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Novak J, Goldberg A, Dharmarajan K, Amini A, Maggiore RJ, Presley CJ, Nightingale G. Polypharmacy in older adults with cancer undergoing radiotherapy: A review. J Geriatr Oncol 2022; 13:778-783. [DOI: 10.1016/j.jgo.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/09/2021] [Accepted: 02/10/2022] [Indexed: 01/09/2023]
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2
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Dale W, Williams GR, R MacKenzie A, Soto-Perez-de-Celis E, Maggiore RJ, Merrill JK, Katta S, Smith KT, Klepin HD. How Is Geriatric Assessment Used in Clinical Practice for Older Adults With Cancer? A Survey of Cancer Providers by the American Society of Clinical Oncology. JCO Oncol Pract 2020; 17:336-344. [PMID: 33064058 DOI: 10.1200/op.20.00442] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE For patients with cancer who are older than 65 years, the 2018 ASCO Guideline recommends geriatric assessment (GA) be performed. However, there are limited data on providers' practices using GA. Therefore, ASCO's Geriatric Oncology Task Force conducted a survey of providers to assess practice patterns and barriers to GA. METHODS Cancer providers treating adult patients including those ≥ 65 years completed an online survey. Questions included those asking about awareness of ASCO's Geriatric Oncology Guideline (2018), use of validated GA tools, and perceived barriers to using GA. Descriptive statistics and statistical comparisons between those aware of the Guideline and those who were not were conducted. Statistical significance was set at P < .05. RESULTS Participants (N = 1,277) responded between April 5 and June 5, 2019. Approximately half (53%) reported awareness of the Guideline. The most frequently used GA tools, among those aware of the Guideline and those who were not, assessed functional status (69% v 50%; P < .001) and falls (62% v 45%; P < .001). Remaining tools were used < 50% of the time, including tools assessing weight loss, comorbidities, cognition, life expectancy, chemotherapy toxicity, mood, and noncancer mortality risk. GA use was two to four times higher among those who are aware of the Guideline. The most frequent barriers for those who reported being Guideline aware were lack of resources, specifically time (81.7%) and staff (77.0%). In comparison, those who were unaware of the Guideline most often reported the following barriers: lack of knowledge or training (78.4%), lack of awareness about tools (75.2%), and uncertainty about use of tools (75.0%). CONCLUSION Among providers caring for older adults, 52% were aware of the ASCO Guideline. Some domains were assessed frequently (eg, function, falls), whereas other domains were assessed rarely (eg, mood, cognition). Guideline awareness was associated with two to four times increased use of GA and differing perceived barriers. Interventions facilitating Guideline-consistent implementation will require various strategies to change behavior.
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Affiliation(s)
- William Dale
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | | | - Sweatha Katta
- American Society of Clinical Oncology, Alexandria, VA
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Maggiore RJ, Zahrieh D, McMurray RP, Feliciano JL, Samson P, Mohindra P, Chen H, Wong ML, Lafky JM, Jatoi A, Le-Rademacher JG. Toxicity and survival outcomes in older adults receiving concurrent or sequential chemoradiation for stage III non-small cell lung cancer in Alliance trials (Alliance A151812). J Geriatr Oncol 2020; 12:563-571. [PMID: 32950428 DOI: 10.1016/j.jgo.2020.09.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/17/2020] [Accepted: 09/01/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Optimal treatment for older adults with stage III non-small cell lung cancer (NSCLC) remains unclear. Here we hypothesized that sequential chemoradiation therapy (sCRT) is better tolerated than concurrent (cCRT) but confers acceptable efficacy. We evaluated these strategies in older adults utilizing Alliance for Clinical Trials in Oncology data. MATERIALS AND METHODS Pooled analyses from 6 first-line stage III NSCLC CRT trials (Cancer and Leukemia Group B 8433, 8831, 9130, 30106, 30407, 39801) were used to compare toxicity and survival outcomes with cCRT versus sCRT in patients age ≥ 65 years. Grade 3-5 adverse events (AEs), progression-free and overall survival (PFS; OS) are reported with adjustment for covariates. RESULTS Four hundred older adults, of whom 106 (26.5%) had received sCRT and 294 (73.5%) had received cCRT, comprised the cohorts. Virtually all had an Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1 (99%). More grade 3-5 AEs were observed at any time-point with cCRT than sCRT (94.2% versus 86.8%; 95% confidence interval for difference in proportions, 1.3%, 15.5%) and this finding remained after adjusting for length of study treatment (P = 0.018). Comparable PFS and OS were observed with sCRT versus cCRT (median: 8.0 versus 9.2 months; median: 11.9 versus 13.4 months, respectively) even after adjustment for age, sex, ECOG PS, body mass index, pretreatment weight loss, stage, and cisplatin-based therapy (P = 0.604 and P = 0.906, respectively). DISCUSSION These data show that sCRT was associated with less toxicity than cCRT with no associated statistically significant decrease in efficacy outcomes and that sCRT merits further study in this population.
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Affiliation(s)
| | - David Zahrieh
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America; Mayo Clinic, Rochester, MN, United States of America.
| | - Ryan P McMurray
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America; Mayo Clinic, Rochester, MN, United States of America
| | | | - Pamela Samson
- Washington University School of Medicine, St. Louis, MO, United States of America
| | | | - Hongbin Chen
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Melisa L Wong
- University of California, San Francisco, CA, United States of America
| | | | - Aminah Jatoi
- Mayo Clinic, Rochester, MN, United States of America
| | - Jennifer G Le-Rademacher
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America; Mayo Clinic, Rochester, MN, United States of America
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Hsu T, Soto-Perez-de-Celis E, Burhenn PS, Korc-Grodzicki B, Wildes TM, Kanesvaran R, Maggiore RJ. Educating healthcare providers in geriatric oncology – A call to accelerate progress through identifying the gaps in knowledge. J Geriatr Oncol 2020; 11:1023-1027. [DOI: 10.1016/j.jgo.2019.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/25/2019] [Indexed: 02/02/2023]
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Hsu T, Kessler ER, Parker IR, Dale W, Gajra A, Holmes HM, Maggiore RJ, Magnuson A, McKoy JM, Hurria A. Identifying Geriatric Oncology Competencies for Medical Oncology Trainees: A Modified Delphi Consensus Study. Oncologist 2020; 25:591-597. [PMID: 32237179 DOI: 10.1634/theoncologist.2019-0950] [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: 12/09/2019] [Accepted: 02/20/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Most oncology trainees are not taught about the needs of older patients, who make up the majority of patients with cancer. Training of health care providers is critical to improve the care of older adults with cancer. There is no consensus about which geriatric oncology (GO) competencies are important for medical oncology trainees. Our objective was to identify GO competencies medical oncology trainees should acquire during training. MATERIALS AND METHODS A modified Delphi consensus of experts in oncology medical education and GO was conducted. Experts categorized at what training stage proposed competencies should be attained: internal medicine, oncology, or GO training. Consensus was obtained if two thirds of experts agreed on the training stage at which the competency should be attained. RESULTS A total of 78 potential competencies were identified, of which 35 (44.9%) proposed competencies were felt to be appropriate to be acquired during oncology training. The majority of the identified competencies pertained to prescribing of systemic therapy (n = 12) and psychosocial and supportive care (n = 13). No competencies related to geriatric assessment were identified for acquisition during oncology training. CONCLUSION Experts in oncology education and geriatric oncology agreed upon a set of GO competencies appropriate for oncology trainees. These results provide the foundation for developing a GO curriculum for medical oncology trainees and will hopefully lead to better care of older adults with cancer. IMPLICATIONS FOR PRACTICE The aging population will drive the projected rise in cancer incidence. Although aging patients make up the majority of patients diagnosed with cancer, oncologists rarely receive training on how to care for them. Training of health care providers is critical to improving the care of older adults with cancer. The results of this study will help form the foundation of developing a geriatric oncology curriculum for medical oncology trainees.
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Affiliation(s)
- Tina Hsu
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Canada
| | | | - Ira R Parker
- Geriatric Oncology Solutions, La Jolla, California, USA
| | - William Dale
- City of Hope National Medical Center, Duarte, California, USA
| | - Ajeet Gajra
- SUNY Upstate Medical University, Syracuse, New York, USA
| | - Holly M Holmes
- McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Ronald J Maggiore
- Wilmot Cancer Institute, University of Rochester, Rochester, New York, USA
- Divisions of Medical Oncology and Geriatrics, University of Rochester, Rochester, New York, USA
| | - Allison Magnuson
- Wilmot Cancer Institute, University of Rochester, Rochester, New York, USA
- Divisions of Medical Oncology and Geriatrics, University of Rochester, Rochester, New York, USA
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Arti Hurria
- City of Hope National Medical Center, Duarte, California, USA
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Archibald WJ, Victor AI, Strawderman MS, Maggiore RJ. Immune checkpoint inhibitors in older adults with melanoma or cutaneous malignancies: The Wilmot Cancer Institute experience. J Geriatr Oncol 2020; 11:496-502. [DOI: 10.1016/j.jgo.2019.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 06/20/2019] [Accepted: 07/03/2019] [Indexed: 01/19/2023]
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Milano MT, Bates JE, Budnik J, Qiu H, Hardy S, Cummings MA, Baumgart MA, Maggiore RJ, Mulford DA, Usuki KY. Risk of brain metastases in T1-3N0 NSCLC: a population-based analysis. Lung Cancer Manag 2020; 9:LMT25. [PMID: 32256710 PMCID: PMC7110582 DOI: 10.2217/lmt-2019-0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/23/2022] Open
Abstract
Aim: Several consensus guidelines recommend against routine brain imaging at diagnosis of T1-3N0 non-small cell lung cancer (NSCLC). Methods: From the Surveillance, Epidemiology and End Results registry, patients with pathologically confirmed T1-3N0 NSCLC were identified. Risks of brain metastases at time of initial diagnosis were analyzed. Results: Patients selected to not undergo primary NSCLC resection had approximately tenfold greater incidence of brain metastases versus those who did. Younger age, adenocarcinoma histology, higher tumor stage and higher histologic grade were all significantly (p < 0.0001) associated with greater likelihood of presenting with brain metastases. Conclusion: Given the morbidity and mortality of brain metastases, routine brain screening after NSCLC diagnosis (particularly adenocarcinoma) may be justifiable, though more refined cost-benefit analyses are warranted.
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Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - James E Bates
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Justin Budnik
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Haoming Qiu
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Sara Hardy
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Michael A Cummings
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Megan A Baumgart
- Department of Radiation Oncology, University of Florida, Gainesville, FL 32610, USA
| | - Ronald J Maggiore
- Department of Radiation Oncology, University of Florida, Gainesville, FL 32610, USA
| | - Deborah A Mulford
- Department of Radiation Oncology, University of Florida, Gainesville, FL 32610, USA
| | - Kenneth Y Usuki
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
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Hatfield J, McClelland S, Luo J, Degnin C, Chen Y, Maggiore RJ, Mitin T. Management of Localized Breast Angiosarcoma by North American Radiation Oncologists and Medical Oncologists. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/s0360-3016(19)30408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Muchnik E, Loh KP, Strawderman M, Magnuson A, Mohile SG, Estrah V, Maggiore RJ. Immune Checkpoint Inhibitors in Real-World Treatment of Older Adults with Non-Small Cell Lung Cancer. J Am Geriatr Soc 2019; 67:905-912. [PMID: 30698276 DOI: 10.1111/jgs.15750] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [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: 09/30/2018] [Revised: 11/08/2018] [Accepted: 12/12/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy and toxicity of immune checkpoint inhibitors (ICIs) in older patients with advanced non-small cell lung cancer (NSCLC) seen in routine clinical practice. DESIGN Retrospective study. SETTING Single academic institution and its affiliated centers. PARTICIPANTS Patients 70 years or older with advanced-stage NSCLC seen between April 1, 2015, and April 1, 2017, and treated with ICIs. MEASUREMENTS Efficacy data included overall survival (OS) and time to treatment failure (TTF), stratified by age, comorbidities (Charlson Comorbidity Index [CCI]), and Eastern Cooperative Oncology Group Performance Status (ECOG PS), and estimated using the Kaplan-Meier method and log-rank test. Toxicity data included immune-related adverse events (irAEs), need for glucocorticoids, and hospitalization. The associations of toxicity with age, CCI, and ECOG PS were evaluated using the exact χ2 test or Fisher exact test. RESULTS We included 75 patients (median age: 74 y; range, 70-92 y); 53% had a CCI of 3 or higher; 49% had ECOG PS of 2 or higher. Median OS for the whole cohort was 8.2 months (ECOG PS 0-1 vs ≥2: 13.7 vs 3.8 mo; p < .01). Median TTF was 4.2 months (ECOG PS 0-1 vs ≥2: 5.6 vs 2.0 mo; p = .02). Overall, 37% of patients experienced irAE of any grade (a total of 37 events); 8% were grade 3 or higher (no ICI-related deaths). Of those who discontinued ICIs (N = 64), 15% were due to irAEs. Of those who experienced irAEs, 64% required glucocorticoids. Hospitalizations during ICI treatment occurred in 72%. Toxicity generally did not differ by age, CCI, or ECOG PS. CONCLUSIONS Outcomes in our cohort were driven by ECOG PS rather than chronological age or comorbidities. The relatively high rates of ICI discontinuation, use of glucocorticoids, and hospitalization during ICI treatment in our study highlight the vulnerability of older adults with advanced NSCLC even in the immunotherapy era. J Am Geriatr Soc 67:905-912, 2019.
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Affiliation(s)
- Eugene Muchnik
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Kah Poh Loh
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Myla Strawderman
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Allison Magnuson
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Vered Estrah
- Mackenzie Health, Richmond Hill, Ontario, Canada
| | - Ronald J Maggiore
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
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Hatfield J, McClelland S, Luo J, Degnin C, Chen Y, Maggiore RJ, Mitin T. Management of Localized Breast Angiosarcoma by North American Radiation and Medical Oncologists. Clin Breast Cancer 2018; 18:498-503. [PMID: 30482726 DOI: 10.1016/j.clbc.2018.09.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/16/2018] [Accepted: 09/24/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Primary breast angiosarcoma is a rare malignancy with no clinical trials to guide management. The current use of surgery, chemotherapy, and radiotherapy among North American oncologists is unknown. PATIENTS AND METHODS An institutional review board-approved anonymous electronic survey was distributed to 9660 practicing North American radiation and medical oncologists. Questions pertained to treatment recommendations for localized nonmetastatic primary breast angiosarcoma, as well as knowledge/use of β-blockers in angiosarcoma. The Fisher exact test was used to compare responses of medical and radiation oncologists. RESULTS Surgery was recommended by 95% of all respondents. Chemotherapy was recommended by over half of medical and radiation oncologists. Radiotherapy was recommended by 92% of radiation and 56% of medical oncologists. The most common treatment recommendation was a trimodal treatment, with up-front surgery followed by adjuvant chemotherapy, then by adjuvant radiotherapy. Twenty-two percent of respondents were aware of clinical data pertaining to the use of β-blockers in management of angiosarcoma, and among these respondents 69% were comfortable incorporating this treatment into standard practice. CONCLUSION Trimodal management of primary localized breast angiosarcoma is supported by North American radiation and medical oncologists, with the majority recommending up-front surgery followed by adjuvant chemotherapy and radiation. The recently published reports of successful use of β-blockers are not yet known among North American clinicians, but there is a great enthusiasm to incorporate these commonly prescribed medications into standard practice. These findings may greatly influence the standard of care for breast angiosarcoma treatment, particularly given the absence of Level I-supported evidence.
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Affiliation(s)
- Jess Hatfield
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - Shearwood McClelland
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - Jia Luo
- Department of Medicine, Oregon Health and Science University, Portland, OR
| | - Catherine Degnin
- Biostatistics Shared Resource, Oregon Health and Science University, Portland, OR
| | - Yiyi Chen
- Biostatistics Shared Resource, Oregon Health and Science University, Portland, OR
| | - Ronald J Maggiore
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Timur Mitin
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR.
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Dunne RF, Roussel B, Culakova E, Pandya C, Fleming FJ, Hensley B, Magnuson AM, Loh KP, Gilles M, Ramsdale E, Maggiore RJ, Jatoi A, Mustian KM, Dale W, Mohile SG. Characterizing cancer cachexia in the geriatric oncology population. J Geriatr Oncol 2018; 10:415-419. [PMID: 30196027 DOI: 10.1016/j.jgo.2018.08.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 04/04/2018] [Revised: 07/31/2018] [Accepted: 08/10/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Cancer cachexia, characterized by weight loss and sarcopenia, leads to a decline in physical function and is associated with poorer survival. Cancer cachexia remains poorly described in older adults with cancer. This study aims to characterize cancer cachexia in older adults by assessing its prevalence utilizing standard definitions and evaluating associations with components of the geriatric assessment (GA) and survival. MATERIALS AND METHODS Patients with cancer older than 65 years of age who underwent a GA and had baseline CT imaging were eligible in this cross-sectional study. Cancer cachexia was defined by the international consensus definition reported in 2011. Sarcopenia was measured using cross-sectional imaging and utilizing sex-specific cut-offs. Associations between cachexia, sarcopenia, and weight loss with survival and GA domains were explored. RESULTS Mean age of 100 subjects was 79.9 years (66-95) and 65% met criteria for cancer cachexia. Cachexia was associated with impairment in instrumental activities of daily living (IADL) (p = .017); no significant association was found between sarcopenia or weight loss and IADL impairment. Cachexia was significantly associated with poorer survival (median 1.0 vs 2.1 years, p = .011). CONCLUSIONS Cancer cachexia as defined by the international consensus definition is prevalent in older adults with cancer and is associated with functional impairment and decreased survival. Larger prospective studies are needed to further describe cancer cachexia in this population.
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Affiliation(s)
- Richard F Dunne
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States.
| | - Breton Roussel
- Department of Medicine, Brown University, Providence, RI, United States
| | - Eva Culakova
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States
| | - Chintan Pandya
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Fergal J Fleming
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Bradley Hensley
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Allison M Magnuson
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States
| | - Kah Poh Loh
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Maxence Gilles
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Erika Ramsdale
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States
| | - Ronald J Maggiore
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Aminah Jatoi
- Mayo Clinic, Department of Oncology, Rochester, MN, United States
| | - Karen M Mustian
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States
| | - William Dale
- City of Hope, Department of Supportive Care Medicine, Duarte, CA, United States
| | - Supriya G Mohile
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States
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Shahrokni A, Maggiore RJ, Ghassemzadeh H. New technologies in geriatric oncology care. J Geriatr Oncol 2018; 9:687-689. [PMID: 30037766 DOI: 10.1016/j.jgo.2018.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/13/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Armin Shahrokni
- Department of Medicine/Geriatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Ronald J Maggiore
- Department of Medicine, Division of Hematology/Oncology, University of Rochester, Rochester, NY 14642, USA
| | - Hassan Ghassemzadeh
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, Washington 99164, USA
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Akthar AS, Hellekson CD, Ganai S, Hahn OM, Maggiore RJ, Cohen EE, Posner MC, Chmura SJ, Howard AR, Golden DW. Interdisciplinary Oncology Education: a National Survey of Trainees and Program Directors in the United States. J Cancer Educ 2018; 33:622-626. [PMID: 27873183 DOI: 10.1007/s13187-016-1139-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Oncologists must have a strong understanding of collaborating specialties in order to deliver optimal cancer care. The objective of this study was to quantify current interdisciplinary oncology education among oncology training programs across the USA, identify effective teaching modalities, and assess communication skills training. Web-based surveys were sent to oncology trainees and program directors (PDs) across the USA on April 1, 2013 and October 8, 2013, respectively. Question responses were Yes/No, five-point Likert scales (1 = not at all, 2 = somewhat, 3 = moderately, 4 = quite, 5 = extremely), or free response. Respondents included the following (trainees/PDs): 254/55 medical oncology, 160/42 surgical oncology, 102/24 radiation oncology, and 41/20 hospice and palliative medicine (HPM). Trainees consistently reported lower rates of interdisciplinary education for each specialty compared with PDs as follows: medical oncology 57 vs. 77% (p < 0.01), surgical oncology 30 vs. 44% (p < 0.01), radiation oncology 70 vs. 89% (p < 0.01), geriatric oncology 19 vs. 30% (p < 0.01), and HPM 55 vs. 74% (p < 0.01). The predominant teaching method used (lectures vs. rotations vs. tumor board attendance vs. workshop vs. other) varied according to which discipline was being taught. The usefulness of each teaching method was rated statistically different by trainees for learning about select disciplines. Furthermore, statistically significant differences were found between PDs and trainees for the perceived usefulness of several teaching modalities. This study highlights a deficiency of interdisciplinary education among oncology training programs in the USA. Efforts to increase interdisciplinary education opportunities during training may ultimately translate into improved collaboration and quality of cancer care.
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Affiliation(s)
- Adil S Akthar
- Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, 5758 South Maryland Avenue MC 9006, Chicago, IL, 60637, USA
| | - Christopher D Hellekson
- University of North Dakota School of Medicine, 1301 N Columbia Rd, Grand Forks, ND, 58203, USA
| | - Sabha Ganai
- Department of Surgery, Southern Illinois University School of Medicine, 801 N Rutledge St, Springfield, IL, 62702, USA
| | - Olwen M Hahn
- Section of Hematology/Oncology, University of Chicago Pritzker School of Medicine, 5758 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Ronald J Maggiore
- Wilmot Cancer Center, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Ezra E Cohen
- University of California at San Diego Moores Cancer Center, 3855 Health Sciences Dr., La Jolla, CA, 92093, USA
| | - Mitchell C Posner
- Department of Surgery, University of Chicago Pritzker School of Medicine, 5758 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Steven J Chmura
- Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, 5758 South Maryland Avenue MC 9006, Chicago, IL, 60637, USA
| | - Andrew R Howard
- Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, 5758 South Maryland Avenue MC 9006, Chicago, IL, 60637, USA
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, 5758 South Maryland Avenue MC 9006, Chicago, IL, 60637, USA.
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Maggiore RJ, Callahan KE, Tooze JA, Parker IR, Hsu T, Klepin HD. Geriatrics fellowship training and the role of geriatricians in older adult cancer care: A survey of geriatrics fellowship directors. Gerontol Geriatr Educ 2018; 39:170-182. [PMID: 27749199 PMCID: PMC5796867 DOI: 10.1080/02701960.2016.1247070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The number of older adults with cancer is growing, necessitating more collaborative training in geriatric principles and cancer care. The authors administered a web-based survey to U.S. geriatrics program directors (PDs) addressing cancer-specific training and perspectives on optimal training content and roles for geriatricians in cancer care. Of 140 PDs contacted, 67 (48%) responded. Topics considered very important in training included cancer screening (79%) and cancer-related pain management (70%). Respondents strongly agreed that some of the geriatrician's roles in cancer care included assessing functional status (64%) and assessing physical/cognitive function for goals of care (64%). About one half (54%) agreed that having a standardized geriatric oncology curriculum overall was important. The presence of a geriatric oncologist, requiring cancer-based rotations, being affiliated with a cancer center, or being internal versus family medicine-based did not affect this response. Despite this high level of support, cancer-related skills and knowledge warrant better definition and integration into current geriatrics training. This survey establishes potential areas for future educational collaborations between geriatrics and oncology training programs.
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Affiliation(s)
- Ronald J Maggiore
- a Department of Medicine, Division of Hematology/Oncology , University of Rochester , Rochester , New York , USA
| | - Kathryn E Callahan
- b Department of Internal Medicine, Section on Hematology and Oncology , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
| | - Janet A Tooze
- c Department of Biostatistical Sciences , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
| | - Ira R Parker
- d Geriatric Oncology Solutions, La Jolla , California , USA
| | - Tina Hsu
- e Division of Medical Oncology , Ottawa Hospital Cancer Centre , Ottawa , Ontario , Canada
| | - Heidi D Klepin
- b Department of Internal Medicine, Section on Hematology and Oncology , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
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Maggiore RJ, Dale W, Hurria A, Klepin HD, Chapman A, Dotan E, Mohile SG, Naeim A, Gajra A, Buss MK. Hematology-Oncology Fellows’ Training in Geriatrics and Geriatric Oncology: Findings From an American Society of Clinical Oncology–Sponsored National Survey. J Oncol Pract 2017; 13:e900-e908. [DOI: 10.1200/jop.2017.022111] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: Older adults compose the majority of patients with cancer in the United States; however, it is unclear how well geriatrics or geriatric oncology training is being incorporated into hematology-oncology (hem-onc) fellowships. Methods: A convenience sample of hem-onc fellows completed a (written or electronic) survey assessing their education, clinical experiences, and perceived proficiency in geriatric oncology during training; knowledge base in geriatric oncology; confidence in managing older adults with cancer; and general attitudes toward geriatric oncology principles. Results: Forty-five percent of respondents (N = 138) were female, 67% were based in the United States, and most (60%) were past their first year of training. Most fellows rated geriatric oncology as important or very important (84%); however, only 25% reported having access to a geriatric oncology clinic and more than one half (53%) reported no lectures in geriatric oncology. Fellows reported fewer educational experiences in geriatric oncology than in nongeriatric oncology. For example, among procedure-based activities, 12% learned how to perform a geriatric assessment but 78% learned how to perform a bone marrow biopsy ( P < .05). Of those completing the knowledge-based items, 41% were able to identify correctly the predictors of chemotherapy toxicity in older adults with cancer. Conclusion: Despite the prevalence of cancer in older adults, hem-onc fellows report limited education in or exposure to geriatric oncology. The high value fellows place on geriatric oncology suggests that they would be receptive to additional training in this area.
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Affiliation(s)
- Ronald J. Maggiore
- University of Rochester, Rochester; State University of New York Upstate, Syracuse, NY; City of Hope, Duarte; University of California, Los Angeles, Los Angeles, CA; Wake Forest University School of Medicine, Winston-Salem, NC; Thomas Jefferson University; Fox Chase Cancer Center, Philadelphia, PA; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - William Dale
- University of Rochester, Rochester; State University of New York Upstate, Syracuse, NY; City of Hope, Duarte; University of California, Los Angeles, Los Angeles, CA; Wake Forest University School of Medicine, Winston-Salem, NC; Thomas Jefferson University; Fox Chase Cancer Center, Philadelphia, PA; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Arti Hurria
- University of Rochester, Rochester; State University of New York Upstate, Syracuse, NY; City of Hope, Duarte; University of California, Los Angeles, Los Angeles, CA; Wake Forest University School of Medicine, Winston-Salem, NC; Thomas Jefferson University; Fox Chase Cancer Center, Philadelphia, PA; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Heidi D. Klepin
- University of Rochester, Rochester; State University of New York Upstate, Syracuse, NY; City of Hope, Duarte; University of California, Los Angeles, Los Angeles, CA; Wake Forest University School of Medicine, Winston-Salem, NC; Thomas Jefferson University; Fox Chase Cancer Center, Philadelphia, PA; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Andrew Chapman
- University of Rochester, Rochester; State University of New York Upstate, Syracuse, NY; City of Hope, Duarte; University of California, Los Angeles, Los Angeles, CA; Wake Forest University School of Medicine, Winston-Salem, NC; Thomas Jefferson University; Fox Chase Cancer Center, Philadelphia, PA; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Efrat Dotan
- University of Rochester, Rochester; State University of New York Upstate, Syracuse, NY; City of Hope, Duarte; University of California, Los Angeles, Los Angeles, CA; Wake Forest University School of Medicine, Winston-Salem, NC; Thomas Jefferson University; Fox Chase Cancer Center, Philadelphia, PA; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Supriya G. Mohile
- University of Rochester, Rochester; State University of New York Upstate, Syracuse, NY; City of Hope, Duarte; University of California, Los Angeles, Los Angeles, CA; Wake Forest University School of Medicine, Winston-Salem, NC; Thomas Jefferson University; Fox Chase Cancer Center, Philadelphia, PA; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Arash Naeim
- University of Rochester, Rochester; State University of New York Upstate, Syracuse, NY; City of Hope, Duarte; University of California, Los Angeles, Los Angeles, CA; Wake Forest University School of Medicine, Winston-Salem, NC; Thomas Jefferson University; Fox Chase Cancer Center, Philadelphia, PA; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ajeet Gajra
- University of Rochester, Rochester; State University of New York Upstate, Syracuse, NY; City of Hope, Duarte; University of California, Los Angeles, Los Angeles, CA; Wake Forest University School of Medicine, Winston-Salem, NC; Thomas Jefferson University; Fox Chase Cancer Center, Philadelphia, PA; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mary K. Buss
- University of Rochester, Rochester; State University of New York Upstate, Syracuse, NY; City of Hope, Duarte; University of California, Los Angeles, Los Angeles, CA; Wake Forest University School of Medicine, Winston-Salem, NC; Thomas Jefferson University; Fox Chase Cancer Center, Philadelphia, PA; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Garinis AC, Cornell A, Allada G, Fennelly KP, Maggiore RJ, Konrad-Martin D. Ototoxicity monitoring through the eyes of the treating physician: Perspectives from pulmonology and medical oncology. Int J Audiol 2017; 57:S19-S24. [PMID: 28978238 DOI: 10.1080/14992027.2017.1381769] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 10/18/2022]
Abstract
OBJECTIVES Integrating audiological management into the care pathways of clinical specialties that prescribe ototoxic medications for essential, often life-preserving medical care that is critical for early hearing loss identification and remediation. Research shows that successful implementation of a new health service or intervention requires alignment of goals among provider groups, institutional leadership and patients. Thoughtful consideration of the physician's viewpoints about ototoxicity and its implications for treatment planning is, therefore, important for the implementation and enduring success of an ototoxicity monitoring programme (OMP). DESIGN This discussion paper uses qualitative methods to explore the perspectives of four physicians on OMP provision in their patient populations. STUDY SAMPLE Three pulmonologists and one oncologist completed the written survey or survey-based interview described in this report. RESULTS Each physician indicated that (i) ototoxicity is a potential problem for their patients; (ii) monitoring hearing is important to ensure good quality of life among their patients and (iii) treatment modification would be considered if an alternative treatment option were available. The physicians differed in their approaches to ototoxicity monitoring, from routine referrals to audiology, to relying on patient self-referral. CONCLUSION Physician provider input is needed to optimise monitoring schedules and OMP care coordination with audiology.
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Affiliation(s)
- Angela C Garinis
- a Department of Otolaryngology - Head and Neck Surgery , Oregon Health & Science University , Portland , OR , USA.,b VA Portland Health Care System , VA RR&D Center of Excellence, National Center for Rehabilitative Auditory Research , Portland , OR , USA
| | - Alexandra Cornell
- c Division of Pulmonary and Critical Care Medicine Adult Cystic Fibrosis Program , Oregon Health & Science University , Portland , OR , USA
| | - Gopal Allada
- d Department of Pediatrics Pulmonary Medicine , Oregon Health & Science University , Portland , OR , USA
| | - Kevin P Fennelly
- e National Heart, Lung and Blood Institute , National Institutes of Health , Bethesda , MD , USA
| | - Ronald J Maggiore
- b VA Portland Health Care System , VA RR&D Center of Excellence, National Center for Rehabilitative Auditory Research , Portland , OR , USA.,f Department of Medicine, Hematology & Oncology , Oregon Health & Science University , Portland , OR , USA , and.,g Department of Medicine, Hematology & Oncology , University of Rochester , Rochester , NY , USA
| | - Dawn Konrad-Martin
- a Department of Otolaryngology - Head and Neck Surgery , Oregon Health & Science University , Portland , OR , USA.,b VA Portland Health Care System , VA RR&D Center of Excellence, National Center for Rehabilitative Auditory Research , Portland , OR , USA
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Light T, Rassi EE, Maggiore RJ, Holland J, Reed J, Suriano K, Stooksbury M, Tobin N, Gross N, Clayburgh D. Improving outcomes in veterans with oropharyngeal squamous cell carcinoma through implementation of a multidisciplinary clinic. Head Neck 2017; 39:1106-1112. [PMID: 28370667 DOI: 10.1002/hed.24721] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Treatment of head and neck cancer is complex, and a multidisciplinary clinic may improve the coordination of care. The value of a head and neck multidisciplinary clinic has not yet been established in oropharyngeal squamous cell carcinoma (SCC). METHODS A retrospective review was conducted of Veterans Affairs patients with oropharyngeal SCC undergoing concurrent chemoradiation before and after implementation of the head and neck multidisciplinary clinic. RESULTS Fifty-two patients before and 54 patients after multidisciplinary clinic were included in this study. Age, tobacco use, and p16+ status were similar between groups. With multidisciplinary clinic, time to treatment decreased, and utilization of supportive services, including speech pathology, dentistry, and nutrition increased. The 5-year disease-specific survival rate increased from 63% to 81% (p = .043) after implementation of the multidisciplinary clinic. Multivariate analysis showed that disease stage (p = .016), p16 status (p = .006), and multidisciplinary clinic participation (p = .042) were predictors of disease-specific survival. CONCLUSION Implementation of a multidisciplinary clinic improved care coordination and disease-specific survival in patients with oropharyngeal SCC. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1106-1112, 2017.
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Affiliation(s)
- Tyler Light
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University and VA Portland Health Care System, Portland, Oregon
| | - Edward El Rassi
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University and VA Portland Health Care System, Portland, Oregon
| | - Ronald J Maggiore
- Department of Radiation Oncology, Oregon Health & Science University and VA Portland Health Care System, Portland, Oregon
| | - John Holland
- Division of Hematology/Medical Oncology, Department of Medicine, Oregon Health & Science University and VA Portland Health Care System, Portland, Oregon
| | - Julie Reed
- Operative Care Division, VA Portland Health Care System, Portland, Oregon
| | - Kathleen Suriano
- Speech and Language Pathology, VA Portland Health Care System, Portland, Oregon
| | | | - Nora Tobin
- Palliative Care Service, Division of Internal Medicine, VA Portland Health Care System, Portland, Oregon
| | - Neil Gross
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Daniel Clayburgh
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University and VA Portland Health Care System, Portland, Oregon
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Nabavizadeh N, Shukla R, Elliott DA, Mitin T, Vaccaro GM, Dolan JP, Maggiore RJ, Schipper PH, Hunter JG, Thomas CR, Holland JM. Preoperative carboplatin and paclitaxel-based chemoradiotherapy for esophageal carcinoma: results of a modified CROSS regimen utilizing radiation doses greater than 41.4 Gy. Dis Esophagus 2016; 29:614-20. [PMID: 26043837 DOI: 10.1111/dote.12377] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Trimodality therapy for resectable esophageal and gastroesophageal junction cancers utilizing preoperative radiotherapy with concurrent carboplatin and paclitaxel-based chemotherapy is being increasingly utilized secondary to the results of the phase III CROSS trial. However, there is a paucity of reports of this regimen as a component of chemoradiotherapy in North America. We aim to report on our clinical experience using a modified CROSS regimen with higher radiotherapy doses. Patients with advanced (cT2-cT4 or node positive) esophageal or gastroesophageal junction carcinoma who received preoperative carboplatin/paclitaxel-based chemoradiotherapy with radiation doses of greater than 41.4 Gray (Gy) followed by esophagectomy were identified from an institutional database. Patient, imaging, treatment, and tumor response characteristics were analyzed. Twenty-four patients were analyzed. All but one tumor had adenocarcinoma histology. The median radiation dose was 50.4 Gy. Pathologic complete response was achieved in 29% of patients, with all receiving 50.4 Gy. Three early postoperative deaths were seen, due in part to acute respiratory distress syndrome and all three patients received 50-50.4 Gy. With a median follow-up of 9.4 months (23 days-2 years), median survival was 24 months. Trimodality therapy utilizing concurrent carboplatin/paclitaxel with North American radiotherapy doses appeared to have similar pathologic complete response rates compared with the CROSS trial, but may be associated with higher toxicity. Although the sample size is small and further follow-up is necessary, radiation doses greater than 41.4 Gy may not be warranted secondary to a potentially increased risk of severe radiation-induced acute lung injury.
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Affiliation(s)
- N Nabavizadeh
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - R Shukla
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - D A Elliott
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - T Mitin
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - G M Vaccaro
- Division of Medical Oncology, Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - J P Dolan
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - R J Maggiore
- Division of Medical Oncology, Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - P H Schipper
- Division of Cardiothoracic and General Thoracic Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - J G Hunter
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - C R Thomas
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - J M Holland
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA
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Maggiore RJ. Locally advanced head and neck cancer in either the older or the vulnerable adult: Making the case for a team-based, "gero-centric" approach. J Geriatr Oncol 2016; 7:334-40. [PMID: 27365288 DOI: 10.1016/j.jgo.2016.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/10/2016] [Revised: 04/04/2016] [Accepted: 06/01/2016] [Indexed: 12/31/2022]
Abstract
Multidisciplinary, team-based care goes hand in hand with geriatric oncology paradigms for caring for older adults with cancer. Team-based care was the central theme for the 2015 SIOG Annual Meeting. Team-based approaches to the evaluation and management of older adults with different cancer types, including head and neck cancer, were presented. This review aims to summarize the salient points of that presentation, including a synthesis of recent multidisciplinary, "gero-centric" research efforts to improve the care for older adults with more advanced stages of head and neck cancer.
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Affiliation(s)
- Ronald J Maggiore
- Portland Veterans Affairs Healthcare System/Oregon Health & Science University, 3710 SW U.S. Veterans Hospital Road, P3HOC, Portland, OR 97239, USA.
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Gleysteen JP, Carroll SR, Sullivan CB, Maggiore RJ, Barnes L, Gross ND. Human Papillomavirus among Veterans Treated for Oropharyngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: The prevalence and significance of high-risk oral human papillomavirus (HPV) among veterans treated for oropharyngeal squamous cell carcinoma (OPSCC) remains unknown. In this study, we aimed to (1) define the prevalence of HPV among veterans with OPSCC and (2) compare outcomes of veterans with OPSCC relative to high-risk HPV status and other well-known prognostic factors. Methods: Patients from a high-volume Veterans Administra-tion (VA) medical center with OPSCC were identified from 2001-2006. Demographic, surgical, and pathological data were extracted from the electronic medical record. P16 immunohistochemistry testing was performed on archived pathological samples as a surrogate marker for HPV status. Outcomes were compared between HPV-positive (+) and negative (–) patients using Kaplan-Meier estimates. Results: Seventy-six veteran patients with available tumor tissue and follow-up data were included. All of the patients were male (100%) and the vast majority were ever smokers (89%). Most patients presented with advanced stage disease (61, 80%) and were treated nonsurgically (64, 84%). The overall prevalence of p16 positivity was 52 out of 76 (68%). Overall survival at 2 and 5 years was 60% and 38%, respectively, for the entire cohort. HPV+ veteran patients had significantly better survival at 2 years (58% vs 33%) and 5 years (40% vs 17%) than HPV– veteran patients ( P = .014). Conclusions: Using p16 as a surrogate marker, HPV is prevalent among veteran patients treated for OPSCC. Veteran patients with HPV-associated OPSCC have improved survival relative to HPV-negative patients. However, their prognosis remains poor compared to a nonveteran population.
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Maggiore RJ, Dale W, Gross CP, Feng T, Tew WP, Mohile SG, Owusu C, Klepin HD, Lichtman SM, Gajra A, Ramani R, Katheria V, Zavala L, Hurria A. Polypharmacy and potentially inappropriate medication use in older adults with cancer undergoing chemotherapy: effect on chemotherapy-related toxicity and hospitalization during treatment. J Am Geriatr Soc 2014; 62:1505-12. [PMID: 25041361 DOI: 10.1111/jgs.12942] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [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: 11/30/2022]
Abstract
OBJECTIVES To evaluate the prevalence of polypharmacy and potentially inappropriate medication (PIM) use and the association between these and chemotherapy-related adverse events in older adults with cancer undergoing chemotherapy. DESIGN Secondary analysis of prospectively collected data. SETTING Outpatient oncology clinics in seven academic medical centers. PARTICIPANTS Adults aged 65 and older with cancer undergoing chemotherapy. MEASUREMENTS Measures included number of daily medications (polypharmacy); PIM use based on three indices (Beers, Zhan, and Drugs to Avoid in the Elderly criteria), and use of six "high risk" medication classes for adverse drug events (anticoagulants, antiplatelet agents, opioids, insulin, oral hypoglycemics, antiarrhythmics). Using multivariate logistic regression, the relations were evaluated between these criteria and Grade 3 to 5 chemotherapy-related toxicity and between these criteria and hospitalization during chemotherapy. RESULTS Participants (N=500; mean age 73, 61% Stage IV disease) took a mean of 5±4 daily medications (range 0-23). PIM use was common (up to 29% according to Beers criteria). No association was found between number of daily medications (reference 0-3 medications) and toxicity (4-9 medications, odds ratio (OR)=1.34, 95% confidence interval (CI)=0.92-1.97; ≥10 medications, OR=0.82, 95% CI=0.45-1.49) or hospitalization (≥4 medications, OR=1.34, 95% CI=0.82-2.18, P=.24). There was also no association between PIM use and toxicity (P=.93) or hospitalization (P=.98). No medication class was associated with either outcome. CONCLUSIONS Polypharmacy and PIM use were common but were not associated with chemotherapy-related toxicity or hospitalization in older adults with cancer.
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Affiliation(s)
- Ronald J Maggiore
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon
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Maggiore RJ, Gorawara-Bhat R, Levine SK, Dale W. Perceptions, attitudes, and experiences of hematology/oncology fellows toward incorporating geriatrics in their training. J Geriatr Oncol 2014; 5:106-15. [DOI: 10.1016/j.jgo.2013.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 08/18/2013] [Accepted: 10/20/2013] [Indexed: 11/28/2022]
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Maggiore RJ, Gross CP, Togawa K, Tew WP, Mohile SG, Owusu C, Klepin HD, Lichtman SM, Gajra A, Ramani R, Katheria V, Klapper SM, Hansen K, Hurria A. Use of complementary medications among older adults with cancer. Cancer 2012; 118:4815-23. [PMID: 22359348 DOI: 10.1002/cncr.27427] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 12/04/2011] [Accepted: 12/08/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Little is known about complementary medication use among older adults with cancer, particularly those who are receiving chemotherapy. The objective of this study was to evaluate the prevalence of complementary medication use and to identify the factors associated with its use among older adults with cancer. METHODS The prevalence of complementary medication use (defined as herbal agents, minerals, or other dietary supplements, excluding vitamins) was evaluated in a cohort of adults aged ≥65 years who were about to start chemotherapy for their cancer. The associations between complementary medication use and patient characteristics (sociodemographics; comorbidities; and functional, nutritional, psychological, and cognitive status), medication use (number of medications and concurrent vitamin use), and cancer characteristics (type and stage) were analyzed. RESULTS The cohort included 545 patients (mean age, 73 years; range, 65-91 years; 52% women) with cancer (61% stage IV). Seventeen percent of these patients (N = 93) reported using ≥1 complementary medication; the mean number of complementary medications among users was 2 (range, 1-10 medications). Complementary medication use was associated with 1) earlier cancer stage (29% had stage I-II disease vs 17% with stage III-IV disease; odds ratio [OR], 2.05; 95% confidence interval [CI], 1.21-3.49) and 2) less impairment with instrumental activities of daily living (OR, 1.39; 95% CI, 1.12-1.73). CONCLUSIONS Complementary medication use was reported by 17% of older adults with cancer and was more common among those who had less advanced disease (i.e., those receiving adjuvant, potentially curative treatment) and higher functional status. Further studies are needed to determine the association between complementary medication use and cancer outcomes among older adults.
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Affiliation(s)
- Ronald J Maggiore
- Department of Medicine, Sections of Geriatrics/Palliative Medicine and Hematology/Oncology, University of Chicago Medical Center, Chicago, Illinois, USA
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Wang R, Gross CP, Maggiore RJ, Halene S, Soulos PR, Raza A, Galili N, Ma X. Pattern of hypomethylating agents use among elderly patients with myelodysplastic syndromes. Leuk Res 2010; 35:904-8. [PMID: 21067809 DOI: 10.1016/j.leukres.2010.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 10/05/2010] [Accepted: 10/08/2010] [Indexed: 10/18/2022]
Abstract
Little is known about how hypomethylating agents (HMAs) have been adopted into the treatment of myelodysplastic syndromes (MDS). We conducted a population-based study to assess the use of HMAs among 4416 MDS patients (age≥66 years) who were diagnosed during 2001-2005 and followed up through the end of 2007. Multivariate logistic regression models were utilized to evaluate the role of various patient characteristics. 475 (10.8%) patients had received HMAs by 2007, with the proportion increasing over time. Patients who were white (odds ratio (OR)=0.66, 95% confidence interval (CI): 0.46-0.95), male (OR=1.47, 95% CI: 1.19-1.82), young (Ptrend<0.01), more recently diagnosed (OR=1.90, 95% CI: 1.54-2.34), had fewer comorbidities (Ptrend<0.01), or had a history of other cancer (OR=1.28, 95% CI: 1.00-1.63) were more likely to receive HMAs. Compared with patients with refractory anemia, those diagnosed with refractory anemia with excess blasts or refractory cytopenia with multilineage dysplasia had a higher chance to be treated with HMAs (OR=3.52 and 2.32, respectively). Relatively few MDS patients were treated with HMAs during the introduction period of these agents, and multiple patient characteristics such as sex, comorbidities, and MDS subtype influence the likelihood a patient receives HMAs.
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Affiliation(s)
- Rong Wang
- Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT 06520-8034, USA
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Abstract
The definition of "polypharmacy" ranges from the use of a large number of medications; the use of potentially inappropriate medications, which can increase the risk for adverse drug events; medication underuse despite instructions to the contrary; and medication duplication. Older adults are particularly at risk because they often present with several medical conditions requiring pharmacotherapy. Cancer-related therapy adds to this risk in older adults, but few studies have been conducted in this patient population. In this review, we outline the adverse outcomes associated with polypharmacy and present polypharmacy definitions offered by the geriatrics literature. We also examine the strengths and weaknesses of these definitions and explore the relationships among these definitions and what is known about the prevalence and impact of polypharmacy.
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Affiliation(s)
- Ronald J Maggiore
- Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut, USA
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