Showing papers by "Martine Extermann published in 2005"

Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG).

Abstract: Background: As more and more cancers occur in elderly people, oncologists are increasingly confronted with the necessity of integrating geriatric parameters in the treatment of their patients. Methods: The International Society of Geriatric Oncology (SIOG) created a task force to review the evidence on the use of a comprehensive geriatric assessment (CGA) in cancer patients. A systematic review of the evidence was conducted. Results: Several biological and clinical correlates of aging have been identified. Their relative weight and clinical usefulness is still poorly defined. There is strong evidence that a CGA detects many problems missed by a regular assessment in general geriatric and in cancer patients. There is also strong evidence that a CGA improves function and reduces hospitalization in the elderly. There is heterogeneous evidence that it improves survival and that it is cost-effective. There is corroborative evidence from a few studies conducted in cancer patients. Screening tools exist and were successfully used in settings such as the emergency room, but globally were poorly tested. The article contains recommendations for the use of CGA in research and clinical care for older cancer patients. Conclusions: A CGA, with or without screening, and with follow-up, should be used in older cancer patients, in order to detect unaddressed problems, improve their functional status, and possibly their survival. The task force cannot recommend any specific tool or approach above others at this point and general geriatric experience should be used.

Never too old? Age should not be a barrier to enrollment in cancer clinical trials.

Abstract: Throughout Europe and the U.S., over 60% of the total incidence of cancer occurs in the elderly (≥65 years) population, a patient group that requires particular consideration when making treatment decisions due to a number of factors. Despite this, elderly patients are generally under-represented in clinical trials such that study data should be interpreted with caution because results in younger cancer patients may not always extrapolate to the typical elderly cancer patient. Reports suggest that elderly cancer patients represent around 22% of patients enrolled in phase II clinical studies. Barriers to the accrual of elderly patients to clinical trials include lack of appropriate trials, high burden of comorbidity, study-imposed restrictions, and attitudes of physicians. There is a belief that elderly patients may be unable to tolerate various cancer therapies, which may result in this patient population being excluded from prospective trials. However, clinical data demonstrate that age alone is not a sufficient reason to withhold treatment. Lack of clinical trial data and the associated lack of evidence-based guidelines for elderly patients mean physicians have little to guide them, with the result that patients may not receive the optimal therapy. As clinical trials are the primary method of evaluating the efficacy and safety of adjuvant and palliative cancer therapies, trials that specifically target the elderly cancer patient are required to adequately assess the risks and benefits of treatment in this vulnerable population. This review

The abbreviated comprehensive geriatric assessment (aCGA): a retrospective analysis

Abstract: Background: A comprehensive geriatric assessment (CGA) is a multidimensional assessment that is designed to detect health problems. A barrier to conducting the CGA is the length of time required to complete the entire assessment. Objective: To understand what items contained in the instruments that make up the CGA could be compiled to construct an abbreviated CGA (aCGA). Design/setting: A retrospective chart review of patients at the H. Lee Moffitt Cancer Center. Participants: Over 500 charts between 1995 and 2001 were reviewed on patients 70 and over. Measurements: Item-to-total correlations and Cronbach's α coefficient were calculated. Construct validity was assessed using a Pearson's product moment correlation coefficient. Results: Fifteen items were compiled to form the aCGA. Cronbach's α was 0.65–0.92 on each instrument of the entire CGA compared to 0.70–0.94 on the aCGA. Correlations ranged from 0.84 to 0.96 for the entire CGA and the aCGA. Conclusion: An aCGA can be helpful in screening for those seniors who would benefit from the entire CGA.

Senior adult oncology clinical practice guidelines in oncology.

Abstract: Cancer is the leading cause of death in women and men aged 60 to 79 years. The biologic characteristics of certain cancers are different in older patients compared with their younger counterparts, and older patients also have decreased tolerance to chemotherapy. Nevertheless, advanced age alone should not be the only criteria to preclude effective cancer treatment that could improve quality of life or lead to a survival benefit in older patients. Treatment should be individualized based the nature of the disease, the physiologic status of the patient, and patient preferences. Chronologic age is not reliable in estimating life expectancy, functional reserve, or the risk of treatment complications. Whether cancer treatment is appropriate may be best determined through careful assessment of the older patient. CGA can be used to assess life expectancy and risk of morbidity from cancer in elderly patients, in turn enabling physicians to develop a coordinated plan for cancer treatment and guide interventions tailored to the patient’s problems.

Toward optimal screening strategies for older women : Costs, benefits, and harms of breast cancer screening by age, biology, and health status

Abstract: CONTEXT: Optimal ages of breast cancer screening cessation remain uncertain. OBJECTIVE: To evaluate screening policies based on age and quartiles of life expectancy (LE). DESIGN AND POPULATION: We used a stochastic model with proxies of age-dependent biology to evaluate the incremental U.S. societal costs and benefits of biennial screening from age 50 until age 70, 79, or lifetime. MAIN OUTCOME MEASURES: Discounted incremental costs per life years saved (LYS). RESULTS: Lifetime screening is expensive ($151,434 per LYS) if women have treatment and survival comparable to clinical trials (idealized); stopping at age 79 costs $82,063 per LYS. This latter result corresponds to costs associated with an LE of 9.5 years at age 79, a value expected for 75% of 79-year-olds, about 50% of 80-year-olds, and 25% of 85-year-olds. Using actual treatment and survival patterns, screening benefits are greater, and lifetime screening of all women might be considered ($114, 905 per LYS), especially for women in the top 25% of LE for their age ($50,643 per LYS, life expectancy of ∼7 years at age 90). CONCLUSIONS: If all women receive idealized treatment, the benefits of mammography beyond age 79 are too low relative to their costs to justify continued screening. However, if treatment is not ideal, extending screening beyond age 79 could be considered, especially for women in the top 25% of life expectancy for their age.

Older Patients, Cognitive Impairment, and Cancer: An Increasingly Frequent Triad

Abstract: The incidence of both cancer and cognitive impairments from various origins increases with age. Oncologists are increasingly being confronted with cancers occurring in patients with cognitive impairment, yet very few studies have addressed the problem. Cognitive impairment affects a patients' survival to an extent similar to an average cancer, and this can be an important thing to consider, especially in the adjuvant setting. Cognitive impairment also predisposes patients to delirium in the surgery setting or during hospitalization. Because effective preventive measures exist, careful attention should be paid to identifying patients at risk. Cognitive impairment does not automatically mean inability to consent, but particular precautions should be taken. For outpatient treatments such as chemotherapy, a comprehensive multidisciplinary approach is key for a good outcome. Proper caregiver support should be ensured up-front, and aggressive supportive care should be used. In the setting of an experienced geriatric oncology team, patients with cognitive impairment appear more likely to receive standard oncologic therapies. Cancer patients with cognitive impairment are at high risk of concomitant depression.

Biological Basis of Geriatric Oncology

Abstract: Epidemiology of Cancer and Aging.- Biological Interactions of Aging and Carcinogenesis.- Replicative Senescence and Cancer.- The Influence of Advanced Age on Cancer Occurrence and Growth.- Age and Co-Morbidity in Cancer Patients: A Population-Based Approach.- Hemopoiesis and Aging.- Clinical and Biochemical Evaluation Changes Over Aging.- Biological Screening and Impact in Elderly Cancer Patients.- Biological Basis of the Association of Cancer and Aging Comorbidity.- Biological Basis of Cancer in the Older Person.- Decision Analysis for Cancer Prevention and Cancer Treatment in the Elderly.- Guidelines for the Management of the Older Cancer Patient.

Pilot testing of the computerized cognitive test Microcog™ in chemotherapy-treated older cancer patients

Abstract: Background: Chemotherapy has a potential for inducing cognitive side effects. However, no study has focused on elderly cancer patients, a group that might be at risk for this complication. Computerized cognitive tests are available and could simplify cooperative group studies on the matter, but have not been applied to older cancer patients. Methods: We tested the performance of Microcog™ (short form) in a sample of 10 consecutive cancer patients, aged 70 and older, having received chemotherapy. Patients were also asked by questionnaire to express their comments on the test. Results: Six patients had never used a computer. All reported at least minor visual impairment. All did complete the test without pause. Nine out of 10 thought that most patients like them would have no problems completing the test. As a group, our patient sample generally performed within normal limits for age and education. There were a wide range of scores for the majority of the subscales, with the greatest variability of scores in Spatial Processing and Information Processing Accuracy and the least variability in reaction time . The results were robust when assessed by level of computer literacy, minor auditory and visual problems, and fluent English as a second language. Conclusions: A computer test such as Microcog™ appears well feasible in older cancer patients. It appears robust to comorbidity. This bodes well for a potential use of such tests in trials conducted in this patient population.

Influence of concomitant medications on toxicity from chemotherapy in elderly patients. Focus on cytochrome P-450 inhibition and protein binding effects

Abstract: 8025 Background: Of the elderly taking 3 or more chronic medications, 33% are rehospitalized within 6 months from hospital discharge, 20% of them due to medication-related problems. Drug interactio...

Biological basis of the association of cancer and aging comorbidity.

Abstract: Comorbidity and its treatment appear to be an important influence on the behavior of cancer in older patients. Rather than a blanket effect, this may be attached to groups of syndromes with common pathophysiological mechanisms. In addition to paying attention to the impact of cancer treatment on comorbidity, or on the impact of comorbidity on the ability to deliver cancer treatment, we will have in the future to pay attention on the direct impact of comorbidity on the behavior of the cancer in elderly patients.

Biological screening and impact in elderly cancer patients.

Abstract: As a result, a single biochemical parameter could not give an overall assessment of the patient, but might be significant for a specific clinical problem such as malnutrition or organ malfunction. The question concerning assessment of frailty or future disability remains unsolved and further research is needed. Simple assessments of clinical diagnosis or biochemical markers or a combination of both are probably more suitable. However screening test such as CRP, albumin, and haemoglobin could be used for initial general screening as these were based on evidence of predicting toxicities.