Geriatric Oncology Research Research Articles

Big Data for Geriatric Oncology Research.

Cancer is the second leading cause of death in North Carolina and approximately half of cancers are diagnosed in older adults (≥65 years). Cancer clinical trials in older adults are limited and there is a lack of evidence on optimal care strategies in this population. We highlight how big data can fill in gaps in geriatric oncology research.

Unmet Needs in Geriatric Oncology.

Nikhil PathiIndia's population is aging, with the number of people aged 60 and over projected to reach 340 million by 2050. This is expected to lead to an increase in the number of older adults with cancer. Geriatric oncology is a rapidly growing field in India that is facing several challenges. Some of these include inadequate access to cancer screening and early detection programs in elderly, leading to late diagnoses and poor outcomes, lack of specialized geriatric oncology services, cancer-specific treatment guidelines and protocols in elderly, limited availability of treatment options due to accessibility, finances and other logistic issues, lack of trained healthcare professionals with expertise in geriatric oncology, lack of awareness, and access to early integrated palliative care services. There are several challenges faced by elderly in this journey like financial dependency, social isolation, difficulty in transportation to healthcare for treatments, and psychosocial aspects attributed to cancer. Awareness about availability of resources, patient assistance programs to reduce financial burdens, education campaigns, use of telemedicine and telehealth services to bypass transportation issues in remote and underserved areas, and integration of geriatric oncology into mainstream oncology services might be some solutions. Additionally, there is a need for more research on the unique characteristics and needs of older cancer patients in India, as well as the development of culturally appropriate interventions to address these needs. Development of India-specific geriatric assessment scales encompassing medical, psychosocial, and functional problems in elderly identifies areas of vulnerability. A multidisciplinary team-based decision-making is required at various levels. There is a need for increased investment in geriatric oncology research, training, and integrated palliative care services in India. Geriatric oncology is slowly being recognized as a separate subspeciality and more geriatric oncology centers and clinics are being set up in major cities in India that should be the way forward.

Missed Opportunities in Geriatric Oncology Research

The field of geriatric oncology has made significant progress in recent decades, but there are still missed opportunities in important areas of research. One issue is the underrepresentation of older patients, especially those aged 75 years and older, in clinical trials. This has resulted in a lack of high-quality data for the care of this population, and the American Society of Clinical Oncology has called for an increase in the evidence base for older patients with cancer. The second missed opportunity is the chance to gather important knowledge from older patients participating in clinical trials, such as medications, social support, insurance, and financial information. These data can be easily collected and incorporated into the trial design to enhance the information available to researchers and clinicians. The third missed opportunity is the chance to robustly analyze and report clinical trial data for the benefit of geriatric oncology research. Many trials only report a median age and range, which is a disservice to both the participants and the patients who will be treated based on the study results. To advance geriatric oncology research, the necessary data need to be collected, analyzed, and reported through appropriate representation of older patients, collection of essential information, and thorough analysis and communication of results. Clinical trial design needs to include geriatric baseline parameters, and Cancer Therapy Evaluation Program (CTEP) has modified its template to include these parameters.

New horizons in managing older cancer survivors: complexities and opportunities

Older adults represent a growing population amongst cancer survivors who require specific consideration given the complex and largely unknown interactions between cancer-related concerns and age-related conditions. The increasing use of geriatric assessment (GA) has enabled oncologists to appropriately assess older patients' overall health status, personalise anti-cancer treatment and improve survival. However, whilst current research and practice focus on improving the management of older adults with cancer in the acute setting, the progress in the field of survivorship research in geriatric oncology is lagging. As cancer survivorship is a continuum, planning for a healthy survivorship should start at the time of cancer diagnosis. GA can play an important role in identifying potential survivorship issues and optimising delivery of survivorship care. A goal-directed, patient-focused geriatric survivorship care plan that involves a multidisciplinary team provides a framework for a personalised delivery of survivorship care in this patient group and there is a need for tailored interventions that support self-management and care integration. Research on the impact of cancer and its treatment on geriatric-specific outcomes needs to be prioritised through global initiatives to encompass a diverse and heterogenous population of adult cancer survivors.

Change in four measures of physical function among older adults during lung cancer treatment: A mixed methods cohort study

IntroductionFunctional outcomes during non-small cell lung cancer (NSCLC) treatment are critically important to older adults. Yet, data on physical function and which measures best capture functional change remain limited. Materials and MethodsThis multisite, mixed methods cohort study recruited adults ≥65 years with advanced NSCLC starting systemic treatment (i.e., chemotherapy, immunotherapy, and/or targeted therapy) with non-curative intent. Participants underwent serial geriatric assessments prior to starting treatment and at one, two, four, and six months, which included the Karnofsky Performance Scale (KPS, range: 0–100%), instrumental activities of daily living (IADL, range: 0–14), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Physical Functioning subscale (EORTC QLQ-C30 PF, range: 0–100), and Life-Space Assessment (LSA, range: 0–120). For all measures, higher scores represent better functioning. In a qualitative substudy, 20 patients completed semi-structured interviews prior to starting treatment and at two and six months to explore how treatment affected their daily functioning. We created joint displays for each interview participant that integrated their longitudinal KPS, IADL, EORTC QLQ-C30 PF, and LSA scores with patient quotes describing their function. ResultsAmong 87 patients, median age was 73 years (range 65–96). Mean pretreatment KPS score was 79% (standard deviation [SD] 13), EORTC QLQ-C30 PF was 69 (SD 23), and LSA was 67 (SD 28); median IADL was 13 (interquartile range [IQR] 10–14). At two months after treatment initiation, 70% of patients experienced functional decline on at least one measure, with only 13% of these patients recovering at six months. At two and six months, decline in LSA was the most common (48% and 35%, respectively). Joint displays revealed heterogeneity in how well each quantitative measure of physical function captured the qualitative patient experience. DiscussionFunctional decline during NSCLC treatment is common among older adults. LSA is a useful measure to detect subtle functional decline that may be missed by other measures. Given heterogeneity in how well each quantitative measure captures changes in physical function, there is value to including more than one functional measure in geriatric oncology research studies.

CN57 Cancer survivors' perceptions of priorities for geriatric oncology research: A qualitative study

People living with and after cancer may experience complex physical and psychosocial issues requiring multidisciplinary support. While adults over the age of 65 are the group most commonly diagnosed with cancer, they also represent the group most under-represented in research. Therefore, this study aims to explore older adults' perceptions of priorities for research in cancer and haematological malignancies.

Danish translation and validation of the Geriatric 8 and the modified Geriatric 8 screening tools

Almost 50% of patients with cancer are diagnosed after the age of seventy, which has fueled geriatric oncology research. [1] Many investigations have underlined the importance of a comprehensive geriatric assessment (CGA) in older patients prior to oncologic treatment to improve treatment decisions and perform non-oncologic interventions. [2,3].

PORTRET, a more inclusive portrait of the older population with breast cancer

PORTRET, a more inclusive portrait of the older population with breast cancer

The Future of Geriatric Oncology Research: Moving Toward Interventions and Objective Biomarkers of Aging.

The Future of Geriatric Oncology Research: Moving Toward Interventions and Objective Biomarkers of Aging.

Including older patients in cancer trials: A qualitative study of collaboration between geriatricians and oncologists

BackgroundThe under-representation of older patients in cancer trials remains an important obstacle to the generation of data on efficacy and safety in this growing patient population. In France, geriatric oncology coordination units (UCOGs) have been created to help oncologists and geriatricians work together on research, best practice, and continuing medical education. Taking these units as a case study, this paper sheds light on the collaboration between geriatricians and oncologists in the inclusion process of older patients in cancer trials. Materials and MethodsEmpirical data were gathered in a series of sociological interviews with all 16 oncologists, geriatricians and unit coordinators in the five UCOGs in the greater Paris region of France. ResultsThe case of French geriatric oncology coordination units shows the gap between professional research cultures in oncology and geriatrics that may account for the low observed inclusion rates. It is easier to include patients in randomized clinical trials than in observational studies. UCOGs have the potential to improve research in geriatric oncology by catalyzing the development and implementation of effective collaboration tools (such as frailty assessments). The units also have the potential to promote Phase IV trials and observational research that are suitable for older patients with cancer. DiscussionBridging the cultural gap between oncologists (the dominant force in setting the cancer research agenda) and geriatricians (a source of specific knowledge and know-how) is essential for producing relevant trial protocols that match the specific yet diverse features of older patient populations.

Challenges and opportunities to developing a frailty index using electronic health record data

Older adults represent the majority of patients diagnosed with cancer yet remain under-represented in clinical trials [ [1] Ludmir E.B. Mainwaring W. Lin T.A. et al. Factors associated with age disparities among Cancer clinical trial participants. JAMA Oncol. 2019; 5: 1769-1773 Crossref PubMed Scopus (60) Google Scholar ]. The reasons for this are multifaceted and include clinician bias against recommending trial participation to older adults, trial unavailability, patient ineligibility, and other social and cultural barriers [ [2] Hurria A. Levit L.A. Dale W. et al. Improving the evidence base for treating older adults with Cancer: American society of clinical oncology statement. J Clin Oncol. 2015; 33: 3826-3833 Crossref PubMed Scopus (227) Google Scholar ]. Underrepresentation leads to a lack of evidence to guide management recommendations for older adults, forcing clinicians to extrapolate from data generated in potentially younger, healthier patients. The American Society of Clinical Oncology (ASCO) has repeatedly identified research using real-world data as a mechanism to fill this evidence gap. A 2015 ASCO research statement recommended that developers of research and clinical databases ensure that their systems collect geriatric assessment (GA) data and have the functionality to support real-world data studies designed to improve the evidence base supporting the treatment of older adults [ [2] Hurria A. Levit L.A. Dale W. et al. Improving the evidence base for treating older adults with Cancer: American society of clinical oncology statement. J Clin Oncol. 2015; 33: 3826-3833 Crossref PubMed Scopus (227) Google Scholar ]. Similarly, action items from a 2017 ASCO-U.S. Food and Drug Administration (FDA) co-sponsored workshop included standardizing and enhancing the quality of data recorded in electronic health records (EHRs) to facilitate better geriatric oncology research [ [3] Levit L.A. Singh H. Klepin H.D. et al. Expanding the evidence base in geriatric oncology: action items from an FDA-ASCO workshop. J Natl Cancer Inst. 2018; 110: 1163-1170 Crossref PubMed Scopus (35) Google Scholar ].

Perspectives on Geriatric Oncology Research Presented at the 2020 San Antonio Breast Cancer Symposium

The 2020 San Antonio Breast Cancer Symposium (SABCS) united healthcare professionals and researchers from all over the globe to showcase the cutting-edge in breast cancer research. Many advancements were virtually presented at this year's symposium, and we here feature research relevant to geriatric oncology.

Perspectives on geriatric oncology research presented at the 2020 ESMO Science Congress

The European Society for Medical Oncology (ESMO) Congress is an important annual oncology meeting. Due to the COVID-19 pandemic, the 2020 edition was held virtually. Over 30,000 registrants from more than 150 countries utilised the platform. Here we present the studies and presentations from the science weekend relevant to the field of geriatric oncology.

A new measure of function in older adults with cancer

A new measure of function in older adults with cancer

Capacity to Provide Geriatric Specialty Care for Older Adults in Community Oncology Practices

American Society of Clinical Oncology guidelines recommend that patients ≥65 years of age starting chemotherapy undergo a geriatric assessment (GA) to inform and guide management; however, little is known about resources available in community oncology practices to implement these guidelines and to facilitate geriatric oncology research. Oncology practices within the National Cancer Institute Community Oncology Research Program (NCORP) were electronically surveyed in 2017 regarding the availability of specialty providers, supportive services, and practice characteristics, as part of a larger survey of cancer care delivery research capacity. Of the 943 NCORP practices, 504 (54%) responded to the survey, representing 210 practice groups. The median new cancer cases per year ≥65 years of age was 457 (interquartile range 227-939). Of respondents, only 2.0% of practices had a fellowship-trained geriatric oncologist on staff. Geriatricians were available for consultation or comanagement at 37% of sites, and of those, only 13% had availability within the oncology clinic (5% of overall). Practice size of ≥1,000 new adult cancer cases (ages ≥18) per year was associated with higher odds (1.81, confidence interval 1.02-3.23) of geriatrician availability. Other multidisciplinary care professionals that could support GA were variably available onsite: social worker (84%), nurse navigator (81%), pharmacist (77%), dietician (71%), rehabilitative medicine (57%), psychologist (42%), and psychiatrist (37%). Only a third of community oncology practices have access to a geriatrician within their group and only 5% of community sites have access within the oncology clinic. Use of primarily self-administered GA tools that direct referrals to available services may be an effective implementation strategy for guideline-based care. Only a minority of community oncology practices in the U.S. have access to geriatric specialty care. Developing models of care that use patient-reported measures and/or other geriatric screening tools to assess and guide interventions in older adults, rather than geriatric consultations, are likely the most practical methods to improve the care of this vulnerable population.

Impact of preexisting cardiovascular disease (CVD) on treatments and outcomes of patients with breast or lung cancer.

12063 Background: Prior cardio-oncology and geriatric oncology research has mainly focused on cancer treatments and their late effects on cardiac health, but little information is known about how cardiac health may influence subsequent cancer treatments. This real-world study aimed to evaluate the associations of pre-existing CVD on treatment adherence and survival in patients with breast or lung cancer. Methods: We linked administrative data from the population-based cancer registry, electronic medical records, and billing claims in a large province (Alberta, Canada) over a 10-year time period (2006-2015). Multivariable logistic regression analyses were performed to identify associations of CVD with cancer treatments. Multivariable Cox proportional hazards models were constructed to determine the effect of CVD on overall survival (OS), while adjusting for receipt of cancer treatments. Results: We identified 46,227 patients with breast or lung cancer, of whom 77% were women and median age was 65 years. While 82% of patients with breast cancer were early stage, 50% with lung cancer had metastasis. The prevalence of pre-existing CVD was 20% where congestive heart failure was most frequent. In logistic regression, CVD was associated with lower odds of receiving appropriate chemotherapy (OR, 0.60, 95% CI, 0.56-0.65, P<.0001), radiotherapy (OR, 0.76, 95% CI, 0.72-0.81, P<.0001), and surgery (OR, 0.60, 95% CI, 0.54-0.66, P <.0001), irrespective of tumor site (Table). The 5-year OS was lower in patients with baseline CVD as compared to those without (46% vs 58%, P<0.0001). Upon adjusting for stage and treatment, CVD continued to correlate with worse OS (HR, 1.23, 95% CI, 1.19-1.26; P<.0001). Conclusions: Cancer patients with prior CVD were less likely to receive standard cancer therapy. Even among those who underwent cancer treatments, worse outcomes were observed in those with CVD. Early cardio-oncology and geriatric oncology engagement may reduce treatment bias and ensure that carefully selected patients with a cardiac history are still offered appropriate cancer therapy. [Table: see text]

Geriatric oncology research presented at the ASCO GI 2020 symposium: Young international society of geriatric oncology perspective paper

Geriatric oncology research presented at the ASCO GI 2020 symposium: Young international society of geriatric oncology perspective paper

Toward Modernization of Geriatric Oncology by Digital Health Technologies.

The number of older adults with cancer is increasing. Over the past 3 decades, geriatric oncology research has focused on improving the assessment of frailty and fitness of older adults with cancer as well as methods of improving their outcomes. At the same time, advances in digital health technologies have opened new frontiers for reaching this goal. Digital health technologies encompass a variety of solutions, from electronic patient-reported outcomes (ePROs) to Big Data and wireless sensors. These solutions have the potential to further advance our understanding of patients' experiences during cancer treatment. Whereas the data on the feasibility and utility of such solutions in the care of older adults with cancer are limited, interest from digital health oncology researchers to further explore the benefits of these products is increasing. In this article, we describe the focus of geriatric oncology, the rationale behind the need to explore digital health technologies in this setting, and emerging data and ongoing studies, as well as provide guidelines for proper selection, implementation, and testing of digital health solutions in the context of geriatric oncology.

Use of an Abbreviated Geriatric Screening Tool in the Assessment of Older Cancer Patients' Functional Status, Dependency, and Comorbidities: Cross-Sectional Audit and Observations From a Regional Cancer Center in Australia.

BackgroundMalignancies are the leading cause of disease burden in Australia, comprising 19% of total diseases. Approximately 1 in 4 men and 1 in 6 women die from malignancies by 85 years of age, with patients aged 65 years and older contributing to 58% of diagnoses and 76% of cancer mortality. In the context of malignancy-related disease and age-related degeneration, there is a need for comprehensive assessment of older patients to plan for appropriate management and predict prognosis. The utility of available comprehensive geriatric assessment tools has been limited in routine practice because of their time-consuming nature, despite their informing clearer understanding of patients’ functional status, better clinical decision making, prevention of unpredictable admissions and emergency department overload, and support services planning. Though there are several promising tools available, there is a lack of literature on tools that can comprehensively assess functional status in an expedited fashion.ObjectiveThis study aimed to document functional status and comorbidities among a geriatric oncology patient cohort attending a regionally located, dedicated cancer care facility, using the completed Adelaide tool assessments. This study documents cohort characteristics, including sociodemographics, malignancy type, and comorbidities. Secondarily, we observed the utility of an abridged functional assessment in the multidisciplinary team (MDT) management of older cancer patients.MethodsThe study comprised a facility-based cross-sectional audit of results obtained from a screening tool administered to patients aged 65 years and older and attending an outpatient medical oncology clinic for management of cancer from late 2015 to 2017. Data relating to five domains were collected, including instrumental activities of daily living, activities of daily living, performance status, unintended weight loss, and exhaustion. Sociodemographic and disease-related factors were summarized as frequencies with percentages or mean with SD. Distribution of functional status based on sociodemographic characteristics, living status, disease-related factors, and comorbidities was analyzed using a chi-square test. Cumulative dependencies in the five domains were identified, and patients were classified as fit, vulnerable, or frail. Supplementary review of presentation notes for cases discussed at MDT meetings was undertaken to identify discrepancies.ResultsA majority of the study population showed poor functional status, with 88.7% (243/274) categorized as vulnerable and 8.4% (23/274) as frail. Exhaustion and unintended weight loss were identified as the most common contributors to dependency. Polypharmacy was strongly associated with decreased functional status.ConclusionsThe outcomes of this study are congruent with the existence of dependency in various domains, and with similar research in geriatric oncology. The Adelaide tool provided a useful basis for MDT discussion and management, where cases were referred to the MDT. We recommend further examination of the tool’s utility and impact in clinical decision making, and the distribution of dependencies in a rural cohort compared with metropolitan patients.

Perspectives on geriatric oncology research presented at the 2019 San Antonio Breast Cancer Symposium

The 2019 San Antonio Breast Cancer Symposium (SABCS) brought together an international audience of researchers and healthcare professionals to discuss the latest in breast cancer research. This year we saw much progress with practice-changing trials that could mean better treatment for patients with breast cancer. Here, we highlight research which we consider having the highest relevance to Geriatric Oncology.