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1.
Gretchen G. Kimmick Xiangrong Li Steven T. Fleming Susan A. Sabatino J. Frank. Wilson Joseph Lipscomb Rosemary Cress Carmen Bergom Roger T. Anderson Xiao-Cheng Wu 《Journal of Geriatric Oncology》2018,9(3):214-220
Objectives
To examine the associations of comorbidity and chemotherapy with breast cancer- and non-breast cancer-related death.Materials and methods
Included were women with invasive locoregional breast cancer diagnosed in 2004 from seven population-based cancer registries. Data were abstracted from medical records and verified with treating physicians when there were inconsistencies and missing information on cancer treatment. Comorbidity severity was quantified using the Adult Comorbidity Evaluation 27. Treatment guideline concordance was determined by comparing treatment received with the National Comprehensive Cancer Network guidelines. Kaplan–Meier method and multivariable Cox proportional hazards regressions were employed for statistical analyses.Results
Of 5852 patients, 76% were under 70 years old and 69% received guideline concordant adjuvant chemotherapy. Comorbidity was more prevalent in women age 70 and older (79% vs. 51%; p < 0.001). After adjusting for tumor characteristics and treatment, severe comorbidity burden was associated with significantly higher cancer-related mortality in older patients (Hazard Ratio [HR] = 2.38, 95% CI 1.08–5.24), but not in younger patients (HR = 1.78, 95% CI 0.87–3.64). Among patients receiving guideline adjuvant chemotherapy, cancer-related mortality was significantly higher in older patients (HR = 2.35, 95% CI 1.52–3.62), and those with severe comorbidity (HR = 3.79, 95% CI 1.72–8.33).Conclusions
Findings suggest that, compared to women with no comorbidity, patients with breast cancer age 70 and older with severe comorbidity are at increased risk of dying from breast cancer, even after adjustment for adjuvant chemotherapy and other tumor and treatment differences. This information adds to risk–benefit discussions and emphasizes the need for further study of the role for adjuvant chemotherapy in these patient groups. 相似文献2.
Idalid Franco Yu-Hui Chen Fallon Chipidza Vishesh Agrawal John Romano Elizabeth Baldini Aileen Chen Yolonda Colson Ying Hou David Kozono Jon Wee Raymond Mak 《Journal of Geriatric Oncology》2018,9(2):130-137
Objectives
Frailty has been shown to increase morbidity and mortality independent of age, but studies are lacking in radiation oncology. This study evaluates a modified frailty index (mFI) in predicting overall survival (OS) and non-cancer death for Stage I/II [N0M0] Non-Small-Cell Lung Cancer (NSCLC) patients treated with Stereotactic Body Radiation Therapy (SBRT).Materials and Methods
Medical records for all patients with Stage I/II NSCLC treated at our institution with SBRT from 2009 to 2014 were reviewed. A validated mFI score, consisting of 11 variables was calculated, classifying patients as non-frail (0–1) or frail (≥ 2). Primary endpoint (OS) was analyzed using Kaplan-Meier method and log-rank. Secondary endpoint, non-cancer death, was analyzed using Fine-Gray's method, with death from lung cancer as a competing risk.Results
Patient cohort consisted of 38 (27.3%) non-frail and 101 (72.7%) frail [median total mFI score 3.0 (range 0–7)]. Median age and pack-year history was 74 and 46 years, respectively. Median follow-up among survivors was 38.5 months (range 4.0–74.1 months). Frailty was associated with a lower 3-year OS (37.3% vs. 74.7%; p = 0.003) and 3-year cumulative incidence of non-cancer death (36.7% vs. 12.5%; p = 0.02). Frailty remained significant in the multivariate model [OS HR for mFI ≥ 2: 2.25 (1.14–4.44); p = 0.02].Conclusion
Frailty is associated with lower OS in older patients with early stage NSCLC treated with SBRT, yet frail patients survived a median 2.5 years, and were more likely to die of causes unrelated to the primary lung cancer, suggesting SBRT should be considered even in older patients deemed unfit for surgery. 相似文献3.
Lore Decoster Cindy Kenis Benedicte Naessens Ghislain Houbier Marc De Man Guy Lambrecht Els Monsaert Veerle Moons Philippe Vergauwe Hans Prenen Eric Van Cutsem Hans Wildiers 《Journal of Geriatric Oncology》2018,9(2):93-101
Objectives
This study aims to investigate the use of chemotherapy with or without bevacizumab in older patients with metastatic colorectal cancer (mCRC) in current daily practice and to identify predictive parameters for treatment-related outcomes.Patients and Methods
This is a Belgian multi-centre, observational cohort study. Patients ≥ 70 years old with mCRC considered suitable for first-line chemotherapy were eligible for inclusion. At baseline geriatric screening and assessment was performed. Treatment choice was at the discretion of the investigator. Treatment duration, Progression Free Survival (PFS) and safety were recorded.Results
Between August 2011 and July 2013, 252 patients with mCRC were included of which 50.8% were treated with bevacizumab. Median treatment duration was 5.5 months and median PFS was 8.9 months. Approximately 50% of patients experienced severe adverse events, most frequently diarrhea. In multivariate analysis, baseline Eastern Cooperative Oncology Group (ECOG)-performance status (PS) was predictive for treatment duration (p = 0.0047), PFS (p < 0.0001) and severe toxicity and baseline nutritional status for PFS (p = 0.0007). In patients with a good ECOG-PS, nutritional status was predictive for PFS.Conclusions
In current daily practice in Belgium, half of older patients with colorectal cancer treated with chemotherapy also receive bevacizumab. Nearly half of older patients presented with severe toxicity during treatment. Baseline nutritional status is a predictive marker for PFS. Patients with a baseline ECOG-PS ≥ 2 have shorter PFS and higher risk of severe toxicity and should therefore be treated with caution. 相似文献4.
Maren Schmidt Rahel Eckardt Sarah Altmeppen Klaus-Dieter Wernecke Claudia Spies 《Journal of Geriatric Oncology》2018,9(1):53-59
Objective
To investigate the prognostic value of elements of the Geriatric Assessment, in particular the Timed Up and Go (TUG) Test and the Barthel Index of Activities of Daily Living (ADL) for one-year post-operative mortality in elderly patients with cancer.Materials and Methods
This prospective cohort study included patients 65 years of age or older undergoing elective major surgery for cancer between June 2008 and June 2010. Preoperative functional status was measured by the TUG Test and the Barthel Index of ADL Cognitive state was assessed by the Mini Mental State Examination (MMSE). Complications were recorded prospectively. The degree of resection was noted.Results
Data from 131 patients (56% women; median age, 71 years) were analysed at 1 year of follow-up. Mortality after 1 year was 28.2%. Twenty-nine patients (22.3%) were dependent in ADLs, and 43 (35.2%) impaired in TUG. Thirteen patients (10.7%) were both, dependent in ADLs and impaired in TUG. Short-term complications after surgery occurred in 66% of patients, and major complications occurred in 29%. Patients who were dependent in ADLs and impaired in TUG had significantly higher 1-year mortality (OR, 4.5; 95% CI, 1.21–18.25; p = 0.034). Lower scores on the MMSE (OR, 0.64; 95% CI, 0.43–0.95; p = 0.048) and incomplete surgical resection (OR, 3.25; 95% CI, 1.15–9.20; p = 0.026) were independently associated with higher 1-year mortality.Conclusion
Functional assessments, such as ADL and TUG scores, as well as mild cognitive impairment, are predictors of long-term outcome in elderly cancer patients.Trial Registration
German Clinical Trials Register (DRKS 00005150) 相似文献5.
Objective
Few studies have examined the impact of cancer treatment on cognitive trajectories in the growing population of older adults diagnosed with and surviving cancer. This study examined whether recent cancer and its treatment accelerated memory decline in older adults.Materials and Methods
We conducted a secondary analysis of observations drawn from the Health and Retirement Study (2002–2012), a population-based sample of older adults in the United States. Changes in immediate (IWR) and delayed word recall (DWR) scores were estimated by latent growth modeling in individuals who never had cancer (n = 10,939) or had been diagnosed with cancer between 2000 and 2002 and received treatment with some combination of radiation and/or surgery (n = 240), chemotherapy only (n = 34), or chemotherapy and some combination of radiation and/or surgery (n = 64).Results
In the period immediately following treatment, individuals reporting a recent cancer treated with chemotherapy and surgery/radiation experienced significantly more rapid decline in IWR (b = ? 0.34, SE = 0.17, p = 0.047) and DWR (b = ? 0.38, SE = 0.19, p = 0.049) than the non-cancer group. Sensitivity analyses addressing mortality selection and memory-related disease at baseline attenuated the strength of these associations. There were no other statistically significant differences in estimated linear or quadratic slope by cancer status or treatment.Conclusion
Our results support a potential association between recent cancer treatment and trajectories of memory decline in older adults and provide guidance on the interpretation of statistical estimates from panel studies of health and aging. 相似文献6.
Enrique Soto-Perez-De-Celis Heeyoung Kim María Patricia Rojo-Castillo Can-Lan Sun Yanin Chavarri-Guerra Ana Patricia Navarrete-Reyes James R. Waisman José Alberto Avila-Funes Álvaro Aguayo Arti Hurria 《Journal of Geriatric Oncology》2018,9(2):145-151
Objectives
Older adults with cancer in developing countries face challenges accessing healthcare due to a lack of personnel and infrastructure. A decline in physical activity (defined as a decrease in the number of daily steps) may be a novel method for the timely detection of toxicity in older adults receiving chemotherapy in resource-constrained settings.Materials and Methods
In this feasibility study, patients aged ≥ 65 years starting first-line chemotherapy for solid tumors were given a smartphone with a pedometer application. Daily steps were monitored daily for one cycle. If a ≥ 15% decrease from baseline was identified, the patient was called and the presence of toxicity assessed. The intervention would be feasible if ≥ 75% of the subjects recorded steps for ≥ 75% of the planned chemotherapy days.Results
Forty patients (median age 73; 57% [N = 23] female) were included. Seventy percent (N = 28) had stage III-IV disease with 45% (N = 18) gastrointestinal, 23% (N = 9) breast, and 32% (N = 13) other malignancies. Mean pre-treatment daily steps was 3111 (Standard Deviation [SD] 1731), and median follow-up was 21 days (range 2–28). Despite having limited exposure to mobile technology, most (93%) patients used the smartphone appropriately, and 85% found it easy to use. Sixty percent of patients (N = 24) had toxicities managed over the phone, 27.5% (N = 10) were sent for urgent medical attention and 15% (N = 6) were hospitalized.Conclusion
Using smartphones to monitor older adults with cancer receiving chemotherapy in a resource-constrained setting is feasible and acceptable. A decrease in the number of daily steps was common and helped to identify chemotherapy toxicity. 相似文献7.
Alice M. Couwenberg Fleur S.A. de Beer Martijn P.W. Intven Johannes P.M. Burbach Anke B. Smits Esther C.J. Consten Anandi H.W. Schiphorst Niels A.T. Wijffels Marnix A.J. de Roos Marije E. Hamaker Wilhemina M.U. van Grevenstein Helena M. Verkooijen 《Journal of Geriatric Oncology》2018,9(2):102-109
Objectives
As result of the aging population and increasing rectal cancer incidence, more older patients undergo treatment for rectal cancer. This study compares treatment course, postoperative complications, and quality of life (QOL) between older and younger patients with rectal cancer and evaluates the impact of postoperative complications on QOL in the elderly.Materials and Methods
Patients with rectal cancer participating in a prospective colorectal cancer cohort and referred for radiotherapy between 2013 and 2016 were included. QOL was assessed with the cancer questionnaire of the European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30) before treatment and at three, six, and twelve months. Outcomes were compared between older patients (≥ 70 years) and younger patients (< 70 years) and stratified by presence of postoperative complications.Results
In total, 115 (33%) older patients and 230 (67%) younger patients were included. Compared to younger patients, older patients underwent significantly more often short-course radiation with delayed surgery (6.1% and 19.1% respectively) and less often chemoradiation (62.6% and 39.1% respectively), and were more likely to undergo a Hartmann procedure with permanent stoma (3.5% and 13.0% respectively) instead of sphincter-sparing surgery (43.9% and 29.6% respectively). Postoperative complication rates were similar (38.5% in older patients versus 34.7% in younger patients). Older patients had worse physical functioning at six and twelve months after diagnosis compared to younger patients. Presence of postoperative complications had a significant stronger impact on physical- and role functioning in older patients.Conclusion
Older patients undergo more often a tailored treatment approach for rectal cancer than younger patients. With this tailored approach, similar postoperative complication rates and QOL are achieved. However, postoperative complications have a larger negative impact on physical- and role functioning in older patients which indicates a need for better prediction of postoperative complications in the elderly. 相似文献8.
David M. Guttmann Nandita Mitra James M. Metz John Plastaras Weiwei Feng Samuel Swisher-McClure 《Journal of Geriatric Oncology》2018,9(1):40-46
Objectives
The aim of this study was to characterize outcomes associated with neoadjuvant chemoradiation prior to esophagectomy, compared to esophagectomy alone, in older patients with esophageal cancer.Materials and Methods
We conducted an observational cohort study in patients ≥ 70 years with locally-advanced esophageal cancer undergoing esophagectomy ± neoadjuvant chemoradiation between 2006 and 2012 using the National Cancer Database. A Cox proportional hazards model with inverse probability of treatment weighting (IPTW) using the propensity score was developed to assess the association between trimodality therapy and overall survival. Perioperative complications and pathologic outcomes associated with trimodality therapy were identified with multivariable logistic regression.Results
1364 patients were included; the mean age was 75 (range 70–90). 904 (66%) were treated with trimodality therapy and 460 (34%) were treated with esophagectomy alone. On IPTW Cox analysis, neoadjuvant chemoradiation was associated with improved overall survival (HR = 0.76, 95%CI [0.70–0.82], p ≤ 0.001). Further, trimodality therapy was associated with lower rates of margin-positive resection (5% vs. 18%; OR = 0.26, 95%CI [0.18–0.37], p < 0.001) and in 18% of trimodality patients, there was no detectable tumor at surgery. 90-day mortality rates were not statistically different (14% vs. 12%; OR = 0.99, 95%CI [0.73–1.36], p = 0.22). Neoadjuvant chemoradiation was associated with lower 30-day readmission rates (5% vs. 8%; OR = 0.48, 95%CI [0.31–0.73], p = 0.004) and shorter surgical hospital stay (median 10 vs. 12 days, p < 0.001) compared to esophagectomy alone.Conclusion
In older patients with esophageal cancer, trimodality therapy, compared to esophagectomy alone, is associated with improved overall survival and favorable pathologic and perioperative outcomes. Further studies are needed to identify which older patients are most suitable for trimodality therapy. 相似文献9.
Yuke Chen Yu Fan Yang Yang Jie Jin Liqun Zhou Zhisong He Zheng Zhao Qun He Xiaoying Wang Wei Yu Shiliang Wu 《Journal of Geriatric Oncology》2018,9(2):124-129
Purpose
To develop nomograms predicting prostate cancer (PCa) and high-grade PCa (HGPCa) in the elderly population.Methods
We reviewed the data of patients aged 75 years and older who underwent first-time prostate biopsy and multiparametric magnetic resonance imaging (mpMRI). The nomograms were developed based on multivariate analysis and evaluated. We performed the external validation and calibration of the risk calculators from the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Prostate Cancer Prevention Trial (PCPT).Results
The present study included 302 subjects with a median age of 78 years (range: 75–91 years). Overall, 225 and 129 subjects were diagnosed with PCa and HGPCa (Gleason score ≥ 4 + 3), respectively. The ratio of free-to-total PSA, prostate-specific antigen density (PSAD), transrectal ultrasound (TRUS), and Prostate Imaging Reporting and Data System (PI-RADS) were used to develop the PCa-predicting nomogram, and PSAD, TRUS, and PI-RADS were used to develop the HGPCa-predicting nomogram. The area under the curve (AUC) values of PCa-predicting and HGPCa-predicting nomograms were 0.90 and 0.87. The ERSPC calculator had acceptable external calibration and validation outcomes. We recommended a cut-off probability of 42% for PCa-predicting nomogram when used in healthy older men to achieve a sensitivity of 95.6%, and a cut-off probability of 73% for HGPCa-predicting nomogram when used in vulnerable older men to achieve a specificity of 98.3%.Conclusions
The present nomograms could help discriminate patients with PCa from healthy elder adults for standard treatment, and discriminate patients with HGPCa from vulnerable elder adults for modified treatment. External validation is expected. 相似文献10.
Esteban T.D. Souwer Norbert M. Verweij Frederiek van den Bos Esther Bastiaannet Rob M.E. Slangen Willem H. Steup Marije E. Hamaker Johanna E.A. Portielje 《Journal of Geriatric Oncology》2018,9(2):110-114
Background
Older patients are at risk for adverse outcomes after surgical treatment of cancer. Identifying patients at risk could affect treatment decisions and prevent functional decline. Screening tools are available to select patients for Geriatric Assessment. Until now their predictive value for adverse outcomes in older colorectal cancer patients has not been investigated.Objective
To study the predictive value of the Geriatric 8 (G8) and Identification of Seniors at Risk for Hospitalized Patients (ISAR-HP) screening tools for adverse outcomes after elective colorectal surgery in patients older than 70 years. Primary outcomes were 30-day complication rates, secondary outcomes were the length of hospital stay and six-month mortality.Study Design and Methods
Multicentre cohort study from two hospitals in the Netherlands. Frail was defined as a G8 ≤ 14 and/or ISAR-HP ≥ 2. Odds ratio (OR) is given with 95% CI.Results
Overall, 139 patients (52%) out of 268 patients were included; 32 patients (23%) were ISAR-HP-frail, 68 (50%) were G8-frail, 20 were frail on both screening tools. Median age was 77.7 years. ISAR-HP frail patients were at risk for 30-day complications OR 2.4 (CI 1.1–5.4, p = 0.03), readmission OR 3.4 (1.1–11.0), cardiopulmonary complications OR 5.9 (1.6–22.6), longer hospital stay (10.3 versus 8.9 day) and six-months mortality OR 4.9 (1.1–23.4). When ISAR-HP and G8 were combined OR increased for readmission, 30-day and six-months mortality. G8 alone had no predictive value.Conclusions
ISAR-HP-frail patients are at risk for adverse outcomes after colorectal surgery. ISAR-HP combined with G8 has the strongest predictive value for complications and mortality.Key Points
Patients screening frail on ISAR-HP are at increased risk for morbidity and mortality. Screening results of G8 alone was not predictive for postoperative outcomes. Predictive value increased when G8 and ISAR-HP were combined. 相似文献11.
Alicia Eubanks Julie Pepe Paula Veldhuis Sebastian G. de la Fuente 《Journal of Geriatric Oncology》2018,9(4):362-366
Purpose
In pancreatic cancer, the greatest increase in survival is attained by surgical resection followed by adjuvant chemotherapy. Although surgical complications and functional status are recognized as independent factors for halting adjuvant therapy in patients that undergo pancreatic resections, other elements may play a role in deciding which patients get treated postoperatively. Here we determined demographic and clinical characteristics of patients receiving adjuvant chemotherapy, with the primary intent to investigate if age alone affects rates of adjuvant therapy.Methods/Materials
National Cancer Database (NCDB) was queried for patients that underwent surgery for pancreatic cancer. Groups were divided into: adjuvant chemotherapy (n = 17,924) and no adjuvant chemotherapy (n = 12,947). Basic demographics and treatment characteristics were analyzed. Age was compared with an independent means test; other comparisons used Chi-square test of independence.Results
There was a statistical difference in age (adjuvant therapy 64.86 ± 9.89 vs. no therapy 67.78 ± 11.22, p < 0.001), insurance type, facility type, and cancer stage for patients that received adjuvant therapy and those that did not. Average age of patients not receiving chemotherapy was significantly older at each pathologic stage. Subset analysis of patients treated with chemotherapy showed that the majority of patients received single agent regimens (62%), at an average of 59 days following surgery, and at academic cancer programs (52%).Conclusions
Regardless of postoperative complications and functional status, age alone appears to affect rates of adjuvant therapy in patients with resected pancreatic cancer. Older patients should be offered tailored regimens that would allow them to complete the intended extent of treatment. 相似文献12.
Chantal Quinten C. Kenis M. Hamaker A. Coolbrandt B. Brouwers L. Dal Lago P. Neven P. Vuylsteke G. Debrock H. Van Den Bulck A. Smeets P. Schöffski A. Bottomley U. Wedding H. Wildiers 《Journal of Geriatric Oncology》2018,9(2):152-162
Objectives
We aim to assess short and long term effects of chemotherapy on patient-reported quality of life (QOL) and patient versus clinician symptom reporting in older patients with breast cancer adjusted for tumour and aging parameters.Material and Methods
In this prospective, multicentre, non-interventional, observational study, women aged ≥ 70 years were enrolled after surgery and assigned to a TC chemotherapy (docetaxel and cyclophosphamide) group or a control group depending on their planned adjuvant treatment. Longitudinal multivariate models were used to assess the statistical and minimal clinically important difference (MCID) in the impact of TC chemotherapy over time on QOL and symptom burden adjusted for baseline aging and tumour parameters. Statistical significance was set at 5% and MCID at 10 points.Results
In total, 57 patients were enrolled in the chemotherapy and 52 patients in the control group. Within the chemotherapy group, clinical deterioration was reported at 3 months for Fatigue (17.73), Dyspnoea (17.05), Diarrhoea (12.06) and Appetite Loss (17.05) scores (all p < 0.001). However, the scores had returned to baseline (or even better for Role Functioning) at year 1. No clinical deterioration was reported in the control group. Symptom scores as reported by patients were significantly (p < 0.05) higher than those reported by the clinicians, even more so for Fatigue, Dyspnoea, and Pain.Conclusion
Our results show that symptom burden and diminished QOL in an older breast cancer population receiving adjuvant TC chemotherapy are short-lived and disappear after a while with no long-term differences compared to a similar population not receiving chemotherapy. 相似文献13.
Paul Ruff Eric Van Cutsem Radek Lakomy Jana Prausova Guy A. van Hazel Vladimir M. Moiseyenko Karen Soussan-Lazard Emmanuelle Dochy Emmanuelle Magherini Teresa Macarulla Demetris Papamichael 《Journal of Geriatric Oncology》2018,9(1):32-39
Objectives
Aflibercept (ziv-aflibercept) significantly improves progression-free (PFS) and overall survival (OS) when added to 5-fluorouracil, leucovorin and irinotecan (FOLFIRI), compared with FOLFIRI alone, in patients with metastatic colorectal cancer previously treated with oxaliplatin-based therapy. This subset analysis of the VELOUR study investigates aflibercept plus FOLFIRI versus placebo plus FOLFIRI according to age.Methods
Efficacy and safety were analyzed by treatment arm and age (≥ or < 65 years).Results
Overall, 443 patients were ≥ 65 years old (205 in aflibercept arm; 238 in placebo arm) and 783 were < 65 years old (407 in aflibercept arm; 376 in placebo arm). Median OS was 12.6 versus 11.3 months (hazard ratio [HR]: 0.85; 95.34% CI 0.68–1.07) in patients ≥ 65 years old and 14.5 versus 12.5 months (HR: 0.80; 95.34% CI 0.67–0.95) in those patients < 65 years old, for patients receiving FOLFIRI plus aflibercept or placebo, respectively. There was no interaction between treatment and age. Treatment-emergent adverse events (AEs) were comparable for patients < 65 years and ≥ 65 years old. The incidence of grade 3/4 AEs was higher for patients ≥ 65 years old than for those < 65 years old in both the aflibercept (89.3% versus 80.5%) and placebo (67.4% versus 59.4%) arms. Interaction tests for grade 3/4 antiangiogenic agent-related AEs suggested no heterogeneity between the older and younger patient populations (p > 0.1).Conclusion
A limited but consistent benefit on both OS and PFS was associated with the addition of aflibercept to FOLFIRI compared with placebo in patients < 65 and ≥ 65 years old, with a marked but manageable increase in the toxicity profile in older patients.14.
Jing Jing Lian Li Li Ma Yi Qun Zhang Wei Feng Chen Yun Shi Zhong Mei Dong Xu Ping Hong Zhou Shi Yao Chen 《Journal of Geriatric Oncology》2018,9(3):249-253
Background and Aims
The colorectal endoscopic submucosal dissection (ESD) remains technically challenging, especially for older patients who frequently encounter complex chronic diseases and have a loose colon. However, only limited number of studies are available for the safety of ESD in older patients with especially large laterally spreading tumors. Therefore, in this retrospective study, we compared the outcomes of ESD for laterally spreading tumors (LST) ≥ 3 cm(cm) in older patients to that in younger patients.Methods
Consecutive patients with LSTs 3 cm or larger were enrolled for from May 2010–2016. These patients were divided into two groups: the younger group (< 65 years) and the older group (≥ 65 years). The clinicopathologic findings and the outcomes of ESD procedures were compared between the two groups.Results
A total of 70 patients in the younger group and 73 patients in the older group were treated by ESD for colorectal LSTs larger than 3 cm. No significant differences were observed in the gender ratio, tumor morphological type, tumor location, and tumor size between the two groups. The en bloc resection rates were 85.7 and 89.0%, respectively, without a significant difference. The procedural time was similar between the younger and older patients (71.8 ± 34.7 min vs. 70.6 ± 29.5 min). The duration of hospital stay was not significantly different between the two groups (4.1 ± 2.2 days vs. 4.4 ± 2.5 days). No significant differences were observed between the two groups with respect to ESD-related complications including delayed bleeding, perforation, and stricture.Conclusions
ESD appears to be an effective and safe method for LSTs larger than 3 cm in older patients. 相似文献15.
Laura Visa Paula Jiménez-Fonseca Elena Asensio Martínez Raquel Hernández Ana Custodio Manuel Garrido Antonio Viudez Elvira Buxo Ignacio Echavarria Juana María Cano Ismael Macias Montserrat Mangas Eva Martínez de Castro Teresa García Felipe Álvarez Manceñido Ana Fernández Montes Aitor Azkarate Federico Longo Alberto Carmona-Bayonas 《Journal of Geriatric Oncology》2018,9(3):254-264
Objective
Advanced gastric cancer (AGC) is a common neoplasm in older adults. Nevertheless, there are few specific management data in the literature. The aim of this study was to assess non-inferiority of survival and efficacy-related outcomes of chemotherapy used in older vs non-older patients with AGC.Materials and Methods
We recruited 1485 patients from the AGAMENON registry of AGC treated with polychemotherapy between 2008–2017. A statistical analysis was conducted to prove non-inferiority for overall survival (OS) associated with the use of chemotherapy schedules in individuals ≥ 70 vs.<70 years. The fixed-margin method was used (hazard ratio [HR]<1.176) that corresponds to conserving at least 85% efficacy. Results: 33% (n = 489) of the cases analyzed were ≥ 70 years. Two-agent chemotherapies and combinations with oxaliplatin (48% vs. 29%) were used more often in the older patients, as were modified schedules and/or lower doses. Toxicity grade 3–4 was comparable in both groups, although when looking at any grade, there were more episodes of enteritis, renal toxicity, and fatigue in older patients. In addition, toxicity was a frequent cause for discontinuing treatment in older patients. The response rate was similar in both groups. After adjusting for confounding factors, the non-inferiority of OS associated with schedules administered to the older vs. younger subjects was confirmed: HR 1.02 (90% CI, 0.91–1.14), P (non inferiority) = 0.018, as well as progression-free survival: HR 0.97 (90% CI, 0.87–1.08), P(non-inferiority) = 0.001.Conclusion
In this AGC registry, the use of chemotherapy with schedules adapted to patients ≥ 70 years provided efficacy that was not inferior to that seen in younger cases, with comparable adverse effects. 相似文献16.
Grant R. Williams Allison M. Deal Hyman B. Muss Marc S. Weinberg Hanna K. Sanoff Emily J. Guerard Kirsten A. Nyrop Mackenzi Pergolotti Shlomit Strulov Shachar 《Journal of Geriatric Oncology》2018,9(1):68-73
Objective
Computerized tomography (CT) imaging is routine in oncologic care and can be used to measure muscle quantity and composition that may improve prognostic assessment of older patients. This study examines the association of single-slice CT-assessed muscle measurements with a frailty index in older adults with cancer.Materials and Methods
Using the Carolina Senior Registry, we identified patients with CT imaging within 60 days ± of geriatric assessment (GA). A 36-item Carolina Frailty Index was calculated. Cross-sectional skeletal muscle area (SMA) and Skeletal Muscle Density (SMD) were analyzed from CT scan L3 lumbar segments. SMA and patient height (m2) were used to calculate skeletal muscle index (SMI). Skeletal Muscle Gauge (SMG) was calculated by multiplying SMI × SMD.Results
Of the 162 patients, mean age 73, 53% were robust, 27% pre-frail, and 21% frail. Significant differences were found between robust and frail patients for SMD (29.4 vs 24.1 HU, p < 0.001) and SMG (1188 vs 922 AU, p = 0.003), but not SMI (41.9 vs 39.5 cm2/m2, p = 0.29). After controlling for age and gender, for every 5 unit decrease in SMD, the prevalence ratio of frailty increased by 20% (PR = 1.20 [1.09, 1.32]) while the prevalence of frailty did not differ based on SMI.Conclusions
Muscle mass (measured as SMI) was poorly associated with a GA-based frailty index. Muscle density, which reflects muscle lipid content, was more associated with frailty. Although frailty and loss of muscle mass are both age-related conditions that are predictive of adverse outcomes, our results suggest they are separate entities. 相似文献17.
Jean Lacau St Guily Éric Bouvard Bruno Raynard François Goldwasser Brigitte Maget Alain Prevost David Seguy Olivier Romano Bérengère Narciso Charles Couet Jean-Michel Balon Damien Vansteene Sébastien Salas Philippe Grandval Emmanuel Gyan Xavier Hebuterne 《Journal of Geriatric Oncology》2018,9(1):74-80
Objectives
To compare the prevalence of malnutrition and nutritional management between elderly (≥ 70 years old) and younger patients (< 70 years) with cancer.Patients and Methods
This is a post-hoc analysis of NutriCancer 2012 study; a one-day cross-sectional nationwide survey conducted to assess malnutrition in adult patients with cancer in France. Patients diagnosed with cancer at the study date in both inpatient and outpatient settings were included. Data collection was performed by means of questionnaires completed by the physician, the patient and the caregiver.Results
This post-hoc analysis compared 578 elderly patients (27.6%) vs. 1517 younger patients (72.4%). There were significant differences in cancer localization between the groups particularly in gastrointestinal cancer (27% in younger patients vs. 42% in elderly), breast cancer (17% vs 8% in elderly) and oropharyngeal (15% vs. 9% in elderly). Weight loss was significantly more reported in the elderly than in younger patients (73.6% vs. 67.6%, p = 0.009). Elderly patients were more frequently malnourished than younger patients (44.9% vs. 36.7%, p = 0.0006). Food intake was comparable between the groups; however, physicians overestimated the food intake, particularly in the elderly. The malnutrition management was more frequently proposed in elderly, as dietary advice and oral nutritional supplements, than in younger patients; however, enteral nutrition was significantly less undertaken in the elderly.Conclusion
Malnutrition is prevalent in elderly patients with cancer, and more frequent than in younger patients. There is a need for an early integration of the nutritional counselling in patients with cancer, and particularly in the elderly. 相似文献18.
Schroder Sattar Shabbir M.H. Alibhai Margaret Fitch Monika Krzyzanowska Natasha Leighl Martine T.E. Puts 《Journal of Geriatric Oncology》2018,9(1):47-52
Purpose
Little is known about the perspectives of older adults (OAs) with newly-diagnosed cancer on their experiences with cancer treatment decision-making. The objective of this study was to explore the factors that were important for accepting or refusing cancer treatment by older adults undergoing chemotherapy and/or radiation therapy.Patients and methods
A qualitative study using semi-structured interviews with 20 OAs aged ≥ 65 years with newly diagnosed cancer (< 6 months) receiving either curative or palliative chemotherapy and/or radiation or who had declined therapy. The COREQ reporting guideline was utilized.Results
The majority of patients accepted the recommended cancer treatment. Most OAs followed their oncologist's recommendation, but spoke of making their own decisions and felt confident about their decisions. Second opinions were not commonly sought. Themes emerged can be divided into two categories: 1) pertaining to cancer treatment decision-making, which includes: “Trust in oncologist”, “prolong life”, “expected outcomes of treatment”, “other people's experience”, skeptical about going online” and “assertion of independence”, and 2) pertaining to oncologist-patient interactions, which includes “communication”.Conclusion
Older patients largely followed their cancer specialists' treatment recommendations. Most patients were satisfied with their treatment decision and were confident in their decisions. Seeking of second opinions was rare. More needs to be done to address the communication gaps and support needs of this population. 相似文献19.
Vicki A. Morrison Linda McCall Hyman B. Muss Aminah Jatoi Harvey J. Cohen Constance T. Cirrincione Jennifer A. Ligibel Jacqueline M. Lafky Arti Hurria 《Journal of Geriatric Oncology》2018,9(3):228-234
Objective
Actual weight-based (AWB) chemotherapy dosing is recommended for obese patients in the 2012 ASCO Clinical Practice Guideline. CALGB 49907, which utilized ABW-based adjuvant chemotherapy dosing, was a phase 3 trial in women age ≥ 65 years with early stage breast cancer, providing the opportunity to examine impact of such dosing on toxicities and outcome in older patients with breast cancer.Materials and Methods
Adverse event data were available for 615 of 633 enrolled patients. Objectives were to assess grade ≥ 3 hematologic/non-hematologic toxicities by treatment arm, age, study entry BSA/BMI, and relapse-free (RFS) and overall survival (OS) by BSA/BMI.Results
The 615 patients were sub-grouped by BSA (quartiles) and standard BMI categories, with BMI underweight/normal weight categories combined. Overall, grade ≥ 3 non-hematologic and hematologic toxicities occurred in 39.8% and 28.3% of patients, respectively. There were no significant differences in grade ≥ 3 toxicities among BSA quartiles. However, more grade ≥ 3 hematologic toxicities occurred in the underweight/normal weight BMI subgroup compared to overweight/obese subgroups (p = 0.048). Type of chemotherapy and age had no impact on toxicity occurrence by BSA/BMI categories. RFS was superior in the 25th–50th BSA percentile patients in univariate analysis (p = 0.042), as was OS in both univariate and multivariate analyses (p = 0.007, p = 0.009, respectively). No differences in RFS or OS were found by BMI categories.Conclusion
Obesity was not correlated with adverse relapse or survival outcome, and grade ≥ 3 toxicities were not greater with ABW-based dosing. This supports safety and efficacy of ABW-based dosing as per the 2012 ASCO clinical practice guideline.ClinicalTrials.gov Identifier: NCT00024102 (49907). 相似文献20.
Alexandre Escande Pierre Maroun Isabelle Dumas Antoine Schernberg Alberto Bossi Renaud De Crevoisier Eric Deutsch Christine Haie-Meder Cyrus Chargari 《Journal of Geriatric Oncology》2018,9(3):275-278