Journal of geriatric oncology最新文献

{"title":"Systemic treatment among frail older patients with cancer: An observational cohort.","authors":"Solène Doublet, Arnaud Pagès, Zoé Ap Thomas, Geoffroy Beraud-Chaulet, Marine Valery, Natacha Naoun, Florence Canoui-Poitrine, Céline Nagera-Lazarovici, Capucine Baldini, Maxime Frélaut","doi":"10.1016/j.jgo.2024.102177","DOIUrl":"https://doi.org/10.1016/j.jgo.2024.102177","url":null,"abstract":"<p><strong>Introduction: </strong>In the past, certain oncological therapies were not offered to frail older patients. However, the advancement of geriatric oncology, tailored chemotherapy regimens, the introduction of new treatments, and the optimization of supportive care have contributed to enhancing the therapeutic margin. We aimed to evaluate the benefit of systemic treatment among older adults by assessing the three-month survival of older frail patients with metastatic cancer.</p><p><strong>Materials and methods: </strong>This retrospective cohort study included patients aged 70 and over with metastatic cancer who underwent pre-therapeutic geriatric assessment at Gustave Roussy Hospital between May 2020 and May 2022 and were categorized as \"frail\" according to the SIOG-1 classification, whether they received systemic treatment (ST group) or exclusive supportive care (SC group).</p><p><strong>Results: </strong>The ST group included 77 patients, and the SC group included 44 patients. Patients in the ST group had a median age of 80.6 years (82.7 years in SC group). The three-month overall survival rate was 81.8 % [95 % Confidence Interval (CI) 71.8; 88.9] in the ST group. The median survival rate was 10.6 months [95 % CI 6.3; 12.6] in the ST group. In multivariate analysis within the ST group, loss of autonomy assessed by activity of daily living (ADL) (HR 2.16 [1.09; 4.28]) and more frailty factors (HR 1.40 [1.01; 1.95]) were associated with lower three-month survival.</p><p><strong>Discussion: </strong>Older frail patients with metastatic cancer may benefit from systemic oncologic treatment. The introduction of such treatment for patients with loss of autonomy in ADL or cumulative frailty factors should be considered only with caution.</p>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"102177"},"PeriodicalIF":3.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872012","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 pervasive impact of frailty on ovarian cancer care and the role of prehabilitation: Qualitative perspectives of key stakeholders.","authors":"Stephanie Cham, Rachel A Pozzar, Neil Horowitz, Colleen Feltmate, Ursula A Matulonis, Jennifer C Lai, Alexi A Wright","doi":"10.1016/j.jgo.2024.102173","DOIUrl":"https://doi.org/10.1016/j.jgo.2024.102173","url":null,"abstract":"<p><strong>Introduction: </strong>We performed a qualitative study to explore key stakeholders' perspectives about the impact of frailty on ovarian cancer care and evaluate a candidate prehabilitation intervention.</p><p><strong>Materials and methods: </strong>We conducted semi-structured interviews with patient-caregiver dyads and multi-disciplinary clinicians. Patients were ≥ 50 years of age with a new diagnosis of advanced stage (III/IV) ovarian cancer who received cancer-directed treatment (chemotherapy and/or surgery) during the past year and met criteria as pre-frail or frail using the FRAIL scale. We used a semi-structured interview guide to elicit participants' views on frailty, nutrition, physical therapy, and a candidate prehabilitation intervention. We used inductive and deductive approaches to code and analyze interviews and identify emergent themes and patterns.</p><p><strong>Results: </strong>Ten patients and caregivers (five dyads) and 10 providers were interviewed. We identified four themes: (1) frailty screening is essential to prevent over- and under-treatment, but underused; (2) stakeholders preferred a multidisciplinary approach to providing tailored care for frail patients over a candidate prehabilitation intervention; (3) patient, family caregiver, and clinician stakeholders reported multiple barriers to prehabilitation programs, including concerns about selection bias, and (4) frail patients and family members are vulnerable and require more psychosocial support.</p><p><strong>Discussion: </strong>We identified significant barriers to prehabilitation interventions for frail patients with ovarian cancer; initiatives to increase frailty screening and provide tailored multi-disciplinary approaches may have a greater impact.</p>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"102173"},"PeriodicalIF":3.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872019","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":"Computed tomography-determined high visceral adipose tissue and sarcopenic obesity and their associations with survival in vulnerable or frail older adults with cancer considered for systemic anticancer treatment.","authors":"Antti Tolonen, Kaisa Lehtomäki, Hanna Kerminen, Heini Huhtala, Maarit Bärlund, Pia Österlund, Otso Arponen","doi":"10.1016/j.jgo.2024.102171","DOIUrl":"https://doi.org/10.1016/j.jgo.2024.102171","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment decisions are challenging in older adults with solid tumors. Geriatric 8 (G8)-screening and comprehensive geriatric assessment (CGA) are important but additional methods are needed. We examined the association of computed tomography (CT)-derived high visceral adipose tissue index (VATI) with or without low skeletal muscle index (SMI) on three-month and overall survival (OS).</p><p><strong>Materials and methods: </strong>Vulnerability was evaluated with G8 in patients ≥75 years referred for systemic anticancer treatment. Vulnerable/frail patients (G8 ≤ 14) received CGA and were included. VATI and SMI were retrospectively measured from CT scans. We examined associations between high VATI with or without low SMI and three-month and OS with Cox regression models and Kaplan-Meier estimation.</p><p><strong>Results: </strong>Seventy-nine patients with median age of 80 (range 75-91) years were evaluated. In the palliative-intent group (n = 58), three-month OS rates were 88 % and 58 % in the normal and high VATI groups, respectively (hazard ratio 4.3; 95 % confidence interval 1.3-14), and 88 % vs. 47 % in group without and with 'high VATI+low SMI', respectively (5.5; 1.9-17). The median OS was 12.7 vs. 9.5 months in normal VATI/SMI and 'high VATI+low SMI' (1.9; 1.1-3.2), respectively. In Cox multivariable models with established predictive factors (ECOG PS, Clinical Frailty Scale, and sex), only high VATI (4.9; 1.0-24) or 'high VATI+low SMI' (8.9; 1.7-46) remained significant predictors of three-month OS.</p><p><strong>Discussion: </strong>High VATI with or without low SMI were associated with impaired three-month OS in the palliative-intent group and with OS in the whole cohort independently of oncologic and geriatric functional status measures; thus, they may aid in treatment decision-making.</p>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"102171"},"PeriodicalIF":3.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828720","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":"Development and validation of the Taiwan Cancer Frailty Tool for older patients with cancer: A prospective longitudinal study.","authors":"Yu-Shin Hung, Kun-Yun Yeh, Shun-Wen Hsueh, Chang-Hsien Lu, Wen-Chi Chou","doi":"10.1016/j.jgo.2024.102170","DOIUrl":"https://doi.org/10.1016/j.jgo.2024.102170","url":null,"abstract":"<p><strong>Introduction: </strong>The increasing occurrence of cancer in Taiwan's older population highlights the need for a culturally attuned frailty assessment tool. This study aimed to develop and validate a frailty screening instrument specifically designed for older Taiwanese patients with cancer to predict survival outcomes.</p><p><strong>Materials and methods: </strong>Patients aged ≥65 years newly diagnosed with cancer before treatment initiation at three Hospitals in Taiwan were prospectively included from July 2018 to December 2020 to participate in the study. Participants were randomly divided into development and validation groups with a 3:1 ratio. Key variables from the comprehensive geriatric assessment (CGA) were selected to create the Taiwan Cancer Frailty Tool (TCFT). The ability of the TCFT to evaluate frailty and predict survival outcomes was tested.</p><p><strong>Results: </strong>Overall, 692 patients were included over the recruitment period, with 519 and 173 in the development and validation cohorts, respectively. The TCFT was developed based on five multivariate analysis factors from the CGA (weight loss, restricted mobility/transfer, falls, impaired cognitive function, and polypharmacy), scoring each factor binary with a maximum score of five. The areas under the receiver operating characteristic curve for the TCFT in predicting frailty were 0.79 (95 % confidence interval [CI]: 0.75-0.83) and 0.86 (95 % CI: 0.80-0.91) in the development and validation groups, respectively, compared with the CGA as the gold standard. Higher TCFT scores correlated with shorter survival (hazard ratio [HR]: 2.39-6.99 and 10.2-88.3) in the development and validation groups, respectively, (p < 0.001).</p><p><strong>Discussion: </strong>Our study suggests that the TCFT effectively predicts frailty and survival among older Taiwanese patients with cancer, proving to be a culturally sensitive screening tool. Future studies should target a wider application and validation across diverse clinical settings.</p>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"102170"},"PeriodicalIF":3.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828750","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":"Moving beyond studying mere association: A methodological perspective.","authors":"Sophie Pilleron","doi":"10.1016/j.jgo.2024.102178","DOIUrl":"https://doi.org/10.1016/j.jgo.2024.102178","url":null,"abstract":"","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":" ","pages":"102178"},"PeriodicalIF":3.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828714","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":"Opioids and benzodiazepines in oncology: Perspectives on coprescribing and mitigating risks.","authors":"Amy O'Regan, Jeehye Rose Lee, Cara L McDermott, Harvey Jay Cohen, Jessica S Merlin, Andrea Des Marais, Aaron N Winn, Salimah H Meghani, Devon K Check","doi":"10.1016/j.jgo.2024.102172","DOIUrl":"https://doi.org/10.1016/j.jgo.2024.102172","url":null,"abstract":"<p><strong>Introduction: </strong>Opioids and benzodiazepines are commonly prescribed for cancer symptoms. In combination, they can increase the risk of adverse events, particularly for older adults with multimorbidity, who represent most patients with cancer. We aimed to understand cancer care providers' practices for opioid and benzodiazepine coprescribing and mitigating potential harms.</p><p><strong>Materials and methods: </strong>We interviewed oncology and palliative care providers from two health systems. Interviews focused on attitudes about and current practices for coprescribing opioids and benzodiazepines. We analyzed interview transcripts using a staged approach to thematic analysis.</p><p><strong>Results: </strong>Twenty providers (10 oncology, 10 palliative care) participated. We identified three key themes. (1) Reluctance to prescribe benzodiazepines: providers reported rarely coprescribing because they do not routinely prescribe benzodiazepines, which were viewed as having a poor safety profile. (2) Medication safety precautions: these included starting at a low dose and titrating up slowly, consolidating prescriptions under one provider whenever possible, and providing patient and caregiver education around side effects, overdose, and naloxone. Compared to oncologists, palliative care providers more often described providing naloxone to patients and caregivers. (3) Risk assessment and monitoring: most providers mentioned checking state Prescription Drug Monitoring Program databases and conducting chart reviews to identify evidence of substance misuse history. Several oncologists expressed discomfort in asking about substance misuse history due to concerns about stigma. Providers described sometimes relying on their perception of a patient's trustworthiness, with some acknowledging the potential for bias.</p><p><strong>Discussion: </strong>We highlight opportunities to improve medication review and reconciliation practices in oncology, increase uptake of naloxone in oncology practice, systematize efforts to screen patients for substance misuse, and strengthen integration of addiction and psychiatry services into oncology and palliative care settings. Regular use of geriatric assessment in oncology would also address many of the safety concerns we observed.</p>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"102172"},"PeriodicalIF":3.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828840","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":"Addressing educational gaps in geriatric oncology: Insights from medical oncologists.","authors":"Kian Godhwani, Shabbir M H Alibhai, Alana Miller, Guillaume Lim Fat","doi":"10.1016/j.jgo.2024.102162","DOIUrl":"https://doi.org/10.1016/j.jgo.2024.102162","url":null,"abstract":"","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":" ","pages":"102162"},"PeriodicalIF":3.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828669","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":"Impressions from a Belgian medical oncologist visiting two world-class geriatric oncology clinics in Canada and the United States.","authors":"Hans Wildiers","doi":"10.1016/j.jgo.2024.102179","DOIUrl":"https://doi.org/10.1016/j.jgo.2024.102179","url":null,"abstract":"","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"102179"},"PeriodicalIF":3.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828789","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":"Examining unmet needs in older adults with lung cancer: A systematic review and narrative synthesis.","authors":"Nicole Knox, Meera R Agar, Shalini Vinod, Louise Hickman","doi":"10.1016/j.jgo.2024.102161","DOIUrl":"https://doi.org/10.1016/j.jgo.2024.102161","url":null,"abstract":"<p><strong>Introduction: </strong>Unmet needs in the older population with cancer are complex due to aging-related health conditions. A review of unmet needs in older people with cancer showed that needs varied among different cancer types. In lung cancer, a higher incidence of geriatric syndromes and comorbidities exist compared to other cancer cohorts, impacting treatment tolerance and completion. Consequently, it is crucial to identify and understand unmet needs to address supportive care needs beyond cancer diagnosis and treatment. This systematic review aims to synthesise the available literature to analyse the number and nature of unmet needs experienced by older patients with lung cancer.</p><p><strong>Materials and methods: </strong>We performed a systematic search following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, which was registered in PROSPERO(CRD42022311105). We searched CINAHL, Medline, Embase, and Scopus electronic databases for published literature (January 2002 to November 2023) on unmet needs of patients ≥65 years diagnosed with lung cancer. We used a narrative synthesis approach to summarise the results and identify themes.</p><p><strong>Results: </strong>The search yielded 1356 articles, of which 35 met the inclusion criteria. A significant portion of older patients with lung cancer reported experiencing unmet needs, ranging from 78 % to100 %. Compared to other cancer streams, older patients with lung cancer experienced a higher burden of unmet needs, with a mean of seven unmet needs per person. Most studies identified psychological and physical/daily living domains as having the greatest prevalence and highest burden of unmet need.</p><p><strong>Discussion: </strong>Increased psychological distress and poorer quality of life correlated with increased unmet needs. Identifying and addressing unmet needs is critical for patient wellbeing and should be prioritised when developing models of care and tailored interventions for older people with lung cancer.</p>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":" ","pages":"102161"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769645","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":"Real-world data on the clinical features, therapy patterns, and outcomes of older adults with diffuse large B-cell lymphoma in Latin America: A study from the Grupo de Estudio Latinoamericano de Linfoproliferativos (GELL)","authors":"Myrna Candelaria ,&nbsp;Luis Villela ,&nbsp;Luis F. Oñate-Ocana ,&nbsp;Brady Beltran ,&nbsp;Maria Torres-Viera ,&nbsp;Ana Oliver ,&nbsp;Henry Idrobo ,&nbsp;Fernando Perez-Jacobo ,&nbsp;Guilherme Perini ,&nbsp;Camila Peña ,&nbsp;Laura Korin ,&nbsp;Denisse Castro ,&nbsp;Victoria Irigoyen ,&nbsp;Sally Paredes ,&nbsp;Jose A. Hernandez-Hernandez ,&nbsp;Perla Colunga ,&nbsp;David Gomez-Almaguer ,&nbsp;Guillermo Ruiz-Argüelles ,&nbsp;Melani Otañez ,&nbsp;Jorge J. Castillo ,&nbsp;Luis Malpica","doi":"10.1016/j.jgo.2024.102160","DOIUrl":"10.1016/j.jgo.2024.102160","url":null,"abstract":"<div><h3>Introduction</h3><div>Diffuse large B-cell lymphoma (DLBCL) is the most common type of B-cell lymphoma, predominantly afflicting older adults. There remains a notable absence of data regarding DLBCL in older adults in Latin America.</div></div><div><h3>Materials and Methods</h3><div>We conducted a retrospective analysis of 608 newly diagnosed Latin American patients with DLBCL aged ≥65 years<strong>.</strong></div></div><div><h3>Results</h3><div>The median age at diagnosis was 74 years (range: 65–96 years), 51 % were female, 36 % had an Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2, and 65 % had advanced disease. The most common regimens used were standard-dose R-CHOP (<em>n</em> = 420, 69 %), R-CVP (<em>n</em> = 77, 12 %), R-mini-CHOP (<em>n</em> = 74, 12 %), and CHOP/CVP (<em>n</em> = 30, 5 %). With a median follow-up of 60 months (95 % confidence interval [CI]: 38.7–75.2 months), the five-year overall survival (OS) rate was 50 % (95 % CI, 43–58). An ECOG PS ≥2 (hazard ratio [HR] 1.93; 95 % CI 1.51–2.46; <em>p</em> &lt; 0.01), advanced clinical stage (HR 1.46; 95 % CI 1.12–1.91; <em>p</em> &lt; 0.01), increased serum lactic dehydrogenase level (HR 1.48; 95 % CI 1.16–1.87; p &lt; 0.01), and albumin level &lt; 3.5 mg/dL (HR 1.64; 95 % CI 1.29–2.10; p &lt; 0.01) were associated with an inferior OS. Using anthracyclines (HR 0.50; 95 % CI 0.38–0.66; p &lt; 0.01) and using rituximab (HR 0.51; 95 % CI 0.36–0.73; p &lt; 0.01) were independently associated with a superior OS.</div></div><div><h3>Discussion</h3><div>In a large cohort of Latin American older patients with DLBCL, therapy and outcome patterns are similar to those reported internationally. The lack of standardized geriatric assessments in Latin America represents an essential area for research to better stratify older patients with DLBCL deemed to be at higher risk for toxicity.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 1","pages":"Article 102160"},"PeriodicalIF":3.0,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142743868","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}