The assessment,management, and reporting of falls,and the impact of falls on cancer treatment in community-dwelling older patients receiving cancer treatment: Results from a mixed-methods study

Background

Falls are major health issues among older adults and even more so in those with cancer due to cancer and its treatment. Delays in cancer treatment caused by fall injuries may have significant implications on disease trajectory and patient outcomes. However, it is not known how falls impact cancer treatment in this population.

Circumstances around falls in older adults with Cancer

ObjectivesFalls are increasingly worrisome to older adults with cancer due to the side effects of cancer and its treatments. Understanding the circumstances of falls is important in the development of fall prevention strategies. The aim of this study is to understand the circumstances of falls in older patients with cancer.Materials and MethodsThis study is a secondary analysis of a prospective cohort study in which adults aged ≥65 years with cancer receiving systemic cancer therapy were followed for fall outcomes for six months. Falls were assessed by monthly fall calendars; 51 participants who reported a fall were interviewed regarding the fall.ResultsThe cohort had an average age of 72.2 ± 5.2 years; 37% were female and 90% were white. Half (25/51) had experienced falls in the six months prior to enrollment. During the follow-up period, 78 falls occurred in 51 individuals over 6 months: 36 patients had 1 fall, 9 patients had 2 falls, 3 had 3 falls, and 1 each had 4, 5, or 6 falls. Nearly half of falls (51%) took place in the home and 38 (49%) occurred outside of the home.ConclusionsFalls occurred at similar rates both inside the home and outside the home, indicating that familiarity with the person's surroundings does not protect against falls. Symptoms of cancer treatments were not mentioned during fall assessment, which may indicate a need for more awareness of the side effects of cancer medications and future developments of fall prevention methods.     

Managing older patients with head and neck cancer: The non-surgical curative approach

Managing older patients with head and neck cancers poses a challenge due to the often reduced levels of physiological reserve, the frequent comorbidities and treatment related toxicity. These factors have implications on speech, breathing and swallowing functions. Treatment management plans in these patients may result in de-intensification strategies and as a result of this, use of non-standard treatments is increasing. There have been published reports that indicate the addition of concurrent systemic therapy to radiation in selected older patients is feasible, and produces outcomes comparable with younger patients. However, some other studies including meta-analyses suggest a lack of real survival benefit with the addition of chemotherapy. So, the key point appears to be the optimal patient selection. Appropriate geriatric and frailty assessments are required to help determine the optimal treatment for older patients with head and neck cancer. Treatment for this population still needs to be well defined and optimized in both modality and intensity.Qualitative studies are also required to address short and long-term post-treatment quality-of-life and survivorship issues in this specific patient population. This review summarizes the evidence available regarding the non-surgical management of older patients with head and neck cancers.     

Detecting geriatric needs in older patients with breast cancer through use of a brief geriatric screening tool

IntroductionIdentification of geriatric syndromes is important for determining functional age and optimizing care for people with cancer. Based on administration of a geriatric screening tool, we aimed to describe needed resources for geriatric syndromes, including lack of social support, depressed mood, deficits in instrumental and activities of daily living (IADL/ADL), falls, nutritional issues, polypharmacy, ability to pay for medications, and memory deficits, in a population of patients with breast cancer.MethodsConsecutive medical oncology patients with breast cancer age 65 years and older, seen at a tertiary care center, completed a screening tool, adapted from Overcash 2006, consisting of a nurse-administered memory assessment and a one-page, self-administered questionnaire. Responses identified geriatric syndromes. Demographics and clinical information were retrospectively gathered. Frequencies and means were used to describe data.ResultsFrom January 2012 through July 2014, patients (n = 429) completed the screening tool as part of routine care. Study group had mean age 76 years (range 65–89), mean time since diagnosis 6.5 years, 91% non-metastatic disease, mean Charlson Comorbidity score 1.8 (range 0–10). Treatment included partial mastectomy (49%), adjuvant radiation (43%), chemotherapy (25%), and endocrine therapy (61%). The screening tool identified need for social support (8%); depression (31%); mobility issues (20%); falls (28%); nutritional needs (33%); polypharmacy (83%); and memory deficit (19%).ConclusionThis screening tool identified geriatric syndromes requiring attention in many patients with breast cancer presenting for medical oncology appointments. In oncology practice, need for referral networks to address geriatric syndromes should be assessed.     

Cetuximab monotherapy and cetuximab plus capecitabine as first-line treatment in older patients with RAS- and BRAF wild-type metastatic colorectal cancer. Results of the multicenter phase II trial SAKK 41/10

Introduction

While the anti-VEGF antibody bevacizumab was studied repeatedly as part of low-intensity regimens in less fit elderly patients with metastatic colorectal cancer (mCRC), anti-EGFR antibodies as upfront treatment modality have been scarcely investigated.

Fear of falling in community-dwelling older adults diagnosed with cancer: A report from the International Mobility in Aging Study (IMIAS)

BackgroundThe incidence of fear of falling (FOF) is high among people with cancer. However, factors that are associated with FOF in people with cancer has not yet been investigated. Therefore, the objective of this study was to identify the associated factors with FOF in people with cancer.MethodThis is a secondary analysis of the International Mobility in Aging Study (IMIAS) study. A total of 175 people self-identified as patients with cancer (mean age: 69.3 years, women: 50.2%) and 177 healthy age-matched group. FOF measured using the Falls Efficacy Scale-International (FES-I) was the primary outcome. Potential variables/factors for consistency known to be associated with FOF (cognitive status, depression, physical performance, the number of falls in the last year, visual acuity and grip strength) were assessed. Simple linear regression was used to identify factors associated with FOF. Variables with p-value <0.05 were then included in a multiple linear regression adjusted for the study confounders (study site, sex, and age).ResultsFor people with cancer, FES-I was significantly associated with the Leganes Cognitive Test, The Short Physical Performance Battery (SPPB) total scores and the number of falls reported in the past 12 months (P-value <0.05). For the healthy group, FOF was only associated with depression and SPPEB.ConclusionFOF is multifactorial in people with cancer and it is associated with cognitive status, physical performance and number of falls in the last year. Healthcare providers for patients with cancer should evaluate all potential factors associated with FOF and manage it.     

Chemotherapy effect on daytime sleepiness and contributing factors in older adults with cancer

ObjectivesThe objective of this study was to determine the prevalence of excessive daytime sleepiness (EDS) among older Iranian patients with cancer and to analyze the effect of chemotherapy treatment on patients' sleep problems. The relationship between sleep disturbances and physical activity, psychological factors, and demographic data, are also explored.MethodsThis cross-sectional study consisted of interviews with 83 patients, >60 years old with a solid tumor, carried out in Cancer Institute of Iran once prior to receiving chemotherapy and the second time after the first cycles of chemotherapy. Questionnaires consisted of demographic data, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scales (HADS), Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and Eastern Cooperative Oncology Group performance status (ECOG PS). Medical data were also gathered from hospital records. Logistic regression was used to identify predictors of excessive daytime sleepiness after chemotherapy.ResultsThe results showed a significant association between EDS and receiving chemotherapy. 8.1% were initially experiencing EDS which increased to 21.6% after chemotherapy (P-value < .001). Anxiety before chemotherapy and number of regions of recurrence of cancer, if any, were identified as independent predictors of daytime sleepiness.ConclusionsAs EDS prevalence increases after chemotherapy, and this can affect patients' quality of life and treatment outcomes; caregivers should bear in mind that senior patient with cancer, especially those suffering from anxiety and cancer recurrence, need special attention before starting treatment in order to manage EDS over the course of chemotherapy.     

Use of comprehensive geriatric assessment (CGA) to define frailty in geriatric oncology: Searching for the best threshold. Cross-sectional study of 418 old patients with cancer evaluated in the Geriatric Frailty Clinic (G.F.C.) of Toulouse (France)

ObjectivesA consensual and operational definition of frailty is necessary in geriatric oncology. While many studies have focused on geriatric syndromes evaluated in the comprehensive geriatric assessment (CGA) to select patients at higher risk of poor outcomes, few have compared CGA data with Fried's phenotype of frailty, the most consensual measurement of frailty in geriatrics. Our objective was to determine a threshold of impaired domains evaluated in CGA associated with Frailty status.MethodsA cross-sectional study including all patients with cancer, evaluated from January 2011 to February 2016 at the Geriatric Frailty Clinic, Toulouse. A CGA was performed evaluating seven geriatric domains. Frailty was measured by Fried's phenotype to classify patients into three groups (robust/pre-frail/frail). We plotted a ROC curve to determine the threshold of impaired domains associated with frailty according to Fried.ResultsWe included 418 patients aged 82.8 years (range 66–100 years). Thirty-three patients (7.9%) were robust, 155 (37.1%) pre-frail and 230 (55%) frail. There was a significant difference in ADL, IADL, nutrition, cognition and polypharmacy between the three groups (p < .001 for each domain). Frail patients had more impaired geriatric domains on CGA than pre-frail and robust patients (respectively 4.5 ± 1.5, 2.8 ± 1.6 and 2.1 ± 1.2; p < .001). The threshold of 4 impaired geriatric domains associated with Fried's Frailty status was identified (Se 77.39%, Sp 67.55%). Area under the curve was 79.6%.ConclusionThe phenotype of frailty is associated with more impaired geriatric domains and a threshold of 4 altered domains could be used to detect frailty from CGA data.