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Ghanem AI, Gilbert M, Li P, Vance S, Tam S, Ghanem T, Siddiqui F. Disease Characteristics, Treatment and Survival for Oropharyngeal Squamous Cell Carcinoma of Elderly. Int J Radiat Oncol Biol Phys 2023; 117:e584. [PMID: 37785771 DOI: 10.1016/j.ijrobp.2023.06.1925] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Incidence of oropharyngeal cancers (OP) has been increasing over the past few decades, mainly driven by human papilloma virus (HPV) associated cancers in younger men. However, a large number of OP patients in recent years are ≥65 years of age. We wanted to determine if there is a difference in outcomes in elderly patients with OP as compared to younger patients. MATERIALS/METHODS We queried our institutional prospectively maintained head and neck cancer database for patients with non-metastatic OP treated between 1/2009-6/2020. We excluded patients who did not receive any definitive treatment. We analyzed clinicopathological and treatment characteristics for elderly (age at diagnosis ≥65 years) compared to young (<65 years) across HPV subtypes. We also studied survival endpoints among age groups using Kaplan-Meier curves and log-rank test. Independent predictors were estimated using multivariate (MVA) Cox regression models for each HPV subtype. RESULTS We identified 340 patients who met our inclusion criteria: elderly 123 (36%) and young 213 (64%). The proportion of elderly HPV+ve patients showed an increasing trend over the years studied. Median age was 70 years (range 65-91) in elderly and 56 years (38-64) in young (p<0.001); and HPV+ve/-ve were 73.2/26.8% vs 74.6/25.3% for both age groups respectively (p = 0.86). Elderly patients had higher Charlson Comorbidity Index (CCI) and included more divorcees (p<0.05). There were more elderly current/former smokers (97% vs 82%; p = 0.007) within HPV-ve cases. Definitive radiotherapy (RT) +/- systemic therapy (CRT) was utilized in 73.2% (n = 249), while the remainder had surgery +/- adjuvant RT/CRT. There was no difference with age for OP subsite, 8th edition AJCC stage and treatment received except for more use of cetuximab (22.5% vs 10.2%; p<0.001) and weekly cisplatin (32.4% vs 25.8%; p<0.001) among elderly patients. After a median follow up of 5.24 years (IQR: 3.53), 3-year overall (OS) (HPV+ve: 85 vs 81%; HPV-ve: 39 vs 52%), locoregional free (LRFS) (HPV+ve: 86 vs 90%; HPV-ve: 67 vs 69%) and distant metastasis free (DMFS) survival (HPV+ve: 91 vs 90%; HPV-ve: 79 vs 81%) were all non-significant for elderly vs young respectively. On MVA, CCI and AJCC stage for HPV+ve; and smoking, T-stage and lymphovascular space invasion for HPV- were associated with OS. For HPV+ve, AJCC stage, adjuvant vs definitive RT and treatment in later years were predictive of better LRFS, whereas smoking index and extracapsular space invasion were deterministic for DMFS. Interestingly, outcomes among those who received cetuximab was similar to those who received concurrent cisplatin for all endpoints. CONCLUSION We did not note any significant difference in outcomes among elderly patients treated for OP when compared to the younger patients when multi-disciplinary head and neck cancer care is provided. This was noted even though a significantly larger proportion of elderly patients received cetuximab concurrent with RT as opposed to standard of care cisplatin.
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Affiliation(s)
- A I Ghanem
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI; Alexandria Clinical Oncology Department, Alexandria University, Alexandria, Egypt
| | - M Gilbert
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI
| | - P Li
- Department of Public Health Sciences, Henry Ford Cancer Institute, Detroit, MI
| | - S Vance
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI
| | - S Tam
- Department of Otolaryngology, Henry Ford Cancer Institute, Detroit, MI
| | - T Ghanem
- Department of Otolaryngology, Henry Ford Cancer Institute, Detroit, MI
| | - F Siddiqui
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI
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Costemale-Lacoste JF, Cerboneschi V, Trichard C, De Beaurepaire R, Villemain F, Metton JP, Debacq C, Ghanem T, Martelli C, Baup E, Loeb E, Hardy P. [Predictive factors of seclusion duration in patients hospitalized in psychiatry settings. A prospective multisite study in the DTRF Paris-Sud]. Encephale 2018; 45:107-113. [PMID: 29580706 DOI: 10.1016/j.encep.2018.01.005] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION In psychiatric inpatient settings seclusion is a last resort to ensure the safety of the patient, other patients, and staff from disturbed behaviors. Despite its major interest for patients, seclusion could negatively impact treatment adherence and patient/staff relationships. Indeed, some secluded patients report a feeling of guilt during the measure and do not consider seclusion to be a healthcare intervention. To be more beneficial and to reduce the feeling by patients of being forced, seclusions should be as short and rare as possible. In other words, measures to reduce seclusion are available and have been clearly identified. Such measures could be applied, in the first instance, in patients with longer duration. In this way, the aim of this study was to investigate predictive factors of a seclusion of long duration. METHODS Our study was based on the dataset of the EPIC study, an observational prospective French multicenter study of seclusion and restraint. The EPIC study occurred in seven French psychiatric hospitals in the southern region of Paris. Inclusions were realized for 73days and allowed a data collection of 302 seclusion measures. Of these measures 236 were effectively a seclusion in a standardized room. Because the median duration was 7days, we defined two groups of patients: duration<7days and duration ≥ 7 days. Our variable to be explicated was duration ≥ 7 days. Explicative variables available in EPIC study were age, sex, forced hospitalization, autoagressivity, heteroagressivity, use of sedative treatment (oral or intramuscular), history of seclusion and patient diagnoses. We used bivariate and multivariate analyses to explore the association between a seclusion duration ≥ 7 days and explicative variables. Diagnoses were classified as psychotic disorders, mood disorders and others diagnoses. To be included in multivariate logistic regressions, diagnoses were treated as dummy variables (mood disorder vs psychotic disorders; psychotic disorders vs others; mood disorders vs others). Statistical analyses were performed using SPSS software 20.0 and R 3.4.0. RESULTS Of the 236 measures of seclusion the mean age was 38.2 (±12.8), 196 (83%) patients were forcibly hospitalized prior to their seclusion, 147 (62%) had a diagnosis of psychotic disorder, 43 (18%) a diagnosis of mood disorder and 33 (14%) an "other diagnosis". Mean duration was 10.2 (1.5) days and median was 7.1 days. One hundred and thirty-five (47%) patients were in the group of duration ≥ 7 days. In bivariate analyses, variables associated with a duration ≥ 7 days were: being in forced hospitalization prior to the seclusion (P=0.04), administration of a sedative treatment (P=0.01) and against the group of others diagnoses the diagnosis of mood disorders (P<0.0005) and psychotic disorders (P=0.001). Multivariate analyses showed that, against the group of other diagnoses, the group of psychotic disorders [OR=3.3, CI 95% (1.3-8.4), P=0.01], the group of mood disorder [OR=2.7, CI 95% (1.4-4.9), P=0.002] and administration of sedative treatment [OR=8.1, CI 95% (2.0-32.5), P=0.003] were significantly associated with a duration ≥ 7 days. These results were independent from other confusion variables. Considering the hospitalization status, psychotic disorders was the only diagnosis which showed an association between duration ≥ 7 days and forced hospitalization [OR=2.9 CI 95% (1.1-7.8), P=0.03]. CONCLUSION Our study highlighted two profiles of higher risk to remain ≥ 7days in seclusion. The first one is patients with a diagnosis of mood disorder who needed sedative treatment. The second one is patients with a diagnosis of psychotic disorder who needed sedative treatment and forced hospitalized before seclusion. Thus, these two profiles could be a good target to practice, in the first instance, measures to reduce seclusion duration in psychiatry settings.
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Affiliation(s)
- J-F Costemale-Lacoste
- Inserm UMRS 1178, Team "Depression and Antidepressants", CESP, 94275 Le Kremlin-Bicêtre, France; Faculté de médecine Paris-Sud, université Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, Hôpital Bicêtre, HUPS, Assistance publique des Hôpitaux de Paris, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France.
| | - V Cerboneschi
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, CH Paul-Guiraud, 54, avenue de la République, 94800 Villejuif, France
| | - C Trichard
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, hôpital Barthélémy-Durand, avenue du 8-Mai-1945, 91150 Etampes, France
| | - R De Beaurepaire
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, CH Paul-Guiraud, 54, avenue de la République, 94800 Villejuif, France
| | - F Villemain
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, hôpital Barthélémy-Durand, avenue du 8-Mai-1945, 91150 Etampes, France
| | - J-P Metton
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, hôpital Erasme, 143, avenue Armand-Guillebaud, 92160 Antony, France
| | - C Debacq
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, hôpital Sud-Francilien, 40, avenue Serge-Dassault, 91100 Corbeil-Essonnes, France
| | - T Ghanem
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, hôpital Orsay, 4, place du Général-Leclerc, 91400 Orsay, France
| | - C Martelli
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, hôpital Paul-Brousse, HUPS, Assistance publique des Hôpitaux de Paris, 12, avenue Paul-Vaillant-Couturier, 94800 Villejuif, France; Inserm Unité 1000 neuro-imagerie et psychiatrie, SHFJ CEA, boulevard Dubreuil, 91400 Orsay, France
| | - E Baup
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, hôpital Corentin-Celton, HUPO, Assistance publique des Hôpitaux de Paris, 4, parvis Corentin-Celton, 92130 Issy-les-Moulineaux, France
| | - E Loeb
- Inserm UMRS 1178, Team "Depression and Antidepressants", CESP, 94275 Le Kremlin-Bicêtre, France; Faculté de médecine Paris-Sud, université Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, Hôpital Bicêtre, HUPS, Assistance publique des Hôpitaux de Paris, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - P Hardy
- Inserm UMRS 1178, Team "Depression and Antidepressants", CESP, 94275 Le Kremlin-Bicêtre, France; Faculté de médecine Paris-Sud, université Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, Hôpital Bicêtre, HUPS, Assistance publique des Hôpitaux de Paris, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France
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