Geriatric Parameters Research Articles

Hospital care trajectories of older adults with cancer and the associated clinical profiles.

The longitudinal hospital care experiences of older adults with cancer, from the treatment decision-making process until their end of life, remain unexplored. We examined the hospital care trajectories of these patients and identified associated clinical determinants. We linked the ELCAPA multicenter cohort study (patients aged ≥70 with a solid tumor and having been referred for a geriatric assessment between 2012 and 2019) and the Greater Paris University Hospitals' clinical data warehouse. Individual care trajectories, defined as series of consultations, hospital admissions (in day, acute, or rehabilitation units), and emergency room (ER) visits, were clustered using multichannel sequence analysis. Cluster membership determinants were identified among socio-demographic, oncological, and geriatric parameters by logistic regression analysis. Seven hundred seven patients (median age: 82; metastatic cancer: 45.2%; 10 998 care episodes) were included. Four trajectory clusters were identified: cluster A (n = 149, 21.1%) with in-hospital surgical trajectories, cluster B (n = 198, 28.0%) with outpatient care trajectories with chemotherapy and/or radiotherapy, cluster C (n = 302, 42.7%) without any hospital cancer treatments, and cluster D (n = 58, 8.2%) with mostly chemotherapy and high hospital care consumption. Cluster belonging determinants included metastatic status and cancer site (for cluster A); cognition, mobility, and mood status (unimpaired parameters for cluster B and impaired for cluster C); and younger age (for cluster D). While highlighting varied hospital care experiences among older patients with cancer, we found that age remains an independent determinant of chemotherapy-dominant care trajectories.

Comparison of efficacy of antibody drug conjugate (ADCs) between younger and older patients: A meta-analysis of phase 3 studies.

e15002 Background: Antibody-Drug-Conjugates (ADCs) are one of the new cornerstone of cancer treatments. New approvals are coming every year in various tumor types and settings. However, older adults remain underrepresented in clinical trials and consequently, few data is available for this population. Therefore, we performed a meta-analysis to compare the efficacy of ADCs between younger and older patients. Methods: PubMed and the ASCO or ESMO databases were searched up to December 2023. We included randomized controlled trials (RCTs) of ADCs (datopotamab deruxtecan, Enfortumab vedotin, mirvetuximab soravtansine, sacituzumab govitecan and trastuzumab deruxtecan) reporting subgroup comparison of overall survival (OS) and/or progression-free survival (PFS) based on age cutoffs. The summary hazard ratio (HR) and 95% confidence interval (CI) were calculated. Results: A total of 4654 patients from nine RCTs (ASCENT; DESTINY-Breast02, -Breast04, -Gastric01; EV-301, EV-302/KEYNOTE-A39; MIRASOL; TROPiCS-02 and TROPION-Lung01) were included. When patients are dichotomized into younger (N=2796) and older (N=1858) groups with an age cut-off of 65 years, ADCs improved OS in both younger (HR, 0.64; 95% CI, 0.52-0.80) and older (HR, 0.56; 95% CI, 0.44-0.71) groups. An improvement in PFS was observed in younger (HR, 0.55; 95% CI, 0.46-0.66) and older (HR, 0.52; 95% CI, 0.41-0.67) patients. Subgroup analyses according to ADCs and tumor type showed a consistent survival benefit in both younger and older groups. Conclusions: A benefit in OS with ADCs was significant in both younger and older patients with a cut-off age of 65 years. Prospective real life cohort study would be of interest to confirm those results with a description of geriatric parameters to better define the population.

Hypomagnesemia may be related to frailty, gait and balance problems, and basic activities of daily living in older adults

ABSTRACT Objectives The study aims to investigate the relationship between hypomagnesemia, preclinical hypomagnesemia, and normomagnesemia as along with geriatric syndrome and comprehensive geriatric parameters(CGA). Methods 217 patients who applied to the geriatric clinic between November 2022 and December 2023 were included in the study. All patients underwent CGA. Patients were categorized into three groups: Magnesium (Mg) level ≤ 1.5 mg/dL, Mg level 1.5–1.8 mg/dL, and Mg level > 1.8 mg/dL. These three groups were compared in terms of demographic characteristics, comorbidities, CGA parameters, and geriatric syndromes. Regression analyses was conducted for significant parameters, adjusting for confounders. Results 74.9% of all participants were female, with an average age of 76.5 ± 6.6 years. The frequency of hypomagnesemia was 14.2%. Demographic characteristics and medication use, including proton pump inhibitors and diuretics, were similar in these three groups. While the FRIED frailty scale and the duration of the timed-up-and-go test were higher in the hypomagnesemia group, the Basic Activities Daily of Living (ADLs) and the Tinetti-POMA(performance-oriented mobility assessment) scores were lower in the hypomagnesemia group. When normomagnesemia was accepted as the reference category, FRIED frailty scale, Basic ADLs, and POMA score were more significant in the hypomagnesemia group (p = 0.025, p = 0.013 and p = 0.011,respectively), but there was no significance in the preclinical hypomagnesemia group regardless of the covariates. Conclusion Hypomagnesemia, particularly serum Mg levels below 1.5 mg/dL, may be associated with frailty, basic ADLs, gait, and balance tests. In geriatric practice, patients with hypomagnesemia should be evaluated in terms of the risk of the mentioned disorders.

Percutaneous aortic valve replacement: outcome of patients evaluated by EMG at Toulouse University Hospital preprocedure

Transcatheter Aortic Valve Implantation has become the preferred method of aortic valve replacement in the elderly. Preoperative standardized geriatric assessment (SGA) helps guide the decision to proceed, taking into account geriatric parameters not targeted by surgical risk scores. This is a descriptive, retrospective study of patients who underwent EGS at the Toulouse University Hospital, analyzing their length of stay and postoperative care pathway.

Additional value of geriatric parameters to Quick Sepsis Related Organ Failure Assessment score for predicting clinical deterioration in older emergency department patients with a suspected infection: post-hoc analysis of a prospective observational study.

To investigate the additional value of geriatric parameters such as physical impairment to the quick Sequential Organ Failure Assessment (qSOFA) tool for predicting clinical deterioration in older ED patients with a suspected infection and to validate the final prediction model. Post-hoc multivariable regression analysis from a prospective observational cohort study of adult patients visiting the ED of a university hospital to develop a prediction model. External validation of the prediction model was performed using the prospective data-biobank Acutelines. In older patients, qSOFA (OR 1.47 (95% CI 1.12-1.95)) and physical impairment (OR 1.84 (95% CI 1.20-2.82)) were independently associated with clinical deterioration within 72 hours. This resulted in a prediction model with an area under the curve of 0.62 (95% CI 0.56-0.68) in the derivation cohort, and of 0.62 (95% CI 0.56-0.68) in the validation cohort. Calibration of the model was poor. In older ED patients with a suspected infection, not only disease severity scores, but also presence of physical impairment is independently associated with clinical deterioration.

Comprehensive geriatric assessment and drug burden in elderly chronic kidney disease patients

Abstract Objectives Chronic kidney disease (CKD) is a condition characterized by atherosclerosis, cognitive impairment, physical limitations, biochemical abnormalities, and vascular aging. The proportion of those with a diagnosis of CKD in the older is increasing. With comprehensive geriatric assessment, it could be possible to detect the disorders that are related to biological aging. The aim is to evaluate geriatric syndromes like frailty, cognitive dysfunction, malnutrition, and polypharmacy in an aged population with pre-dialytic CKD (stages 3a–5), and to investigate possible relations with biochemical features and anticholinergic drug burden (ADB). Methods One hundred and fifty-six CKD patients aged 60 and older and 164 healthy controls were included in the study. Geriatric parameters that were used for the evaluation of the groups were, Clinical Frailty Index; Charlson Comorbidity Index; Montreal Cognitive Assessment and Mini Nutritional Assessment Short-Form. Besides, biochemical parameters and ADB defined with 3 scales Anticholinergic Burden Classification (ABC), Chew’s scale, and Drug Burden Index were recorded. Results Despite being younger, CKD patients had higher comorbidity and frailty scores than the controls. Patients and controls had similar nutritional status, and cognitive function test results. Frailty was an important predictor for geriatric parameters and eGFR. ABC score was higher in the CKD group in ADB scale. Conclusions Frailty and polypharmacy are more prevalent than expected in older with CKD. In addition, anticholinergic burden and polypharmacy may form causal links with one and other and lead to increased mortality rates especially with frailty. Therefore, geriatric assessment and appropriate ADB evaluation may be recommended in CKD patients.

Safety and efficacy of preoperative chemotherapy for muscle-invasive bladder cancer in elderly patients.

This study aimed at describing the feasibility and oncological outcomes of standard cisplatin-based neoadjuvant chemotherapy (C-NAC) for muscle-invasive bladder cancer (MIBC) in patients aged ≥ 75 and assess the impact of baseline geriatric parameters. This retrospective study included patients with stage cT2-4NanyM0 MIBC aged 75 and older treated with ≥ 1 cycle of C-NAC from 2011 to 2021 at a high-volume academic center. Primary outcome was overall survival (OS). Secondary outcomes were chemotherapy feasibility (administration of ≥ 4 cycles), safety, and pathological downstaging. Fifty-six patients were included. Median age was 79 (range 75-90). C-NAC regimen was ddMVAC in 41 patients and GC in 15. Seventy-three percent of patients received ≥ 4 cycles of C-NAC. Grade ≥ 3 toxicity was observed in 55% of patients. The febrile neutropenia rate was 7%. Thirty patients underwent cystectomy, and 13 underwent chemoradiotherapy. Three-year OS was 63%. Geriatric parameters polypharmacy, undernutrition, and age-adjusted Charlson comorbidity index ≥ 8 predicted worse OS. Standard-of-care C-NAC and local treatments are feasible in selected elderly MIBC patients, with efficacy and safety findings similar to that observed in pivotal trials with younger patients. The prognostic impact of geriatric parameters underlines the need for specialized evaluation before treatment initiation.

Frailty IO: Frailty parameters and incidence of immune related adverse events in older patients treated with immune checkpoint blockers (ICB).

12062 Background: Immune checkpoint blockers (ICB) are one of the cornerstone of cancer treatment. The favorable tolerance profile makes it an interesting option in older patients with cancer. However, few evidence is available in patients aged 70 years and older according to geriatric parameters. We aimed to determine the impact of frailties on immune related adverse events (irAEs) in a real-life population of older patients treated with ICB. Methods: This retrospective French multicentric cohort study enrolled all patients aged 70 years or over who underwent a geriatric assessment before the start of ICB in monotherapy or in combination between January 1st 2016 and December 31st 2021. Main endpoint was to assess frailty and incidence of irAEs. Results: In total, 224 patients were included. Median age was 82 years old (Q1:77-Q3:87). Patients were mostly men (66%), 40% were treated for a skin cancer (melanoma or squamous), 35% lung and 15% genitourinary. Median number of comedications was 5 (3-8) and median G8 was 12 (9 – 14). Median ADL (/6) was 6 and IADL (/4) was 3 (2-4). Most patients were treated with ICB in monotherapy (80%). Altogether, 49% of patients experienced all-grade toxicity and 25% had more than 1 adverse event during the treatment course. The incidence of high-grade toxicity (≥ 3) was 14%. The most frequent types of toxicity were gastro-intestinal (17%), skin (13%), thyroid (9%) and rheumatoid (7%). Male gender (p < 0.02), normal IADL (p < 0.01), normal Timed up and go test (p < 0.02), not having falls in the last 6 months (p < 0.001) and visual impairment (p = 0.02) were significantly associated with toxicity in univariate analysis. Multiple toxicities were associated with male gender (p = 0.03), vision impairment (p < 0.001), normal IADL (p < 0.05), normal Timed up and go test (p < 0.02) not having falls in the last 6 months (p < 0.001). There were no association with 4-month hospitalization (p = 0.73). Median overall survival (OS) was 16.33 months [95%CI 12.78 - 20.63] and the 3-month OS rate 84.83% [95%CI 79.26 - 89.11]. Median progression free survival (PFS) was 6.08 [95%CI 5.13 - 8.71] in the overall population. Toxicity was associated with better PFS compared to no toxicity (logrank test : p < 0.01) with a median PFS (toxicity group) of 6.14 months [95%CI 5.13 - 8.94] versus median PFS (no toxicity group) of 5.26 months [95%CI 3.25 - 8.41]. Median PFS for patients with multiple toxicity was longer 9.86 months [95%CI 5.13 - 23.92] (p < 0.01). Conclusions: Older patients without IADL or walk impairments but with visions problem had increased incidence of irAEs. The PFS analysis shows a positive association of toxicity confirming that longer exposure to ICB might result in higher risk of irAE. The absence of IADL or mobility impairement may be associated with longer benefit from ICB. Further analysis will be presented at the meeting.

P407 MULTIDIMENSIONAL ASSESSMENT OF THE ELDERLY PATIENT WITH SEVERE AORTIC STENOSIS: THE ROLE OF FRAILTY IN THE CHOICE OF TREATMENT (TAVI/SAVR)

Abstract Background Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVI) are treatment options in patients with severe aortic stenosis. International guidelines suggest both traditional risk scores and a Comprehensive Geriatric Assessment (GCA) be determinants in treatment decision–making. The aim of the study is to identify the GCA parameters associated with the decision to perform TAVI instead of SAVR in elderly patients with severe aortic stenosis. Materials and Methods Between 2019 and 2022, 66 patients aged ≥75 years were referred to the Cardiology department of Padua Hospital for pre–operative evaluation, including CGA. The CGA consisted of functional status (Activities of Daily Living and Instrumental Activities of Daily Living Scales), cognitive impairment (Mini Mental State Examination, Montreal Cognitive Assessment), mood disorders (Geriatric Depression Scale), physical performance (Short Physical Performance Battery, 6–minute Walking Test, grip strength) and quality of life (Short–Form 36 items Health Survey). Results SAVR was proposed to 53% of patients and TAVI to 47%. The mean age was 78.9 ± 4.8 years and 47% were women. TAVI patients were older and had lower scores on both cognitive and motor performance tests than SAVR patients. The geriatric parameters associated with treatment decision–making between SAVR and TAVI were age (OR= 1.64, p < 0.04) and gait speed (OR= 0.09, p = 0.05). Conclusions Therapeutic decision–making in elderly patients with severe aortic stenosis is not only influenced by age, but also by a frailty index, gait speed. This could become a simple, quick and inexpensive routine test to effectively stratify patients.

Ovarian cancer in the older patient: where are we now? What to do next?

In recent years, major advances have been made toward the individualization of epithelial ovarian cancer care, leading to an overall improvement of patient outcomes. However, real-life data indicate that the oldest populations do not benefit from this, due to aspects related to cancer (more aggressive histopathological features), treatment (i.e. frequently suboptimal), and the host (increased toxicities in patients with lower physiological reserve). A specific risk-benefit perspective should therefore be taken when considering surgery, chemotherapy, and maintenance treatments: the decision for cytoreductive surgery should include geriatric vulnerability and surgical complexity, neo-adjuvant chemotherapy being an option when primary surgery appears at high risk; carboplatin paclitaxel association remains the standard even in vulnerable older patients; and bevacizumab and poly(ADP-ribose) polymerase inhibitors maintenance are interesting options provided they are prescribed according to their indications with a close monitoring of their toxicities. Future studies should aim to individualize care without limiting access of older patients to innovation. A specific focus is needed on age-specific translational analyses (focusing on tumor mutational burden and impaired biological pathways), a better patient stratification according to geriatric parameters, an adaptation of both oncological treatment and geriatric interventions, and treatment adaptations not a priori but according to formal pharmacokinetic data.

Association of Pretreatment Physical and Geriatric Parameters with Treatment Tolerance and Survival in Elderly Patients with Stage I-II Non-Small Cell Lung Cancer: An Evaluation of Usual Care Data.

In this study, the association of pretreatment physical and geriatric parameters with treatment tolerance and survival in elderly patients with stage I−II NSCLC was evaluated. Retrospective data for patients aged ≥70 years, diagnosed between 2016 and 2020 with stage I−II NSCLC, and who underwent surgery or stereotactic ablative radiotherapy (SABR) in a large Dutch teaching hospital were retrieved from medical records. Associations of pretreatment physical and geriatric parameters with treatment tolerance and survival were analyzed. Of 160 patients, 49 of 104 (47%) patients who underwent surgery and 21 of 56 (38%) patients who received SABR did not tolerate treatment. In univariable analysis, World Health Organization (WHO) performance status ≥ 2, short nutritional assessment questionnaire score > 1, short physical performance battery score ≤ 9, and geriatric-8 score ≤ 14 were significantly associated with postoperative complications. Forced expiratory volume of one second < 80% of predicted was significantly associated with intolerance of SABR. In multivariable analysis, WHO performance status ≥ 2 and diffusing capacity for carbon monoxide < 80% were significantly associated with decreased overall survival. This is the first study that investigated the association between pretreatment physical and geriatric parameters and treatment outcomes in patients with stage I−II NSCLC. Evaluation of physical and geriatric parameters before treatment initiation seems highly recommended to select patients who might benefit from preventive interventions before and/or during treatment.

Delirium in older COVID-19 patients: Evaluating risk factors and outcomes.

ObjectivesA high incidence of delirium has been reported in older patients with Coronavirus disease 2019 (COVID‐19). We aimed to identify determinants of delirium, including the Clinical Frailty Scale, in hospitalized older patients with COVID‐19. Furthermore, we aimed to study the association of delirium independent of frailty with in‐hospital outcomes in older COVID‐19 patients.MethodsThis study was performed within the framework of the multi‐center COVID‐OLD cohort study and included patients aged ≥60 years who were admitted to the general ward because of COVID‐19 in the Netherlands between February and May 2020. Data were collected on demographics, co‐morbidity, disease severity, and geriatric parameters. Prevalence of delirium during hospital admission was recorded based on delirium screening using the Delirium Observation Screening Scale (DOSS) which was scored three times daily. A DOSS score ≥3 was followed by a delirium assessment by the ward physician In‐hospital outcomes included length of stay, discharge destination, and mortality.ResultsA total of 412 patients were included (median age 76, 58% male). Delirium was present in 82 patients. In multivariable analysis, previous episode of delirium (Odds ratio [OR] 8.9 [95% CI 2.3–33.6] p = 0.001), and pre‐existent memory problems (OR 7.6 [95% CI 3.1–22.5] p < 0.001) were associated with increased delirium risk. Clinical Frailty Scale was associated with increased delirium risk (OR 1.63 [95%CI 1.40–1.90] p < 0.001) in univariable analysis, but not in multivariable analysis. Patients who developed delirium had a shorter symptom duration and lower levels of C‐reactive protein upon presentation, whereas vital parameters did not differ. Patients who developed a delirium had a longer hospital stay and were more often discharged to a nursing home. Delirium was associated with mortality (OR 2.84 [95% CI1.71–4.72] p < 0.001), but not in multivariable analyses.ConclusionsA previous delirium and pre‐existent memory problems were associated with delirium risk in COVID‐19. Delirium was not an independent predictor of mortality after adjustment for frailty.

Sequential Geriatric Assessment in Older Patients with Colorectal Cancer during Chemotherapy: Subgroup Analysis of a Prospective, Multicenter Study EpiReal 75

Introduction: Colorectal cancer (CRC) is a disease of older patients, but evidence-based guidelines for chemotherapy in older patients are scarce. Geriatric assessment (GA) evaluates a patient’s functional status (FS) and helps in decision-making when choosing chemotherapy for older patients. However, the change of FS during chemotherapy is rarely studied as GA is mostly performed once instead of sequentially. Methods: We performed a subgroup analysis of a prospective, multicenter study EpiReal 75. Patients aged ≥75 years with gastrointestinal malignancy prior to initiation of chemotherapy or receiving palliative chemotherapy were screened. We defined geriatric core assessments including the Eastern Cooperative Oncology Group score, Barthel’s activities of daily living (ADL) scale, Lawton’s instrumental activities of daily living (IADL) scale, and G-8 questionnaire, which were performed at baseline and repeated every 3 months. Quality of life (QoL) assessed by QLQ-C30 questionnaire was also re-evaluated every 3 months. We defined any deterioration in any of the geriatric parameters as unstable in the corresponding function. Results: 28 patients with CRC were enrolled between April 2014 and December 2018. 20 patients were evaluable for statistical analysis with a mean age of 78.5 years (range, 75–88). Most patients received chemotherapy in palliative setting. During 3 months of chemotherapy, 25% of patients became more dependent as measured by ADL or IADL. During a median follow-up of 15 months, patients with unstable ADL or IADL had a significantly shorter overall survival (OS) than those with stable ADL or IADL (p_logrank = 0.0055 and 0.0253, respectively), without a significant difference in progression-free survival (PFS). Also, unstable IADL correlated with a deterioration in aspects of QoL such as role functioning and emotional functioning (p = 0.0189 and 0.0239, respectively). 20% of patients experienced treatment-related grade 3 adverse events (AEs), no grade 4–5 AEs occurred. Conclusion: Sequential GA revealed changes in FS in older patients with CRC receiving chemotherapy. A deterioration of FS during chemotherapy did not influence PFS but had a negative impact on OS and QoL. It is therefore important to maintain FS in older patients with cancer, and regular performance of geriatric core assessments should be encouraged in the clinical practice.

Impact of specific oncologic and geriatric parameters in predicting chemotherapy toxicity and death in elderly cancer patients.

e24026 Background: Cancer is mainly a disease of the elderly with more than 75% of patients aged 65 years and more at diagnosis. Comprehensive geriatric assessment (CGA) is usually used to assess elderly cancer patients¹. However, its sensitivity in predicting their outcome is questionable. Methods: We investigated whether specific oncologic and geriatric markers could predict chemotherapy toxicity and cancer-related death in a prospective single center study with 110 chemo-naive patients with advanced cancer. All patients underwent a CGA. Frailty markers as defined by Fried2 as well as basic oncologic data were collected. Bivariate and multivariate analysis were done to assess the relation between the different variables and major toxicity. A Cox regression model for survival analysis was also performed. Results: Median age is 74 years [65-90 years]. 46% have stage IV disease. 27% have aggressive cancer as defined by Hurria et al3. Grade III-IX chemotherapy-related toxicity occurred in 22% of patients. Combined chemotherapy drug regimens, loss of appetite in the last 3 months and polypharmacy at baseline were predictive of chemotherapy toxicity in multivariate analysis. After a median follow-up of 12 months, 59% died of disease progression. In multivariate analysis, advanced cancer stage, initial loss of &gt; 5% body weight within 1 year, altered physical activity and Activity of Daily Living (ADL), anemia and heavy comorbidities (CIRS – G score) were predictive of poor outcome (Table). Conclusions: In elderly cancer patients, poor nutritional status and heavy comorbidities are predictive of both chemotherapy intolerance and death. In addition, markers such as anemia, advanced cancer stage, altered physical activity and impaired ADL predict early death. Balducci L. The Oncologist 2000. Fried LP. J Gerontol A Biol Sci Med Sci 2001. Hurria A. J Clin Oncol 2011. Clinical trial information: 02-02-18. [Table: see text]

Predictive value of selected geriatric parameters for postoperative outcomes in older patients with rectal cancer – A multicenter cohort study

IntroductionOlder 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. MethodsWe 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. ResultsWe 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). ConclusionsGeriatric 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.

Selected Domains within a Comprehensive Geriatric Assessment in Older Patients with Non-Hodgkin Lymphoma are Highly Associated with Frailty

BackgroundThe incidence of Non-Hodgkin Lymphoma (NHL) is increasing, particularly among older patients who tend to have worse outcomes and can be predisposed to increased toxicities and less treatment tolerance. Therefore, a thorough pre-treatment assessment is essential. A comprehensive geriatric assessment (CGA) can be used to evaluate the older patient considering chemotherapy and is the preferred evaluation tool. However, a formal CGA is laborious, complex and time-consuming.ObjectivesTo characterize older adults with NHL and determine the CGA variables with the greatest association to frailty in order to propose a more simplified assessment.MethodsWe performed a cross-sectional study using data collected from CGAs in NHL patients > 65 years admitted to our oncology service, from September 2015 to August 2017. Our evaluation parameters included: polypharmacy, a screening tool of older people's prescriptions (STOPP), the Lawton scale, Barthel index, Katz index, gait speed, a Timed Up and Go (TUG) test, a Mini-Mental state examination (MMSE), the Yesavage and Gijon scales, a Mini-nutritional assessment (MNA), a Geriatric Syndromes assessment, and a Cumulative Illness Rating Scale-Geriatric (CIRS-G). The formal CGA was comprised of nine domains; frailty was defined as an impairment in > 2 domains. Each parameter was individually compared with frailty, and the results were used to build different multivariate models using logistic regression analyses to obtain the variables with the highest frailty association.ResultsA total of 253 patients were included. Their median age was 75.4 years (range 65–92), and 62.1% had > 1 impaired domain, with 39.9% considered frail. Bivariate analysis showed strong associations with age > 85 and all the geriatric parameters except for STOPP. Our final multivariate analysis resulted in 5 domains (the use of > 5 medications, a Lawton < 7, TUG > 20, Yesavage > 5, and the presence of at least one geriatric syndrome) being significantly associated with frailty and performing similarly to a CGA.ConclusionIn our population of older NHL patients, an abbreviated evaluation based of only five domains, polypharmacy, TUG, Lawton scale, Yesavage scale and the presence of at least one geriatric syndrome, had similar performance to a formal CGA in determining frailty.

Association between Sarcopenia and Insulin-Like Growth Factor-1, Myostatin, and Insulin Resistance in Elderly Patients Undergoing Hemodialysis.

Sarcopenia is common in hemodialysis patients, especially in the elderly patients undergoing hemodialysis. Various factors may contribute to the occurrence of sarcopenia, such as anabolic and catabolic imbalance. This study aims to investigate the correlation of insulin-like growth factor-1 (IGF-1) levels as an anabolic factor, myostatin levels, and insulin resistance as catabolic factors with sarcopenia in the pathogenesis of sarcopenia in elderly patients undergoing hemodialysis. A total of 40 subjects aged 60 years or more who undergoing hemodialysis in Dr. Soetomo Hospital Surabaya were included in this cross-sectional study. Sarcopenia was diagnosed according to Asian Working Group Sarcopenia 2019 criteria. IGF-1, myostatin, and insulin resistance levels were measured once before hemodialysis. Subjects with sarcopenia diagnosis were 33 (82.5%), that is, 19 (47.5%) men and 14 (35%) women. There were 28 (70%) of the subjects diagnosed with severe sarcopenia. Furthermore, there were significant differences in the characteristics and geriatric parameters between the sarcopenia and nonsarcopenia groups. There were differences between the two groups in hemoglobin levels, IGF-1 levels, myostatin levels, homeostasis model assessment-insulin resistance (HOMA-IR) levels, muscle mass, handgrip strength, body mass index status, mini nutritional assessment status, and physical activity scale for elderly status (all p < 0.05). Correlation analyses showed that IGF-1 levels negatively correlated with sarcopenia status in elderly patients undergoing hemodialysis (p < 0.05). On the contrary, myostatin and HOMA-IR levels were positively correlated with sarcopenia status in elderly patients undergoing hemodialysis (all p < 0.05). Based on this recent study, IGF-1, myostatin, and insulin resistance were significantly correlated with sarcopenia in elderly patients undergoing hemodialysis.

The efficacy of rehabilitation for elderly chronic kidney disease patients: a retrospective, single-center study.

As the geriatric population is growing rapidly, so is the prevalence of chronic kidney disease (CKD). Suitable rehabilitation programs are needed to decrease disability and improve functionality to maintain independence in activities of daily life. To assess the impact of CKD on the efficacy of rehabilitation in the geriatric population. Retrospective single-center cohort study, demographic and clinical data of 190 elderly, non-dialysis dependent CKD patients, who underwent rehabilitation, during 2016-2020 were analyzed. Early CKD patients had longer duration of rehabilitation as compared with advanced CKD (32.6 ± 19.5 vs. 25.1 ± 17.6days, p = 0.011) and tended to be more independent at discharge (37.2% vs. 27.9%, respectively; p < 0.001). Duration of rehabilitation, Mini-Mental State Examination (MMSE), Functional Independence Measurement (FIM) admission and estimated GFR were important predictors of FIM at discharge. Age was negatively correlated with admission FIM, eGFR, MMSE, and discharge FIM. The odds ratio for mortality among patients with advanced as compared to early CKD was 2.197 (CI 95% 1.159-4.166, p = 0.015). Existing rehabilitation programs raise questions of suitability for the consistently aging population, play an indispensable part in the goal of achieving functional independence in the elderly and should promote further investigation of the efficacy of rehabilitation for CKD patients. Advanced CKD was associated with lower FIM at admission and discharge, shorter duration of rehabilitation and more dependence at discharge, as compared to patients with early CKD. Implementing a multidisciplinary team, focused on the specific needs of geriatric CKD patients, with clear, objective parameters and goals may lead to better rehabilitative outcomes, with decreased public and private costs of ongoing care.

Multi-Disciplinary Care Planning of Ovarian Cancer in Older Patients: General Statement-A Position Paper from SOFOG-GINECO-FRANCOGYN-SFPO.

Simple SummaryThis position paper aims to provide practitioners a proposal for multidisciplinary care planning for older patients with ovarian cancer from the time of suspected diagnosis. The first-line treatment of advanced ovarian cancer involves several interdependent sequences: cytoreductive surgery, (neo)adjuvant chemotherapy and maintenance targeted treatments. In older patients, care planning must be adapted to their geriatric parameters and consider the geriatric impact of each treatment sequence to allow treatment completion. Care planning should be centered on patient motivation and imply multidisciplinarity. Each step of treatment plan should be reconsidered in light of a geriatric assessment and follow-up. Studies are needed to prospectively evaluate the impact of geriatric vulnerability parameters at each step of the treatment agenda and the impact of geriatric interventions on patient outcomes.In this position paper the Société Francophone d’OncoGériatrie (SOFOG; French-speaking oncogeriatric society), the Société Française de Pharmacie Oncologique (SFPO, French society for oncology pharmacy), the Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO, National Investigators’ Group for Studies in Ovarian and Breast Cancer) and the Groupe Français de chirurgie Oncologique et Gynécologique (FRANCOGYN) propose a multi-disciplinary care planning of ovarian cancer in older patients. The treatment pathway is based on four successive decisional nodes (diagnosis, resectability assessment, operability assessment, adjuvant, and maintenance treatment decision) implying multidisciplinarity and adaptation of the treatment plan according to the patient’s geriatric covariates and her motivation towards treatment. Specific attention must be paid to geriatric intervention, supportive care and pharmaceutical conciliation. Studies are needed to prospectively evaluate the impact of geriatric vulnerability parameters at each step of the treatment agenda and the impact of geriatric interventions on patient outcomes.

Overall Survival and Prognostic Factors among Older Patients with Metastatic Pancreatic Cancer: A Retrospective Analysis Using a Hospital Database.

Simple SummaryThe benefits of standard treatments in metastatic pancreatic cancer (mPC) in terms of overall survival (OS) remain to date unclear, especially after 70 years. Alongside geriatric and oncologic parameters, we showed that the gemcitabine + nab-paclitaxel regimen and anti-diabetic therapy were significantly associated with a better OS, while impaired functional status, the liver metastases and high neutrophil count were associated with a worse OS in older adults with mPC. We confirm the feasibility and efficacy of chemotherapy in older adults with mPC.Pre-therapeutic factors associated with overall survival (OS) among older patients ≥70 years with metastatic pancreatic cancer (mPC) are not known. This was a retrospective single-centre cohort study in Paris including 159 consecutive older patients with mPC between 2000 and 2018. Alongside geriatric parameters, specific comorbidities, cancer-related data and chemotherapy regimens were retrieved. Cox multivariate models were run to assess predictors for OS. The median age was 80 years, 52% were women, 21.5% had diabetes, and 48% had pancreatic head cancer and 72% liver metastases. 62% of the patients (n = 99) received chemotherapy, among which the gemcitabine + nab-paclitaxel (GnP) regimen was the most frequent (72%). Median OS [95%CI] was 7.40 [5.60–10.0] and 1.40 [0.90–2.20] months respectively for patients with and without chemotherapy. The GnP regimen (aHR [95%CI] = 0.47 [0.25–0.89], p = 0.02) and diabetes (aHR = 0.44 [0.24–0.77], p = 0.004) (or anti-diabetic therapy) were multivariate protective factors for death, while ECOG-PS, liver metastases, and the neutrophil cell count were multivariate risk factors for death. In the chemotherapy group, ECOG-PS, number of metastatic sites and the GnP remained significantly associated with OS. Our study confirms the feasibility and efficacy of chemotherapy and the protective effects of diabetes among older patients with mPC.