected to dramatically increase. Despite this, older adults remain vastly underrepresented in research that sets the standards for cancer treatments and, consequently, clinicians struggle with how to interpret data from clinical trials and apply them to older adults in practice. A combination of system, clinician, and patient barriers bar opportunities for trial participation for many older patients, and strategies are needed to address these barriers at multiple fronts, five of which are offered here. This review highlights the need to (1) broaden eligibility criteria, (2) measure relevant end points, (3) expand standard trial designs, (4) increase resources (e.g., institutional support, interdisciplinary care, and telehealth), and (5) develop targeted interventions (e.g., behavioral interventions to promote patient enrollment). Implementing these solutions requires a substantial investment in engaging and collaborating with community-based practices, where the majority of older patients with cancer receive their care. Multifaceted strategies are needed to ensure that older patients with cancer, across diverse healthcare settings, receive the highest-quality, evidence-based care.
Collapse
Affiliation(s)
- Jennifer Liu
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Eutiquio Gutierrez
- Department of Internal Medicine, Harbor-UCLA Medical Center, Los Angeles, CA 90502, USA;
| | - Abhay Tiwari
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Simran Padam
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, CA 91010, USA;
| | - Sumanta K. Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Daphne Stewart
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Shanmugga Subbiah
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Linda D. Bosserman
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Cary Presant
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Tanyanika Phillips
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Kelly Yap
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Addie Hill
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Geetika Bhatt
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Christina Yeon
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Mary Cianfrocca
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Yuan Yuan
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Joanne Mortimer
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Mina S. Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
- Correspondence:
| |
Collapse
|
27
|
Abdel-Razeq H, Mansour A, Bater R. Trends, Patterns, and Treatment Outcomes of Cancer Among Older Patients in Jordan: A Retrospective Analysis of National Cancer Registry and Institutional Outcome Data. JCO Glob Oncol 2020; 6:745-751. [PMID: 32437264 PMCID: PMC7268897 DOI: 10.1200/go.20.00044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cancer is a leading cause of morbidity and the second leading cause of mortality in Jordan and worldwide. Because of their age and comorbidities, older patients may receive suboptimal cancer therapy. This article addresses trends in cancer incidence and reports key treatment outcomes in this age group. MATERIALS AND METHODS This is a retrospective study using data obtained from the national Jordan Cancer Registry (JCR) and our institutional cancer registry. The first data set reports only on demographics, whereas the second data set reports also on treatment outcomes. Older patients were defined as those age 65 years or older at time of diagnosis. RESULTS Between 2001 and 2015, a total of 19,397 older patients were diagnosed with cancer, representing 29.8% of the total 65,050 patients with cancer diagnosed during this time. More men than women developed cancer, and colorectal, breast, lung, prostate, and bladder cancers were the most commonly reported cancers. Among this age group over the 15-year study period, cancer diagnoses increased by a rate of 77%, much higher than the 55% increment among all ages during the same study period. The 5-year survival rate for all of the 3,821 older patients diagnosed, treated, and followed up at our institution was 33% but varied by stage (63% for stage I disease and 14% for stage IV disease). CONCLUSION Cancer diagnoses among older patients are increasing at a rate higher than that of all ages and much higher than the witnessed increase in Jordanian population in same age group, which highlights the importance of looking for factors other than just aging to explain this increase. Strategies to offer better care for this rapidly expanding group are highly needed.
Collapse
Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan.,School of Medicine, University of Jordan, Amman, Jordan
| | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Rayan Bater
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
| |
Collapse
|
28
|
Haase KR, Puts M, Sattar S, Gray M, Kenis C, Donison V, Hall S, McLean B, Wills A, Howell D. Protocol for a systematic review of self-management interventions for older adults living with cancer. Syst Rev 2020; 9:80. [PMID: 32303263 PMCID: PMC7164137 DOI: 10.1186/s13643-020-01346-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 04/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer predominates in adults over age 65. Cancer treatments are known to create physical and psychosocial challenges, which may be amplified for older adults with cancer. Learning and applying self-management behaviours and skills during treatment with cancer can help to manage/recover health and improve quality of life. In many other chronic illnesses, self-management interventions are known to improve health outcomes and lower healthcare costs. The purpose of this systematic review is to determine the effectiveness of self-management interventions for older adults with cancer on physical, psychosocial, and health system-related outcomes. METHODS We are conducting a systematic review of self-management interventions for older adults (65+) diagnosed with cancer (solid tumour or haematological) in the active treatment phase of cancer. This systematic review is guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Studies are limited to experimental or quasi-experimental methods published in English, French, German, or Dutch. A search strategy was designed with a Health Sciences librarian and performed using the following electronic databases: Ageline, AMED, ASSIA, Cinahl, Cochrane, Embase, Medline, PsychINFO, and Sociological Abstracts. Approximately 14,000 titles and abstracts are being electronically screened by a minimum of 2 reviewers, with relevant studies to be screened for full text. The final sample of included studies will be assessed for quality using the Cochrane Risk of Bias tool and Down and Black for quasi-experimental studies, with data synthesized in a narrative and tabular format. DISCUSSION This systematic review will expand the knowledge base of interventions supporting self-management for older adults with cancer. This study will inform future intervention development by identifying gaps and strengths in effective self-management interventions targeting the needs of older adults receiving active treatment for cancer. SYSTEMATIC REVIEW REGISTRATION PROPERO registry ID# CRD42019134113.
Collapse
Affiliation(s)
- Kristen R Haase
- College of Nursing, University of Saskatchewan, 4th Floor, Health Sciences E-Wing, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada.
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Schroder Sattar
- College of Nursing, University of Saskatchewan, Regina, Canada
| | - Mikaela Gray
- Gerstein Science Information Centre, University of Toronto, Toronto, Canada
| | - Cindy Kenis
- Department of General Medical Oncology and Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Valentina Donison
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Steven Hall
- College of Nursing, University of Saskatchewan, 4th Floor, Health Sciences E-Wing, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada
| | - Bianca McLean
- De Groote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Aria Wills
- De Groote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Doris Howell
- Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
29
|
Trevino KM, Stern A, Prigerson HG. Adapting psychosocial interventions for older adults with cancer: A case example of Managing Anxiety from Cancer (MAC). J Geriatr Oncol 2020; 11:1319-1323. [PMID: 32253159 DOI: 10.1016/j.jgo.2020.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 01/06/2023]
Affiliation(s)
| | - Amy Stern
- Weill Cornell Medicine, USA; NewYork Presbyterian Hospital, USA
| | | |
Collapse
|
30
|
Hamaker ME, van Huis-Tanja LH, Rostoft S. Optimizing the geriatrician's contribution to cancer care for older patients. J Geriatr Oncol 2020; 11:389-394. [DOI: 10.1016/j.jgo.2019.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/28/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022]
|
31
|
Joharatnam-Hogan N, Shiu KK, Khan K. Challenges in the treatment of gastric cancer in the older patient. Cancer Treat Rev 2020; 85:101980. [PMID: 32065879 DOI: 10.1016/j.ctrv.2020.101980] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 12/24/2022]
Abstract
Gastric cancer is considered an age-related disease, with the majority of new cases in the UK diagnosed in individuals over the age of 75. At present most guidance related to the management of gastric cancer is based on trials undertaken in the fit, younger patient. Historically the elderly have been underrepresented in clinical trials, which frequently have a restricted inclusion to an upper age limit of 75. The European Society for Medical Oncology (ESMO) recommends use of a geriatric assessment to determine functional age when initiating treatment in elderly patients with gastric cancer, which has been shown to be a better predictor of treatment response than chronological age. The physiological changes that occur with age, including reduced organ function and pharmacokinetic and pharmacodynamic variability, together with impaired functional status, necessitate a more individualised approach to treatment decisions in the older patient to provide them with the same advantages from radical treatment and palliative chemotherapy as younger patients. This review summarises the current evidence extrapolated from trial data on how best to optimise treatment for elderly patients with gastric cancer.
Collapse
Affiliation(s)
- Nalinie Joharatnam-Hogan
- Gastrointestinal Oncology, Department of Medicine, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - Kai Keen Shiu
- Gastrointestinal Oncology, Department of Medicine, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - Khurum Khan
- Gastrointestinal Oncology, Department of Medicine, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK.
| |
Collapse
|
32
|
Shahrokni A, Tin A, Alexander K, Sarraf S, Afonso A, Filippova O, Harris J, Downey RJ, Vickers AJ, Korc-Grodzicki B. Development and Evaluation of a New Frailty Index for Older Surgical Patients With Cancer. JAMA Netw Open 2019; 2:e193545. [PMID: 31074814 PMCID: PMC6512296 DOI: 10.1001/jamanetworkopen.2019.3545] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Frailty based on the modified Frailty Index is associated with poor postoperative outcomes. However, the index requires high levels of personnel time and effort and often has missing data. OBJECTIVE To evaluate the association of the Memorial Sloan Kettering-Frailty Index (MSK-FI) with established geriatric assessment (GA) and surgical outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study included prospectively evaluated patients with cancer 75 years and older who were referred to MSK Geriatrics Service clinics for preoperative evaluation before undergoing surgery requiring hospitalization between February 2015 and September 2017. Patients were comanaged by the Geriatrics Service and Surgery Service in the postoperative period. EXPOSURES Impairments identified by GA and comorbid conditions retrieved from submitted International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes within the first 48 hours of hospitalization. MAIN OUTCOMES AND MEASURES The association of MSK-FI score (which included ICD-9 and ICD-10 codes) with GA impairments (based on clinical interview and examination as well as patient reports) was examined. The associations of MSK-FI score with short-term surgical outcomes (ie, frequency of complications, length of stay, 30-day surgical complications, 30-day intensive care unit admissions, and 30-day readmissions) and 1-year survival, estimated by Kaplan-Meier methods, were determined. RESULTS In total, 1137 patients (median [interquartile range] age, 80 [77-84] years; 583 [51.2%] women) were included in the study. A higher MSK-FI score was associated with the number of GA impairments (ρ = 0.52; bootstrapped 95% CI, 0.47-0.56). Each 1-point increase in MSK-FI score was associated with longer length of stay (0.58 d; 95% CI, 0.22-0.95; P = .002) and higher odds of intensive care unit admission (odds ratio, 1.28; 95% CI, 1.04-1.58; P = .02). Median (interquartile range) follow-up among survivors was 12.1 (5.6-19.1) months. The MSK-FI score was associated with overall mortality; 12-month risk of death was 5% for a score of 0 and approximately 20% for scores of 4 and higher (nonlinear association, P = .005). CONCLUSIONS AND RELEVANCE In this study, the MSK-FI was associated with the previously validated GA and postoperative outcomes in older patients with cancer and may be a feasible tool for perioperative assessment of older surgical patients with cancer. Future studies should assess the association of MSK-FI score with postoperative care and outcomes of older, frail patients with cancer.
Collapse
Affiliation(s)
- Armin Shahrokni
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amy Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Koshy Alexander
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Saman Sarraf
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anoushka Afonso
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Olga Filippova
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jennifer Harris
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert J. Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J. Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Beatriz Korc-Grodzicki
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
33
|
Exploring the geriatric needs of oncology inpatients at an academic cancer centre. J Geriatr Oncol 2018; 10:824-828. [PMID: 30587462 DOI: 10.1016/j.jgo.2018.12.001] [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: 10/18/2018] [Revised: 11/28/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE Geriatric Assessments (GAs) in older adults with cancer have informed treatment decision-making and refined survival prediction. However, little is known about the needs of older inpatients with cancer. Our objectives were to test the feasibility of a bedside GA, assess the prevalence of impairments in geriatric domains, determine how many were unknown to the medical team, and assess the impact of GA on patient care. METHODS We conducted a cross-sectional observational single-centre pilot study. Structured GAs were performed on patients age 65+ admitted to the medical or radiation oncology inpatient wards at a tertiary care cancer centre. GA findings were shared with the patient's most responsible physician (MRP). RESULTS 356 patients were screened, 39 were eligible and approached, and 37 were enrolled (recruitment rate 95%). Completion of the GA was possible in 92% of patients (34/37) and required a mean of 35 min. The mean number of geriatric domains impaired per patient was five (of seven assessed domains). The most common abnormal domains not known to the medical team were medication optimization (91%), cognition (90%), mood (69%), and social vulnerability (69%). MRPs responded to our survey for fifteen of thirty-three participants (45% response rate), and indicated that the GA results provided helpful information for patient management in 10 of 15 cases. CONCLUSION Abnormal geriatric domains are common in older inpatients with cancer. Domains such as medication optimization, cognition, mood, and social vulnerability often go undetected and unaddressed. Identifying abnormal domains may improve the care of older inpatients with cancer.
Collapse
|
34
|
McCormick PJ. Cancer Tsunami: Emerging Trends, Economic Burden, and Perioperative Implications. CURRENT ANESTHESIOLOGY REPORTS 2018; 8:348-354. [PMID: 31130826 PMCID: PMC6530937 DOI: 10.1007/s40140-018-0294-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This review discusses global trends in cancer mortality and survival, the socioeconomic drivers of those trends, and recent innovations in cancer surgery. RECENT FINDINGS Cancer is a leading cause of death worldwide. Cancer, previously a disease primarily of wealthy countries, is rapidly becoming a leading cause of death in low- and middle-income countries. Major economic forces driving global cancer trends include aging, frailty, and obesity. Alcohol consumption, poor diet, and lack of exercise also contribute to cancer types associated with modifiable causes. Surgery is responsible for 65% of cancer care globally, providing an opportunity for anesthesiologists to improve that care. Anesthesiologists can contribute to cancer remission through perioperative interventions that reduce risk of metastasis and speed return to intended oncologic therapy. SUMMARY Cancer surgery comprises a large proportion of anesthetic caseload. Good outcomes come from high volume cancer centers using a multidisciplinary approach.
Collapse
Affiliation(s)
- Patrick J McCormick
- Department of Anesthesiology & Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
35
|
Beyond the black box of geriatric assessment: Understanding enhancements to care by the geriatric oncology clinic. J Geriatr Oncol 2018; 9:679-682. [DOI: 10.1016/j.jgo.2018.03.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 03/06/2018] [Accepted: 03/21/2018] [Indexed: 11/24/2022]
|
36
|
Yoshida Y, Schmaltz CL, Jackson-Thompson J, Simoes EJ. Ovarian Cancer Survival in Missouri, 1996-2014. MISSOURI MEDICINE 2018; 115:542-547. [PMID: 30643350 PMCID: PMC6312176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We evaluated relative survival (RS) for ovarian cancer (OC) overall, by demographic and by clinicopathological characteristics in Missouri. Survival data from the Missouri Cancer Registry were obtained for cases diagnosed 1996-2014. An improved OC survival, especially in late stage, was observed in the study period. Our findings showed demographic, especially race-associated, and geographical variations of OC survival. OC survival also differed by first course treatment received and histology. These differences indicate disparities in OC care.
Collapse
Affiliation(s)
- Yilin Yoshida
- Yilin Yoshida, PhD, MPH is in the University of Missouri School of Medicine, Department of Health Management and Informatics, and the Missouri Cancer Registry and Research Center
| | - Chester L Schmaltz
- Chester L. Schmaltz, PhD is in the University of Missouri School of Medicine, Department of Health Management and Informatics, and the Missouri Cancer Registry and Research Center
| | - Jeanette Jackson-Thompson
- Jeanette Jackson-Thompson, PhD, MSPH is in the University of Missouri School of Medicine, Department of Health Management and Informatics, and the Missouri Cancer Registry and Research Center
| | - Eduardo J Simoes
- Eduardo J. Simoes, MD, MSc, is in University of Missouri School of Medicine, Department of Health Management and Informatics, Columbia, Missouri
| |
Collapse
|
37
|
Korc-Grodzicki B, Tew W, Hurria A, Yulico H, Lichtman S, Hamlin P, Bosl G. Development of a Geriatric Service in a Cancer Center: Lessons Learned. J Oncol Pract 2018; 13:107-112. [PMID: 28972835 DOI: 10.1200/jop.2016.017590] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Beatriz Korc-Grodzicki
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - William Tew
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Arti Hurria
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Heidi Yulico
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Stuart Lichtman
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Paul Hamlin
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - George Bosl
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| |
Collapse
|
38
|
Kocik L, Geinitz H, Track C, Geier M, Nieder C. Feasibility of radiotherapy in nonagenarian patients: a retrospective study. Strahlenther Onkol 2018; 195:62-68. [PMID: 30167713 DOI: 10.1007/s00066-018-1355-6] [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: 01/04/2018] [Accepted: 08/17/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Specific information about radiation therapy in nonagenarians is limited. In order to shed more light on the feasibility of radiotherapy in this challenging subgroup, a retrospective study was performed. METHODS The data of 93 consecutive patients receiving irradiation treatment at the Department of Radiation Oncology, Ordensklinikum Linz Barmherzige Schwestern between June 2005 and December 2016 were analyzed. Patient- and treatment-related factors were extracted from the patient records. Overall survival (OS) was defined as time from irradiation to death or last follow-up. The survival rates were analyzed using the Kaplan-Meier method and log-rank test. RESULTS The study population of 93 patients was between 90 and 99 years old (median 91 years). It included 59 women (63%) and 34 men (37%). Of these, 38 (41%) received definitive radiotherapy, 14 (15%) received neoadjuvant or adjuvant radiotherapy, whereas a palliative regimen was prescribed in 44% of the cases (n = 41). In all, 79 patients (85%) were able to complete their prescribed course of radiotherapy. While 16 (17%) patients reported grade 2 toxicities or higher, 4 had ≥grade 3 side effects (4%). The median survival was significantly higher in patients treated with adjuvant, neoadjuvant or definitive radiotherapy (13.8 months) compared to patients treated with palliative radiotherapy (3.6 months; p < 0.001). CONCLUSION Even in patients managed without preradiotherapy comprehensive geriatric assessment, carefully planned fractionated radiotherapy was feasible and resulted in acceptable rates of acute toxicities.
Collapse
Affiliation(s)
- L Kocik
- Department of Radiation Oncology, Ordensklinikum Linz Barmherzige Schwestern, 4010, Linz, Austria.
| | - H Geinitz
- Department of Radiation Oncology, Ordensklinikum Linz Barmherzige Schwestern, 4010, Linz, Austria
| | - C Track
- Department of Radiation Oncology, Ordensklinikum Linz Barmherzige Schwestern, 4010, Linz, Austria
| | - M Geier
- Department of Radiation Oncology, Ordensklinikum Linz Barmherzige Schwestern, 4010, Linz, Austria
| | - C Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, 8092, Bodø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, 9037, Tromsø, Norway
| |
Collapse
|
39
|
Role of the geriatrician, primary care practitioner, nurses, and collaboration with oncologists during cancer treatment delivery for older adults: A narrative review of the literature. J Geriatr Oncol 2018; 9:398-404. [DOI: 10.1016/j.jgo.2018.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/09/2018] [Accepted: 04/25/2018] [Indexed: 12/20/2022]
|
40
|
Shahrokni A, Alexander K, Wildes TM, Puts MTE. Preventing Treatment-Related Functional Decline: Strategies to Maximize Resilience. Am Soc Clin Oncol Educ Book 2018; 38:415-431. [PMID: 30231361 DOI: 10.1200/edbk_200427] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The majority of patients with cancer are older adults. A comprehensive geriatric assessment (CGA) will help the clinical team identify underlying medical and functional status issues that can affect cancer treatment delivery, cancer prognosis, and treatment tolerability. The CGA, as well as more abbreviated assessments and geriatric screening tools, can aid in the treatment decision-making process through improved individualized prediction of mortality, toxicity of cancer therapy, and postoperative complications and can also help clinicians develop an integrated care plan for the older adult with cancer. In this article, we will review the latest evidence with regard to the use of CGA in oncology. In addition, we will describe the benefits of conducting a CGA and the types of interventions that can be taken by the interprofessional team to improve the treatment outcomes and well-being of older adults.
Collapse
Affiliation(s)
- Armin Shahrokni
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Koshy Alexander
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Tanya M Wildes
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Martine T E Puts
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
41
|
Dotan E. Adjusting Our Current Practice to Better Care for the Older Patient With Cancer. J Oncol Pract 2017; 13:103-104. [PMID: 28972828 DOI: 10.1200/jop.2016.019687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
42
|
Ramsdale EE, Mohile SG. Providing Optimal Multidisciplinary Care to Older Patients With Cancer. J Oncol Pract 2017; 13:105-106. [PMID: 28972826 DOI: 10.1200/jop.2016.019695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Erika E Ramsdale
- University of Rochester, James P. Wilmot Cancer Institute, Rochester, NY
| | - Supriya G Mohile
- University of Rochester, James P. Wilmot Cancer Institute, Rochester, NY
| |
Collapse
|