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Padovan BV, Bijl MAJ, Langendijk JA, van der Laan HP, Van Dijk BAC, Festen S, Halmos GB. Evaluation of a new two-step frailty assessment of head and neck patients in a prospective cohort. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08651-8. [PMID: 38653824 DOI: 10.1007/s00405-024-08651-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Assessing frailty, in head and neck cancer (HNC) patients is key when choosing appropriate treatment. Optimal screening is challenging, as it should be feasible and should avoid over-referral for comprehensive geriatric assessment (CGA) This study aims to evaluate the association between geriatric assessment using a new two-step care pathway, referral to geriatrician and adverse outcomes. METHODS This institutional retrospective analysis on a prospective cohort analysed the multimodal geriatric assessment (GA) of newly diagnosed HNC patients. Uni- and multivariable logistic regression was performed to study the association between the screening tests, and referral to the geriatrician for complete geriatric screening, and adverse outcomes. RESULTS This study included 539 patients, of whom 276 were screened. Patients who underwent the GA, were significantly older and more often had advanced tumour stages compared to non-screened patients. Referral to the geriatrician was done for 30.8% of patients. Of the 130 patients who underwent surgery, 26/130 (20%) experienced clinically relevant postoperative complications. Of the 184 patients who underwent (radio)chemotherapy, 50/184 (27.2%) had clinically relevant treatment-related toxicity. Age, treatment intensity, polypharmacy and cognitive deficits, were independently associated with referral to geriatrician. A medium to high risk of malnutrition was independently associated with acute radiation induced toxicity and adverse outcomes in general. CONCLUSION The current study showed a 30.8% referral rate for CGA by a geriatrician. Age, treatment intensity, cognitive deficits and polypharmacy were associated with higher rates of referral. Furthermore, nutritional status was found to be an important negative factor for adverse treatment outcomes, that requires attention.
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Affiliation(s)
- Beniamino Vincenzoni Padovan
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - M A J Bijl
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H P van der Laan
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B A C Van Dijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - S Festen
- University Medical Center Groningen, University Medical Center for Geriatric Medicine, Groningen, The Netherlands
| | - G B Halmos
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Stueger A, Joerger M, De Nys K. Geriatric evaluation methods in oncology and their use in clinical studies: A systematic literature review. J Geriatr Oncol 2024; 15:101684. [PMID: 38072709 DOI: 10.1016/j.jgo.2023.101684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/04/2023] [Accepted: 12/01/2023] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Therapeutic options in oncology keep on expanding. Nonetheless, older adults are underrepresented in clinical trials and those enrolled often have a better health status than their average peers, resulting in a lack of representative evidence for this heterogenous population. The inclusion of older patients and a uniform categorization of "frailty" is becoming increasingly urgent. Standardized tools could contribute to the quality and comparability of clinical trials and facilitate clinical decisions. The aim of this literature review was to elaborate an overview of the use of geriatric evaluation (GE) methods in clinical cancer research. MATERIALS AND METHODS We performed a literature review of the PubMed database. Clinical pharmacotherapy studies that applied or evaluated a clearly defined system for the GE of oncological patients were included. Data retrieved encompassed the applied GE method(s), cancer type(s), and pharmacotherapy investigated, the number of included patients, study type, year of publication, as well as the primary purpose of the GE. The GEs used most frequently were depicted in more depth. RESULTS In this literature review, 103 publications were selected for inclusion. The biggest proportion of studies (36%, n = 34) used clearly defined, but not previously validated, GE methods (study-specific GE). Standardized GE methods encountered in at least five publications were the G8 screening test (applied in 18% of included studies, n = 17), the Balducci score (7%, n = 7), and a geriatric assessment based on Hurria (5%, n = 5). The primary purpose of GE was predominantly an appraisal of its potential role in pharmacotherapy optimization. The GE also served as baseline and outcome measure, inclusion/exclusion criterion, factor for stratified randomization, and to determine treatment allocation. DISCUSSION The wide range of GE methods used across studies make direct comparisons difficult, and many methods are poorly characterized and/or not previously validated. The further inclusion of representative older patients in clinical trials combined with the use of a standardized GE could help clinicians in the decision-making process.
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Affiliation(s)
- Amelie Stueger
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland.
| | - Markus Joerger
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland; Department of Oncology and Hematology, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9000 St. Gallen, Switzerland.
| | - Katelijne De Nys
- Palliativzentrum, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9000 St. Gallen, Switzerland; KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, ON2 Herestraat 49 - box 424, BE-3000 Leuven, Belgium.
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Horiuchi K, Kuno T, Takagi H, Egorova NN, Afezolli D. Predictive value of the G8 screening tool for postoperative complications in older adults undergoing cancer surgery: A systematic review and meta-analysis. J Geriatr Oncol 2024; 15:101656. [PMID: 37940482 DOI: 10.1016/j.jgo.2023.101656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Older adults with cancer who are being considered for cancer surgery are heterogenous, with variation in their physical, mental, and social baselines and risk of postoperative complications. Due in part to the complex nature of this population, the optimal preoperative evaluation method is not clearly defined. In this study we investigated whether geriatric-8 (G8), a screening tool for older patients with cancer that determines the need for a full geriatric assessment, is suitable for assessing the risk of postoperative complications in this population being considered for surgery. MATERIALS AND METHODS Studies that enrolled older patients undergoing cancer surgery and compared prevalence of postoperative complications in G8 "high" (≥15) patients and G8 "low" (<15) patients were identified using PubMed and EMBASE. A meta-analysis was conducted to calculate the risk ratio of postoperative complication rate. Postoperative mortality was systematically reviewed. RESULTS Eleven studies published between 2017 and 2022 were included in our analysis with a total of 2,691 older patients who underwent various types of cancer surgery and were characterized by their G8 scores: 1,255 G8 high (≥15) patients and 1,436 G8 low (<15) patients. G8 low patients had a significantly higher prevalence of postoperative complications than G8 high patients (risk ratio [95% confidence interval]: 1.56 [1.18-2.07], p = 0.002, I2 = 79%). DISCUSSION G8 can be an effective and efficient preoperative tool to assess risk of postoperative complications in older adults undergoing cancer surgery and identify potential need for further evaluation of an individual's risk with a comprehensive geriatric assessment.
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Affiliation(s)
- Kohei Horiuchi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA.
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizouka, Japan
| | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Debora Afezolli
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Özkan A, van den Bos F, Mooijaart SP, Slingerland M, Kapiteijn E, de Miranda NFCC, Portielje JEA, de Glas NA. Geriatric predictors of response and adverse events in older patients with cancer treated with immune checkpoint inhibitors: A systematic review. Crit Rev Oncol Hematol 2024; 194:104259. [PMID: 38199430 DOI: 10.1016/j.critrevonc.2024.104259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/13/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Immunotherapy with checkpoint inhibitors (ICI) has improved cancer treatment in recent years. Older and frail patients are frequently treated with ICIs, but since they have been underrepresented in previous clinical trials, the real impact of ICI in this patient group is not well defined. The aim of this systematic review was to evaluate the evidence for associations between geriatric impairments and treatment outcomes in older patients with advanced and metastatic cancer treated with ICIs. METHODS A systematic search was conducted in PubMed, Cochrane Library, Embase, and Web of Science for relevant articles published before June 2022. Studies investigating the association between impairments in at least two geriatric domains and treatment outcome were considered eligible. Data extraction and risk of bias assessment using the QUIPS tool was performed independently by two investigators. RESULTS A total of nine studies were included. Median sample size of the studies was 92 patients (interquartile range (IQR) 47-113), with a median of 26 frail patients (IQR 21-35). Five studies investigated disease-related and survival outcomes, and two of them found a statistically significant association between geriatric impairments and either survival or disease progression. Eight studies investigated toxicity outcomes, and two of them showed a statistically significant association between geriatric impairments and immune-related adverse events (irAEs). Few studies suggested a relation between geriatric impairments and worse clinical outcomes. CONCLUSIONS Only a few studies have investigated the association between geriatric impairments and treatment outcomes and these studies were small. Older patients with geriatric impairments seem to be more likely to experience irAEs, but larger studies that include frail patients and use geriatric screening tools are required to confirm this association. These studies will be essential to improve the development of specific strategies to deal with frail patients.
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Affiliation(s)
- Asli Özkan
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frederiek van den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands; Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands
| | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Nienke A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
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Bouzan J, Nellas S, Stoilkov B, Willschrei P, Horstmann M. Item analysis of G8 screening in uro-oncologic geriatric patients. Int Urol Nephrol 2023; 55:1441-1446. [PMID: 37067702 DOI: 10.1007/s11255-023-03594-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/07/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION/BACKGROUND The G8 score is a widespread screening tool for geriatric frailty in oncology. The aim of this study was to evaluate the scores and relevance of G8 items in a standard screening of geriatric patients with uro-oncologic diseases to better understand the results of the assessment. METHODS Eighty-two consecutive uro-oncologic geriatric patients aged 75 years and older were evaluated. All patients underwent a G8 screening that consisted of 8 items. Patients with a G8 score above 14 were considered geriatric "fit", while others were considered to be "frail". Overall results and single item scores were evaluated. Clinical data were gathered from patients' charts. RESULTS The mean age of the patients was 82 years (min. 75-max. 102). In 36 of the patients, the G8 score indicated "no-frailty", and in 46 patients, the G8 score indicated "frailty". The mean G8 score was 12.9 (min 4-max 17 pts). Item analysis revealed that points were most often lost in items H (polypharmacy), P (comparison of health status to peers) and Age. Fifty-nine, 56 and 52 patients lost points on item Age, item H and item P, respectively. In contrast, the majority of patients reached the maximum score for nutritional items [i.e., items A (food intake), B (weight loss) and F (body mass index (BMI))]. For item A, 73 patients reached the maximum score; for item B, 62 patients reached the maximum score; and for item F, 72 patients reached the maximum score. There were no differences in this distribution pattern when comparing tumour entities, sex, and patients with local vs. metastatic disease. CONCLUSION The present study revealed a high percentage of suspicious test results. Potential reasons for these findings include the low threshold of the G8 overall score and the fact that in some items, points were easily lost. Modifications of the test should be considered.
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Affiliation(s)
- J Bouzan
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - S Nellas
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - B Stoilkov
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - P Willschrei
- Department of Geriatrics, Evang. Hospital Essen-Steele, Am Deimelsberg 34, 45276, Essen, Germany
| | - M Horstmann
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany.
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
- Department of Urology, Klinikum Guetersloh, Reckenberger Str. 19, 33332, Gütersloh, Germany.
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Depoorter V, Vanschoenbeek K, Decoster L, De Schutter H, Debruyne PR, De Groof I, Bron D, Cornélis F, Luce S, Focan C, Verschaeve V, Debugne G, Langenaeken C, Van Den Bulck H, Goeminne JC, Teurfs W, Jerusalem G, Schrijvers D, Petit B, Rasschaert M, Praet JP, Vandenborre K, Milisen K, Flamaing J, Kenis C, Verdoodt F, Wildiers H. Linking clinical and population-based data in older patients with cancer in Belgium: Feasibility and clinical outcomes. J Geriatr Oncol 2023; 14:101428. [PMID: 36804333 DOI: 10.1016/j.jgo.2023.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 11/04/2022] [Accepted: 01/11/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Geriatric screening and geriatric assessment (GS/GA) have proven their benefits in the care for older patients with cancer. However, less is known about the predictive value of GS/GA for outcomes. To research this, clinical data on GS/GA can be enriched with population-based data. In this article we describe the methods and feasibility of data linkage, and first clinical outcomes (GS/GA results and overall survival). MATERIALS AND METHODS A large cohort study consisting of patients aged ≥70 years with a new cancer diagnosis was established using linked data from clinical and population-based databases. Clinical data were derived from a previous prospective study where older patients with cancer were screened with G8, followed by GA in case of an abnormal result (GS/GA study; 2009-2015). These data were linked to cancer registration data from the Belgian Cancer Registry (BCR), reimbursement data of the health insurance companies (InterMutualistic Agency, IMA), and hospital discharge data (Technical Cell, TCT). Cox regression analyses were conducted to evaluate the prognostic value of the G8 geriatric screening tool. RESULTS Of the 8067 eligible patients with a new cancer diagnosis, linkage of data from the GS/GA study and data from the BCR was successful for 93.7%, resulting in a cohort of 7556 patients available for the current analysis. Further linkage with the IMA and TCT database resulted in a cohort of 7314 patients (96.8%). Based on G8 geriatric screening, 67.9% of the patients had a geriatric risk profile. Malnutrition and functional dependence were the most common GA-identified risk factors. An abnormal baseline G8 score (≤14/17) was associated with lower overall survival (adjusted HR [aHR] = 1.62 [1.50-1.75], p < 0.001). DISCUSSION Linking clinical and population-based databases for older patients with cancer has shown to be feasible. The GS/GA results at cancer diagnosis demonstrate the vulnerability of this population and the G8 score showed prognostic value for overall survival. The established cohort of almost 8000 patients with long-term follow-up will serve as a basis in the future for detailed analyses on long-term outcomes beyond survival.
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Affiliation(s)
| | | | - Lore Decoster
- Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Oncologisch Centrum - Department of Medical Oncology, Brussels, Belgium
| | | | - Philip R Debruyne
- General Hospital Groeninge, Kortrijk Cancer Centre, Kortrijk, Belgium; Anglia Ruskin University, Medical Technology Research Centre (MTRC), School of Life Sciences, Cambridge, UK; University of Plymouth, School of Nursing & Midwifery, Plymouth, UK
| | - Inge De Groof
- Iridium Cancer Network Antwerp - Sint-Augustinus, Department of Geriatric Medicine, Wilrijk, Belgium
| | - Dominique Bron
- ULB Institute Jules Bordet, Department of Hematology, Brussels, Belgium
| | - Frank Cornélis
- Cliniques Universitaires Saint-Luc - UCLouvain, Department of Medical Oncology, Brussels, Belgium
| | - Sylvie Luce
- University Hospital Erasme- Université Libre de Bruxelles ULB, Department Medical Oncology, Brussels, Belgium
| | - Christian Focan
- Clinique CHC-MontLégia, Groupe Santé CHC-Liège, Department of Oncology, Liège, Belgium
| | - Vincent Verschaeve
- GHDC Grand Hôpital de Charleroi, Department of Medical Oncology, Charleroi, Belgium
| | - Gwenaëlle Debugne
- Centre Hospitalier de Mouscron, Department of Geriatric Medicine, Mouscron, Belgium
| | | | | | | | - Wesley Teurfs
- ZNA Stuivenberg, Department Medical Oncology, Antwerp, Belgium
| | - Guy Jerusalem
- Centre Hospitalier Universitaire Sart Tilman - Liège University, Department of Medical Oncology, Liège, Belgium
| | - Dirk Schrijvers
- ZNA Middelheim, Department of Medical Oncology, Antwerp, Belgium
| | - Bénédicte Petit
- Centre Hospitalier Jolimont, Department of Medical Oncology, La Louvière, Belgium
| | - Marika Rasschaert
- University Hospital Antwerp, Department of Medical Oncology, Edegem, Belgium
| | - Jean-Philippe Praet
- CHU St-Pierre - Free Universities Brussels, Department of Geriatric Medicine, Brussels, Belgium
| | | | - Koen Milisen
- University Hospitals Leuven - KU Leuven, Department of Geriatric Medicine - Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Johan Flamaing
- University Hospitals Leuven - KU Leuven, Department of Geriatric Medicine - Department of Public Health and Primary Care, Gerontology and Geriatrics, Leuven, Belgium
| | - Cindy Kenis
- University Hospitals Leuven, Department of General Medical Oncology - Department of Geriatric Medicine, Leuven, Belgium
| | - Freija Verdoodt
- Belgian Cancer Registry, Research Department, Brussels, Belgium
| | - Hans Wildiers
- University Hospitals Leuven - KU Leuven, Department of General Medical Oncology - Department of Oncology, Leuven, Belgium.
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Logroño Wiese PE, Seeber F, Endres AS, Brockmann C, Pleyer U. Screening for common eye diseases in the elderly with Optos ultra-wide-field scanning laser ophthalmoscopy: a pilot study with focus on ocular toxoplasmosis. Int Ophthalmol 2021; 41:1573-1584. [PMID: 33725270 PMCID: PMC8087594 DOI: 10.1007/s10792-020-01683-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/21/2020] [Indexed: 12/03/2022]
Abstract
Purpose Studies on the occurrence of ocular toxoplasmosis (OT) in a general population are rare. Therefore, we conducted this pilot study to assess whether a nonmydriatic ultra-wide-field (UWF) scanning laser ophthalmoscope (SLO) is suitable for a simple, rapid screening procedure. Methods The population of this cross-sectional study was randomly recruited from a cohort of hospital-based patients in an urban geriatric hospital. Ophthalmologic evaluation was performed on 201 eyes from 101 participants through nonmydriatic UWF-SLO (Optos Daytona) and assessed for suspicious lesions and other relevant ocular findings. All images were evaluated by two independent examiners. Individuals who presented lesions with a morphological appearance suggestive of OT underwent fundoscopy and serological analysis of Toxoplasma gondii-specific antibodies. Results The mean age of the study group was 76 years, and 63 (62%) were female. Despite many health restrictions, the SLO examination was carried out easily in this geriatric population. Three participants presented findings by SLO suspicious for T. gondii-related injury. Further clinical examination and serological investigation confirmed the diagnosis, with funduscopic evaluation and positive T. gondii ELISA testing. In addition, a high rate of arterial hypertension and dyslipidemias within the cohort led to a high incidence of vascular changes and age-related fundus findings. Conclusion In our study, we confirm that UWF-SLO technology is helpful in the rapid detection of peripheral retinal injuries in elderly patients such as OT and may be used as a routine screening tool.
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Affiliation(s)
- Pablo Eduardo Logroño Wiese
- Department of Ophthalmology, Charité, University Hospital Berlin, Campus Virchow, Augustenburger Platz 1, Berlin, 13353, Germany.
| | - Frank Seeber
- FG 16: Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Seestraße 10, Berlin, 13353, Germany
| | - Anne-Sophie Endres
- Evangelisches Geriatriezentrum Berlin, Reinickendorfer Str. 61, Berlin, 13347, Germany
| | - Claudia Brockmann
- Department of Ophthalmology, Charité, University Hospital Berlin, Campus Virchow, Augustenburger Platz 1, Berlin, 13353, Germany.,Department of Ophthalmology, Universitätsmedizin Rostock, Doberaner Str. 140, 18055, Rostock, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Charité, University Hospital Berlin, Campus Virchow, Augustenburger Platz 1, Berlin, 13353, Germany
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van Soolingen NJ, Smorenburg CH, Hamaker ME, Groen WG, Retèl VP, Lok CAR, van de Poll-Franse LV, Trum JW. GERiatric Screening in the treatment of elderly patients with Ovarian Carcinoma (GERSOC): study protocol for a pragmatic, cluster randomised controlled trial. Trials 2020; 21:214. [PMID: 32087750 PMCID: PMC7036170 DOI: 10.1186/s13063-020-4157-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/10/2020] [Indexed: 01/07/2023] Open
Abstract
Background Approximately 40% of the newly diagnosed patients with advanced ovarian cancer are aged 70 years or older. Standard treatment for advanced disease consists of cytoreductive surgery and combination chemotherapy. In older patients, standard treatment is often withheld or prematurely stopped due to suspected frailty. It remains challenging to distinguish fit elderly patients who can endure standard therapy from frail patients who may benefit from an adapted treatment strategy. As a comprehensive geriatric assessment (CGA) can contribute to the identification of frail patients and improve tailored therapy in this population, screening tests were developed to select those who may benefit from a CGA. However, the use of these geriatric screening tests has rarely been compared with usual clinical care. The GERSOC-trial will evaluate whether geriatric screening in elderly patients with advanced-stage ovarian cancer improves treatment completion and quality of life. Methods This pragmatic, cluster randomised controlled trial will be conducted at a minimum of 20 hospitals in the Netherlands. Hospitals are randomly assigned to geriatric screening care (in which a geriatric screening comprised of the G8 questionnaire and the Timed Up and Go test is performed), or care as usual (in which current usual care is continued). A total of 320 patients aged ≥ 70 years with primary, advanced-stage ovarian carcinoma will be included. Patients considered fit on geriatric screening will receive standard treatment; patients who are considered unfit will be referred to a geriatrician for analysis and treatment advice. The primary outcome is the percentage difference in completed standard and adapted therapies between the two study arms. Secondary outcomes include quality of life, cost-effectiveness and survival. Discussion This trial aims to gather evidence for the use of geriatric screening in treatment decision-making in elderly patients with advanced ovarian cancer. If proven feasible, beneficial and cost-effective, geriatric screening may be implemented in routine clinical practice. Trial registration Netherlands Trial Registry, ID: NL6745. Registered on 2 August 2017.
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Affiliation(s)
- Neeltje J van Soolingen
- Department of Gynaecologic Oncology, Centre for Gynaecologic Oncology Amsterdam, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Carolina H Smorenburg
- Department of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Wim G Groen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Valesca P Retèl
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Health Technology and Services Research (HTSR), University of Twente, Hallenweg 5, 7522 NH, Enschede, The Netherlands
| | - Christianne A R Lok
- Department of Gynaecologic Oncology, Centre for Gynaecologic Oncology Amsterdam, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Lonneke V van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands.,The Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Johannes W Trum
- Department of Gynaecologic Oncology, Centre for Gynaecologic Oncology Amsterdam, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
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Yuk HD, Kim JJ, Ku JH, Kwak C, Kim HH, Jeong CW. Korean version of the G-8 geriatric screening tool: Translation and linguistic validation. J Geriatr Oncol 2020; 11:470-4. [PMID: 31235435 DOI: 10.1016/j.jgo.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 05/02/2019] [Accepted: 06/05/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To develop a Korean version of the G-8 questionnaire validated with Korean patients over 70 years-of-age who were scheduled to undergo cancer surgery. MATERIALS AND METHODS We conducted a translation study over a nine-month period from February to November 2017. Permission was received to use the original version of the G-8 questionnaire for forward translation into Korean and reconciliation, for backward translation of the translated Korean version into English, for cognitive debriefing, and final proofreading. These steps were performed in the order of translation and then language validation. Forward translation was performed independently by two translators who were fluent in Korean and English. The cognitive debriefing was carried out through interviews with ten Korean nurses who cared for the patients surveyed. RESULTS In the forward translation, "mobility" was replaced by "degree of activity". During the reconciliation, the difference in meaning between the terms "loss of appetite" and "severe," as determined by the two translators, was adjusted. Moreover, to achieve more natural Korean expression, some revisions were made to the questions and answers. In the backward translation, most of the forward translations were accepted without any objection. During the final proofreading, no difficulties were found in understanding the questionnaire's content, and most terms were deemed easy to understand. CONCLUSION This Korean version of the G-8 questionnaire has been validated in accordance with appropriate procedures. Therefore, the questionnaire is appropriate for use as a geriatric screening tool for older patients with cancer in Korea.
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