Journal of geriatric oncology最新文献

Introduction: Cancer treatment puts older adults with cancer at increased risk for functional decline, impaired quality of life (QOL), and treatment-related toxicity. Geriatric co-management has been proposed as a strategy to improve outcomes in this vulnerable population.

Materials and methods: This prospective, randomized (1:1) trial evaluated the impact of geriatric co-management and intervention in patients aged ≥70 years with a G8 score < 15 initiating new systemic outpatient treatment. The aim was to assess the efficacy of targeted interventions versus standard care. Two primary endpoints were chosen: independence (no restrictions in instrumental activities of daily living (IADL)) and QOL (global health scale of the European Organisation for the Research and Treatment of Cancer questionnaire: EORTC QLQ-C30) at 12 weeks (T2). Secondary endpoint was "incidence of severe adverse events" (Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0, grade ≥ 3). A multiprofessional team performed the geriatric assessment and co-management in the intervention group (IG).

Results: A total of 217 patients were enrolled (207 in full analysis set; median age 75 (range 70-89) years; 42% female). For both primary endpoints, a tendency for improvement in the IG was observed: an adjusted odds ratio (OR) of 1.34 (97.5% CI 0.60-2.98; p = 0.42) for regaining independence, and an adjusted difference in global QOL T2 scores of 1.82 (CI -4.44-8.07; p = 0.51). Statistical significance could not be demonstrated. Geriatric co-management reduced grade ≥ 3 toxicities compared with standard care (15.5% vs 30.8% of patients, risk difference - 15.2%, 95% CI -26.5%; -3.9%) and lowered unplanned hospitalizations (21.4% vs 28.8% of patients, risk difference - 7.5%, 95% CI -19.3%; 4.3%).

Discussion: The interventions showed a consistent, yet statistically insignificant, impact on quality of life and independence. Importantly, it was associated with a reduction in severe toxicity and may have led to fewer unplanned hospitalizations. Findings support further integration of geriatric co-management into routine oncology care for older adults with cancer.

Introduction: Older adults with cancer have a higher risk of developing sarcopenia, which may contribute to a worse prognosis. This study aimed to verify if sarcopenia predicts early death in older adults with cancer at the time of admission for outpatient treatment.

Materials and methods: This prospective cohort study was based on secondary data analysis from individuals over 60 years old with cancer admitted to an oncogeriatric outpatient clinic from 2016 to 2020. Upon admission, sociodemographic data, clinical variables, nutritional, and physical assessment were evaluated. We considered probable sarcopenia (low hand grip strength [HGS], < 16 kg women and < 27 kg men), sarcopenia (low HGS and calf circumference [CC] < 31 cm), and severe sarcopenia (low HGS, decreased CC, and timed up and go test ≥20 s). The primary outcome was all-cause early death within 180 days from outpatient evaluation. A multivariate analysis using the Cox proportional hazards model was performed, and the survival curve was established according to the degrees of sarcopenia.

Results: Of the 403 individuals included, 44.2% (n = 178) had some degree of sarcopenia upon admission (25.1% had probable sarcopenia and 15.6% had sarcopenia). Eighty-seven (21.6%) individuals died within 180 days. All degrees of sarcopenia were associated with death; probable sarcopenia (hazard ratio [HR] 1.76; confidence interval of 95% [95% CI] 1.05 to 2.99; p = 0.03), sarcopenia (HR 2.00; 95% CI 1.11 to 3.62; p = 0.02), and severe sarcopenia (HR 3.15; 95% CI 1.35 to 7.32; p = 0.007). Low HGS was the only criterion for diagnosing sarcopenia associated with early death. The other risk factors associated with death were male sex, primary site of cancer, metastatic disease, reduced functionality, and polypharmacy.

Discussion: Identifying predictors of early death in older adults with cancer is clinically relevant and has a direct impact on therapeutic decision-making processes.