Journal of geriatric oncology最新文献

{"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}

{"title":"Short-term mortality in older (≥70 years) patients with early breast cancer treated with neo‐/adjuvant chemotherapy: A Swedish nationwide retrospective population-based study","authors":"Christine Lundgren ,&nbsp;Kristina Engvall ,&nbsp;Irma Fredriksson ,&nbsp;Antonios Valachis","doi":"10.1016/j.jgo.2025.102220","DOIUrl":"10.1016/j.jgo.2025.102220","url":null,"abstract":"<div><h3>Introduction</h3><div>There are substantial differences in the utilization of chemotherapy between younger and older patients, mainly due to the higher risk for adverse events among older patients. Short-term mortality after chemotherapy could reveal fatal side effects of treatment. The aim of this study was to explore the impact of treatment setting (neoadjuvant vs. adjuvant) and different chemotherapeutic agents on short-term mortality among older patients with early breast cancer.</div></div><div><h3>Material and Methods</h3><div>The population-based, national, research database BCBaSe 3.0 was used as a data source to identify older (≥70 years old) patients with stage I–III breast cancer, diagnosed between 2008 and 2019, who received neoadjuvant or adjuvant chemotherapy. Primary outcome was short-term mortality defined as death due to any cause within one year after breast cancer diagnosis. Multivariable logistic regression analysis was applied to investigate the impact of treatment setting and different chemotherapeutic agents (anthracycline-based vs. taxane-based vs. sequential anthracyclines and taxanes) on outcome, adjusted for potential confounders.</div></div><div><h3>Results</h3><div>In total, 4,072 older patients were treated with neoadjuvant or adjuvant chemotherapy and median age was 73 years (quartile [Q]1–Q3; 71–75). The one-year mortality rate was 1.5 % (95 % confidence interval [CI]: 1.2–1.9 % [63 of 4072 patients]). Risk factors independently associated with one-year mortality were older age, larger tumor size, positive nodal status, presence of triple negative breast cancer, and use of neoadjuvant as compared to adjuvant chemotherapy (odds ratio [OR]: 2.00, 95 % CI: 1.04–3.84). No association was found between type of chemotherapeutic regimen and one-year mortality. Median time to death was 7 months (interquartile range: 5–9). The reason for death was mainly classified as breast cancer-related (neoadjuvant: 78 %, <em>n</em> = 14; adjuvant: 49 %, <em>n</em> = 22), followed by potential treatment-related deaths (neoadjuvant: 11 %, n = 2; adjuvant: 27 %, <em>n</em> = 12).</div></div><div><h3>Discussion</h3><div>The short-term mortality rate at first year after diagnosis among older (≥70 years) patients with breast cancer was relatively low. The higher risk among patients treated with neoadjuvant chemotherapy could be attributed to residual confounding and deserves further evaluation. The low risk of potential treatment-associated death suggests that chemotherapy in this respect is safe, and older patients should not be disqualified for this treatment.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 3","pages":"Article 102220"},"PeriodicalIF":3.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609765","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":"Frailty predicts treatment-related toxicity and discontinuation in older adults with chronic lymphocytic leukemia treated with BTK and BCL-2 inhibitors: Findings from a prospective single-center cohort study","authors":"Enrica Antonia Martino ,&nbsp;Ernesto Vigna ,&nbsp;Paola De Luca ,&nbsp;Antonella Bruzzese ,&nbsp;Caterina Labanca ,&nbsp;Francesco Mendicino ,&nbsp;Eugenio Lucia ,&nbsp;Virginia Olivito ,&nbsp;Valentina Fragliasso ,&nbsp;Antonino Neri ,&nbsp;Fortunato Morabito ,&nbsp;Andrea Corsonello ,&nbsp;Massimo Gentile","doi":"10.1016/j.jgo.2025.102219","DOIUrl":"10.1016/j.jgo.2025.102219","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic lymphocytic leukemia (CLL) particularly impacts older adults with multiple comorbidities. The advent of targeted therapies has improved outcomes, but challenges related to treatment adherence and drug interactions persist. Assessment of frailty is recommended to tailor treatment, though its application in clinical settings is often limited due to its complexity. This study aimed to investigate the predictive value of frailty regarding treatment toxicity and discontinuation in older patients with CLL treated with targeted therapies.</div></div><div><h3>Materials and Methods</h3><div>This prospective cohort study involved 82 older adults with CLL (≥65 years) treated with Bruton's tyrosine kinase inhibitors (BTKi) or BCL-2 inhibitors (BCL-2i) from November 2018 to February 2024. Patients were assessed by the Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS) within a week before starting treatment. Demographics, CLL characteristics, comorbidities, and treatment-related adverse events were collected. Statistical analyses included receiver operating characteristic (ROC) curve analysis to determine the optimal cut-off for predicting treatment discontinuation due to toxicity.</div></div><div><h3>Results</h3><div>The median age of patients was 75 years. Most patients (90.2 %) were at Binet stage B/C, with 14.6 % having 17p deletion and 17.1 % <em>TP53</em> mutations. Overall, 46 patients experienced treatment-related toxicity. The ROC curve analysis showed that the best cut-off for predicting treatment-related toxicity was a CSHA CFS &gt;3. The accuracy was fair, with an area under the curve (AUC) of 0.695 (95 % CI 0.55–0.84; <em>P</em> = 0.02), sensitivity = 85 % and specificity = 53 %. Patients with a score &gt; 3 experienced higher rates of treatment discontinuation (28.6 %) compared to those with a score ≤ 3 (12.5 %; <em>P</em> &lt; 0.05). Other factors such as polypharmacy, cumulative illness rating, and comorbidity indices did not significantly affect treatment discontinuation rates.</div></div><div><h3>Discussion</h3><div>The CSHA CFS is a feasible tool for identifying older adults with CLL at higher risk of treatment toxicity and discontinuation. Patients with a CFS &gt;3 had a significantly higher likelihood of treatment interruption due to adverse effects. Therefore, CSHA CFS can aid in stratifying patients and optimizing therapeutic strategies. Further validation in multicenter studies is warranted to confirm these results and explore the potential for adjusting treatment dosages based on frailty assessments in the era of targeted therapies.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 3","pages":"Article 102219"},"PeriodicalIF":3.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578383","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":"Feasibility of home step-tracking using wearable devices for older adults undergoing thoracic surgery: A brief report","authors":"Anupama Singh ,&nbsp;Mary E. Cooley ,&nbsp;Emanuele Mazzola ,&nbsp;Ashley L. Deeb ,&nbsp;Miles McAllister ,&nbsp;Fatemehsadat Pezeshkian ,&nbsp;Clark DuMontier ,&nbsp;Laura N. Frain ,&nbsp;Paula Ugalde Figueroa ,&nbsp;Desiree Steimer ,&nbsp;Michael T. Jaklitsch","doi":"10.1016/j.jgo.2025.102218","DOIUrl":"10.1016/j.jgo.2025.102218","url":null,"abstract":"","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 3","pages":"Article 102218"},"PeriodicalIF":3.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534306","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}