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Geriatric AND cancer AND comorbidity

Janette Vardy, Prunella Blinman, Erin B Moth
Colon cancer is common and can be considered a disease of older adults with more than half of cases diagnosed in patients aged over 70 years. Decision-making about treatment with chemotherapy for older adults may be complicated by age-related physiological changes, impaired functional status, limited social supports, concerns regarding the occurrence of and ability to tolerate treatment toxicity, and the presence of comorbidities. This is compounded by a lack of high quality evidence guiding cancer treatment decisions for older adults...
October 10, 2016: Expert Review of Gastroenterology & Hepatology
Petr Szturz, Jan B Vermorken
The demographics of squamous cell carcinoma of the head and neck (SCCHN) is marked by a growing number of patients aged 65 and over, which is in line with global projections for other cancer types. In developed countries, more than half of new SCCHN cases are diagnosed in older people, and in 15 years from now, the proportion is expected to rise by more than 10%. Still, a high-level evidence-based consensus to guide the clinical decision process is strikingly lacking. The available data from retrospective studies and subset analyses of prospective trials suffer from a considerable underrepresentation of senior participants...
2016: Frontiers in Oncology
Ali Alkan, Arzu Yaşar, Ebru Karcı, Elif Berna Köksoy, Muslih Ürün, Filiz Çay Şenler, Yüksel Ürün, Gülseren Tuncay, Hakan Ergün, Hakan Akbulut
PURPOSE: Due to more comorbidities, polypharmacy is common in elderly patients and drug interactions are inevitable. It is also challenging to treat an elderly patient with a diagnosis of cancer. Prevalence and clinical impacts of drug interactions and using potentially inappropriate medications (PIMs) have been studied in geriatric patients. However, these are not well defined in oncology practice. The purpose of this study is to define the prevalence of PIMs and severe drug interactions (SDIs) in elderly cancer patients and investigate the factors associated with them...
September 12, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Amandine Gouverneur, Magali Rouyer, Angela Grelaud, Philip Robinson, Françoise Colombani, Eric Terrebonne, Denis Smith, Annie Fourrier-Réglat, Pernelle Noize
Metastatic colorectal cancer (mCRC) is frequent among elderly patients. However, in the era of new targeted therapies, little is known about real-life mCRC treatment in this population. This study aimed to describe elderly mCRC patients and the current real-life treatment practices. mCRC patients aged ≥65 years were identified using the registry of multidisciplinary team meetings, mandatory for all cancer patients, held between January 1, 2013 and June 30, 2014 at the Bordeaux University Hospital. Data were collected from medical records using a standardized questionnaire...
September 7, 2016: Fundamental & Clinical Pharmacology
Katarzyna J Jerzak, Danielle N Desautels, Kathleen I Pritchard
INTRODUCTION: Elderly women with early breast cancer require an individualized approach to risk assessment and treatment. Unfortunately, there are limited data to inform optimal adjuvant therapy decisions in this population. Cytotoxic chemotherapy, biologic treatments and endocrine agents, while important in reducing breast cancer recurrence and mortality, are associated with the potential for adverse effects that may be of particular significance to elderly patients. AREAS COVERED: In this review, we summarize the evidence for geriatric assessment in elderly patients with early breast cancer, outline special considerations for the use of chemotherapy and trastuzumab in older adults, and describe the age-specific risks of endocrine therapy in the adjuvant breast cancer setting...
October 2016: Expert Opinion on Pharmacotherapy
Masayuki Yokode
Age-specific analyses of mortality rates in Japan show that cancer was the leading cause of death for the age group 40-89 years in the year 2013. Although the crude mortality rate from cancer has recently increased, the age-adjusted cancer mortality rate has shown a decreasing trend. This suggests that the increases in the crude mortality rate may have been caused by the aging of the population. Cancer patients who are old present many comorbidities and newly diagnosed geriatric problems. Several tools provide determinants of survival in cancer patients who are old (including the comprehensive geriatric assessment [CGA]) in order to improve the quality of cancer care in this population...
August 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
A C Dodd, C Bulka, A Jahangir, H R Mir, W T Obremskey, M K Sethi
INTRODUCTION: With the cost of healthcare in the United States reaching $2.9 trillion in 2013 and expected to increase with a growing geriatric population, the Center for Medicare and Medicaid Services (CMS) and Hospital Quality Alliance (HQA) began publicly reporting 30-day mortality rates so that hospitals and physicians may begin to confront clinical problems and promote high-quality and patient-centered care. Though the 30-day mortality is considered a highly effective tool in measuring hospital performance, little data actually exists that explores the rate and risk factors for trauma-related hip and pelvis fractures...
October 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Marie Lange, Natacha Heutte, Olivier Rigal, Sabine Noal, Jean-Emmanuel Kurtz, Christelle Lévy, Djelila Allouache, Chantal Rieux, Johan Lefel, Bénédicte Clarisse, Corinne Veyret, Philippe Barthélémy, Nadine Longato, Hélène Castel, Francis Eustache, Bénédicte Giffard, Florence Joly
BACKGROUND: The impact of chemotherapy on cognition among elderly patients has received little attention, although such patients are more prone to presenting with age-related cognitive deficits and/or cognitive decline during chemotherapy. The present study assessed the cognitive function in older adults treated for early-stage breast cancer (EBC). PATIENTS AND METHODS: The participants were newly diagnosed EBC patients aged ≥65 years without previous systemic treatment or neurological or psychiatric disease and matched healthy controls...
July 29, 2016: Oncologist
Sushma Jonna, Leslie Chiang, Jingxia Liu, Maria B Carroll, Kellie Flood, Tanya M Wildes
PURPOSE: Survival in older adults with cancer varies given differences in functional status, comorbidities, and nutrition. Prediction of factors associated with mortality, especially in hospitalized patients, allows physicians to better inform their patients about prognosis during treatment decisions. Our objective was to analyze factors associated with survival in older adults with cancer following hospitalization. METHODS: Through a retrospective cohort study, we reviewed 803 patients who were admitted to Barnes-Jewish Hospital's Oncology Acute Care of Elders (OACE) unit from 2000 to 2008...
November 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
A Zamora-Mur, R García-Foncillas, A Zamora-Catevilla, M Nabal-Vicuña, V Calderero-Aragón, F Lostalé-Latorre
INTRODUCTION: Sedation, used as a therapeutic measure in the field of Palliative Care, continues to present difficulties for many professionals in its management and indications. Is varied existing literature in this regard, often exclusive cancer patients. Our objective is to analyse the characteristics of patients attended by a Home Care Support Team who required sedation compared to non-sedated patients, for possible determining factors for its use that could help in decision-making...
July 18, 2016: Semergen
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
Thuy Koll, Mackenzi Pergolotti, Holly M Holmes, Huibrie C Pieters, G J van Londen, Zachary A Marcum, Amy R MacKenzie, Christopher B Steer
Supportive care is an essential component of anticancer treatment regardless of age or treatment intent. As the number of older adults with cancer increases, and supportive care strategies enable more patients to undergo treatment, greater numbers of older patients will become cancer survivors. These patients may have lingering adverse effects from treatment and will need continued supportive care interventions. Older adults with cancer benefit from geriatric assessment (GA)-guided supportive care interventions...
August 2016: Current Oncology Reports
P Lai, S Sud, T Zhang, T Asmis, P Wheatley-Price
BACKGROUND: Colorectal cancer (crc) has a median diagnostic age of 68 years. Despite significant progress in chemotherapy (ctx) options, few data on outcomes or toxicity from ctx in patients 80 years of age and older are available. We investigated ctx in such patients with metastatic crc (mcrc), hypothesizing high rates of hospitalization and toxicity. METHODS: A retrospective chart review identified patients 80 years of age and older with mcrc who initiated ctx between 2005-2010 at our institution...
June 2016: Current Oncology
Chen-Yi Wu, Hsiao-Yun Hu, Yiing-Jenq Chou, Nicole Huang, Yi-Chang Chou, Chung-Pin Li
OBJECTIVES: To assess the relationship between hemoglobin concentration and cause-specific mortality. DESIGN: Cohort study. SETTING: Data from the government-sponsored Annual Geriatric Health Examination Program. PARTICIPANTS: Community-dwelling Taipei citizens aged 65 and older followed up between 2006 and 2010 (N = 77,532). MEASUREMENTS: Mortality was determined by matching participants' medical records with national death files...
June 2016: Journal of the American Geriatrics Society
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
Francesca Maria Giugliano, Sara Falivene, Emanuela Esposito, Rossella Di Franco, Massimiliano D'Aiuto, Francesca Lanza, Valentina Borzillo, Piera Ferraioli, Rita Compagna, Bruno Amato, Vincenzo Ravo, Paolo Muto
BACKGROUND: Breast cancer is the most common malignancy amongst elderly women. It represents the main cause of mortality for those women and it is steadily increasing. The primary therapeutic approach remains surgery, as in other age groups. The role of radiotherapy following surgery is still debated. The use of hypofractionated schedules is challenging the standard fractionation and has now been considered an advantageous option within this subgroup of patients. Results from randomized controlled trials have not been shown to be inferior to standard fractionation in terms of local recurrence, disease-free survival and overall survival...
September 2016: International Journal of Surgery
Nathalie Denewet, Sandra De Breucker, Sylvie Luce, Bernard Kennes, Sandra Higuet, Thierry Pepersack
OBJECTIVES: The comprehensive geriatric assessment (CGA) can detect geriatric problems and potentially improve survival, physical, and cognitive state of patients, as well as increase an older person's chances of staying at home longer. In older people, the number and severity of comorbidity increase with age and are an important determinant of survival. The aim of the study was to assess to which extent CGA and comorbidities could be seen as determinants of survival. MATERIALS AND METHODS: This study analyzed data from two hospitals that included geriatric assessments of patients aged 70 years and more with cancer linked to mortality...
August 2016: Acta Clinica Belgica
A K Whittle, T Kalsi, G Babic-Illman, Y Wang, P Fields, P J Ross, N R Maisey, S Hughes, W Kwan, D Harari
Oncology services do not routinely assess broader needs of older people with cancer. This study evaluates a comprehensive geriatric assessment and comorbidity screening questionnaire (CGA-GOLD) covering evidence-based domains and quality of life (EORTC-QLQ-C30). Patients aged 65+ attending oncology services were recruited into (1) Observational cohort (completed CGA-GOLD, received standard oncology care), (2) Intervention cohort (responses categorised 'low-risk', 'high-risk', 'possible need' by geriatricians)...
May 1, 2016: European Journal of Cancer Care
Jürgen Eiche, Florian Schache
Pains belong to the most frequent reasons for a doctor's visit. In elderly people, it is the result of progressive degenerative processes (e. g. , arthrosis, Osteoarthritis, degenerative spinal changes) and a higher prevalence of cancer disease to a further increase of the patients who suffer unnecessarily from pains. By the increasing polymorbidity (e.g. diabetes mellitus, vascular disease) and a declining immune competence, the prevalence of polyneuropathy and post-herpetic neuralgia rises. Insufficiently treated chronic or periodically returning pain can lead to serious interferences of the physical, cognitive and social everyday competence and therefore to a limited quality of life...
April 2016: Deutsche Medizinische Wochenschrift
H Woopen, G Inci, R Richter, R Chekerov, F Ismaeel, J Sehouli
BACKGROUND: Barriers for optimal treatment and enrolment in clinical trials are the physicians' perceptions towards age, comorbidities and fear of toxicity as well as the eligibility criteria of clinical trials. There is a high need to gain more knowledge about this patient group in order to optimize treatment. We aimed to evaluate the influence of age above 65 years on comorbidities, comedication, grade III/IV toxicity, prior discontinuation of chemotherapy and survival. PATIENTS AND METHODS: An individual participant data meta-analysis of three phase II/III studies ('Tower', 'Topotecan phase III' and 'Hector') of the North-Eastern German Society of Gynecological Oncology including 1213 patients with recurrent ovarian cancer was conducted using logistic regression and Cox regression analysis...
June 2016: European Journal of Cancer
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