Introduction: As the population is ageing, the number of older patients with multimorbidity including cancer continues to increase. To improve care for these patients, the European Union-funded... Show moreIntroduction: As the population is ageing, the number of older patients with multimorbidity including cancer continues to increase. To improve care for these patients, the European Union-funded project "Streamlined Geriatric and Oncological evaluation based on IC Technology" (GERONTE) was initiated to develop a new, patientcentred, holistic care pathway. The aim of this paper is to analyse what challenges are encountered in everyday clinical practice according to patients, their informal caregivers, and healthcare professionals as a starting point for the development of the care pathway.Materials and Methods: An expert panel of cancer and geriatrics specialists participated in an online survey to answer what challenges they experience in caring for older patients with multimorbidity including cancer and what treatment outcomes could be improved. Furthermore, in-depth interviews with older patients and their informal caregivers were organised to assess what challenges they experience.Results: Healthcare professionals (n = 36) most frequently mentioned the challenge of choosing the best treatment in light of the lack of evidence in this population and how to handle interactions between the (cancer) treatment and multimorbidities. Twelve patients and caregivers participated, and they most frequently mentioned challenges related to treatment outcomes, such as how to deal with symptoms of disease or treatment and how to maintain quality of life. From the challenges, five main themes emerged that should be taken into account when developing a new care pathway for older patients with multimorbidity including cancer. Two themes focus on decision making aspects such as personalized treatment recommendations and inclusion of nononcologic information, two focus on patient support and monitoring to maintain quality of life and functioning, and one overarching theme addresses care coordination to prevent fragmentation of care.Discussion: In conclusion, the management of older patients with multimorbidity including cancer is complex and although progress has been made on improving aspects of their care, challenges remain and patients are at risk of receiving inappropriate, unnecessary, and potentially harmful treatment. A patient-centred care pathway that integrates solutions to the five main themes and that moves away from a single-disease centred approach is needed. Show less
Brokaar, E.J.; Visser, L.E.; Bos, F. van den; Portielje, J.E.A. 2023
Introduction: Polypharmacy is common in older adults with cancer and is associated with drug related problems (DRPs) and potentially inappropriate medication (PIM). We introduced a medication... Show moreIntroduction: Polypharmacy is common in older adults with cancer and is associated with drug related problems (DRPs) and potentially inappropriate medication (PIM). We introduced a medication optimization care pathway for older adults with advanced cancer and a limited life expectancy and studied the prevalence of DRPs and PIMs as well as the adherence to medication-related recommendations and the patient satisfaction. Materials and Methods: A medication review was performed in patients aged >65 years with polypharmacy and a life expectancy of <24 months. Recommendations on adjustments of medication were discussed in a multidisciplinary team including a pharmacist, an oncologist, and a geriatrician. Implementation of the recommendations was left to the discretion of the oncologist. Four weeks after the implementation, the patient filled a questionnaire to assess satisfaction.Results: One hundred twenty patients were included. The mean age was 75 years and 39% were female. A mean of 12 medications was used. The median number of DRP was 6.0 per patient and median number of PIMs was 3.0 per patient. Overtreatment accounted for 26% of DRP and the most frequently involved drug classes were antihypertensive medication (22%), non-opioid analgesics (22%), and antilipemics (12%). The multidisciplinary team accepted 78% of the recommendations of the pharmacist and the oncologist implemented 54% of the recommendations. Overall, patients were satisfied or very satisfied with the intervention.Discussion: DRPs and PIMs are highly prevalent in this population and can be reduced by a multidisciplinary medication optimization intervention. Patients appreciate the medication optimization intervention and are satisfied with the intervention. Show less
Gans, E.A.; Portielje, J.E.A.; Dekkers, O.M.; Kroon, C.D.D.; Munster, B.C. van; Derks, M.G.M.; ... ; Bos, F. van den 2023
Introduction: Vulvar cancer is a disease that mainly affects older women. Frailty is an important predictor of outcomes and geriatric assessment can help tailor treatment decisions and improve... Show moreIntroduction: Vulvar cancer is a disease that mainly affects older women. Frailty is an important predictor of outcomes and geriatric assessment can help tailor treatment decisions and improve outcomes. This study aims to assess the prevalence of frailty in older women with vulvar cancer, and how it relates to integrated geriatric care and treatment according to the oncological guidelines. Materials and Methods: A single-center cohort study was performed, among patients 70 years and older, who were diagnosed with vulvar cancer at Leiden University Medical Center, between January 2012 and May 2020. Data on geriatric assessment, treatment decision-making and treatment-related outcomes were collected. Results: Our study included 114 patients. Mean age was 79.7 years, and 52 patients (45.6%) were frail. Of the frail patients, 42.0% were referred to a geriatrician. In eight of these cases, the geriatrician was actively involved in weighing the benefit and harm of standard oncological treatment versus de-escalated treatment. Frailty, higher age, impairment in the somatic domain, cognitive impairment, and functional dependency were associated with referral to a geriatrician and with active involvement of a geriatrician in decision making. In 26 of frail patients (50.0%) oncological treatment was de-escalated. Frailty, higher age, impairment in the somatic domain, cognitive impairment, and functional dependency were associated with de-escalation of treatment. De-escalated treatment did not compromise survival. Discussion: Frailty is prevalent among older women with vulvar cancer and is associated with referral to a geriatrician and de-escalation of oncological treatment. While this reflects that it is deemed important to tailor treatment decision for frail patients, most frail patients are not routinely evaluated by a geriatrician. Further multidisciplinary collaboration and research is necessary to optimize tailored treatment decisions for this patient group. Show less
Introduction: To compare the real-world safety profile of programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1) inhibitors between younger and older patients.Materials and... Show moreIntroduction: To compare the real-world safety profile of programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1) inhibitors between younger and older patients.Materials and Methods: All patients receiving pembrolizumab, nivolumab, atezolizumab or durvalumab between September 2016 and September 2019 at Haga Teaching Hospital, The Hague, The Netherlands were included in this retrospective study. Immune-related adverse drug reactions (irADRs) were manually retrieved from the electronic patient files. The cumulative incidence of irADRs were compared between younger (<65 years) and older (>= 65 years) patients using a Pearsons Chi-square test.Results: We identified 217 patients who were treated with at least one dose of PD-(L)1 inhibitor. 58% were 65 years or older at the start of immunotherapy. 183 patients (84.3%) received monotherapy PD-(L)1 inhibitors and 34 (15.7%) received chemo-immunotherapy. A total of 278 irADRs were registered. Cutaneous irADRs (53.9%), thyroid gland disorders (20.3%), and non-infectious diarrhoea/colitis (17.5%) were the most frequently reported irADRs. The majority of the irADRs were mild to moderate and no fatal irADRs were observed. 61 (21.9%) of the irADRs needed systemic treatment, of which 19 (6.8%) required treatment with corticosteroids. 18 irADRs (6.5%) were severe and resulted in hospitalisation.The cumulative incidence of cutaneous irADRs was different between the age groups: 45.7% of the patients <65 years and in 60.0% of the patients >= 65 years (p = 0.036). No statistical difference was found in the cumulative incidence of other irADRs between the two age groups.Discussion: Advanced age is not associated with immune-related adverse drug reactions of PD-1 and PD-L1 inhibitors. Show less
Background: A decade ago, it was demonstrated that the difference in survival between older patients and younger patients with colorectal cancer (CRC) was mainly due to mortality in the first... Show moreBackground: A decade ago, it was demonstrated that the difference in survival between older patients and younger patients with colorectal cancer (CRC) was mainly due to mortality in the first postoperative year. Over the last few years, improvements -especially in perioperative care-have increased survival. The current research investigates whether a survival gap between younger and older patients with CRC still exists on a national level in four European countries. Methods: Population-based data from Belgium, the Netherlands, Norway, and Sweden were collected from patients that underwent surgical resection for primary stage I-III CRC between 2007 and 2016. Relative survival and conditional relative survival (CS), with the condition of surviving the first postoperative year, were calculated for colon and rectal cancer separately, stratified for country and age category (< 65, 65-75, >= 75 years). In addition, relative excess risk of death (RER) was estimated, and one-year excess mortality was calculated. Results: Data of 206,024 patients were analyzed. In general, compared to patients < 65 years, patients >= 75 years had a worse survival during the first year after surgery, which was most pronounced in Belgium (RER colon cancer 2.5 [95% confidence interval (CI) 2.3-2.8] and RER rectal cancer 2.6 [95% CI 2.3-2.9]). After surviving the first year, CS was mostly not statistically different between patients < 65 years and patients >= 75 years with stage I-II, with the exception of stage II colon cancer in Belgium. However, CS remained worse in the largest part of the patients & GE;75 years with stage III colon or rectal cancer (except for rectal cancer in Norway). Conclusions: Although differences exist between the countries, the survival gap between young and older patients is based mainly on early mortality and remains only for stage III disease after surviving the first year. Show less
Hulst, H.C.V.; Dekker, J.W.T.; Bastiaannet, E.; Bol, J.M. van der; Bos, F. van den; Hamaker, M.E.; ... ; Souwer, E.T.D. 2022
Background: For clinical decision making it is important to identify patients at risk for adverse outcomes after co-lorectal cancer (CRC) surgery, especially in the older population. Because the... Show moreBackground: For clinical decision making it is important to identify patients at risk for adverse outcomes after co-lorectal cancer (CRC) surgery, especially in the older population. Because the American College of Surgeons Na-tional Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator is potentially useful in clinical practice, we performed an external validation in a Dutch multicenter cohort of patients >= 70 years undergoing elective non-metastatic CRC surgery.Methods: We compared the ACS NSQIP calculator mean predicted risk to the overall observed rate of anastomotic leakage, return to operation room, pneumonia, discharge not to home, and readmission in our cohort using a one-sample Z-test. Calibration plots and receiver operating characteristic (ROC) curves were used to determine the calculator's performance.Results: Six hundred eighty-two patients were included. Median age was 76.2 years. The ACS NSQIP calculator ac-curately predicted the overall readmission rate (predicted: 8.6% vs. observed: 7.8%, p = 0.456), overestimated the rate of discharge not to home (predicted:11.2% vs. observed: 7.0% p = 0.005) and underestimated the observed rate of all other outcomes. The calibration plots showed poor calibration for all outcomes. The ROC-curve showed an area under the curve (AUC) of 0.75 (95% confidence interval [CI] 0.67-0.83) for pneumonia and 0.70 (0.62-0.78) for discharge not to home. The AUC for all other outcomes was poor.Conclusions: The ACS NSQIP surgical risk calculator had a poor individual risk prediction (calibration) for all out-comes and only a fair discriminative ability (discrimination) to predict pneumonia and discharge not to home. The calculator might be considered to identify patients at high risk of pneumonia and discharge not to home to initiate additional preoperative interventions. (c) 2022 Elsevier Ltd. All rights reserved. Show less
Argillander, T.E.; Hulst, H.C. van der; Zaag-loonen, H.J. van der; Duijvendijk, P. van; Dekker, J.W.T.; Bol, J.M. van der; ... ; Munster, B.C. van 2022
Introduction: Older patients have a higher risk for complications after rectal cancer surgery. Although screening for geriatric impairments may improve risk prediction in this group, it has not... Show moreIntroduction: Older patients have a higher risk for complications after rectal cancer surgery. Although screening for geriatric impairments may improve risk prediction in this group, it has not been studied previously. Methods: We retrospectively investigated patients >= 70 years with elective surgery for non-metastatic rectal cancer between 2014 and 2018 in nine Dutch hospitals. The predictive value of six geriatric parameters in combination with standard preoperative predictors was studied for postoperative complications, delirium, and length of stay (LOS) using logistic regression analyses. The geriatric parameters included the four VMS -questionnaire items pertaining to functional impairment, fall risk, delirium risk, and malnutrition, as well as mobility problems and polypharmacy. Standard predictors included age, sex, body mass index, American Society of Anesthesiologists (ASA)-classification, comorbidities, tumor stage, and neoadjuvant therapy. Changes in model performance were evaluated by comparing Area Under the Curve (AUC) of the regression models with and without geriatric parameters. Results: We included 575 patients (median age 75 years; 32% female). None of the geriatric parameters improved risk prediction for complications or LOS. The addition of delirium risk to the standard preoperative prediction model improved model performance for predicting postoperative delirium (AUC 0.75 vs 0.65, p = 0.03). Conclusions: Geriatric parameters did not improve risk prediction for postoperative complications or LOS in older patients with rectal cancer. Delirium risk screening using the VMS-questionnaire improved risk prediction for delirium. Older patients undergoing rectal cancer surgery are a pre-selected group with few impairments. Geriatric screening may have additional value earlier in the care pathway before treatment decisions are made. Show less
Hamaker, M.E.; Walree, I.C. van; Seghers, P.A.L.; Bos, F. van den; Soubeyran, P.; O'Hanlon, S.; Rostoft, S. 2022
Background: Understanding what information patients want and need is an important step in optimizing care. Therefore, we set out to collect all available evidence about the information that is most... Show moreBackground: Understanding what information patients want and need is an important step in optimizing care. Therefore, we set out to collect all available evidence about the information that is most important to older patients with a new cancer diagnosis and whether or not these information needs are sufficiently addressed.Method: A systematic literature review of Embase and Medline.Results: We included eighteen studies addressing the importance of a range of information topics and studies ad -dressing the sufficiency of information provided. On a scale from 1 to 10, patients ranked information about prognosis and the chance of cure as the most important category (median ranking 10, interquartile range (IQR) 8-10), followed by information on cancer itself (median 9, IQR 5.5-9), and treatment options (median 8, IQR 8-9). In-formation on side-effects of treatment (median 7, IQR 6-8), and practicalities (median 6, IQR 5-7.5) were also considered important. Patients rated information about the practicalities of treatment as the most insufficiently addressed (median 9.5), followed by self-care at home (median 9), and information about prognosis and side-effects (median 8 for both).Conclusion: This systematic review demonstrates that information provision about the cancer itself and about treatment options is generally satisfactory to patients, while information about prognosis, practicalities of treatment and self-care at home could be improved. However, there is significant heterogeneity among older patients regarding which information is most important to them, thus requiring an ongoing dialogue between patients and health care providers about which information is most needed at any given time. (c) 2021 Elsevier Ltd. All rights reserved. Show less
Background: The incidence of metastatic melanoma is increasing in all ages. Multiple trials with targeted drugs and immune checkpoint inhibitors showed improved survival in metastatic melanoma.... Show moreBackground: The incidence of metastatic melanoma is increasing in all ages. Multiple trials with targeted drugs and immune checkpoint inhibitors showed improved survival in metastatic melanoma. However, patients aged >_75 years are often under-represented in clinical trials, therefore raising questions on safety and efficacy of treatment. Patients and methods: We analyzed a real-world cohort of 3054 patients with metastatic melanoma stratified for age (<_65 years, 66-74 years and >_ 75 years), and BRAF status, providing data on treatment strategies, toxicity, and survival. Kaplan Meier curves and Cox Proportional Hazard Models were used to present overall survival (OS) and Melanoma Specific Survival (MSS). Results: Overall, 52.2% of patients were <_ 65 years and 18.4% of patients >_75 years. BRAF mutated tumors were found less often in patients >_75 years: 34.5% versus 65% in patients <_65 years. Patients >_75 years received systemic therapy less frequently compared to their younger counterparts independent of the BRAF status. When receiving treatment, no statistical significant difference in grade 3 or 4 toxicity was observed. Three year Overall Survival rate was 13.7% (9.1-19.3) in patients >_75 years versus 26.7% (23.1-30.4) in patients <_65 years, with a Hazard Ratio (HR) of 1.71 (95%CI 1.50-1.95), p < 0.001. Three year Melanoma Specific Survival was 30.4% (22.0-39.2) versus 34.0% (29.7-38.2), HR 1.26 (95% CI 1.07-1.49), p = 0.005 with an adjusted HR of 1.21 (1.00-1.47), p = 0.049 Conclusion: Patients with metastatic melanoma >_75 years are less frequently treated, but when treated there is no statistical significant increase in toxicity and only a borderline statistical significant difference in Melanoma Specific Survival was seen, compared to younger patients. (c) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/). Show less
Plas-Krijgsman, W.G. van der; Boer, A.Z. de; Jong, P. de; Bastiaannet, E.; Bos, F. van den; Mooijaart, S.P.; ... ; Glas, N.A. de 2021
The number of older patients with breast cancer has increased due to the aging of the general population. The use of a geriatric assessment in this population has been advocated in many studies and... Show moreThe number of older patients with breast cancer has increased due to the aging of the general population. The use of a geriatric assessment in this population has been advocated in many studies and guidelines as it can be used to identify high risk populations for early mortality and toxicity. Additionally, geriatric parameters could predict relevant outcome measures. This systematic review summarizes all available evidence on predictive factors for various outcomes (disease-related and survival, toxicity, and patient-reported outcomes), with a special focus on geriatric parameters and patient-reported outcomes, in older patients with breast cancer. Studies were identified through systematic review of the literature published up to September 1st 2019 in the PubMed database and EMBASe. A total of 173 studies were included. Most studies investigated disease-related and survival outcomes (n = 123, 71%). Toxicity was investigated in 40 studies (23%) and a mere 15% (n = 26) investigated patient-reported outcomes. Various measures that can be derived from a geriatric assessment were predictive for survival endpoints. Furthermore, geriatric parameters were among the most frequently found predictors for toxicity and patient-reported outcomes. In conclusion, this study shows that geriatric parameters can predict survival, toxicity, and patient-reported outcomes in older patients with breast cancer. These findings can be used in daily clinical practice to identify patients at risk of early mortality, high risk of treatment toxicity or poor functional outcome after treatment. A minority of studies used relevant outcome measures for older patients, showing the need for studies that are tailored to the older population.(c) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/). Show less
Souwer, E.T.D.; Bastiaannet, E.; Steyerberg, E.W.; Dekker, J.W.T.; Bos, F. van den; Portielje, J.E.A. 2020
Background: An increasing number of patients with Colorectal Cancer (CRC) is 65 years or older. We aimed to systematically review existing clinical prediction models for postoperative outcomes of... Show moreBackground: An increasing number of patients with Colorectal Cancer (CRC) is 65 years or older. We aimed to systematically review existing clinical prediction models for postoperative outcomes of CRC surgery, study their performance in older patients and assess their potential for preoperative decision making.Methods: A systematic search in Pubmed and Embase for original studies of clinical prediction models for outcomes of CRC surgery. Bias and relevance for preoperative decision making with older patients were assessed using the CHARMS guidelines.Results: 26 prediction models from 25 publications were included. The average age of included patients ranged from 61 to 76. Two models were exclusively developed for 65 and older. Common outcomes were mortality (n = 10), anastomotic leakage (n = 7) and surgical site infections (n = 3). No prediction models for quality of life or physical functioning were identified. Age, gender and ASA score were common predictors; 12 studies included intraoperative predictors. For the majority of the models, bias for model development and performance was considered moderate to high.Conclusions: Prediction models are available that address mortality and surgical complications after CRC surgery. Most models suffer from methodological limitations, and their performance for older patients is uncertain. Models that contain intraoperative predictors are of limited use for preoperative decision making. Future research should address the predictive value of geriatric characteristics to improve the performance of prediction models for older patients. (C) 2020 The Authors. Published by Elsevier Ltd. Show less
Vlies, E. van der; Smits, A.B.; M. los; Hengel, M. van; Bos, W.J.W.; Dijksman, L.M.; ... ; Noordzij, P.G. 2020
Objective: To determine the influence of a preoperative multidisciplinary evaluation for frail older patients with colorectal cancer (CRC) on preoperative decision making and postoperative outcomes... Show moreObjective: To determine the influence of a preoperative multidisciplinary evaluation for frail older patients with colorectal cancer (CRC) on preoperative decision making and postoperative outcomes.Background: Surgery is the main treatment for CRC. Older patients are at increased risk for adverse outcomes. For complex surgical cases, a multidisciplinary team (MDT) approach has been suggested to improve postoperative outcome. Evidence is lacking.Methods: Historical cohort study from 2015 to 2018 in surgical patients >= 70 years with CRC. Frailty screening was used to appraise the somatic, functional and psychosocial health status. An MDT weighed the risk of surgery versus the expected gain in survival to guide preoperative decision making and initiate a prehabilitation program. Primary endpoint was the occurrence of a Clavien-Dindo (CD) Grade III-V complication. Secondary endpoints included the occurrence of any complication (CD II-V), length of hospital stay, discharge destination, readmission rate and overall survival.Results: 466 patients were included and 146 (31.3%) patients were referred for MDT evaluation. MDT patients were more often too frail for surgery compared to non-MDT patients (10.3% vs 2.2%, P = .01). Frailty was associated with overall mortality (aOR 2.6 95% CI 1.1-6.1). Prehabilitation was more often performed in MDT patients (74.8% vs 23.4% in non-MDT patients). Despite an increased risk, MDT patients did not suffer more postoperative complications (CD III-V) than non-MDT patients (14.9% vs 12.4%; P = .48). Overall survival was worse in MDT patients (35 (32-37) vs 48 (47-50) months in non-MDT patients; P < .01).Conclusions: Implementation of preoperative MDT evaluation for frail patients with CRC improves risk stratification and prehabilitation, resulting in comparable postoperative outcomes compared to non-frail patients. However, frail patients are at increased risk for worse overall survival. (C) 2020 Published by Elsevier Ltd. Show less
Bol, N.; Linn, A.J.; Smets, E.M.A.; Verdam, M.G.E.; Weert, J.C.M. van 2020
Introduction: Understanding how information needs of older patients with cancer vary is essential for patient-centered communication. Little research has considered the potential complex patterns... Show moreIntroduction: Understanding how information needs of older patients with cancer vary is essential for patient-centered communication. Little research has considered the potential complex patterns in information needs among older patients with cancer. This study aims to identify profiles of older patients with cancer based on differences in their information needs.Materials and Methods: Two-hundred and twenty-three patients with cancer and survivors aged 70 years or older completed an online survey. Based on an extensive scoping review, we included measures on information needs (i.e., monitoring coping style and type of information needs as measured with QUOTE) and related factors (i.e., psychological distress, ability, motivation, participation in decision making, and demographics). Profiles were identified using k-means duster analysis.Results: Analysis revealed three profiles of older patients with cancer exhibiting differences in monitoring coping style and type of information needs: the so-called "information seeker (38.8%), the "listener (472%), and the "information avoider (14.0%). Besides differences in information needs, the profiles differed on psychological distress (i.e., intrusive thinking, cancer worry, and intolerance of uncertainty), ability (i.e., self-efficacy in interaction with physician), and motivation (i.e., information goals and future time perspective).Discussion: Our findings revealed a nuanced perspective to information needs of older patients with cancer by combining two measurements of information needs with factors contributing to these needs. Clinicians could use these results to increase their awareness of the complexity and heterogeneity of information needs in older patients with cancer and to tailor their information to the needs of older patients. (C) 2020 The Authors. Published by Elsevier Ltd. Show less
Introduction: Approximately 20% of older patients with breast cancer either present with metastatic disease or develop distant metastases after early breast cancer. The aims of this study were to... Show moreIntroduction: Approximately 20% of older patients with breast cancer either present with metastatic disease or develop distant metastases after early breast cancer. The aims of this study were to assess the prevalence of psychosocial problems in older patients with metastatic breast cancer, and to assess longitudinal changes in functional status, psychosocial functioning, and quality of life.Methods: For this prospective cohort study, patients with metastatic breast cancer aged 70 years and older were recruited in four Dutch hospitals. A baseline geriatric assessment was performed evaluating somatic, functional and psychosocial domains. Self-administered questionnaires were performed at baseline, three and six months: the Groningen Activity Restriction Scale, Geriatric Depression Scale. Loneliness scale, Apathy scale, Distress Thermometer and EORTC-QLQ-C30. Longitudinal changes on these scales were assessed by performing crude and adjusted linear mixed models.Results: Of the 100 patients that were included and underwent a geriatric assessment, 85 patients completed the baseline self-administered questionnaires. Almost half of the patients (46%) had depressive symptoms, and up to 64% experienced distress. Apathy was present in 53%, and 36% experienced loneliness. Three- and six-month questionnaires were completed by 77 and 72 patients, respectively. Although a significant increase in loneliness between baseline and six months was seen, this size of this change was not clinically relevant. No other longitudinal changes were found.Conclusion: The prevalence of distress, depressive symptoms, apathy and loneliness in older patients with metastatic breast cancer is high. Timely detection, for which a geriatric assessment is effective, could potentially improve quality of life. (C) 2020 The Authors. Published by Elsevier Ltd. Show less
Pergolotti, M.; Battisti, N.M.L.; Padgett, L.; Sleight, A.G.; Abdallah, M.; Newman, R.; ... ; Ahles, T.A. 2020
Cancer-related cognitive decline (CRCD) may have particularly significant consequences for older adults, impacting their functional and physical abilities, level of independence, ability to make... Show moreCancer-related cognitive decline (CRCD) may have particularly significant consequences for older adults, impacting their functional and physical abilities, level of independence, ability to make decisions, treatment adherence, overall quality of life, and ultimately survival. In honor of Dr. Hurria's work we explore and examine multiple types of screening, assessment and non-pharmacologic treatments for CRCD. We then suggest future research and clinical practice questions to holistically appreciate the complexity of older adults with cancer's experiences and fully integrate the team-based approach to best serve this population. (C) 2019 Elsevier Ltd. All rights reserved. Show less
Souwer, E.T.D.; Oerlemans, S.; Poll-Franse, L.V. van de; Erning, F.N. van; Bos, F. van den; Schuijtemaker, J.S.; ... ; Maas, H.A.A. 2019
Objectives: A significant proportion of patients with pancreatic cancer are over the age of 70 years. The aim was to compare treatment and survival for older patients with pancreatic cancer treated... Show moreObjectives: A significant proportion of patients with pancreatic cancer are over the age of 70 years. The aim was to compare treatment and survival for older patients with pancreatic cancer treated throughout the Netherlands or Moffitt Cancer Center (Tampa, Florida).Methods: All age-eligible patients with pancreatic adenocarcinoma (2008-2012) were identified. Results were stratified by stage. Treatment (neoadjuvant, surgery, adjuvant and palliative treatment) and short-term survival were compared, and where appropriate adjusted (sex, age, grade, year) or stratified according to age or hospital (Netherlands-academic, teaching, non-teaching).Results: In total, 2728 patients were included. Neo-adjuvant chemoradiation was more often administered at Moffitt (non-metastatic stages), as was adjuvant chemoradiation and chemotherapy (p <.001). The proportion surgery was not significantly different. In patients with advanced disease, more patients at Moffitt underwent palliative chemotherapy (64.5% versus 17.4%; p < .001). Short-term survival was better among Moffitt patients (HR 0.30 (95%CI 0.11-0.82), HR 0.56 (0.41-0.72), HR 0.43 (0.36-0.52) for early, T3 or node positive and advanced). Differences were less pronounced comparing Dutch academic hospitals to Moffitt.Conclusion: In the present comparison, a treatment regimen as delivered at Moffitt was associated with prolonged short-term survival. Further detailed analyses of selection criteria for systemic treatment could lead to tailored treatment and improved outcomes. (C) 2019 Elsevier Ltd. All rights reserved. Show less
Bastiaannet, E.; Battisti, N.; Loh, K.P.; Glas, N. de; Soto-Perez-de-Celis, E.; Baldini, C.; ... ; Lichtman, S. 2019
Malignant melanoma is an aggressive cancer associated with a poor prognosis in patients with metastatic disease. As in many other cancers, the incidence of melanoma rises with age; and combined... Show moreMalignant melanoma is an aggressive cancer associated with a poor prognosis in patients with metastatic disease. As in many other cancers, the incidence of melanoma rises with age; and combined with the longer life expectancy, this led to an increasing prevalence of melanoma in the older population. Recently, immune checkpoint inhibitors significantly improved the treatment of melanoma given their efficacy and tolerability profile. Two major classes of agents include the anti-cytotoxic T lymphocyte-associated protein 4 (CFLA-4) inhibitors, such as ipilimumab, and the anti-programmed death-ligand 1 (PD-1) inhibitors, such as nivolumab and pembrolizumab. Treatment of metastatic disease with immune checkpoint inhibitors demonstrated improved efficacy and better safety profiles compared to cytotoxic drugs and appears to be an attractive treatment option. Nevertheless, there is a need for tools designed to better predict which older patients will benefit from its use and who will experience toxicities related to the treatment. Current data do not show a major increase in toxicity rates in older patients. However, patients above 75 are often under-represented and those who are included are not representative of the general population of older patients, thereby also stressing the need for real-life data. Ongoing research is aiming at maximizing the potential treatment efficacy and developing novel immune-targeting modalities. Future studies should include older patients and assess geriatric domains in these older patients to better guide decision-making. This review discusses published clinical trials and where known, the efficacy and toxicity in older patients. Moreover, the clinical implications and future perspectives are discussed, with current recommendations for older patients, management of toxicities, and a proposal for an initial approach to the treatment of older patients with metastatic melanoma. (C) 2018 Elsevier Ltd. All rights reserved. Show less
