Background: Patients with potentially curable esophageal cancer can be treated with neo-adjuvant chemoradiotherapy followed by surgery or definitive chemoradiotherapy with curative intent. For... Show moreBackground: Patients with potentially curable esophageal cancer can be treated with neo-adjuvant chemoradiotherapy followed by surgery or definitive chemoradiotherapy with curative intent. For frail older patients choosing the appropriate oncological treatment can be difficult, and data on geriatric deficits as determinants of treatment outcomes are not yet available. Objectives: To describe the prevalence of geriatric deficits and to study their association with treatment discontinuation and mortality in older patients with potentially curable esophageal cancer. Material and Methods: A cohort study was conducted in a Dutch tertiary care hospital including patients aged >= 70 years with primary stage I-IVA esophageal cancer. Geriatric screening and assessment data were collected. Outcomes were treatment discontinuation and one year all-cause mortality. Results: In total, 138 patients with curable esophageal cancer were included. Mean age was 76.1 years (standard deviation 4.7), 54% had clinical stage III and 24% stage IVA disease. Most patients received neo-adjuvant chemoradiotherapy and surgery (41%), 32% definitive chemoradiotherapy and 22% palliative radiotherapy. Overall, one year all-cause mortality was 36%. Geriatric screening and assessment was performed in 94 out of 138 patients, of which 60% was malnourished, 20% dependent in Instrumental Activities of Daily Living (IADL) and 52% was frail. Malnutrition was associated with higher mortality risk (Hazard Ratio, 3.2; 95% Confidence Interval, 1.3-7.7)) independent of age, sex and tumor stage. Seventy-six out of 94 patients were treated with chemoradiotherapy, of which 23% discontinued treatment. Patients with IADL dependency and Charlson Comorbidity Index >= 1 discontinued treatment more often. Conclusion: All-cause mortality within one year was high, irrespective of treatment modality. Treatment discontinuation rate was high, especially in patients treated with definitive chemoradiotherapy. Geriatric assessment associates with outcomes in older patients with esophageal cancer and may inform treatment decisions and optimization in future patients, but more research is needed to establish its predictive value. Show less
Luttikhuis, H.M.; Blomaard, L.C.; Kaaij, M.A.E. van der; Gombert-Handoko, K.B.; Groot, B. de; Mooijaart, S.P. 2021
Key summary pointsAim To investigate (a) the prevalence and clinical manifestations of Drug-Related Admissions (DRAs) and the drugs responsible for these admissions, (b) to study the association... Show moreKey summary pointsAim To investigate (a) the prevalence and clinical manifestations of Drug-Related Admissions (DRAs) and the drugs responsible for these admissions, (b) to study the association between geriatric characteristics and DRAs and c) to study the predictive performance of geriatric screening instrument for identifying DRAs in older patients presenting to the Emergency Department (ED). Findings DRAs are prevalent in older hospitalized patients. Polypharmacy, ADL dependency and a high ISAR or ISAR-HP score are associated with higher risk for a DRA, but the predictive value of geriatric screeners is insufficient and therefore they cannot be used alone to predict for Drug-Related Hospital Admissions in Emergency Department. Message Geriatric screening instruments are not specific and sensitive enough to use alone for identifying drug-related hospital admissions in older patients in the ED.Purpose Drug-Related Admissions (DRAs) are a well-known problem among older patients in the Emergency Department (ED). The aim of this study was (a) to investigate the prevalence and clinical manifestations of DRAs and the responsible drugs, (b) to study the association between geriatric characteristics and DRAs, and (c) to study the predictive performance of geriatric screeners for identifying DRAs in older ED patients. Methods Patients aged >= 70 hospitalized from the ED were included. Demographics, geriatric characteristics and medications were collected. The the Acutely Presenting Older Patient (APOP)-screener, the Identification of Seniors At Risk (ISAR) and the ISAR-Hospitalized Patients (ISAR-HP) were used as geriatric screeners. Potential DRAs were identified retrospectively, the association between geriatric screeners and DRAs was investigated with logistic regression and the predictive performance was assessed by calculating the Area under the Curve (AUC) of the Receiver Operator Characteristics (ROC). Results The mean age of patients was 78 (IQR 73-83), using an average of 6 medications. Out of 240 admissions, 77 (30%) were classified as a DRA. Independent risk factors for DRAs were polypharmacy (OR 2.42; 95% CI 1.23-4.74) and the ADL dependency (OR 1.23; 95%CI 1.05-1.44). ISAR (OR 3.27; 95%CI 1.60-6.69) and ISAR-HP (OR 1.83; 95% CI 1.02-3.27) associated with increased risk of DRAs, whereas the APOP screener did not (OR 1.56; 95% CI 0.82-2.97). The predictive performance of all geriatric screeners for predicting DRAs was poor (AUC for all screeners < 0.60). Conclusion DRAs are highly prevalent in older ED patients. Polypharmacy, ADL dependency and a high ISAR or ISAR-HP are associated with higher risk for DRAs, but the predictive value of geriatric screeners is insufficient. Show less
Kaaij, M.A.E. van der; Echten-Arends, J. van; Heutte, N.; Meijnders, P.; Abeilard-Lemoisson, E.; Spina, M.; ... ; Grp Etud Lymphomes Adulte 2014
