Cyndi V. Le

Bio: Cyndi V. Le is an academic researcher from Washington University in St. Louis. The author has contributed to research in topics: Acute care & Polypharmacy. The author has an hindex of 3, co-authored 3 publications receiving 228 citations. Previous affiliations of Cyndi V. Le include Barnes-Jewish Hospital.

Geriatric Syndromes in Elderly Patients Admitted to an Oncology–Acute Care for Elders Unit

Abstract: Purpose The goal of this study was to characterize an elderly population admitted to a novel Oncology–Acute Care for Elders (OACE) unit, determine the prevalence of functional dependencies and geriatric syndromes, and examine their suitability for an interdisciplinary model of care. Patients and Methods We conducted a retrospective review of 119 patients age 65 years or older who had a primary oncologic or hematologic diagnosis and were admitted to the OACE Unit. Standard geriatric screens were administered to assess mood, functional, and cognitive status. Demographic and medical data were compiled by review of patients' medical records. Results The mean age of the patients was 74.1 years (standard deviation, 5.9 years). The sample was predominantly white, of equal sex, had limitations in instrumental and basic activities of daily living, and a mean length of stay of 6 days. Geriatric syndromes detected by the OACE interdisciplinary team included cognitive impairment (dementia and/or delirium), depression...

Polypharmacy in hospitalized older adult cancer patients: experience from a prospective, observational study of an oncology-acute care for elders unit.

Abstract: Background: A novel Oncology-Acute Care for Elders (OACE) unit that uses an interdisciplinary team to enhance recognition and management of geriatric syndromes in hospitalized older adult cancer patients has been established at Barnes-Jewish Hospital (St. Louis, Missouri). The OACE team includes a clinical pharmacist whose primary role is to improve the appropriateness of prescribing. Objective: Using polypharmacy as the prototypical geriatric syndrome addressed by the OACE team, the objective of this study was to document the processes of communication of an interdisciplinary team and the impact on polypharmacy when the treating physician did not participate in the daily interdisciplinary team rounds. Methods: This was a prospective, observational study of older cancer patients admitted to the OACE unit. We tracked processes and outcomes of interdisciplinary communication regarding medications by prospectively recording OACE team recommendations and evaluating the frequency of implementation of these recommendations through a chart review. Treating physicians, who did not attend team rounds, received these recommendations on a communication form placed in the patient's chart. Results: Forty–seven patients were included in the study. The mean (SD) age was 73.5 (7.5) years. Twenty–one percent (10/47) of patients were prescribed ≥1 Beers medication as part of their home-care regimen before admission to the OACE unit. The OACE team made 51 medication recommendations, and 42 of those recommendations (82%) were implemented. Twenty–five patients (53%) had an alteration in their medication regimen; 13 (28%) had a potentially inappropriate medication discontinued. A medication error was corrected in ~1 of every 8 patients (6/47 [13%]). Conclusions: We found that polypharmacy was common in older cancer patients and increased during hospitali-zation. We also found that most OACE team recommendations communicated to physicians were implemented even though the primary physicians were not members of the OACE team. Future randomized trials are needed to assess the impact of the OACE team model of care on adverse events, survival, and cost in hospitalized older adult cancer patients.

Geriatric syndromes in elderly patients admitted to an inpatient cardiology ward.

Abstract: BACKGROUND Older adults make up an increasing proportion of patients hospitalized with cardiovascular disease. Such patients often have multiple coexisting geriatric syndromes that may affect management and outcomes and are frequently underdiagnosed and untreated. OBJECTIVES To determine the prevalence of geriatric syndromes and incidence of selected adverse events in hospitalized elderly patients with cardiovascular disease. DESIGN A prospective cohort study. SETTING Urban academic medical center. PATIENTS One hundred patients at least 70 years old with cardiovascular disease hospitalized on a cardiology ward. MEASUREMENTS Standard geriatric screens were administered to assess mood, function, and cognitive status. Patients were followed prospectively for adverse events such as falls, urinary tract infection (UTI), and use of restraints. RESULTS The mean age of the patients was 79.2 ± 5.5 years, 61% were female, 68% were white, and mean length of stay was 7 days. Geriatric syndromes were prevalent and included functional impairment (35% dependent in ≥1 activity of daily living), cognitive impairment (19% with abnormal results on the Short Blessed Test), and polypharmacy. Thirty-seven percent of patients were prescribed a potentially inappropriate medication on admission or discharge. Patients receiving a Foley catheter were at increased risk for UTI. CONCLUSIONS These findings suggest that geriatric syndromes are prevalent among older patients hospitalized for cardiovascular disease. Further study is needed to determine if interventions designed to increase recognition and treatment of these syndromes can improve outcomes in this patient population. Journal of Hospital Medicine 2007;2:394–400. © 2007 Society of Hospital Medicine.

International Society of Geriatric Oncology Consensus on Geriatric Assessment in Older Patients With Cancer

Abstract: Purpose To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. Methods SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment–related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. Results GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensit...

Comprehensive Geriatric Assessment for Older Patients With Cancer

Abstract: Purpose During the last decade, oncologists and geriatricians have begun to work together to integrate the principles of geriatrics into oncology care. The increasing use of a comprehensive geriatric assessment (CGA) is one example of this effort. A CGA includes an evaluation of an older individual's functional status, comorbid medical conditions, cognition, nutritional status, psychological state, and social support; and a review of the patient's medications. This article discusses recent advances on the use of a CGA in older patients with cancer. Methods In this article, we provide an update on the studies that address the domains of a geriatric assessment applied to the oncology patient, review the results of the first studies evaluating the use of a CGA in developing interventions to improve the care of older adults with cancer, and discuss future research directions. Results The evidence from recent studies demonstrates that a CGA can predict morbidity and mortality in older patients with cancer. Acc...

Use of Geriatric Assessment for Older Adults in the Oncology Setting: A Systematic Review

Abstract: In North America and Europe, the majority of persons who receive a cancer diagnosis every year are aged 65 years or older (1–3). Cancer treatment decision making for older adults is often complicated by the presence of comorbidities and psychosocial factors. The US National Comprehensive Cancer Network (NCCN) and the International Society of Geriatric Oncology (SIOG) (4,5) have recommended that some form of geriatric assessment be conducted to help cancer specialists determine the best treatment for their older patients. Despite their recommendations, neither organization has indicated what constitutes the best form of assessment. Geriatric assessment has been used in geriatric medicine since the 1980s (6). The aim of geriatric assessment in a traditional geriatric population is to identify current health problems and to guide interventions to reduce adverse outcomes and to optimize the functional status of older adults (7–9). A traditional geriatric assessment is not an intervention in itself but rather aims to identify opportunities for intervention. A geriatric assessment conducted in the oncology setting may not have the same goals as a traditional geriatric assessment, because the latter was never intended to help identify the best cancer treatment (10). The SIOG and NCCN recommend that a geriatric assessment be used to help select the best cancer treatment for an older patient with cancer (11–13). Oncology clinics see many more older adults each day compared with clinics that specialize in geriatric medicine, and the concerns of patients attending each type of clinic are often quite different (10). The feasibility and effectiveness of geriatric assessments in the oncology setting might also be very different compared with the geriatric medicine setting. Furthermore, the older cancer population is heterogeneous in terms of cancer type, cancer stage, and disease and treatment trajectories. These factors might affect the feasibility and efficacy of geriatric assessment in the oncology setting. There has been only one review published to date on the use of geriatric assessment in older cancer patients. That review (4) was based on a literature search of MEDLINE up to February 2003 and was limited to English-language articles. It is not clear which data were abstracted and by whom, and how the quality assessment of the included studies was conducted. Similarly, descriptions of the included studies were not reported. Numerous geriatric assessment studies have been published since the publication of that review. The objectives of this systematic review were: 1) to provide an overview of all geriatric assessment instruments that have been developed and/or are in use in the oncology setting for older adults with cancer; 2) to examine the feasibility of geriatric assessment instrument use in the oncology setting (ie, time needed to complete, proportion of patients with complete assessments), and the psychometric properties or diagnostic accuracy of the instruments (ie, reliability and validity, sensitivity and specificity); and 3) to systematically evaluate the impact of geriatric assessment instruments on the treatment decision-making process and their effectiveness in predicting cancer and treatment outcomes. The outcomes of interest were chosen a priori as part of the review protocol according to Cochrane review methodology as described in the Cochrane Handbook for Systematic Reviews of Interventions (14) and included mortality, complications and toxicity of treatment, health and functional status (ie, impact on activities of daily living), use of inpatient and outpatient care, use of geriatric assessment to avoid complications of treatment, and the impact on cancer treatment decisions and approaches. Geriatric assessment is typically used to predict functional status, use of care, and mortality (7–9). We included prediction of complications and toxicity of treatment and impact on planned cancer treatment as outcomes of interest in this review based on suggestions by experts and SIOG and NCCN that they may be impacted by the use of a geriatric assessment (11–13).

The changing prevalence of comorbidity across the age spectrum.

Abstract: The purpose of the research was to demonstrate that comorbid health conditions disproportionately affect elderly cancer patients. Descriptive analyses and stacked area charts were used to examine the prevalence and severity of comorbid ailments by age of 27,506 newly diagnosed patients treated at one of eight cancer centers between 1998 and 2003. Hypertension was the most common ailment in all patients, diabetes was the second most prevalent ailment in middle-aged patients, and previous solid tumor(s) were the second most prevalent ailment in patients aged 74 and older. Although the prevalence and severity of comorbid ailments including dementia and congestive heart failure increased with age, some comorbidities such as HIV/AIDS and obesity decreased. Advances in cancer interventions have increased survivorship, but the impact of the changing prevalence and severity of comorbidities at different ages has implications for targeted research into targeted clinical and psychosocial interventions.