Survival In Older Adults Research Articles

Association of malnutrition at diagnosis with survival among older adults with pancreatic cancer.

680 Background: Malnutrition is common among older adults newly diagnosed with pancreatic cancer. However, the implications of malnutrition among this vulnerable population are poorly understood. We sought to understand the association between malnourishment at diagnosis and overall survival (OS) among older adults with pancreatic cancer. Methods: We included adults aged ≥ 60 years with newly diagnosed pancreatic cancer, who were enrolled in the University of Alabama at Birmingham (UAB) Cancer and Aging Resilience Evaluation (CARE) registry between October 2017 and April 2024. To assess nutritional status, we administered an abridged version of the Patient-Generated Subjective Global Assessment (abPG-SGA) to patients at baseline prior to receiving chemotherapy. Using abPGSGA scores, we categorized patients as either normal (score ≤ 5) or malnourished (score ≥ 6). All participants were followed until death or until the cutoff date of July 10, 2024. We employed Kaplan-Meier survival analysis to estimate overall survival (OS) for both malnourished and non-malnourished groups and compared them using log-rank test. Additionally, we built multivariable Cox proportional hazards models to test the association between malnutrition and OS, while controlling for age at diagnosis, sex, race/ethnicity, and cancer stage. Results: A total of 274 patients were included; the median age at diagnosis was 70 (interquartile range, IQR: 65-75) years with 52% males, 75% non-Hispanic White and 52% with Stage IV disease at diagnosis. At baseline, 59% of patients were malnourished, and the median abPGSGA score was 8 (IQR 4-14). Patients who were malnourished had a similar demographic and clinical characteristics as compared to those without malnutrition. Over a median follow up of 36 months, a total of 202 patients (74 %) died. The median overall survival (OS) was significantly lower for malnourished patients at 13 months compared to 21 months for non-malnourished patients (log-rank test, p < .001). After adjusting for potential age, sex, race/ethnicity and cancer stage, malnutrition at diagnosis remained independently associated with worse survival outcomes (adjusted HR: 1.762; 95% CI: 1.316–2.358; p < .001). Conclusions: Our study reports that malnutrition at baseline is significantly associated with worse overall survival in older adults with pancreatic cancer. These findings underscore the importance of early nutritional assessment and intervention to enhance outcomes in this population.

Resting Body Temperature and Long-Term Survival in Older Adults at a Mental Health Center: Cross-Sectional and Longitudinal Data

Background/Objectives: Elevated body temperature is a well-established biomarker of infection, increased disease risk, and adverse health outcomes. However, the relationship between resting body temperature and long-term survival in older individuals is complex. Emerging evidence suggests that higher basal body temperature is associated with reduced survival and accelerated aging in non-obese older adults. This study aimed to compare body temperatures across different age groups in hospitalized older adults. Methods: Data were retrospectively collected from 367 physically healthy residents of a mental health center. Longitudinal data from 142 individuals (68 men and 74 women), aged 45 to 70 years and monitored continuously over 25 years, were compared with cross-sectional data from 225 individuals (113 men and 112 women) who underwent periodic clinical examinations with temperature measurements. The cross-sectional sample was stratified into four survival categories. Resting oral temperatures were measured under clinical conditions to ensure protocol consistency. Age-related changes in both sexes were evaluated using standard regression analysis, Student’s t-tests, ANOVA, and Generalized Linear Models. Results: Longitudinal analysis revealed an increase in body temperature with age among women, while cross-sectional analysis showed that long-lived residents generally had lower body temperatures compared to their shorter-lived counterparts. Conclusions: These findings support the hypothesis that lower lifetime steady-state body temperature is associated with greater longevity in physically healthy older adults. However, further research is needed to determine whether the lower body temperature observed in long-lived individuals is linked to specific health advantages, such as enhanced immune function, absence of detrimental factors or diseases, or a reduced metabolic rate potentially influenced by caloric restriction.

Palliative Care Initiated in the Emergency Department

The emergency department (ED) offers an opportunity to initiate palliative care for older adults with serious, life-limiting illness. To assess the effect of a multicomponent intervention to initiate palliative care in the ED on hospital admission, subsequent health care use, and survival in older adults with serious, life-limiting illness. Cluster randomized, stepped-wedge, clinical trial including patients aged 66 years or older who visited 1 of 29 EDs across the US between May 1, 2018, and December 31, 2022, had 12 months of prior Medicare enrollment, and a Gagne comorbidity score greater than 6, representing a risk of short-term mortality greater than 30%. Nursing home patients were excluded. A multicomponent intervention (the Primary Palliative Care for Emergency Medicine intervention) included (1) evidence-based multidisciplinary education; (2) simulation-based workshops on serious illness communication; (3) clinical decision support; and (4) audit and feedback for ED clinical staff. The primary outcome was hospital admission. The secondary outcomes included subsequent health care use and survival at 6 months. There were 98 922 initial ED visits during the study period (median age, 77 years [IQR, 71-84 years]; 50% were female; 13% were Black and 78% were White; and the median Gagne comorbidity score was 8 [IQR, 7-10]). The rate of hospital admission was 64.4% during the preintervention period vs 61.3% during the postintervention period (absolute difference, -3.1% [95% CI, -3.7% to -2.5%]; adjusted odds ratio [OR], 1.03 [95% CI, 0.93 to 1.14]). There was no difference in the secondary outcomes before vs after the intervention. The rate of admission to an intensive care unit was 7.8% during the preintervention period vs 6.7% during the postintervention period (adjusted OR, 0.98 [95% CI, 0.83 to 1.15]). The rate of at least 1 revisit to the ED was 34.2% during the preintervention period vs 32.2% during the postintervention period (adjusted OR, 1.00 [95% CI, 0.91 to 1.09]). The rate of hospice use was 17.7% during the preintervention period vs 17.2% during the postintervention period (adjusted OR, 1.04 [95% CI, 0.93 to 1.16]). The rate of home health use was 42.0% during the preintervention period vs 38.1% during the postintervention period (adjusted OR, 1.01 [95% CI, 0.92 to 1.10]). The rate of at least 1 hospital readmission was 41.0% during the preintervention period vs 36.6% during the postintervention period (adjusted OR, 1.01 [95% CI, 0.92 to 1.10]). The rate of death was 28.1% during the preintervention period vs 28.7% during the postintervention period (adjusted OR, 1.07 [95% CI, 0.98 to 1.18]). This multicomponent intervention to initiate palliative care in the ED did not have an effect on hospital admission, subsequent health care use, or short-term mortality in older adults with serious, life-limiting illness. ClinicalTrials.gov Identifier: NCT03424109.

Use of SGLT2 Inhibitors in Frail Older Adults is Associated with Increased Survival: A Retrospective Study.

In recent years, sodium-glucose co-transporter 2 inhibitors (SGLT2i) have emerged as a valuable treatment for type 2 diabetes (T2D) and heart failure. Despite these medications seeming to be safe in older people, the literature about SGLT2i and frailty is still limited. This study aims to evaluate whether SGLT2i use is associated with increased survival in older adults and if frailty can affect the findings. We enrolled over 65 patients admitted to the Geriatrics Wards at the University Hospital 'P. Giaccone' in Palermo, Italy, between December 2022 and May 2023. After 12 months of follow-up, various outcomes were assessed, including mortality, hospitalization, glycemic dysregulation, urinary tract infections, and falls. The association between SGLT2i use and mortality was analyzed and reported as hazard ratios (HRs) with their 95% confidence intervals (CIs). A total of 80 patients were included in the study (mean age 79.5 ± 8.5 years; 50% were women). Patients using SGLT2i had a higher prevalence of T2D (p = 0.02) and cirrhosis (p = 0.001). After adjusting for potential confounders, SGLT2i use was significantly associated with a reduced mortality risk (HR = 0.53; 95% CI: 0.20-0.93; p = 0.02). When stratified by the presence of multidimensional frailty, SGLT2i use was significantly associated with a lower risk of mortality in frail patients (HR = 0.27; 95% CI: 0.06-0.88; p = 0.008), but not in robust ones. In older frail patients, the use of SGLT2i is associated with reduced mortality after 12 months of follow-up. Further larger studies are needed to evaluate the role of these medications in older adults.

Is a higher body mass index associated with longer duration of survival with disability in frail than in non-frail older adults?

This study investigated the hitherto unclear association of body mass index (BMI) with age at overall, disability, and disability-free survival in older adults with and without frailty. This prospective cohort study enroled 10232 Japanese adults aged ≥65 years, who underwent follow-up for adverse events, from the Kyoto-Kameoka Study conducted from 2011-2016. BMI, calculated based on self-reported height and body weight, was classified into five categories: <18.5, 18.5-21.4, 21.5-24.9, 25.0-27.4, and ≥27.5 kg/m2. Frailty was assessed using the validated Kihon Checklist. The relationships between BMI and disability and mortality were analysed using multivariate Cox proportional hazards models and Laplace regression. During the 5.3-year median follow-up period (45472 person-years), 2348 (22.9%) incidences of disabilities occurred. After adjusting for confounders, including medical history and lifestyle, individuals in the lowest and highest BMI categories had a higher hazard ratio (HR) of disability [<18.5 kg/m2: HR: 1.31, confidence interval (CI): 1.16-1.49; ≥27.5 kg/m2: HR: 1.27, 95% CI: 1.08-1.49, p for non-linearity <0.001] compared with that of those with BMI = 21.5-24.9 kg/m2. In the 50th percentile differences in age at overall and disability-free survival, participants with BMI < 18.5 kg/m2 were more likely to die before disability incidence [survival with disability (overall survival - disability-free survival): -10.2 months]; those with BMI ≥ 27.5 kg/m2 had longer survival with disability (12.5 months). These relationships were more marked in the frailty-stratified model, where in the BMI ≥ 27.5 kg/m2 group, individuals with frailty survived longer with disability (27.2 months) than did individuals without frailty (6.2 months). Higher BMI is associated with a longer duration of survival with disability among older adults, especially in those with frailty. Therefore, reversing frailty should be prioritised because individuals with frailty have a shorter probability of disability-free survival than do individuals without frailty, regardless of BMI.

Health-related quality of life and survival of older adults in Campinas, São Paulo, Brazil: A retrospective analysis from 2008 to 2018

As the average life expectancy continues to rise, the prevalence of multimorbidity is also expected to increase, potentially leading to outcomes such as functional decline, a higher risk of premature death, and adverse effects on overall health and well-being. This study aimed to estimate the survival rates of older adults with varying levels of health-related quality of life (HRQoL) and to assess the association between the domains and components of the 36-item Short Form Health Survey and all-cause mortality over a 10-year period in Brazil. We conducted a retrospective longitudinal study using baseline data from 1,520 elders (aged 60 years and older) who participated in the Health Care Survey of the Municipality of Campinas, S&amp;atilde;o Paulo, Brazil (ISACamp 2008/2009). A linkage was established between the ISACamp databases and the Mortality Information System. An active search was performed for individuals whose data could not be paired to confirm the death status. Survival functions were calculated using the Kaplan&amp;ndash;Meier method, while hazard ratios (with 95% confidence intervals) were determined using Cox regression analysis. All HRQoL domains showed proportional hazards and statistically significant differences (p &lt; 0.05) between survival curves, except for the bodily pain domain. In the multivariate analysis, lower scores in physical functioning and role-physical were associated with a 74% and 42% increased risk of death, respectively. In addition, impairments in role-emotional, mental health, and general health heightened the risk of mortality by approximately 36%. Notably, the lowest score in the physical component emerged as a significant predictor of mortality, increasing the probability of death by 47%, while the mental component showed no significant association. Our findings provide compelling evidence of the predictive capacity of HRQoL in evaluating mortality risk among older people in low- and middle-income countries.

Exploring geriatric assessment-driven rehabilitation referral patterns and its influence on functional outcomes and survival in older adults with advanced cancer.

Older adults with advanced cancer experience functional disability that warrants rehabilitation services; however, evidence indicates inconsistencies in referral. The purpose was to (1) identify predictors of geriatric assessment (GA)-driven referrals to rehabilitation services and (2) explore associations between referral and change in function, health-related quality of life (HRQoL), and overall survival among older adults with advanced cancer. This was a secondary analysis (NCT020107443, UG1CA189961) of a nationwide GA clinical trial. Patients were older adults with advanced cancer who had at least one GA-defined physical performance or functional status impairment. Primary outcomes were oncologist-initiated discussion about or referral to rehabilitation services after the GA (Aim 1) and decline in activities of daily living (ADL), Instrumental ADL (IADL), and HRQoL within 3 months, and overall survival at 1 year (Exploratory Aims). Analyses included multivariable logistic regression and Cox proportional hazards models. Demographic and clinical factors were controlled for by using 1:1 propensity score matching. In total 265 patients were analyzed. After adjustment, impaired cognition (odds ratio [OR] = 2.25, p = 0.01), Karnofsky score indicating disability (OR = 2.86, p < 0.01), and receipt of monoclonal antibodies (OR = 1.95, p = 0.04) were associated with higher odds of referral. In contrast, polypharmacy was associated with lower odds of referral (OR = 0.31, p < 0.01). Referred patients were less likely to decline in ADL (OR 0.30, p = 0.07) and IADL (OR 0.64, p = 0.35), but more likely to decline in HRQoL (OR 1.20, p = 0.67) and have worse survival (HR 1.18, p = 0.62). Cancer treatment, polypharmacy, cognition, and disability status likely influence oncologists' decision to refer for rehabilitation. Referral was not independently associated with change in functional disability, HRQoL, or survival. Future studies should evaluate patients' utilization of rehabilitation services post-referral and determine whether dose/timing of rehabilitation services influence clinical outcomes.

COVID-19 infection and 2-year mortality in nursing home residents who survived the first wave of the pandemic

BackgroundDuring the first COVID-19 pandemic wave (1st CoPW), nursing homes (NHs) experienced a high rate of COVID-19 infection and death. Residents who survived the COVID-19 infection may have become frailer. This study aimed to determine the predictive value of having a COVID-19 infection during the 1st CoPW for 2-year mortality in NH residents.MethodsThis was a retrospective study conducted in three NHs. Residents who had survived the 1st CoPW (March to May 2020) were included. The diagnosis of COVID-19 was based on the results of a positive reverse transcriptase-polymerase chain reaction test. The collected data also included age, sex, length of residence in the NH, disability status, legal guardianship status, nutritional status, need for texture-modified food, hospitalization or Emergency Department visits during lockdown and SARS-COV2 vaccination status during the follow-up. Non-adjusted and adjusted Cox models were used to analyse factors associated with 2-year post-1st CoPW mortality.ResultsAmong the 315 CoPW1 survivors (72% female, mean age 88 years, 48% with severe disability), 35% presented with COVID-19. Having a history of COVID-19 was not associated with 2-year mortality: hazard ratio (HR) [95% confidence interval] = 0.96 [0.81–1.13], p = 0.62. The factors independently associated with 2-year mortality were older age (for each additional year, HR = 1.05 [1.03–1.08], p < 0.01), severe disability vs. moderate or no disability (HR = 1.35 [1.12–1.63], p < 0.01) and severe malnutrition vs. no malnutrition (HR = 1.29 [1.04–1.60], p = 0.02). Considering that vaccination campaign started during the follow-up, mortality was associated with severe malnutrition before and severe disability after the start of the campaign. Vaccination was independently associated with better survival (HR 0.71 [0.55–0.93], p = 0.02).ConclusionsHaving survived a COVID-19 infection during the 1st CoPW did not affect subsequent 2-year survival in older adults living in NHs. Severe malnutrition and disability remained strong predictor of mortality in this population, whereas vaccination was associated to better survival.

A nomogram for predicting disability-free survival in older adults over 15 years: A population-based cohort study

BackgroundThis article aimed to develop and validate a simple-to-use nomogram to predict 15-year disability-free survival among older adults. MethodsA cohort of 1878 disability-free participants aged ≥60 was followed for 15 years. Participants were randomly divided into a training cohort for nomogram development (n = 1314 [70 %]) and validation cohort to confirm the model's performance (n = 564 [30 %]). Information on socio-demographic, lifestyle factors, the Life Satisfaction Index A (LSI-A), chronic diseases, and Mini-Mental State Examination (MMSE) score, and biomarkers were collected through interviews, clinical and neuropsychological examinations, and medical records. Disability-free survival was defined as survival in the absence of dementia and physical disability, and the composite endpoint is first occurrence of events of death, dementia and physical disability. We developed a nomogram summing the number of risk points corresponding to weighted covariates to predict disability-free survival. Validation of the nomogram using C statistic, calibration plots, and Kaplan-Meier curves. ResultsIn the multivariate-adjusted model, factors associated with composite end point were younger age, high MMSE (hazard ratio [HR], 0.93; [95 % CI, 0.87–0.99]), high LSI-A (0.78, [0.64–0.97]), non-smoking (0.74, [0.59–0.94]), engagement in physical leisure activity (0.62, [0.48–0.78]), and absence of chronic diseases (0.78, [0.66–0.91]). Incorporating these 6 factors, the nomogram achieved C-statistics of 0.78 (95 % CI, 0.75–0.81) and 0.77 (95 % CI, 0.74–0.80) in predicting disability-free survival in the training and validation cohorts, respectively, and had good calibration curves. ConclusionThe nomogram was able to predict long-term of disability-free survival and performed well on internal validation, and may be considered for use in effective surveillance, promote, management of clinical and public health ageing.

The Prognostic Role of Prognostic Nutritional Index and Controlling Nutritional Status in Predicting Survival in Older Adults with Oncological Disease: A Systematic Review

The increase in new cancer diagnoses in the elderly calls for new, accessible, and easy-to-use prognostic tools that contribute to lowering the burden of the disease. Recognising the importance of inflammation and nutritional status in the progression of the disease, the purpose of this systematic review was to synthesise the evidence on the prognostic role of Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) in predicting survival of older adult cancer patients. A comprehensive search was conducted in PubMed and Web of Science Core Collection databases until 22 February 2024. The articles included in this review (n = 38) examined the relationships of PNI and CONUT with survival outcomes in elderly cancer patients. Despite high heterogeneity between the studies, most concluded that low PNI values are associated with poor overall survival (OS), particularly in gastric cancer patients. Most studies did not find an association between PNI and cancer-specific survival, progression-free survival, disease-free survival, recurrence-free survival, and mortality. Results regarding the prognostic role of CONUT in predicting survival were inconclusive. This study suggests that PNI could be used to predict OS in elderly cancer patients, while more studies are needed to assess the prognostic role of CONUT.

Self-Rated Health and its Impact on Survival of Older Adults.

Self -rated health (SRH) is a subjective assessment of health status that results from asking a question as "How do you assess your health?". The aim of this study was to determine the value of SRH for survival of older adults. This cohort study was conducted among a population aged 60 years and over living in the north region of Iran. The participants' characteristics including demographic information, life-style behaviors, medical history, body mass index, depressive symptoms, cognitive function, and social support were examined. SRH was categorized into two groups (1. poor or fair and 2. good or excellent). All of the study population were followed up again after 5 years to determine the survival condition. Totally, 1475 elderly people were included. Good or excellent SRH showed a significant association with male gender, to be married, higher physical activity, less co-morbid chronic disorders, no depressive symptoms, normal cognitive function, higher social support, smoking (P < 0.001), and normal body mass index (BMI) (P = 0.021); however, no significant association with age (P < 0.083) was observed. Out of 944 elderly people expressing good or excellent SRH, 85 (9%) persons died after 5-year follow-up (P < 0.001). Cox regression analysis revealed that SRH had a significant impact on mortality of older adults (adjusted hazard ratio = 1.447; 95% confidence interval: 1.008-2.076; P = 0.045). Considering health-related characteristics including age, gender, number of drugs the participant was taking, physical activity, BMI, and social support, SRH showed a significant effect on 5-year survival of older adults.

Association of Fried’s frailty phenotype, but not the clinical frailty scale, with overall survival in older adults with acute myeloid leukemia.

e23222 Background: Frailty is a geriatric syndrome marked by increased vulnerability to stressors. “Fitness,” is utilized to guide treatment in acute myeloid leukemia (AML) where the intensity of initial induction may be high (anthracycline and cytarabine-based), intermediate (venetoclax combinations), or low (single hypomethylating agent or targeting therapy). Fried’s Frailty Phenotype (FP) combines subjective (self-reported exhaustion, weight loss &gt; 5%, activity level) and objective (4-meter walk speed and grip strength) measures to categorize patients into fit, pre-frail, and frail. In prior work, we demonstrated an association of FP with survival for newly diagnosed older adults with AML. Clinical Frailty Scale (CFS) is a purely subjective score that utilizes chart data to stratify the degree of fitness. The incorporation of objective measures into clinical practice is limited due to time constraints, we sought to determine if CFS could similarly identify frailty and risk-stratify older adults with AML. Methods: Eighty-three patients 60 years or older with a new diagnosis of AML were enrolled on an IRB approved study from September, 2018 to May, 2023 at the Hospital of the University of Pennsylvania. FP was performed prior to initiation of therapy. A CFS certified trainee blinded to FP scores retrospectively reviewed electronic medical records to assign a CFS score. CFS was collapsed into variations defined as CFS fit (1-3), pre-frail (4), and frail (5 or greater); CFS Collapse 1 fit (1-2), pre-frail (3-4), and frail (5 or greater), and CFS Collapse 2 fit (1-4) and mild to moderately frail (5-6). Variations were based on the scale’s descriptions and literature. Results: Median patient age was 71 (range 60-91) years. By European LeukemiaNet 2017, 64% of patients had adverse-risk AML. 39% of patients received IC, 52% received HMA/ven, 6% received HMA alone or targeted therapy, and 2% received supportive care. By FP, 18% were fit, 38% were pre-frail, and 45% were frail. FP was significantly associated with OS (p = 0.047): 2-year OS was 57%, 42%, and 21% in fit, pre-frail, and frail. By CFS, 43% were fit, 32% pre-frail, and 24% frail. CSF was not significantly associated with OS (p = 0.495); 2-year OS was 24%, 35%, and 19% for fit, pre-frail, and frail patients, respectively. CSF collapse 1 (p = 0.249) and 2 (p = 0.070) were not significant. Conclusions: FP identified more patients as frail and was associated with a doubling of early mortality and inferior 2-year OS. CFS identified more patients as fit and was not associated with 2-yr OS. The discrepancy emphasizes the importance of objective measurements to capture frailty and the difficulty in determining frailty based on chart reviews in an acutely ill population. Future work to streamline objective measurements in frailty assessments to increase utilization in clinics given its likely importance for accurate risk-stratification.

CD4+ T cell lymphopenia decreases survival in older adults with glioblastoma

Abstract OBJECTIVE: Glioblastoma (GBM) is the most common and aggressive primary brain tumor with a median age of onset at ~70 years of age. GBM patients ≥ 65 years of age have worse survival outcomes than younger counterparts (p&amp;lt;0.0001). Older human GBM patients with CD4+ lymphopenia show decreased survival as compared to age-matched GBM controls (p&amp;lt;0.05). Here, we evaluated the effects of tumor and various forms of lymphopenia in young and old mice with GBM. METHODS: Young 6-12 weeks of age or old ≥80-120 weeks of age C57BL/6 mice were treated with either IgG isotype control antibodies or with depleting antibodies against murine CD4, CD8, or NK1.1 beginning at 3 days prior to- and every 3 days post-intracranial injection of the syngeneic GBM cell lines, GL261, CT-2A, or SB28. Overall survival was compared between groups. RESULTS: Older adult mice, but not younger mice, with either intracranial GL261, CT-2A, or SB28 cell-based brain tumors have a significantly decreased overall survival when depleted for CD4+ T cells as compared to the IgG control-treated group or groups depleted for CD8+ T- or NK-cells (p&amp;lt;0.05). Based on the precipitous decline in overall survival due to CD4+ T cell lymphopenia, a tumor-independent effect is suspected. CONCLUSIONS: The data suggest that CD4+ T cells play a more sophisticated role in maintaining the survival of older adult subjects with GBM than in the younger subjects and that their contribution goes beyond an anti-tumor-only contribution.

Association of Use and Dose of Lipid-Lowering Therapy Post Acute Myocardial Infarction With 5-Year Survival in Older Adults.

Older people are underrepresented in randomized trials. The association between lipid-lowering therapy (LLT) and its intensity after acute myocardial infarction and long-term mortality in this population deserves to be assessed. The FAST-MI (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) program consists of nationwide French surveys including all patients admitted for acute myocardial infarction ≤48 hours from onset over a 1- to 2-month period in 2005, 2010, and 2015, with long-term follow-up. Numerous data were collected and a centralized 10-year follow-up was organized. The present analysis focused on the association between prescription of LLT (atorvastatin ≥40 mg or equivalent, or any combination of statin and ezetimibe) and 5-year mortality in patients aged ≥80 years discharged alive. Cox multivariable analysis and propensity score matching were used to adjust for baseline differences. Among the 2258 patients aged ≥80 years (mean age, 85±4 years; 51% women; 39% ST-segment elevation myocardial infarction; 58% with percutaneous coronary intervention), 415 were discharged without LLT (18%), 866 with conventional doses (38%), and 977 with high-dose LLT (43%). Five-year survival was 36%, 47.5%, and 58%, respectively. Compared with patients without LLT, high-dose LLT was significantly associated with lower 5-year mortality (adjusted hazard ratio, 0.78 [95% CI, 0.66-0.92]), whereas conventional-intensity LLT was not (adjusted hazard ratio, 0.93 [95% CI, 0.80-1.09]). In propensity score-matched cohorts (n=278 receiving high-intensity LLT and n=278 receiving no statins), 5-year survival was 52% with high-intensity LLT at discharge and 42% without statins (hazard ratio, 0.78 [95% CI, 0.62-0.98]). In these observational cohorts, high-intensity LLT at discharge after acute myocardial infarction was associated with reduced all-cause mortality at 5 years in an older adult population. These results suggest that high-intensity LLT should not be denied to patients on the basis of old age. URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00673036, NCT01237418, and NCT02566200.

Comparison of Comorbidity Models Within a Population-Based Cohort of Older Adults With Non-Hodgkin Lymphoma.

Compare the association of individual comorbidities, comorbidity indices, and survival in older adults with non-Hodgkin lymphoma (NHL), including in specific NHL subtypes. Data source was SEER-Medicare, a population-based registry of adults age 65 years and older with cancer. We included all incident cases of NHL diagnosed during 2008-2017 who met study inclusion criteria. Comorbidities were classified using the three-factor risk estimate scale (TRES), Charlson comorbidity index (CCI), and National Cancer Institute (NCI) comorbidity index categories and weights. Overall survival (OS) and lymphoma-specific survival, with death from other causes treated as a competing risk, were estimated using the Kaplan-Meier method from time of diagnosis. Multivariable Cox models were constructed, and Harrel C-statistics were used to compare comorbidity models. A two-sided P value of <.05 was considered significant. A total of 40,486 patients with newly diagnosed NHL were included. Patients with aggressive NHL had higher rates of baseline comorbidity. Despite differences in baseline comorbidity between NHL subtypes, cardiovascular, pulmonary, diabetes, and renal comorbidities were frequent and consistently associated with OS in most NHL subtypes. These categories were used to construct a candidate comorbidity score, the non-Hodgkin lymphoma 5 (NHL-5). Comparing three validated comorbidity scores, TRES, CCI, NCI, and the novel NHL-5 score, we found similar associations with OS and lymphoma-specific survival, which was confirmed in sensitivity analyses by NHL subtypes. The optimal measure of comorbidity in NHL is unknown. Here, we demonstrate that the three-category TRES and five-category NHL-5 scores perform as well as the 14-16 category CCI and NCI scores in terms of association with OS and lymphoma-specific survival. These simple scores could be more easily used in clinical practice without prognostic loss.

Thyroid paradox in older age

BACKGROUND: The thyroid gland plays an important role in our body, influencing almost all metabolic processes in the body throughout life. However, literature data on the effect of decreased thyroid function on mortality in older people is contradictory.&#x0D; AIM: To evaluate the impact of thyroid-stimulating hormone levels on 5-year survival in older adults.&#x0D; MATERIALS AND METHODS: This work was carried out on the basis of the second screening of the Crystal study of community-dwelling individuals 65+ (n = 383). Main study parameters: thyroid-stimulating hormone level, blood test, lipid profile, albumin, total protein, comprehensive geriatric assessment, 5 years of follow-up.&#x0D; RESULTS: A thyroid-stimulating hormone level of 3.3–10.0 mIU/L was associated with a 44.6% reduced risk of all-cause mortality (hazard ratio 0.554; 95% confidence interval 0.307–0.999) at 5 years of follow-up, regardless of the presence of non-communicable diseases and geriatric status. A thyroid-stimulating hormone level more 10.0 mIU/L is not associated with an increased risk of mortality. The lower risk of mortality in patients with high thyroid-stimulating hormone levels may be due to a larger thigh muscle circumference. After adjustment for all covariates used and thyroid-stimulating hormone level, a 1 cm increase in thigh muscle circumference was associated with a 4.5% reduction in the risk of all-cause mortality (hazard ratio 0.955; 95% confidence interval 0.932–0.979).&#x0D; CONCLUSIONS: The lowest risk of all cause-mortality mortality in persons aged 65 years and older is observed with a thyroid-stimulating hormone level of 3.3–10.0 mIU/L. Thyroid-stimulating hormone level more 10.0 mIU/L is not associated with an increased risk of all cause-mortality.

The impact of prognostic factors and comorbidities on survival in older adults with stage I − III cutaneous melanoma in Southwest Finland: A register study

IntroductionDespite being diagnosed with thicker and more often ulcerated melanomas, cancer-specific survival (CSS) is not necessarily inferior in older adults with melanoma compared to younger patients. Materials and MethodsOur aim was to evaluate the impact of baseline melanoma-specific prognostic factors and comorbidities on recurrence-free survival (RFS), CSS, and overall survival (OS) in patients aged 70–79 (n = 474) and ≥ 80 years (n = 286) with resected stage I − III cutaneous melanoma in Southwest Finland between January 1, 2000 and December 31, 2020. Patients were restaged according to the 8th edition of TNM classification, and comorbidities were assessed using the Charlson Comorbidity Index (CCI). ResultsPatients aged ≥80 years had thicker and more commonly ulcerated melanomas: 43.0%, 40.9%, and 16.1% of patients aged ≥80 and 56.5%, 25.3%, and 18.1% of patients aged 70–79 years were diagnosed with stage I, II, and III melanoma, respectively. Multiple comorbidities (CCI ≥2) were more common and sentinel lymph node biopsy less frequently performed in patients aged ≥80 years. RFS and CSS were similar in patients aged 70–79 years and ≥ 80 years: median RFS 13.8 years vs not reached, with the hazard ratio of melanoma recurrence or death from melanoma 1.25 (95% confidence interval [CI]: 0.91–1.71); median CSS was not reached, with the hazard ratio of death from melanoma 1.12 (95%CI: 0.81–1.75). The proportion of patients who were alive with melanoma recurrence or had died from melanoma was similar in both age groups. In multivariable analysis, higher pathological stage was the only independent risk factor for short RFS regardless of age group, sex, CCI, and tumor ulceration. Higher stage and male sex were associated with short CSS. Age ≥ 80 years, stage III disease, and CCI ≥ 2 were associated with short OS and female sex with long OS in multivariable analysis. DiscussionPathological stage was the most influential factor determining RFS and CSS in older adults with resected stage I − III melanoma. Concerning OS, age ≥ 80 years, stage III disease, and multiple comorbidities had a significant negative impact.

The impact of CARE Frailty Index on overall survival in older adults with hepatocellular carcinoma.

462 Background: Pre-treatment frailty is associated with unfavorable short and long-term outcomes among patients with hepatocellular cancer (HCC) post liver resection.However, there is a knowledge gap in identifying the subset of older adults with HCC at high risk for inferior survival outcomes. Methods: We evaluated the association between patient-reported geriatric assessment (GA)-based frailty index and overall survival (OS) among older adults (≥60y) diagnosed with HCC enrolled in a single institutional prospective registry (Cancer and Aging Resilience Assessment (CARE) registry). All patients underwent a patient-reported GA at enrollment that encompassed multiple health domains related to aging. To determine frailty, we utilized a 44-item CARE Frailty Index (CARE-FI) based on the principles of deficit accumulation (Giri S et al JAGS 2021). We categorized frailty into robust, pre-frail and frail. The primary outcome was OS from the time of GA. Comparison of survival between groups was made using log-rank statistic. A multivariable Cox regression model measured the independent association between frailty and OS adjusted for age, etiology, Child-Pugh score and cancer stage. Results: A total of 116 older adults with HCC were identified with a median follow-up 2.1 year, median age was 67y (63-72) with 82% males, 27% blacks, 64% with Child-Pugh-A and 78% with stage III/IV disease. Overall, 50.1% (n=58) were frail, 33.6% (n=39) pre-frail and 16.3% (n=19) robust. No significant clinico-demographic differences across the 3 frailty groups were observed. In univariable analysis, there was a marginally significant difference between the three frailty groups (p value 0.06). However, in multivariable analysis, being frail vs robust was associated with an increased risk of mortality (HR 2.6 [95% CI 1.03 – 6.56]; p=0.04) after adjustment for aforementioned confounders. Conclusions: Frailty status assessed by patient-reported GA using CARE-FI is associated with an increased risk of mortality in older adults with HCC. Frailty assessment should be encouraged and considered in prospective clinical trials to estimate the impact of treatment on the most vulnerable adults. [Table: see text]

Influence of Pre-Treatment Features and Therapy Choice By Physicians on Overall Survival in Older Adults with Acute Myeloid Leukemia: A Report from the Beat AML Master Trial

Background: Acute myeloid leukemia (AML) therapy in older patients (age ≥ 60) has undergone a transformation with the introduction of multiple targeted therapies, which has allowed more patients to receive therapy than before. The most successful has been the combination of venetoclax + azacitidine (VA) which generated higher overall complete response rates in phase 2 studies than would be expected with azacitidine alone, leading to accelerated FDA approval on 21Nov2018. The VIALE-A phase 3 study confirmed the improved overall survival (OS, median 14.7 versus 9.6 months) of VA, leading to full FDA approval for marketing. This retrospective analysis provides real world data on the impact of baseline clinical and genomic markers of individuals receiving intensive chemotherapy versus VA. Methods: The precision medicine Beat AML Master Trial (NCT03013998) assigns patients to biomarker specific sub-study treatments based on targeted DNA sequencing and cytogenetics. However, a large subset of patients did not enroll on a sub-study, but were followed for off-study treatment and OS. From this subset, patients enrolled onward from 21Nov2018, when VA received accelerated approval, were examined for differences in clinical/genetic characteristics and OS in those receiving venetoclax + hypomethylating agent (V/HMA), any form of intensive chemotherapy (IC), alternative non-intensive therapy (NIT), or no therapy. The genetic mutations identified in this study are characterized by a variant allele frequency of 20%+, as defined in the trial for determining the dominant clone. The method of Kaplan-Meier was used to estimate OS, and the Cox model was fit to associate patient characteristics with OS. Results: From 21Nov2018, a total of 468 AML patients consented to the Beat AML trial and did not enroll to a sub-study. Treatment was chosen by the investigator based upon available clinical and genomic data. Of these 468 patients, 62 did not receive treatment, 2 had treatment data missing, 226 were treated with V/HMA, 112 with IC, and 66 with NIT. Demographics for all patients include median age 71 (60-90), 40% female, performance status (PS) (0-20%; 1-55%; 2-22%; 3-3%), median white blood cell (WBC) 4.1 (range 0.3-298.6), complex karyotype (CK) 20.6%, core binding factor (CBF) 7.8%, KMT2A-rearranged 3.6%, NPM1-mutated (m) 15.6%, IDH2m 14.6%, TP53m 13.2%, FLT3-ITD/TKD 12.9%, and NRASm/ PTPN11m/ KRASm/ NF1m/ CBLm 23.6%. Demographics that were significantly different (p&amp;lt;0.01) among the three groups (V/HMA, IC, and NIT) include age (younger in IC), PS (worse in NIT), AST/ALT (worse in NIT), CBF (more in IC), CK and TP53m (less in IC). Of the 404 patients who underwent treatment with V/HMA, IC, or NIT, 208 have died with those surviving having a median follow-up of 22.3 months. Figure 1 summarizes the OS of each treatment group. The median OS (95% CI) from time of initiating therapy is 13.6 (10.9-16.8) for V/HMA, 33.8 (20.7-not reached) for IC, and 11.6 (5.2-21.3) months for NIT. Univariable analysis for OS was significant at p&amp;lt;0.05 for increased age, WBC, PS, hemoglobin, CBF, CK, NPM1m, TP53m, TET2m and IC versus V/HMA. Multivariable analysis was significant at p&amp;lt;0.05 (hazard ratio) for increased age (1.14), PS (1.83), WBC (1.08), hemoglobin (0.91), and select genomic aberrations including CBF (0.37), NPM1m (0.35), and TP53m (2.1). Conclusions: These results from a large cohort of older AML patients treated with V/HMA, IC, or NIT show that their outcome is best defined by pre-treatment clinical features previously identified including age, performance status, WBC and hemoglobin along with limited genomic characteristics including CBF, NPM1m, and TP53m. While univariate analysis of OS favored IC over V/HMA and NIT, multivariable analysis supports that this advantage was most likely due to the favorable clinical and genomic features. The OS of V/HMA patients in this cohort is similar to that in the VIALE-A registration study of VA, providing further justification for this treatment for older AML patients deemed ineligible for intensive chemotherapy. Additionally, this data supports use of the patient cohort in this study for ongoing work in understanding and/or validating biomarkers associated with survival with V/HMA.

SIOG2023-3-P-251 - Overall survival in older adults with non-small cell lung cancer by smoking status from 1990 to 2020

SIOG2023-3-P-251 - Overall survival in older adults with non-small cell lung cancer by smoking status from 1990 to 2020