Socioeconomic Considerations and Shared-Care Models of Cancer Care for Older Adults

Dale, William; Chow, Selina; Sajid, Saleha

doi:10.1016/j.cger.2015.08.007

Cited by 13 publications

(7 citation statements)

References 41 publications

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“…Cancer represents a major public health problem, with total cure remaining elusive for most cancer types (1,2). Chemotherapy resistance in patients with recurrent and advanced disease (3) and strong systemic toxicity, especially in elderly (4), have raised concerns over the progress of cancer therapy, making it necessary to change the paradigm in the search for new treatments, more effective and with milder adverse effects. Thus, alternative cell death pathways capable of killing apoptosisand therapy resistant cancer cells, have gained vast interest among cancer researchers, leading to the identification of autophagy and lysosomal cell death programs as attractive means to circumvent therapy resistance (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Psychotropic Drugs Show Anticancer Activity by Disrupting Mitochondrial and Lysosomal Function

et al. 2020

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Background and Purpose: Drug repositioning is a promising strategy for discovering new therapeutic strategies for cancer therapy. We investigated psychotropic drugs for their antitumor activity because of several epidemiological studies reporting lower cancer incidence in individuals receiving long term drug treatment. Experimental Approach: We investigated 27 psychotropic drugs for their cytotoxic activity in colorectal carcinoma, glioblastoma and breast cancer cell lines. Consistent with the cationic amphiphilic structure of the most cytotoxic compounds, we investigated their effect on mitochondrial and lysosomal compartments. Results: Penfluridol, ebastine, pimozide and fluoxetine, fluspirilene and nefazodone showed significant cytotoxicity, in the low micromolar range, in all cell lines tested. In MCF7 cells these drugs caused mitochondrial membrane depolarization, increased the acidic vesicular compartments and induced phospholipidosis. Both penfluridol and spiperone induced AMPK activation and autophagy. Neither caspase nor autophagy inhibitors rescued cells from death induced by ebastine, fluoxetine, fluspirilene and nefazodone. Treatment with 3-methyladenine partially rescued cell death induced by pimozide and spiperone, whereas enhanced the cytotoxic activity of penfluridol. Conversely, inhibition of lysosomal cathepsins significantly reduced cell death induced by ebastin, penfluridol, pimozide, spiperone and mildly in fluoxetine treated cells. Lastly, Spiperone cytotoxicity was restricted to colorectal cancer and breast cancer and caused apoptotic cell death in MCF7 cells. Conclusions: The cytotoxicity of psychotropic drugs with cationic amphiphilic structures relied on simultaneous mitochondrial and lysosomal disruption and induction of cell death that not necessarily requires apoptosis. Since dual targeting of lysosomes and mitochondria constitutes a new promising therapeutic approach for cancer, particularly those in which the apoptotic machinery is defective, these data further support their clinical development for cancer therapy.

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Section: Introductionmentioning

confidence: 99%

Psychotropic Drugs Show Anticancer Activity by Disrupting Mitochondrial and Lysosomal Function

et al. 2020

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“…Several models have been created to enhance assessment and management of frailty in older adults with cancer. In a recent review, 66 Dale and colleagues discuss four that have emerged in the United States. The first, the primary provider model, uses formally trained geriatric oncologists who perform an initial comprehensive assessment and manage all geriatric and oncology needs.…”

Section: Multidisciplinary Care Modelsmentioning

confidence: 99%

Frailty and the management of hematologic malignancies

Abel

Klepin

2018

Blood

161

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The majority of blood cancers occur in the elderly. This fact conspires with an aging population in many countries to make rigorous assessment for frailty increasingly important for hematologic oncologists. In this review, we first define frailty and its relevance for patients with hematologic malignancy. Next, we review current data regarding the effect of domains of frailty on outcomes for blood cancers including myelodysplastic syndromes, acute leukemia, non-Hodgkin lymphomas such as chronic lymphocytic leukemia, and multiple myeloma. Finally, after presenting assessment and treatment options for the practicing hematologist, we propose elements of a new research agenda for geriatric hematology: the exchange of age limits for rigorous frailty screening, development of disease-specific measures, and inclusion of functional and patient-reported outcomes alongside survival.

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“…The model adopted by MSKCC (Fig 1) is based on the following: the large population of patients evaluated and treated; the subspecialization of the oncologists in a specific type of cancer, and the limited availability of clinicians (dually certified geriatric oncologists, board-certified geriatricians) who have expertise in the care of the complex problems faced by older patients with cancer. Models that have been successful in smaller institutions, like the primary provider model 14 in which the older patients are evaluated and treated by a dually trained geriatric oncologist, have tight limits in the number of patients that can be seen. In centers such as MSKCC, which has greater than 3,000 new registrations of patients older than age 65 years annually (in its Manhattan location only), this model would limit the expertise to an extremely small percentage of patients.…”

Section: Development Of a Geriatrics Servicementioning

confidence: 99%

“…13 The need for collaboration between geriatrics and oncology has been recognized, but a uniform model to achieve it has not been established. [14][15][16] This article describes the model of care for older adults with cancer that was developedatMemorialSloanKetteringCancer Center (MSKCC); shares the lessons learned since its inception; and, more important, identifies barriers and tactics that were successful to overcomethese barriers during its development.…”

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confidence: 99%