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3 pages, 183 KiB

Open AccessEditorial

Geriatric Oncology: From Research to Clinical Practice

by Nienke A. de Glas

Cancers 2021, 13(22), 5720; https://doi.org/10.3390/cancers13225720 - 15 Nov 2021

Viewed by 1562

Abstract

The incidence of cancer in older adults is strongly increasing due to the ageing of the population [...] Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

2 pages, 171 KiB

Open AccessEditorial

Geriatric Oncology: From Research to Clinical Practice

by Nienke A. de Glas

Cancers 2020, 12(11), 3279; https://doi.org/10.3390/cancers12113279 - 5 Nov 2020

Cited by 2 | Viewed by 1790

Abstract

The number of older adults with cancer is strongly increasing due to the ageing of Western societies [...] Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

Research

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12 pages, 1102 KiB

Open AccessArticle

Combination of the G-8 Screening Tool and Hand-Grip Strength to Predict Long-Term Overall Survival in Non-Small Cell Lung Cancer Patients Undergoing Stereotactic Body Radiotherapy

by Kristian Kirkelund Bentsen, Olfred Hansen, Jesper Ryg, Ann-Kristine Weber Giger and Stefan Starup Jeppesen

Cancers 2021, 13(13), 3363; https://doi.org/10.3390/cancers13133363 - 5 Jul 2021

Cited by 9 | Viewed by 2562

Abstract

The Geriatric 8 (G-8) is a known predictor of overall survival (OS) in older cancer patients, but is mainly based on nutritional aspects. This study aimed to assess if the G-8 combined with a hand-grip strength test (HGST) in patients with NSCLC treated [...] Read more.

The Geriatric 8 (G-8) is a known predictor of overall survival (OS) in older cancer patients, but is mainly based on nutritional aspects. This study aimed to assess if the G-8 combined with a hand-grip strength test (HGST) in patients with NSCLC treated with stereotactic body radiotherapy can predict long-term OS better than the G-8 alone. A total of 46 SBRT-treated patients with NSCLC of stage T1-T2N0M0 were included. Patients were divided into three groups: fit (normal G-8 and HGST), vulnerable (abnormal G-8 or HGST), or frail (abnormal G-8 and HGST). Statistically significant differences were found in 4-year OS between the fit, vulnerable, and frail groups (70% vs. 46% vs. 25%, p = 0.04), as well as between the normal and abnormal G-8 groups (69% vs. 39%, p = 0.02). In a multivariable analysis of OS, being vulnerable with a hazard ratio (HR) of 2.03 or frail with an HR of 3.80 indicated poorer OS, but this did not reach statistical significance. This study suggests that there might be a benefit of adding a physical test to the G-8 for more precisely predicting overall survival in SBRT-treated patients with localized NSCLC. However, this should be confirmed in a larger study population. Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

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13 pages, 475 KiB

Open AccessArticle

A Prediction Model for Severe Complications after Elective Colorectal Cancer Surgery in Patients of 70 Years and Older

by Esteban T. D. Souwer, Esther Bastiaannet, Ewout W. Steyerberg, Jan Willem T. Dekker, Willem H. Steup, Marije M. Hamaker, Dirk J. A. Sonneveld, Thijs A. Burghgraef, Frederiek van den Bos and Johanna E. A. Portielje

Cancers 2021, 13(13), 3110; https://doi.org/10.3390/cancers13133110 - 22 Jun 2021

Cited by 14 | Viewed by 2840

Abstract

Introduction Older patients have an increased risk of morbidity and mortality after colorectal cancer (CRC) surgery. Existing CRC surgical prediction models have not incorporated geriatric predictors, limiting applicability for preoperative decision-making. The objective was to develop and internally validate a predictive model based [...] Read more.

Introduction Older patients have an increased risk of morbidity and mortality after colorectal cancer (CRC) surgery. Existing CRC surgical prediction models have not incorporated geriatric predictors, limiting applicability for preoperative decision-making. The objective was to develop and internally validate a predictive model based on preoperative predictors, including geriatric characteristics, for severe postoperative complications after elective surgery for stage I–III CRC in patients ≥70 years. Patients and Methods: A prospectively collected database contained 1088 consecutive patients from five Dutch hospitals (2014–2017) with 171 severe complications (16%). The least absolute shrinkage and selection operator (LASSO) method was used for predictor selection and prediction model building. Internal validation was done using bootstrapping. Results: A geriatric model that included gender, previous DVT or pulmonary embolism, COPD/asthma/emphysema, rectal cancer, the use of a mobility aid, ADL assistance, previous delirium and polypharmacy showed satisfactory discrimination with an AUC of 0.69 (95% CI 0.73–0.64); the AUC for the optimism corrected model was 0.65. Based on these predictors, the eight-item colorectal geriatric model (GerCRC) was developed. Conclusion: The GerCRC is the first prediction model specifically developed for older patients expected to undergo CRC surgery. Combining tumour- and patient-specific predictors, including geriatric predictors, improves outcome prediction in the heterogeneous older population. Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

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18 pages, 1678 KiB

Open AccessArticle

Contemporary Analysis of Electronic Frailty Measurement in Older Adults with Multiple Myeloma Treated in the National US Veterans Affairs Healthcare System

by Clark DuMontier, Nathanael R. Fillmore, Cenk Yildirim, David Cheng, Jennifer La, Ariela R. Orkaby, Brian Charest, Diana Cirstea, Sarvari Yellapragada, John Michael Gaziano, Nhan Do, Mary T. Brophy, Dae H. Kim, Nikhil C. Munshi and Jane A. Driver

Cancers 2021, 13(12), 3053; https://doi.org/10.3390/cancers13123053 - 18 Jun 2021

Cited by 17 | Viewed by 2988

Abstract

Electronic frailty indices based on data from administrative claims and electronic health records can be used to estimate frailty in large populations of older adults with cancer where direct frailty measures are lacking. The objective of this study was to use the electronic [...] Read more.

Electronic frailty indices based on data from administrative claims and electronic health records can be used to estimate frailty in large populations of older adults with cancer where direct frailty measures are lacking. The objective of this study was to use the electronic Veterans Affairs Frailty Index (VA-FI-10)—developed and validated to measure frailty in the national United States (US) VA Healthcare System—to estimate the prevalence and impact of frailty in older US veterans newly treated for multiple myeloma (MM) with contemporary therapies. We designed a retrospective cohort study of 4924 transplant-ineligible veterans aged ≥ 65 years initiating MM therapy within VA from 2004 to 2017. Initial MM therapy was measured using inpatient and outpatient treatment codes from pharmacy data in the VA Corporate Data Warehouse. In total, 3477 veterans (70.6%) were classified as frail (VA-FI-10 > 0.2), with 1510 (30.7%) mildly frail (VA-FI-10 > 0.2–0.3), 1105 (22.4%) moderately frail (VA-FI-10 > 0.3–0.4), and 862 (17.5%) severely frail (VA-FI-10 > 0.4). Survival and time to hospitalization decreased with increasing VA-FI-10 severity (log-rank p-value < 0.001); the VA-FI-10 predicted mortality and hospitalizations independently of age, sociodemographic variables, and measures of disease risk. Varying data sources and assessment periods reclassified frailty severity for a substantial portion of veterans but did not substantially affect VA-FI-10’s association with mortality. Our study supports use of the VA-FI-10 in future research involving older veterans with MM and provides insights into its potential use in identifying frailty in clinical practice. Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

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14 pages, 6959 KiB

Open AccessFeature PaperArticle

Octogenarians’ Breast Cancer Is Associated with an Unfavorable Tumor Immune Microenvironment and Worse Disease-Free Survival

by Maiko Okano, Masanori Oshi, Swagoto Mukhopadhyay, Qianya Qi, Li Yan, Itaru Endo, Toru Ohtake and Kazuaki Takabe

Cancers 2021, 13(12), 2933; https://doi.org/10.3390/cancers13122933 - 11 Jun 2021

Cited by 4 | Viewed by 2535

Abstract

Elderly patients are known to have a worse prognosis for breast cancer. This is commonly blamed on their medical comorbidities and access to care. However, in addition to these social issues, we hypothesized that the extreme elderly (octogenarians—patients over 80 years old) have [...] Read more.

Elderly patients are known to have a worse prognosis for breast cancer. This is commonly blamed on their medical comorbidities and access to care. However, in addition to these social issues, we hypothesized that the extreme elderly (octogenarians—patients over 80 years old) have biologically worse cancer with unfavorable tumor immune microenvironment. The Cancer Genomic Atlas (TCGA) and the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) breast cancer cohorts were analyzed. The control (aged 40–65) and octogenarians numbered 668 and 53 in TCGA and 979 and 118 in METABRIC, respectively. Octogenarians had significantly worse breast cancer-specific survival in both cohorts (p < 0.01). Octogenarians had a higher ER-positive subtype rate than controls in both cohorts. Regarding PAM50 classification, luminal-A and -B subtypes were significantly higher in octogenarians, whereas basal and claudin-low subtypes were significantly lower (p < 0.05) in octogenarians. There was no difference in tumor mutation load, intratumor heterogeneity, or cytolytic activity by age. However, the octogenarian cohort was significantly associated with high infiltration of pro-cancer immune cells, M2 macrophage, and regulatory T cells in both cohorts (p < 0.05). Our results demonstrate that octogenarians’ breast cancer is associated with worse survival and with an unfavorable tumor immune microenvironment. Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

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13 pages, 582 KiB

Open AccessArticle

Toxicity, Response and Survival in Older Patients with Metastatic Melanoma Treated with Checkpoint Inhibitors

by Nienke A. de Glas, Esther Bastiaannet, Frederiek van den Bos, Simon P. Mooijaart, Astrid A. M. van der Veldt, Karlijn P. M. Suijkerbuijk, Maureen J. B. Aarts, Franchette W. P. J. van den Berkmortel, Christian U. Blank, Marye J. Boers-Sonderen, Alfonsus J. M. van den Eertwegh, Jan-Willem B. de Groot, John B. A. G. Haanen, Geke A. P. Hospers, Hilde Jalving, Djura Piersma, Rozemarijn S. van Rijn, Albert J. ten Tije, Gerard Vreugdenhil, Michel W. J. M. Wouters, Johanneke E. A. Portielje and Ellen W. Kapiteijn Show full author list Hide full author list

Cancers 2021, 13(11), 2826; https://doi.org/10.3390/cancers13112826 - 5 Jun 2021

Cited by 16 | Viewed by 3200

Abstract

Background: Previous trials suggest no differences in immunotherapy treatment between older and younger patients, but mainly young patients with a good performance status were included. The aim of this study was to describe the treatment patterns and outcomes of “real-world” older patients with [...] Read more.

Background: Previous trials suggest no differences in immunotherapy treatment between older and younger patients, but mainly young patients with a good performance status were included. The aim of this study was to describe the treatment patterns and outcomes of “real-world” older patients with metastatic melanoma and to identify predictors of outcome. Methods: We included patients aged ≥65 years with metastatic melanoma from the Dutch Melanoma Treatment Registry. We described the reasons for hospital admissions and treatment discontinuation. Additionally, we assessed predictors of toxicity and response using logistic regression models and survival using Cox regression models. Results: We included 2216 patients. Grade ≥3 toxicity was not associated with age, comorbidities or WHO status. Patients aged ≥75 discontinued treatment due to toxicity more often, resulting in fewer treatment cycles. Response rates were similar to previous trials (40.3% and 43.6% in patients aged 65–75 and ≥75, respectively, for anti-PD1 treatment) and did not decrease with age or comorbidity. Melanoma-specific survival was not affected by age or comorbidity. Conclusion: Response rates and toxicity outcomes of checkpoint inhibitors did not change with increasing age or comorbidity. However, the impact of grade I-II toxicity on quality of life deserves further study as older patients discontinue treatment more frequently. Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

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18 pages, 13840 KiB

Open AccessArticle

A Serum Metabolomics Classifier Derived from Elderly Patients with Metastatic Colorectal Cancer Predicts Relapse in the Adjuvant Setting

by Samantha Di Donato, Alessia Vignoli, Chiara Biagioni, Luca Malorni, Elena Mori, Leonardo Tenori, Vanessa Calamai, Annamaria Parnofiello, Giulia Di Pierro, Ilenia Migliaccio, Stefano Cantafio, Maddalena Baraghini, Giuseppe Mottino, Dimitri Becheri, Francesca Del Monte, Elisangela Miceli, Amelia McCartney, Angelo Di Leo, Claudio Luchinat and Laura Biganzoli

Cancers 2021, 13(11), 2762; https://doi.org/10.3390/cancers13112762 - 2 Jun 2021

Cited by 14 | Viewed by 3327

Abstract

Adjuvant treatment for patients with early stage colorectal cancer (eCRC) is currently based on suboptimal risk stratification, especially for elderly patients. Metabolomics may improve the identification of patients with residual micrometastases after surgery. In this retrospective study, we hypothesized that metabolomic fingerprinting could [...] Read more.

Adjuvant treatment for patients with early stage colorectal cancer (eCRC) is currently based on suboptimal risk stratification, especially for elderly patients. Metabolomics may improve the identification of patients with residual micrometastases after surgery. In this retrospective study, we hypothesized that metabolomic fingerprinting could improve risk stratification in patients with eCRC. Serum samples obtained after surgery from 94 elderly patients with eCRC (65 relapse free and 29 relapsed, after 5-years median follow up), and from 75 elderly patients with metastatic colorectal cancer (mCRC) obtained before a new line of chemotherapy, were retrospectively analyzed via proton nuclear magnetic resonance spectroscopy. The prognostic role of metabolomics in patients with eCRC was assessed using Kaplan–Meier curves. PCA-CA-kNN could discriminate the metabolomic fingerprint of patients with relapse-free eCRC and mCRC (70.0% accuracy using NOESY spectra). This model was used to classify the samples of patients with relapsed eCRC: 69% of eCRC patients with relapse were predicted as metastatic. The metabolomic classification was strongly associated with prognosis (p-value 0.0005, HR 3.64), independently of tumor stage. In conclusion, metabolomics could be an innovative tool to refine risk stratification in elderly patients with eCRC. Based on these results, a prospective trial aimed at improving risk stratification by metabolomic fingerprinting (LIBIMET) is ongoing. Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

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12 pages, 543 KiB

Open AccessArticle

Improving Care for Spanish-Speaking Older Adults with Breast Cancer: Feasibility, Reliability, and Validity of a Self-Administered Spanish Language Geriatric Assessment

by Enrique Soto-Perez-de-Celis, Jessica Vazquez, Heeyoung Kim, Can-Lan Sun, Kemeberly Charles, Ashley Celis, Vani Katheria, Daneng Li, William Dale and Mina S. Sedrak

Cancers 2021, 13(11), 2685; https://doi.org/10.3390/cancers13112685 - 29 May 2021

Cited by 1 | Viewed by 2598

Abstract

We evaluated the feasibility, reliability, and validity of a Spanish-language self-administered geriatric assessment (GA) in older (age ≥ 65) Spanish-speaking women with breast cancer in the United States. Eligible participants (n = 181) were recruited and randomized. Feasibility was defined as the [...] Read more.

We evaluated the feasibility, reliability, and validity of a Spanish-language self-administered geriatric assessment (GA) in older (age ≥ 65) Spanish-speaking women with breast cancer in the United States. Eligible participants (n = 181) were recruited and randomized. Feasibility was defined as the participant’s unassisted GA completion rate, completion time, and perception on ease of completion. Reliability and validity were assessed using Spearman’s correlation coefficients. Two-sided p < 0.05 was considered significant. Ninety-eight percent of participants (n = 177) completed the GA at least once. Median age was 70 years (range: 65–95) and 55% had ≤8th grade education. Forty-one percent (n = 73) were unable to complete the GA unassisted, median completion time was 28 min (range 8–90), and 77% (n = 136) rated the GA as “easy”/“very easy”. Patients with ≤8th grade education took longer to complete the GA (30 vs. 25 min, p = 0.0036) and needed more assistance (59% vs. 19%, p < 0.001) than those with ≥9th grade education. Test–retest reliability was high (≥0.82) for all domains except social activity (0.73). Validity among similar scales was found. The self-administered GA is a feasible, reliable, and valid tool for Spanish-speaking older women with breast cancer. Tailoring GA tools to the patients’ educational level is important when implementing tools in multicultural environments. Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

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17 pages, 1002 KiB

Open AccessArticle

Quality of Life in Vulnerable Older Patients with Metastatic Colorectal Cancer Receiving Palliative Chemotherapy—The Randomized NORDIC9-Study

by Gabor Liposits, Henrik Rode Eshøj, Sören Möller, Stine Brændegaard Winther, Halla Skuladottir, Jesper Ryg, Eva Hofsli, Carl-Henrik Shah, Laurids Østergaard Poulsen, Åke Berglund, Camilla Qvortrup, Pia Österlund, Bengt Glimelius, Halfdan Sorbye and Per Pfeiffer

Cancers 2021, 13(11), 2604; https://doi.org/10.3390/cancers13112604 - 26 May 2021

Cited by 15 | Viewed by 3961

Abstract

Quality of life data from randomized trials are lacking in older patients with metastatic colorectal cancer (mCRC). In the randomized NORDIC9-study, reduced-dose S1+oxaliplatin (SOx) showed superior efficacy compared to full-dose S1 monotherapy. We hypothesized that treatment with SOx does not result in inferior [...] Read more.

Quality of life data from randomized trials are lacking in older patients with metastatic colorectal cancer (mCRC). In the randomized NORDIC9-study, reduced-dose S1+oxaliplatin (SOx) showed superior efficacy compared to full-dose S1 monotherapy. We hypothesized that treatment with SOx does not result in inferior quality of life. Patients with mCRC aged ≥70 years and that were not a candidate for standard combination chemotherapy were included and randomly assigned to receive either S1 or SOx. The EORTC QLQ-C30 questionnaire was completed at baseline, after 9, and 18 weeks. The primary endpoint was global Quality of Life (QoL) at 9 weeks. For statistical analysis, a non-inferiority design was chosen applying linear mixed effects models for repeated measurements. The results were interpreted according to statistical significance and anchor-based, clinically relevant between-group minimally important differences (MID). A total of 160 patients aged (median (Interquartile range (IQR))) 78 years (76–81) were included. The QLQ-C30 questionnaire was completed by 150, 100, and 60 patients at baseline, at 9, and 18 weeks, respectively. The difference at 9 weeks in global QoL was 6.85 (95%CI—1.94; 15.65) and 7.37 (0.70; 14.05) in the physical functioning domain in favor of SOx exceeding the threshold for MID. At 18 weeks, the between-group MID in physical functioning was preserved. Dose-reduced combination chemotherapy may be recommended in vulnerable older patients with mCRC, rather than full-dose monotherapy. Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

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12 pages, 559 KiB

Open AccessArticle

Brain Tumor Resection in Elderly Patients: Potential Factors of Postoperative Worsening in a Predictive Outcome Model

by Paolo Ferroli, Ignazio Gaspare Vetrano, Silvia Schiavolin, Francesco Acerbi, Costanza Maria Zattra, Marco Schiariti, Matilde Leonardi and Morgan Broggi

Cancers 2021, 13(10), 2320; https://doi.org/10.3390/cancers13102320 - 12 May 2021

Cited by 6 | Viewed by 2208

Abstract

The decision of whether to operate on elderly patients with brain tumors is complex, and influenced by pathology-related and patient-specific factors. This retrospective cohort study, based on a prospectively collected surgical database, aims at identifying possible factors predicting clinical worsening after elective neuro-oncological [...] Read more.

The decision of whether to operate on elderly patients with brain tumors is complex, and influenced by pathology-related and patient-specific factors. This retrospective cohort study, based on a prospectively collected surgical database, aims at identifying possible factors predicting clinical worsening after elective neuro-oncological surgery in elderly patients. Therefore, all patients ≥65 years old who underwent BT resection at a tertiary referral center between 01/2018 and 12/2019 were included. Age, smoking, previous radiotherapy, hypertension, preoperative functional status, complications occurrence, surgical complexity and the presence of comorbidities were prospectively collected and analyzed at discharge and the 3-month follow-up. The series included 143 patients (mean 71 years, range 65–86). Sixty-five patients (46%) had at least one neurosurgical complication, whereas 48/65 (74%) complications did not require invasive treatment. Forty-two patients (29.4%) worsened at discharge; these patients had a greater number of complications compared to patients with unchanged/improved performance status. A persistent worsening at three months of follow-up was noted in 20.3% of patients; again, this subgroup presented more complications than patients who remained equal or improved. Therefore, postoperative complications and surgical complexity seem to influence significantly the early outcome in elderly patients undergoing brain tumor surgery. In contrast, postoperative complications alone are the only factor with an impact on the 3-month follow-up. Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

17 pages, 2057 KiB

Open AccessArticle

Blood Immunosenescence Signatures Reflecting Age, Frailty and Tumor Immune Infiltrate in Patients with Early Luminal Breast Cancer

by Lieze Berben, Asier Antoranz, Cindy Kenis, Ann Smeets, Hanne Vos, Patrick Neven, Giuseppe Floris, Hans Wildiers and Sigrid Hatse

Cancers 2021, 13(9), 2185; https://doi.org/10.3390/cancers13092185 - 2 May 2021

Cited by 4 | Viewed by 2615

Abstract

Background: Immune/senescence-related host factors play a pivotal role in numerous biological and pathological process like aging, frailty and cancer. The assessment of these host factors via robust, non-invasive, and easy-to-measure blood biomarkers could improve insights in these processes. Here, we investigated in a [...] Read more.

Background: Immune/senescence-related host factors play a pivotal role in numerous biological and pathological process like aging, frailty and cancer. The assessment of these host factors via robust, non-invasive, and easy-to-measure blood biomarkers could improve insights in these processes. Here, we investigated in a series of breast cancer patients in which way single circulating biomarkers or biomarker panels relate to chronological age, frailty status, and tumor-associated inflammatory microenvironment. Methods: An extensive panel of blood immune/senescence markers and the tumor immune infiltrate was studied in young, middle-aged, and old patients with an early invasive hormone-sensitive, HER2-negative breast cancer. In the old group, clinical frailty was estimated via the G8-scores. Results: Several three-blood biomarker panels proved to be able to separate old chronological age from young age very efficiently. Clinically more important, several three-blood biomarker panels were strongly associated with clinical frailty. Performance of blood biomarker panels for prediction of the tumor immune infiltrate was lower. Conclusion: Immune/senescence blood biomarker panels strongly correlate with chronological age, and clinically more importantly with frailty status in early breast cancer patients. They require further investigation on their ability to provide a more complete picture on clinical frailty status and direct personalized therapy in older persons. Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

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13 pages, 1262 KiB

Open AccessArticle

Prediction of Other-Cause Mortality in Older Patients with Breast Cancer Using Comorbidity

by Anna Z. de Boer, Esther Bastiaannet, Hein Putter, Perla J. Marang-van de Mheen, Sabine Siesling, Linda de Munck, Kelly M. de Ligt, Johanneke E. A. Portielje, Gerrit Jan Liefers and Nienke A. de Glas

Cancers 2021, 13(7), 1627; https://doi.org/10.3390/cancers13071627 - 1 Apr 2021

Cited by 13 | Viewed by 2498

Abstract

Background: Individualized treatment in older patients with breast cancer can be improved by including comorbidity and other-cause mortality in prediction tools, as the other-cause mortality risk strongly increases with age. However, no optimal comorbidity score is established for this purpose. Therefore, this [...] Read more.

Background: Individualized treatment in older patients with breast cancer can be improved by including comorbidity and other-cause mortality in prediction tools, as the other-cause mortality risk strongly increases with age. However, no optimal comorbidity score is established for this purpose. Therefore, this study aimed to compare the predictive value of the Charlson comorbidity index for other-cause mortality with the use of a simple comorbidity count and to assess the impact of frequently occurring comorbidities. Methods: Surgically treated patients with stages I-III breast cancer aged ≥70 years diagnosed between 2003 and 2009 were selected from the Netherlands Cancer Registry. Competing risk analysis was performed to associate 5-year other-cause mortality with the Charlson index, comorbidity count, and specific comorbidities. Discrimination and calibration were assessed. Results: Overall, 7511 patients were included. Twenty-nine percent had no comorbidities, and 59% had a Charlson score of 0. After five years, in 1974, patients had died (26%), of which 1450 patients without a distant recurrence (19%). Besides comorbidities included in the Charlson index, the psychiatric disease was strongly associated with other-cause mortality (sHR 2.44 (95%-CI 1.70–3.50)). The c-statistics of the Charlson index and comorbidity count were similar (0.65 (95%-CI 0.64–0.65) and 0.64 (95%-CI 0.64–0.65)). Conclusions: The predictive value of the Charlson index for 5-year other-cause mortality was similar to using comorbidity count. As it is easier to use in clinical practice, our findings indicate that comorbidity count can aid in improving individualizing treatment in older patients with breast cancer. Future studies should elicit whether geriatric parameters could improve prediction. Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

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11 pages, 1135 KiB

Open AccessArticle

Prediction of Unplanned Hospitalizations in Older Patients Treated with Chemotherapy

by Jaime Feliu, Enrique Espinosa, Laura Basterretxea, Irene Paredero, Elisenda Llabrés, Beatriz Jiménez-Munárriz, Beatriz Losada, Alvaro Pinto, Ana Belén Custodio, María del Mar Muñoz, Jeniffer Gómez-Mediavilla, María Dolores Torregrosa, Patricia Cruz, Oliver Higuera and María José Molina-Garrido

Cancers 2021, 13(6), 1437; https://doi.org/10.3390/cancers13061437 - 22 Mar 2021

Cited by 11 | Viewed by 2258

Abstract

Purpose: To determine the incidence of unplanned hospitalization (UH) and to identify risk factors for UH in elderly patients with cancer who start chemotherapy. Methods: In all, 493 patients over 70 years starting new chemotherapy regimens were prospectively included. A pre-chemotherapy geriatric assessment [...] Read more.

Purpose: To determine the incidence of unplanned hospitalization (UH) and to identify risk factors for UH in elderly patients with cancer who start chemotherapy. Methods: In all, 493 patients over 70 years starting new chemotherapy regimens were prospectively included. A pre-chemotherapy geriatric assessment was performed, and tumor and treatment variables were collected. The association between these factors and UH was examined by using multivariable logistic regression. Score points were assigned to each risk factor. Results: During the first 6 months of treatment, 37% of patients had at least one episode of UH. Risk factors were the use of combination chemotherapy at standard doses, a MAX2 index ≥1, a Charlson comorbidity score ≥2, albumin level <3.5 g/dL, falls in the past 6 months ≥1, and weight loss >5%. Three risk groups for UH were established according to the score in all patients: 0–1: 17.5%; 2: 34%; and 3–7: 57% (p < 0.001). The area under receiver operation characteristic (ROC) curve was 0.72 (95% CI: 0.67–0.77). Conclusion: This simple tool can help to reduce the incidence of UH in elderly patients with cancer who are scheduled to initiate chemotherapy treatment. Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

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11 pages, 909 KiB

Open AccessArticle

Impact of Androgen Deprivation Therapy Associated to Conformal Radiotherapy in the Treatment of D’Amico Intermediate-/High-Risk Prostate Cancer in Older Patients

by Anne-Laure Couderc, Emanuel Nicolas, Romain Boissier, Mohammed Boucekine, Cyrille Bastide, Delphine Badinand, Dominique Rossi, Benedicte Mugnier, Patrick Villani, Gilles Karsenty, Didier Cowen, Eric Lechevallier and Xavier Muracciole

Cancers 2021, 13(1), 75; https://doi.org/10.3390/cancers13010075 - 29 Dec 2020

Cited by 4 | Viewed by 2032

Abstract

Purpose/objective: The association of 3D Conformal External Beam Radiotherapy (3D-CEBRT) with adjuvant Androgen Deprivation Therapy (ADT) proved to treat patients with intermediate- and high-risk localized prostate cancer (IR and HR). However, older patients were underrepresented in literature. We aimed to report the oncological [...] Read more.

Purpose/objective: The association of 3D Conformal External Beam Radiotherapy (3D-CEBRT) with adjuvant Androgen Deprivation Therapy (ADT) proved to treat patients with intermediate- and high-risk localized prostate cancer (IR and HR). However, older patients were underrepresented in literature. We aimed to report the oncological results and morbidity 3D-CEBRT +ADT in ≥80 years patients. Material and Methods: From June 1998 to July 2017, 101 patients ≥80 years were included in a tertiary center. The median age was 82 years. ADT was initiated 3 months prior 3D-CEBRT in all patients, with a total duration of 6 months for IR prostate cancer (group A; n = 41) and 15 months for HR prostate cancer (group B; n = 60). Endpoints included overall survival (OS), metastasis-free survival (DMFS), biochemical recurrence-free survival (BRFS) and toxicity. Results: Five years-OS was 95% and 86.7% in groups A and B, respectively. Cardiovascular events occurred in 22.8% of ≥80 years patients with no impact on OS. In the multivariate analysis, age <82 years, Karnofsky index and normalization of testosterone levels were significantly associated with better OS. Conclusion: Age ≥80 years should not be a limitation for the treatment of IR and HR prostate cancer patients with 3D-CEBRT and ADT, but cardiovascular monitoring and prevention are mandatory. Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

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Review

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18 pages, 723 KiB

Open AccessReview

Cultural and Ethical Barriers to Cancer Treatment in Nursing Homes and Educational Strategies: A Scoping Review

by Cynthia Filteau, Arnaud Simeone, Christine Ravot, David Dayde and Claire Falandry

Cancers 2021, 13(14), 3514; https://doi.org/10.3390/cancers13143514 - 14 Jul 2021

Cited by 4 | Viewed by 3364

Abstract

(1) Background: The aging of the population, the increase in the incidence of cancer with age, and effective chronic oncological treatments all lead to an increased prevalence of cancer in nursing homes. The aim of the present study was to map the cultural [...] Read more.

(1) Background: The aging of the population, the increase in the incidence of cancer with age, and effective chronic oncological treatments all lead to an increased prevalence of cancer in nursing homes. The aim of the present study was to map the cultural and ethical barriers associated with the treatment of cancer and educational strategies in this setting. (2) Methods: A systematic scoping review was conducted until April 2021 in MEDLINE, Embase, and CINAHL. All articles assessing continuum of care, paramedical education, and continuing education in the context of older cancer patients in nursing homes were reviewed. (3) Results: A total of 666 articles were analyzed, of which 65 studies were included. Many factors interfering with the decision to investigate and treat, leading to late- or unstaged disease, palliative-oriented care instead of curative, and a higher risk of unjustified transfers to acute care settings, were identified. The educational strategies explored in this context were generally based on training programs. (4) Conclusions: These results will allow the co-construction of educational tools intended to develop knowledge and skills to improve diagnostic and therapeutic decision-making, the consistency of care, and, ultimately, the quality of life of older cancer patients in nursing homes. Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

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Cancer and Aging: Two Tightly Interconnected Biological Processes

by Lieze Berben, Giuseppe Floris, Hans Wildiers and Sigrid Hatse

Cancers 2021, 13(6), 1400; https://doi.org/10.3390/cancers13061400 - 19 Mar 2021

Cited by 116 | Viewed by 8615

Abstract

Age is one of the main risk factors of cancer; several biological changes linked with the aging process can explain this. As our population is progressively aging, the proportion of older patients with cancer is increasing significantly. Due to the heterogeneity of general [...] Read more.

Age is one of the main risk factors of cancer; several biological changes linked with the aging process can explain this. As our population is progressively aging, the proportion of older patients with cancer is increasing significantly. Due to the heterogeneity of general health and functional status amongst older persons, treatment of cancer is a major challenge in this vulnerable population. Older patients often experience more side effects of anticancer treatments. Over-treatment should be avoided to ensure an optimal quality of life. On the other hand, under-treatment due to fear of toxicity is a frequent problem and can lead to an increased risk of relapse and worse survival. There is a delicate balance between benefits of therapy and risk of toxicity. Robust biomarkers that reflect the body’s biological age may aid in outlining optimal individual treatment regimens for older patients with cancer. In particular, the impact of age on systemic immunity and the tumor immune infiltrate should be considered, given the expanding role of immunotherapy in cancer treatment. In this review, we summarize current knowledge concerning the mechanistic connections between aging and cancer, as well as aging biomarkers that could be helpful in the field of geriatric oncology. Full article

(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)

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