Journal of geriatric oncology最新文献

{"title":"Exercise interventions for older adults with advanced cancer: A scoping review","authors":"Schroder Sattar ,&nbsp;Kristen R. Haase ,&nbsp;Isabel Tejero ,&nbsp;Cara Bradley ,&nbsp;Saul Cobbing ,&nbsp;Neha Pathak ,&nbsp;Joanne H. Callow ,&nbsp;Jee A. Lam ,&nbsp;Chloe Perlon ,&nbsp;Kristine Jones del Socorro ,&nbsp;Michelle B. Nadler ,&nbsp;Shabbir M.H. Alibhai ,&nbsp;Kristin L. Campbell ,&nbsp;Efthymios Papadopoulos","doi":"10.1016/j.jgo.2025.102237","DOIUrl":"10.1016/j.jgo.2025.102237","url":null,"abstract":"<div><h3>Introduction</h3><div>The feasibility, safety, acceptability, and perceptions of exercise in older adults with advanced disease are not well understood due to the scarcity of evidence. This scoping review aimed to (1) summarize evidence on the feasibility, acceptability, and safety of exercise interventions for older adults with advanced cancer and (2) explore this population's perceptions on participating in exercise programs.</div></div><div><h3>Materials and Methods</h3><div>A systematic search was conducted by an expert research librarian in Medline, CINAHL, EMBASE, Cochrane CENTRAL, and SPORTDiscus (inception through November 2023). Eligible studies included older adults with advanced (stage IV or receiving treatment with non-curative intent) solid cancers and intervention or qualitative studies on physical activity/exercise in older adults pertaining to our objectives.</div></div><div><h3>Results</h3><div>A total of 36 studies were included: 28 (78 %) intervention studies, seven (19 %) qualitative studies, and one (3 %) cross-sectional study. The Frequency/Intensity/Time/Type (FITT) principle was described in 18 studies (64 %). <em>Feasibility</em> was examined in 15 of the 28 intervention studies (54 %) using various definitions. Four studies had predetermined feasibility thresholds, yielding mixed results. One intervention study reported on two intervention-related severe adverse events. Nineteen of the 28 intervention studies (68 %) examined acceptability, reporting high levels of participant satisfaction. Qualitative data revealed several barriers and facilitators to exercise.</div></div><div><h3>Discussion</h3><div>Exercise appears to be feasible, acceptable, and safe in older adults with advanced cancer. Consistent reporting on the FITT principle and feasibility operationalization are areas of improvement in exercise studies in older adults with advanced disease.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 4","pages":"Article 102237"},"PeriodicalIF":3.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term neurological tolerance of chimeric antigen receptor-T cell therapy for refractory B-cell malignancy in patients with pre-existing cognitive impairment: A retrospective cohort study","authors":"Andrei Haddad ,&nbsp;Mickaël Zedet ,&nbsp;Louise Roulin ,&nbsp;Charlotte Degoutte ,&nbsp;Romain Gounot ,&nbsp;Mathieu Leclerc ,&nbsp;Dehbia Menouche ,&nbsp;Keyvan Razazi ,&nbsp;Wesam Saeed ,&nbsp;François Lemonnier ,&nbsp;Anne-Catherine Bachoud-Levi ,&nbsp;Thierry Gendre","doi":"10.1016/j.jgo.2025.102236","DOIUrl":"10.1016/j.jgo.2025.102236","url":null,"abstract":"","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 4","pages":"Article 102236"},"PeriodicalIF":3.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143748690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of pre-existing cognitive impairment in patients treated for cancer and the impact of cancer treatment on cognitive outcomes: A scoping review","authors":"Nelly Toledano ,&nbsp;Valentina Donison ,&nbsp;Avital Sigal ,&nbsp;Samantha Mayo ,&nbsp;Shabbir M.H. Alibhai ,&nbsp;Martine Puts","doi":"10.1016/j.jgo.2025.102235","DOIUrl":"10.1016/j.jgo.2025.102235","url":null,"abstract":"<div><h3>Introduction</h3><div>Pre-existing cognitive impairment (CI) is likely underreported in patients treated for cancer, and its prevalence remains unclear. Older adults with CI may have a greater risk of treatment failure and increased morbidity and mortality than patients with intact cognition. To our knowledge, there has not been a previous review summarizing data on the prevalence of pre-existing CI in patients with cancer. This review addresses: (1) What is the prevalence of pre-existing CI in patients treated for cancer and (2) What is the impact of cancer treatment on cognitive outcomes among patients exhibiting pre-existing CI before planned cancer treatment?</div></div><div><h3>Materials and Methods</h3><div>We defined CI as a diagnosis of dementia or mild or unspecified CI before any cancer treatment, including surgery. This scoping review followed the Arksey and O'Malley framework and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Two reviewers independently screened titles, abstracts, and full-text articles, resolving disagreements with a third reviewer. The reviewers systematically searched MEDLINE, Excerpta Medica Database (EMBASE), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception until July 15, 2023, including original research focused on participants aged 60 or older reporting the prevalence of pre-existing CI before any cancer treatment.</div></div><div><h3>Results</h3><div>Among the 10,490 screened citations, 23 manuscripts reporting on 21 studies met the inclusion criteria for both review questions. Pre-existing CI was prevalent at a mean rate of 6 % in administrative database studies, while clinical studies employing pre-treatment cognitive screening tools, primarily the Mini-Mental State Examination and Mini-Cog, reported a higher mean prevalence of 26 % (range 2.6 to 52 %). Only one study reported postoperative delirium in 27.9 % of patients with CI following cancer surgery, suggesting a higher risk of delirium in this population. However, none of the reviewed studies provided data on other cognitive outcomes, such as chemotherapy-related CI or treatment toxicity, in these individuals.</div></div><div><h3>Discussion</h3><div>Pre-existing CI is common but highly variable. The variability in reported prevalence rates can largely be attributed to significant differences in study inclusion criteria of participants and sample size, with some studies relying on regionally limited datasets.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 4","pages":"Article 102235"},"PeriodicalIF":3.0,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143734592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Australian healthcare professionals' experiences and perception of management of older adults with cancer: A qualitative study","authors":"Sharon He ,&nbsp;Heather L. Shepherd ,&nbsp;Meera Agar ,&nbsp;Rebekah Laidsaar-Powell ,&nbsp;Joanne Shaw","doi":"10.1016/j.jgo.2025.102234","DOIUrl":"10.1016/j.jgo.2025.102234","url":null,"abstract":"<div><h3>Introduction</h3><div>Older adults with cancer make up a large proportion of cancer diagnoses in Australia. Multimorbidity and aging-related vulnerabilities can make cancer treatment and management challenging. There are limited qualitative studies exploring current practice of care and use of geriatric assessments (GAs) in Australia. This study aimed to qualitatively explore Australian healthcare professionals' (HCPs) experiences of treatment decision-making in relation to older adults with cancer and perceptions of the role of GAs in cancer care in Australia to identify potential barriers to implementation.</div></div><div><h3>Materials and Methods</h3><div>Australian HCPs providing care for older adults with cancer completed a short online survey and participated in a semi-structured telephone interview exploring their perceptions and experiences of treatment decision-making, and management of older adults with cancer. Purposive sampling ensured representation across disciplines. Thematic analysis using a framework approach identified key themes.</div></div><div><h3>Results</h3><div>Thirty-one HCPs (<em>n</em> = 19 medical HCPs, <em>n</em> = 7 cancer nurses, <em>n</em> = 5 allied HCPs) completed the online questionnaire. Most participants rated assessment of geriatric domains to be important/very important when considering treatment decisions, however there was variability in perceived importance for assessing objective measures of function and mobility. Of the 31 participants that completed the questionnaire, 29 participated in a semi-structured telephone interview. Qualitative analysis of interviews revealed four main themes: (1) Who do we consider older? Chronological vs. functional age, (2) Clinical management of older adults – theory vs. practice, (3) Is there value in geriatric assessments? (4) Factors that impact GA implementation, and one overarching theme (5) Treatment decision-making for older adults with cancer.</div></div><div><h3>Discussion</h3><div>This study provides insight into current practice of care for older adults with cancer and the barriers and facilitators to GA implementation within Australian cancer services. Health economic research demonstrating cost-effectiveness of GAs to facilitate system-level change is required. There is also need for further education and training for Australian HCPs on geriatric principles and assessments to improve management for older adults with cancer.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 4","pages":"Article 102234"},"PeriodicalIF":3.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preferences for quality of life versus length of life in older women deciding about treatment for early breast cancer: A cross-sectional sub-analysis of the Bridging the Age Gap study","authors":"Jenna L. Morgan ,&nbsp;Anne Shrestha ,&nbsp;Charlene Martin ,&nbsp;Stephen Walters ,&nbsp;Michael Bradburn ,&nbsp;Malcolm Reed ,&nbsp;Thompson G. Robinson ,&nbsp;Kwok-Leung Cheung ,&nbsp;Riccardo Audisio ,&nbsp;Jacqui Gath ,&nbsp;Deirdre Revell ,&nbsp;Tracy Green ,&nbsp;Alistair Ring ,&nbsp;Kate J. Lifford ,&nbsp;Katherine Brain ,&nbsp;Adrian Edwards ,&nbsp;Lynda Wyld","doi":"10.1016/j.jgo.2025.102226","DOIUrl":"10.1016/j.jgo.2025.102226","url":null,"abstract":"<div><h3>Introduction</h3><div>Prioritising quality of life (QoL) or length of life is often necessary in the decision-making process for cancer care. This may be complicated in patients with limited life expectancy due to age and comorbidities. Older women with early breast cancer often receive non-standard care (primary endocrine therapy [PET] or omission of chemotherapy or radiotherapy) to reduce treatment morbidity and maintain QoL. We aimed to determine the perceived relative influence of QoL versus length of life in treatment decision making by older women with early (potentially curable) breast cancer.</div></div><div><h3>Materials and Methods</h3><div>This was a sub-study of the Age Gap multi-centre, cohort study, which prospectively recruited women &gt;70 yrs. with early breast cancer. Baseline demographics, health characteristics, and QoL scores were analysed alongside a bespoke questionnaire to assess QoL and length of life preferences, including a modified version of the validated quality/quantity questionnaire, in a subset of the main study.</div></div><div><h3>Results</h3><div>The questionnaire was sent to 308 patients and 194 (63 %) were returned by participants with a median age of 75 years (range 70–93). Of these, 14 had PET and 180 had standard treatment (ST) (surgery +/− adjuvant therapy) including 37 who had chemotherapy. The PET group was older (median age 83.5 versus 76 years) and in poorer health (9/14; 64.3 % patients had one or more comorbidities versus 69/144; 47.9 %) with inferior baseline physical domain QoL scores. Patients who received PET valued QoL and length of life equally (Q score 0.87, L score 0.91), and patients who received chemotherapy favoured length of life over QoL (Q score 0.67, L score 0.86). Subgroup analysis showed a small correlation between increasing age and QoL preferences (Spearman's <em>r</em> = 0.2, <em>P</em> &lt; 0.009). There was no correlation between co-morbidities, frailty, or global QoL and length of life/QoL preferences.</div></div><div><h3>Discussion</h3><div>Older women with early breast cancer valued length of life and QoL highly, with an association between preference for QoL and less aggressive treatment choices. Relative QoL preference increased with advancing age. More research is needed to define QoL determinants and outcomes following treatment to help patients make decisions that reflect their priorities.</div></div><div><h3>Trial Registration Number</h3><div>ISRCTN: 46099296.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 4","pages":"Article 102226"},"PeriodicalIF":3.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143696131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What are the determinants of functional decline in older adults with cancer? Results from the INCAPAC study","authors":"Yvanna Simon ,&nbsp;Catherine Helmer ,&nbsp;Fleur Delva ,&nbsp;Isabelle Baldi ,&nbsp;Gaëlle Coureau ,&nbsp;Sandra Leguyader-Peyrou ,&nbsp;Hélène Amieva ,&nbsp;Simone Mathoulin-Pelissier ,&nbsp;Karine Pérès ,&nbsp;Angéline Galvin","doi":"10.1016/j.jgo.2025.102223","DOIUrl":"10.1016/j.jgo.2025.102223","url":null,"abstract":"<div><h3>Introduction</h3><div>Older adults with cancer are exposed to greater difficulties in carrying out their daily activities due to cancer itself, its treatment, or both. The aim of this study was to describe functional decline after cancer diagnosis and to investigate the determinants of this decline among older individuals with cancer.</div></div><div><h3>Materials and Methods</h3><div>Using the Gironde cancer registries, older subjects (≥65 years) with a diagnosis of cancer between 2005 and 2018 were identified in three prospective cohorts on aging. Functional decline was defined as an increase of 1 point for Activities of Daily Living (ADL), 2 points for Instrumental Activities of Daily Living (IADL), and 3 points for the overall score (ADL + IADL) between cancer pre- and post-diagnosis visits. Logistic regression models were used to identify determinants of functional decline among older subjects who underwent a post-diagnostic assessment. Additionally, multinomial logistic regression models were performed to account for individuals who had died prior to the post-diagnostic cancer visit.</div></div><div><h3>Results</h3><div>A total of 306 individuals followed-up after the cancer diagnosis were included (median age at cancer diagnosis: 83; 44 % female). Older age at cancer, low educational level, impaired initial functional status, and poor five-year cancer-related prognosis were significantly associated with functional decline across all three scores. Multinomial logistic regression analyses (<em>n</em> = 489) yielded similar results, but only cancer-related factors, specifically unfavorable vital prognosis, were associated with higher risk of death.</div></div><div><h3>Discussion</h3><div>Functional decline in older individuals with cancer is both multifactorial and multidimensional. Further studies are needed to disentangle the effects of cancer and aging.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 4","pages":"Article 102223"},"PeriodicalIF":3.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of electronic patient-reported outcomes presentation during multi-disciplinary tumor board on clinician discussion of older adults' fitness and preferences","authors":"Nicole L. Henderson ,&nbsp;Garrett Bourne ,&nbsp;Etzael Ortiz-Olguin ,&nbsp;Cameron Pywell ,&nbsp;J. Bart Rose ,&nbsp;Grant R. Williams ,&nbsp;S.M. Qasim Hussaini ,&nbsp;Ryan D. Nipp ,&nbsp;Gabrielle Rocque","doi":"10.1016/j.jgo.2025.102225","DOIUrl":"10.1016/j.jgo.2025.102225","url":null,"abstract":"<div><h3>Introduction</h3><div>Treatment of pancreatic cancer often entails multiple modalities (e.g., chemotherapy, surgery, radiation) that vary in intensity, timing, and toxicity profiles. Some treatment options are only recommended for medically ‘fit’ patients regardless of age, yet formal fitness measures (such as the geriatric assessment [GA]) and patient preferences are seldom utilized during treatment decision-making.</div></div><div><h3>Materials and Methods</h3><div>The INtegrating Systematic PatIent-Reported Evaluations into Multi-Disciplinary Tumor Board (INSPIRE-MDTB) intervention involves the presentation of GA and treatment preferences data during tumor board discussions of older patients with stage I-IV pancreatic adenocarcinoma. This qualitative study recorded, transcribed, and inductively analyzed historical (November 2021–February 2022) and intervention (September 2022–June 2023) MDTBs using NVivo software. A constant comparative method was used to establish a grounded scheme representative of clinicians' characterization of patients' fitness and preferences during decision-making.</div></div><div><h3>Results</h3><div>Recordings of the primary MDTB presentation of 31 historical and 49 intervention patients with similar sex (52 %; 53 % female), age (m = 68.1; 72.3), race (65 %; 59 % White), and cancer stage (26 %; 22 % stage IV) were included. Although GA was captured for all included patients, it was not discussed in any historical cases, but was in 94 % of intervention cases. When compared to historical controls, INSPIRE patients had more frequent discussions of (1) cancer-related factors (e.g., size, location, rate of progression; 35 % vs. 43 %), (2) individual risk factors (e.g., age, comorbidities, tolerance; 90 % vs 98 %), and (3) psychosocial factors (e.g., health literacy, social support, substance use; 19 % vs 33 %). Identified preference domains were discussed in 39 % of historical and 80 % of intervention patients, with notably higher rates of discussion of patients' concerns regarding physical (0 %; 35 %) and mental/emotional (0 %; 20 %) side effects, ability to work (0 %; 10 %), and the logistics and convenience of treatment (6 %; 14 %).</div></div><div><h3>Discussion</h3><div>The INSPIRE intervention enhanced MDTB discussion of patient fitness and preferences and represents a promising approach for fostering consistent and systematic presentation and discussion of patient-reported data, such as the GA and treatment preferences. This adds to our previous findings that INSPIRE was feasible, acceptable, appropriate, and time-effective according to patients and provider participants.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 4","pages":"Article 102225"},"PeriodicalIF":3.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Distress Thermometer in older patients with cancer","authors":"Charlotte Zuber ,&nbsp;Kristine Swartz ,&nbsp;Andrew E. Chapman ,&nbsp;Lora Rhodes ,&nbsp;Ting Ting Zhan ,&nbsp;Kuang-Yi Wen","doi":"10.1016/j.jgo.2025.102221","DOIUrl":"10.1016/j.jgo.2025.102221","url":null,"abstract":"<div><h3>Introduction</h3><div>The Geriatric Depression Scale is a useful tool in screening for depression in older adults, a particularly vulnerable population in oncology. The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) has been validated as a fast and effective screening tool for psychological distress in general oncology populations, and it could possibly be used as a surrogate for the longer Geriatric Depression Scale (GDS) test in older adults with cancer.</div></div><div><h3>Materials and Methods</h3><div>In this retrospective cross-sectional study in older adults prior to starting cancer treatment, we evaluated the relationship between the DT and GDS by comparing 242 older adults with cancers' DT scores to their GDS scores, used receiver operating characteristic analysis to determine a DT cutoff score, and used logistic regression to identify variables associated with higher distress.</div></div><div><h3>Results</h3><div>The Spearman correlation coefficient between GDS and DT was 0.41, <em>p</em> &lt; 0.001. A cutoff score of 4 was found to be most sensitive and specific (0.66,0.68) for predicting a positive GDS (c-index = 0.70).</div></div><div><h3>Discussion</h3><div>These results indicate the potential utility of the DT as a mildly to moderately effective screening tool for depression in older adults with cancer starting treatment and support the current NCCN cutoff guidelines to indicate the need for additional distress interventions.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 4","pages":"Article 102221"},"PeriodicalIF":3.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on prehabilitation for older adults with cancer: A report from the International Society of Geriatric Oncology (SIOG) rehabilitation group","authors":"Efthymios Papadopoulos ,&nbsp;Rachelle Brick ,&nbsp;Ailsa Sirois ,&nbsp;Bérengére Beauplet ,&nbsp;Kelley C. Wood ,&nbsp;Hannah Furness ,&nbsp;Caitriona Barrett ,&nbsp;Aida Ward ,&nbsp;Jane Murphy ,&nbsp;Megan Pattwell ,&nbsp;Erna Carmen Navarrete ,&nbsp;Kate Williams ,&nbsp;Kristen Haase","doi":"10.1016/j.jgo.2025.102224","DOIUrl":"10.1016/j.jgo.2025.102224","url":null,"abstract":"","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 3","pages":"Article 102224"},"PeriodicalIF":3.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unsupervised learning to identify symptom clusters in older adults undergoing chemotherapy","authors":"Erika Ramsdale ,&nbsp;Yilin Zhou ,&nbsp;Lisa Smith ,&nbsp;Huiwen Xu ,&nbsp;Rachael Tylock ,&nbsp;Marie Flannery ,&nbsp;Supriya Mohile ,&nbsp;Ajay Anand","doi":"10.1016/j.jgo.2025.102222","DOIUrl":"10.1016/j.jgo.2025.102222","url":null,"abstract":"<div><h3>Introduction</h3><div>Unsupervised machine learning (ML) approaches such as clustering have not been commonly applied to patient-reported data. This study describes ML methods to explore and describe patient-reported symptom trajectories in older adults receiving chemotherapy.</div></div><div><h3>Materials and Methods</h3><div>This secondary analysis of prospectively collected data from the GAP 70+ Trial (<span><span>NCT02054741</span><svg><path></path></svg></span>; PI: Mohile) collected patient-reported symptoms at baseline (pre-chemotherapy), six weeks, three months, and six months. Complete patient-reported symptom data were available for at least one timepoint for 708/718 patients (98.6 %). Correlation analysis was performed on all symptom items. Multiple clustering algorithms were applied to selected baseline symptoms as an exploratory analysis, using gap statistic and elbow plots to understand optimal cluster numbers for each algorithm. Silhouette scores and t-stochastic neighbor embedding (t-SNE) plots were generated for each algorithm. Hierarchical agglomerative clustering was applied to symptoms at each timepoint, and clusters generated for each timepoint were examined longitudinally utilizing statistical measures, violin plots, and a Sankey diagram.</div></div><div><h3>Results</h3><div>Twenty-six patient-reported items were used for clustering analyses, representing symptom severity and interference. There was significant variability in how different unsupervised learning algorithms clustered the baseline symptom data. Silhouette scores ranged from −0.22 (OPTICS) to 0.16 (BIRCH). Examining agglomerative clustering across timepoints, cluster composition was largely driven by the symptom sum score (i.e., adding the Likert-scale scores). Most patients had “low” symptoms at baseline that remained low, but symptom trajectory was otherwise heterogeneous. A small number of patients had high hand-foot/neuropathy symptoms (but low other symptoms) at six weeks, and another small cluster had high mucosal toxicity at six months. Despite specific symptom patterns in these small clusters, chemotherapy regimens varied.</div></div><div><h3>Discussion</h3><div>Unsupervised machine learning techniques may be helpful to understand longitudinal patient-reported data such as symptoms. They permit data-driven exploration, which may uncover patterns to inform hypotheses or further analysis (e.g., outcome prediction). Results of clustering analyses should be validated through further hypothesis-driven analysis. In this analysis, it was challenging to uncover consistent symptom patterns, though it suggests symptom composite (sum) scores may warrant further investigation. Clinicians should understand the philosophy, strengths, and limitations of an unsupervised machine learning approach applied to patient data.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 3","pages":"Article 102222"},"PeriodicalIF":3.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}