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Rompen IF, Crnovrsanin N, Nienhüser H, Neuschütz K, Fourie L, Sisic L, Müller-Stich BP, Billeter AT. Age-dependent benefit of neoadjuvant treatment in adenocarcinoma of the esophagus and gastroesophageal junction: a multicenter retrospective observational study of young versus old patients. Int J Surg 2023; 109:3804-3814. [PMID: 37720939 PMCID: PMC10720874 DOI: 10.1097/js9.0000000000000713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/13/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES The objective was to provide evidence for age-dependent use of neoadjuvant treatment by clinical comparisons of young (lower quartile, <56.6 years) versus old (upper quartile, >71.3 years) patients with esophageal and esophagogastric-junction adenocarcinoma. BACKGROUND Neoadjuvant treatment is the standard of care for locally advanced and node-positive EAC. However, the effect of age on oncological outcomes is disputable as they are underrepresented in treatment defining randomized controlled trials. METHODS Patients with EAC undergoing esophagectomy between 2001 and 2022 were retrospectively analyzed from three centers. Patients having distant metastases or clinical UICC-stage I were excluded. Cox proportional hazards regression was used to identify the variables associated with survival benefit. RESULTS Neoadjuvant treatment was administered to 185/248 (74.2%) young and 151 out of 248 (60.9%) elderly patients ( P =0.001). Young age was associated with a significant overall survival (OS) benefit (median OS: 85.6 vs. 29.9 months, hazard ratio 0.62, 95% CI: 0.42-0.92) after neoadjuvant treatment versus surgery alone. In contrast, elderly patients did only experience a survival benefit equaling the length of neoadjuvant treatment itself (median OS: neoadjuvant 32.8 vs. surgery alone 29.3 months, hazard ratio 0.89, 95% CI: 0.63-1.27). Despite the clear difference in median OS benefit, histopathological regression was similar ((Mandard-TRG-1/2: young 30.7 vs. old 36.4%, P= 0.286). More elderly patients had a dose reduction or termination of neoadjuvant treatment (12.4 vs. 40.4%, P <0.001). CONCLUSION Old patients benefit less from neoadjuvant treatment compared to younger patients in terms of gain in OS. Since they also experience more side effects requiring dose reduction, upfront surgery should be considered as the primary treatment option in elderly patients.
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Affiliation(s)
- Ingmar F. Rompen
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Henrik Nienhüser
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Kerstin Neuschütz
- Department of Visceral Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Lana Fourie
- Department of Visceral Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Leila Sisic
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Beat P. Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of Visceral Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Adrian T. Billeter
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of Visceral Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
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2
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Shin IB, Han W, Lee HB, Kim HK, Moon HG. Life-Threatening Hematoma in an Elderly Breast Cancer Patient Undergoing Chemotherapy. J Breast Cancer 2023; 26:514-518. [PMID: 37704385 PMCID: PMC10625869 DOI: 10.4048/jbc.2023.26.e41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/26/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023] Open
Abstract
The use of neoadjuvant chemotherapy in older patients is increasing. However, chemotherapy should be administered considering the medical comorbidities of the patients and the toxicity of chemotherapeutic agents. Here, we present a case of abdominal wall hematoma with spontaneous inferior epigastric artery injury caused by coughing in a 70-year-old woman who was treated with neoadjuvant chemotherapy. Abdominal computed tomography demonstrated an abdominal wall hematoma with active bleeding. However, angiography with selective embolization of the right inferior epigastric artery and the right internal mammary artery was performed successfully. Scheduled chemotherapy was discontinued over concerns of rebleeding and breast-conserving surgery was performed. When deciding on chemotherapy for older patients, attention should be paid to the various complications.
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Affiliation(s)
- Ik Beom Shin
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
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Raychaudhuri S, Kyko JM, Ruterbusch JJ, Pandolfi SS, Beebe‐Dimmer JL, Schwartz AG, Simon MS. The impact of preexisting comorbidities on receipt of cancer therapy among women with Stage I-III breast cancer in the Detroit Research on Cancer Survivors cohort. Cancer Med 2023; 12:19021-19032. [PMID: 37563982 PMCID: PMC10557862 DOI: 10.1002/cam4.6456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Pre-existing comorbidities play an important role in choice of cancer treatment. We retrospectively evaluated the relationship between pre-existing comorbidities and receipt of local and systemic therapy in a cohort of Black women with Stage I-III breast cancer. METHODS The study population for analysis included 1169 women with Stage I-III disease enrolled in the Detroit Research on Cancer Survivors (ROCS) cohort. Information on comorbidities, socio-demographic, and clinical variables were obtained from self-reported questionnaires and the cancer registry. Comorbidities were analyzed individually, and comorbidity burden was categorized as low (0-1), moderate (2-3) or high (≥4). We used logistic regression analysis to evaluate factors associated with receipt of local treatment (surgery ± radiation; N = 1156), hormonal (N = 848), and chemotherapy (N = 680). Adjusted models included variables selected a priori that were significant predictors in univariate analysis. RESULTS Receipt of treatment was categorized into local (82.6%), hormonal (73.7%), and/or chemotherapy (79.9%). Prior history of arthritis and depression were both associated with a lower likelihood to receive local treatment, [odds ratio (OR), 95% confidence interval (CI), 0.66, 0.47-0.93, and 0.53, 0.36-0.78], respectively. Obesity was associated with higher likelihood of receiving hormonal therapy (OR: 1.64, 95% CI: 1.19, 2.26), and heart failure a lower likelihood (OR: 0.46, 95% CI: 0.23, 0.90). Older age (Ptrend <0.01) and increasing co-morbidity burden (Ptrend = 0.02) were associated with lower likelihood of receiving chemotherapy. CONCLUSION History of prior co-morbidities has a potentially detrimental influence on receipt of recommended cancer-directed treatment among women with Stage I-III breast cancer.
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Affiliation(s)
- Sreejata Raychaudhuri
- Department of Medical Oncology/HematologyUniversity of Pittsburgh, Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Jaclyn M. Kyko
- Department of OncologyKarmanos Cancer Institute at Wayne State UniversityDetroitMichiganUSA
| | - Julie J. Ruterbusch
- Department of OncologyKarmanos Cancer Institute at Wayne State UniversityDetroitMichiganUSA
| | - Stephanie S. Pandolfi
- Department of OncologyKarmanos Cancer Institute at Wayne State UniversityDetroitMichiganUSA
| | - Jennifer L. Beebe‐Dimmer
- Department of OncologyKarmanos Cancer Institute at Wayne State UniversityDetroitMichiganUSA
- Population Studies and Disparities Research ProgramKarmanos Cancer InstituteDetroitMichiganUSA
| | - Ann G. Schwartz
- Department of OncologyKarmanos Cancer Institute at Wayne State UniversityDetroitMichiganUSA
- Population Studies and Disparities Research ProgramKarmanos Cancer InstituteDetroitMichiganUSA
| | - Michael S. Simon
- Department of OncologyKarmanos Cancer Institute at Wayne State UniversityDetroitMichiganUSA
- Population Studies and Disparities Research ProgramKarmanos Cancer InstituteDetroitMichiganUSA
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Kjeldsted E, Gehl J, Sørensen DM, Lodin A, Ceballos SG, Dalton SO. Patient-Related Characteristics Associated with Treatment Modifications and Suboptimal Relative Dose Intensity of Neoadjuvant Chemotherapy in Patients with Breast Cancer-A Retrospective Study. Cancers (Basel) 2023; 15:cancers15092483. [PMID: 37173949 PMCID: PMC10177586 DOI: 10.3390/cancers15092483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/15/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Reduced relative dose intensity (RDI) of neoadjuvant chemotherapy (NACT) in patients with breast cancer may compromise treatment outcome and survival. We examined patient-related characteristics associated with treatment modifications and suboptimal RDI and tumour response in patients with breast cancer. METHODS In this observational study, electronic medical records were reviewed retrospectively for female patients with breast cancer scheduled for NACT at a university hospital in Denmark between 2017 and 2019. The RDI (ratio of delivered dose intensity in relation to standard dose intensity) was calculated. Multivariate logistic regression analyses examined associations of sociodemographics, general health and clinical cancer characteristics with dose reductions, dose delays, discontinuation of NACT and suboptimal RDI < 85%. RESULTS Among 122 included patients, 43%, 42% and 28% experienced dose reductions, dose delays ≥3 days and discontinuation, respectively. A total of 25% received an RDI < 85%. Comorbidity, taking long-term medications and being overweight were statistically significantly associated with treatment modifications, while age ≥ 65 years and comorbidity were associated with RDI < 85%. Around one third of all patients had radiologic (36%) or pathologic (35%) complete tumour response, with no statistically significant differences by RDI < or ≥85% irrespective of breast cancer subtype. CONCLUSIONS While most patients had RDI ≥85%, still one out of four patients received an RDI < 85%. Further investigations of possible supportive care initiatives to improve patients' treatment tolerability are needed, particularly among subgroups of older age or with comorbidity.
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Affiliation(s)
- Eva Kjeldsted
- Danish Research Center for Equality in Cancer (COMPAS), 4700 Næstved, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, 4700 Næstved, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Julie Gehl
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, 4700 Næstved, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Dina Melanie Sørensen
- Danish Research Center for Equality in Cancer (COMPAS), 4700 Næstved, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, 4700 Næstved, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Alexey Lodin
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, 4700 Næstved, Denmark
| | | | - Susanne Oksbjerg Dalton
- Danish Research Center for Equality in Cancer (COMPAS), 4700 Næstved, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, 4700 Næstved, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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Zainal Abidin MN, Omar MS, Islahudin F, Mohamed Shah N. The survival impact of palliative chemotherapy dose modifications on metastatic colon cancer. BMC Cancer 2022; 22:731. [PMID: 35787795 PMCID: PMC9254497 DOI: 10.1186/s12885-022-09831-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An uninterrupted dose of oxaliplatin-based cytotoxic therapy is an essential component in the standard treatment regimen of metastatic colon cancer (mCC). Data on the impacts of dose intensity reduction on the palliative treatment for patients with mCC remain scarce. Hence, this study aimed to investigate the impact of palliative chemotherapy dose modifications (DM) on the survival of patients with mCC. METHODS Patients with stage IV colon cancer who received first-line palliative FOLFOX regimen chemotherapy between 2014 until 2018 in the Oncology Department of the National Cancer Institute were conveniently sampled retrospectively to analyse the treatment efficacy. The cumulative dose and duration of chemotherapy received by the patients were summarised as relative dose intensity (RDI) and stratified as High RDI (RDI ≥ 70%) or Low RDI (RDI < 70%). Progression-free survival (PFS) and 2-year overall survival (OS) between the two groups were analysed using Kaplan-Meier survival analysis and Cox proportional hazards models. RESULTS Out of the 414 patients identified, 95 patients with mCC were eligible and included in the final analysis. About half of the patients (n = 47) completed the 12-cycle chemotherapy regimen and one patient received the complete (100%) RDI. The overall median RDI was 68.7%. The Low RDI group (n = 49) had a 1.5 times higher mortality risk than the High RDI group [OS, Hazard Ratio (HR) = 1.5, 95% Cl: 1.19-1.82] with a significant median OS difference (9.1 vs. 16.0 months, p < 0.01). Furthermore, patients with lower dose intensity showed double the risk of disease progression (PFS, HR = 2.0, 95% CI: 1.23-3.13) with a significant difference of 4.5 months of median PFS (p < 0.01). Gender and RDI were the independent prognostic factors of both OS and PFS. CONCLUSION Reduction in the dose intensity of palliative chemotherapy may adversely affect both disease progression and overall survival among mCC patients.
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Affiliation(s)
- Mohd Naqib Zainal Abidin
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan, Bangi, Malaysia.,National Cancer Institute, Ministry of Health, Putrajaya, Malaysia
| | - Marhanis Salihah Omar
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan, Bangi, Malaysia
| | - Farida Islahudin
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan, Bangi, Malaysia
| | - Noraida Mohamed Shah
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan, Bangi, Malaysia.
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Ghabashi EH, Sharaf BM, Kalaktawi WA, Calacattawi R, Calacattawi AW. The Magnitude and Effects of Early Integration of Palliative Care Into Oncology Service Among Adult Advanced Cancer Patients at a Tertiary Care Hospital. Cureus 2021; 13:e15313. [PMID: 34211813 PMCID: PMC8237381 DOI: 10.7759/cureus.15313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Palliative care (PC) has a positive effect on symptom burden, quality of life, psychosocial communication, prognostic understanding, mood, and quality of care at the end of life of patients with advanced cancer. Objectives To investigate the timing of the first palliative consultation and referral of advanced cancer patients to the palliative care service and their determinants at King Faisal Specialist Hospital and Research Center (KFSHRC), Jeddah, Saudi Arabia. Subjects and methods A retrospective cohort study was conducted at KFSHRC. It included advanced cancer patients who died between January 1, 2019 and Jun 30, 2020. The dependent variable of primary interest is the timing of PC consultation and the timing of PC referral. The independent variables included age, sex, marital status, nationality, date of death, types of cancer, Eastern Cooperative Oncology Group (ECOG), palliative performance status (PPS), palliative prognostic index (PPI), code status (do not resuscitate [DNR]), the severity of symptoms (assessed by the Edmonton Symptom Assessment System - Revised [ESAS-r]), referral to home health care (HHC), referral to long-term care (LTC), referral to interdisciplinary team (IDT), length of survival after the first PC consultation, length of survival after the referral to the PC service, length of hospital stay, frequency of emergency room (ER) visits and hospital admission in the last year before death, and involvement in bereavement with advanced care planning (ACP) services. Results Of the 210 advanced cancer patients, 109 (51.9%) were male, and their ages ranged between 18 and 90 years. More than half of patients (56.7%) had a history of PC consultation. Among them, PC consultation was described as late in 60.5% of patients. Concerning the timing of palliative care referral among advanced cancer patients, it was too late and much too late among 25.7% and 58.1% of them, respectively. Patients who visited ER more frequently (≥3 times) (p=0.014) and those who referred to HHC (p=0.005) were more likely to consult PC early compared to their counterparts. Length of survival was significantly higher among patients who reported early PC consultation compared to those without PC consultation and those with late PC consultation, p<0.001. Referral to PC for both transfer of care and symptom management was associated with earlier PC consultation, p=0.021. Patients who were admitted to the hospital three times or more were less likely to be much too late referred to PC services, p=0.046. Also, patients who were not referred to long-term care or home health care were more likely to be referred to PC services much too late, p<0.001. Among 28.8% of patients whose PPS ranged between 30% and 50% compared to 14.9% of those whose PPS ranged between 10% and 20% expressed too late referral time to PC, p=0.040. Conclusion In a considerable proportion of terminal cancer patients, palliative care was consulted late, and the timing of palliative care referral was too late/much too late among most of those consulted palliative care. Length of survival was higher among patients who reported early PC consultation and who with ideal referral time to PC services than others. Therefore, future considerations to facilitate early integration of palliative care in cancer patients are highly recommended through mainly improving staff education in communication skills and palliative care approach.
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Affiliation(s)
| | - Belal M Sharaf
- Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
| | | | - Retaj Calacattawi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Jauhari Y, Dodwell D, Gannon MR, Horgan K, Clements K, Medina J, Cromwell DA. The influence of age, comorbidity and frailty on treatment with surgery and systemic therapy in older women with operable triple negative breast cancer (TNBC) in England: A population-based cohort study. Eur J Surg Oncol 2021; 47:251-260. [PMID: 33268213 DOI: 10.1016/j.ejso.2020.09.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/26/2020] [Accepted: 09/18/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Surgery and chemotherapy use were studied among older women with early stage triple negative breast cancer (TNBC) in a population-based cohort. METHODS Women aged ≥50 years with unilateral early (stage 1-3a) TNBC diagnosed in 2014-2017 were identified from English cancer registration data. Information on surgery and chemotherapy was from linked Hospital Episode Statistics and Systemic Anti-Cancer Therapy datasets, respectively. Logistic regression was used to investigate the influences of patient age, comorbidity and frailty on uptake of surgery and chemotherapy. RESULTS There were 7094 women with early stage TNBC. Overall rate of surgery was 94%, which only decreased among women aged ≥85 years (74%) and among the most frail. Among the 6681 women receiving surgery, 16% had neoadjuvant and 42% had adjuvant chemotherapy; the use of both decreased with age. More comorbidities and greater frailty were associated with lower rates of chemotherapy. There were differences in the uptake of chemotherapy across geographical regions and in the neoadjuvant and adjuvant chemotherapy regimens between age groups. CONCLUSION Majority of older women with early TNBC had surgery, although some physically fit older women did not. Chemotherapy use varied by age and fitness.
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Affiliation(s)
- Yasmin Jauhari
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Melissa Ruth Gannon
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kieran Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | - Karen Clements
- National Disease Registration Service, Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, UK
| | - Jibby Medina
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - David Alan Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Couderc AL, Boisseranc C, Rey D, Nouguerede E, Greillier L, Barlesi F, Duffaud F, Deville JL, Honoré S, Villani P, Correard F. Medication Reconciliation Associated with Comprehensive Geriatric Assessment in Older Patients with Cancer: ChimioAge Study. Clin Interv Aging 2020; 15:1587-1598. [PMID: 32982194 PMCID: PMC7489933 DOI: 10.2147/cia.s262209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/30/2020] [Indexed: 12/27/2022] Open
Abstract
Background Polymorbidity induces polypharmacy in older patients may lead to potential drug–drug interactions (DDI) which can modify the tolerance and safety of oncological treatments and alter the intended therapeutic effect. The objective of our study was to describe the decision-making process for oncological treatment and related outcomes, in a population of older adults undergoing a comprehensive geriatric assessment (CGA) associated to a comprehensive medication reconciliation (CMR) prior to initiating oncological treatment. Methods ChimioAge is a prospective observational study conducted between 01/2017 and 07/2018 at Marseille University Hospital and approved by the French National Ethics Committee. It comprised all consecutive patients aged 70 years and over who were referred for a CGA as part of CMR, before initiating systemic treatment. Results One hundred and seventy-one cancer patients were included. Mean age was 79.2 years, over half had metastatic cancers, 75% had an ECOG performance status zero or one, and two-thirds were independent in daily activities. Two-thirds of the patients had polypharmacy and the CMR identified potential DDI with systemic treatment in 43.3% of patients. Following the CGA, the CMR and the hospital oncologists decision, 30% of the patients received adapted systemic treatment with reduced doses at initiation. They presented fewer toxicities – irrespective of grade and type – than patients who received standard treatment (p<0.001) and had comparable overall survival (Log rank p=0.21). Conclusion This is one of the first studies to highlight the value in conducting CMR and a CGA simultaneously before initiating systemic treatment in older patients with cancer. These two evaluations could give oncologists decisive information to personalize cancer treatment of older patients and optimize treatment dose to offer the best efficacy and minimize toxicity.
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Affiliation(s)
- Anne-Laure Couderc
- Internal Medicine, Geriatry and Therapeutic Unit, AP-HM, Marseille, France;Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France.,Aix-Marseille Université, CNRS, EFS, ADES, Marseille, France
| | | | - Dominique Rey
- Internal Medicine, Geriatry and Therapeutic Unit, AP-HM, Marseille, France;Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France
| | - Emilie Nouguerede
- Internal Medicine, Geriatry and Therapeutic Unit, AP-HM, Marseille, France;Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France
| | - Laurent Greillier
- Aix-Marseille University, Marseille, France.,Multidisciplinary Oncology and Therapeutic Innovations Unit, AP-HM, Marseille, France
| | - Fabrice Barlesi
- Aix-Marseille University, Marseille, France.,Multidisciplinary Oncology and Therapeutic Innovations Unit, AP-HM, Marseille, France
| | - Florence Duffaud
- Aix-Marseille University, Marseille, France.,Oncology Unit, AP-HM, Marseille, France
| | | | - Stéphane Honoré
- Pharmacology Department, AP-HM, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Patrick Villani
- Internal Medicine, Geriatry and Therapeutic Unit, AP-HM, Marseille, France;Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France.,Aix-Marseille Université, CNRS, EFS, ADES, Marseille, France
| | - Florian Correard
- Pharmacology Department, AP-HM, Marseille, France.,Aix-Marseille University, Marseille, France
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Abstract
Aim: Breast cancer patients over the age of 65 are more likely to suffer chemotherapy side effects, with premature discontinuation, which negatively affects survival. Methods: We conducted a retrospective cohort study enrolling breast cancer patients; dose reductions or interruptions of chemotherapy have been collected, as well as side effects. Progression-free survival was determined by Kaplan–Meier and evaluated for its association with reduction/suspension. The study included 128 women (median age: 71). Results: Nineteen patients experienced cardiotoxicity, while dosage of chemotherapy was reduced in 23 patients (18.0%), and 14 (10.9%) had premature interruptions. Dose reduction/interruptions were associated with numerically worse progression-free survival (78.2 vs 94.8 months; p = 0.10). Conclusion: Reduction/discontinuation of chemotherapy due to side effects affected nearly 30% of our population, potentially worsening outcomes. Breast cancer patients over the age of 65 are more likely to suffer chemotherapy side effects, which negatively affect survival. We conducted a retrospective study of 128 elderly breast cancer patients, collecting changes in chemotherapy doses and schedules, as well side effects. Progression-free survival (PFS) was calculated and evaluated for its association with reduction/suspension. Nineteen patients experienced cardiotoxicity, while dosage of chemotherapy was reduced in 23 patients (18.0%), and 14 (10.9%) had premature interruptions. Dose reduction/interruption were associated with numerically worse PFS (78.2 vs 94.8 months; p = 0.10). Occurrence of reduction/discontinuation of chemotherapy and cardiotoxicity in this population could potentially worsen outcomes.
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Affiliation(s)
- Valentina Zanuso
- Humanitas Cancer Center, IRCCS Istituto Clinico Humanitas, 20089 Rozzano (MI), Italy.,Humanitas University, 20090 Pieve Emanuele (MI), Italy
| | - Vittorio Fregoni
- ASST Valtellina e Alto Lario, UOC Medicina Generale, 23035 Sondalo (SO), Italy
| | - Lorenzo Gervaso
- European Institute of Oncology (IEO) IRCCS, Gatrointestinal Medical Oncology and Neuroendocrine Tumors, 20141 Milan, Italy.,Molecular Medicine Program, University of Pavia, 27100 Pavia, Italy
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Gadisa DA, Assefa M, Tefera GM, Yimer G. Patterns of Anthracycline-Based Chemotherapy-Induced Adverse Drug Reactions and Their Impact on Relative Dose Intensity among Women with Breast Cancer in Ethiopia: A Prospective Observational Study. J Oncol 2020; 2020:2636514. [PMID: 32148494 PMCID: PMC7054818 DOI: 10.1155/2020/2636514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The breast cancer chemotherapy leads to diverse aspects of noxious or unintended adverse drug reactions (ADRs) that cause the relative dose intensity (RDI) reduced to below optimal (i.e., if the percentage of actual dose received per unit time divided by planned dose per unit time is less than 85%). Hence, this prospective observational study was conducted to evaluate chemotherapy-induced ADRs and their impact on relative dose intensity among women with breast cancer in Ethiopia. METHODS The study was conducted with a cohort of 146 patients from January 1 to September 30, 2017, Gregorian Calendar (GC) at the only nationwide oncology center, Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. The ADRs of the chemotherapy were collected using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) (version 4.03). The patients were personally interviewed for subjective toxicities, and laboratory results and supportive measures were recorded at each cycle. SPSS version 22 was used for analysis. RESULTS Grade 3 neutropenia (23 (15.8%)) was the most frequently reported ADR among grade 3 hematological toxicity on cycle 4. However, overall grade fatigue (136 (93.2%)) and grade 3 nausea (31 (21.2%)) were the most frequently reported nonhematological toxicities on cycle 1. The majority of ADRs were reported during the first four cycles except for peripheral neuropathy. Oral antibiotics and G-CSF use (17 (11.6%)) and treatment delay (31 (21.2%)) were frequently reported on cycle 3. Overall, 61 (41.8%) and 42 (28.8%) of study participants experienced dose delay and used G-CSF, respectively, at least once during their enrollment. Of the 933 interventions observed, 95 (10%) cycles were delayed due to toxicities in which neutropenia attributed to the delay of 89 cycles. Forty-four (30.1%) of the patients received overall RDI < 85%. Pretreatment hematological counts were significant predictors (P < 0.05) for the incidence of first cycle hematological toxicities such as neutropenia, anemia, and leukopenia and nonhematological toxicities like vomiting. CONCLUSION Ethiopian women with breast cancer on anthracycline-based AC and AC-T chemotherapy predominantly experienced grade 1 to 3 hematological and nonhematological ADRs, particularly during the first four cycles. Neutropenia was the only toxicity that led to RDI < 85%. Thus, enhancing the utilization of G-CSF and other supportive measures will improve RDI to above 85%.
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Affiliation(s)
- Diriba Alemayehu Gadisa
- College of Medicine and Health Sciences, Pharmacy Department, Ambo University, Ambo, Ethiopia
| | - Mathewos Assefa
- School of Medicine, College of Health Sciences, Radiotherapy Center, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gosaye Mekonen Tefera
- College of Medicine and Health Sciences, Pharmacy Department, Ambo University, Ambo, Ethiopia
| | - Getnet Yimer
- Ohio State Global One Health Initiative, Office of International Affairs, The Ohio State University, Addis Ababa, Ethiopia
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11
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Jauhari Y, Gannon MR, Dodwell D, Horgan K, Tsang C, Clements K, Medina J, Tang S, Pettengell R, Cromwell DA. Addressing frailty in patients with breast cancer: A review of the literature. Eur J Surg Oncol 2020; 46:24-32. [PMID: 31439357 DOI: 10.1016/j.ejso.2019.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/12/2019] [Indexed: 11/25/2022]
Abstract
Various studies have documented variation in the management of older patients with breast cancer, and some of this variation stems from different approaches to balancing the expected benefit of different treatments, with the ability of patients to tolerate them. Frailty is an emerging concept that can help to make clinical decisions for older patients more consistent, not least by providing a measure of 'biological' ageing. This would reduce reliance on 'chronological' age, which is not a reliable guide for decisions on the appropriate breast cancer care for older patients. This article examines the potential of frailty assessment to inform on breast cancer treatments. Overall, the current evidence highlights various benefits from implementing comprehensive geriatric assessment and screening for frailty in breast cancer patients. This includes a role in supporting the selection of appropriate therapies and improving physical fitness prior to treatment. However, there are challenges in implementing routine frailty assessments in a breast cancer service. Studies have used a diverse array of frailty assessment instruments, which hampers the generalisability of research findings. Consequently, a number of issues need to be addressed to clearly establish the optimal timing of frailty assessment and the role of geriatric medicine specialists in the breast cancer care pathway.
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Affiliation(s)
- Yasmin Jauhari
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; St George's University of London, London, UK.
| | - Melissa Ruth Gannon
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kieran Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | - Carmen Tsang
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Karen Clements
- Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, UK
| | - Jibby Medina
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Sarah Tang
- Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, UK
| | - Ruth Pettengell
- Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, UK
| | - David Alan Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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12
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van Abbema DL, van den Akker M, Janssen-Heijnen ML, van den Berkmortel F, Hoeben A, de Vos-Geelen J, Buntinx F, Kleijnen J, Tjan-Heijnen VC. Patient- and tumor-related predictors of chemotherapy intolerance in older patients with cancer: A systematic review. J Geriatr Oncol 2019; 10:31-41. [DOI: 10.1016/j.jgo.2018.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/22/2018] [Accepted: 04/03/2018] [Indexed: 12/19/2022]
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13
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Prasanna T, Beith J, Kao S, Boyer M, McNeil CM. Dose modifications in adjuvant chemotherapy for solid organ malignancies: A systematic review of clinical trials. Asia Pac J Clin Oncol 2018; 14:125-133. [PMID: 29498201 DOI: 10.1111/ajco.12864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/21/2018] [Indexed: 12/19/2022]
Abstract
Toxicities of systemic cancer therapies are often less frequently observed in clinical trials than in clinical practice, due to the careful selection of patients with fewer comorbidities. Although guidelines exist for the estimation of chemotherapy dose, clinical factors like age, comorbid illness and extremes of body habitus are not considered in the method of dose calculation, which can result in significant toxicity. We reviewed the referenced clinical trials from which the evidence-based curative-intent cancer treatment protocols were developed for EVIQ, which is an Australian government, online resource. This review shows that a significant proportion of patients in curative-intent clinical trials experience toxicities that result in dose modifications-dose reduction, dose delays or missed doses-despite strict selection criteria and intense monitoring. Thus, even in ideal, clinical-trial settings chemotherapy dose calculation remains imprecise and subject to adjustment as clinically appropriate. In real-world clinical practice, dose alterations or modifications in response to toxicities need to be thoroughly discussed and implemented with clear understanding of the patient with appropriate documentation. This review may be used as a reference in these situations to elaborate the extent of toxicities seen in clinical trials with optimal settings.
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Affiliation(s)
- Thiru Prasanna
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jane Beith
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Steven Kao
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Michael Boyer
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Catriona M McNeil
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, New South Wales, Australia
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14
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Park JH, Choi IS, Kim KH, Kim JS, Lee KH, Kim TY, Im SA, Kim SH, Kim YJ, Kim JH. Treatment Patterns and Outcomes in Elderly Patients with Metastatic Breast Cancer: A Multicenter Retrospective Study. J Breast Cancer 2017; 20:368-377. [PMID: 29285042 PMCID: PMC5743997 DOI: 10.4048/jbc.2017.20.4.368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/06/2017] [Indexed: 12/16/2022] Open
Abstract
Purpose Currently, there is little information regarding optimal treatment for metastatic breast cancer (MBC) in elderly patients. In this retrospective study, we examined a cohort of elderly patients with MBC receiving a range of treatments, in terms of demographic and clinicopathologic characteristics, treatment patterns, and outcomes. Methods Patients aged 65 years and older, and diagnosed with MBC between 2003 and 2015, were identified from the databases of three academic hospitals in South Korea. A total of 161 cases were eligible for inclusion. We assessed clinicopathologic features, treatment patterns, and outcomes, using the available electronic medical records. Based on age at MBC diagnosis, patients were divided into three groups: 65 to 69, 70 to 74, and ≥75 years. Results Most patients had received active treatment according to biologic subtype as in younger patients, although frequent dose modifications were observed during chemotherapy. The median overall survival (OS) for all patients was 30.3 months; age (≥70 years), Eastern Cooperative Oncology Group (ECOG) performance status (PS) (≥2), triple-negative cancer, and number of metastatic sites (≥2) were significant poor prognostic factors for OS in multivariate analyses. All types of systemic treatments according to biologic subtype conferred more prolonged OS in patients receiving treatment. Patients aged ≥75 years were more likely to have a poor ECOG PS and advanced comorbidity, and tended to receive less intensive treatments compared to the other age groups. Conclusion Elderly patients with MBC should not be excluded from receiving standard treatments prescribed for younger patients. Future research plans for elderly patients, especially aged ≥75 years with breast cancer, should include a geriatric assessment for identifying individuals at risk for treatment-related toxicity. Overall, this analysis will provide a better understanding of this population and help guide clinical care in real-world practice.
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Affiliation(s)
- Jin Hyun Park
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - In Sil Choi
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Hwan Kim
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Soo Kim
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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15
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Edwards MJ, Campbell ID, Lawrenson RA, Kuper-hommel MJ. Influence of comorbidity on chemotherapy use for early breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 2017; 165:17-39. [DOI: 10.1007/s10549-017-4295-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
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16
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Lee JS, Lee HY, Sung NS, Cheon KW, Moon JI, Lee SE, Choi IS, Choi WJ, Yoon DS. Predictive factor for excessive myelosuppression in patients receiving chemotherapy for breast cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.14216/kjco.16009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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17
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Wallwiener CW, Hartkopf AD, Grabe E, Wallwiener M, Taran FA, Fehm T, Brucker SY, Krämer B. Adjuvant chemotherapy in elderly patients with primary breast cancer: are women ≥65 undertreated? J Cancer Res Clin Oncol 2016; 142:1847-53. [PMID: 27350260 DOI: 10.1007/s00432-016-2194-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To establish whether women over 65 years of age with newly diagnosed with breast cancer (BC) receive adjuvant chemotherapy less frequently than younger postmenopausal women and whether comorbidity influences this potential undertreatment. MATERIALS AND METHODS In a single-site, retrospective, comparative study, postmenopausal early stage BC patients treated between 01/2001 and 12/2005 at a major German university hospital were analyzed in two age Groups A and B (≥65 vs. <65 years) for initiation and completion of guideline-recommended adjuvant chemotherapy. Risk stratification was based on the 2005 St. Gallen Consensus Conference criteria. Comorbidity was parametrized using the Charlson Comorbidity Index (CCI). RESULTS Analysis included 634 patients, 380 in Group A and 254 in Group B. Mean age (range) was 73 (65-94) and 61 (55-64) years, respectively. The proportion of patients from Group A given ≥3 cycles of chemotherapy was significantly decreased as compared to Group B. 52 % of patients with CCI <3 but only 20 % with CCI ≥3 were recommended to undergo chemotherapy (p < 0.001). Median follow-up [95 % confidence interval (CI)] was 85 (82-88) months. DFS was significantly shorter in patients aged ≥65 years as compared to younger postmenopausal patients (HR, 0.598; 95 % CI, 0.358-0.963; p = 0.048). CONCLUSIONS Despite being high-risk patients, older women with early stage BC were often not given guideline-recommended chemotherapy. Higher recurrence rates compared with younger postmenopausal women suggest that older patients are undertreated. Treatment needs to be adapted to general health and tumor biology rather than age. More trials in elderly BC patients are needed.
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18
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Hsu T, Chen R, Lin SCX, Djalalov S, Horgan A, Le LW, Leighl N. Pilot of three objective markers of physical health and chemotherapy toxicity in older adults. ACTA ACUST UNITED AC 2015; 22:385-91. [PMID: 26715870 DOI: 10.3747/co.22.2623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patient function is a key part of the clinical decision to offer chemotherapy and has, in earlier studies, been associated with chemotherapy toxicity. Objective testing might be more accurate than patient-reported or physician-assessed physical function, and thus might be a stronger predictor of chemotherapy toxicity in older adults. METHODS Patients, 70 years of age and older, with thoracic or colorectal cancer were recruited. Three physical tests were performed before commencement of a new line of chemotherapy: grip strength, 4-m walk test, and the Timed Up and Go (tug). Our pilot study explored the association between those tests and chemotherapy toxicity. RESULTS The 24 patients recruited had a median age of 74.5 years (range: 70-84 years), and 54.2% had an Eastern Cooperative Oncology Group performance status of 0 or 1. Median score on the Charlson comorbidity index was 1 (range: 0-4). Almost two thirds had metastatic disease, 70% were chemonaïve, and 83.3% were about to receive polychemotherapy. Patients had a mean tug of 13.2 ± 5.7 s and a mean gait speed of 0.74 ± 0.24 m/s; 50% had a grip strength test in the lowest 20th percentile. Grades 3-5 chemotherapy toxicities occurred in 34.7% of the patients; two thirds required a dose reduction or delay; and one third discontinued chemotherapy because of toxicity. Hospitalization attributable to chemotherapy was uncommon (12.5%). A trend toward increased severe chemotherapy toxicity with slower gait speed was observed (p = 0.049). CONCLUSIONS Abnormalities in objective markers of physical function are common in older adults with cancer, even in those deemed fit for chemotherapy. However, those abnormalities were not associated with an increased likelihood of chemotherapy toxicity in the population included in this small pilot study.
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Affiliation(s)
- T Hsu
- University of Toronto, Toronto, ON
| | - R Chen
- University of Toronto, Toronto, ON
| | - S C X Lin
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - S Djalalov
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - A Horgan
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - L W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON
| | - N Leighl
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
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19
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Enright K, Grunfeld E, Yun L, Moineddin R, Ghannam M, Dent S, Eisen A, Trudeau M, Kaizer L, Earle C, Krzyzanowska MK. Population-Based Assessment of Emergency Room Visits and Hospitalizations Among Women Receiving Adjuvant Chemotherapy for Early Breast Cancer. J Oncol Pract 2015; 11:126-32. [DOI: 10.1200/jop.2014.001073] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The authors conclude that emergency room visits and hospitalization are common among patients with early breast cancer receiving chemotherapy and significantly higher than among controls.
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Affiliation(s)
- Katherine Enright
- Trillium Health Partners–Credit Valley Hospital, Mississauga; Institute for Clinical Evaluative Sciences; Sunnybrook Odette Cancer Centre; Cancer Care Ontario; Princess Margaret Cancer Centre; University of Toronto; Ontario Institute for Cancer Research, Toronto; and Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Eva Grunfeld
- Trillium Health Partners–Credit Valley Hospital, Mississauga; Institute for Clinical Evaluative Sciences; Sunnybrook Odette Cancer Centre; Cancer Care Ontario; Princess Margaret Cancer Centre; University of Toronto; Ontario Institute for Cancer Research, Toronto; and Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Lingsong Yun
- Trillium Health Partners–Credit Valley Hospital, Mississauga; Institute for Clinical Evaluative Sciences; Sunnybrook Odette Cancer Centre; Cancer Care Ontario; Princess Margaret Cancer Centre; University of Toronto; Ontario Institute for Cancer Research, Toronto; and Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Rahim Moineddin
- Trillium Health Partners–Credit Valley Hospital, Mississauga; Institute for Clinical Evaluative Sciences; Sunnybrook Odette Cancer Centre; Cancer Care Ontario; Princess Margaret Cancer Centre; University of Toronto; Ontario Institute for Cancer Research, Toronto; and Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Mohammad Ghannam
- Trillium Health Partners–Credit Valley Hospital, Mississauga; Institute for Clinical Evaluative Sciences; Sunnybrook Odette Cancer Centre; Cancer Care Ontario; Princess Margaret Cancer Centre; University of Toronto; Ontario Institute for Cancer Research, Toronto; and Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Susan Dent
- Trillium Health Partners–Credit Valley Hospital, Mississauga; Institute for Clinical Evaluative Sciences; Sunnybrook Odette Cancer Centre; Cancer Care Ontario; Princess Margaret Cancer Centre; University of Toronto; Ontario Institute for Cancer Research, Toronto; and Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Andrea Eisen
- Trillium Health Partners–Credit Valley Hospital, Mississauga; Institute for Clinical Evaluative Sciences; Sunnybrook Odette Cancer Centre; Cancer Care Ontario; Princess Margaret Cancer Centre; University of Toronto; Ontario Institute for Cancer Research, Toronto; and Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Maureen Trudeau
- Trillium Health Partners–Credit Valley Hospital, Mississauga; Institute for Clinical Evaluative Sciences; Sunnybrook Odette Cancer Centre; Cancer Care Ontario; Princess Margaret Cancer Centre; University of Toronto; Ontario Institute for Cancer Research, Toronto; and Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Leonard Kaizer
- Trillium Health Partners–Credit Valley Hospital, Mississauga; Institute for Clinical Evaluative Sciences; Sunnybrook Odette Cancer Centre; Cancer Care Ontario; Princess Margaret Cancer Centre; University of Toronto; Ontario Institute for Cancer Research, Toronto; and Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Craig Earle
- Trillium Health Partners–Credit Valley Hospital, Mississauga; Institute for Clinical Evaluative Sciences; Sunnybrook Odette Cancer Centre; Cancer Care Ontario; Princess Margaret Cancer Centre; University of Toronto; Ontario Institute for Cancer Research, Toronto; and Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Monika K. Krzyzanowska
- Trillium Health Partners–Credit Valley Hospital, Mississauga; Institute for Clinical Evaluative Sciences; Sunnybrook Odette Cancer Centre; Cancer Care Ontario; Princess Margaret Cancer Centre; University of Toronto; Ontario Institute for Cancer Research, Toronto; and Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
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20
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Hong C, Ambrosone CB, Goodwin PJ. Comorbidities and Their Management: Potential Impact on Breast Cancer Outcomes. Improving Outcomes for Breast Cancer Survivors 2015. [DOI: 10.1007/978-3-319-16366-6_11] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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21
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Klepin HD, Pitcher BN, Ballman KV, Kornblith AB, Hurria A, Winer EP, Hudis C, Cohen HJ, Muss HB, Kimmick GG. Comorbidity, chemotherapy toxicity, and outcomes among older women receiving adjuvant chemotherapy for breast cancer on a clinical trial: CALGB 49907 and CALGB 361004 (alliance). J Oncol Pract 2014; 10:e285-92. [PMID: 25074878 DOI: 10.1200/jop.2014.001388] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We evaluated associations among comorbidity, toxicity, time to relapse (TTR), and overall survival (OS) in older women with early-stage breast cancer receiving adjuvant chemotherapy. METHODS Cancer and Leukemia Group B 49907 (Alliance) randomly assigned women ≥ 65 years old with stages I-III breast cancer to standard adjuvant chemotherapy or capecitabine. We reviewed data from 329 women who participated in the quality of life companion study CALGB 70103 and completed the Physical Health Subscale of the Older American Resources and Services Questionnaire. This questionnaire captures data on 14 comorbid conditions and the degree to which each interferes with daily activities. A comorbidity burden score was computed by multiplying the total number of conditions by each condition's level of interference with function. Outcomes were grade 3 to 5 toxicity, TTR, and OS. Logistic regression was used to evaluate associations between comorbidity and toxicity, and Cox proportional hazards models for TTR and survival. RESULTS Number of comorbidities ranged from 0 to 10 (median 2); the comorbidity burden score ranged from 0 to 25 (median 3). The most common conditions were arthritis (58%) and hypertension (55%). Comorbidity was associated with shorter OS, but not with toxicity or TTR. The hazard of death increased by 18% for each comorbidity (hazard ratio [HR] = 1.18, 95% CI = 1.06 to 1.33) after adjusting for age, tumor size, treatment, node and receptor status. Comorbidity burden score was similarly associated with OS (HR = 1.08; 95% CI, 1.03 to 1.14). CONCLUSIONS Among older women enrolled onto a clinical trial, comorbidity was associated with shorter OS, but not toxicity or relapse.
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Affiliation(s)
- Heidi D Klepin
- Wake Forest School of Medicine, Winston-Salem; Alliance Statistics and Data Center, Duke University; Duke University Medical Center, Durham; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; Dana Farber Cancer Institute, Boston, MA; City of Hope National Medical Center, Duarte, CA; and Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brandelyn N Pitcher
- Wake Forest School of Medicine, Winston-Salem; Alliance Statistics and Data Center, Duke University; Duke University Medical Center, Durham; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; Dana Farber Cancer Institute, Boston, MA; City of Hope National Medical Center, Duarte, CA; and Memorial Sloan Kettering Cancer Center, New York, NY
| | - Karla V Ballman
- Wake Forest School of Medicine, Winston-Salem; Alliance Statistics and Data Center, Duke University; Duke University Medical Center, Durham; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; Dana Farber Cancer Institute, Boston, MA; City of Hope National Medical Center, Duarte, CA; and Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alice B Kornblith
- Wake Forest School of Medicine, Winston-Salem; Alliance Statistics and Data Center, Duke University; Duke University Medical Center, Durham; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; Dana Farber Cancer Institute, Boston, MA; City of Hope National Medical Center, Duarte, CA; and Memorial Sloan Kettering Cancer Center, New York, NY
| | - Arti Hurria
- Wake Forest School of Medicine, Winston-Salem; Alliance Statistics and Data Center, Duke University; Duke University Medical Center, Durham; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; Dana Farber Cancer Institute, Boston, MA; City of Hope National Medical Center, Duarte, CA; and Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric P Winer
- Wake Forest School of Medicine, Winston-Salem; Alliance Statistics and Data Center, Duke University; Duke University Medical Center, Durham; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; Dana Farber Cancer Institute, Boston, MA; City of Hope National Medical Center, Duarte, CA; and Memorial Sloan Kettering Cancer Center, New York, NY
| | - Clifford Hudis
- Wake Forest School of Medicine, Winston-Salem; Alliance Statistics and Data Center, Duke University; Duke University Medical Center, Durham; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; Dana Farber Cancer Institute, Boston, MA; City of Hope National Medical Center, Duarte, CA; and Memorial Sloan Kettering Cancer Center, New York, NY
| | - Harvey J Cohen
- Wake Forest School of Medicine, Winston-Salem; Alliance Statistics and Data Center, Duke University; Duke University Medical Center, Durham; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; Dana Farber Cancer Institute, Boston, MA; City of Hope National Medical Center, Duarte, CA; and Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hyman B Muss
- Wake Forest School of Medicine, Winston-Salem; Alliance Statistics and Data Center, Duke University; Duke University Medical Center, Durham; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; Dana Farber Cancer Institute, Boston, MA; City of Hope National Medical Center, Duarte, CA; and Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gretchen G Kimmick
- Wake Forest School of Medicine, Winston-Salem; Alliance Statistics and Data Center, Duke University; Duke University Medical Center, Durham; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; Dana Farber Cancer Institute, Boston, MA; City of Hope National Medical Center, Duarte, CA; and Memorial Sloan Kettering Cancer Center, New York, NY
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Kimmick G, Fleming ST, Sabatino SA, Wu XC, Hwang W, Wilson JF, Lund MJ, Cress R, Anderson RT. Comorbidity burden and guideline-concordant care for breast cancer. J Am Geriatr Soc 2014; 62:482-8. [PMID: 24512124 DOI: 10.1111/jgs.12687] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To explore the relationship between level and type of comorbidity and guideline-concordant care for early-stage breast cancer. DESIGN Cross-sectional. SETTING National Program of Cancer Registry (NPCR) Breast and Prostate Cancer Patterns of Care study, which re-abstracted medical records from 2004 in seven cancer registries. PARTICIPANTS Individuals with stage 0-III breast cancer. MEASUREMENTS Multicomponent guideline-concordant management was modeled based on tumor size, node status, and hormone receptor status, according to consensus guidelines. Comorbid conditions and severity were measured using the Adult Comorbidity Evaluation Index (ACE-27). Multivariate logistic regression models determined factors associated with guideline-concordant care and included overall ACE-27 scores and 26 separate ACE comorbidity categories, age, race, stage, and source of payment. RESULTS The study sample included 6,439 women (mean age 58.7, range 20-99; 76% white; 44% with no comorbidity; 70% estrogen- or progesterone-receptor positive, or both; 31% human epidermal growth factor receptor 2 positive). Care was guideline concordant in 60%. Guideline concordance varied according to overall comorbidity burden (70% for none; 61% for minor; 58% for moderate, 43% for severe; P < .05). In multivariate analysis, the presence of hypertension (odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.01-1.30) predicted guideline concordance, whereas dementia (OR = 0.45, 95% CI = 0.24-0.82) predicted lack of guideline concordance. Older age (≥ 50) and black race were associated with less guideline concordance, regardless of comorbidity level. CONCLUSION When reporting survival outcomes in individuals with breast cancer with comorbidity, adherence to care guidelines should be among the covariates.
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Affiliation(s)
- Gretchen Kimmick
- Department of Internal Medicine, Division of Oncology, Duke University Medical Center, Durham, North Carolina
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Gerritse FL, Meulenbeld HJ, Roodhart JM, van der Velden AM, Blaisse RJ, Smilde TJ, Erjavec Z, de Wit R, Los M; NePro Study Investigators. Analysis of docetaxel therapy in elderly (≥70 years) castration resistant prostate cancer patients enrolled in the Netherlands Prostate Study. Eur J Cancer 2013; 49:3176-83. [PMID: 23849828 DOI: 10.1016/j.ejca.2013.06.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/31/2013] [Accepted: 06/10/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prostate cancer truly is an age-associated disease. Due to the increased life expectancy and more sensitive diagnostic techniques in the Western world, prostate cancer is diagnosed more frequently and with rapidly increasing incidence and prevalence rates. However, age above 65 or 70 years has been an exclusion criterion in clinical trials for decades and the knowledge about chemotherapy tolerance in elderly is limited. METHODS We performed a retrospective analysis of data acquired from the recently published Netherlands Prostate Study (NePro) to evaluate the influence of advanced age on docetaxel therapy in elderly men (>70 years) with castration resistant prostate cancer (CRPC) and bone metastases. Statistical analyses were performed stratified for age into four categories: <70 (n=315), 70-74 (n=150), 75-79 (n=85), and ≥80 years old (n=18). RESULTS We analysed 568 patients (median age 68.1 years, range 46-89 years, 44.5% aged ≥70 years). There was no relation between dosage and age (p=0.60). We found no significant differences between the number of dose reductions, time to progression (TTP), overall survival, chemotherapy tolerance and toxicity up to the age of 80 years. However, when compared to younger men, men aged 80 years or above more frequently experienced grade 3/4 toxicity and were five times less likely to complete the first three treatment cycles at the intended dose (Odds ratio (OR) 5.34, p=0.0052) and showed decreased overall survival (15.3 months versus 24.5 months in <80 years group, p=0.020). CONCLUSION In CRPC patients up to the age of 80 years, docetaxel chemotherapy is well tolerated, with toxicity levels and TTP comparable to those of younger patients. For chemotherapeutic treatment of patients above the age of 80 years an individual assessment should be made.
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Abstract
Establishing an indication for adjuvant chemotherapy in older cancer patients represents a major challenge. after surgery, older cancer patients can also have a significant risk of relapse and cancer death (even reported to be higher than in younger patients), but this is counterbalanced by the fact that the chance of dying from a noncancer cause is also much higher. a careful geriatric evaluation including assessment of comorbidity can provide some insight into the life expectancy and expected benefit from adjuvant chemotherapy for individual patients. age-related physiological changes can decrease tolerance of classical chemotherapy regimens, indicating the need for close monitoring and preventive measures.
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Affiliation(s)
- H Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium.
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25
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O'connor TL, Edge SB, Kossoff EB, Groman A, Wilding GE, Ademuyiwa FO, Levine EG, Watroba N, Ngamphaiboon N. Factors affecting the delivery of adjuvant/neoadjuvant chemotherapy in older women with breast cancer. J Geriatr Oncol 2012; 3:320-8. [DOI: 10.1016/j.jgo.2012.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I, Reed M, Ciatto S, Voogd AC, Brain E, Cutuli B, Terret C, Gosney M, Aapro M, Audisio R. Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol 2012; 13:e148-60. [PMID: 22469125 DOI: 10.1016/s1470-2045(11)70383-7] [Citation(s) in RCA: 394] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
As the mean age of the global population increases, breast cancer in older individuals will be increasingly encountered in clinical practice. Management decisions should not be based on age alone. Establishing recommendations for management of older individuals with breast cancer is challenging because of very limited level 1 evidence in this heterogeneous population. In 2007, the International Society of Geriatric Oncology (SIOG) created a task force to provide evidence-based recommendations for the management of breast cancer in elderly individuals. In 2010, a multidisciplinary SIOG and European Society of Breast Cancer Specialists (EUSOMA) task force gathered to expand and update the 2007 recommendations. The recommendations were expanded to include geriatric assessment, competing causes of mortality, ductal carcinoma in situ, drug safety and compliance, patient preferences, barriers to treatment, and male breast cancer. Recommendations were updated for screening, primary endocrine therapy, surgery, radiotherapy, neoadjuvant and adjuvant systemic therapy, and metastatic breast cancer.
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Affiliation(s)
- Laura Biganzoli
- Sandro Pitigliani Medical Oncology Unit, Istituto Toscano Tumori, Hospital of Prato, Prato, Italy.
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27
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Puts M, Monette J, Girre V, Wolfson C, Monette M, Batist G, Bergman H. Changes in functional status in older newly-diagnosed cancer patients during cancer treatment: A six-month follow-up period. Results of a prospective pilot study. J Geriatr Oncol 2011; 2:112-20. [DOI: 10.1016/j.jgo.2010.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Roorda C, de Bock GH, van der Veen WJ, Lindeman A, Jansen L, van der Meer K. Role of the general practitioner during the active breast cancer treatment phase: an analysis of health care use. Support Care Cancer 2012; 20:705-14. [PMID: 21437780 DOI: 10.1007/s00520-011-1133-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 02/28/2011] [Indexed: 11/20/2022]
Abstract
Purpose Little is known about the actual involvement of the general practitioner (GP) during the active breast cancer treatment phase. Therefore, this study explored (disease-specific) primary health care use among women undergoing active treatment for breast cancer compared with women without breast cancer. Methods A total of 185 women with a first diagnosis of early-stage breast cancer between 1998 and 2007 were identified in the primary care database of the Registration Network Groningen and matched with a reference population of 548 women without breast cancer on birth year and GP. Results Since diagnosis, patients with breast cancer had twice as many face-to-face contacts compared with women from the reference population (median 6.0 vs 3.0/year, Mann–Whitney (M-W) test p < 0.001). The median number of drug prescriptions and referrals was also significantly higher among patients than among the reference population (11.0 vs 7.0/year, M-W test p < 0.001 and 1.0 vs 0.0/year, M-W test p < 0.001). More patients than women from the reference population had face-to-face contacts or were prescribed drugs for reasons related to breast cancer and its treatment, including gastrointestinal problems, psychological reasons and endocrine therapy. Conclusions During the active breast cancer treatment phase, GPs are involved in the management of treatment-related side effects and psychological symptoms, as well as in the administration of endocrine therapy. Based on the findings of this study, interventions across the primary/secondary interface can be planned to improve quality of life and other outcomes in patients undergoing breast cancer treatment.
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Lee L, Cheung WY, Atkinson E, Krzyzanowska MK. Impact of Comorbidity on Chemotherapy Use and Outcomes in Solid Tumors: A Systematic Review. J Clin Oncol 2011; 29:106-17. [DOI: 10.1200/jco.2010.31.3049] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The treatment of cancer in patients with comorbidities can be challenging as these individuals are underrepresented in clinical trials. We conducted a systematic review to determine the impact of comorbidity on chemotherapy use, delivery, tolerability, and survival among patients with solid tumors to summarize current data and provide recommendations for future research. Methods All English-language articles from 1990 to 2009 that explored the association between comorbidity and chemotherapy were identified from MEDLINE and EMBASE. Abstracts were reviewed for eligibility, and data on study design and results were extracted. Results Thirty-four articles met the inclusion criteria. Study populations and design were heterogeneous, and the quality of reporting was generally poor. Most studies were retrospective (76%), were based on a cancer registry linked with administrative data (47%), and assessed the overall effect of comorbidity using an index score (76%). Sixteen studies (47%) investigated chemotherapy use, and 29 (85%) addressed survival. The majority reported decreased chemotherapy use (75%) and inferior survival (69%) for patients with comorbidities compared to those without. In 11 of 14 studies, inferior survival was independent of treatment. Of the few studies that addressed chemotherapy tolerability, seven of 10 reported an increased rate of severe toxicity, and three of five reported increased treatment delays for patients with comorbidity. Conclusion Chemotherapy use and outcomes among cancer patients with comorbidities are generally inferior, but the existing evidence is limited and of insufficient quality to determine the relationship between decreased use and inferior survival. Further studies that are prospective and site and stage specific are warranted.
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Affiliation(s)
- Linda Lee
- From Princess Margaret Hospital, University of Toronto, Toronto, Ontario; British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Winson Y. Cheung
- From Princess Margaret Hospital, University of Toronto, Toronto, Ontario; British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Esther Atkinson
- From Princess Margaret Hospital, University of Toronto, Toronto, Ontario; British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Monika K. Krzyzanowska
- From Princess Margaret Hospital, University of Toronto, Toronto, Ontario; British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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