Improved targeting of cancer care for older patients: A systematic review of the utility of comprehensive geriatric assessment

Ramjaun, Aliya; Nassif, Mohammed; Krotneva, Stanimira; Huang, Allen; Meguerditchian, Ari N.

doi:10.1016/j.jgo.2013.04.002

Cited by 93 publications

(60 citation statements)

References 42 publications

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“…because of comorbidities. In contrast to young patients where the diagnosis of PCNSL is typically the only severe diagnosis, elderly patients are much more likely to suffer from one or more additional comorbidities which preclude intense therapy regimens [22]. Still, the successful completion of elderly trials in PCNSL demonstrates that such studies are feasible and enrolment of patients into open trials should be encouraged whenever possible.…”

Section: Clinical Trials For Elderly Pcnsl Patientsmentioning

confidence: 99%

Challenges in the treatment of elderly patients with primary central nervous system lymphoma

Roth

Hoang-Xuân

2014

Current Opinion in Neurology

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PURPOSE OF REVIEW: Approximately 50% of all patients with primary central nervous system lymphoma (PCNSL) are 60 years or older and may therefore be considered as elderly. Although the diagnostic work-up is basically the same in young and in elderly patients, therapeutic strategies vary considerably. Here, we review the characteristics of elderly PCNSL patients with a particular focus on advances in the optimization of treatment regimens. RECENT FINDINGS: Age has been repeatedly confirmed as a major therapy-independent negative prognostic factor. Benefit from treatment and the tolerability of tumor-specific therapy, particularly whole-brain radiotherapy, are significantly lower in the elderly patients. Still, for patients with newly diagnosed PCNSL, several studies emphasized the indisputable role of high-dose methotrexate as backbone for any therapy regimen also in elderly patients. However, the durability of responses to primary chemotherapy is significantly shorter than in young patients. Recent data from a randomized phase II study for elderly PCNSL patients suggest that the combination of high-dose methotrexate, procarbazine, vincristine and cytarabine is superior to methotrexate in combination with temozolomide. SUMMARY: Current efforts aim at treating elderly PCNSL patients within clinical trials that are specifically designed for this group of patients. Determining adapted consolidation and/or maintenance treatment to improve disease control in responding patients are the main challenges to be faced by future trials. Together with a better understanding of age-specific changes in the biology of PCNSL, this will pave the road for elderly tailored therapies. are 60 years or older and may therefore be considered as elderly. While the diagnostic work-up is basically the same in young and in elderly patients, therapeutic strategies vary considerably.Here we review characteristics of elderly PCNSL patients with a particular focus on advances in the optimization of treatment regimens. Recent findings:Age has been repeatedly confirmed as a major therapy-independent negative prognostic factor. Benefit from treatment and the tolerability of tumor-specific therapy, particularly whole brain radiotherapy, are significantly lower in the elderly. Still, for patients with newly diagnosed PCNSL, several studies emphasized the undisputable role of high-dose methotrexate as backbone for any therapy regimen also in elderly patients. However, the durability of responses to primary chemotherapy is significantly shorter than in young patients.Recent data from a randomized phase II study for elderly PCNSL patients suggest that the combination of high-dose methotrexate, procarbazine, vincristine and cytarabine is superior to methotrexate in combination with temozolomide.Summary: Current efforts aim at treating elderly PCNSL within clinical trials which are specifically designed for this group of patients. Determining adapted consolidation and/or maintenance treatment to improve disease control in responding patients ar...

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Section: Clinical Trials For Elderly Pcnsl Patientsmentioning

confidence: 99%

Challenges in the treatment of elderly patients with primary central nervous system lymphoma

Roth

Hoang-Xuân

2014

Current Opinion in Neurology

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“…Also, no specific oncogeriatric tools [34] such as PACE, CGA, aCGA, frailty index, gait speed, STOPP, and so on have been used. Both PACE and CGA have been validated elsewhere in their ability to better predict perioperative outcomes, by super selecting within elderly patients based on their physiologic rather than chronological age [35,36] . How- 155 ever, as they are time consuming and cumbersome to administer, they are presently best performed within the framework of dedicated (onco)geriatric clinics, available only at a few centres worldwide [34] .…”

Section: Discussionmentioning

confidence: 99%

Major Gastrointestinal Cancer Resections in the Elderly in India: Poised for Future Challenges

Batra¹,

Suradkar²,

Talole

et al. 2016

Dig Surg

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Background: There are no data on surgical outcomes of major gastrointestinal cancer resections in the expanding Indian oncogeriatric population. Methods: A prospective database of patients who underwent major gastrointestinal cancer resections during varying time periods (2006-2014) was analyzed retrospectively. Results: Two thousand six hundred and forty three patients with a median age of 53 were analyzed. Four hundred and seventy two (17.9%) patients were aged ≥65 years and 235 (8.9%) patients were ≥70 years. Mortality rates were not significantly higher in the elderly (≥65 years) or the very elderly (≥70 years) when compared to younger controls, being 2.8 vs. 1.6% (p = 0.09) and 3.0 vs. 1.7% (p = 0.162) respectively. Overall morbidity was similar for patients ≥65 or <65 years (24.2 vs. 21.7%, p = 0.253), but was higher in patients ≥70 years (29.8 vs. 21.4%, p = 0.003). The incidence of severe complications, however, was not significantly greater in this age group (13.2 vs. 12.5%, p = 0.74). Conclusions: Major gastrointestinal cancer resections in the elderly Indian population, though uncommon, are safe when performed at experienced high volume centres. These results should serve as a starting point for the gradual development of dedicated oncogeriatric programs in the Indian subcontinent.

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“…Similarly, in patients ≥65 years undergoing pancreaticoduodenectomy for benign disease, a 'Severe Nutritional Risk' was found to be a prognostic factor for long-term survival (adjusted hazard ratio 2.74; 95% CI 1.25-6.02) [34]. Furthermore, NS, assessed either by the MNA-score, recent weight loss, body mass index (BMI) or serum albumin levels, are known prognostic factors of survival and response to chemotherapy in cancer patients [5,8,35]. Data on the predictive ability of nutritional markers on postoperative outcomes in the elderly general surgery and hip surgery patient populations are scarce and nutritional markers are operationalized in several ways, according to a systematic review including 15 studies [36].…”

Section: A C C E P T E Dmentioning

confidence: 99%

“…Surgery plays an essential role in the treatment of solid tumours and it is therefore expected that increasing numbers of oncogeriatric patients will require surgery. Whilst fit onco-geriatric patients might recover from surgery as well as their younger counterparts, it is acknowledged that patients with geriatric domain impairments are at an increased risk of adverse postoperative outcomes, mortality and discharge to a non-home institution [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Poor nutritional status is associated with other geriatric domain impairments and adverse postoperative outcomes in onco-geriatric surgical patients – A multicentre cohort study

Huisman

Veronese

Audisio

et al. 2016

European Journal of Surgical Oncology (EJSO)

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Somasundar, P S et al. (2016) Poor nutritional status is associated with other geriatric domain impairments and adverse postoperative outcomes in onco-geriatric surgical patients -a multicentre cohort study. European Journal of Surgical Oncology, 42 (7). pp. 1009 -1017 This version is available from Sussex Research Online: http://sro.sussex.ac.uk/60520/ This document is made available in accordance with publisher policies and may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the URL above for details on accessing the published version. Copyright and reuse:Sussex Research Online is a digital repository of the research output of the University.Copyright and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable, the material made available in SRO has been checked for eligibility before being made available.Copies of full text items generally can be reproduced, displayed or performed and given to third parties in any format or medium for personal research or study, educational, or not-for-profit purposes without prior permission or charge, provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Accepted Manuscript M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT

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Improved targeting of cancer care for older patients: A systematic review of the utility of comprehensive geriatric assessment

Cited by 93 publications

References 42 publications

Challenges in the treatment of elderly patients with primary central nervous system lymphoma

Challenges in the treatment of elderly patients with primary central nervous system lymphoma

Major Gastrointestinal Cancer Resections in the Elderly in India: Poised for Future Challenges

Poor nutritional status is associated with other geriatric domain impairments and adverse postoperative outcomes in onco-geriatric surgical patients – A multicentre cohort study

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