Polypharmacy and potentially inappropriate medication use in geriatric oncology

Sharma, Manvi; Loh, Kah Poh; Nightingale, Ginah; Mohile, Supriya G.; Holmes, Holly M.

doi:10.1016/j.jgo.2016.07.010

Cited by 178 publications

(126 citation statements)

References 65 publications

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“…GA assesses age‐related vulnerabilities or domains that are predictive of morbidity and mortality in older adults with cancer . In our study, GA domains were assessed using validated tools and cutoffs and included comorbidity , functional status , physical performance , cognition , instrumental social support (e.g., someone to help if you were confined to bed) , polypharmacy , psychological health , and nutrition (supplemental online Table 1).…”

Section: Methodsmentioning

confidence: 99%

Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists

et al. 2019

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Background Ensuring older patients with advanced cancer and their oncologists have similar beliefs about curability is important. We investigated discordance in beliefs about curability in patient‐oncologist and caregiver‐oncologist dyads. Materials and Methods We used baseline data from a cluster randomized trial assessing whether geriatric assessment improves communication and quality of life in older patients with advanced cancer and their caregivers. Patients were aged ≥70 years with incurable cancer from community oncology practices. Patients, caregivers, and oncologists were asked: “What do you believe are the chances the cancer will go away and never come back with treatment?” Options were 100%, >50%, 50/50, <50%, and 0% (5‐point scale). Discordance in beliefs about curability was defined as any difference in scale scores (≥3 points were severe). We used multivariate logistic regressions to describe correlates of discordance. Results Discordance was present in 60% (15% severe) of the 336 patient‐oncologist dyads and 52% (16% severe) of the 245 caregiver‐oncologist dyads. Discordance was less common in patient‐oncologist dyads when oncologists practiced longer (adjusted odds ratio [AOR] 0.90, 95% confidence interval [CI] 0.84–0.97) and more common in non‐Hispanic white patients (AOR 5.77, CI 1.90–17.50) and when patients had lung (AOR 1.95, CI 1.29–2.94) or gastrointestinal (AOR 1.55, CI 1.09–2.21) compared with breast cancer. Severe discordance was more common when patients were non‐Hispanic white, had lower income, and had impaired social support. Caregiver‐oncologist discordance was more common when caregivers were non‐Hispanic white (AOR 3.32, CI 1.01–10.94) and reported lower physical health (AOR 0.88, CI 0.78–1.00). Severe discordance was more common when caregivers had lower income and lower anxiety level. Conclusion Discordance in beliefs about curability is common, occasionally severe, and correlated with patient, caregiver, and oncologist characteristics. Implications for Practice Ensuring older patients with advanced cancer and their caregivers have similar beliefs about curability as the oncologist is important. This study investigated discordance in beliefs about curability in patient‐oncologist (PO) and caregiver‐oncologist (CO) dyads. It found that discordance was present in 60% (15% severe) of PO dyads and 52% (16% severe) of CO dyads, raising serious questions about the process by which patients consent to treatment. This study supports the need for interventions targeted at the oncologist, patient, caregiver, and societal levels to improve the delivery of prognostic information and patients’/caregivers’ understanding and acceptance of prognosis.

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Section: Methodsmentioning

confidence: 99%

Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists

et al. 2019

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“…Comorbidities were graded using the Adult Comorbidity Evaluation (ACE-27) as none, mild, moderate or severe [22]. Polypharmacy was defined as the prescription of five or more medications on a daily basis [23]. Nutritional status was assessed using the Malnutrition Universal Screening Tool (MUST) [24].…”

Section: Data Collectionmentioning

confidence: 99%

Geriatric assessment of patients treated for cutaneous head and neck malignancies in a tertiary referral center: Predictors of postoperative complications

Vries

Heirman

Bras

et al. 2020

European Journal of Surgical Oncology

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a b s t r a c tIntroduction: As cutaneous head and neck malignancies are highly prevalent especially in older patients, the risk of surgical complications is substantial in this potentially vulnerable population. The objective of this study was to evaluate the value of geriatric assessment of this population with respect to postoperative complications. Methods: Patients were prospectively included in OncoLifeS, a databiobank. Before surgery, patients underwent a geriatric assessment including multiple validated screening tools for frailty, comorbidity, polypharmacy, nutrition, functional status, social support, cognition and psychological status. Postoperatively, complications (Clavien-Dindo grade II) were registered. Uni-and multivariable logistic regression analyses were performed yielding odds ratios (ORs) and 95% confidence intervals (95%CIs). Results: 151 patients undergoing surgery for cutaneous head and neck malignancies were included in this study (mean age 78.9 years, 73.5% male). In a multivariable analysis, frailty measured by the Geriatric 8 (G8) (OR ¼ 6.34; 95%CI:1.73e23.25) was the strongest independent predictor of postoperative complications, among other predictors such as major treatment intensity (OR ¼ 2.73; 95%CI:1.19e6.26) and general anesthesia (OR ¼ 4.74; 95%CI:1.02e22.17), adjusted for age and sex. Conclusion: Frailty, measured by G8, is the strongest predictor of postoperative complications in patients undergoing surgery for cutaneous head and neck malignancies in addition to treatment intensity and type of anesthesia. Geriatric screening on multiple domains is recommended for patients with cutaneous malignancies undergoing head and neck surgery is recommended, as this population includes old patients and frequently suffers postoperative complications.

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“…and Lawton's Instrumental Activities of Daily Living (IADL), 33 the fall history during the last year, 34 fatigue as assessed by the Mobility-Tiredness Test (MOB-T), 35 mental status as assessed by the Mini Mental State Examination (MMSE) 36 and the 15-item Geriatric Depression Scale, 37 nutritional status as assessed by the Mini Nutritional Assessment Short Form (MNA-SF), 38 comorbidities as assessed by the Charlson Comorbidity Index (CCI),39 and a polypharmacy assessment 40. …”

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confidence: 99%

The added value of geriatric screening and assessment for predicting overall survival in older patients with cancer

Kenis

Baitar

Decoster

et al. 2018

Cancer

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BACKGROUND:The aim of this study was to determine and compare the added prognostic value of screening tools, geriatric assessment (GA) components, and GA summaries to clinical information for overall survival (OS) in older patients with cancer. METHODS: A screening and a 10-item GA were systematically performed in patients ≥70 years old with cancer. Cox regression analyses were conducted to evaluate the added prognostic value for OS of screening tools, GA, and GA summaries to clinical information (age, stage, and tumor type) in 2 cohorts (A and B). Cox models were compared on the basis of the Akaike information criterion and the concordance probability estimate. The 2 cohorts for the analyses were similar but independent. RESULTS: A complete case analysis was available for 763 patients (median age, 76 years) in cohort A and for 402 patients (median age, 77 years) in cohort B. In both cohorts, most individual GA components were independent prognostic factors for OS. Nutritional status (assessed with the Mini Nutritional Assessment Short Form) and functional status (assessed with the Instrumental Activities of Daily Living) consistently displayed a strong capacity to predict OS. Less consistent results were found for screening tools. GA summaries performed the best in comparison with the screening tools and the individual GA components. CONCLUSIONS: Most individual GA components, especially nutritional status and functional status, are prognostic factors for OS in older patients with cancer. GA summaries provide more prognostic information than individual GA components but only moderately improve the prognostic baseline model with clinical information.

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Polypharmacy and potentially inappropriate medication use in geriatric oncology

Cited by 178 publications

References 65 publications

Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists

Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists

Geriatric assessment of patients treated for cutaneous head and neck malignancies in a tertiary referral center: Predictors of postoperative complications

The added value of geriatric screening and assessment for predicting overall survival in older patients with cancer

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