Crowder V, Cho Y, Teng CH
… +10 more, Anderson D, Batchelor M, Beeber A, Coombs LA, Richardson D, Sawyer AS, Fogle R, Holliday AM, Schwartz TA, Bryant AL
Pillai A, Ramaswamy A, Rao AR
… +19 more, Kumar A, Mittal K, Sehgal A, Dhekale R, Pawar A, Shetake A, Mahajan S, Daptardar A, Sonkusare L, Deodhar J, Ansari N, Vagal M, Mahajan P, Timmanpyati S, Nookala M, Gota V, Banavali SD, Prabhash K, Noronha V
INTRODUCTION: Sarcopenia is age-related loss of muscle mass and function. It is highly prevalent in older adults with cancer and is associated with adverse outcomes. Various consensus guidelines are available for assessi...INTRODUCTION: Sarcopenia is age-related loss of muscle mass and function. It is highly prevalent in older adults with cancer and is associated with adverse outcomes. Various consensus guidelines are available for assessing sarcopenia. Sarcopenia screening is not routinely done in geriatric oncology clinic. Data on the SARC-F questionnaire and its functional correlation with objective parameters are lacking from older Indian patients with cancer. MATERIALS AND METHODS: This was a retrospective observational study done in the geriatric oncology clinic at the Tata Memorial Hospital in Mumbai, India. We included patients aged ≥60 years who had undergone geriatric assessment (GA) and had completed the SARC-F questionnaire. Function was objectively assessed with hand grip and Timed-Up-and-Go test (TUG). We aimed to assess the utility of SARC-F by correlating it with the objective functional parameters and to find the association between grip strength and clinicodemographic parameters and vulnerabilities in various geriatric domains. RESULTS: Between November 2022 and October 2023, we enrolled 1025 patients. The mean age was 67 years (standard deviation, 5.8), 78.2% were male. Primary malignancies included gastrointestinal (36.7%), lung (27.7%), genitourinary (17.2%), and head and neck (16.2%). Palliative intent therapy was planned in 62.9% of patients. SARC-F was positive for sarcopenia in 24.2% (n = 248), while 58.8% (n = 603) participants had low handgrip strength, and 52.9% (n = 520) had prolonged TUG scores. SARC-F has a low sensitivity in identifying patients with low handgrip (sensitivity 29.6%, specificity 83.6%, negative predictive value [NPV] 45.4%, positive predictive value [PPV] 72.1%). SARC-F also has low sensitivity in identifying patients with prolonged TUG scores (sensitivity 35.9%, specificity 95.4%, NPV 57.03%, PPV 89.9%). Multivariate analysis using logistic regression showed that low handgrip strength significantly correlated with age, sex, TUG score, mid arm circumference, calf circumference, albumin level, clinical frailty scale, and the Cancer and Aging Research Group chemotherapy toxicity risk score. DISCUSSION: Simple objective measures of grip strength and TUG should be incorporated apart from SARC-F for screening of sarcopenia and assessing muscle strength in geriatric oncology clinic.
Matsuoka A, Ayata M, Tanno K
… +16 more, Ando Y, Umegaki H, Kanai F, Sasaki T, Suzuki M, Tanaka C, Tsubata Y, Terada T, Nagashima F, Majima Y, Yanagawa M, Yamanaka T, Yamamoto H, Yokoyama T, Shimazu T, Fujimori M
INTRODUCTION: As Japan's population ages, home-based care has become increasingly important for older adults with cancer. Many patients experience functional decline, multimorbidity, and psychosocial challenges, making c...INTRODUCTION: As Japan's population ages, home-based care has become increasingly important for older adults with cancer. Many patients experience functional decline, multimorbidity, and psychosocial challenges, making continuity of care across medical and long-term care services essential. However, coordination between hospital-based and community-based providers remains fragmented. This study aimed to explore the perspectives of healthcare and long-term care providers to identify key elements for effective coordination in home-based care for older adults with cancer. MATERIALS AND METHODS: We conducted semi-structured interviews with healthcare and long-term care providers from designated cancer care hospitals, home-visit medical institutions, and long-term care agencies. Institutions were purposively selected based on prior reports or expert recognition of structured coordination practices, and additional participants were recruited through snowball sampling. Interviews were conducted online between September 2024 and January 2025. Transcripts were analyzed using conventional content analysis, and themes were synthesized to capture essential components of coordination. RESULTS: Seventy-seven participants from 48 institutions were enrolled. Six key elements were identified for effective coordination: (1) system infrastructure, (2) information exchange, (3) communication, (4) timeliness, (5) human resource development, and (6) information dissemination. Institutions with structured referral protocols, designated coordinators, and information and communication technology platforms demonstrated smoother transitions from hospital-based treatment to home-based care. Timely, patient-centered information sharing was emphasized as more important than technology. Beyond medical details, functional status, psychosocial information, and patient goals were considered essential. Real-time, bidirectional communication ensured goal alignment across care settings. Early initiation of coordination-ideally during treatment or even at diagnosis-was considered critical for advanced care planning and symptom management. Cross-training, interprofessional workshops, and multidisciplinary conferences were perceived as effective strategies to increase hospital providers' awareness of community resources, foster mutual understanding, and strengthen workforce capacity. Proactive education and outreach were considered essential to addressing the limited understanding of home-based care systems among patients and caregivers. DISCUSSION: Six key elements, including structural, procedural, and educational components, were identified as essential to strengthening transitional and longitudinal care. Effective coordination in home-based care for older adults with cancer requires appropriate tools or systems along with proactive, timely, and multidimensional engagement across medical and long-term care sectors.
Blumberg R, Ng RQM, Wang Y
… +11 more, Gilbride E, Mousaw K, Hayward E, Magnuson A, Lawley M, Abdallah M, DuMontier C, Rossi L, Mohile SG, Ramsdale E, Loh KP
INTRODUCTION: Frailty is frequent among older adults with cancer and may affect treatment tolerance. Frailty screening is recommended to help guide clinical decision-making. This study evaluates the association between f...INTRODUCTION: Frailty is frequent among older adults with cancer and may affect treatment tolerance. Frailty screening is recommended to help guide clinical decision-making. This study evaluates the association between frailty, assessed with the Geriatric 8 (G8), and first-line oncologic treatment intensity, treatment tolerance within nine months, and one-year overall survival in older adults with various cancers. MATERIALS AND METHODS: This prospective cohort study at Odense University Hospital, Denmark included older adults age ≥ 70 years with solid cancers who underwent G8 screening at their initial oncology consultation between June 1, 2020-October 15, 2021. Clinical and survival data were extracted from medical records. Guideline treatment was defined as regimens consistent with national guidelines for first-line oncologic treatment, allowing add-on protocol treatment, while reduced-intensity treatment referred to regimens not among first choices. Treatment tolerance was defined as the absence of discontinuations, dose reductions after treatment initiation, or un-administered treatments (excluding delays). Associations between G8 frailty (G8 ≤ 14/17 points) and outcomes were analyzed using adjusted multivariate logistic regression and Cox proportional hazards regression. RESULTS: Among the 1398 patients screened, 65% were frail. Non-frail patients were more likely to receive guideline treatment (OR 1.98, 95%CI 1.28-3.06) and had better first-line treatment tolerance, irrespective of treatment intensity, compared to frail patients (OR 2.38, 95%CI 1.49-3.81), though this effect was more pronounced when receiving guideline treatment (OR 3.08, 95%CI 1.72-5.52). Frailty was associated with twice the risk of one-year mortality (HR 2.03, 95%CI 1.47-2.78), with an absolute mortality risk of 40%, compared to 10% for non-frail patients. Frail patients able to tolerate reduced-intensity treatment had a 68% lower mortality risk compared to frail patients who were unable to tolerate guideline treatment (HR 0.32, 95%CI 0.21-0.49). DISCUSSION: G8 screening identifies older adults at a higher risk of treatment intolerance and mortality. Our findings support the need for clinical trials investigating the effects of initially reduced-intensity treatments with potential escalation in frail older adults receiving systemic treatment. Study registration The study is registered at clinicaltrials.gov [NCT04644874].
INTRODUCTION: Microsatellite instability-high/deficient mismatch repair (MSI-H/dMMR) colon cancers are associated with reduced lymph node (LN) metastasis and improved outcomes in early-stage disease; however, whether the...INTRODUCTION: Microsatellite instability-high/deficient mismatch repair (MSI-H/dMMR) colon cancers are associated with reduced lymph node (LN) metastasis and improved outcomes in early-stage disease; however, whether these associations vary by patient age remains unclear. MATERIALS AND METHODS: Using the National Cancer Database (2018-2021), we identified 116,623 patients with stage I-III colon adenocarcinoma undergoing upfront surgery and stratified them by age (<65 vs. ≥65 years) and MSI status (MSI-H/dMMR vs. microsatellite stable). Multivariable linear regression assessed LN positivity and lymph node ratio, and Cox proportional hazards models evaluated overall survival, including an interaction term between age and MSI status. RESULTS: MSI-H tumors were more common in older patients (24.9% vs. 13.6%). MSI-H status was independently associated with 0.53 fewer positive lymph nodes (95% CI -0.73 to -0.34), and older age was associated with 0.37 fewer positive lymph nodes (95% CI -0.47 to -0.28). A significant interaction between age and MSI status demonstrated attenuation of the MSI-associated nodal protection in older adults. In node-negative disease, MSI-H was associated with improved overall survival in younger but not older patients, whereas in stage III disease MSI-H was associated with worse survival in older patients. The age-MSI interaction remained significant in adjusted survival models. DISCUSSION: These findings suggest that the prognostic and biologic implications of MSI-H in stage I-III colon cancer are meaningfully modified by age and should be interpreted within an age-specific context.
INTRODUCTION: Older adults receiving curative-intent cancer treatment face a challenging balance between treatment and quality-of-life (QoL). While comprehensive geriatric assessment (CGA) is known to reduce toxicity, it...INTRODUCTION: Older adults receiving curative-intent cancer treatment face a challenging balance between treatment and quality-of-life (QoL). While comprehensive geriatric assessment (CGA) is known to reduce toxicity, its impact on QoL remains inconsistent. Early supportive care has been shown to improve QoL. The Geriatric Oncology SuPportive clinic for ELderly (GOSPEL) study aimed to determine if a geriatric oncology supportive clinic (GOSC) can maintain QoL in older adults undergoing curative-intent chemotherapy and/or radiotherapy. MATERIALS AND METHODS: This single-center, randomised controlled trial enrolled patients aged ≥65 years with a Geriatric-8 (G8) score ≤ 14 and solid organ malignancies scheduled for curative treatment. Participants were randomised 1:1 to GOSC (CGA-guided multidisciplinary interventions and supportive care) or usual care. The primary outcome was the change in QoL (EORTC QLQ-ELD14 mobility subscale). Secondary outcomes included EQ-5D-VAS, treatment toxicity, healthcare utilisation, and survival. RESULTS: Fifty-two participants (mean age 71.8 years; mean G8 12.1) were randomised 1:1 to both arms between 2019 and 2024. While there was no significant difference in the primary outcome between the arms, the intervention arm demonstrated significant longitudinal improvement in the secondary analysis of quality-of-life mean EQ-5D-VAS at 1, 2, 3, 6, and 12 months compared to baseline (all p < 0.05). No significant differences were found between the GOSC and UC arms regarding treatment-related toxicity, healthcare utilisation, or overall and disease-free survival. DISCUSSION: GOSPEL showed that addition of supportive care measures along with CGA-guided multidisciplinary intervention (GOSC) improves quality of life in older adults undergoing curative treatment for solid organ cancer. Larger multicenter studies are needed to confirm these benefits.
INTRODUCTION: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is a complex and costly treatment for peritoneal surface malignancies. While preoperative frailty is known to worsen postop...INTRODUCTION: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is a complex and costly treatment for peritoneal surface malignancies. While preoperative frailty is known to worsen postoperative outcomes, its economic impact in CRS + HIPEC remains underexplored. This study evaluated the association between preoperative frailty and in-hospital costs in this population. MATERIALS AND METHODS: A retrospective cohort study was conducted at a tertiary center in Sydney, Australia, including adults who underwent CRS + HIPEC from May 2017 to June 2024. Frailty was assessed using the Clinical Frailty Scale (CFS), with scores of 4 or higher classified as frail. Patient characteristics, surgical outcomes, and in-hospital cost data, including staff, intensive care, diagnostics, theatre, ward, and other services, were collected. Mann-Whitney U tests and chi-square tests were used for comparisons. Multivariable linear regression identified cost drivers in frail patients. RESULTS: Among 466 patients, 60 (12.9%) were classified as frail. Frail patients were significantly older than non-frail patients. Cost differences were particularly evident in staffing, diagnostics, and ward-related care, with frail patients incurring higher expenses across all categories. Total in-hospital costs were significantly higher in frail compared to non-frail patients (median AU$115,282 vs AU$106,938; p = 0.005). Multivariate analysis identified intensive care unit stay as the primary driver of total in-hospital cost within the frail cohort. DISCUSSION: Preoperative frailty is independently associated with increased in-hospital costs among patients undergoing CRS + HIPEC. These findings highlight the value of incorporating frailty assessment into preoperative evaluation and suggest a need for targeted perioperative strategies to optimise outcomes and resource use in frail surgical populations.
INTRODUCTION: Hematological malignancies (HM) occur mostly in older patients; aging is potentially associated with loss of autonomy and cognitive impairment. However, the role, burden, and supportive needs of primary car...INTRODUCTION: Hematological malignancies (HM) occur mostly in older patients; aging is potentially associated with loss of autonomy and cognitive impairment. However, the role, burden, and supportive needs of primary caregivers (PC) of older patients with HM have rarely been investigated. Thus, our main objective was to measure associations between the instrumental, educational, and emotional unmet needs of PCs of older patients with various HM and the quality of life (QoL) in these dyads, and, secondarily, to explore related factors. MATERIALS AND METHODS: This multicenter cross-sectional study was offered to all patients over 65 years diagnosed with any HM, treated or not, having a PC, and able to fill out a self-questionnaire. Questionnaires were given to outpatients, who passed them on to their PC to fill in and return. Questionnaires assessed burden, cognition, quality of life, tasks for which help is needed, and needs from the PC's perspective. RESULTS: Among 104 included patients, only 59 questionnaires of dyads were analyzable. The median age of patients was 76 years and of PCs was 70 years. PCs were mainly the spouses (n = 36/59). Few PCs stated they needed support: 10% required emotional support (higher when PC had cognitive complaint, p = 0.001), 18% instrumental support (higher when patients were male, p = 0.05 or PC had cognitive complaint, p = 0.01) and 24% educational support. The median EQ-5D-5L global score was 65 in patients and 80 in PCs. The patients' self-perceived burden (SPB) had a median at 5/10 (IQR = 7). When the patient was male, the Zarit burden score was higher (p = 0.002), as well as disrupted schedule (p = 0.05), financial problems (p = 0.03), and health problems (p < 0.001), and self-esteem lower (p < 0.001) at Caregiver Reaction Assessment (CRA) sub scores. An overall cognitive complaint concerned 54.4% of patients and 33% of PCs. There was a higher proportion of cognitive complaints in male patients (70% vs 33% in females, p = 0.01), who reported a significantly higher level of responsibility in their last professions and were more likely to be under active cancer treatment. DISCUSSION: This study highlights the need to explore cognitive complaints before and during treatment and potentially provide neuropsychological assessment and educational support in these dyads.
INTRODUCTION: Wearable devices offer promising opportunities for continuous monitoring of recovery in older patients after cancer surgery. Understanding patient experiences is essential for successful clinical implementa...INTRODUCTION: Wearable devices offer promising opportunities for continuous monitoring of recovery in older patients after cancer surgery. Understanding patient experiences is essential for successful clinical implementation. This study aimed to explore the usability of wearable devices for monitoring recovery in older patients after oncologic surgery, focusing on their experiences, challenges, and preferences for future clinical implementation. MATERIALS AND METHODS: We conducted semi-structured interviews with older patients who wore a wearable device before and after undergoing cancer surgery at Leiden University Medical Center. Participants were recruited from an ongoing cohort study. Interviews were structured around Morville's User Experience Honeycomb framework and performed between February and August 2025. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS: We performed interviews with 16 patients (median age 77 years, range 70-82) who underwent surgery for solid tumors, most commonly pancreatic cancer (56%). Participants had the device for a median of 104 days (range 66-132), wearing it for a median of 23 h per day. Three main themes emerged: (1) successful integration of the device into daily life despite practical challenges such as smartphone battery drain, (2) high trust in the technology with nuances regarding privacy and voluntary adoption, and (3) enthusiasm for future implementations centered on data access, personalized feedback, and safety monitoring. The value of monitoring was emphasized particularly by patients living alone. DISCUSSION: Older patients successfully adopted wearable devices during recovery after cancer surgery and demonstrated high trust in the technology. Clinical implementation should prioritize voluntary adoption, address practical barriers such as smartphone compatibility, and integrate wearables within a blended care approach combining technology with human support. Patients living alone may particularly appreciate wearable monitoring during recovery.
Rota S, Tozzi AE, Fanelli M
… +16 more, Dri A, Bortolus G, Tortorella A, Zambotti E, Congi R, Pretto G, Serra R, Membrino A, Di Civita M, Cursano MC, Zanardi E, Procopio G, Santini D, Zucali PA, Verzoni E, Gusmaroli E
INTRODUCTION: Immune checkpoint inhibitors (ICIs) are increasingly administered to older patients with cancer; however, early treatment discontinuation due to performance status (PS) deterioration remains a major concern...INTRODUCTION: Immune checkpoint inhibitors (ICIs) are increasingly administered to older patients with cancer; however, early treatment discontinuation due to performance status (PS) deterioration remains a major concern. Although geriatric assessment (GA) tools such as the G8 score have been proposed to support treatment decision-making, their predictive value in ICI therapy is limited. In this study, we evaluated the association between a modified G8 (mG8) score and treatment discontinuation due to PS deterioration in older patients receiving ICIs. MATERIALS AND METHODS: In this retrospective observational study, patients aged ≥75 years who received ICI monotherapy at Yokohama City Minato Red Cross Hospital between 2015 and 2023 were included. Clinical data, including mG8 scores, were extracted from medical records. The primary outcome was treatment discontinuation attributed to PS deterioration. Logistic regression and receiver operating characteristic (ROC) curve analyses were conducted to assess the discriminatory performance of the mG8 score for PS-related discontinuation. RESULTS: A total of 91 patients were analyzed. The median age of the patients was 78 years (range, 75-88). Treatment discontinuation due to PS deterioration occurred in 10 (11.0%) patients. Univariate logistic regression analysis revealed a significant association between the mG8 score and discontinuation due to PS deterioration (odds ratio 0.44, 95% confidence intervals [CI] 0.27-0.74; P = 0.002). ROC curve analysis showed good predictive performance (area under the curve [AUC] 0.848, 95% CI 0.743-0.954). Internal validation using bootstrap resampling (1000 iterations) yielded a bootstrap AUC estimate of 0.855 (95% CI 0.737-0.941). An exploratory cutoff of ≤9 points was derived using the Youden index; this cutoff and its sensitivity/specificity require external validation. DISCUSSION: Overall, lower mG8 scores were associated with treatment discontinuation related to PS deterioration in older patients treated with ICIs. Pretreatment mG8-based assessment may help identify older patients potentially at risk of early treatment intolerance; however, clinical use of this score should be validated against the full version of G8 in independent cohorts.