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Meckstroth S, Tin AL, Downey RJ, Korc-Grodzicki B, Vickers AJ, Shahrokni A. Preoperative frailty predicts postoperative falls in older patients with cancer. J Geriatr Oncol 2024; 15:101688. [PMID: 38141587 DOI: 10.1016/j.jgo.2023.101688] [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: 03/20/2023] [Revised: 07/25/2023] [Accepted: 12/12/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Patient falls in the hospital lead to adverse outcomes and impaired quality of life. Older adults with cancer who are frail may be at heightened risk of falls in the postoperative period. We sought to evaluate the association between degree of preoperative frailty and risk of inpatient postoperative falls and other outcomes among older adults with cancer. MATERIALS AND METHODS We identified 7,661 patients aged 65 years or older who underwent elective cancer surgery from 2014 to 2020, had a hospital stay of ≥1 day, and had Memorial Sloan Kettering-Frailty Index (MSK-FI) data to allow assessment of frailty. Univariable logistic regression analysis was performed to evaluate the association between frailty and falls. Multivariable logistic regression analysis was performed to evaluate the composite outcome of 30-day readmission or 90-day death, with frailty, falls, and the interaction between frailty and falls as predictors; the analysis was adjusted for age, sex, race, and preoperative albumin level. RESULTS In total, 7,661 patients were included in the analysis. Seventy-one (0.9%) had a fall, of whom eight (11%) were readmitted to the hospital within 30 days and seven (10%) died within 90 days. Higher MSK-FI score was associated with higher risk of falls (odds ratio [OR], 1.40 [95% confidence interval [CI], 1.21-1.59]). The risk of falls for a patient with an MSK-FI score of 1 was 0.6%, compared with 1.7% for a patient with an MSK-FI score of 4. Poor outcome was associated with frailty (OR, 1.07 [95% CI, 1.02-1.13]) but not with falls (OR, 1.17 [95% CI, 0.57-2.22]). DISCUSSION Preoperative frailty is associated with risk of inpatient postoperative falls and with other adverse outcomes after surgery among older adults with cancer. Screening for frailty in the preoperative setting would enable healthcare institutions to implement interventions aimed at reducing the incidence of inpatient postoperative falls to reduce fall-related adverse events.
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Affiliation(s)
- Shelby Meckstroth
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, NY, New York, USA; Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Beatriz Korc-Grodzicki
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, NY, New York, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Armin Shahrokni
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, NY, New York, USA.
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Neuendorff NR, Gagelmann N, Singhal S, Meckstroth S, Thibaud V, Zhao Y, Mir N, Shih YY, Amaro DMC, Roy M, Lombardo J, Gjærde LK, Loh KP. Hypomethylating agent-based therapies in older adults with acute myeloid leukemia - A joint review by the Young International Society of Geriatric Oncology and European Society for Blood and Marrow Transplantation Trainee Committee. J Geriatr Oncol 2023; 14:101406. [PMID: 36435726 PMCID: PMC10106360 DOI: 10.1016/j.jgo.2022.11.005] [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: 05/06/2022] [Revised: 10/23/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
Acute myeloid leukemia (AML) is associated with poor outcomes in older adults. A major goal of treatment is to balance quality of life and functional independence with disease control. With the approval of new, more tolerable regimens, more older adults are able to receive AML-directed therapy. Among these options are hypomethylating agents (HMAs), specifically azacitidine and decitabine. HMAs have become an integral part of AML therapy over the last two decades. These agents are used either as monotherapy or nowadays more commonly in combination with other agents such as the Bcl-2 inhibitor venetoclax. Biological AML characteristics, such as molecular and cytogenetic risk factors, play crucial roles in guiding treatment decisions. In patients with high-risk AML, HMAs are increasingly used rather than intensive chemotherapy, although further trials based on a risk-adapted approach using patient- and disease-related factors are needed. Here, we review trials and evidence for the use of HMA monotherapy and combination therapy in the management of older adults with AML. Furthermore, we discuss the use of HMAs and HMA combination therapies in AML, mechanisms of action, their incorporation into hematopoietic stem cell transplantation strategies, and their use in patients with comorbidities and reduced organ function.
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Affiliation(s)
- Nina Rosa Neuendorff
- Clinic for Hematology and Stem-Cell Transplantation, University Hospital Essen, Hufelandstrasse 55, D-45147 Essen, Germany.
| | - Nico Gagelmann
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Surbhi Singhal
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Shelby Meckstroth
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA, USA
| | - Vincent Thibaud
- Department of Hematology, Hôpital Saint-Vincent, Université Catholique de Lille, 59000 Lille, France
| | - Yue Zhao
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, 50937 Cologne, Germany
| | - Nabiel Mir
- Section of Geriatrics and Palliative Medicine, The University of Chicago Medical Center, Chicago, USA
| | - Yung-Yu Shih
- Department of Hematology and Oncology, Clinic Favoriten Vienna, Austria
| | - Danielle M C Amaro
- Department of Oncology and Hematology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mukul Roy
- Department of Radiation Oncology, Jaslok Hospital, Mumbai, India
| | - Joseph Lombardo
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Lars Klingen Gjærde
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
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Evans JP, Meckstroth S, Garai J. The Amelioration of Grazing through Physiological Integration by a Clonal Dune Plant. Plants (Basel) 2023; 12:plants12040724. [PMID: 36840072 PMCID: PMC9962606 DOI: 10.3390/plants12040724] [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] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 05/14/2023]
Abstract
Rhizomatous growth and associated physiological integration can allow a clonal dune species to potentially compensate for the selective removal of leaves associated with herbivory. Hydrocotyle bonariensis is a rhizomatous clonal plant species that is abundant in the coastal dune environments of the southeastern United States that are inhabited by large feral horse populations. H. bonariensis has been shown to integrate resources among ramets within extensive clones as an adaptation to resource heterogeneity in sandy soils. In this study, we hypothesized that clonal integration is a mechanism that promotes H. bonariensis persistence in these communities, despite high levels of herbivory by feral horses. In a field experiment, we used exclosures to test for herbivory in H. bonariensis over a four-month period. We found that feral horses utilized H. bonariensis as a food species, and that while grazing will suppress clonal biomass, H. bonariensis is able to maintain populations in a high grazing regime with and without competition present. We then conducted an experiment in which portions of H. bonariensis clones were clipped to simulate different levels of grazing. Half of the clones were severed to eliminate the possibility of integration. We found that after 12 weeks, the mean number of leaves and ramets increased as the grazing level increased, for integrated clones. Integrated clones had significantly increased biomass production compared to the severed equivalents. Our research suggests that rhizomatous growth and physiological integration are traits that allow clonal plant species to maintain populations and to tolerate grazing in coastal dune environments.
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Affiliation(s)
- Jonathan P. Evans
- Department of Biology, University of the South, Sewanee, TN 37383, USA
- Correspondence: ; Tel.: +1-(931)-598-1304
| | - Shelby Meckstroth
- Department of Biology, University of the South, Sewanee, TN 37383, USA
| | - Julie Garai
- Department of Mathematics and Computer Science, University of the South, Sewanee, TN 37383, USA
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Meckstroth S, Tin A, Shahrokni A. Frailty and Falls During the Perioperative Period in Older Cancer Patients. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00395-7] [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: 11/16/2022]
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Subbiah S, Meckstroth S, Yi Y, Maniscalco L, Wu XC, Plaisance-Bonstaff K, Parsons C. Association of HIV infection with survival and cancer-specific death in cancer patients in Louisiana. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
e18630 Background: Studies have reported elevated mortality in HIV patients (pts), including cancer-specific mortality, compared to non-HIV pts. However, many of these studies did not include data from Louisiana. Louisiana has among the highest HIV and AIDS case rates in the country, but there is no available large-scale data regarding cancer outcomes in HIV pts in the state. We compared our data in Louisiana to the largest known study to date over an expanded time period to evaluate for disparities. Methods: Following linkage of Louisiana Tumor Registry data from 1995-2016 and Louisiana Office of Public Health, STD/HIV Program database, we identified a total of 435,478 cancer cases, of which 2,949 were HIV-positive (0.67%). Analyses of categorical variables were performed using Pearson’s chi-squared test. Cause of death was extracted from death certificate or autopsy report. Survival analyses were performed utilizing SEER*Stat. Results: Despite the higher proportion of HIV in cancer pts in Louisiana, demographics are similar to previously published data in that cancer pts with HIV tended to be male, black, and younger than their HIV-negative counterparts (p<0.001). However, although 5-year survival was substantially decreased in HIV-cancer pts in congruence with other studies, cancer-specific mortality was lower than non-HIV pts in all cohorts, including both AIDS-defining cancers (ADC) and non-AIDS-defining cancers (non-ADC). Conclusions: HIV infection in cancer pts in Louisiana is associated with lower survival but not increased cancer-specific death, independent of race, gender, age, ADC vs non-ADC, and viral vs non-viral etiology. HIV-related deaths still comprise a substantial cause of death in this population.[Table: see text]
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Affiliation(s)
- Suki Subbiah
- Section of Hematology/Oncology, LSU School of Medicine, New Orleans, LA
| | | | - Yong Yi
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Lauren Maniscalco
- Louisiana Tumor Registry, LSU School of Public Health, New Orleans, LA
| | - Xiao-Cheng Wu
- LSU Health Sciences Center School of Public Health, New Orleans, LA
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Meckstroth S, Wang R, Ma X, Podoltsev N. Patterns of Care for Older Patients With Myelofibrosis: A Population-based Study. Clin Lymphoma Myeloma Leuk 2021; 21:e551-e558. [PMID: 33648884 DOI: 10.1016/j.clml.2021.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Current treatments for myelofibrosis (MF) are largely palliative, with the JAK inhibitor ruxolitinib being the breakthrough approved for higher-risk patients by the United States Food and Drug Administration in November 2011. There are limited data on the "real-world" clinical experiences among patients with MF who are treated in the JAK inhibitor era. PATIENTS AND METHODS We evaluated patterns of care for older patients with MF before and after ruxolitinib approval, using the Surveillance, Epidemiology, and End Results-Medicare database. Treatment patterns were assessed using Medicare part B and D claims. RESULTS This study included 528 patients diagnosed during 2007 to 2015, with a median age at diagnosis of 76 years. Among 298 patients diagnosed in the ruxolitinib era (2012-2015), 113 (37.9%) were ruxolitinib users. Similar numbers of users started ruxolitinib at 5, 10, 15, or 20 milligrams twice a day (BID). Among 31 patients starting at 5 milligrams BID or less, 48.4% were unable to escalate the dose, and < 11 users could increase the dose to the maximum 25 mg BID. Approximately one-half of ruxolitinib users took hydroxyurea and/or prednisone simultaneously with ruxolitinib. The median time on ruxolitinib was 11.9 months (interquartile range, 4.2-21.7 months). CONCLUSION It would be important to optimize the use of ruxolitinib and develop new drugs that may be administered together with or after ruxolitinib to accomplish better outcomes in older patients with MF.
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Affiliation(s)
- Shelby Meckstroth
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Rong Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Xiaomei Ma
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Nikolai Podoltsev
- Department of Internal Medicine (Hematology), Yale School of Medicine, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT.
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Affiliation(s)
- S Meckstroth
- Department of Medicine, Tulane University, New Orleans, Louisiana
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