1
|
Eriksen GF, Benth JŠ, Grønberg BH, Rostoft S, Kirkhus L, Kirkevold Ø, Oldervoll LM, Bye A, Hjelstuen A, Slaaen M. Geriatric impairments are associated with reduced quality of life and physical function in older patients with cancer receiving radiotherapy - A prospective observational study. J Geriatr Oncol 2023; 14:101379. [PMID: 36180379 DOI: 10.1016/j.jgo.2022.09.008] [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: 03/09/2022] [Revised: 08/03/2022] [Accepted: 09/19/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Quality of life (QoL) and function are important outcomes for older adults with cancer. We aimed to assess differences in trends in patient-reported outcomes (PROs) during radiotherapy (RT) between (1) groups with curative or palliative treatment intent and (2) groups defined according to the number of geriatric impairments. MATERIALS AND METHODS A prospective observational study including patients aged ≥65 years receiving curative or palliative RT was conducted. Geriatric assessment (GA) was performed before RT, and cut-offs for impairments within each domain were defined. Patients were grouped according to the number of geriatric impairments: 0, 1, 2, 3, and ≥ 4. Our primary outcomes, global QoL and physical function (PF), were assessed by The European Organisation for Research and Treatment of Cancer Quality-of-Life Core Questionnaire (EORTC) (QLQ-C30) at baseline, RT completion, and two, eight, and sixteen weeks later. Differences in trends in outcomes between the groups were assessed by linear mixed models. RESULTS 301 patients were enrolled, mean age was 73.6 years, 53.8% received curative RT. Patients receiving palliative RT reported significantly worse global QoL and PF compared to the curative group. The prevalence of 0, 1, 2, 3 and ≥ 4 geriatric impairments was 16.6%, 22.7%, 16.9%, 16.3% and 27.5%, respectively. Global QoL and PF gradually decreased with an increasing number of impairments. These group differences remained stable from baseline throughout follow-up without any clinically significant changes for any of the outcomes. DISCUSSION Increasing number of geriatric impairments had a profound negative impact on global QoL and PF, but no further decline was observed for any group or outcome, indicating that RT was mainly well tolerated. Thus, geriatric impairments per se should not be reasons for withholding RT. GA is key to identifying vulnerable patients in need of supportive measures, which may have the potential to improve treatment tolerance. Registered at clinicaltrials.gov (NCT03071640).
Collapse
Affiliation(s)
- Guro Falk Eriksen
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, 2313 Ottestad, Norway; Department of Internal Medicine, Hamar Hospital, Innlandet Hospital Trust, Postboks 4453, 2326 Hamar, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Pb 1171 Blindern, 0318 Oslo, Norway.
| | - Jūratė Šaltytė Benth
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, 2313 Ottestad, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, P.O.Box 1171, 0318 Blindern, Norway; Health Services Research Unit, Akershus University Hospital, P.O.Box 1000, 1478 Lørenskog, Norway
| | - Bjørn Henning Grønberg
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU),Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, NO-7491 Trondheim, Norway
| | - Siri Rostoft
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Pb 1171 Blindern, 0318 Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, Pb 4956 Nydalen, 0424 Oslo, Norway
| | - Lene Kirkhus
- Department of Oncology, Oslo University Hospital, Pb 4956 Nydalen, 0424 Oslo, Norway
| | - Øyvind Kirkevold
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, 2313 Ottestad, Norway; The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Postboks 2136, 3103 Tønsberg, Norway; Faculty of Health, Care and Nursing, NTNU Gjøvik, Box 191, N-2802 Gjøvik, Norway
| | - Line Merethe Oldervoll
- Center for Crisis Psycology, Faculty of Psychology, University of Bergen, PB 7807, 5020 Bergen, Norway; Department of Public Health and Nursing, NTNU, PB 8905, 7491 Trondheim, Norway
| | - Asta Bye
- Department of nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Postboks 4, St. Olavs plass, 0130 Oslo, Norway
| | - Anne Hjelstuen
- Department of Internal Medicine, Innlandet Hospital Trust, Kyrre Grepps gate 11, 2819 Gjøvik, Norway
| | - Marit Slaaen
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, 2313 Ottestad, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Pb 1171 Blindern, 0318 Oslo, Norway
| |
Collapse
|
2
|
Eriksen GF, Šaltytė Benth J, Grønberg BH, Rostoft S, Kirkhus L, Kirkevold Ø, Hjelstuen A, Slaaen M. Geriatric impairments are prevalent and predictive of survival in older patients with cancer receiving radiotherapy: a prospective observational study. Acta Oncol 2022; 61:393-402. [PMID: 34874228 DOI: 10.1080/0284186x.2021.2009561] [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] [Indexed: 10/19/2022]
Abstract
BACKGROUND A systematic assessment of problems that are frequent in older age (geriatric assessment [GA]) provides prognostic information for patients undergoing cancer surgery and systemic cancer treatment. We aimed to investigate the prevalence of geriatric impairments and their impact on survival in older patients with cancer receiving radiotherapy (RT). MATERIAL AND METHODS A single-centre prospective observational study was conducted including patients ≥65 years referred for curative or palliative RT. Prior to RT, we performed a modified GA (mGA) assessing comorbidities, medications, nutritional status basic- and instrumental activities of daily living (IADL) mobility, falls, cognition and depressive symptoms. Impairments in each mGA domain were defined. Overall survival (OS) was presented by Kaplan Meier plots for groups defined according to the number of impairments, and compared by log-rank test. The association between mGA domains and OS was assessed by Cox proportional hazard regression analysis. RESULTS Between February 2017 and July 2018, 301 patients were included, 142 (47.2%) were women. Mean age was 73.6 (SD 6.3) years, 162 (53.8%) received curative RT. During the median observation time of 24.2 months (min 0.3, max 25.9), 123 (40.9%) patients died. In the overall cohort, 49 (16.3%) patients had no geriatric impairment, 81 (26.9%) had four or more. OS significantly decreased with an increasing number of impairments (p < .01). Nutritional status (HR 0.90, 95% CI [0.81; 0.99], p = .038) and IADL function (HR 0.98, 95% CI [0.95; 1.00], p = .027) were independent predictors of OS. CONCLUSION Geriatric impairments were frequent among older patients with cancer receiving RT and nutritional status and IADL function predicted OS. Targeted interventions to remediate modifiable impairments may have the potential to improve OS. TRIAL REGISTRATION Cinicaltrials.gov ID:NCT03071640.
Collapse
Affiliation(s)
- Guro Falk Eriksen
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Department of Internal Medicine, Innlandet Hospital Trust, Hamar, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Bjørn Henning Grønberg
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Siri Rostoft
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Lene Kirkhus
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Øyvind Kirkevold
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Health, Care and Nursing, NTNU Gjøvik, Gjøvik, Norway
| | - Anne Hjelstuen
- Department of Internal Medicine, Innlandet Hospital Trust, Gjøvik, Norway
| | - Marit Slaaen
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
3
|
Hjelstuen A, Anderssen SA, Holme I, Seljeflot I, Klemsdal TO. Effect of lifestyle and/or statin treatment on soluble markers of atherosclerosis in hypertensives. SCAND CARDIOVASC J 2008; 41:313-20. [PMID: 17852781 DOI: 10.1080/14017430701411234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the independent and combined effects of lifestyle changes and statin treatment on soluble markers of atherosclerotic activity. DESIGN The study was a randomised, 2 x 2 factorial 1 year intervention trial. Participants (n=177) were sedentary, drug-treated, hypertensive men (aged 40-74 years). They were randomised to placebo, lifestyle intervention (diet and physical activity), fluvastatin 40 mg, or the combination of lifestyle and fluvastatin. RESULTS Lifestyle intervention significantly reduced intercellular adhesion molecule-1 (sICAM-1) compared to usual care (p=0.003). Thrombomodulin level remained higher among individuals receiving lifestyle intervention (p=0.025). sICAM-1 was less reduced among fluvastatin treated participants compared to the placebo treated (p=0.029). Changes of blood pressure, weight or waist circumference were not significantly different between treatment groups. Individuals who achieved improvement of classical risk factors also had a significant reduction of endothelial markers (E-selectin, von Willebrands factor, tissue plasminogen activator antigen). CONCLUSIONS One year of lifestyle intervention reduced the level of sICAM-1 in sedentary, drug-treated hypertensives, in spite of no impact on traditional risk factors. Low dose fluvastatin had no beneficial effect on the measured markers.
Collapse
Affiliation(s)
- Anne Hjelstuen
- Research Forum, Ullevål University Hospital, Oslo, Norway.
| | | | | | | | | |
Collapse
|
4
|
Hjelstuen A, Anderssen SA, Holme I, Seljeflot I, Klemsdal TO. Markers of inflammation are inversely related to physical activity and fitness in sedentary men with treated hypertension. Am J Hypertens 2006; 19:669-75; discussion 676-7. [PMID: 16814119 DOI: 10.1016/j.amjhyper.2005.11.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Revised: 11/01/2005] [Accepted: 11/01/2005] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Physical inactivity is an important risk factor for atherosclerotic disease. We studied the relationship between physical activity and physical fitness and soluble markers of atherosclerotic activity in men with drug-treated hypertension. METHODS The participants (n = 177, 40 to 74 years of age), who were randomly recruited from the Hypertension High Risk Management Trial (HYRIM), were overweight and had sedentary lifestyles. The inflammatory markers high-sensitivity C-reactive protein (hs-CRP), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (SICAM-1) and soluble E-selectin (sE-selectin) and the hemostatic markers soluble thrombomodulin (sTM), von Willebrand factor (vWf), and tissue plasminogen activator antigen (tPAag) were measured. Physical activity was measured by use of a questionnaire. Time to exhaustion in a bicycle test was used as an expression of physical fitness. RESULTS The hs-CRP showed a significant inverse relationship with physical fitness independent of major cardiovascular risk factors (P = .017) but was not related to physical activity. The sE-selectin was significantly related to physical activity, although only when other factors were taken into account (P = .033), and it had no significant association with physical fitness. In addition there were strong associations between hs-CRP and sICAM-1 and the Framingham Coronary Heart Disease risk score (P < .001). CONCLUSIONS The observed inverse relations between physical fitness and hs-CRP and between level of physical activity and sE-selectin in drug-treated, hypertensive sedentary men indicates a beneficial effect of good fitness status as well as activity of low intensity on vessel wall inflammation.
Collapse
Affiliation(s)
- Anne Hjelstuen
- Medical Division, Ullevål University Hospital, Kirkeveien, Oslo, Norway.
| | | | | | | | | |
Collapse
|