Baltussen JC, Knikman JE, de Glas NA
… +22 more, de With M, Baars A, Creemers GJ, Droogendijk HJ, Fiets E, van Iersel-Valkenburg L, Mandigers CMPW, Imholz ALT, van de Poel MHW, Jeurissen FJF, Wymenga M, Nieboer P, Tigges T, Wesseling E, Schellens JHM, Swen JJ, Guchelaar HJ, Mathijssen RHJ, Gelderblom H, Mooijaart SP, Cats A, Portielje JEA
INTRODUCTION: Although fluoropyrimidines are widely prescribed to older patients, studies investigating predictors for chemotherapy intolerance in this patient population are scarce. Therefore, we aimed to identify predi...INTRODUCTION: Although fluoropyrimidines are widely prescribed to older patients, studies investigating predictors for chemotherapy intolerance in this patient population are scarce. Therefore, we aimed to identify predictors of poor treatment tolerability in older patients receiving fluoropyrimidine-based chemotherapy. MATERIALS AND METHODS: Patients aged ≥70 years who received fluoropyrimidine-based chemotherapy were selected from the prospective, multicentre, non-randomized Alpe2U study. Before treatment initiation, participants underwent a geriatric assessment investigating the somatic, nutritional, functional, and mental domains. Predictors of the composite endpoint "poor treatment tolerability," defined as either Common Toxicity Criteria Adverse Events (CTCAE) grade 3-5 chemotherapy-related toxicity, dose reduction, or treatment discontinuation within the first two cycles, were analysed using uni- and multivariable logistic regression models. RESULTS: Of the 194 included patients, median age was 75 (interquartile range 73-79) years and the most common tumour types were colorectal (60%) and esophagogastric (19%) cancer. Most patients (89%) received capecitabine-based chemotherapy. Poor treatment tolerability within the first two cycles was seen in 31% of patients. In multivariable analyses, associations with poor treatment tolerability were found for deficits in 3-4 geriatric domains compared with 0 deficits (odds ratio [OR] 4.03, 95% confidence interval [CI] 1.09-14.97, p = 0.04) and for combination chemotherapy (OR 2.83, 95% CI 1.31-6.09, p = 0.008). DISCUSSION: Having deficits in multiple geriatric domains and combination chemotherapy were predictors of poor treatment tolerability within the first two cycles in older patients treated with fluoropyrimidine-based chemotherapy. These findings highlight the importance of a geriatric assessment before fluoropyrimidine administration to estimate risk of treatment intolerance.
INTRODUCTION: Frailty and depression commonly coexist in patients with cancer, potentially compounding its vulnerability, and affecting outcomes. However, the strength of its association remains uncertain. This meta-anal...INTRODUCTION: Frailty and depression commonly coexist in patients with cancer, potentially compounding its vulnerability, and affecting outcomes. However, the strength of its association remains uncertain. This meta-analysis aims to evaluate the relationship between frailty and depressive symptoms in adults with cancer. MATERIALS AND METHODS: The PubMed, Embase, and Web of Science databases were systematically searched up to February 19, 2025 for observational studies that compared depression prevalence between frail and non-frail patients with cancer. The random-effects model was used to pool the odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Thirteen cross-sectional studies that involved 7037 patients with cancer were included. The pooled analysis revealed that frailty was significantly associated with higher odds of depression (OR: 5.79, 95% CI: 4.31-7.77, p < 0.001), with moderate heterogeneity (I = 63%). By excluding one study at a time, the sensitivity analyses yielded consistent results (the ORs ranged within 5.43-6.39). The subgroup analyses indicated generally consistent trends across regions (Asian vs. Western countries), age groups (<70 vs. ≥70 years), genders, frailty assessment methods, depression diagnostic tools, analytic models (univariate or multivariate), and study quality scores (all p for subgroup difference > 0.05). However, these findings should be considered exploratory and interpreted with caution due to the limited studies in each subgroup. The Egger's test results revealed no significant publication bias (p = 0.72). DISCUSSION: Frailty may be associated with depressive symptoms in patients with cancer across diverse populations and assessment methods. Routine screening for depression in frail patients with cancer may support early intervention and improve comprehensive care.
INTRODUCTION: Older adults represent the majority of patients with acute myeloid leukemia (AML), and an increasing proportion receive allogeneic hematopoietic cell transplantation (alloHCT). Mutations in the FMS-like tyr...INTRODUCTION: Older adults represent the majority of patients with acute myeloid leukemia (AML), and an increasing proportion receive allogeneic hematopoietic cell transplantation (alloHCT). Mutations in the FMS-like tyrosine kinase 3 gene (FLT3) confer high relapse risk, and post-transplant maintenance with FLT3 tyrosine kinase inhibitors (FLT3-TKIs) is guideline-recommended. However, real-world utilization, adherence, and tolerability of FLT3-TKIs in older adults remain poorly characterized. MATERIALS AND METHODS: Using 100% Medicare claims (Parts A/B/D and Medicare Advantage encounter data), we conducted a retrospective cohort study of beneficiaries ≥65 years old with AML who received alloHCT between January 1, 2016 and June 30, 2024, and initiated FLT3-TKI maintenance (gilteritinib, midostaurin, or sorafenib) within 100 days post-transplant. Baseline demographics, comorbidities, prior therapy, and health care resource utilization (HCRU) were captured from 2010 through the index date. Adherence was assessed using proportion of days covered (PDC). Dose modification, FLT3-TKI switching, and post-transplant HCRU were evaluated descriptively. Centers for Medicare & Medicaid Services suppression rules were applied throughout. RESULTS: Of 7403 eligible older adults with AML undergoing alloHCT, 150 (2.0%) initiated FLT3-TKI maintenance (gilteritinib: 54.7%, midostaurin: 24.0%, sorafenib: 21.3%). Mean age was 70.5 years, and 59.3% had Charlson Comorbidity Index ≥4. Utilization of post-transplant FLT3-TKIs was sustained from 2020 onwards at approximately 20% of eligible patients annually. Overall adherence was modest, with a mean PDC of 47% and very few patients achieving PDC ≥80%. Higher mean PDC was observed in patients ≥70 years of age, those with fewer comorbidities, those previously treated with low-intensity chemotherapy, and those who received gilteritinib as maintenance. Among patients treated with gilteritinib, two-thirds had no evidence of dose change, and no patients switched to an alternative FLT3-TKI. Across all patients, post-alloHCT HCRU was predominantly outpatient visits, with low hospitalization rates across FLT3-TKIs. DISCUSSION: In this first real-world analysis of post-alloHCT FLT3-TKI maintenance in older adults, utilization was low and adherence was modest, although not impaired by age alone. Gilteritinib demonstrated the highest adherence and appeared to have favorable tolerability. Strategies to improve adherence and prospective data in older adults are needed to maximize the benefits of FLT3-TKI maintenance in this population.
Singh S, Mann S, Dorsey C
… +6 more, Lahoff D, McDermott W, Cagle J, Min SJ, Lum HD, Fischer SM
J Geriatr Oncol
· 2026 May · PMID 41861729
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INTRODUCTION: Hospitalized older adults with malignant solid tumor cancer discharged to skilled nursing facilities (SNFs) are at high risk of being "rehabbed to death." These patients have high 6-month mortality, experie...INTRODUCTION: Hospitalized older adults with malignant solid tumor cancer discharged to skilled nursing facilities (SNFs) are at high risk of being "rehabbed to death." These patients have high 6-month mortality, experience burdensome care transitions near the end of life, and have limited access to palliative care. The Assessing and Listening to Individual Goals and Needs (ALIGN) intervention aims to address unmet palliative care needs and leverages the skills of palliative care social workers (PCSWs) to support serious illness communication, decision-making, and caregiver needs. We report the protocol of a pilot randomized controlled trial (RCT) of ALIGN that tests the (a) feasibility of delivering the intervention with fidelity across multiple SNFs, (b) collection of patient-centered outcomes, (c) preliminary efficacy, and (d) risk of contamination. MATERIALS AND METHODS: This single site, single-blinded, pilot RCT of ALIGN versus enhanced usual care will recruit 60 patients with cancer and up to 60 caregivers from an academic medical center discharged to a SNF. Patients will be randomized 1:1 to ALIGN or enhanced usual care. ALIGN consists of virtual PCSW visits every 1-2 weeks during a SNF stay and for up to 45 days after SNF discharge. ALIGN visits are manualized, theory-driven, and evidence-based, focusing on illness understanding, discussing evolving care preferences, caregiver needs, and care transition needs. The enhanced usual care arm will receive usual care and additional information about advance care planning (ACP). Participants will complete assessments at baseline, 1, 3, and 6-months after enrollment. The primary goal of the pilot RCT is to measure feasibility, defined by enrollment within 20% of the target sample of 60 patients, ≥ 70% intervention completion, <5% missing data for patient-centered outcomes collected in the electronic health record, and < 10% contamination in the control arm based on caregiver report of exposure to ALIGN content from SNF staff. Fidelity will be assessed through checklists, review of visit notes, and auditing of audio-recorded visits. DISCUSSION: This trial will test whether ALIGN can be delivered feasibly and with high fidelity across multiple SNFs, a high-risk transition point for older adults with cancer. Findings will inform a fully powered efficacy trial of ALIGN.
INTRODUCTION: Older adults with early-stage non-small cell lung cancer (NSCLC) undergoing stereotactic body radiation therapy (SBRT) have a high competing risk of adverse cardiac events, but adherence to guideline-direct...INTRODUCTION: Older adults with early-stage non-small cell lung cancer (NSCLC) undergoing stereotactic body radiation therapy (SBRT) have a high competing risk of adverse cardiac events, but adherence to guideline-directed cardiovascular care remains unclear. This study examined cardiovascular risk, management, and outcomes among older adults with early-stage NSCLC receiving SBRT. MATERIALS AND METHODS: This retrospective cohort study included patients aged ≥65 with early-stage NSCLC who completed SBRT between 2019 and 2023 at our institution. The following were assessed: (1) 10-year atherosclerotic cardiovascular disease (ASCVD) Framingham risk score, (2) baseline rates of guideline-directed management for hypertension, hyperlipidemia, and diabetes, (3) primary care and cardiology visits in the year before and after SBRT, and (4) competing risk-adjusted cumulative incidence of major adverse cardiac events (MACE). RESULTS: Among 330 patients (median age 77.1 years, 61.8% female), 98.5% (n = 325) had cardiovascular comorbidities, including hypertension (88.2%, n = 291) and hyperlipidemia (86.4%, n = 285). At SBRT initiation, 30.6% (n = 101) had prior ASCVD, and 91.8% (n = 303) were at high, or very high risk for future events based on their history or calculated risk score. Following SBRT, at a median follow-up of 21.3 months (IQR 12.8-33.6 months), 17.6% (n = 58) experienced MACE, with a risk-adjusted cumulative incidence at 2 years of 13.0%. Guideline-directed management was infrequent: 45.7% (n = 133) for hypertension, 28.7% (n = 82) for hyperlipidemia, and 30.3% (n = 20) for diabetes. Before and after SBRT, more than half of patients had no primary care or cardiology visits (pre: 54.5%; post: 55.8%). DISCUSSION: Older adults undergoing SBRT face substantial cardiovascular risk, but many do not receive appropriate preventive care. These findings highlight opportunities for multidisciplinary collaboration to support age-appropriate cardiovascular assessment and care delivery.
INTRODUCTION: Healthcare is increasingly shifting from a paternalistic model to one that prioritises person-centred care (PCC). Despite this trend, implementing PCC in the care of older adults diagnosed with cancer remai...INTRODUCTION: Healthcare is increasingly shifting from a paternalistic model to one that prioritises person-centred care (PCC). Despite this trend, implementing PCC in the care of older adults diagnosed with cancer remains challenging. The Age-Friendly Health Systems (AFHS) initiative provides a structured framework - the 4Ms (What Matters, Medication, Mentation, and Mobility) - to promote consistent, evidence-based care for older adults. It has demonstrated benefits in general geriatric care; however, applying the 4Ms principles in oncology is underexplored. This study aimed to assess the feasibility of enhancing geriatric assessment (GA) by integrating two novel person-centred elements: Photovoice (two patient-supplied photographs inspired by "Photovoice" principles but not constituting a full Photovoice methodology) and the "This is Me" (TiM) tool. MATERIALS AND METHODS: A cross-sectional mixed-methods study evaluated the feasibility of integrating two novel elements (two patient-supplied photographs and the TiM tool) into GA, with the aim of promoting practice based on the AFHS 4Ms framework principles. Twenty consecutive patients (≥70 years, G8 score ≤ 14) from a regional cancer centre completed the assessment (electronic Rapid Fitness Assessment [eRFA]-Photo-TiM, as well as the Mini-Cog and Timed-Up-and-Go). Results were presented at a weekly "enhanced supportive care" (ESC) multidisciplinary team (MDT) meeting. Participants completed post-assessment surveys and interviews. RESULTS: All patients (n = 20), aged 79 years, 45% female, completed the eRFA, 19 completed the TiM, and 18 provided photographs. The combined assessment was overall acceptable and feasible, user-friendly, captured patients' values and contexts, and facilitated supportive care referrals and advance care planning discussions. ESC-MDT members valued the holistic view for informing supportive care decisions. However, photo submission required substantial assistance for most participants, hence a significant barrier to overcome for implementation. Other barriers included digital literacy and delays in completion, which averaged 2.5 weeks. DISCUSSION: The eRFA-Photo-TiM approach was feasible and acceptable in a real-world cancer care in a regional cancer centre and may support more person-centred care decision making. Further research should evaluate effect on cancer care outcomes and sustainable implementation.
INTRODUCTION: Older adults comprise the majority of patients with cancer yet prior studies report that most oncology trainees never receive geriatric oncology (GO) teaching. Although international societies have incorpor...INTRODUCTION: Older adults comprise the majority of patients with cancer yet prior studies report that most oncology trainees never receive geriatric oncology (GO) teaching. Although international societies have incorporated GO into global curricula, it is unclear whether GO teaching has increased. Understanding how GO training is currently delivered and how trainees perceive such training will help educators identify and address gaps to optimize care of older adults. MATERIALS AND METHODS: An explanatory sequential mixed methods design of a survey followed by semi-structured interviews of current trainees and recent graduates of Canadian medical oncology programs was conducted. Survey results were summarized using descriptive statistics. Factors associated with attitudes towards learning about GO and comfort caring for older adults were analyzed. Qualitative interviews were thematically analyzed with the results of the survey in mind. RESULTS: While 76.6% of survey respondents (n = 47) reported receiving some GO teaching, the overall amount is low. Interviewees (n = 22) expanded on survey findings about the perceived learning value and preferred methods for GO training, and overall preparedness for caring for older adults. Specifically, most teaching was opportunistic and informal, with little formal teaching. While respondents reported that learning about older adults was important, this may evolve as trainees enter practice. Participants generally felt comfortable caring for older adults with cancer due to the volume of older adults seen in oncology care, though some acknowledged potential lack of awareness of blind spots. Clinical teaching and application of knowledge were described as essential elements for GO training. DISCUSSION: While exposure to GO training has increased, formal teaching remains low in comparison to the proportion of older adults oncologists care for. While trainees report feeling comfortable caring for these patients, what is being taught and thus whether trainees are adequately prepared to address the needs of older adults is unclear. Opportunistic learning is valuable but should complement curriculum and assessment, rather than form the foundation of GO training. Future work should formally evaluate GO knowledge and skills and develop strategies to reduce reliance on opportunistic teaching to ensure all oncology trainees are adequately prepared to care for older adults with cancer.
INTRODUCTION: We aimed to evaluate population-based outcomes of chemoradiation therapy (CRT) for muscle-invasive bladder cancer given a lack of population-based data, particularly in older adults. MATERIALS AND METHODS:...INTRODUCTION: We aimed to evaluate population-based outcomes of chemoradiation therapy (CRT) for muscle-invasive bladder cancer given a lack of population-based data, particularly in older adults. MATERIALS AND METHODS: We conducted observational analyses using SEER-Medicare based on the CRT protocol in the control arm of SWOG/NRG 1806. We included adults aged 66-89 years with T2-T4a N0 M0 urothelial bladder cancer treated with radiation and concurrent chemotherapy (cisplatin, gemcitabine, or 5-FU + mitomycin C) within 90 days of transurethral resection of bladder tumor (TURBT) from 2000 to 2017. We examined progression-free (PFS), cancer-specific (CSS), and overall survival (OS) using claims-based proxies and the Kaplan-Meier method. Associations of baseline characteristics with outcomes were evaluated using Cox regression. RESULTS: A total of 283 patients were included. Median age was 78 years (IQR 73-82), and tumor stage was T2 in 247 (87%) patients. Median follow-up was 26.0 months. At five years, PFS was 47%, CSS was 53%, and OS was 35%. On multivariable analysis, female sex (HR 1.74) was associated with increased risk of cancer-specific mortality (CSM), while higher education level (HR 0.37 for <14% without high school education versus >29%) was associated with reduced CSM. DISCUSSION: Notwithstanding the limitations of SEER-Medicare, in observational analyses designed to evaluate outcomes of a hypothetical single-arm trial, CRT was associated with lower CSS and OS than reported in prior clinical trials. Additional studies are required to determine if this is related to the efficacy or completeness of CRT in population-based practices or differences between trial and non-trial populations.
INTRODUCTION: Geriatric assessment improves clinical decision-making in older adults with cancer, but its systematic implementation remains challenging in routine oncology practice. In many centres, geriatric screening i...INTRODUCTION: Geriatric assessment improves clinical decision-making in older adults with cancer, but its systematic implementation remains challenging in routine oncology practice. In many centres, geriatric screening is not consistently performed before multidisciplinary tumour boards (MTBs). Our institution applies a pragmatic model in which an onco-geriatrician participates in all MTBs, enabling early identification of frailty and selective referral for comprehensive geriatric assessment (CGA). We evaluated whether older adults with colorectal cancer managed without formal CGA experienced higher rates of treatment-related complications or mortality. MATERIALS AND METHODS: We retrospectively included consecutive patients aged 70 years or older with colorectal cancer discussed at weekly MTBs between 2020 and 2023. Patients were classified into CGA and no-CGA groups. Clinical characteristics, treatments, major postoperative complications (Clavien-Dindo grade ≥ III), severe treatment toxicities (CTCAE grade ≥ 3), treatment interruptions, and unplanned readmissions were collected. Ninety-day mortality and 12-month overall survival were analysed using Kaplan-Meier estimates and log-rank tests. RESULTS: Among 170 patients, 83 underwent CGA and 87 did not. Patients in the CGA group were older and had more comorbidities as well as greater functional and social frailty. Rates of major postoperative complications, severe treatment toxicities, treatment interruptions, unplanned readmissions, and 90-day mortality were similar between groups (all p > 0.05). Dose reductions during chemotherapy or chemoradiotherapy were more frequent in the CGA group (87.8% vs 51.0%; p < 0.001). Twelve-month mortality was 25.3% in the CGA group and 14.9% in the no-CGA group. Median overall survival was not reached in either group, and no significant difference was observed between survival curves (log-rank p = 0.12). DISCUSSION: In this real-world cohort, older adults managed without formal CGA did not experience higher rates of major complications, treatment-related toxicity, or early mortality than those who underwent CGA, despite greater baseline vulnerability in the latter group. Systematic involvement of an onco-geriatrician in MTBs therefore supported appropriate triage and selective referral without compromising patient safety. Embedding geriatric expertise directly within MTBs may represent a pragmatic and scalable strategy to optimize care for older adults with colorectal cancer, particularly in settings with limited geriatric resources.
INTRODUCTION: Dose attenuated rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-miniCHOP) is a curative-intent regimen that balances safety and efficacy in older patients with diffuse large B-cell...INTRODUCTION: Dose attenuated rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-miniCHOP) is a curative-intent regimen that balances safety and efficacy in older patients with diffuse large B-cell lymphoma (DLBCL). Incorporation of targeted agents into this backbone and the use of geriatric assessments (GA) are research priorities. Brentuximab vedotin (BV) is an anti-CD30 antibody drug conjugate that is active in DLBCL and has been safely combined with chemoimmunotherapy in younger patients. We conducted a feasibility study of BV in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone (R-miniCHP), integrating GA and frailty assessment to describe the physiologic health of the cohort. MATERIALS AND METHODS: Patients aged 75 years and older with DLBCL were treated with six cycles of BV and R-miniCHP. All patients underwent GA at screening, following prephase and at the end of treatment. Frailty was determined using the Deficit Accumulation Frailty Index (DAFI) using clinical and GA variables. The primary feasibility endpoint was the treatment completion rate. Secondary endpoints included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and complete response (CR). Exploratory endpoints included PFS, OS, ORR, and CR by CD30 status, and PFS and OS by DAFI score. RESULTS: We enrolled 22 patients with a median age of 77.5 years (range 75-91). Seventeen patients (77.3%) completed six cycles of BV-R-miniCHP. The ORR was 85.7% (71.4% CR). With a median follow up of 4.3 years, the median PFS was not reached and the two-year PFS was 63.6% (90% CI = 44.3%, 77.8%). There was no difference in response, or survival by CD30 status. All 22 patients completed components of the baseline GA. There was no difference in two-year PFS (non-frail 50.0% (90% CI =23.0%, 72.1%) vs prefrail/frail 75.0% (90% CI = 47.4%, 89.5%), p = 0.49) or OS (non-frail 50.0% (90% CI = 23.0%, 72.1%) vs prefrail/frail 83.3% (90% CI =55.7%, 94.5%), p = 0.22) based on frailty as measured by DAFI score. Hematologic toxicities and infections were the most common grade ≥ 3 adverse events. Ten patients (45%) reported a total of 16 serious adverse events. There were two deaths during treatment. DISCUSSION: Incorporation of GA and BV R-miniCHP is feasible in untreated, older adults with DLBCL.