Treatment Of Older Cancer Patients Research Articles

Geriatric assessment in older patients with non-small cell lung cancer: Insights from a cluster-randomized, phase III trial—ENSURE-GA study (NEJ041/CS-Lung001).

1502 Background: To determine optimal treatment in older cancer patients, it is recommended to conduct a geriatric assessment (GA) before chemotherapy. The ENSURE-GA study, which focused on patients aged 75 and older with non-small cell lung cancer (NSCLC), reported that the implementation of GA not only enhanced patient satisfaction with regards to communication with their physicians, but also improve the patients’ quality of life. Additionally, we assessed whether GA could improve overall survival and serve as a predictor for severe adverse events. Methods: Patients aged ≥75 with NSCLC who were unable undergo radical treatment were enrolled. All patients underwent a standardized GA before treatment. The participating institutions were cluster-randomized into either intervention group or control group. For the intervention group, GA summaries and recommendations for GA-guided interventions were provided to guide physicians in selecting treatments and interventions. The control group did not provide physicians with GA summaries. Geriatric 8 (G8) and CARG scores were calculated at enrollment, and we investigated whether adverse events during a 3-month follow-up could be predicted. Results: Between 2019 and 2022, 1,021 patients were enrolled from 78 institutions in Japan. No significant differences were observed in patient characteristics or for GA domains between intervention and control groups. Additionally, there were no significant differences seen in 1-year overall survival (20.7m vs 18.8m, p = 0.414), or the incidence of grade 3 or higher adverse events in patients treated with medical treatment (36.8% vs 38.1%, p = 0.732). The ROC curve for G8 regarding the occurrence of grade 3 or higher adverse events in cases receiving cytotoxic chemotherapy yielded an AUC of 0.525, indicating no discriminatory ability. Furthermore, there was no difference in the incidence of adverse events between low-risk and high-risk patients based on the CARG score. Conclusions: The implementation of GA and interventions based on its results enhances patient satisfaction. However, additional studies are needed before incorporating GA into an adverse event prediction system. Developing risk scoring tools specific to cancer types and races may prove useful. Clinical trial information: UMIN0000037590 .

Satisfaction in older patients by geriatric assessment using a novel tablet-based questionnaire system: A cluster-randomized, phase III trial of patients with non–small-cell lung cancer (ENSURE-GA study; NEJ041/CS-Lung001).

12041 Background: To provide optimal treatment for older cancer patients, it is necessary to carry out a geriatric assessment (GA) to evaluate geriatric syndrome. However, GA is not widely performed because it requires expertise. In this ENSURE-GA study, we evaluated if providing a GA summary and recommendations for GA-guided interventions using a novel tablet-based questionnaire system improved satisfaction about communication with physicians for older patients with non-small-cell lung cancer (NSCLC). Methods: Patients with NSCLC who were incapable of radical treatment aged 75 or older were enrolled. All patients underwent a standardized GA using a tablet before starting treatment. Participating institutions were cluster-randomized into the intervention group and the control group. In the intervention group, GA summary and recommendations for GA-guided interventions were immediately returned to guide physicians in selecting treatments and interventions. The control group did not provide a GA summary. The primary outcomes were difference in patient satisfaction pre-treatment and percent change pre- and post-treatment according to the HCCQ questionnaire. Results: A total of 1,021 patients from 78 institutions in Japan were enrolled between 2019–2022. There were no differences in patient backgrounds between the intervention group and the control group: mean age 80.1 yrs. vs. 80.0 yrs.; male 64.1% vs. 66.8%; adenocarcinoma 70.4% vs. 64.8%; and performance status 0-1, 82.4% vs. 79.0%, respectively. All GA domain evaluation results, such as ADL and cognitive function, also did not differ between the two groups. Pre-treatment satisfaction scores were significantly higher in the intervention group than in the control group (29.9 vs. 29.1, p = 0.003). There was no significant difference in the mean percent change between the two groups (-0.13 vs. 2.38, p = 0.165). Conclusions: Providing the oncologist with a GA summary and recommendations for GA-guided interventions improved patient satisfaction from the start of treatment. A novel system using a tablet may be effective at promoting GA more widely. Clinical trial information: UMIN0000037590 .

Comprehensive geriatric assessment based multidisciplinary team intervention for hospitalized frail patients in oncology: COMPASS-ONCO/KCSG AL21-13.

TPS12138 Background: Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary assessment for evaluating older patients’ medical, psychological, physical functions and social status. CGA-based multidimensional intervention is the gold standard in geriatric oncology to identify patients at high risk of adverse outcomes and optimize cancer and overall management. Numerous studies have demonstrated that CGA could modify oncologic treatment decision. However, little is known about the treatment outcomes of a multidisciplinary team intervention based on CGA. Methods: The COMPASS study is the first pragmatic multicentre trial within a cohort comprising three randomized controlled trials focusing on focusing on CGA and multidisciplinary intervention for hospitalised elderly patients in various healthcare settings of Korea. COMPASS-ONCO compares the effect of an oncologist-led multidisciplinary team intervention based on the CGA to that of conventional treatment for older cancer patients without the involvement of geriatricians. The patients will be randomised into the intervention or control groups in a 1:1 ratio. The inclusion criteria are as follows: (1) 65 years of age or older, (2) prefrail or frail status assessed by Korean version of the Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight scale questionnaire, (3) having two or more of the following diseases; hypertension, diabetes, ischaemic heart disease, chronic lung disease, arthritis, stroke, depression, chronic kidney disease and dementia. (4) living at home for more than 3 months before hospitalization, (5) subject to palliative chemotherapy and (6) histologically confirmed gastric, colorectal, lung, pancreatic or biliary tract carcinoma. The intervention includes CGA and CGA-based multidisciplinary interventions by oncologists, nurses, nutritionists and pharmacists. The multidisciplinary intervention includes nutritional support, medication review and adjustment, rehabilitation, early discharge planning and prevention of geriatric syndromes (falls, delirium, pressure sore and urinary retention). The analysis will be based on an intention-to-treat principle. The primary outcome is overall treatment utility which is a clinical outcome incorporating objective and subjective measures of anticancer efficacy, tolerability and acceptability. Additionally, recognition of advance directives, changes in body composition and validity of anticancer drug toxicity prediction model will also be assessed. Approximately 1040 patients will be required for COMPASS study, and 260 will be enrolled in the COMPASS-ONCO substudy at five hospitals in Korea. Participants have been recruited from 2 November 2021, and recruitment will continue until December 2024. Clinical trial information: KCT0006270 .

A Study to Assess the Knowledge on Cancer among Geriatric Patients at SRM General Hospital, Kattankulathur in Kancheepuram District, Tamil Nadu, India

Cancer is a dread full disease in India and all over the world. Nowadays after age of 75 many people are living longer. Therefore special attention must be taken to the treatment of older cancer patients. Hence it is necessary assess the knowledge on cancer among the geriatric patients to develop awareness on cancer. Objectives To assess the knowledge on cancer among Geriatric patients at SRM General Hospital, Kattankulathur. To associate the knowledge on cancer among Geriatric patients with their demographic variables. Methodology: Non experimental descriptive research design was adopted to assess the knowledge regarding cancer among Geriatric patients. Totally 100 samples who fulfilled the inclusion criteria were selected by convenient sampling technique. Self structured objective type questionnaire was used to assess the knowledge on cancer among Geriatric patients in SRM General Hospital at kattankulathur. Major Findings: The result of the study revealed 23(23%) patients have poor level of knowledge; 70 (70%) patients have moderate level of knowledge; 7 (7%) patients have high level of knowledge regarding cancer. Conclusion: The study conclude that there is a need for health education among Geriatric patients to understand and treat cancer earlier, hence morbidity and mortality may be prevented and their quality of life may be improved.

The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients - A systematic review.

The aim of this systematic review is to summarise all available data on the effect of a geriatric evaluation on the multidisciplinary treatment of older cancer patients, focussing on oncologic treatment decisions, the implementation of non-oncologic interventions and the impact on treatment outcome. A systematic search in MEDLINE and EMBASE for studies on the effect of a geriatric evaluation on oncologic and non-oncologic treatment decisions and outcome for older cancer patients. 36 publications from 35 studies were included. After a geriatric evaluation, the oncologic treatment plan was altered in a median of 28% of patients (range 8-54%), primarily to a less intensive treatment option. Non-oncologic interventions were recommended in a median of 72% of patients (range 26-100%), most commonly involving social issues (39%), nutritional status (32%) and polypharmacy (31%). Effect on treatment outcome was varying, with a trend towards a positive effect on treatment completion (positive effect in 75% of studies) and treatment-related toxicity/ complications (55% of studies). A geriatric evaluation affects oncologic and non-oncologic treatment and appears to improve treatment tolerance and completion for older cancer patients. Fine-tuning the decision-making process for this growing patient population will require more specific and robust data on the effect of a geriatric evaluation on relevant oncologic and non-oncologic outcomes such as survival and quality of life.

Recent advances in cancer surgery in older patients.

Age is the most important risk factor for the occurrence of cancer, and a declining mortality from heart disease and other non-cancer causes leaves an older population that is at high risk of developing cancer. Choosing the optimal treatment for older cancer patients may be a challenge. Firstly, older age and associated factors such as comorbidities, functional limitations, and cognitive impairment are risk factors for adverse effects of cancer treatment. Secondly, older patients are often excluded from clinical trials, and current clinical guidelines rarely address how to manage cancer in patients who have comorbidities or functional limitations. The importance of incorporating frailty assessment into the preoperative evaluation of older surgical patients has received increasing attention over the last 10 years. Furthermore, studies that include endpoints such as functional status, cognitive status, and quality of life beyond the standard endpoints, i.e. postoperative morbidity and mortality, are starting to emerge. This review looks at recent evidence regarding geriatric assessment and frailty in older surgical cancer patients and provides a summary of newer studies in colorectal, liver, pancreatic, and gynecological cancer and renal and central nervous system tumors.

Satisfaction With Pain Treatment in Older Cancer Patients

How satisfied a patient is with their medical treatment may influence compliance and adherence to medical regimens. While a number of studies have examined patient satisfaction among younger populations, few have determined the impact social factors have on satisfaction with pain treatment among older adults. This study aimed to determine the influence discrimination, trust, communication, and other health characteristics have on satisfaction with pain treatment among older adults receiving outpatient services from a comprehensive cancer center. Participants were surveyed on questions assessing pain symptomatology, and identified social (discrimination, trust, and communication), physical (comorbidities, pain interference), behavioral (self-efficacy), and demographic characteristics. Analyses were calculated to determine the total and indirect effects of trust, communication, and self-efficacy as mediators on the perceived discrimination-patient satisfaction with pain treatment relationship. Data showed a significant relationship of communication and discrimination on patient satisfaction. However, none of the mediating effects were significant. It must be recognized that patient satisfaction is contingent upon a myriad of social factors that are not exclusive, but rather coexisting determinants of health. Particularly among the elderly, perceived discrimination and incidences of poor communication may be significant influences on health and the lived day-to-day experiences of this adult population.

Is Effective and Safe a Radiochemotherapy Approach in Elderly Cancer Patients? A Review

Although more than 60% of all cancer patients in Europe and the USA are older than 65 years at the time of diagnosis, elderly patients are generally under-represented in clinical trials. A general consensus on how to treat elderly patients is still far from being achieved. In this review, we address some of the issues and challenges surrounding the treatment of older cancer patients and radiochemotherapy. We discuss the existing evidence related to radiochemotherapy in the elderly, focusing primarily on the malignancies most commonly seen in older patients and making general treatment recommendations where applicable.

Does it matter if I’m satisfied? Predictors of satisfaction with pain treatment in older cancer patients

Does it matter if I’m satisfied? Predictors of satisfaction with pain treatment in older cancer patients

Impact of differences in treatment strategy on relative survival of elderly patients with operable, hormone receptor positive breast cancer

progression). At baseline all patients underwent a geriatric screening using G8 and the Flemish version of the Triage Risk Screening Tool (TRST) followed by a uniform Comprehensive Geriatric Assessment (CGA) including social data (marital status, living situation, educational level), Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), presence of falls, Mobility-Tiredness Test (MOB-T), Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Mini Nutritional Assessment (MNA), ECOGPerformance Status (ECOG-PS), Charlson Comorbidity Index (CCI) and polypharmacy assessment. Functionality of patients was followed 2 to 3 months after treatment decision by repeating ADL, IADL and presence of falls. Worsening of ADL and IADL was calculated on total scores. Worsening of ADL was defined as an increase of ≥2 points at follow-up compared to baseline score. Worsening of IADL was defined as a decrease of ≥1 points at follow-up compared to baseline score. In the group of patients receiving chemotherapy, treatment related toxicity grades III–IV were recorded using the NCI CTCAE, version 4.0 for adverse events. Univariate analysis was performed, followed by multivariate logistic regressions to identify predictive markers. Results: A total of 937 patientswere included from10/2009 till 07/2011 with a median age of 76 years and 63.5% women. Breast cancer was the most common malignancy (40.4%) followed by colorectal cancer (20.6%), hematological malignancies (15.9%), prostate cancer (9%), lung cancer (7.8%) and ovarian cancer (6.3%). Data from 811 patients were available at follow-up. Worsening of ADL and IADL was observed in 17.2% and 38.9% respectively. During follow-up, 17.5% of the patients had at least 1 fall. ADL worsening was predicted in multivariate model by baseline IADL, MNA and Flemish version of the TRST (all pb0.05). Worsening of IADL was predicted by baseline ECOG-PS, Flemish version of the TRST, GDS-15, and chemotherapy (all pb0.05). Presence of falls during follow-up could be predicted (pb0.05) by presence of falls during the year before inclusion, baseline ADL and G8, living situation and disease setting (new diagnosis or progression) at baseline. In the chemotherapy group (n=411), hematologic and nonhematologic grade III–IV toxicities developed both in 16% of the patients. Hematological disease (versus solid tumors) was the only baseline variable in univariate analysis predictive for severe hematological toxicity (pb0.05). G8 for hematologic toxicities, and MNA and IADL for non-hematologic toxicities were borderline associated (pb0.1). Conclusion: Parameters from CGA before treatment in older cancer patients can identify at-risk patients for decline in functionality and development of falls. Severe chemotherapy toxicity is not well predicted by baseline CGA parameters, but this effect might be obscured by the utilization of many different chemotherapy regimens with different toxicity profiles.

Elderly Lung Cancer Patients and Radiochemotherapy: A Review

More than 60% of lung cancer patients in Europe and the USA are older than 65 years at the time of diagnosis. Despite this, elderly patients are generally under-represented in clinical trials. That being so, a general consensus on how to treat elderly patients is still far from being achieved. In this review, we address some of the issues and challenges surrounding the treatment of older cancer patients and radiochemotherapy. We discuss the existing evidence related to radio-chemotherapy in the elderly, focusing primarily on the lung cancer (NSCLC and SCLC) most commonly seen in older patients, and making general treatment recommendations.

End‐of‐life care for older cancer patients in the Veterans Health Administration versus the private sector

Treatment of older cancer patients at the end of life has become increasingly aggressive, despite the absence of evidence for better outcomes. We compared aggressiveness of end-of-life care of older metastatic cancer patients treated in the Veterans Health Administration (VHA) and those under fee-for-service Medicare arrangements. Using propensity score methods, we matched 2913 male veterans who were diagnosed with stage IV lung or colorectal cancer in 2001-2002 and died before 2006 with 2913 similar men enrolled in fee-for-service Medicare living in Surveillance, Epidemiology, and End Result (SEER) areas. We assessed chemotherapy within 14 days of death, intensive care unit (ICU) admissions within 30 days of death, and >1 emergency room visit within 30 days of death. Among matched cohorts, men treated in the VHA were less likely than men in the private sector to receive chemotherapy within 14 days of death (4.6% vs 7.5%, P<.001), be admitted to an ICU within 30 days of death (12.5% vs 19.7%, P<.001), or have >1 emergency room visit within 30 days of death (13.1 vs 14.7, P=.09). Older men with metastatic lung or colorectal cancer treated in the VHA healthcare system received less aggressive end-of-life care than similar men in fee-for-service Medicare. This may result from the absence of financial incentives for more intensive care in the VHA or because this integrated delivery system is better structured to limit potentially overly aggressive care. Additional studies are needed to assess whether men undergoing less aggressive end-of-life care also experience better outcomes.

EORTC elderly task force position paper: Approach to the older cancer patient

As a result of an increasing life expectancy, the incidence of cancer cases diagnosed in the older population is rising. Indeed, cancer incidence is 11-fold higher in persons over the age of 65 than in younger ones. Despite this high incidence of cancer in older patients, solid data regarding the most appropriate approach and best treatment for older cancer patients are still lacking, mostly due to under-representation of these patients in prospective clinical trials. The clinical behaviour of common malignant diseases, e.g. breast, ovarian and lung cancers, lymphomas and acute leukaemias, may be different in older patients because of intrinsic variation of the neoplastic cells and the ability of the tumour host to support neoplastic growth. The decision to treat or not these patients should be based on patients’ functional age rather than the chronological age. Assessment of patients’ functional age includes the evaluation of health, functional status, nutrition, cognition and the psychosocial and economic context. The purpose of this paper is to focus on the influence of age on cancer presentation and cancer management in older cancer patients and to provide suggestions on clinical trial development and methodology in this population.

Use of physical performance measures to predict future disability and mortality in older cancer patients: The Health Aging and Body Composition Study (Health ABC)

9553 Background: Optimal treatment for older cancer patients remains unclear due to a poor understanding of which clinical characteristics predict toxicity and survival. Our objective was to examine baseline physical performance measures as predictors of future disability or death in older adults with incident cancer diagnoses. Methods: Among 3,075 individuals aged ≥70 years participating in the Health ABC observational study, 431 had a confirmed cancer diagnosis in the first 6 years of follow-up. Measures of physical performance included usual gait speed over 20 meters, 400 meter long distance corridor walk, and grip strength. We assessed the relationship between measures of physical performance most closely preceding cancer diagnosis and progression to major disability or death at 2 years after diagnosis. Major disability is defined by any of the following: requiring cane or walker for ambulation, inability to walk a quarter mile and/or climb 10 steps, or requiring assistance with activities of daily living. 404 subjects had complete data for analysis. Logistic regression models were fit for each performance measure, adjusting for demographics, health habits, comorbidity, metastatic disease, and cancer type. Results: The mean age was 77.1±3.3 years; 35.6% were female; and 44.7% were black. Progression to disability or death at 2 years after diagnosis occurred in 45.7%. Mean gait speed was 1.2±0.2 meters/second (m/s) and mean grip strength was 33.7±11.9 kilograms. A 0.1 m/s faster usual gait speed on the 20 meter course was associated with a 15% decrease in risk of subsequent disability or death (OR=0.85, 0.74- 0.96). Individuals who completed the long distance corridor walk had a 66% decrease in risk of subsequent disability or death compared to those who were unable to complete the test (OR=0.34, 0.19–0.60). There was no association between grip strength and progression to disability or death (OR=0.98, 0.96–1.02). Conclusions: In our study of cancer patients aged ≥70years, pre-diagnosis physical performance is independently associated with progression to disability or death. These results suggest that simple performance tests may provide useful information in pre-treatment evaluations of older adults with cancer. No significant financial relationships to disclose.

P.32 Clinical experience of physicians involved in cancer treatment of older cancer patients: a qualitative interview study

P.32 Clinical experience of physicians involved in cancer treatment of older cancer patients: a qualitative interview study

Determinants of survival in older cancer patients.

We and others have previously described a number of characteristics that are associated with delays in diagnosis and increased risk for inadequate treatment of older women and men with cancer. These characteristics include poor social support, limited access to transportation, and impaired cognition. However, there is little information on how these factors influence survival of older cancer patients. The purpose of the study was to determine which patient characteristics predicted survival up to 10 years after the diagnosis of cancer. In 1984, we initiated a population-based study of men and women who were 65 years of age or older, living in a six-county area of New Mexico, and newly diagnosed with cancer. For 646 individuals with cancer of the breast (n = 188), prostate (n = 247), or colon or rectum (n = 211), we assessed patient baseline characteristics, disease stage at diagnosis, and adequacy of treatment (definitive or nondefinitive) as determinants of survival for up to 10 years following diagnosis. Multivariate survival models were used to analyze the data; all P values were two-sided. In multivariate analyses, we first included all patient characteristics, except the stage at diagnosis and the adequacy of treatment. In this initial analysis, the following were among variables that were significantly associated with patient survival: age, education, cancer knowledge, ethnic group, and cognitive status. When stage at diagnosis and adequacy of treatment were added to the model, both advanced stage at diagnosis (hazard ratio = 1.7 [95% confidence interval ¿CI¿ = 1.3-2.1] for diagnosis at regional stage versus local stage; hazard ratio = 3.0 [95% CI = 2.0-4.7] for distant stage versus local stage) and inadequate treatment (hazard ratio = 1.6 [95% CI = 1.1-2.3]) were associated with poor survival. However, adding stage at diagnosis and adequacy of treatment to the analysis had little influence on the magnitude of the effect of patient characteristics on survival. In separate analyses of patient data by cancer site, receipt of nondefinitive therapy was associated with increased mortality among patients with colon/rectal cancer (hazard ratio = 7.8 [95% CI = 2.8-21.4]) and breast cancer (hazard ratio = 2.2 [95% CI = 1.1-4.3]) but not among patients with prostate cancer (hazard ratio = 1.0 [95% CI = 0.6-1.9]). Advanced stage at diagnosis and inadequate treatment of older cancer patients are associated with poor survival. Impaired cognition and inadequate education in elderly patients are also associated with poor survival. This decreased survival does not appear to be a consequence of known barriers to health care that are responsible for delays in diagnosis and for inadequate treatment. Efforts to facilitate early diagnosis and receipt of definitive treatment for cancer in older individuals may improve their survival.

977 Cancer in the elderly

Although cancer is not an inevitable consequence of aging, malignant diseases, especially solid tumors, occur disproportionately in the subset of the population aged 65 years and older. Thus, because the older population are rapidly expanding in most industrial nations, there is a high potential in these countries for many more persons to have cancer. Although two thirds of all cancer deaths occur in the 65-and-olderage segment of the population, there have been so far only a few descriptive, cross-sectional retrospective and prospective studies on cancer in the elderly. More interest and activity in research on aging and cancer has however been evidenced in the 1990s. Directions for the future could be as follows: 1.Establish multidisciplinary clinical trial design teams to address the challenging issues of old age and cancer therapy in a prospective study methodology. 2.Focus on the pharmacokinetics and drug sensitivity of elderly cancer patients to assess and deal with differences in drug metabolism. 3.Introduce in clinical oncology “multidimensional geriatric assessment” methods for pretreatment and follow-up evaluation of elderly cancer patients. 4.Develop special “patterns of care” studies of the major tumors to characterize the treatment of older cancer patients who, because of an excess of comorbid conditions, are not eligible for placement on clinical trials. 5.Increase the cooperation of geriatricians with clinical oncologists since cancer is one of the more prevalent chronic diseases of their older patients. Although cancer is not an inevitable consequence of aging, malignant diseases, especially solid tumors, occur disproportionately in the subset of the population aged 65 years and older. Thus, because the older population are rapidly expanding in most industrial nations, there is a high potential in these countries for many more persons to have cancer. Although two thirds of all cancer deaths occur in the 65-and-olderage segment of the population, there have been so far only a few descriptive, cross-sectional retrospective and prospective studies on cancer in the elderly. More interest and activity in research on aging and cancer has however been evidenced in the 1990s. Directions for the future could be as follows: 1.Establish multidisciplinary clinical trial design teams to address the challenging issues of old age and cancer therapy in a prospective study methodology. 2.Focus on the pharmacokinetics and drug sensitivity of elderly cancer patients to assess and deal with differences in drug metabolism. 3.Introduce in clinical oncology “multidimensional geriatric assessment” methods for pretreatment and follow-up evaluation of elderly cancer patients. 4.Develop special “patterns of care” studies of the major tumors to characterize the treatment of older cancer patients who, because of an excess of comorbid conditions, are not eligible for placement on clinical trials. 5.Increase the cooperation of geriatricians with clinical oncologists since cancer is one of the more prevalent chronic diseases of their older patients.