Outcomes In Elderly Women Research Articles

A study of treatments and outcomes in elderly women with cervical cancer

ObjectiveWith the population aging, development of safe and effective treatments for elderly patients with cancer is needed. Although old age is considered a poor prognostic factor, this is not only because of the patient’s disease condition or response to treatment, but also because of treatment strategy and intensity. The purpose of this study was to clarify the influence of age on treatment and prognosis in patients with cervical cancer. MethodsWomen with stage Ib–IV cervical cancer treated at our institution between 1997 and 2014 were retrospectively analyzed. Patients were stratified by age into groups for analysis, <65 years and ≥65 years. Categorical variables were compared using chi-squared and Fisher’s exact tests. Survival analyses were performed using the Kaplan–Meier method, and comparisons were made using the log-rank test. Subsequently, Cox proportional hazards models were developed to find independent prognostic factors. ResultsOf 959 patients included in our study, 247 were ≥65 and 712 were <65 years of age. Elderly patients tended to be at a more advanced stage than younger patients (p < 0.001). Elderly patients more commonly had comorbidities. More received standard treatment in the younger patient group at any disease stage than in the elderly patient group (p < 0.001). Similar rates of adverse effects caused by surgery or radiotherapy were seen in patients from both groups. Although overall survival was statistically shorter in elderly patients (74.7 vs. 57.1%, p < 0.001), there was no significant difference in disease-specific survival for patients treated only with standard treatment. In multivariate analyses, clinical stage, histological type, treatment intensity, and primary surgery remained independent prognostic factors. Age was not an independent prognostic factor. ConclusionsThe influence of age on prognosis in patients with cervical cancer was less than we expected. Elderly patients might have better outcomes depending on the type of standard treatment they receive. The appropriate modality and intensity of treatment should be based on the patient’s general condition and background.

Clinical characteristics and outcomes in elderly women with BRCA1 and BRCA2 mutations

Clinical characteristics and outcomes in elderly women with BRCA1 and BRCA2 mutations

Water-based aerobic training improves strength parameters and cardiorespiratory outcomes in elderly women.

The aim of the present study was to compare the effects of water-based aerobic training and water-based resistance training on muscular strength and cardiorespiratory fitness in older women. Sixty-nine individuals were randomized into the following three groups: the water-based aerobic training (WA, n = 23) group, the water-based resistance training (WR, n = 23) group, and the control group (CG, n = 23). Participants were trained two times per week for 10 weeks. The trainings presented a linear periodization with an increase in the volume-intensity relation. Maximal dynamic muscular strength and the cardiorespiratory fitness were evaluated before the start of training and after 10 weeks of training. Only the WA group showed an increase in maximal oxygen consumption (13.8%) and oxygen consumption at the second ventilatory threshold (16.4%). Maximal dynamic strength of knee extensors improved in 10.6% of WA, 8.0% of WR, and 4.7% of CG participants, without any difference between the groups. Maximal dynamic strength of knee flexors was increased in 14.1% of WA and in 17.7% of WR participants; however, it remains unchanged in CG participants. No differences were observed in resting heart rate, peak heart rate, heart rate at the second ventilatory threshold and maximal dynamic strength of shoulder horizontal flexors. It was concluded that WA seems to be more efficient for improvement in cardiorespiratory responses, and both WA and WR were efficient for development of maximal dynamic strength of knee flexion and extension.

Liposuction-assisted four pedicle-based breast reduction (LAFPBR): A new safer technique of breast reduction for elderly patients

As older people increasingly care for their body image and remain active longer, the demand for reduction mammaplasty is increasing in this population. Only a few studies of reduction mammaplasty have specifically focussed on the outcomes in elderly women. We developed a new breast reduction technique: the Liposuction-Assisted Four Pedicle-Based Breast Reduction (LAFPBR) that is especially indicated for elderly patients. The aim of this paper was to describe the LAFPBR technique and to determine whether it could be considered a safer option for elderly patients compared to the superomedial pedicle (SMP) technique. A retrospective study included sixty-two women aged 60 years and over who underwent bilateral breast reduction mammaplasty. Thirty-one patients underwent LAFPBR and 31 patients were operated using the SMP technique. Complications and patient satisfaction in both groups were analysed. Patient satisfaction was measured using a validated questionnaire: the client satisfaction questionnaire 8 (CSQ-8). The LAFPBR technique required less operating time, and avoided significant blood loss. Six minor complications were observed in SMP patients. No LAFPBR women developed a procedure-related complication. Patient satisfaction was high with a mean score of 29.65 in LAFPBR patients and 28.68 in SMP patients. The LAFPBR is an easy procedure that appears safer than SMP and results in a high satisfaction rate in elderly women.

The analysis of the long-term outcomes in elderly women treated for locally advanced cervical cancer

PurposeLocally advanced cervical cancer (LACC) should be treated with a combination of external irradiation and brachytherapy with concurrent chemotherapy. However, as cervical carcinoma cells can disperse by way of the lymphatic system to either pelvic or para-aortic nodes, planning the extent of radiation requires precise information about the spread of the disease to the lymph nodes, especially to the para-aortic area.Material and methodsAll of the 75 women included in our study underwent chemoradiotherapy, which started with brachytherapy. Out of them, 54 have undergone radical hysterectomy with lymphadenectomy followed by chemoradiation. We have retrospectively analyzed the 5-year overall survival (OS) rates relative to the lymph node involvement, the type of lymphadenectomy performed (pelvic, para-aortic, or both), the size of the tumor (> or < 4 cm), the histological type, grading, and the age of patients.ResultsWe observed significant differences in the OS rates relative to the age of the patients with LACC. We noted significant differences in the OS rates related to para-aortic lymphadenectomy and presence of lymph node metastases.ConclusionsPara-aortic lymphadenectomy seems to have a positive influence on long-term outcomes in the LACC patients, and elderly patients may benefit more from applied therapy.

The Influence of Histologic Grade on Outcomes of Elderly Women with Early Stage Breast Cancer Treated With Breast Conserving Surgery With or Without Radiation Therapy

The Influence of Histologic Grade on Outcomes of Elderly Women with Early Stage Breast Cancer Treated With Breast Conserving Surgery With or Without Radiation Therapy

Asthma Medication Ratio Phenotypes in Elderly Women

With population aging, further asthma research is needed in the elderly. We assessed the relevance of the controller-to-total asthma medication ratio and its fluctuations over time to identify participants with a subsequent risk of poor asthma-related outcomes among well-characterized elderly women. We studied 4,328 women with ever asthma (69.6 ± 6.1 years) from the Asthma-E3N study (Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l'Education Nationale), which combined drug claims data since 2004 with prospective individual characteristics. The levels of the yearly controller-to-total asthma medication ratio from 2004 to 2011 were included in latent class analysis to identify groups of women characterized by specific long-term fluctuations of the ratio. Multiple regression models estimated the subsequent risk of uncontrolled asthma, asthma attacks, asthma exacerbations, and poor asthma-related quality of life associated with the level and the fluctuations of the ratio. A short-term (12 months) ratio below 0.5 was associated with a higher risk of subsequent uncontrolled asthma, asthma attacks, asthma exacerbations (odds ratio [95% confidence interval (CI)]= 2.13 [1.41; 3.23], 1.51 [1.01; 2.26], and 2.18 [1.37; 3.44], respectively), and a lower total asthma quality of life questionnaire score (β [95% CI]=-0.49 [-0.68;-0.29]). The analysis of the long-term fluctuations of the ratio identified 5 profiles ("Never regular treatment," 53.2%; "Persistent high ratio," 21.8%; "Increasing ratio," 4.4%; "Initiating treatment," 8.8%; "Treatment discontinuation," 11.8%). The subsequent risk of poor asthma-related outcomes was significantly higher in profiles characterized by no or interrupted asthma maintenance therapy over time, compared with the "Persistent high ratio" group. The level and the long-term fluctuations of the controller-to-total asthma medication ratio predict poor asthma-related outcomes in elderly women.

Sex differences in stroke: a socioeconomic perspective.

BackgroundA number of studies have explored the issue of sex differences in stroke from biomedical perspective; however, there are still large gaps in the existing knowledge. The purpose of this study was to assess whether the differences in socioeconomic status and living conditions between men and women may explain the part of the sex differences in incidence and outcomes of stroke.MethodsAll stroke participants aged ≥60 years admitted in Vaseie Hospital in Sabzevar, Iran, from March 21, 2013, until March 20, 2014, were included in this study. Computerized tomography and magnetic resonance imaging were used to confirm stroke. A series of χ2 tests were performed and Statistical Program for Social Sciences, Version 21.0, was used to investigate the potential differences between older men and women in stroke incidence and outcomes.ResultsA total of 159 incident stroke cases were documented during 1 year. The annual rate of stroke was statistically significantly higher in elderly women than in elderly men (401 vs 357 per 100,000; P<0.001). Female elderly participants had significantly lower socioeconomic status, poorer living conditions, and higher lifetime history of depression, hypertension, and diabetes mellitus than their male counterparts.ConclusionThe findings from this study showed that elderly women are more adversely affected by stroke in terms of incidence and outcomes of stroke than elderly men. The most noticeable result is that sex differences in socioeconomic status and living conditions may result in increased incidence of stroke and poorer outcomes in elderly women. Therefore, it is imperative to identify vulnerable elderly women and provide them appropriate treatment and services.

Lack of Prognostic Impact of Adjuvant Radiation on Oncologic Outcomes in Elderly Women with Breast Cancer.

Radiotherapy plays an important role as adjuvant treatment in locally advanced breast cancer and in those patients who have undergone breast-conserving surgery. This study aimed to investigate the prognostic impact of adjuvant radiation on oncologic outcomes in elderly women with breast cancer. In this retrospective study, we reviewed and analyzed the characteristics, treatment outcome and survival of elderly women (aged ≥ 60 years) with breast cancer who were treated and followed-up between 1993 and 2014. The median follow up for the surviving patients was 38 (range 3-207) months. One hundred and seventy-eight patients with a median age of 74 (range 60-95) years were enrolled in the study. Of the total, 60 patients received postoperative adjuvant radiation (radiation group) and the remaining 118 did not (control group). Patients in the radiation group were significantly younger than those in the control group (P value=0.004). In addition, patients in radiation group had higher node stage (P value<0.001) and disease stage (P=0.003) and tended to have higher tumor grade (P=0.031) and received more frequent (P value <0.001) adjuvant and neoadjuvant chemotherapy compared to those in the control group. There was no statistically significant difference between two groups regarding the local control, disease-free survival and overall survival rates. In this study, we did not find a prognostic impact for adjuvant radiation on oncologic outcomes in elderly women with breast cancer.

Management and Outcomes for Elderly Women with High-Grade Endometrial Cancer

Management and Outcomes for Elderly Women with High-Grade Endometrial Cancer

Treatment Practices and Outcomes of Elderly Women with Breast Cancer in a Community Hospital

There is a paucity of clinical data available on specific treatment in the oncogeriatric population with breast cancer. The purpose of this study was to evaluate treatment patterns and survival outcomes in the elderly to address any disparities at our community hospital. We retrospectively identified a total of 1749 patients diagnosed and treated for breast cancer at our institution between 2001 and 2011. Patient demographics, surgical treatment, stage of disease, tumor characteristics, adjuvant therapy, and 5-year survival data were obtained from tumor registry records. Comparisons between study groups were made using the Pearson χ(2) test and Student's t test. We found more favorable prognostic makers among women older than 70 years of age. Of the women with lymph node-positive disease, 84 per cent of those younger than 70 years and 33 per cent in the older than 70 years of age study group received chemotherapy. Adjuvant chemotherapy and radiation therapy were more frequently performed in the younger group. Overall 5-year survival was 90 per cent and 71 per cent for younger than 70 years and older than 70 years groups, respectively. Women older than 70 years of age have more favorable breast cancer characteristics compared with younger women and received less aggressive treatment and experienced a higher mortality rate. Prospective trials are needed to assess the impact of aggressive multimodality therapy in this oncogeriatric population.

Management and outcomes for elderly women with vulvar cancer over time

Objective To examine changes over time in survival and treatment for women diagnosed with vulvar squamous cell carcinoma included in the Surveillance, Epidemiology, and End Results (SEER) Program. Design Retrospective analysis. Setting USA, data obtained from the SEER Program for 1988–2009. Population Women with vulvar squamous cell carcinoma. Methods Women were stratified by age: <50, 50–64, 65–79, and ≥80 years. Differences in survival and treatment patterns were analysed between age groups. Multivariate logistic regression models were constructed to examine treatment patterns. Kaplan–Meier and Cox proportional hazards survival methods were used to assess survival. Main outcome measures Vital status from the date of diagnosis until death, censoring or last follow-up. Results The final study group consisted of 8553 women, 1806 (21.12%) 80 years old. After adjusting for patient and tumour characteristics, older women were less likely to have surgery and more likely to receive radiotherapy. Compared with women under 50 years, women 50–64 had a two-fold higher risk of death (HR 1.91, 95% CI 1.55–2.34); those 65–79 years had a four-fold higher risk of death (HR 4.01, 95% CI 3.32–4.82), and those ≥80 years had a seven-fold higher risk of death (HR 6.98, 95% CI 5.77–8.46). These trends stayed relatively constant over the time periods studied. Conclusions Women over 50 years are at a higher risk of vulvar cancer-specific mortality, which increases with age. These trends stayed relatively constant over the time periods studied.

Management and outcomes for elderly women with vulvar cancer over time

To examine changes over time in survival and treatment for women diagnosed with vulvar squamous cell carcinoma included in the Surveillance, Epidemiology, and End Results (SEER) Program. Retrospective analysis. USA, data obtained from the SEER Program for 1988-2009. Women with vulvar squamous cell carcinoma. Women were stratified by age: <50, 50-64, 65-79, and ≥80years. Differences in survival and treatment patterns were analysed between age groups. Multivariate logistic regression models were constructed to examine treatment patterns. Kaplan-Meier and Cox proportional hazards survival methods were used to assess survival. Vital status from the date of diagnosis until death, censoring or last follow-up. The final study group consisted of 8553 women, 1806 (21.12%) <50years, 2141 (25.03%) 50-64years, 2585 (30.22%) 65-79years, and 2021 (23.63%) >80years old. After adjusting for patient and tumour characteristics, older women were less likely to have surgery and more likely to receive radiotherapy. Compared with women under 50years, women 50-64 had a two-fold higher risk of death (HR 1.91, 95% CI 1.55-2.34); those 65-79years had a four-fold higher risk of death (HR 4.01, 95% CI 3.32-4.82), and those ≥80years had a seven-fold higher risk of death (HR 6.98, 95% CI 5.77-8.46). These trends stayed relatively constant over the time periods studied. Women over 50years are at a higher risk of vulvar cancer-specific mortality, which increases with age. These trends stayed relatively constant over the time periods studied.

Preoperative breast MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a population-based study

Preoperative breast MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a population-based study

Preoperative breast MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a population-based study.

Existing evidence suggests that preoperative breast magnetic resonance imaging (MRI) might not improve surgical outcomes in the general breast cancer population. To determine if patients differentially benefit from breast MRI, we examined surgical outcomes-initial mastectomy, reoperation, and final mastectomy rates-among patients grouped by histologic type. We identified women diagnosed with early-stage breast cancer from 2004 to 2007 in the SEER-Medicare dataset. We classified patients as having invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), mixed ductal/lobular carcinoma (IDLC) or other histologic type. Medicare claims were used to identify breast MRI and definitive surgeries during the initial surgical treatment episode. We used propensity score methods to account for the differential likelihood of exposure to MRI. Of the 20,332 patients who met our inclusion criteria for this study, 12.2% had a preoperative breast MRI. Patients with ILC as compared to other histologic groups were most likely to receive MRI [OR 2.32; 95% CI (2.02-2.67)]. In the propensity score-adjusted analyses, breast MRI was associated with an increased likelihood of an initial mastectomy for all patients and among all histologic subgroups. Among patients with ILC, having a breast MRI was associated with lower odds of a reoperation [OR 0.59; 95% CI (0.40-0.86)], and an equal likelihood of a final mastectomy compared to similar patients without a breast MRI. Overall and among patients with IDC and IDLC, breast MRI was not significantly associated with a likelihood of a reoperation but was associated with greater odds of a final mastectomy. Our study provides evidence in support of the targeted use of preoperative breast MRI among patients with ILC to improve surgical planning; it does not provide evidence for the routine use of breast MRI among all newly diagnosed breast cancer patients or among patients with IDC.

Associations of Proanthocyanidin Intake with Renal Function and Clinical Outcomes in Elderly Women

BackgroundProgression to chronic renal failure involves accelerated atherosclerosis and vascular calcification. Oxidative stress and endothelial dysfunction play a role in renal failure pathophysiology. In addition to improving vascular health and function, proanthocyanidins have been shown to exert renoprotective effects in animal models. Thus we hypothesize that proanthocyanidins may contribute to the maintenance of healthy renal function.ObjectiveDetermine the association of habitual proanthocyanidin intake with renal function and the risk of clinical renal outcomes in a population of elderly women.Design948 women aged over 75 y, free of prevalent renal disease at baseline, were randomly selected from ambulant Caucasian women. Proanthocyanidin consumption was determined using a validated food frequency questionnaire and the United States Department of Agriculture proanthocyanidin food content database. Fasting serum cystatin C and creatinine were assessed at baseline. Renal failure hospitalisations and deaths were assessed over 5 years of follow-up through the Western Australia Data Linkage System.ResultsCompared to participants with low consumption, participants in the highest tertile of proanthocyanidin intake had a 9% lower cystatin C concentration (P<0.001). High proanthocyanidin consumers were at 50% lower risk of moderate chronic kidney insufficiency, and 65% lower risk of experiencing a 5-year renal disease event (P<0.05). These relationships remained significant following adjustment for renal disease risk factors and diet-related potential confounders.ConclusionIncreased consumption of proanthocyanidins was associated with better renal function and substantially reduced renal associated events, which has been supported by mechanistic and animal model data. Proanthocyanidin intake should be further examined as a dietary contributor to better renal health.

Calcium and vitamin D supplementation and cognitive impairment in the women's health initiative.

To examine the effects of vitamin D and calcium on cognitive outcomes in elderly women. Post hoc analysis of a randomized double-blind placebo-controlled trial. Forty Women's Health Initiative (WHI) clinical centers across the United States. Four thousand one hundred forty-three women aged 65 and older without probable dementia at baseline who participated in the WHI Calcium and Vitamin D Trial and the WHI Memory Study. Two thousand thirty-four women were randomized to receive 1,000 mg of calcium carbonate combined with 400 IU of vitamin D(3) (treatment) and 2,109 to placebo. Primary: classifications of probable dementia or mild cognitive impairment (MCI) based on a four-phase protocol that included central adjudication. Secondary: global cognitive function and individual cognitive subtests. Mean age of participants was 71. During a mean follow-up of 7.8 years, 39 participants in the treatment group and 37 in the placebo group developed incident dementia (hazard ratio (HR) = 1.11, 95% confidence interval (CI) = 0.71-1.74, P = .64). Likewise, 98 treatment participants and 108 placebo participants developed incident MCI (HR = 0.95, 95% CI = 0.72-1.25, P = .72). There were no significant differences in incident dementia or MCI or in global or domain-specific cognitive function between groups. There was no association between treatment assignment and incident cognitive impairment. Further studies are needed to investigate the effects of vitamin D and calcium separately, on men, in other age and ethnic groups, and with other doses.

Patterns of care and treatment outcomes for elderly women with cervical cancer

Cervical cancer is common in the elderly. The authors examined the patterns of care, treatment, and outcomes of elderly women with cervical cancer. Women with cervical cancer diagnosed between 1988 and 2005 and registered in the Surveillance, Epidemiology, and End Results database were analyzed. Patients were stratified by age: <50, 50 to 59, 60 to 69, 70 to 79, and ≥80 years. Multivariate logistic regression models were constructed to examine treatment; cancer-specific survival was examined using Cox proportional hazards models. A total of 28,902 women were identified, including 2543 women 70 to 79 years old and 1364 ≥80 years. For women with early stage (IB1-IIA) tumors, primary surgery was performed in 82.0% of women <50 years old compared with 54.5% of those 70 to 79 years old and 33.2% of those ≥80 years old (P < .0001). For women treated surgically, lymphadenectomy was performed in 66.8% of women <50 years old versus 9.1% of patients ≥80 years old (P < .0001). Compared with patients <50 years old, those >80 years old were less likely to undergo radical hysterectomy (odds ratio [OR], 0.10; 95% confidence interval [CI], 0.07-0.14) and lymphadenectomy (OR, 0.11; 95% CI, 0.08-0.16) and to receive adjuvant radiation therapy (OR, 0.06; 95% CI, 0.01-0.35). Among women with stage IIB-IVA disease, use of brachytherapy declined with age (P < .0001). For women with stage IB1-IIA tumors, the hazard ratio for death from cancer was 1.35 (95% CI, 1.16-1.58) for women 70 to 79 years old and 2.08 (95% CI, 1.72-2.48) for those ≥80 years old compared with younger women. Elderly women with cervical cancer are less likely to undergo surgery, receive adjuvant radiation, and receive brachytherapy. After adjusting for treatment disparities, cancer-specific mortality is higher in older women.

Comorbidity and outcomes in elderly women treated with breast-conserving therapy

599 Background: Breast cancer incidence increases with age and is a major cause of morbidity and mortality among elderly women. Co-morbidities are often considered in treatment management of elderly women. Methods: Between 1979 and 2002, 238 women age 70 or older with unilateral stage I or II invasive breast cancer underwent conventional breast conservation treatment with radiation. The age distribution was 122 women (51%) age 70–74 years, 71 women (30%) age 75–79 years, and 45 women (19%) age ≥80 years. Surgical axillary staging was performed in 73% (n= 173) of patients, of which 73% (n=126) were N0, and 27% (n=47) were N1. Co-morbidities were scored using the Charlson Comorbidity Index and Cumulative Illness Rating Scale (CIRS). Median follow-up was 6.2 years. Results: On analysis by age groups, the 10-year cancer specific outcomes were not significantly different (see Table ). However, distant metastases were the most common site of first failure in all age groups: 9% for age 70–74; 12% for age 75–79 and 11% for age &gt;/= 80. Second malignancies were the second most common cause of first failure in all age groups. Death from intercurrent disease was significantly more likely in the older age groups. In this cohort, moderate and severe co-morbidities were not significantly more common in the older age groups, and CIRS score did not correlate with overall survival. Conclusions: Breast conserving surgery and definitive breast irradiation provide excellent outcomes in appropriately selected elderly women. Older age itself is not a contraindication to breast conserving therapy. Women of any age with lower co-morbidity indices should be offered standard treatment. [Table: see text] No significant financial relationships to disclose.

Management and Outcomes of Elderly Women and Men With Acute Coronary Syndromes in 2000 and 2002

Signal dynamics is representative of perceptual signatures of sound in the time domain. Narrowband envelopes expressing frequency-dependent signal dynamics are keys to estimating intelligibility of speech materials. On the other hand, waveforms can be decomposed into the magnitude and phase spectral components in the frequency domain. An interesting question from a perceptual frame of reference would be whether the magnitude- or phase-spectral component is dominant for speech samples to be intelligible. This chapter investigates the spectral dominance on the intelligibility through synthesizing spectrally (magnitude or phase) or temporally modified (reversed or random permutation) speech materials and listening tests. Results confirm that keeping narrowband envelopes is significant in order to preserve the intelligibility of speech materials. For the preservation of narrowband envelopes or the frequency-dependent signal dynamics in the time domain, the spectral dominance may be temporally dependent. Frame-wise (temporally dependent) spectral analysis reveals the magnitude-spectral dominance in the medium range of frame lengths around 30(ms) for speech to be intelligible, while the phase may be significant in other shorter or longer frame length conditions. The magnitude dominance region provides appropriate frame length conditions for frequency resolution for selecting narrowband frequencies such as 1/4-octave band and temporal resolution for envelope periods. In contrast, the spectral structure obtained in the longer frame length conditions is fine enough to reconstruct the envelopes from the phase. In the very shorter frame length conditions, the micro structure of the waveform such as zero-crossings in the time domain could be preserved so that the envelopes are preserved by the phase spectrum.