Importance Although older patients are at increased risk of developing grade 3 or higher chemotherapy-related toxic effects, no studies, to our knowledge, have focused on the association between... Show moreImportance Although older patients are at increased risk of developing grade 3 or higher chemotherapy-related toxic effects, no studies, to our knowledge, have focused on the association between toxic effects and quality of life (QOL) and physical functioning.Objective To investigate the association between grade 3 or higher chemotherapy-related toxic effects and QOL and physical functioning over time in older patients.Design, Setting, and Participants In this prospective, multicenter cohort study, patients aged 70 years or older who were scheduled to receive chemotherapy with curative or palliative intent and a geriatric assessment were included. Patients were treated with chemotherapy between December 2015 and December 2021. Quality of life and physical functioning were analyzed at baseline and after 6 months and 12 months.Exposures Common Terminology Criteria for Adverse Events grade 3 or higher chemotherapy-related toxic effects.Main Outcomes and Measures The main outcome was a composite end point, defined as a decline in QOL and/or physical functioning or mortality at 6 months and 12 months after chemotherapy initiation. Associations between toxic effects and the composite end point were analyzed with multivariable logistic regression models.Results Of the 276 patients, the median age was 74 years (IQR, 72-77 years), 177 (64%) were male, 196 (71%) received chemotherapy with curative intent, and 157 (57%) had gastrointestinal cancers. Among the total patients, 145 (53%) had deficits in 2 or more of the 4 domains of the geriatric assessment and were classified as frail. Grade 3 or higher toxic effects were observed in 94 patients (65%) with frailty and 66 (50%) of those without frailty (P = .01). Decline in QOL and/or physical functioning or death was observed in 76% of patients with frailty and in 64% to 68% of those without frailty. Among patients with frailty, grade 3 or higher toxic effects were associated with the composite end point at 6 months (odds ratio [OR], 2.62; 95% CI, 1.14-6.05) but not at 12 months (OR, 1.09; 95% CI, 0.45-2.64) and were associated with mortality at 12 months (OR, 3.54; 95% CI, 1.50-8.33). Toxic effects were not associated with the composite end point in patients without frailty (6 months: OR, 0.76; 95% CI, 0.36-1.64; 12 months: OR, 1.06; 95% CI, 0.46-2.43).Conclusions and Relevance In this prospective cohort study of 276 patients aged 70 or older who were treated with chemotherapy, patients with frailty had more grade 3 or higher toxic effects than those without frailty, and the occurrence of toxic effects was associated with a decline in QOL and/or physical functioning or mortality after 1 year. Toxic effects were not associated with poor outcomes in patients without frailty. Pretreatment frailty screening and individualized treatment adaptions could prevent a treatment-related decline of remaining health. Show less
Straten, B. van; Heiden, D.R. van der; Robertson, D.; Riekwel, C.; Jansen, F.W.; Elst, M. van der; Horeman, T. 2021
Introduction: Hospitals in the Netherlands generate approximately 1.3 million kg of waste from the polypropylene (PP) wrapping paper (WP) used to wrap surgical instruments each year. The aim of... Show moreIntroduction: Hospitals in the Netherlands generate approximately 1.3 million kg of waste from the polypropylene (PP) wrapping paper (WP) used to wrap surgical instruments each year. The aim of this study was to develop a method to recycle WP waste into new medical devices.Methods: WP was recovered from Maasstad Hospital, Netherlands. The WP was melted into bars, granulated, and mixed with virgin material at different ratios and temperatures. Dog bones were injection-molded from volume (v.%) virgin, mixed (%R), and recycled (100%R) granulate, and a tensile testing machine was used to compare the material properties before and after ten disinfection cycles at the sterilization department. Then, 25 instrument openers were made from the 50%R material and circulated for four weeks.Results: The data indicated no significant differences in the mechanical properties at different melting temperatures. For dog bones made from the 100%R, 50%R, and virgin granulate, the Young's moduli were 1021 (SD13), 879 (SD13), and 795 (SD14) MPa, and the strains were 8%, 12%, and 14%. Ten disinfection cycles did not significantly change the material properties. After one month, the openers did not show any deterioration or damage other than surface scratches.Discussion: The results indicated that the initial WP melting temperature did not influence the mechanical properties. Although devices could be produced directly from the recycled WP granulate, increasing the recycled granulate in the mix ratio increased the strength and brittleness.Conclusions: It is feasible to recycle WP waste into a high-quality raw material for the injection molding of medical devices without using additives. This would allow hospitals to become more compliant with the circular economy enabling economically viable and circular processes that positively contribute to cleaner technical processes, sustainable products, and the reduction of medical waste. Show less
Opstal, A.M. van; Akintola, A.A.; Elst, M. van der; Westendorp, R.G.; Pijl, H.; Heemst, D. van; Grond, J. van der 2017
