Journal of geriatric oncology最新文献

Introduction: The global population of older adults with cancer is increasing, presenting care challenges caused by comorbidity, polypharmacy, and frailty. In response to these complexities, healthcare professionals (HCPs) rely on their own attitudes to a larger extent due to limitations in the treatment evidence for this population. This scoping review aims to explore and describe the attitudes of HCPs in the context of treatment decision-making for older adults with cancer.

Materials and methods: We conducted a scoping review on HCP attitudes or subjective inclinations in the treatment decision-making process for older adults with cancer. PubMed, Embase, Medline, and EBSCO CINAHL Complete were searched using predefined inclusion criteria. A two-step screening process was implemented, conducted by two-reviewer teams.

Results: From 5161 de-duplicated references, 21 studies were retained for analysis (nine qualitative, six quantitative, five mixed methods). Five patterns were observed, highlighting how HCP attitudes can shape consultation dynamics, influence the interpretation of patient factors such as age and comorbidities, and impact communication with older patients. Additionally, HCP background profession and practice environment emerged as influential in shaping both attitudes and decision-making processes.

Discussion: This scoping review describes the role of HCP attitudes in communicating treatment options with older adults with cancer. It suggests the importance of considering the role of attitudes in decision-making when developing educational resources for geriatric-centred communication skills to support shared decision-making practices in the cancer treatment of older adults.

Introduction: Chronological and functional aging complicates care in older patients, and therapeutic decisions need to consider individual needs to minimise morbidity and mortality. Therapeutic decisions should be guided by a multidisciplinary geriatric assessment, allowing a complete assessment of physical and functional performance. In this context, the GERABEL study aimed to orientate the irradiation strategy based on a detailed oncogeriatric assessment in women more than 70 years old with breast cancer.

Materials and methods: This was a multicentre clinical trial conducted between January 2017 and June 2021. The oncogeriatric assessment comprised seven questionnaires (activities of daily living [ADL], instrumental ADL, Mini-Mental State Examination, mini Geriatric Depression Scale, Mini-Nutritional Assessment, Cumulative Illness Rating Scale-Geriatric, and Timed Up and Go) to determine a predictive score. Irradiation regimen was assigned according to oncogeriatric score: normofractionated - NF (score range, 160-200), hypofractionated - HF (score range, 159-120), or high-dose hypofractionated - HDHF (score ≤ 119). Endpoints were the overall tolerance to treatment, using the oncogeriatric score as a proxy at six months post-treatment, and compliance.

Results: After oncogeriatric assessment at baseline, 177 patients were treated with a NF regimen, 24 with a HF regimen, and four with a HDHF regimen. Tolerance was excellent in the three groups, as no decrease of more than 20 % in the oncogeriatric score was noted at six months post-treatment. More generally, 68 % and 73 % of patients reported an improvement of the oncogeriatric score at two months and six months post-treatment, respectively. Only four treatment interruptions were observed and quality-of-life was well-conserved. In the hypo fractionated groups, short-term toxicities were not increased and no impact was noted on compliance.

Discussion: Decision-making guidance for irradiation schemes in breast cancer according to oncogeriatric determinants was successful in older patients, who tolerated treatment well and, overall, had a preserved general condition.

Introduction: Hospital admissions often result in functional decline for patients with dementia, yet evidence on the impact of cancer treatments in this population during hospitalization is limited. We aimed to examine the association between dementia and functional decline after cancer treatment in patients with non-small cell lung cancer (NSCLC).

Materials and methods: A total of 30,213 patients aged 65 years or older hospitalized for NSCLC treatment, from a dataset of 366 acute care hospitals in Japan, were eligible for this study. The primary outcome was activities of daily living (ADL) at discharge, assessed using the Barthel Index, with a total score ranging from 0 to 100, and the secondary outcome was the length of hospital stay. We conducted causal mediation analysis by cancer treatment within a counterfactual framework using the g-formula approach with direct counterfactual imputation. Bias-corrected and adjusted bootstrapped 95 % confidence intervals (CIs) were calculated based on 100 bootstrap samples. Dementia status served as the exposure, ADL scores at admission as the mediator, and ADL scores at discharge as the outcome. Covariates measured at admission were used to adjust for dementia status. Subgroup analyses were performed by treatment group including surgery.

Results: Compared with patients with NSCLC who did not have dementia, those with dementia exhibited lower ADLs at discharge across most cancer treatments, regardless of ADL scores at admission. Patients with dementia who underwent chemotherapy had prolonged hospital stays of 2.90 days longer (95 % CI, 1.27 to 4.52) and lower ADL scores at discharge than their counterparts without dementia (-9.77 [95 % CI, -12.55 to -7.00]). Similarly, patients with dementia who received radiotherapy experienced lower ADL scores at discharge compared with those without dementia (-15.06 [95 % CI, -19.59 to -10.54]), with no difference in the length of hospital stay (-0.54 [95 % CI, -2.84 to 1.75] days). Similar findings were observed from the total effects after adjusting for potential confounders.

Discussion: Patients with comorbid cancer and dementia consistently displayed lower ADL scores at discharge following various cancer treatments. Understanding the effects of dementia on functional decline may aid in making optimal treatment choices for inpatient care for patients with NSCLC.

Introduction: Both Geriatric-8 (G8) and geriatric assessment (GA) assess frailty and facilitate providing appropriate interventions as recommended by the International Society for Geriatric Oncology. The main objective of this study is to evaluate the impact of G8 and GA-based interventions on the quality of life (QOL) of older adults with cancer.

Materials and methods: This is a prospective study of patients with cancer aged ≥70 y. A G8, GA, and a European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was performed at study entry. Targeted interventions were offered. After three months, a follow-up EORTC QLQ-C30 was repeated for patients who required interventions. The study's primary outcome measure was a comparison of pre-and post-geriatric intervention EORTC QLQ-C30 scores.

Results: Two hundred thirty patients were accrued. Median age was 74 y (range:70-90). Based on the GA, 11 % were classified as frail, 58 % as pre-frail, and 31 % as fit. A total of 79 % had a G8 scores ≤14. Patients who were pre-frail, frail, and those with G8 ≤ 14 had lower baseline EORTC QLQ-C30 function scores and higher EORTC QLQ-C30 symptom scores (p < 0.05). They also had significantly shorter overall survival (OS) compared to fit patients or those with G8 > 14. (hazard ratio: 2.54 95 % CI 1.46-4.43, p = 0.001 for frail vs fit patients; 1.72 95 % CI 1.18-2.53, p = 0.005 for pre-frail vs fit patients; 1.51 95 % CI 1.05-2.18, p = 0.03 for G8 ≤ 14 vs >14). Geriatric oncology (GO) interventions were suggested for 144 patients with 104 patients completing a second EORTC QLQ-C30. These patients reported significant improvements in the EORTC emotional and social functioning domains (mean difference + 4.6, p < 0.001 and + 12.3 p < 0.001, respectively), a significant reduction in the EORTC symptom scale of pain, insomnia, constipation, and financial difficulties (mean difference - 5.8 p = 0.003, -8.3 p < 0.001, -9.0 p < 0.001, and - 6 p = 0.01), with no significant deterioration in other QOL domains.

Discussion: GA-based targeted interventions delivered by a multidisciplinary GO service improved multiple QOL domains in older adult patients undergoing cancer treatment.

Introduction: Chemotherapy toxicity tools are rarely studied in patients with hematologic malignancy (HM). The primary aim of this pilot study was to determine the predictive ability of the Cancer and Aging Research Group (CARG) chemo-toxicity calculator in estimating grade 3-5 toxicity in patients with HM.

Materials and methods: Patients 60 years and older with HM were prospectively evaluated using the CARG chemo-toxicity calculator. Discrimination and calibration were checked by applying the published model in our data. Additionally, a full geriatric assessment (GA), the Short Physical Performance Battery (SPPB), and health related quality of life (HRQoL) were captured longitudinally at the start of treatment and at end of study. Secondary aims explored the association of GA metrics with chemo-related toxicities and survival.

Results: One hundred forty-five patients were approached, 118 patients consented, and 97 patients were evaluable. Most patients were newly diagnosed (n = 91). The median CARG score was 9 (range 4-18). The CARG score was not validated in our cohort of older patients with HM, with area under the receiver operation characteristic curve being 0.53 (95 % CI: 0.41-0.65). In multivariable analysis, after controlling for disease type, risk factors associated with grade 3-5 toxicity included living alone (hazard ratio [HR] 4.24, 95 %CI: 2.07-8.68, p < 0.001), increase in body mass index (HR 1.06, 95 %CI: 1.01-1.12, p = 0.03) and a higher social activities score (HR 1.27, 95 %CI: 1.06-1.51, p = 0.01). In multivariable analysis of overall survival, the only prognostic factor was an objective marker of physical function (SPPB score HR = 0.85, 95 %CI:0.78-0.93, p < 0.001).

Discussion: The CARG chemo-toxicity calculator was not predictive of grade 3-5 toxicity in patients with hematologic malignancy. The SPPB was associated with overall survival in multivariable analysis, suggesting future use as an objective biomarker in HM. We also report a comprehensive trajectory of function, QoL, psychosocial well-being, and cognition among older adults with HM. The predictive accuracy of the CARG chemo-toxicity calculator may be affected by the diverse range of HM treatment options that are not traditional chemotherapy.