Elderly Cancer Patients Research Articles

Contributing and limiting factors to guideline-adherent therapy in senior and elderly breast cancer patients: a questionnaire-based cross-sectional study using clinical and cancer registry data in Germany

PurposeElderly cancer patients are less likely to be treated in accordance with evidence-based guideline recommendations. This study examines patient-related factors associated with deviations from guideline recommendations.MethodsUsing medical documentation and cancer registry data, we investigated the treatment courses of female breast cancer patients aged 50 and older in Germany regarding compliance with German guidelines. Participants completed a questionnaire querying factors hypothesized to be associated with guideline adherence. We conducted univariate analyses to explore the data and select variables for multivariate logistic regression to estimate adjusted odds ratios.ResultsOf 1150 participants, 206 (17.9%) were treated in deviation from guideline recommendations. Patients 70 years and older were more likely to be treated deviating from guideline recommendations than patients 50–69 years old (OR: 2.07; 95% CI: 1.52–2.80). Patients aged 50–69 years who reported that quality of life guided their treatment decision were more likely to be treated in deviation from guideline recommendations (AOR: 2.08; 95% CI: 1.11–3.92) than the elderly. In older patients, higher age was associated with an increased chance of receiving guideline-discordant care (AOR: 1.06; 95% CI: 1.01–1.11), as was depression diagnosed prior to cancer (AOR: 1.84; 95% CI: 1.00–3.40).ConclusionReasons for deviations from guideline recommendations in breast cancer patients differ by age. In decision-making concerning elderly patients, particular attention should be paid to those with pre-existing depressive disorders. Adequately addressing their needs and concerns could prevent inappropriate deviations from guideline recommendations.

CONUT can be a predictor of postoperative complications after laparoscopic-assisted radical gastrectomy for elderly gastric cancer patients.

Compared with young patients, elderly patients with gastric cancer usually have lower muscle mass, poorer nutritional status, lower immunity, and worse cardiopulmonary function. Therefore, how to improve the prognosis of elderly gastric cancer patients after laparoscopic-assisted radical gastrectomy is the focus and difficulty of clinician. The aim of our study was to investigate the risk factors for postoperative complications of these patients. The data of gastric cancer patients aged ≥ 60 years who underwent laparoscopic-assisted radical gastrectomy were analyzed. Univariate was used to determine the potential risk factors and then multivariate analyses was used to determine the independent risk factors for postoperative complications. Univariate analysis showed that age, preoperative red blood cell (RBC), preoperative albumin (ALB), preoperative C-reactive protein (CRP), preoperative hemoglobin (Hb), preoperative blood transfusion, preoperative lymphocytes, total cholesterol, CRP-to-ALB ratio, controlling nutritional status (CONUT) score, TNM stage were all the potential risk factors for postoperative complications. Binary logistic regression showed that CONUT, age and preoperative RBC were correlated with postoperative complications. For elderly gastric cancer patients after laparoscopic-assisted radical gastrectomy, CONUT, age and preoperative RBC were all the independent risk factors for overall postoperative complications and could be used as reliable indicators for judging the short-term prognosis.

Survival Impacts of Impaired Lung Functions and Comorbidities on Elderly Esophageal Cancer Patients.

Preoperative physiological assessments are crucial for optimizing clinical outcomes, especially those of elderly esophageal cancer (EC) patients who are generally frail and at the high risk of mortality. Patients who underwent surgery for EC between 2004 and 2018 were retrospectively reviewed. Patients were categorized into elderly (>70years) or non-elderly (≤70years) groups. Various physiological parameters including the Charlson Comorbidity Index (CCI), immunonutritional parameters and pulmonary functions were studied. Pulmonary functions included %vital capacity (VC) and forced expiratory volume in one second (FEV1.0) and FEV1.0%. The thresholds were set as the lowest quartile (100% for %VC and 2L for FEV1.0) in this cohort. Multivariate Cox hazards models were applied to determine independent predictors of non-EC-related deaths. In total, 824 patients were included (elderly; n = 306, non-elderly; n = 518). Elderly patients had a significantly lower 5-year OS rate than non-elderly patients (53.3% vs. 57.2%, P = 0.03), mainly due to increased risk of death from non-EC related causes. In the elderly group, multivariate Cox hazards analysis identified 3 independent predictors of non-EC-related deaths; high CCI (HR 1.98, P=0.006), low %VC (HR 2.01, P = 0.004) and low FEV1.0 (HR 1.6, P=0.048). Elderly patients without risk factors had a significantly better 5-year OS rate (63.5%) than those with 1 (50.0%) or 2-3 (36.3%) risk factors (P <0.01). Deaths due to pulmonary disease rose significantly as the number of risk factors increased (P=0.03). The severity of comorbidities and pulmonary function impairments are useful for predicting long-term outcomes, especially non-EC-related deaths, in elderly EC patients.

Recurrence and characteristics of endometrial cancer in elderly patients

Aim: In this study, evaluated the treatment options of patients of advanced age (≥70 years) with recurrence, survival results were analyzed. Methods: The data of patients diagnosed with endometrial cancer (EC) in the Gynecological Oncology Clinic between 2001 and 2020 were evaluated retrospectively. Seventy six cases with advanced age and relapse were evaluated. Patients who underwent hysterectomy surgery in our center and continued their follow-up regularly were included in the study. Results: The mean age at the time of recurrence was 74.6 ± 3.9 years. The endometrioid type, seen in half of the patients, was the most common histological type. Pelvic paraaortic lymph node (LN) sampling/dissection was performed in 84.2% of the patients. Deep myometrial invasion was detected in 56 (73.7%) patients, and LVSI was found in 42 (56.8%) patients. The mean time to recurrence was found to be 25.1 ± 17.8 months. Total survival times were calculated as 47.2 ± 28.2 months. The five-year overall survival (OS) rate was analyzed as 35.7%. The most common site of recurrence was lung, and isolated lung recurrence was seen in 14 (18.5%) patients. There was no significant difference for OS among patients with pelvic recurrence and extra-pelvic/multiple recurrences (P= 0.723). Conclusion: Survival outcomes in recurrences are worse in advanced age endometrial cancer patients. This may be due to more limited treatment options for recurrence due to additional internal problems.

S438 A Survey of Advanced Colorectal Cancer in Elderly Patients in a Large Community-Based Healthcare System

S438 A Survey of Advanced Colorectal Cancer in Elderly Patients in a Large Community-Based Healthcare System

2169P Immunotherapy-based treatment in elderly cancer patients: A real-world multicenter study

2169P Immunotherapy-based treatment in elderly cancer patients: A real-world multicenter study

Prevalence and Risk Factors of Cardiotoxicity in Elderly Cancer Patients

Prevalence and Risk Factors of Cardiotoxicity in Elderly Cancer Patients

PB0963 Clinical Outcomes of Anticoagulation for the Treatment of Thromboembolism (TE) in Elderly Cancer Patients

PB0963 Clinical Outcomes of Anticoagulation for the Treatment of Thromboembolism (TE) in Elderly Cancer Patients

Pre-existing cardiometabolic comorbidities and survival of middle-aged and elderly non-small cell lung cancer patients

Pre-existing cardiometabolic comorbidities and survival of middle-aged and elderly non-small cell lung cancer patients

The effect of the enhanced recovery after surgery protocol and the reduced use of opioids on postoperative outcomes in elderly patients with colorectal cancer.

The study aimed to assess the impact of the enhanced recovery after surgery (ERAS) pathways and the reduced use of opioids on postoperative outcomes in elderly colorectal cancer (CRC) patients who underwent laparoscopic surgery under general anesthesia (GA). Clinical data from 99 elderly patients who underwent laparoscopic CRC surgery in the First Affiliated Hospital of Hebei North University from April 2021 to April 2023 were retrospectively analyzed and grouped based on the method of pain control measures received. Of 99 patients, 51 received conventional doses of opioid drugs (conventional group), and 48 patients were treated with reduced doses of opioids based on the principles of ERAS (low-dose group). Perioperative characteristics, postoperative pain level, cognitive function, serum biochemical index levels, and adverse reactions were compared between the two groups. The first exhaust time, defecation time, and bedtime activity time of the low-dose group were compared to the conventional group (p<0.05). On the first day after the surgery, the mini-mental state examination (MMSE) score of the low-dose group was higher than the conventional group (p<0.05). After the surgery, the levels of serum brain-derived neurotrophic factor (BDNF) decreased in both groups, while the levels of neuron-specific enolase (NSE) and 5-hydroxytryptamine (5-HT) increased. However, compared to the conventional group, the low-dose group had higher levels of BDNF and lower levels of NSE and 5-HT (p<0.05). The incidence of adverse reactions in the low-dose group was lower than that in the conventional group (p<0.05). ERAS protocol and the reduced use of opioid drugs in CRC patients who underwent surgery under GA is associated with an analgesic effect that is comparable to that of conventional opioid use. Reduced dosage of opioid drugs lessened cognitive impairment and lowered the incidence of adverse reactions in surgical patients with CRC.

1483P Challenge of systemic first-line treatment of elderly lung cancer patients

1483P Challenge of systemic first-line treatment of elderly lung cancer patients

269P Achieving treatment goals in elderly breast cancer patients with neoadjuvant chemotherapy: A remarkable insight

269P Achieving treatment goals in elderly breast cancer patients with neoadjuvant chemotherapy: A remarkable insight

Impact of the G8 Score on Treatment Strategies and Outcome in Definitive Radiotherapy for the Elderly Esophageal Cancer Patients

Although chemoradiotherapy (CRT) is widely used as a curative treatment for esophageal cancer, it is often difficult to perform standard CRT for the elderly in the real world. This study aimed to investigate the impact of the Geriatric 8 (G8) score on treatment strategies and outcome in definitive radiotherapy (RT) for elderly esophageal cancer patients. We analyzed 81 esophageal cancer patients aged ≥65 years who received definitive RT between 2018 and 2021. The G8 score was acquired at the first visit to the radiation oncology department. The treatment strategy was decided by a multi-disciplinary conference, and the G8 score was not used to determine the treatment strategy. Standard treatment (standard CRT) was defined as RT with elective nodal irradiation and a total dose ≥50 Gy, and chemotherapy with two cycles of platinum (70 mg/m2) and 5FU (700 mg/m2 for 4 days) concurrently. The Kaplan-Meier method was used to generate actual survival curves. The Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 was used to assess toxicities. The Mann-Whitney U test was used to compare the two groups, and statistical significance was set at p<0.05. The Receiver Operating Characteristic (ROC) curve was used to calculate the cutoff value. The Median follow-up time was 30 months (range: 8-51) for survivors. The mean G8 scores by treatment strategy were 13.9 (range: 9-17) for standard CRT group (n = 26), 12.1 (range: 7-16) for reduced CRT group (n = 30), and 9.7 (range: 4.5-14) for RT alone group (n = 25). G8 score was significantly higher for standard CRT (p = 0.017) and significantly lower for RT alone (p<0.01). The cut-off value of the G8 score for standard treatment, calculated by the ROC curve, was 12.5 points. In the non-standard treatment group, the cut-off value of the G8 score for RT alone, calculated by the ROC curve, was 10.5 points. The 2-year overall survival (OS) rates for standard CRT, reduced CRT and RT alone were 74%, 71% and 35%, respectively, and significantly lower in RT alone (p<0.001). The 2-years OS rates for G8 score >10.5 points and ≤10.5 points were 69% and 48%, respectively (p = 0.039). Grade 3 or higher acute toxicities were observed in 33 patients (41%); 14 (54%) in standard CRT, 17 (57%) in reduced CRT and 2 (8%) in RT alone. Grade 5 acute toxicity was not observed. G8 scores tended to be higher in the patients with grade 3 or higher acute toxicities, but the difference was not statistically significant (p = 0.057). Grade 3 or higher late toxicities were observed in 7 patients. Our results suggest that there is an association between the G8 score and clinicians' treatment decisions. Although RT alone could be safely performed even in patients with low G8 scores, administration of chemotherapy strongly affected prognosis. These results suggest the importance of developing less toxic systemic therapy regimens for patients with low G8 scores.

Comparative Effectiveness Analysis of Lumpectomy and Mastectomy for Elderly Female Breast Cancer Patients: A Deep Learning-based Big Data Analysis.

Objectives: To evaluate the comparative effectiveness of treatments, a randomized clinical trial remains the gold standard but can be challenged by a high cost, a limited sample size, an inability to fully reflect the real world, and feasibility concerns. The objective is to showcase a big data approach that takes advantage of large electronic medical record (EMR) data to emulate clinical trials. To overcome the limitations of regression analysis, a deep learning-based analysis pipeline was developed. Study Design and Setting: Lumpectomy (breast-conserving surgery) and mastectomy are the two most commonly used surgical procedures for early-stage female breast cancer patients. An emulation trial was designed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare data to evaluate their relative effectiveness in overall survival. The analysis pipeline consisted of a propensity score step, a weighted survival analysis step, and a bootstrap inference step. Results: A total of 65,997 subjects were enrolled in the emulated trial, with 50,704 and 15,293 in the lumpectomy and mastectomy arms, respectively. The two surgery procedures had comparable effects in terms of overall survival (survival year change = 0.08, 95% confidence interval (CI): -0.08, 0.25) for the elderly SEER-Medicare early-stage female breast cancer patients. Conclusion: This study demonstrated the power of "mining large EMR data + deep learning-based analysis," and the proposed analysis strategy and technique can be potentially broadly applicable. It provided convincing evidence of the comparative effectiveness of lumpectomy and mastectomy.

Multi-Institutional Fact-Finding Study: Association between Geriatric Assessment and Reduction in Intensity of Radiotherapy for Elderly Cancer Patients without Metastasis

Vulnerable patients receive a low-intensity, palliative treatment rather than the standard treatment. Defining vulnerability in terms of standard or reduced radiation intensity can result in appropriate radiotherapy for elderly cancer patients without excessive adverse events and poor outcomes. However, it is difficult to define vulnerability, because radiation oncologists hesitate to include vulnerable patients in clinical trials involving radical radiotherapy. We hypothesized that for elderly cancer patients without metastasis, vulnerability scores, obtained by geriatric assessment (GA), could help in predicting the reduction in radiation intensity determined by radiation oncologists based on their experience. In this multicenter prospective study, we enrolled cancer patients (70 years or older) without metastasis. The reduction in radiation intensity was categorized into 3 groups as follows: i) standard schedule of radiotherapy, but conversion of irradiation fields, ii) standard irradiation fields, but converted schedule of radiotherapy, and iii) conversion of radiotherapy schedule and irradiation fields. Standard radiotherapy was defined as recommended doses and radiation fields according to the guidelines for the primary tumors analyzed. GA was performed by calculating geriatric 8 (G8) and vulnerable elders survey (VES-13) scores before radiotherapy and 3-5 and 8-16 weeks after completion of radiotherapy. The primary endpoint was to evaluate the correlation between vulnerability assessed by G8 and change in radiation intensity. Between November 2020 and February 2022, 317 patients were included in this study at 13 centers in Japan. The median age was 77 (range, 70-90) years. The primary cancer sites were head and neck, esophagus, lungs, breasts, pancreas, bladder, uterus, and prostate in 63, 22, 62, 48, 6, 5, 26, and 85 patients, respectively. High-precision radiotherapy was performed for 199 patients (63%). Of the 31 patients (10%) whose radiation intensity was reduced, 14, 9, and 8 patients were provided i, ii, and iii category, respectively. Planned radiotherapy was completed for 312 patients (98%). G8 and VES-13 vulnerability scores were obtained for 201 and 61 patients, respectively, before radiotherapy. The mean G8 and VES-13 scores were 13.3 ± 2.4 and 1.8 ± 1.8, 12.9 ± 2.6 and 2.0 ± 2.0, and 13.4 ± 2.4 and 2.0 ± 1.9 before radiotherapy and 3-5 and 8-16 weeks after completion of radiotherapy, respectively. Multivariate analysis revealed that reduction in radiation intensity was significantly associated with vulnerability assessed using VES-13 (p < 0.001) but not G8 (p = 0.06). An excellent completion rate was obtained for planned radiotherapy, and vulnerability assessed using VES-13, not G8, was associated with the reduction in intensity of radiotherapy.

Adverse Effects and Intervention of Frailty on Elderly Cancer Patients

Purpose: To study the adverse effects of frailty on elderly cancer patients and explore effective interventions. Methods: The convenience sampling method was used to select 362 elderly cancer patients who were consecutively admitted to the Oncology Department of the Affiliated Hospital of Hebei University from April 2020 to March 2021. The patients had five physical dimensions of activity tested and were divided into a frail group (n = 128) and a non-frail group (n = 234) based on the test results. The Chinese version of the Vulnerable Elders Questionnaire was formed on the basis of the Vulnerable Elders Survey-13 (VES-13). The two groups of patients were surveyed within three days of admission. The questionnaire includes general information (age, gender, education level, marital status, monthly income, living area, smoking, and alcohol history, hearing, vision, and sleep status), Geriatric Depression Scale (GDS), Mini Nutritional Assessment (MNA), Mini-Mental State Examination (MMSE), and Charlson Comorbidity Index (CCI). Results: (1) By comparing the general information of the two groups of patients, it was found that the gender, education level, marital status, living area, and history of tobacco and alcohol had no statistical significance (P &gt; 0.05). In contrast, the frail group’s age, hearing status, vision status, and sleep status are significantly worse than those of the non-frail group (P &lt; 0.05); (2) Analysis of Vulnerable Elderly Questionnaire results found that the GDS scores in the frail group were higher than those in the non-frail group, and the MNA and MMSE scores were lower than those in the non-frail group (P &lt; 0.05). This indicated that the patients in the frail group had more severe depression, poor nutritional status, and specific impairments in cognitive function. Conclusion: Frailty adversely affects elderly cancer patients, and effective measures should be taken to intervene.

Geriatric Assessment of Older Adults With Cancer During Acute Hospitalizations: Challenges and Opportunities.

Introduction Geriatrics is a discipline that covers all adult healthcare, and oncology is no exception. The global geriatric assessment process plays a crucial role, impacting research, funding, resource allocation, as well as therapeutic decision-making. Thus, greater knowledge of the epidemiology of the frailty and functionality of elderly patients with cancer will allow for the development of a global care strategy. This study aimed to assess the prevalence of geriatric conditions in elderly cancer patients admitted to a medical geriatric unit following unplanned hospitalisation. Methods A retrospective, single-centre cohort study was conducted of patients aged ≥ 75 with an active oncological disease who were admitted to a geriatric medicine unit over a two-year period. Results A total of 65 patients were included. The median age was 85 (IQR 81-88), and 86% were aged ≥ 80. A moderate-to-high functional dependence was found: 67.7% on ≥ 3 basic activities of daily living (Katz ≥ D), with the majority classified as severely dependent based on the Barthel Index (mean 49.0 ± 33.7). Frailty was found in 90.7%. A high prevalence of geriatric syndromes was observed: malnutrition (84.6%), polypharmacy (64.6%), urinary incontinence (58.5%) and pressure ulcers (33.8%). The mortality rate was 36.9% during hospitalisation and 13.8%, 30 days post-discharge. Conclusions The study revealed a high prevalence of geriatric conditions, emphasising the importance of comprehensive assessment in managing elderly patients at different stages of the disease. This multidimensional and multidisciplinary approach optimises patient care throughout admission, hospitalisation and discharge.

Real-world analysis of survival benefit of surgery and adjuvant therapy in elderly patients with colorectal cancer

Treatment guidelines for colorectal cancer (CRC) in elderly patients remain unclear. This study aimed to investigate whether elderly patients (≥ 70 years) with CRC benefit from surgery and adjuvant therapy. A total of 90,347 eligible CRC patients older than 70 years were collected from the Surveillance, Epidemiology, and End Results (SEER) database and divided into a surgery group and a no-surgery group. After being matched by propensity score matching at a 1:1 ratio, 23,930 patients were included in our analysis. The Kaplan‒Meier method and log-rank test were applied to compare overall survival (OS) and cancer-specific survival (CSS). Univariate and multivariate Cox regression analyses were utilized to confirm independent prognostic factors for OS and CSS. In age-stratified analysis (70–74; 75–79; 80–84; ≥ 85), the OS and CSS rates of patients in the surgery group were significantly higher than those of patients in the no-surgery group (all P < 0.001). Adjuvant therapy was an independent prognostic factor for OS and CSS in elderly patients with CRC (all P < 0.001). Further analysis showed that elderly colon cancer patients with stage III and stage IV disease gained a survival benefit from adjuvant chemotherapy. Adjuvant chemoradiotherapy can significantly improve OS and CSS in elderly rectal cancer patients with stage II, III, and IV disease. In conclusion, among CRC patients aged ≥ 70 years reported in the SEER database, treatment with surgical resection is significantly associated with improved OS and CSS. Moreover, adjuvant therapy led to a significant prognostic advantage for elderly advanced CRC patients who underwent surgery.

TPVB and general anesthesia affects postoperative functional recovery in elderly patients with thoracoscopic pulmonary resections based on ERAS pathway.

Thoracic surgery is easy to cause various perioperative complications, especially in elderly patients, due to their physical weakness and physiological function degeneration. Postoperative cognitive dysfunction is a common complication in elderly patients undergoing thoracic surgery. This study focuses on exploring the effects of thoracic paravertebral block (TPVB) combined with general anesthesia on postoperative functional recovery in elderly patients undergoing thoracoscopic radical resection for lung cancer based on enhanced recovery after surgery (ERAS) pathway. A total of 104 patients aged 60 years or older undergoing thoracoscopic radical resection of lung cancer were randomized into the combination group (n = 52) and the control group (n = 52). Patients in the control group were given general anesthesia alone, while patients in the combination group were given TPVB combined with general anesthesia. All patients applied the ERAS model for the perioperative intervention. Hemodynamic indices (heart rate [HR] and mean arterial pressure [MAP]) before anesthesia (T0), 5 min after thoracoscopic trocar placement (T1), at extubation (T2), 30 min after extubation (T3), and 6 h after the surgery (T4), postoperative analgesia, preoperative and postoperative serum pain stress factors (5-hydroxytryptamine [5-HT], prostaglandin E2 [PGE2], cortisol [Cor], substance P [SP], and norepinephrine [NE]), tumor markers (CYFRA21-1, CEA, and CA50), inflammatory factors (IL-6, TNF-α, and c-reactive protein (CRP)), lung function indicators (forced vital capacity [FVC] and forced expiratory volume in the first second [FEV1]), 6 min walking distance (6MWD), clinical recovery indicators, hospitalization status, and postoperative complications in patients between both groups were compared. Compared with the control group, patients in the combination group had lower HR and MAP at T1-T4 time points, less intraoperative doses of remifentanil and propofol, less patient-controlled interscalene analgesia compression number 24 h after the surgery, lower visual analogue scale scores 24 h after the surgery, shorter hospitalization time, postoperative off-bed time, postoperative chest tube removal time, postoperative first feeding time and gastrointestinal function recovery time, reduced postoperative serum levels of 5-HT, PGE2, Cor, SP, NE, CYFRA21-1, CEA, CA50, IL-6, TNF-α, and CRP, decreased complications, and higher FVC, FEV1, and 6MWD. Based on the ERAS pathway, TPVB combined with general anesthesia in thoracoscopic surgery for lung cancer in elderly patients can effectively reduce the patients' hemodynamic fluctuations, alleviate postoperative pain, accelerate the recovery process, and reduce complications.

Trajectory patterns and influencing factors of supportive care needs in Chinese elderly breast cancer patients.

The aim of this study was to identify the trajectory patterns of supportive care needs in Chinese older patients with breast cancer and their predictive factors. A total of 122 older patients with breast cancer were recruited. Demographic and disease-related information, type D personality, and supportive care needs were investigated at baseline, 3, and 6 months. Latent class growth model was used to identify the trajectory patterns of supportive care needs. Multiple logistic regression was used to determine the predictors for membership. Three trajectories with different characteristics of changing categories of supportive care needs were identified in the final analysis, named as "High needs decline group" (38.5%), "High needs sustained group" (51.6%), and "Low needs sustained group" (9.8%). Univariate analysis showed that age, education level, number of children, primary caregiver, pathological stage, surgical modality, treatment protocols, and personality traits were associated with the trajectory categories of supportive care needs of older patients with breast cancer. Multiple logistic regression showed that primary caregiver type, treatment protocols, and personality traits were influential factors in the trajectory of supportive care needs of older patients with breast cancer. Our study demonstrates the heterogeneity of changes in supportive care needs. The supportive care needs of older patients with breast cancer show a trajectory of change in different categories, and healthcare providers can develop individualized interventions based on the characteristics of different patients.