Care For Older Cancer Patients Research Articles

Examining provider perceptions and practices for comprehensive geriatric assessment among cancer survivors: a qualitative study with an implementation science focus.

Introduction: Cancer rates increase with age, and older cancer survivors have unique medical care needs, making assessment of health status and identification of appropriate supportive resources key to delivery of optimal cancer care. Comprehensive geriatric assessments (CGAs) help determine an older person's functional capabilities as cancer care providers plan treatment and follow-up care. Despite its proven utility, research on implementation of CGA is lacking. Methods: Guided by a qualitative description approach and through interviews with primary care providers and oncologists, our goal was to better understand barriers and facilitators of CGA use and identify training and support needs for implementation. Participants were identified through Cancer Prevention and Control Research Network partner listservs and a national cancer and aging organization. Potential interviewees, contacted via email, were provided with a description of the study purpose. Eight semi-structured interviews were conducted via Zoom, recorded, and transcribed verbatim by a professional transcription service. The interview guide explored providers' knowledge and use of CGAs. For codebook development, three representative transcripts were independently reviewed and coded by four team members. The interpretive process involved reflecting, transcribing, coding, and searching for and identifying themes. Results: Providers shared that, while it would be ideal to administer CGAs with all new patients, they were not always able to do this. Instead, they used brief screening tools or portions of CGAs, or both. There was variability in how CGA domains were assessed; however, all considered CGAs useful and they communicated with patients about their benefits. Identified facilitators of implementation included having clinic champions, an interdisciplinary care team to assist with implementation and referrals for intervention, and institutional resources and buy-in. Barriers noted included limited staff capacity and competing demands on time, provider inexperience, and misaligned institutional priorities. Discussion: Findings can guide solutions for improving the broader and more systematic use of CGAs in the care of older cancer patients. Uptake of processes like CGA to better identify those at risk of poor outcomes and intervening early to modify treatments are critical to maximize the health of the growing population of older cancer survivors living through and beyond their disease.

Spirituality, altruism, and resilience of older patient’s informal caregivers: investigating the moderating effect of the context of care in Pakistan

ABSTRACT Ageing causes complications, especially with chronic diseases like cancer. Long-term care for older cancer patients causes care burden. Resilience factors are essential for coping with adversity. The current study sought to establish a relationship between spirituality and altruism as predictor variables of caregiver resilience and context of care as a moderating variable. The study was conducted using quantitative research design. Data was collected from 305 family caregivers from four hospitals using convenient sampling techniques. By using Model 1 in PROCESS Macro, the results indicated spirituality and altruism have positive and significant effects on caregiver resilience within the context of care as a moderating variable.

Cell cycle arrest: A breakthrough in the supportive care of older cancer patients.

Age is a major risk factor for the acute and chronic complications of cancer chemotherapy. The current approach to the prevention of these complications is reactive and involves the reduction of the doses and the delay of treatment which may compromise the outcome. There is a limited number of antidotes to chemotherapy toxicity and these have complications of their own. Oldest old and frail patients are mostly excluded from life saving cancer treatment due to the risk of severe and even lethal complications. molecular biology has revealed that different checkpoints control the proliferative cycle of normal and neoplastic cells. Two new drugs, Trilaciclib and ALRN-6924 may cause a temporary cell cycle arrest (CCA) of normal cells without blocking the proliferation of the neoplastic ones and render the normal cells temporarily invulnerable to the toxicity of chemotherapy. We reviewed the publications related to these drugs on the Medline, the published drug information and the presentations to major medical conferences. In three randomized controlled phase II trials Trilaciclib proved effective in preventing neutropenia, thrombocytopenia and anemia in patients with non small cell lung cancer with non proficient RB1 gene. Forty-five percent of patients were 65 and older and age did not prevent the effectiveness of the drug. Trilaciclib was approved by the FDA for the management of these patients. ALRN-6924 appeared promising in preventing myelotoxicity in patients whose cancer had deleted or mutated TP53, but failed to show any significant activity in a randomized controlled study. The development of this drug is now on hold CONCLUSIONS: CCA is a novel proactive approach to the toxicity of chemotherapy of special interest to older patients. At the very least it may prevent all forms of myelotoxicity with a single agent, obviating the risk and cost of polypharmacy. It allows to avoid the complications of myelopoietic growth factors which include severe pain, stem cell competition, bone marrow exhaustion, and hematological malignancies. It may allow the treatment of frail patients with full chemotherapy doses. It is also reasonable to expect that may complications other common and sometimes lethal complications of chemotherapy such as stomatitis, esophagitis, diarrhea and dehydration.

Updated International Society of Geriatric Oncology COVID-19 working group recommendations on COVID-19 vaccination among older adults with cancer

Updated International Society of Geriatric Oncology COVID-19 working group recommendations on COVID-19 vaccination among older adults with cancer

Attitudes of oncology nurses regarding ageism.

Ageism is reported to have negative impacts on older cancer patients' health and wellbeing. Nurses' attitudes to ageism influence the quality of care of older cancer patients and the prognosis of the disease. The aim of this descriptive and quantitative study was to determine oncology nurses' attitudes regarding ageism. Data were collected online by using a sociodemographic and clinical features form developed in light of the literature and the Ageism Attitude Scale. The data collection tools were filled in by 237 oncology nurses between June and September in 2020. Obtained data were analyzed with mean, standard deviation, numbers, percentages, independent samples t-test, one-way analysis of variance, and Pearson's correlation analysis. The mean score of the oncology nurses on the Ageism Attitude Scale was 87.76 ± 9.22 (ranging from 63 to 111), and their attitudes to old age were positive. The mean scores of the nurses on the subscales were as follows: 37.45 ± 4.69 for restricting life of the elder, 30.05 ± 5.27 for positive discrimination, and 20.30 ± 4.58 for negative discrimination. Also, 75.94% of the nurses experienced difficulty in offering care to older patients. The mean score of the nurses on the Ageism Attitude Scale significantly differed in terms of age, duration of work experience, staying with older people, and financial status (p < 0.05). The study revealed that the oncology nurses generally had positive attitudes to older people. Incorporation of geriatrics related topics into both undergraduate education and in-service training could help to maintain positive attitudes to older people and prevent unfavorable attitudes to them. It can also be recommended that attitudes of health professionals to ageism should be evaluated by older people in further studies.

Association of Physician Referrals with Timely Cancer Care Using Tumor Registry and Claims Data.

More Americans are being screened for and more are surviving colorectal cancer due to advanced treatments and better quality of care; however, these benefits are not equitably distributed among diverse or older populations. Differential care delivery outcomes are driven by multiple factors, including access to timely treatment that comes from high-quality care coordination. Providers help ensure such coordinated care, which includes timely referrals to specialists. Variation in referrals between providers can also result in differences in treatment plans and outcomes. Patients who are more often referred between the same diagnosing and treating providers may benefit from more timely care compared to those who are not. Our objective is to examine patterns of referral, or patient-sharing networks (PSNs), and our outcome, treatment delay of 30-days (yes/no). We hypothesize that if a patient is in a PSN they will have lower odds of a 30-day treatment initiation delay. Our observational population-based analysis using the National Cancer Institute (NCI)-linked tumor registry and Medicare claims database includes records for 27,689 patients diagnosed with colorectal cancer from 2001 to 2013, and treated with either chemotherapy, radiotherapy, or surgery. We modeled the adjusted odds of a delay and found 17.04% of patients experienced a 30-day delay in initial treatment. Factors that increased odds of a delay were lack of membership in a PSN (adjusted odds ratio [AOR]: 2.20; 95% confidence interval [CI]: 1.71–2.84), racial/ethnic minority status, and having multiple comorbidities. Provider characteristics significantly associated with greater odds of a delay were if dyads were not in the same facility (AOR: 1.95; 95% CI: 1.81–2.10), if providers were different genders, most notably male (diagnosing) and female (treating) [AOR: 1.23; 95% CI: 1.08–1.40, p = 0.0015]. PSNs appear to be associated with reduced of a care delay. The associations observed in our study address the demand for developing multilevel interventions to improve the delivery and coordination of high-quality of care for older cancer patients.

Perceptions of Behavioral Awareness, Intention, and Readiness for Advance Care Planning: A Mixed-Method Study among Older Indigenous Patients with Late-Stage Cancers in Remote Areas of Eastern Taiwan.

The first Patient Right to Autonomy Act enacted in Asia in 2019 has enabled every Taiwanese citizen to plan for his/her end-of-life (EOL) in case of incompetency. Advance care planning (ACP) has been highly promoted for individuals with terminal, life-threatening illnesses, particularly in the mainstream society, and efforts have been made by the Taiwanese government to train health care providers in order to optimize patients’ quality of dying. However, such advanced decisions and discussions regarding life-sustaining treatment and EOL care remain scarce among older ethnically minority patients. A multiple-case study employing a mixed-method (n = 9) was undertaken to explore indigenous patients’ ACP perceptions. Both quantitative and qualitative information was obtained from indigenous patients, a minority group whose socio-economic and educational status are different from the general Taiwanese population. An initiative was made to describe ACP behavioral awareness, intention, and readiness of older terminal patients from four tribes with seven late-stage cancers in remote, mountainous areas of eastern Taiwan. Our findings showed that according to the Transtheoretical Model, terminal indigenous patients’ ACP readiness was at a precontemplation stage. Their lack of fundamental ACP awareness, insufficient healthcare resources, life-sustaining value in a Christian faith context, and the prevalent health disparity in the remote communities have negatively affected indigenous patients’ intention to participate in ACP. We provide suggestions to further promote ACP in this group and suggest that health information should be tailored at various readiness stages in order to overcome barriers and decrease ACP literacy discrepancies. This study calls attention to an understudied area of ACP behaviors, an overlooked need in EOL care for older cancer patients of unique cultural backgrounds, and the imperativeness to ensure cultural minority group’s EOL care is consistent with patients’ preferences.

Clinical Communication Within Hospital Pharmacy Practice: Exploring Pharmaceutical Oncological Consultations

ABSTRACT This exploratory study aimed to identify communication trends typical of pharmacists’ clinical communication in the context of hospital consultations. A cross-sectional design was used to investigate the pharmacist-patient exchange, applying the Roter Interaction Analysis System (RIAS). Communication variables and RIAS composites were assessed, including therapeutic information complexity, estimated through the ad-hoc score CTICS (Cancer Therapy Information Complexity Score). The study comprised 13 consultations of cancer patients with one female pharmacist, of which 6 included a patient family member, lasting on average 22.74 minutes and presenting repeated or overlapping consultation phases. The pharmacist’s talk dominance reached 53.49%, slightly higher in dyadic consultations (U = 6.0, p = .032), and with an overall predominance of closed-ended questioning (W = 81.0, p = .013). Patients’ questioning on biomedical issues was higher in dyadic consultations. The level of the pharmacist’s rapport-building with the relative was higher when the patient’s age was ≥80 years. Several strong correlations, both positive and negative, were found between composites, including between patient positive rapport-building and relative lifestyle/psychosocial information giving (Rho = −0.971, p = .001). Pharmaceutical consultations seem to be lengthier than other hospital practitioners’ interviews, indicating a lack of clear organization and flow, thus challenging their efficiency regarding therapy management. Still, several positive communication features were found regarding the pharmaceutical care of older cancer patients. Further studies are needed, involving larger samples and other hospital consultation settings.

The role of family confidants and caregivers in the care of older cancer patients: Extending the concept of "shared decision-making".

Background and aimsFamily caregivers play an important role in assisting their family members with cancer, but their influence on the treatment decision‐making process has not yet been adequately investigated. This exploratory study approached this topic via reconstructive methodology, focusing on assessing patient‐caregiver relationships.MethodsWe conducted semi‐structured interviews with 37 mostly elderly cancer patients (median age: 74 years) about the context of their diagnosis, treatment decision, and family support. Additionally, we interviewed 34 caregivers of cancer patients. Of these, 25 were related to patients interviewed. We analyzed the interviews via a multi‐step coding method informed by Grounded Theory methodology toward characterizing patient‐caregiver relationships, the treatment decision‐making process, and the caregivers' role therein.ResultsIn the majority of cases (86%), patients were being supported by caregivers. We categorized patient‐caregiver relationships in regards to the caregivers' involvement in the therapy decision‐making process. We found patient‐caregiver interaction patterns that indicate the potential of caregivers to decidedly influence the therapy decision‐making process. Yet, only in 38% of cases, a caregiver attended relevant patient‐physician‐consultations.ConclusionDepending on the nature of the patient‐caregiver relationship, the traditional concept of shared decision‐making, which assumes a dyadic relationship, needs to be extended toward a more dynamic concept in which caregivers should be involved more frequently. This could enable physicians to better understand a patient's reasons for or against a therapy proposal and ensure that the patient's wishes are communicated and considered. On the other hand, strong caregiver‐involvement bears risks of over‐stepping elderly patients' wishes, thus violating patient autonomy.

Nurses' perceptions of care quality for older patients suffering cancer in acute care settings: A descriptive study.

To describe the quality of care for older cancer patients in acute care settings as perceived by the responsible nursing staff. A cross-sectional study design was used. Data were collected using a questionnaire completed by 90 nursing staff at a university hospital and a city hospital. Quality of care was measured using the Revised Humane Caring Scale. Descriptive statistics, reliability analysis, nonparametric tests and linear regression analysis were used to analyse the data. Generally, the nursing staff perceived the quality of care as good; however, university hospital nursing staff perceived the quality of care to be better than city hospital nursing staff. Compared with other age groups, nursing staff in the 30- to 40-year age group more frequently indicated that patients' information and participation need improvement. Moreover, supplemental education in cancer care was found to have no significant impact on the quality of care. Altogether, nursing staff disagreed the most about their perceptions of staffing, sufficient time and an unhurried atmosphere. Nursing staff should focus more on patients' personal needs, particularly with regard to patients' provision of information and participation in care. Younger nurses need more support and mentoring about complex care from their experienced colleagues when performing their work. Leaders should guarantee availability of the adequate number of competent staff in hospital wards.

The care of older cancer patients in the United Kingdom.

The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area. Older cancer patients are at a higher risk of both under- and over-treatment. Therefore, the assessment of a patient’s biological age and effective organ functional reserve becomes paramount. This may then guide treatment decisions by better estimating a prognosis and the risk-to-benefit ratio of a given therapy to anticipate and mitigate against potential toxicities/difficulties. Moreover, older cancer patients are often affected by geriatric syndromes and other issues that impact their overall health, function and quality of life. Comprehensive geriatric assessments offer an opportunity to identify and address health problems which may then optimise one’s fitness and well-being. Whilst it is widely accepted that older cancer patients may benefit from such an approach, resources are often scarce, and access to dedicated services and research remains limited to specific centres across the UK. The aim of this project is to map the current services and projects in the UK to learn from each other and shape the future direction of care of older patients with cancer.

Geriatric interventions in the older with cancer based on comprehensive geriatric assessment. Optimization areas: what the geriatrician can contribute to the multidisciplinar team

The ageing of the world population, the early detection of some types of tumours, and the increasing survival rates demand/claim a change of model in the specific care of older cancer patient. According to recent data, it is estimated that there will be 29.5 million patients with cancer in 2040, more than 50% of them over 65 years. Most cancer-related deaths and survivorships also belong to this group of age. In this context, the multidisciplinary management of these processes and the development of oncogeriatric oncology become more relevant, both in the decision-making process and in the planning of interventions that affect oncological treatment outcomes and patients' survival, autonomy and quality of life. The evaluation by a geriatrician identifies vulnerability areas using the comprehensive geriatric assessment (CGA) as the key tool, leading us to detect problems that are unidentified by the Eastern Cooperative Oncology Group Performance Status (ECOG) or the Karnofsky index (IK) and bringing us valuable information, essential in the decision-making process. I To conclude, the evaluation by a geriatrician allows to identify impairments, classify the elderly, uncover vulnerability and intervene on it, and predict treatment-related toxicity and mortality, taking part on the decision making process. The CGA offers the possibility to apply a tailored treatment according to the characteristics of each patient. Investigation is necessary in order to get specific evidence to adapt care models working in a multidisciplinary way. Therefore, the collaboration between the different specialists that are involved in the care of cancer elderly patient is essential.

Impact of travel time on healthcare costs and resource utilization by phase of care for older cancer patients.

6560 Background: Closures of hospitals and clinics may have unintended consequences, including increasing patient travel time. Increased patient travel time to healthcare facilities has the potential to adversely impact patient outcomes. Limited data exist on the impact of travel time on healthcare costs and resource utilization. Methods: This retrospective cohort study from 2012-2015 evaluated drive time to cancer care site for Medicare beneficiaries age ≥ 65 in the Southeastern US. The primary outcome was Medicare spending by phase of care (initial, survivorship, end of life [EOL]). Secondary outcomes included resource utilization measured by hospitalization rates, hospitalization sites, intensive care unit (ICU) admissions, and chemotherapy-related hospitalization rates. Hierarchical linear models with patients clustered within cancer care site and adjusted for pertinent covariates were used to determine the effects of drive time on average monthly phase-specific Medicare spending. Results: Median drive time was 32 minutes (IQR 18-59) for the 23,382 included Medicare beneficiaries, with 24% of patients driving &gt; 1 hour to their cancer care site. During the initial phase of care, Medicare spending was 14% higher for patients traveling &gt; 1 hour than those traveling ≤ 30 minutes.Hospitalizationrates were 4-13% higher for patients traveling &gt; 1 hour vs. ≤ 30 minutes in the initial (61 vs. 54), survivorship (27 vs. 26), and EOL (310 vs. 86) phases of care (all p &lt; .05). The majority of patients traveling &gt; 1 hour were hospitalized at a local hospital rather than at their cancer care site, whereas the converse was true for patients traveling ≤ 30 minutes. Conclusions: As healthcare locations close, patients living farther from treatment sites may experience more limited access to care, and healthcare spending could increase for Medicare.

Fitness scale-4 item (FS4) to predict six-month postoperative mortality of cancer patients aged 75.

11542 Background: We have been prospectively collecting Geriatric Assessment (GA) data on patients aged 75+ undergoing oncologic surgery at a single institution. We aimed to to determine if a fitness scale based on a limited number of easily captured datafields can be developed, validated, and associated with 6 month postoperative mortality. Methods: From patients referred to Memorial Sloan Kettering (MSK) Geriatrics Service for preoperative GA since 2015, we have selected patients who were aged 75+, had elective surgery, with hospital length of stay (LOS) of ≥1 day, and had at least 6-month follow up. The Fitness Scale-4 item (FS4) is composed of 3 variables from the GA; Karnofsky Performance Scale (KPS), ability to walk outside, ability to perform housekeeping, and additional variable of preoperative albumin level. The FS4 total score ranges from 0-8 (frail = 0-2, vulnerable = 3-5, and fit = 6+). We validated this scale against prevalence of geriatric syndromes in each fitness category. We performed multivariable regression (MVR) analysis to assess the odds of six-month postoperative mortality among vulnerable and frail patients vs. fit patients. Results: Out of 1270 patients (median age 79, IQR 77-83), 792 (61.4%), 327 (25.7%) and 151 (11.9%) were fit, vulnerable, and frail, respectively. All of the geriatric syndromes were more prevalent among frail and vulnerable patients than fit patients. Six-month mortality rate was 4.7%, 12.5%, and 21.2% for fit, vulnerable, and frail patients, respectively. In the MVR analysis, and after adjustment for age, gender, ASA PS, LOS, operation time, KPS, and preoperative albumin, the odds of six-month mortality among frail (OR = 4.58, p = 0.004) and vulnerable patients (OR = 2.63, p = 0.004) vs. fit patients were much higher. Conclusions: Frail and vulnerable patients based on FS4 are at significantly higher risk for six-month postoperative mortality vs. fit patients. Future studies should assess the external validation of FS4, and its impact on surgical decision making, and perioperative care of older cancer patients.

Aggressive Care near the End of Life for Cancer Patients in Medicare Accountable Care Organizations.

To compare aggressiveness of end-of-life (EoL) care for older cancer patients attributed to Medicare Shared Savings Programs with that for similar fee for service (FFS) beneficiaries not in an accountable care organization (ACO) and examine whether observed differences in EoL care utilization vary across markets that differ in ACO penetration. Cross-sectional observational study comparing ACO-attributed beneficiaries with propensity score-matched beneficiaries not attributed to an ACO. A total of 21 hospital referral regions (HRRs) in the United States. Medicare FFS beneficiaries with a cancer diagnosis who were 66 years or older and died in 2013-2014. Outcome measures were claims-based quality measures of aggressive EoL care: (1) one or more intensive care unit (ICU) admissions in the last month of life, (2) two or more hospitalizations in the last month of life, (3) two or more emergency department visits in the last month of life, (4) chemotherapy 2 weeks or less before death, and (5) no hospice enrollment or hospice enrollment within 3 days of death. Analyses were adjusted for demographic and clinical characteristics of beneficiaries and practice characteristics. Compared with beneficiaries not in an ACO, ACO-attributed beneficiaries had a higher rate of ICU admission during the last month of life (37.7% vs 34.0%; adjusted difference = +2.8 percentage points; 95% confidence interval (CI) = 1.0-4.6) but fewer repeated hospitalizations (14.5% vs 15.2%; adjusted difference = -1.7 percentage points; CI = -3.1 to -.3). Other measures did not differ for the two groups. Although the ICU admission rates tended to decrease as ACO-penetration rates increased (P < .01), ACO patients had higher rates of ICU admission than non-ACO patients in both medium and high ACO-penetration HRRs. Cancer patients attributed to ACOs had fewer repeated hospitalizations but more ICU admissions in the last month of life than non-ACO patients; they had similar rates of other measures of aggressive care at the EoL. This suggests opportunities for ACOs to improve EoL care for cancer patients. J Am Geriatr Soc 67:961-968, 2019.

Impact of travel time on hospitalizations and patient cost responsibility by phase of care for older patients with cancer.

37 Background: Healthcare reimbursement changes are contributing to increased closures of community hospitals and oncology practices, which may lead cancer patients to travel greater distances for care. Limited data exists on the impact of travel time on hospitalization rates and patient cost responsibility by phase of care for older cancer patients. Methods: This was a secondary analysis of Medicare claims from 2012-2015 for cancer patients age ≥65 receiving care in the University of Alabama at Birmingham Cancer Community Network. Patient addresses were obtained from network data, hospitalizations from inpatient claims, and patient cost responsibility from inpatient, outpatient, skilled nursing facility, carrier, and durable medical equipment claims. Drive time was calculated from patient home to cancer care site (CCS). Phase of care-specific (initial, survivorship, end-of-life [EOL]) rates of hospitalizations overall and by CCS vs. other care site (OCS) were calculated per 100 person-years. Hierarchical linear models compared average monthly phase-specific costs by drive time to CCS. Results: Of 23,605 older cancer patients, median drive time to CCS was 32 minutes (IQR 18-59), with 24% driving ≥1 hour to CCS. Rates of hospitalizations by initial (n = 14,225), survivorship (n = 18,805), and EOL (n = 8,211) phases of care were 54, 26, and 301 per 100 person-years, respectively. Higher rates of hospitalizations at OCS vs. CCS were shown for patients traveling ≥1 hour to CCS (initial, survivorship, and EOL rate of 41 vs. 20, 21 vs. 6, and 220 vs. 95 per 100 person-years, respectively). Median monthly costs by phase were $401 (IQR $182-$814) for initial, $369 (IQR $123-$1046) for survivorship, and $2075 (IQR $1123-$3723) for EOL. Patients traveling ≥1 hour to their CCS had higher cost responsibility, with patients in initial, survivorship, and EOL phases having $303 (95% CI $130-$476), $75 (95% CI $46-$105), and $736 (95% CI $308-$1164) higher average costs per month than those traveling &lt; 1 hour, respectively. Conclusions: Cancer patients traveling further to receive care are potentially vulnerable to higher cost responsibility and limited access to care if community hospitals close, especially at EOL.

Optimising Clinical Trial Design in Older Cancer Patients.

Cancer is predominantly a disease of older patients, with over half of those aged over 65 years of age being diagnosed with cancer at some stage. Despite comprising a significant proportion of the patients that we see in clinical practice, there is a lack of representation of older patients in cancer clinical trials. This is mainly due to restrictive trial inclusion criteria that prevent older patients from participating. Also, trial endpoints, such as overall survival, may not represent the most important and most meaningful endpoints for older patients. The latter may place more significance on quality of life and other outcomes such as functional independence. Baseline assessment using Comprehensive Geriatric Assessment, may provide a better framework for quantifying patient outcomes for varying degrees of fitness or frailty. This short communication makes the case for more age appropriate endpoints, such as quality of life, toxicity and functional independence, and that novel trial designs are necessary to inform evidence-based care of older cancer patients.

Evidence based tailoring of cancer care for older patients

Cancer is adisease that disproportionately affects the elderly. Evidence-based treatment is the golden standard of current medical care, and this is also true for older cancer patients. In developing guidelines, all available evidence is collected, appraised and summarized. Subsequent recommendations are then translate to criteria used to judge the quality of care. The heterogeneity of the elderly population requires tailoring of care, which is the opposite of the often strictly formulated treatment recommendations in guidelines and protocols. This paper discusses several issues regarding evidence based treatment versus tailored care for older cancer patients.

Self-rated health and associated factors in elderly patients with non-Hodgkin lymphoma

BackgroundSelf-rated health is a useful indicator for understanding health issues in elderly populations and considered to be a predictor of adverse health outcomes in this group. This study aims to identify factors associated with self-rated health in elderly people with non-Hodgkin’s lymphoma. MethodsCross-sectional study performed at a cancer referral hospital in Rio de Janeiro, Brazil, included 162 patients, aged 60 or more years. All patients received a Multidimensional Geriatric Assessment, including seven health dimensions, and socio-demographic, epidemiological and it were collected clinical data. Descriptive analyses were performed and prevalence ratios were calculated to assess associations between self-rated health and the independent variables. Multivariate analysis was performed using Poisson’s regression, to a ≤0.05 level of statistical significance. ResultsThe study population mean age was 68.8 (SD=7.1) years; most were women, lived with a partner and had little education. Prevalence of fair/poor self-rated health was 33.6%. Being female, not living with a partner, functional dependence, depressive symptoms and nutritional risk/malnutrion showed associations with fair/poor self-rated health. In the multiple model, dependence in instrumental activities of daily living (PR 2.96; 95%CI 1.66-5.30) and presence of depressive symptoms (PR 1.78; 95%CI 1.15-2.75) remained associated with fair/poor health. ConclusionVariation in perceived health status supports the hypothesis that self-rated health is related to multiple issues, regardless of disease status. The risk profile for poor self-rated health identified may be a useful tool in care for older cancer patients, as it points to those at higher risk of adverse health outcomes.

National Survey Among Radiation Oncology Residents Related to Their Needs in Geriatric Oncology.

Currently, there is no formal curriculum addressing geriatric oncology within Canadian radiation oncology (RO) residency programs. Knowledge related to geriatric medicine may help radiation oncologists modify RT based on frailty status and geriatric considerations. Understanding specific learning needs allow program coordinators to align the current curriculum with residents' geriatric oncology learning needs. The purpose of this study is to determine the geriatric oncology educational needs of the Canadian RO residents and to inform Canadian RO residency training. A cross-sectional survey, with Likert, multiple choice, and open-ended questions, was pretested and distributed electronically by program directors to Canadian RO residents over 6weeks. Responses were analyzed with descriptive statistics and common themes. One-hundred and thirty-five Canadian RO residents were contacted and 63 responded (47%). Half (49%) lacked confidence managing the elderly with multiple comorbidities, polypharmacy, functional and cognitive impairment, and challenging social circumstances;73% agreed additional training would be helpful. Forty-four percent lacked confidence regarding psychogeriatric referrals, fall prevention, palliative and hospice care, and community resources preventing re-hospitalization; 63% agreed additional training would be helpful. Seventy-six percent believed discussion groups, continuing education, geriatric oncology electives, and journal clubs would provide learning opportunities. Seventy-one percent agreed integrating geriatric assessment into RO curricula would improve care. Seventy-nine percent believed geriatric oncology principles have not been adequately integrated into radiation oncology curricula. There are significant gaps specific to geriatric assessment and management of older cancer patients in the current Canadian RO curricula. Most residents agreed that it is important to integrate geriatric oncology training to improve and personalize the care of older cancer patients.