Padovan BV, van der Velden LA, Hardillo JAU
… +12 more, van Egmond SL, Hoeben A, Eerenstein SEJ, Schoon Y, de Bree R, de Kleijn BJ, van Bemmel AJM, Sedee RJ, Vesseur A, Plaat RE, Festen S, Halmos GB
INTRODUCTION: Older age is associated with changes in physical, social, and psychological health in ways that influence treatment decisions, potentially impacting on quality and quantity of life. This systematic review e...INTRODUCTION: Older age is associated with changes in physical, social, and psychological health in ways that influence treatment decisions, potentially impacting on quality and quantity of life. This systematic review explores the experiences of older adults, their significant others, and health care professionals when decisions regarding cancer treatment and support are made. MATERIALS AND METHODS: Synonyms relating to search terms Cancer, Older People, Complexity, and Qualitative research were used to search the databases CINAHL, Medline, Embase, and PsycINFO. The Mixed Methods Appraisal Tool (MMAT) identified strengths and limitations of the evidence allowing concurrent appraisal of qualitative, quantitative, and mixed methods studies. Data analysis and synthesis was conducted using narrative synthesis. RESULTS: Five hundred thirty-four articles were identified of which 64 underwent full text screening. Fourteen studies fulfilled the selection criteria and were included in the review. Narrative synthesis identified four themes: (1) Preconditions in decision making - identifying frailty and setting goals; (2) Preferences, choice, and the need to maintain independence; (3) The influence of information provision; (4) Support during the decision-making process, role distribution, and trust in physician. Most included studies reported the views of the older adult, or health care professionals. However, there was paucity of evidence representing the older adult's significant other. DISCUSSION: Research is urgently needed to understand how and why decisions are made regarding cancer treatment and support, as well as how older adults are involved in these decisions throughout their diagnosis and treatment trajectory. A comprehensive understanding would help healthcare professionals to prioritise the individual's healthcare preferences.
INTRODUCTION: Despite recommendations on frailty screening (FS) and referral to a comprehensive geriatric assessment (CGA) when needed, the average G8 completion rate into Oncological Multidisciplinary Team reports for o...INTRODUCTION: Despite recommendations on frailty screening (FS) and referral to a comprehensive geriatric assessment (CGA) when needed, the average G8 completion rate into Oncological Multidisciplinary Team reports for older patients with cancer barely reached 10% in recent years. As financial and educational incentives are already offered, this study aimed to explore potential psychosocial remaining barriers toward the implementation of the geriatric approach in oncology. MATERIALS AND METHODS: This multicenter mixed-method cross-sectional study explored, in both older patients treated for cancer and physicians (MDs), the psychosocial determinants related to "Performing FS" and "Referral to CGA". The quantitative part was based on an online survey sent to the MDs in the 46 hospitals labeled to treat cancer in Normandy, and a self-questionnaire offered to all consecutive eligible older patients aged 70 and above in six participating outpatient clinics. Their perceptions of ageing was examined using the Attitudes Toward Own Ageing (ATOA) and Expectations Regarding Ageing (ERA-12) questionnaires in older patients and MDs, respectively. Face-to-face semi-structured interviews with both stakeholders were led by a social psychologist. RESULTS: The response rate to the physician's survey was 9.94% (n = 51) and seven participated in interviews. Among older patients, 192 (29.4%) completed analyzable paper surveys and nine participated in interviews. Barely half of MDs considered FS and CGA as a norm, three quarters declared using FS and CGA, but almost all had a Positive Attitude and Intention to Implement. Female MDs had a significantly better ERA-12 total score (64.20% vs 49.60% in male, p = .01), and the most experienced (≥20 yrs) had worse expectations (49.15% vs 61.44% in <10 yrs. and 66.39% in 10-19 yrs., p = .02). Older patients having experienced a CGA (vs only FS or neither) had significantly higher Positive Anticipated Emotion (p = .006), Positive Attitude (p = .01), Subjective Norm (p = .03), and Perceived Behavior Control (p = .004) toward CGA referral. However, the qualitative interviews showed that the words "geriatric" and "frailty" remained associated with ageist stereotypes and reluctance. DISCUSSION: Psychosocial barriers were found both in patients and in physicians toward FS and CGA in cancer treatment decisions. Psychoeducational strategies for both MDs and patients should be reinforced to highlight the benefit of geriatric interventions in oncology.
INTRODUCTION: Older patients with cancer are at increased risk for adverse drug events due to chronic conditions and complex medication regimens often leading to polymedication. A pharmacist-led medication review has the...INTRODUCTION: Older patients with cancer are at increased risk for adverse drug events due to chronic conditions and complex medication regimens often leading to polymedication. A pharmacist-led medication review has the potential to reduce drug-related problems and enhance medication safety. Oncogeriatric scores are effective in predicting chemotherapy-associated toxicity. However, risk scores are only of benefit for the patient if the results lead to therapeutic consequences. This study aimed to develop and evaluate an interprofessional risk-adapted medication management intervention (IrMa) to reduce the symptom burden caused by adverse drug events in older patients with cancer. MATERIALS AND METHODS: The individualized care approach entailed adapting the intensity of care to the toxicity risk of each patient. This was determined prior to tumor therapy by using the Cancer and Aging Research Group (CARG) score and existing polymedication. Based on their individual risk, patients were divided into different groups and received either standard care ("low-risk patients"), or, for high-risk patients, symptom counseling, medication review, or both. Feasibility and acceptability of the intervention were investigated as primary outcome. Toxicity and patient-reported symptom burden were documented and analyzed as secondary outcomes. A non-inferiority analysis was conducted to assess whether high-risk patients who received the IrMa intervention experienced a similar level of toxicity or symptom burden as low-risk patients, despite their higher risk. This analysis aimed to identify preliminary efficacy signals. RESULTS: The intervention was feasible and well accepted. Out of 101 enrolled patients, 96 patients aged between 70 and 88 years were stratified. Implementation rates were 100% for medication reviews and 74% for symptom counseling. Of the identified drug-related problems requiring intervention, 73.9% were resolved. In the first cycle, the overall toxicity rate (CTCAE grade ≥ 3) was 67.5% in low-risk patients and 80.4% in high-risk patients. Preliminary efficacy signals were identified for patient-reported mucositis, vomiting, constipation and diarrhea in the first cycle but not for toxicity grade ≥ 3. DISCUSSION: The interprofessional, risk-adapted medication management for older patients with cancer is a feasible and accepted approach to improve patient safety. Patient-reported outcomes indicate a preliminary efficacy in reducing symptoms that can be influenced by appropriate supportive care.
INTRODUCTION: Breast cancer disproportionately affects older adults. Older adults may experience either over- or undertreatment with curative intent cytotoxic chemotherapy. The risk of cancer versus non-cancer mortality...INTRODUCTION: Breast cancer disproportionately affects older adults. Older adults may experience either over- or undertreatment with curative intent cytotoxic chemotherapy. The risk of cancer versus non-cancer mortality in this population is poorly quantified in existing literature. We aimed to explore the causes of death in a large population-based cohort of patients with high-risk, stage II and III breast cancer. MATERIALS AND METHODS: This was a retrospective cohort study using the BC Cancer Breast Cancer Outcomes Unit database. Patients aged 50 and above diagnosed between 2005 and 2010 with high-risk breast cancer (any stage III, stage II triple negative or HER-2 positive breast cancer) were included. Patients were followed up until our primary outcome of death, or until the end of 2020. Cause of death was obtained from vital statistics and confirmed with chart review. Undertreatment was defined as no chemotherapy and died from breast cancer; overtreatment was defined as having received chemotherapy and died from non-breast cancer causes. RESULTS: A total of 2,390 patients aged 50 and above were included, of whom 756 were older (age 70 and above). During the study period, 1,122 patients died. Older patients were more likely to die from non-breast cancer causes (61.4% vs 26.9%, p < 0.001). Cardiovascular disease and second malignancies were the most common non-breast cancer causes of death. Younger patients were more likely to be overtreated (22.7% vs 12.9%, p < 0.001), while older patients were more likely to be undertreated (28.5% vs 11.8%, p < 0.001). ECOG score, age, and having two or more comorbidities were predictors of non-breast cancer mortality. DISCUSSION: Older adults with high-risk breast cancer have significant risk of non-cancer death. However, undertreatment with chemotherapy remains prevalent. Thorough risk/benefit assessments and consideration of competing causes of death are necessary when discussing treatment for this population.
Jeng MY, Wong P, Flynn JR
… +13 more, Ritter E, Ho C, Ruiz JD, Jakubowski AA, Papadopoulos EB, Shaffer BC, Ponce DR, Tamari R, Young JW, Perales MA, Devlin S, Giralt SA, Lin RJ
J Geriatr Oncol
· 2025 Nov · PMID 40834739
·
Full text
INTRODUCTION: The Older Adults with Cancer Clinic (OACC) performs comprehensive geriatric assessments (CGAs) for patients aged ≥65 with cancer. To manage limited resources and increasing wait times, raising the age cut-o...INTRODUCTION: The Older Adults with Cancer Clinic (OACC) performs comprehensive geriatric assessments (CGAs) for patients aged ≥65 with cancer. To manage limited resources and increasing wait times, raising the age cut-off from 65 to 75 was considered. Our objective was to determine whether the CGA has a similar impact on primary and secondary outcomes for patients under 75 compared to those aged 75+. MATERIALS AND METHODS: We performed a retrospective analysis of 1402 consecutive patients aged 65 or older referred from July 2015 to June 2024 in the pre-treatment setting. Data were obtained from a custom clinical database. The primary outcome of the CGA is its impact on the oncology treatment plan, and secondary outcomes include the identification of abnormalities across eight geriatric domains, CGA-based recommendations, and five care enhancements: comorbidity management, cancer treatment delivery, educational support, peri-operative management, and symptom management. Descriptive analytics were used to identify differences in the primary and secondary outcomes of the CGA for patients under 75 versus those ≥75 using chi-square tests. RESULTS: There was a significant association between age group and treatment changes (χ = 5.58, p = 0.02). Specifically, 52.2% of patients aged ≥75 experienced a treatment change after the CGA compared to 43.5% of those under 75. Apart from the 'mood' domain (χ = 7.07, p = 0.008), no notable differences were observed in the percentage of patients with abnormalities across the geriatric domains. Similarly, no significant differences in CGA-based recommendations or care enhancements were found between patients under 75 and those aged ≥75 (all p > 0.05). DISCUSSION: Patients aged ≥75 are slightly more likely to undergo treatment changes following the CGA. However, the 43.5% treatment change rate among those under 75 and the lack of differences in secondary outcomes between age groups confirm the value of CGA in improving care for both age groups. Our findings suggest that among patients aged 65 or older, age should not be used to define who might benefit from a CGA.
INTRODUCTION: There is a notable gap in practical application of evidence synthesis from systematic exploration and summarization of barriers and strategies for implementing geriatric assessment (GA) in older adults with...INTRODUCTION: There is a notable gap in practical application of evidence synthesis from systematic exploration and summarization of barriers and strategies for implementing geriatric assessment (GA) in older adults with cancer globally. This review systematically mapped out and synthesized the evidence on barriers and strategies for GA implementation in older adults with cancer. MATERIALS AND METHODS: A comprehensive, systematic search across seven electronic databases (MEDLINE, PsycINFO, CINAHL, Web of Science, Proquest, Scopus, and Ageline) was performed to identify peer-reviewed articles from January 1, 2013 to October 30, 2024. The scoping review followed the JBI methodology for scoping reviews guidelines and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension. The protocol was registered on Open Science Framework. Two researchers independently screened 2871 records and extracted relevant data from 34 full-text study reports and performed content analyses to consolidate the findings. RESULTS: The 34 articles were classified into the following categories: cross-sectional surveys (n = 16), observational cohort studies (n = 7), randomized controlled trials (n = 3), single-arm intervention trials (n = 4), qualitative studies (n = 2), and mixed methods (online surveys and interviews) (n = 2). The articles included were from 12 countries, with one global collaboration, and the majority (29/34) were published in the past five years. Five themes describing 27 barriers influencing the implementation of GA in older adults with cancer were summarized. Seventeen implementation strategies were identified and summarized from content analyses of the included articles. An initial draft of the barriers and strategies guide template for geriatric assessment (BeST-GA) was developed as a synthesized summary of the findings from this scoping review. DISCUSSION: The literature confirms that barriers affecting GA implementation in older adults with cancer and the strategies to overcome them are unique to individual settings and require a tailored approach. The draft BeST-GA guide template should be further tested and may be used as a first step to assess the setting during the planning phase of GA implementation.
INTRODUCTION: The efficacy and tolerability of anticancer drugs may be affected by several factors that change with age. No specific trials of cabozantinib have been conducted in older patients with metastatic renal cell...INTRODUCTION: The efficacy and tolerability of anticancer drugs may be affected by several factors that change with age. No specific trials of cabozantinib have been conducted in older patients with metastatic renal cell carcinoma (mRCC). The CABOMAYOR study was aimed at evaluating the efficacy in terms of objective response rate in previously untreated fragile older patients with mRCC. MATERIALS AND METHODS: An exploratory, phase 2, single-arm study was conducted in patients who were ≥ 70 years with a risk of frailty or who were > 75 years regardless of frailty, had a diagnosis of mRCC with measurable disease, had an ECOG-PS of 0-2, and had not received previous treatment for mRCC. Cabozantinib was orally administered once daily at a dose of 40 mg for 28-day cycles, which could be increased to 60 mg to prevent suboptimal exposure. The primary endpoint was the objective response rate (ORR). Other outcomes included progression-free survival, overall survival and adverse events. RESULTS: Thirty-eight patients were screened, and 24 patients were included in the study. Patients had a median age of 78 years (interquartile range [IQR] 75-81), and 12 (50%) had a Geriatric-8 score equal to or less than 14 points (i.e., risk of frailty). The median duration of follow-up was 27.0 (16.6-47.1) months. There were no confirmed complete responses, and seven patients achieved a confirmed partial response, thus leading to an ORR of 29.2% (95% confidence interval [CI]: 11.0-47.4%). The median progression-free survival and overall survival were 2.8 (95% CI: 2.0-3.6) months and 33.7 (95% CI: 20.5-46.8) months, respectively. Fourteen (58.3%) patients required dose reductions, and 17 patients (70.8%) required dose interruptions, mostly due to nonhematologic toxicity. Most of the adverse events were grade 1-2 events. There were three grade 5 adverse events, none of which were considered treatment-related: these events included physical health deterioration, cerebral hemorrhage, or COVID-19-related pneumonia. Serious adverse events occurred in 11 (45.8%) patients, three of which were considered treatment-related. DISCUSSION: Our results suggest that cabozantinib is effective as an initial monotherapy for older patients with mRCC with a toxicity profile consistent with that reported in younger adults.
INTRODUCTION: The incidence of renal cell carcinoma (RCC) increases with age, yet older patients (≥70 years) are underrepresented in clinical trials. Evidence on the efficacy of immune checkpoint inhibitors (ICIs) and on...INTRODUCTION: The incidence of renal cell carcinoma (RCC) increases with age, yet older patients (≥70 years) are underrepresented in clinical trials. Evidence on the efficacy of immune checkpoint inhibitors (ICIs) and on reliable prognostic tools for this population remains limited. We aimed to evaluate the effectiveness of nivolumab-based immunotherapy in older patients with metastatic RCC (mRCC) and assess the prognostic accuracy of the International Metastatic RCC Database Consortium (IMDC) and Meet-URO scores. MATERIALS AND METHODS: This multicenter study included 889 patients with mRCC treated with nivolumab alone or in combination with ipilimumab, using data from the Meet-URO 15 study and the Italian Expanded Access Program. Progression-free survival (PFS), overall survival (OS), and prognostic factors were analyzed by age group (<70 and ≥ 70 years) using Kaplan-Meier curves and multivariate models. RESULTS: Median OS and PFS were similar between younger and older patients (mOS: 23.5 vs. 25.1 months, HR: 1.02, p = 0.82; mPFS: 6.28 vs. 7.82 months, HR: 0.93, p = 0.40). The Meet-URO score outperformed the IMDC score in prognostic accuracy (p < 0.001), particularly in older patients. Non-clear cell histology was linked to shorter PFS (HR: 1.37, p = 0.05), while prior nephrectomy improved OS (HR: 0.55, p = 0.001). Limitations include the retrospective design and treatment heterogeneity. Prospective validation is needed. DISCUSSION: In this large real-world cohort, outcomes in older patients with mRCC receiving nivolumab-based immunotherapy were comparable to those in younger patients. The Meet-URO score improved prognostic stratification and supported clinical decision-making.
INTRODUCTION: Older adults with cancer often prioritize functional health over quantity of life. Understanding factors that influence functional health in older adults with cancer can help identify at-risk individuals as...INTRODUCTION: Older adults with cancer often prioritize functional health over quantity of life. Understanding factors that influence functional health in older adults with cancer can help identify at-risk individuals as well as tailoring variables for the development of tailored behavioral interventions to improve goal-concordant cancer care and optimize quality of life. The purpose of this study was to (1) characterize physical function over time in older adults (aged 65+) receiving systemic cancer therapy, (2) identify demographic, clinical, and symptom correlates associated with physical function over time, and (3) determine the impact of baseline symptoms and frailty on physical function trajectories over time. MATERIALS AND METHODS: Data for this secondary analysis were obtained from a longitudinal, cohort, IRB-approved study in 213 older adults (aged 65+) with mixed cancer diagnoses receiving systemic cancer therapy. Data were obtained from participant medical records, self-administered cancer-specific geriatric assessment, self-reported physical function (PROMIS Physical Function-Short Form and Karnofksy Performance Status), and performance-based physical function (Timed Up and Go). Participants were followed for a six-month period, with assessments repeated at every clinical visit. Correlations were used to assess relationships between variables at baseline, and between baseline variables and physical functioning at later time points. Longitudinal linear mixed models, or hierarchical linear models, using maximum likelihood estimation were performed to assess changes in physical functioning over time, as well as predictors/moderators of change. RESULTS: Age, fatigue, and frailty were associated with worse self-reported physical functioning over time. Targeted treatments were associated with improvement in self-reported physical function over time. No significant moderators were identified for performance-based physical function over time. Baseline fatigue, pain, and frailty status were all significant predictors of change in self-reported physical function over time. Only frailty status predicted change in Timed Up and Go scores over time. DISCUSSION: We identified sociodemographic, clinical, and symptom variables that contribute to physical function over time in older adults receiving systemic therapy. These findings highlight the importance of tailoring education, conducting symptom screenings and geriatric assessments at regular clinical intervals, and early intervention to optimize physical function and quality of life for older adults with cancer.
INTRODUCTION: Older adults with cancer undergoing systemic therapy are at the greatest risk of experiencing adverse effects including functional decline. We aimed to understand the risk of functional decline at three mon...INTRODUCTION: Older adults with cancer undergoing systemic therapy are at the greatest risk of experiencing adverse effects including functional decline. We aimed to understand the risk of functional decline at three months after starting systemic therapy among older adults with gastrointestinal (GI) cancer undergoing systemic therapy. MATERIALS AND METHODS: Using data from a prospective cohort study, we identified older adults ≥60y with newly diagnosed GI cancer initiating systemic therapy at our institution, who underwent functional status evaluation at baseline and at three months follow up. Functional status was measured by self-report using Older American Resources and Services (OARS) activities of daily living questionnaire. Functional decline was defined as a 1-point decline in activities of daily living (ADL) or independent activities of daily living (IADL). We used Cox regression models to study the association between functional decline and all-cause mortality adjusting for relevant confounders. RESULTS: We identified 306 older adults with a median age at study participation of 68 years. Overall, 31.4% experienced functional decline. Functional decline was associated with significantly greater risk of all-cause mortality (adjusted hazard ratio 1.45; 95% confidence interval 1.04-2.01; p value <0.001) after adjusting for age, sex, race/ethnicity, cancer type, cancer stage, baseline frailty, baseline functional status, and regimen intensity. Similar results were seen when analyzing separately for ADL and IADL decline. DISCUSSION: One in three older adults (≥60y) with GI cancers initiating systemic therapy experience functional decline at 3 months follow-up. Early functional decline is independently associated with a 45% increased risk of all-cause mortality.
INTRODUCTION: Decisions on the treatment of head and neck cancers (HNCs) in older adults are challenging, as there is a vast diversity in biological age, comorbidities, geriatric syndromes, and the capacity to tolerate o...INTRODUCTION: Decisions on the treatment of head and neck cancers (HNCs) in older adults are challenging, as there is a vast diversity in biological age, comorbidities, geriatric syndromes, and the capacity to tolerate oncological treatments among coeval individuals. This study investigated factors affecting the overall survival in older patients with HNC. MATERIALS AND METHODS: This retrospective, observational cohort study included 163 patients aged 70 and older who were diagnosed with a primary HNC and treated at a tertiary care centre between 2010 and 2015. The primary outcome was an overall survival of up to 3.5 years for all patients, including 142 patients treated with curative intent and 17 patients treated with palliative intent. The Kaplan-Meier estimate with the log-rank test was used to draw the lifetime graph for overall survival, and univariate and multivariate Cox regression analyses were used to assess the associations between patient characteristics and survival in the curative intent treatment group. RESULTS: The cohort included 163 patients (median age [interquartile range] of 77 (83-73) years. Most patients were male (n =112, 69%), functionally independent (n = 107, 66%), diagnosed with two or more chronic diseases (n = 130, 80%), used at least five regular medications (n = 90, 55%), and could walk without assistive devices (n = 124, 76%). The survival rate of all patients during the 3.5-year follow-up was 42% (n = 69/163). All patients who underwent palliative treatment died (n = 17). Of the curatively treated patients, 69 (47%) were alive at the end of the follow-up. In the univariate analysis, the use of mobility aids, living in a nursing home, need for help with daily activities, diagnosis of depression, number of comorbidities and medications, anaemia, and tumour characteristics were associated with mortality. In multivariate analysis, the use of mobility aids, need for help in daily activities, anaemia, and tumour stage remained significantly associated with mortality. DISCUSSION: The need for help in daily activities, use of mobility aids, high tumour stage, and anaemia should be considered as risk factors for death in older patients with potentially curable HNC. Further assessment of a patient's holistic situation should be performed to assist in decision-making before and during HNC treatment.