共查询到20条相似文献，搜索用时 15 毫秒
1.
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2.
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3.
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4.
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5.
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6.
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7.
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8.
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9.
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10.
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
Background
No study has examined the possibility to perform an organ sparing strategy in older patients with penile carcinoma, and amputation is frequently proposed. We report our experience of interstitial brachytherapy for the conservative treatment of penile carcinoma confined to the glans in patients aged of 70 years and more.Methods
A total of 55 patients candidates to conservative brachytherapy were identified. Median age was 73.8 years (range: 70–95 years). Patients underwent a circumcision then 3–4 weeks later, an interstitial brachytherapy was delivered, median dose of 65 Gy (range 55–74 Gy). Salvage surgery was discussed in patients with histological confirmation of residual/relapsed tumor.Results
With median follow-up of 9.0 years, eight patients (14.5%) experienced a relapse, including five patients with local relapse. Three patients with local relapse only underwent salvage penile surgery, including two partial glansectomies and one total penectomy, and were in second complete remission at last follow-up. Among 55 patients analyzed for late side effects, seven patients (13.0%) presented pain or ulceration, 12 (22.2%) experienced urethral or meatal stenosis requiring at least one dilatation, two patients (3.7%) experienced both ulcerations and urethral complication. Three patients (5.5%) needed partial glansectomy for focal necrosis. At five years, estimated overall survival rate was 74.5% (95%CI: 62.0–87.0%) and local relapse free rate was 91.0% (95%CI: 82.6–99.4%).Conclusion
Brachytherapy is feasible in selected older patients with penile carcinoma, with efficacy and toxicity rates comparable to that of other series in younger patients. 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.
Shih-Feng Cho Wan-Hsuan Wu Yi-Hsin Yang Yi-Chang Liu Hui-Hua Hsiao Chao-Sung Chang 《Journal of Geriatric Oncology》2018,9(4):315-320
Background
This nationwide population study aimed to investigate treatment patterns, medical resource utilization and demographic prognostic factors in older Taiwanese patients with non-Hodgkin lymphoma (NHL).Patients and Methods
This study was conducted using the National Health Insurance Research Database (NHIRD) of Taiwan. The older patients (65 years or older) diagnosed with NHL between 1997 and 2008 were identified for analysis.Results
A total of 5136 patients (3049 males and 2087 females) with a median age of 74.1 years were identified for analysis. Among these patients, 3267 patients (63.6%) received various combinations of systemic therapies. The older the patient, the less likely it was for intensive curative treatment to be given. Regarding medical resource usage, younger patients or patients living in more urbanized areas were more likely to receive NHL treatment in medical centers. The median overall survival of all patients with NHL was 49.41 months (range, 0.03 to 143.97). The investigation for prognostic factors by multivariate analysis revealed that more advanced age, treatment in non-medical centers and living in less urbanized areas were associated with poorer outcomes.Conclusion
Treatment of older patients with NHL is still a challenge. For better outcomes, it is very important to evaluate the patient and tailor treatment modalities. Additionally, health policy makers should help to narrow discrepancies in survival based on demographics. 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.
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15.
Parameswaran Hari Dorothy Romanus Katarina Luptakova Marlo Blazer Candice Yong Aditya Raju Eileen Farrelly Richard Labotka Vicki A. Morrison 《Journal of Geriatric Oncology》2018,9(2):138-144
Objectives
One-third of patients with multiple myeloma (MM) are diagnosed at age ≥ 75 years. Older patients have increased incidence of cardiovascular disease (CVD) and renal insufficiency (RI), hallmark complications of MM. We examined cumulative incidence of CVD and RI in relapsed/refractory MM (RRMM) and outcomes by age and RI/CVD.Materials and Methods
Retrospective cohort study using a large US electronic medical records database of adult patients with RRMM initiating first- and second-line therapy (2LT) between 1/2008–06/2015. RI and CVD comorbidities were based on diagnosis codes and/or lab values.Results
Among 628 patients, 37.1% were ≥ 75 years. Cumulative incidence of CVD and/or RI increased from 47.7% at MM diagnosis to 67.8% at first relapse. Age ≥ 75 years had a trend toward higher risk of relapse post 2LT, proxied by time to next treatment (TTNT), (adjusted HR: 1.28; 95% CI: 1.00, 1.65; P = 0.05). TTNT was significantly higher with comorbid CVD + RI (adjusted HR: 1.50; 95% CI: 1.11, 2.02; P < 0.01). Age ≥ 75 years, RI, CVD, and CVD + RI were associated with increased mortality risk from 2LT initiation; adjusted HR: 1.66 (95% CI: 1.19, 2.33; P < 0.01), 1.51 (95% CI: 1.01, 2.26; P = 0.04), 1.75 (95% CI: 1.03, 2.96; P = 0.04), and 1.95 (95% CI: 1.29, 2.93; P < 0.01), respectively.Conclusion
Despite treatment with novel agents for RRMM in 86% of patients, an outcome gap persists for older patients and those with RI and/or CVD. Personalized treatment approaches that account for age and comorbidities, and further evaluation of innovative regimens and dosing schedules, are needed to improve outcomes for these patients. 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.
Fady GH. Haddad Joseph Kattan Hampig R. Kourie Elie El Rassy Tarek Assi Salim M. Adib 《Journal of Geriatric Oncology》2018,9(2):120-123
Objective
By 2020, 70% of all cancers will occur in patients aged 65 years and older, causing an increase in related morbidity, mortality, and cost. This study projects cancer trends in the elderly population in Lebanon, a country experiencing accelerating aging trends. Findings will guide future policy decisions regarding geriatric oncology in Lebanon and the surrounding Arab world.Materials and Methods
Cancer incidence rates were derived for men and women 65 years and above, divided into three age groups: 65–69 years, 70–74 years, and 75 years and above. Raw data were obtained from the National Cancer Registry reports 2003–2010. The eight consecutive year data were used to project the incidence until 2025 using a logarithmic model. The Average Annual Percent Change in incidence rates was calculated to determine whether it would significantly increase, decrease, or remain stable over time.Results
Incidence rates are projected to increase significantly in all age groups of both genders until 2025. In men, the fastest rise is expected in prostate cancer, followed by bladder, lung, colorectal, and NHL. In women, the rise will be fastest in breast, followed by colorectal, lung, NHL, and ovary. Projected rates increase faster in the “younger” age group 65–69 compared to the “oldest” ≥ 75, both in men and women. Only kidney and liver cancers continue to rise significantly after 75.Conclusions
Cancer incidence is projected to increase in individuals between 65 and 74 years of age. Lebanese and Middle Eastern physicians must implement adapted therapeutic strategies in the management of the increasing caseload among frail, elderly patients. 相似文献18.
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19.
Cynthia Owusu Elizabeth Antognoli Nora Nock Paul Hergenroeder Kristina Austin Elizabeth Bennet Nathan A. Berger Stephen Cerne Katelyn Foraker Kevin Heine Ellen Heyman Halle Moore Jean Petkac Mark Schluchter Kathryn H. Schmitz Anastasia Whitson Susan Flocke 《Journal of Geriatric Oncology》2018,9(3):235-242
Background
We sought to explore the perspective of older breast cancer survivors (BCS) from diverse racial and socioeconomic backgrounds toward physical activity (PA) to inform the design of a PA program that fosters acceptability.Methods
Participants included sixty women, ≥ 65 years, within two years of treatment completion for stage I-III breast cancer. We purposely sampled ≥ ten patients in each race [African-American (AA) and Non-Hispanic White (NHW)] and socioeconomic status (SES) [SES disadvantaged and SES non-disadvantaged] group. Participants completed in-person interviews (n = 60) and follow-up focus groups (n = 45). Thematic analyses were employed.Results
The median age was 71.0 years (range: 65–87 years). Five themes emerged: 1) importance of PA; 2) current PA participants engaged in; 3) influence of race and culture on PA attitudes and beliefs; 4) barriers to PA and facilitators to PA; and 5) PA preferences. Barriers included health issues (43%), particularly cancer treatment side effects such as fatigue. Facilitators included religious faith (38%) and family (50%). Preferences included group exercise (97%) and strength training (80%) due to concerns participants had with diminished upper body strength after cancer treatment. Although AA (59%) and SES non-disadvantaged (78%) participants reported that race and culture influenced their attitudes toward PA, it did not translate to racial and SES differences in preferences.Conclusion
Among older BCS, physical activity preferences were shaped by cancer experience, rather than by race and SES. Physical activity programs for older BCS should focus on addressing cancer treatment-related concerns and should include strength training to ensure PA programs are more acceptable to older BCS. 相似文献20.
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