Journal of Geriatric Oncology

Editorial Board

2012-04-01

Geriatric thoracic oncology: Gaining momentum

Ajeet Gajra — 2012-03-14

Lung cancer accounts for the highest cancer associated mortality in the US. Of the 160,000 estimated deaths from lung cancer this year, the majority will be secondary to non-small cell lung cancer. Lung cancer is a disease of the older adult with over two-thirds of cases diagnosed in patients over the age of 65years and half of the cases diagnosed in patients over the age of 70years. With the rapid “graying” of the US population, akin to other age associated conditions, the overall incidence of lung cancer is expected to rise over the next 15–20years. With significant research in the field of lung cancer over the last 20years, the incidence and mortality from lung cancer decreased among individuals aged ≤50years, but increased among those aged ≥70years.

Impact of age, comorbidity and symptoms on physical function in long-term breast cancer survivors (CALGB 70803)

2012-02-13

Abstract: Objective: The purpose of this study was to assess the impact of aging, comorbidities and symptoms on physical function in patients surviving 20years since adjuvant treatment for breast cancer.Patients and methods: Patients were originally treated on CALGB 7581 (from 1975 to 1980), a randomized trial of three adjuvant therapies and reassessed (153 of 193 eligible survivors) 20years from the onset of therapy for physical function and symptoms by the EORTC QLQ-C30 and comorbidities by the OARS questionnaire.Results: The average age at reassessment was 64.5years. 66% of patients had at least two comorbidities and 22% had four or more, but relatively little interference with activities. Older patients had greater multimorbidity. Physical function was generally high and comparable to matched population norms. Older patients had greater difficulty with strenuous activities. For every increase in number of comorbidities, physical function score decreased by 5.1 (p<.001). Symptoms were also frequent (80%) and correlated strongly with decreases in function (0–100u scale) (p<.001), to an even greater degree than comorbidities.Conclusion: Very long-term cancer survivors have changes in physical function and symptoms largely consistent with their aging suggesting that the impact of cancer and its treatment is attenuated over time and largely replaced by the impact of age-related comorbidities and functional decline.

Exercise and cancer treatment symptoms in 408 newly diagnosed older cancer patients

2012-01-27

Abstract: While the benefits of exercise for managing cancer and treatment-related side effects have been shown among various populations of cancer survivors, a relative dearth of information exists among older cancer patients.Objectives: To determine the prevalence of exercise participation during and after primary cancer treatment in older (≥65years) and the oldest (≥80years) cancer patients and to examine the relationships between exercise, symptoms, and self-rated health (SRH).Materials and methods: 408 newly diagnosed older cancer patients (mean age=73, range=65–92) scheduled to receive chemotherapy and/or radiation therapy reported symptoms and SRH prior to, during, and 6months after treatment, and exercise participation during and following treatment.Results: Forty-six percent of older and 41% of the oldest patients reported exercising during treatment. Sixty percent of older and 68% of the oldest patients reported exercising in the 6months thereafter. Older patients who exercised during treatment reported less shortness of breath and better SRH during treatment, and better SRH following treatment. The oldest patients who exercised during treatment reported less memory loss and better SRH during treatment and less fatigue and better SRH following treatment. The oldest patients who exercised following treatment reported less fatigue, skin problems, and total symptom burden following treatment.Conclusion: These data suggest a willingness of older cancer patients to attempt exercise during and after treatment. Exercise during these times is associated with less severe symptoms; further clinical research examining the efficacy of formal exercise interventions to reduce symptoms and improve SRH in older cancer patients is needed.

Comprehensive Geriatric Assessment (CGA) of elderly lung cancer patients: A single-center experience

2012-01-27

Abstract: Purpose: This study investigated the association of CGA variables with function and survival in elderly lung cancer patients.Patients and methods: We prospectively included 83 consecutive elderly patients with lung cancer who were seen at the outpatient oncology unit at the Hospital Lluis Alcanyis. The patients completed a geriatric assessment tool to measure functional status, comorbidity, cognitive function, psychological state, social support and nutritional status. The correlations of oncological and geriatric variables with survival were determined.Results: The median patient age was 77years, and the mean number of comorbidities was 3. The measures of dependency were 48.2% for ADL and 69.9% for IADL. PS (p<0.001), IADL dependency (p<0.001), dementia (p<0.001), depression (p<0.001), weight loss, hypoalbuminemia, delirium and incontinence were independently associated with survival. Frail patients exhibited poorer survival (mean: 18.5months vs. 9.1months), but this difference was statistically not significant (p=0.07).Conclusions: Geriatric assessment detects more information than oncological evaluation alone. Factors related to survival may assist in the classification of elderly lung cancer patients.

Multimodality therapy improves survival in elderly patients with locally advanced non-small cell lung cancer—A retrospective analysis

2012-01-16

Abstract: Objectives: Concurrent combined modality therapy is optimal treatment for patients with stage III non-small cell lung cancer (NSCLC) and is given with curative intent. However, elderly patients (≥75) are often undertreated, despite good performance status (PS). This study evaluated the treatment, outcomes and survival in elderly patients with stage III NSCLC versus patients <75years old.Materials and Methods: A retrospective review of data from the Lung Cancer Registry at Mayo Clinic Arizona (MCA) was conducted. Patients with newly diagnosed stage III NSCLC from 1998 to 2006 were analyzed for type of therapy and outcomes.Results: Three hundred and eighty-nine patients with newly diagnosed stage III NSCLC were identified from 1998 to 2006. Two hundred and forty-three (62%) patients were <75years old, and 146 patients (38%) were ≥75years old. Among 374 eligible patients, 45% of patients <75years old received combined chemoradiation therapy vs. only 21% of patients ≥75years old (p<0.0001). The median survival in the <75 age group was 14.5months vs. 10.1months in the ≥75 age group (p=0.0014). In the <75 age group, median survival was 15.0months in patients who received combined modality treatment vs. 14.1months in the other treatments group (p=0.02). In the elderly group, median survival was 19.9months in the combined modality group vs. 7.8months in the other treatments group (p=0.0048).Conclusion: Our results confirm that older patients are less likely to receive optimal therapy, regardless of functional status. Prospective studies are desperately needed to help improve management of the burgeoning geriatric oncology population.

Ageing and other factors behind recent cancer incidence and mortality trends in Italy

2012-02-10

Abstract: Objective: The aim of this paper is to outline the age effect on cancer trends observed in Italy between 1998 and 2005.Methods: We analysed crude and age-adjusted cancer incidence and mortality trends for 36 sites and both sexes using data from 22 population-based registries of the Italian Network of Cancer Registries (AIRTUM). Some 818,017 incident cancers and 342,444 cancer deaths were analysed.Results: The population aged 65years and older increased from 19.0% to 20.6% between 1998 and 2005 with a significant effect on the cancer burden. The all-cancer, age-adjusted incidence rate was quite stable over the period (all sites excluding non-melanoma skin cancers: annual percent change (APC) men +0.3 CI +0.1/+0.5, women +0.2 CI −0.1/+0.4), but population ageing resulted in a growing number of new cases (crude rates: APC men +1.3 CI +1.0/+1.7, women +0.9 CI +0.6/+1.2). This effect was not evident for those cancer sites with high incidence rates among young subjects. The all-cancer, age-adjusted mortality rate decreased in both sexes but the crude rate changed in women only. Mortality increased for lung cancer among women (APC +1.5; CI +0.5/+2.5) and for melanoma among men (APC +2.7; CI +0.5/+4.8).Conclusions: Recent cancer trends in Italy are quite favourable, showing decreasing mortality rates for most sites (except for lung cancer among women and melanoma among men) and showing overall stable incidence. However, it follows that population ageing will have increased the cancer diagnostic and therapeutic needs and costs.

Knowledge of prescription medications among cancer patients aged 65years and above

P. Si, K.N. Koo, D. Poon, L. Chew — 2012-01-20

Abstract: Objectives: Studies have repeatedly shown that older adults have poor medication knowledge and utilize a disproportionate share of medications. These put them at high risk for drug–drug interactions. This study aims to determine the knowledge of prescription medications among cancer patients aged ≥65years and determine the extent of safe medication practices adopted by patients. Secondary objectives include determining potential drug–drug interactions and uncovering potential areas of risk in safe medication use.Materials and Methods: This is a cross-sectional study of patients/caregivers attending outpatient clinics at the National Cancer Centre Singapore. Patients (≥65years) taking ≥1 prescription medication at home were recruited. Patients were interviewed using structured questionnaires in a language understood by patients. Information was verified through the electronic prescription system and case notes.Results: A total of 196 patients were included in the analysis. The mean age (S.D.) of patients was 71 (4.54) years. Patients were on an average of 4.09 medications. Seventy-four (37.7%) patients failed to report≥one of their medications. Few patients could name their medications (8.7%), were aware of precautionary instructions (23.5%) and keep a medication list (15.3%). A majority of patients correctly identified the indications for use (69.4%), prescribed doses (77.0%) and dosing frequencies (73.0%). Approximately half of the patients would read drug labels (51.0%), discard medication when no longer needed (60.7%) and check expiry dates (44.9%). About a third would check for any changes in medication/regimen associated with new prescriptions (37.8%). No clinically significant drug–drug interaction was detected.Conclusion: Elderly patients do not possess a complete knowledge about their medications and lack practices for safe medication use.

Colon cancer treatment and adherence to national guidelines: Does age still matter?

J.M. Jonker, M.E. Hamaker, M. Soesan, C.R. Tulner, I.M.J.A. Kuper — 2012-01-20

Abstract: Introduction: In the past decades, much attention has been given to the risks of undertreatment of cancer in older patients. We set out to determine whether current treatment of colon cancer in older patients still differs from younger patients and to identify risk factors and physician's reasons for deviation from Dutch treatment guidelines.Patients and methods: Retrospective cohort study of all consecutive patients newly diagnosed with colon cancer at the Slotervaart Hospital in Amsterdam from January 2002 to December 2007. Data were collected using clinical charts.Results: Of 286 patients, 183 were 70years or older. Ninety-one percent of older patients received curative surgery and 32% received adjuvant chemotherapy in accordance with guidelines compared to 100% and 85% in the younger group (p=0.002 and p<0.001 respectively). The primary reasons stated by the treating physician for withholding surgery were comorbidity and poor general health. For adjuvant chemotherapy, the main reason stated was age. For both surgery and chemotherapy, multivariate analysis revealed that deviation from guidelines was most strongly associated with age (surgery OR 1.18 (CI 1.06–1.30); p=0.002 and chemotherapy OR 1.19 (CI 1.08–1.31); p<0.001 respectively). Despite this selection, older patients experienced more postoperative morbidity and mortality than younger patients. Chemotherapy toxicity was equal in both groups, despite less aggressive regimens for older patients.Conclusion: At our centre, guideline adherence for surgery in older patients was high, and deviations were well motivated. Age still seems to be the most important factor for withholding chemotherapy, despite evidence suggesting benefit in selected older patients.

Adjuvant radiation and outcomes after breast conserving surgery in publicly insured patients

2012-02-10

Abstract: Objectives: Epidemiologic studies report that lack of adjuvant radiation (RT) after breast conserving surgery (BCS) is associated with higher short-term mortality. It is generally accepted that adjuvant RT decreases risk of breast cancer recurrence and thereby lowers long-term mortality; here, we explore reasons for its relationship to short-term mortality.Materials and Methods: We studied 1583 publically insured women who had BCS between 1998 and 2002 (mean 71.8years, range 27–101), of whom 1346 (85%) received RT. Multivariate analyses with Cox Proportional Hazards and Logistic Regression models included: age; race; comorbidity; insurance status; tumor size; number of nodes positive; hormone receptor status; receipt of radiation; adjuvant chemotherapy; preventive care — including mammography, Pap smear and primary care visits; and hospitalization.Results: At a mean follow-up of 52.8months, overall mortality was significantly lower in those who received RT (HR 0.45, p<0.0001) and higher with older age (HR 1.05, p<0.0001) and greater comorbidity (HR 1.16, p=0.0007). Local recurrence was less with receipt of optimal radiation (HR 0.47; p=0.03). Breast cancer event, as determined by a clinically logical algorithm to detect breast cancer recurrence and death, however, was not significantly associated with receipt of RT (OR 1.32, p=0.2).Conclusion: These results imply that the higher short-term mortality in women not receiving RT after BCS is related to factors other than breast cancer recurrence.

Perioperative care of the elderly oncology patient: A report from the SIOG task force on the perioperative care of older patients with cancer

2012-02-24

Abstract: The increasing number of older cancer patients seen in daily practice demands reflection on how to optimize their care during the perioperative period. Optimally tailored surgical management, at present the most successful cancer treatment, firmly rests on an accurate and careful anesthesiological management.The unique peculiarities of anesthesia in older cancer patients prompted the International Society of Geriatric Oncology (SIOG) to put together a panel of international experts with the aim of reviewing the literature and drafting a consensus document. This article summarizes their views.

Falling through the cracks: A review of psychological distress and psychosocial service needs in older Black and Hispanic patients with cancer

Talia Weiss, Mark I. Weinberger, Jimmie Holland, Christian Nelson, Alyson Moadel — 2011-12-29

Abstract: The U.S. population is growing older and becoming more ethnically diverse. Cancer is a disease of the elderly: 61% of cancer diagnoses and 70% of cancer deaths occur in patients above the age of 65. By 2050 there is an expected 99% increase in incidence of cancer in the ethnically diverse population; older ethnically diverse cancer patients will carry 28% of all cancer diagnoses. Among older patients with cancer, 41% experience emotional distress throughout the course of their illness; certain ethnic minority subpopulations may be at greater risk for high levels of distress. Older ethnically diverse cancer patients are significantly underrepresented in the psychosocial oncology literature. In an effort to highlight this gap in the psychosocial oncology literature, we conducted a systematic review of the literature on psychological distress in the geriatric oncology population, ethnic minority oncology populations namely, Blacks and Hispanics. The psychosocial barriers, protective factors and service needs in these populations are reviewed, and the relationship between needs and distress are discussed. It is apparent there is a lack of research aimed at older Black and Hispanic cancer patients; the prevalence and nature of psychological distress and psychosocial needs in this population are unknown. Future research is needed in this understudied area to document the basic information regarding the prevalence and nature of psychological distress in this population.

Comprehensive geriatric assessment (CGA) in older oncological patients: Why and how?

Hans Wildiers, Cindy Kenis — 2011-12-12

Abstract: A Comprehensive Geriatric Assessment (CGA) is the most appropriate method to obtain a view on the general health status of an older individual (including social situation, functionality, falls, cognition, mood changes, nutritional status). There is often limited knowledge among oncologists/healthcare workers on practical aspects of geriatric assessment. Under the auspices of the educational committee of SIOG, a practice guideline was developed with very concrete information on the most frequently used geriatric assessment tools. This guideline is available at the SIOG website, and is meant to become an 'up-to-date' system where healthcare workers can add new evidence or information if required. This editorial also discusses the reasons why oncologists need a geriatric assessment.