Life expectancy, comorbidity and quality of life: the treatment equation in the older cancer patients

Repetto, Lazzaro; Comandini, Danila; Mammoliti, Serafina

doi:10.1016/s1040-8428(00)00104-9

Cited by 83 publications

(55 citation statements)

References 22 publications

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“…Comorbidities may mask symptoms of malignancies, or may highlight an existing or developing neoplasm. [42] As part of a comprehensive geriatric assessment of senior cancer patients, comorbidity assessment with the ACE-27 Index has the potential to more fully inform physicians about prognosis, treatment, and quality of life. Undertreated comorbid conditions and geriatric syndromes can combine with the index cancer and cancer treatment (chemotherapy, radiation, surgery) to decrease a patient's functional status and quality of life.…”

Section: Discussionmentioning

confidence: 99%

The changing prevalence of comorbidity across the age spectrum

Piccirillo¹,

Vlahiotis²,

Barrett³

et al. 2008

Critical Reviews in Oncology/Hematology

274

151

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The purpose of the research was to demonstrate that comorbid health conditions disproportionately affect elderly cancer patients. Descriptive analyses and stacked area charts were used to examine the prevalence and severity of comorbid ailments by age of 27,506 newly diagnosed patients treated at one of eight cancer centers between 1998 and 2003. Hypertension was the most common ailment in all patients, diabetes was the second most prevalent ailment in middle-aged patients, and previous solid tumor(s) were the second most prevalent ailment in patients aged 74 and older. Although the prevalence and severity of comorbid ailments including dementia and congestive heart failure increased with age, some comorbidities such as HIV/AIDS and obesity decreased. Advances in cancer interventions have increased survivorship, but the impact of the changing prevalence and severity of comorbidities at different ages has implications for targeted research into targeted clinical and psychosocial interventions.

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Section: Discussionmentioning

confidence: 99%

The changing prevalence of comorbidity across the age spectrum

Piccirillo¹,

Vlahiotis²,

Barrett³

et al. 2008

Critical Reviews in Oncology/Hematology

274

151

View full text Add to dashboard Cite

show abstract

“…Besides age, more attention should be paid to the presence of comorbid conditions, chronic diseases and functional disabilities that are frequent causes of complications and death in the elderly. A number of questionnaires have been devised with the purpose of selecting frail subjects in older cohorts (Repetto et al, 2001;Matthes et al, 2004) and probably a multiparameter evaluation should replace age alone in the selection of candidates for chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

New insights into the role of age and carcinoembryonic antigen in the prognosis of colorectal cancer

et al. 2007

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The aim of this study was to verify through relative survival (an estimate of cancer-specific survival) the true prognostic factors of colorectal cancer. The study involved 506 patients who underwent locally radical resection. All the clinical, histological and laboratory parameters were prognostically analysed for both overall and relative survival. This latter was calculated from the expected survival of the general population with identical age, sex and calendar years of observation. Univariate and multivariate analyses were applied to the proportional hazards model. Liver metastases, age, lymph node involvement and depth of bowel wall involvement were independent prognosticators of both overall and relative survival, whereas carcinoembryonic antigen (CEA) was predictive only of relative survival. Increasing age was unfavourably related to overall survival, but mildly protective with regard to relative survival. Three out of the five prognostic factors identified are the cornerstones of the current staging systems, and were confirmed as adequate by the analysis of relative survival. The results regarding age explain the conflicting findings so far obtained from studies considering overall survival only and advise against the adoption of absolute age limits in therapeutic protocols. Moreover, the prechemotherapy CEA level showed a high clinical value. British Journal of Cancer (2008) A large body of investigational data demonstrates that the prognosis of patients undergoing bowel resection for colorectal cancer is mainly determined by factors related to local tumour growth and the presence or absence of nodal and/or distant metastases. Many classification systems have been devised to categorise these anatomical factors for clinical use but an increasing number of new pathological and nonanatomical elements show interesting correlations with survival and would be worth testing systematically for selective integration into the available staging classifications. Improvement of the prognostic accuracy of these classifications might allow a more flexible use of the increasing number of new drugs and therapeutic options now available for postsurgical management of patients with colorectal cancer. However, since this malignancy is a disease of the elderly and the populations of developed countries are ageing rapidly, overall survival, as currently investigated, may not be the most suitable outcome parameter for evaluating the real prognostic impact of tumour-linked factors. Because about one-half of all colorectal carcinomas in our series occur in people aged 65 years or older, and a considerable number of these subjects die of other causes with no evidence of cancer, a fraction of these deaths should not be related to the tumour.There are two main purposes of the present work: (1) to verify the prognostic significance of the current clinicopathological factors through a study of both overall and relative survival, this latter being a selective estimate of the chance of surviving the effects of cancer; (2) to includ...

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“…46,47 Evidence suggests that the coexistence of comorbidities can exacerbate the effects of cancer on older adults. 6,11,13,14,46,48,49 Solely considering the physiologic aspects of aging would lead to the assumption that cancer is likely to have greater impact for older patients and longer-term survivors.…”

Section: Physiologic Agingmentioning

confidence: 99%

A gerontologic perspective on cancer and aging

Blank

Bellizzi

2008

Cancer

105

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Most people diagnosed with cancer are aged >65 years, and many diagnosed younger live to become older survivors. Geriatric oncology is becoming recognized as a specialty area within oncology. It focuses specifically on the functional impacts of the interplay of aging and cancer, including the role of comorbidities.Nevertheless, to the authors' knowledge, little attention has been given to cancer from a gerontologic and lifespan perspective, especially quality of life and psychologic impact. Research has shown that the amount and type of psychologic impact of cancer is highly variable and that part of that variation is related to age, in that older persons are often less affected in both negative and positive ways. Gerontologic concepts and empiric findings related to physical, psychologic, and social aging processes may serve as partial explanations for that agerelated pattern. Important potential contributors include psychologic factors, such as changes in future time perspective and goals, as well as social ones, such as roles and previous experience. The result is a complex interplay of factors that vary across persons but are covaried with age. Empiric findings regarding 1-year to 8-year prostate cancer survivors illustrate the age differences and the differential impacts of age itself and comorbidity. The use of gerontologic concepts to explain the age-related impact of cancer will benefit both research and clinical practice by providing a means to target interventions more effectively by taking into account the psychologic and social changes that often accompany aging. Cancer 2008;112(11 suppl):2569-76.2008 American Cancer Society.KEYWORDS: aging, gerontology, oncology, quality of life, psychology, psychosocial aspects, survivors, prostate cancer.T he intimate link between cancer incidence and aging is well understood in the medical community. Most of the major tumors occur in greater proportion in men and women over the age of 65 years.1-6 Many individuals diagnosed and treated earlier in life eventually become older cancer survivors because of the increased likelihood of long-term survival for many cancers. As a result, greater than 60% of the 10.8 million cancer survivors in the U.S. today are over the age of 65 years. 1,3 Despite the finding that older men and women are disproportionately affected by cancer, to our knowledge remarkably little attention has been given to cancer in gerontology and geriatric communities, and even less to aging processes in oncology. Fortunately, we are beginning to see changes in both sides of the equation, as reflected by a special issue of the Journal of Clinical Oncology on geriatric oncology and a recent Institute of Medicine workshop on cancer in the elderly. 7,8 Nevertheless, most of that

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Life expectancy, comorbidity and quality of life: the treatment equation in the older cancer patients

Cited by 83 publications

References 22 publications

The changing prevalence of comorbidity across the age spectrum

The changing prevalence of comorbidity across the age spectrum

New insights into the role of age and carcinoembryonic antigen in the prognosis of colorectal cancer

A gerontologic perspective on cancer and aging

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