Survival In Older Patients Research Articles

Is adjuvant chemotherapy necessary in older patients with breast cancer?

BackgroundDue to the lack of clinical trials on the efficacy of chemotherapy in older patients, an optimal treatment strategy has not been developed. We investigated whether adjuvant chemotherapy could improve the survival of older patients with breast cancer in Japan.MethodsWe retrospectively analyzed data of patients with breast cancer aged ≥ 70 years who underwent breast cancer surgery in eight hospitals between 2008 and 2013. Clinical treatment and follow-up data were obtained from the patients’ medical electric records.ResultsA total of 1095 patients were enrolled, of which 905 were included in the initial non-matched analysis. The median age and follow-up period were 75 (range 70–93) and 6.3 years, respectively. Of these patients, 127 (14%) received adjuvant chemotherapy (Chemo group) while the remaining 778 (86%) did not (Control group). The Chemo group was younger (mean age in years 73 vs 76; P < 0.0001), had a larger pathological tumor size (mean mm 25.9 vs 19.9; P < 0.0001), and more metastatic axillary lymph nodes (mean numbers 2.7 vs 0.7; P < 0.0001) than the Control group. The disease-free survival (DFS) and overall survival (OS) did not differ significantly between the two groups (P = 0.783 and P = 0.558). After matched analyses, DFS was found to be significantly prolonged with adjuvant chemotherapy (P = 0.037); however, OS difference in the matched cohort was not statistically significant (P = 0.333).ConclusionThe results showed that adjuvant chemotherapy was associated with a reduced risk of recurrence, but survival benefits were limited.

Oral Maintenance Therapy to Improve Survival in Older Patients With AML

Oral Maintenance Therapy to Improve Survival in Older Patients With AML

Effect of Intravesical Chemotherapy on the Survival of Patients with Non-Muscle-Invasive Bladder Cancer Undergoing Transurethral Resection: A Retrospective Cohort Study Among Older Adults

Background: The average age of diagnosis for bladder cancer is 73 and about 75 percent of all bladder cancers are non-muscle invasive at initial diagnosis. It is recommended that non-muscle invasive bladder cancers (NMIBC) should be treated with transurethral resection of the bladder tumor (TURBT) followed by chemotherapy. However, there is no large-scale study from real-world databases to show the effectiveness of chemotherapy on the survival of older adults with NMIBC that have undergone TURBT. This study aimed to investigate the effects of chemotherapy on survival among older NMIBC patients with TURBT. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database (2010-2015), we performed analyses of cancer-specific mortality and overall mortality comparing chemotherapy versus no chemotherapy after TURBT. Coarsened exact matching was performed to balance the baseline patient characteristics. Cox proportional hazards and Kaplan-Meir analyses were used to evaluate survival outcomes. Results: A total of 3,222 matched patients with 1,611 in each arm (chemotherapy and no chemotherapy) were included in our study. After adjusting for covariates, multivariable Cox regression analyses show chemotherapy was associated with lower cancer-specific mortality (HR 0.63; 95% CI 0.42-0.94; p value 0.024). However, chemotherapy did not have any effect on overall mortality (HR 0.84; 95% CI 0.65-1.07; p value 0.159). The Kaplan-Meier curves show the protective effects of chemotherapy on cancer specific survival (p=0.032), but not on overall survival (p=0.34). Conclusion: Chemotherapy improved cancer specific survival among older patients with non-muscle invasive bladder cancer undergoing TURBT surgery, but it had no effect on overall survival. There is a need for more granular level real-world data on chemotherapy regimens and dosage to effectively investigate the effects of chemotherapy on the survival of older patients with NMIBC that have undergone TURBT.

Geriatric impairments are prevalent and predictive of survival in older patients with cancer receiving radiotherapy: a prospective observational study

Background A systematic assessment of problems that are frequent in older age (geriatric assessment [GA]) provides prognostic information for patients undergoing cancer surgery and systemic cancer treatment. We aimed to investigate the prevalence of geriatric impairments and their impact on survival in older patients with cancer receiving radiotherapy (RT). Material and methods A single-centre prospective observational study was conducted including patients ≥65 years referred for curative or palliative RT. Prior to RT, we performed a modified GA (mGA) assessing comorbidities, medications, nutritional status basic- and instrumental activities of daily living (IADL) mobility, falls, cognition and depressive symptoms. Impairments in each mGA domain were defined. Overall survival (OS) was presented by Kaplan Meier plots for groups defined according to the number of impairments, and compared by log-rank test. The association between mGA domains and OS was assessed by Cox proportional hazard regression analysis. Results Between February 2017 and July 2018, 301 patients were included, 142 (47.2%) were women. Mean age was 73.6 (SD 6.3) years, 162 (53.8%) received curative RT. During the median observation time of 24.2 months (min 0.3, max 25.9), 123 (40.9%) patients died. In the overall cohort, 49 (16.3%) patients had no geriatric impairment, 81 (26.9%) had four or more. OS significantly decreased with an increasing number of impairments (p < .01). Nutritional status (HR 0.90, 95% CI [0.81; 0.99], p = .038) and IADL function (HR 0.98, 95% CI [0.95; 1.00], p = .027) were independent predictors of OS. Conclusion Geriatric impairments were frequent among older patients with cancer receiving RT and nutritional status and IADL function predicted OS. Targeted interventions to remediate modifiable impairments may have the potential to improve OS. Trial registration Cinicaltrials.gov ID:NCT03071640.

SIOG2021-0018 - Differences in treatment and survival of older patients with operable breast cancer between the United Kingdom and the Netherlands – a comparison of two national prospective longitudinal multi-centre cohort studies

SIOG2021-0018 - Differences in treatment and survival of older patients with operable breast cancer between the United Kingdom and the Netherlands – a comparison of two national prospective longitudinal multi-centre cohort studies

The Prognostic Nutritional Index (PNI) is an independent predictor of overall survival in older patients with follicular lymphoma

The Prognostic Nutritional Index (PNI), a parameter combining serum albumin concentration and absolute lymphocyte count, is considered a measure of the nutritional and inflammatory status and the host’s anti-tumor response. We analyzed the clinical characteristics and outcomes according to the PNI of 351 grades 1–3 A FL patients. Forty-one patients (12%) had a PNI ≤45, who were older and showed adverse baseline features. A low PNI was associated with a shorter PFS (only for patients >60 years), and OS (for all patients, 10-year OS, 52% versus 74%, p = 0.0001). The prognostic impact of the PNI on OS was confirmed in a multivariate model for patients >60 years (HR = 3, p = 0.006). In conclusion, the PNI is a readily accessible piece of information that can identify a small subset of FL patients with shorter survival, and it could be an aid to improve the nutritional status of patients prior to treatment initiation.

Limited Impact of Breast Cancer and Non-breast Malignancies on Survival in Older Patients with Early-Stage Breast Cancer: Results of a Large, Single-Centre, Population-Based Study

AimsTo analyse the disease-free survival and overall survival in older adults with breast cancer after breast-conserving therapy, focusing on the relevance of non-breast malignancy (NBM) with respect to survival rates. Materials and methodsAnalyses were based on 1205 women aged 65 years and older with breast cancer treated with breast-conserving therapy between 1999 and 2015. Patients were divided into three age categories: 65–70, 71–75 and >75 years. Multivariate survival analysis was carried out using Cox regression analysis. ResultsThe two youngest age categories showed excellent results, with a 12-year disease-free survival of 84.6 and 86.3%, respectively. We noted a 17.2% incidence of NBM, particularly for colon cancer and lung cancer. Most (72.9%) occurred after a diagnosis of breast cancer. Of those 72.9%, about 50% died as a result of NBM within 2 years of the diagnosis of NBM. The overall 12-year NBM-specific survival was 92.0%. The 12-year overall survival was 60.0% for all and for the three abovementioned age categories was 73.3, 54.4 and 28.4%, respectively. The cause of death for all was predominantly non-malignancy-related morbidity. ConclusionThe impact of breast cancer on life expectancy was limited, in particularly for women aged 65–75 years. The relevance of NBM on survival was limited.

Effects of postmastectomy radiotherapy on survival in different age groups for patients with T3N0M0 breast cancer

BackgroundPostmastectomy radiotherapy (PMRT), as an important regional treatment, improves the survival rate of patients with T3N0M0 breast cancers. However, the therapeutic effect of PMRT on T3N0M0 patients in different age groups is unclear. MethodsUsing Surveillance, Epidemiology, and End Results database, we identified 4840 T3N0M0 patients between 2000 and 2015. The primary and secondary outcomes were overall survival (OS) and breast cancer-specific survival (BCSS). Survival outcomes were compared using Kaplan-Meier survival test, COX regression analysis, propensity score matching and forest plot, which present the relationship between age and PMRT. ResultsSurvival analysis demonstrated that for young patients (aged 18–45 and 46–55), there was no significant difference in OS between with and without PMRT. However, for patients older than 65 years, PMRT could significantly improve survival time (P < 0.001). Multivariate Cox analysis of OS showed older patients with PMRT had a lower hazard ratio (HR) than those without PMRT (aged 56–65: HR = 0.67, P = 0.014; aged >65: HR = 0.60, P < 0.001), and little benefit for young patients. The consistent results were also observed in 1:1 matched cohort. Subgroup analysis revealed the survival HRs of with versus without PMRT for patients older than 65 years were significant in most subgroups. ConclusionThe effect of PMRT in T3N0M0 patients is related to the age. PMRT is associated with improved survival in older patients with T3N0M0 breast cancer, especially those older than 65 years. While the benefit of PMRT is limited in T3N0M0 patients of young age. The observation suggests the importance of age for T3N0M0 patients when individualized treatment is made.

Higher Skeletal Muscle Index Is Associated with Improved Overall Survival in Older Patients with Sarcopenia Undergoing Allogeneic Stem Cell Transplant

Introduction: Allogeneic stem cell transplantation (allo-SCT) can be curative for patients with hematologic malignancies. Despite optimization of supportive measures, the risk of non-relapse mortality is a particularly important consideration in older individuals. Sarcopenia, defined as low skeletal muscle mass, has been shown to be associated with decreased overall survival in cancer patients and may identify individuals at higher risk of treatment-related complications.Methods: Using Mayo Clinic Arizona's hematopoietic stem cell transplantation database, patients aged 60 years or older who underwent allo-SCT between 2008 and 2018 were identified. Patients who underwent abdominal computed tomography (CT) at our institution within 90 days prior to their transplant date were included in the study. The skeletal muscle area (SMA) was obtained using a fully automated algorithm for segmenting abdominal CT images to quantify body composition based on a deep learning approach (Weston et al., Radiology, 2019). The skeletal muscle index (SMI) was then calculated using the SMA and the subject's height at the time the CT was obtained. Sarcopenia was defined based on previously described consensus (Cruz-Jentoft et al., Age Ageing, 2010; Magudia et al., Radiology, 2021). T-tests and Fisher's exact tests compared patient characteristics between groups, where appropriate. Kaplan-Meier methods were used to construct survival times. Log-rank tests compared survival distributions and Cox proportional hazards models estimated hazard ratios.Results: A total of 79 patients met inclusion criteria (Table 1). Of these, 50 (63%, n=50/79) had sarcopenia, and 29 (37%, n=29/79) had normal skeletal muscle mass. Among the sarcopenia group, 43 (86%, n=43/50) had SMI measurements. No differences were seen between groups in age at transplant, sex, Karnofsky performance scale, disease risk index, or conditioning regimen intent.There was no statistically significant difference in overall survival between those with sarcopenia and those with normal skeletal muscle mass (log-rank p=0.18). Median survival was 3.3 years (95% CI: 0.8, not estimable (NE)) for those with sarcopenia and 3.6 years (95% CI: 1.3, NE) for those with normal skeletal muscle mass. Given the infrequency of events, the upper bounds of the median survival confidence intervals were not estimable. The unadjusted hazard ratio (HR) for sarcopenia versus normal skeletal muscle mass was 1.65 (95% CI: 0.79, 3.47; p=0.18).Males had a higher mean SMI than females, as expected (50.4 versus 37.5, p<0.001; mean difference 13.0, 95% CI: 8.9, 17.1). Without considering sex, higher or lower SMI was not associated with survival time in a Cox model in those with sarcopenia (HR: 0.97, 95% CI: 0.92, 1.03; p=0.32). Sex alone was also not associated with any survival benefit among these 43 patients. After adjusting for the difference seen in SMI between sexes, on average, those with higher SMI were associated with a survival benefit (HR: 0.92, 95% CI: 0.84, 0.99; p=0.039). This amounts to roughly an 8% reduction in hazard rate as SMI increased.Conclusions: The presence of sarcopenia alone was not associated with overall survival in patients 60 years and older undergoing allo-SCT for hematologic malignancy. Rating sarcopenia severity using SMI may assist in identifying high risk individuals with sarcopenia as lower sarcopenia severity was associated with improved overall survival. Further studies are warranted to explore the possible impacts of interventions directed at improving skeletal muscle mass on transplant-related outcomes. [Display omitted] DisclosuresGaulin: DeciBio: Honoraria; Olson Research Group: Honoraria. Jain: CareDx: Other: for advisory board participation; CTI Biopharma: Research Funding; Syneos Health: Research Funding; Bristol Myers Squibb: Other: for advisory board participation; Targeted Healthcare Communications: Consultancy. Palmer: PharmaEssentia: Research Funding; Incyte: Research Funding; Sierra Oncology: Consultancy, Research Funding; CTI BioPharma: Consultancy, Research Funding; Protagonist: Consultancy, Research Funding.

Association of Treatment Intensity With Survival in Older Patients With Hodgkin Lymphoma

Hodgkin lymphoma is an aggressive blood cancer that is highly curable in younger patients who receive multiagent chemotherapy. Worse survival in older patients may reflect less-aggressive treatment, competing risks of death, or different disease biological factors. To examine the association between treatment intensity and cause-specific mortality among older adults with Hodgkin lymphoma. This was a population-based cohort study of patients aged 65 years or older with Medicare Part A and B fee-for-service coverage who received a diagnosis of Hodgkin lymphoma from 2000 to 2013. The association between treatment intensity and cause-specific mortality was estimated separately for early-stage and advanced-stage disease with Cox proportional hazards models. Multivariable adjustment and propensity score weighting helped control for confounding. Data are from the 1999 to 2016 Surveillance, Epidemiology, and End Results Medicare database. Data analysis was performed from April 2020 to June 2021. First-line treatment categorized as (1) full chemotherapy regimen, (2) partial chemotherapy regimen, (3) single chemotherapy agent or radiotherapy, or (4) no treatment. The main outcome was 3-year Hodgkin lymphoma-specific and other-cause mortality. Among 2686 patients (mean [SD] age, 75.7 [6.9] years; 1333 men [50%]), 1307 had early-stage disease and 1379 had advanced-stage disease. For Hodgkin lymphoma-specific mortality in patients with early-stage disease, hazard ratios (HRs) were higher for partial regimens (HR, 1.77; 95% CI, 1.22-2.57) or no treatment (HR, 1.91; 95% CI, 1.31-2.79) than for full regimens; there was no difference between single-agent chemotherapy or radiotherapy and full regimens. For other-cause mortality in patients with early-stage disease, HRs were higher for partial regimens (HR, 1.69; 95% CI, 1.18-2.44), single-agent chemotherapy or radiotherapy (HR, 1.62; 95% CI, 1.13-2.33), or no treatment (HR, 2.71; 95% CI, 1.95-3.78) than for full regimens. For Hodgkin lymphoma-specific mortality in patients with advanced-stage disease, HRs were higher for partial regimens (HR, 3.26; 95% CI, 2.44-4.35), single-agent chemotherapy or radiotherapy (HR, 2.85; 95% CI, 1.98-4.11), or no treatment (HR, 4.06; 95% CI, 3.06-5.37) than for full regimens. For other-cause mortality in patients with advanced-stage disease, HRs were higher for partial regimens (HR, 1.76; 95% CI, 1.32-2.33), single-agent chemotherapy or radiotherapy (HR, 1.65; 95% CI, 1.15-2.37), or no treatment (HR, 2.24; 95% CI, 1.71-2.94) than for full regimens. This cohort study found variability in the magnitude of the association between treatment intensity and mortality by stage and cause-specific mortality, possibly reflecting competing risks of death. However, full chemotherapy regimens were associated with lower mortality and could be considered for older adults who can tolerate them.

Cognitive assessment for older adults with cancer: A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative

Cancer is a disease that mostly affects older adults around the world and the incidence is expected to increase further due to the aging of the world population [ [1] Pilleron S. Sarfati D. Janssen-Heijnen M. et al. Global cancer incidence in older adults, 2012 and 2035: a population-based study. Int J Cancer. 2019; 144: 49-58 Crossref PubMed Scopus (162) Google Scholar ]. Cognitive impairment is also common in the older adult population, and can span in severity from Mild Cognitive Impairment (MCI) to dementia. Dementia is a prevalent condition, occurring in 5–7% in older adults aged 60 years and older and this prevalence is also expected to increase due to the aging of the population [ [2] Prince M. Bryce R. Albanese E. Wimo A. Ribeiro W. Ferri C.P. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement. 2013; 9 (63–75.e62) Abstract Full Text Full Text PDF Scopus (2840) Google Scholar ]. Dementia, also referred to as major neurocognitive disorder in the DSM-5, is diagnosed when an older adult has substantial cognitive impairment in one or more cognitive domains that interferes with independence in daily activities [ [3] Brodaty H. Aerts L. Crawford J.D. et al. Operationalizing the diagnostic criteria for mild cognitive impairment: the salience of objective measures in predicting incident dementia. Am J Geriatr Psychiatry. 2017; 25: 485-497 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. Whereas, MCI is an early stage of memory loss that is defined as: a) a cognitive complaint or concern, ideally corroborated by an informant, b) objective evidence of cognitive impairment that is abnormal for their age on standardized testing (usually defined as 1–2 standard deviations below normal on the test used); and c) no significant impact on function [ [3] Brodaty H. Aerts L. Crawford J.D. et al. Operationalizing the diagnostic criteria for mild cognitive impairment: the salience of objective measures in predicting incident dementia. Am J Geriatr Psychiatry. 2017; 25: 485-497 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. There is no clear data on how many older adults with MCI develop dementia as rates vary between clinical and population samples, but reversal to normal function is also possible [ [3] Brodaty H. Aerts L. Crawford J.D. et al. Operationalizing the diagnostic criteria for mild cognitive impairment: the salience of objective measures in predicting incident dementia. Am J Geriatr Psychiatry. 2017; 25: 485-497 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. MCI incidence varies widely but meta-analyses showed ranges per 1000 person-years from 22.5 (5.1–51.4) for ages 75-79y, 40.9 (7.7–97.5) for ages 80-84y, to 60.1 (6.7–159.0) for ages 85 and older [ [4] Gillis C. Mirzaei F. Potashman M. Ikram M.A. Maserejian N. The incidence of mild cognitive impairment: a systematic review and data synthesis. Alzheimers Dement (Amst). 2019; 11: 248-256 Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar ]. In older adults with pre-existing MCI or dementia who are subsequently diagnosed with cancer, cognitive impairment can lead to challenges in cancer care, including later diagnosis, receive less treatment, having more complications during their cancer treatment and have shorter cancer survival [ [5] Hopkinson J.B. Milton R. King A. Edwards D. People with dementia: what is known about their experience of cancer treatment and cancer treatment outcomes? A systematic review. Psychooncology. 2016; 25: 1137-1146 Crossref PubMed Scopus (26) Google Scholar ]. A prior study using the Surveillance, Epidemiology and End Results (SEER) database reported a prevalence of precancer diagnosis of dementia of 7.4% in patients with breast cancer, 10.0% for colon cancer, and 5.1% for prostate cancer [ [6] Raji M.A. Kuo Y.F. Freeman J.L. Goodwin J.S. Effect of a dementia diagnosis on survival of older patients after a diagnosis of breast, colon, or prostate cancer: implications for cancer care. Arch Intern Med. 2008; 168: 2033-2040 Crossref PubMed Scopus (96) Google Scholar ].

Pretreatment red blood cell distribution width as an efficient predictor of survival in older patients undergoing hip fracture surgery.

We aimed to determine whether pretreatment red blood cell distribution width (RDW) is an efficient predictor of 30-day mortality in older patients undergoing hip fracture surgery. In this prospective cohort study, 203 patients with hip fractures were eligible and followed up for at least 30days. All the patients underwent medical examinations. RDW was measured using an automated hematology analyzer. To evaluate the prognostic significance of RDW, Cox proportional hazard model and Kaplan-Meier analyses were performed. Of the 203 patients (114 men, 89 women), 28 (13.79%) died within 30days. The mean RDW was significantly higher in the deceased group than in the survival group (14.54%±1.09% vs 13.26%±0.57%; P<.001). Multivariate Cox regression analysis showed that elevated RDW (hazard ratio=2.73, 95% confidence interval=2.06-3.62, P<.001) was the key predictor of 30-day mortality in older patients undergoing hip fracture surgery. Survival analysis showed that patients with a high RDW had a significantly higher 30-day mortality rate (log-rank test, P<.05). Similar results were observed in the male and female subgroups. RDW might be an effective predictor of 30-day mortality in older patients undergoing hip fracture surgery.

Adherence to Treatment Guidelines and Associated Survival in Older Patients with Prostate Cancer: A Prospective Multicentre Cohort Study.

Simple SummaryAccording to international guidelines, the treatment of prostate cancer in men aged 70 or over should consider the patient’s health status. Although these guidelines were published more than ten years ago, the level of their implementation in routine clinical practice has not been evaluated. Here, we studied the degree of implementation of these guidelines and the association between their implementation and patients’ survival. We found that the selected treatment was not guideline-compliant in almost half the patients, that non-metastatic disease was a factor related to non-compliance with the guidelines and that non-compliance with the guidelines was associated with worse survival.The guidelines on prostate cancer treatment in older men recommend evaluating the patient’s underlying health status before treatment selection. We aimed to evaluate the frequency of a guideline–discordant treatment (GDT), identify factors associated with GDT, and assess the relationship between GDT and overall survival. We studied patients with prostate cancer aged 70 or older included in the ELCAPA cohort between 2010 and 2019. Multivariable logistic regression assessed GDT-associated factors. The restricted mean survival time (RMST) assessed the 24- and 36-month OS using stabilized inverse probability of treatment weighting of propensity scores. We included 356 patients (median age: 81 years), and 164 (46%) received a GDT (95% confidence interval (CI) = (41–51%)). Patients with metastases were less likely to receive a GDT (adjusted odds ratio (95% CI) = 0.34 (0.17–0.69); p = 0.003). After weighting, the RMST at 24 months was shorter in the GDT group (13.9 months, vs. 17 months for compliant treatments; difference (95% CI): −3.1 months (−5.3, −1.0); p = 0.004). RMST at 36 months was 18.5 months, vs. 21.8 months (difference: −3.3 months (−6.7, 0.0); p = 0.053). GDT is common in older patients with prostate cancer and especially those with non-metastatic disease. GDT was associated with worse survival, independently of health status and tumour characteristics.

Patient-reported outcomes predict overall survival in older patients with acute myeloid leukemia

IntroductionPatient-reported outcomes (PROs) predict overall survival (OS) in many cancer types, but there is little evidence of their prognostic value in older patients with acute myeloid leukemia (AML). We examined whether the Functional Assessment of Cancer Therapy – Leukemia (FACT-Leu) predicted OS beyond established prognostic factors among these patients. Materials and MethodsData were from AML2002 (n = 309), a randomized phase 2/3 study comparing decitabine plus talacotuzumab versus decitabine alone in older AML patients ineligible for intensive chemotherapy. We used ridge-penalized Cox proportional hazards models to estimate the association between baseline FACT-Leu scales and OS. We then conducted a bootstrap analysis to determine how often FACT-Leu scales appeared in forward- and backward- selected “final models” predicting OS relative to prognosticators from the AML Composite Model (AML-CM; e.g., chronic comorbidities, previous cancer, cytogenetic/molecular risk). ResultsIn ridge-penalized models, the FACT-Leu Physical Well-Being (PWB), Trial Outcomes Index (TOI), and Total scales predicted OS. Adjusting for AML-CM factors, an important increase (3 points) in PWB score was associated with a 14% reduction in the hazard of death. In the bootstrap analysis, the PWB scale appeared in 93% of backward- and 98% of forward selected models, while the TOI [57% (backward), 79% (forward)] and FACT-Leu Total [51% (backward), 78% (forward)] appeared less often in final models. Discussion and ConclusionsThese results indicate PROs' value for predicting outcomes among older AML patients and underscore the need to more systematically collect PRO data in routine care with these patients.ClinicalTrials.gov Registration: NCT02472145

AML-447: Survival of Patients with Acute Myeloid Leukemia According to Age in a University Hospital in Colombia

Context: The overall survival (OS) of acute myeloid leukemia (AML) decreases as age increases among patients. Studies have shown that several factors, such as socioeconomic and demographic factors, are associated with worse OS outcomes among patients. Objective: To determine the OS of patients diagnosed with AML according to age: under 65 years ( 65) at Clinica FOSCAL, a University Hospital in Colombia, during 2013–2020. Results: A total of 157 patients were registered, with a median age at the time of diagnosis of 58.8 years (range: 18–95). Regarding age, 57.2% of patients were 65. The OS in patients Conclusion: As has been shown in other studies, our analyses agree and show a decrease in survival in older patients (≥65 years). It is important to recognize older adult patients with these pathologies to evaluate treatment strategies with new alternatives with which better responses can be achieved with less toxicity.

Adipose browning response to burn trauma is impaired with aging.

BACKGROUNDThe incidence of burn injuries in older patients is dramatically increasing as the population of older people grows. Despite the increased demand for elderly burn care, the mechanisms that mediate increased morbidity and mortality in older trauma patients are unknown. We recently showed that a burn injury invokes white adipose tissue browning that leads to a substantially increased hypermetabolic response associated with poor outcomes. Therefore, the aim of this study was to determine the effect of age on the metabolic adipose response of browning after a burn injury.METHODOne hundred and seventy patients with burn injury admitted to the Ross Tilley Burn Centre were prospectively enrolled and grouped by age as older (≥50 years) and young (≤35 years). Adipose tissue and sera were collected and analyzed for browning markers and metabolic state via histology, gene expression, and resting energy expenditure assays.RESULTSWe found that older patients with burn injury lacked the adipose browning response, as they showed significant reductions in uncoupling protein 1 (UCP1) expression. This failure of the browning response was associated with reduced whole-body metabolism and decreased survival in older patients with burn injury. Mechanistically, we found that the adipose of both aged patients after burn trauma and aged mice after a burn showed impairments in macrophage infiltration and IL-6, key immunological regulators of the browning process after a severe trauma.CONCLUSIONTargeting pathways that activate the browning response represents a potential therapeutic approach to improve outcomes after burn trauma for elderly patients.FUNDINGNIH (R01-GM087285-01), Canadian Institutes of Health Research (grant no. 123336), and Canada Foundation for Innovation Leaders Opportunity Fund (no. 25407).

Updated Population Based Survival Analysis in Patients with Chronic Myeloid Leukemia: Increased Survival but Continued Disparities for Older Patients

Background: Survival for patients with chronic myeloid leukemia (CML) has increased dramatically since the advent of the first tyrosine kinase inhibitors (TKI) targeting the fusion gene BCR-ABL. However, survival has improved more for younger patients than for older patients. The reasons for this disparity are unclear. Here, we examine changes in survival for patients with CML by age between 2007-10 and 2011-14. In addition, we perform a subgroup analysis of patients known to have received chemotherapy.Methods: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database, using the SEER18 dataset. Patients with ICD-10 code C92.1 were included in the analysis. Period analysis was used to calculate 5-year relative survival. Limited data on use of chemotherapy (yes or no/unknown) is available in the SEER dataset.Results: A total of 9209 cases of CML were found in the SEER18 database from 2007-14. Of these, 6868 were documented to have received chemotherapy. Overall 5-year relative survival increased from 69.0% in 2007-10 to 74.4% in 2011-14 (see table). Age specific analysis showed that there was little or no change for patients age 15-44, but point estimates of survival increased between 2007-10 and 2011-14 for all other age groups, although the differences were not statistically significant for individual age groups. Survival for patients age 45-54 was lower than for those aged 15-44 in 2007-10 but similar in 2011-14. However, survival continued to be lower for those aged 55 and older compared to younger patients, despite the observed increases in point estimate of survival for these patients.When analysis was limited to those patients documented to have received chemotherapy, the pattern of survival observed, i.e. increases in survival in 2011-14 compared to 2007-10 in all groups except for age 15-44 but decreased survival with increasing age, was unchanged.Conclusions: Survival increased for patients with CML age 45 and older between 2007-10 and 2011-14. However, there was a persistent disparity in survival for older patients. This disparity decreased only minimally when only patients known to have received chemotherapy were included, suggesting that chemotherapy usage is not the primary problem. Older patients may be treated less optimally despite receiving at least some chemotherapy, may suffer more fatal adverse events in treatment, or may have more resistant disease compared to younger patients. Further research into the optimal treatment of CML in older patients is needed to improve survival in this population. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Prognostic value of disease risk score versus gait speed in older adults with lymphoma

Measures of physical function predict survival in older patients with lymphoma but their prognostic ability has not been compared to disease-specific risk scores. We prospectively recruited patients ≥75 years with lymphoma. Patients underwent a frailty screen including 4-m gait speed. Disease-specific risk scores were obtained retrospectively. Among 168 patients, there was no association between disease-specific risk score and survival. Conversely, faster gait speed was significantly associated with survival in the entire cohort (HR = 0.16; 95%CI, 0.06–0.42; p = 0.0003) indicating a HR of 0.63 for an increase in gait speed of 0.25 m/s. When gait speed was added to the DLBCL IPI and FLIPI separately, it was significantly associated with OS (p = 0.004 for DLBCL, p = 0.03 for FLIPI) which increased its predictive power. Our study of older lymphoma patients demonstrates gait speed may improve outcome prediction beyond standard prognostic scores.

Defining prognostic factors in older patients with endometrial cancer.

Endometrial cancer (EC) is most frequently seen in older and postmenopausal women. The aim of this study was to evaluate the rate of recurrence and survival and clinical, pathological, surgical, and treatment factors affecting recurrence and survival in older patients with EC. Three hundred and six (21.7%) patients aged ≥ 65 out of a total of 1413 patients diagnosed with and treated for epithelial EC at the Division of Gynecologic Oncology between January 1993 and May 2013 were evaluated retrospectively. All patients were staged according to FIGO 2009 staging system. Progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) were determined. Independent prognostic factors affecting recurrence and survival were evaluated by multivariate logistic regression analysis. The median age of the patients was 68 (65-92) years. Eighty-nine patients (29.1%) were diagnosed with stage III-IV disease. Tumor type was endometrioid in 226 (73.9%) patients, and 101 (33%) patients were diagnosed with FIGO grade 1 endometrioid endometrial cancer. One hundred fifty-three patients received adjuvant therapy after surgery. Five-year PFS, 5-year CSS, and 5-year OS were 73%, 85%, and 83%, respectively. Only the 2009 FIGO stage was independently associated with PFS (OR = 3.495, 95% CI 1.592-7.675; p = 0.002) and CSS (OR = 6.135, 95%CI 1.269-31.417; p = 0.024). In conclusion, 2009 FIGO stage was found to be the only independent prognostic factor associated with recurrence and death in older patients with endometrial cancer.

Toxicity, Response and Survival in Older Patients with Metastatic Melanoma Treated with Checkpoint Inhibitors.

Simple SummaryTrials suggest no differences in immunotherapy treatment between older and younger patients, but mainly young patients with a good performance status were included in these trials. The aim of this study was to describe the treatment patterns and outcomes of “real-world” older patients with metastatic melanoma. We included 2216 patients aged ≥65 years from the Dutch Melanoma Treatment Registry and described outcomes of immunotherapy. The study showed that responses and severe side effects did not differ from previously reported younger populations and randomized trials, even in the oldest patients and in patients with other diseases. However, patients aged ≥75 discontinued treatment due to toxicity more often, resulting in fewer treatment cycles. We therefore conclude that immunotherapy seems to have similar effects in older patients compared to younger patients, but the impact of less severe toxicity on quality of life should be further studied as older patients are more likely to discontinue treatment.Background: Previous trials suggest no differences in immunotherapy treatment between older and younger patients, but mainly young patients with a good performance status were included. The aim of this study was to describe the treatment patterns and outcomes of “real-world” older patients with metastatic melanoma and to identify predictors of outcome. Methods: We included patients aged ≥65 years with metastatic melanoma from the Dutch Melanoma Treatment Registry. We described the reasons for hospital admissions and treatment discontinuation. Additionally, we assessed predictors of toxicity and response using logistic regression models and survival using Cox regression models. Results: We included 2216 patients. Grade ≥3 toxicity was not associated with age, comorbidities or WHO status. Patients aged ≥75 discontinued treatment due to toxicity more often, resulting in fewer treatment cycles. Response rates were similar to previous trials (40.3% and 43.6% in patients aged 65–75 and ≥75, respectively, for anti-PD1 treatment) and did not decrease with age or comorbidity. Melanoma-specific survival was not affected by age or comorbidity. Conclusion: Response rates and toxicity outcomes of checkpoint inhibitors did not change with increasing age or comorbidity. However, the impact of grade I-II toxicity on quality of life deserves further study as older patients discontinue treatment more frequently.