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frailty in the elderly cancer patients

Rakhee Yash Pal, Win Sen Kuan, Yiwen Koh, Kuhan Venugopal, Irwani Ibrahim
INTRODUCTION: Elderly patients with serious chronic diseases often present to the emergency department (ED) in the last moments of their life, many with identifiable trajectories of dying: organ failure; advanced cancer; and chronic frailty. These patients and their families may benefit more from good end-of-life (EOL) care provision than the standard resuscitative approach. This study aimed to determine the incidence and nature of death among patients aged 65 years and above in an ED, and characterise their trajectories of dying...
December 5, 2016: Singapore Medical Journal
Hsiu-Chuan Lee, Wei-Yu Chen, Wen- Tsung Huang, Kuo- Chen Cheng, Yu-Feng Tian, Chung-Han Ho, Chao- Jung Tsao, Yin- Hsun Feng
Purpose: Decisions as to whether to provide adjuvant treatment in older breast cancer patients remains challenging. Side effects of chemotherapy have to be weighed against life expectancy, comorbidities, functional status, and frailty. To aid decision-making, we retrospectively analyzed 110 women with breast cancer treated with a curative intention from 2006 to 2012. Survival data with clinical and pathological parameters were evaluated to address the role of adjuvant chemotherapy in this study population. Method: A total of 110 elderly (>70 years) patients that received mastectomy at two hospitals in Taiwan were observed retrospectively for a medium of 51 months...
January 10, 2016: Asian Pacific Journal of Cancer Prevention: APJCP
Jun Lu, Long-Long Cao, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Mi Lin, Ru-Hong Tu, Chang-Ming Huang
BACKGROUND: Due to increased life expectancy, the number of elderly patients with gastric cancer is increasing. This study was designed to determine the role of preoperative frailty (PF) as a risk factor for postoperative complications and prognosis in the oldest elderly gastric cancer patients undergoing curative resection. METHODS: A total of 165 patients older than 80 years who underwent radical gastrectomy for primary gastric cancer between 2000 and 2012 were analyzed...
November 2, 2016: Annals of Surgical Oncology
Bachir Tazkarji, Robert Lam, Shawn Lee, Soumia Meiyappan
OBJECTIVE: To guide family physicians in creating preventive screening and treatment plans for their elderly patients. SOURCES OF INFORMATION: The MEDLINE database was searched for Canadian guidelines on primary health care and the elderly; guidelines or meta-analyses or practice guidelines or systematic reviews related to mass screening in those aged 80 and older and the frail elderly, limited to between 2006 and July 2016; and articles on preventive health services for the elderly related to family practice or family physicians, limited to English-language publications between 2012 and July 2016...
September 2016: Canadian Family Physician Médecin de Famille Canadien
Chiara Della Pepa, Carla Cavaliere, Sabrina Rossetti, Marilena Di Napoli, Sabrina C Cecere, Anna Crispo, Carlo De Sangro, Emanuela Rossi, Dino Turitto, Domenico Germano, Gelsomina Iovane, Massimiliano Berretta, Carmine D'Aniello, Salvatore Pisconti, Luigi Maiorino, Bruno Daniele, Cesare Gridelli, Sandro Pignata, Gaetano Facchini
The Comprehensive Geriatric Assessment (CGA) represents the future of the geriatric oncology to reduce toxicities and treatment-related hospitalization in the elderly. Most patients receiving docetaxel for metastatic castration-resistant prostate cancer are in their seventies or older. We explored the efficacy of the CGA in predicting chemotherapy feasibility and response to docetaxel in a cohort of 24 patients aged at least 70. This was an observational, prospective study involving 24 patients who were 70 years of age or older and about to start chemotherapy with docetaxel for metastatic castration-resistant prostate cancer; we performed a CGA including five domains and divided our patients into 'healthy' and 'frail'; the relations between general condition and (i) early chemotherapy discontinuation and (ii) response to docetaxel were explored...
January 2017: Anti-cancer Drugs
Angélique Brunot, Samuel Le Sourd, Marc Pracht, Julien Edeline
Hepatocellular carcinoma (HCC) is the second most common cause of death by cancer in the world. Due to the delayed HCC development in hepatitis C carriers and nonalcoholic fatty liver disease, the incidence of HCC in the elderly is increasing and is becoming a global health issue. Elderly patients with HCC should be assessed through proper oncologic approach, namely, screening tools for frailty (Geriatric-8 or Vulnerable Elders Survey-13) and comprehensive geriatric assessment. This review of the literature supports the same treatment options for elderly patients as for younger patients, in elderly patients selected as fit following proper oncogeriatric assessment...
2016: J Hepatocell Carcinoma
K E Hamnett, A Subramanian
AIM: Women not undergoing breast reconstruction after mastectomy tend to be older. This review aims to aid in effective, evidence-based choices regarding breast reconstruction in an older population, appraising the influencing patient factors described in the literature and those directing the reconstructive surgeon. This may refute current misconceptions and ensure surgical decisions are made based on evidence without ageist assumptions. The review forms the basis of an evidence-based algorithm addressing each step of the decision-making process...
October 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
M G Huisman, M Kok, G H de Bock, B L van Leeuwen
The onco-geriatric population is increasing and thus more and more elderly will require surgery; an important treatment modality for many cancer types. This population's heterogeneity demands preoperative risk stratification, which has led to the introduction of Geriatric Assessment (GA) and associated screening tools in surgical oncology. Many reviews have investigated the use of GA in onco-geriatric patients. Discrepancies in outcomes between studies currently hamper the implementation of a preoperative GA in clinical practice...
June 21, 2016: European Journal of Surgical Oncology
Minsu Kwon, Shin-Ae Kim, Jong-Lyel Roh, Sang-Wook Lee, Sung-Bae Kim, Seung-Ho Choi, Soon Yuhl Nam, Sang Yoon Kim
INTRODUCTION: Frailty refers to a decreased physiologic reserve in geriatric patients and its importance in terms of treatment planning and outcome prediction has been emphasized in oncologic practices for older patients with cancer. We investigated the clinical implications of a head and neck cancer (HNC)-specific frailty index suggested by prospective clinical and functional evaluations of HNC patients. MATERIALS AND METHODS: We analyzed data on 165 elderly patients with HNC who were prospectively enrolled in our hospital from 2010 to 2013...
September 2016: Oncologist
Karlijn J G Schulkes, Marije E Hamaker, Frederiek van den Bos, Leontine J R van Elden
Lung cancer is predominantly a disease of the elderly: one half of all newly diagnosed patients will be > 70 years old. In the Netherlands, > 12,000 new cases are diagnosed annually. We sought to assemble all available evidence on the relevance of a geriatric assessment for lung cancer patients. A systematic Medline and Embase search was performed for studies in which a geriatric assessment was used to detect health issues or that had addressed the association between a baseline geriatric assessment (composed of ≥ 2 of the following domains: cognitive function, mood/depression, nutritional status, activities of daily living, instrumental activities of daily living, polypharmacy, objectively measured physical capacity, social support and frailty) and outcome...
September 2016: Clinical Lung Cancer
Fiammetta Monacelli, Manuela Tafuro, Luigi Molfetta, Marina Sartini, Alessio Nencioni, Michele Cea, Roberta Borghi, Fabrizio Montecucco, Patrizio Odetti
AIM: Prognosis informs the physician's decision-making process, especially for frail older adults. So far, any non-disease-specific index has proven full evidence for routine use in clinical practice. Here, we aimed at assessing, prospectively, the calibration and discriminating accuracy of validated prognostic indices in a cohort of elderly hospitalized patients. METHODS: This was a prospective observational study that enrolled elderly patients (n = 100). The patients' assessment included clinical variables, as well as the following five prognostic indices of mortality: (i) Levine index (2007); (ii) Walter index (2001); (iii) CARING (C, primary diagnosis of cancer; A, ≥ 2 admissions to the hospital for a chronic illness within the last year; R, resident in a nursing home; I, intensive care unit admission with multiorgan failure, NG, noncancer hospice guidelines [meeting ≥ 2 of the National Hospice and Palliative Care Organization's guidelines]) criteria of Fischer (2006-2011); (iv) Silver Code of Di Bari (2010); and (v) Burden of Illness Score for Elderly Persons of Inouye (2003)...
June 15, 2016: Geriatrics & Gerontology International
Stéphanie Chemama, Bruno Raynard, Sami Antoun
Administration of targeted therapies as a flat dose and administration of chemotherapy based on body surface area do not take into account several important sources of inter-individual variation. These variations could be responsible partially for the occurrence of toxicity. Furthermore, the availability of high-resolution CT images in the record of cancer patients, from which key body composition information may be derived, allows us to study the relationship between body composition and toxicity. If many studies have highlighted this relationship, the mechanisms are not completely understood...
September 2016: Bulletin du Cancer
Leopold Hentschel, Anke Rentsch, Felicitas Lenz, Beate Hornemann, Jochen Schmitt, Michael Baumann, Gerhard Ehninger, Markus Schuler
BACKGROUND: The aim of this study was to identify an appropriate screening instrument for the identification of frail elderly patients in a tertiary cancer center. In order to improve cancer care for older patients, the use of a geriatric assessment (GA) has been proposed to identify frail patients or those who are at a higher risk for chemotherapy-related toxicities. In busy clinical routine, an appropriate screening instrument could be used to spare time- and resource-consuming application of GA...
2016: Oncology Research and Treatment
Arden R Barry, Deirdre E O'Neill, Michelle M Graham
Primary prevention of cardiovascular events in older adults is challenging because of a general paucity of evidence for safe and efficacious therapy. Furthermore, there is no validated cardiovascular risk assessment tool for older adults (≥75 years of age), yet most are intermediate-to high-risk. Assessment of cardiovascular risk should include a discussion of the potential benefits and risks of therapy, and allow for incorporation of the patients' values and preferences, functionality and/or frailty, comorbidities, and concomitant medications (eg, polypharmacy, drug-drug interactions, adherence)...
September 2016: Canadian Journal of Cardiology
Salvatore Pisani, Maria Gambino, Lorena Balconi, Cristina Degli Stefani, Sabina Speziali, Domenico Bonarrigo
Since over 10 years, the Lombardy Region (Italy) has developed a system for classifying all persons registered with the healthcare system (database of persons registered with a general practitioner), according to their use of major healthcare services (hospitalizations, outpatient consultations, pharmaceutical) and whether they are exempt from copayment fees for disease-specific medications and healthcare services. The present study was conducted by the local health authorities of the province of Varese (Lombardy region, Italy) with 894...
January 2016: Igiene e Sanità Pubblica
Theresa Westphal, Gabriel Rinnerthaler, Brigitte Mlineritsch
The probability of developing breast cancer increases with age. Therefore, more than 50 % of women with breast cancer are older than 65 years at the time of diagnosis. However, elderly patients are often undertreated and clinical trials for elderly patients in the adjuvant setting are lacking. Elderly patients who are otherwise fit should receive the standard treatment regimen independent of age. Endocrine therapy should not be withheld from patients by age alone. Thus, there are more adverse events in the elderly population...
2016: Memo
Maria José Molina Garrido, Carmen Guillén Ponce, Borja Manuel Fernández Félix, Maria Del Mar Muñoz Sánchez, Maria Del Carmen Soriano Rodríguez, Amaya Olaverri Hernández, Jose Antonio Santiago Crespo
OBJECTIVES: To develop a predictive model of toxicity to chemotherapy in elderly patients with cancer, using the variables associated with sarcopenia, and to identify which of these parameters, sarcopenia or frailty, is the best predictor of toxicity to chemotherapy in the elderly. MATERIAL AND METHODS: A prospective observational study with patients ≥70 years treated with chemotherapy in the Cancer Unit for the Elderly, in the Medical Oncology Section of the Hospital Virgen de la Luz de Cuenca...
March 21, 2016: Revista Española de Geriatría y Gerontología
Meera R Chappidi, Max Kates, Hiten D Patel, Jeffrey J Tosoian, Deborah R Kaye, Nikolai A Sopko, Danny Lascano, Jen-Jane Liu, James McKiernan, Trinity J Bivalacqua
OBJECTIVE: To investigate the modified frailty index (mFI) as a preoperative predictor of postoperative complications following radical cystectomy (RC) in patients with bladder cancer. MATERIALS AND METHODS: Patients undergoing RC were identified from the National Surgical Quality Improvement Program participant use files (2011-2013). The mFI was defined in prior studies with 11 variables based on mapping the Canadian Study of Health and Aging Frailty Index to the National Surgical Quality Improvement Program comorbidities and activities of daily livings...
June 2016: Urologic Oncology
Aurélie Petit-Monéger, Muriel Rainfray, Pierre Soubeyran, Carine A Bellera, Simone Mathoulin-Pélissier
OBJECTIVE: The G8 is a screening test to identify frail elderly patients with cancer. Objectives were to design and evaluate the performance of alternative tests taking into account other predictive domains for frailty. METHODS: We conducted a literature review to identify predictive factors of frailty. Using a Delphi consensus, we collected 24 European experts' opinions to validate the most relevant items to improve the G8. Alternative tests were created and performance assessed on a development population (ONCODAGE cohort)...
March 2016: Journal of Geriatric Oncology
P Hanotier
Hyponatremia is the most common electrolyte disorder in elderly patients. The incidence is about 7% in elderly healthy people but can exceed 40% in hospitalized patients. Considering all its aetiologies hyponatremia is associated with increased mortality and appears as a factor of poor prognosis. Alteration in the regulation of water homeostasis in the elderly result from multiple consequence of aging: change in body composition, alteration in renal function and hormonal changes. The high frequency of nutritional problems, particularly protein malnutrition predisposes the elderly to the development of hyponatremia...
November 2015: Revue Médicale de Bruxelles
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