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Journal ArticleDOI

Geriatric Oncology: Past, Present, Future

01 Jul 2008-Journal of Oncology Practice (American Society of Clinical Oncology)-Vol. 4, Iss: 4, pp 190-192

TL;DR: Efforts to integrate geriatric oncology principles in the training of all medical oncologists are underway.

AbstractEfforts to integrate geriatric oncology principles in the training of all medical oncologists are underway.

Topics: Geriatric oncology (68%)

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Citations
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Journal ArticleDOI
TL;DR: It was found that polypharmacy was common in older cancer patients and increased during hospitali-zation, and most OACE team recommendations communicated to physicians were implemented even though the primary physicians were not members of the O ACE team.
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.

75 citations


Journal ArticleDOI
TL;DR: The LIVESTRONG Young Adult Alliance, a Lance Armstrong Foundation program and a result of the Adolescent and Young Adult Oncology Progress Review Group, assembled a group of experts representing relevant medical, psychosocial, and advocacy disciplines to create a blueprint for the training and development of health care professionals caring for AYA patients with cancer.
Abstract: We outline here the essential elements of training for health care professionals who work with adolescent and young adult (AYA) patients with cancer. Research is emerging that a number of cancers manifest themselves differently in the AYA population, both in terms of biology and treatment response. In addition, there are a number of issues uniquely experienced by the AYA population that are critical for health care professionals working within AYA oncology (AYAO) to understand. The LIVESTRONG Young Adult Alliance, a Lance Armstrong Foundation program and a result of the Adolescent and Young Adult Oncology Progress Review Group cosponsored by the Lance Armstrong Foundation and the National Cancer Institute, assembled a group of experts representing relevant medical, psychosocial, and advocacy disciplines to create a blueprint for the training and development of health care professionals caring for AYA patients with cancer. The Alliance recommends that all health care professionals working in AYAO receive training that provides expertise in the following three critical areas: AYA-specific medical knowledge; care delivery specific to AYAs relative to pediatric and older adult populations; and competency in application and delivery of AYA-specific practical knowledge. These three areas should form the foundation for curricula and programs designed to train health care professionals caring for AYAO patients.

67 citations


Cites background from "Geriatric Oncology: Past, Present, ..."

  • ...The evolution of the field of AYAO from special forums, lectures, continuing medical education activities, and courses to integrated formal subspecialty training and certification may follow a path similar to that of the field of geriatric oncology.(11) Various models for AYAO fellowships are already being explored, including either as combined fellowship training in both pediatric and adult medical oncology or as additional training after completion of either fellowship alone....

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Journal ArticleDOI
TL;DR: The field must strengthen its research in clinical trials and comparative outcomes, and must articulate the key competencies that distinguish a practitioner of young adult oncology (both to define clinical programs and educational curricula).
Abstract: The clinical care of young adults with cancer, and related research, was a novel focus of oncology a decade ago, but 10 years of data on patients' needs and outcome disparities, well-reviewed in the articles of this special issue and its predecessor (June 2009), prove the merit of this subspecialty. The field, emerging from its childhood and entering adolescence, must continue to look to the future to solidify its worth. In this concluding article we examine important themes that must receive attention for the discipline to develop and flourish. We must overcome the challenges inherent in serving a population that is difficult to define, and which crosses traditional boundaries and disciplines. The field must strengthen its research in clinical trials and comparative outcomes, and must articulate the key competencies that distinguish a practitioner of young adult oncology (both to define clinical programs and educational curricula). Key opportunities are collaborations with leaders in oncofertility, developmental psychology, and transitional care, and with patient advocates. We must garner support from federal entities, as well as philanthropic agencies and accrediting bodies. With strategic effort, the field of young adult oncology will mature and grow wise.

35 citations


Journal ArticleDOI
Tina Hsu1
TL;DR: Key strategies to accelerate the uptake and impact of educational initiatives to address this gap include the use of effective educational strategies, broad dissemination of educational material that is freely available, and the integration of geriatric oncology topics into teaching, curriculum, assessments and exams.
Abstract: The population is aging accounting for a large increase in anticipated cancer cases. Specialty training for trainees interested in geriatric oncology have been established in many countries and is growing globally. However, the number of clinicians with a particular interest in geriatric oncology and who complete training in both specialties is low. There are insufficient geriatric oncologists and geriatricians to address the unique needs of this population of patients. The majority of older adults with cancer are, and will continue to be, treated by oncologists. Currently clinicians caring for patients with cancer receive little to no formal training in caring for older adults, resulting in gaps in knowledge as well as a lack of confidence when treating older adults with cancers. Key strategies to accelerate the uptake and impact of educational initiatives to address this gap include the use of effective educational strategies, broad dissemination of educational material that is freely available, and the integration of geriatric oncology topics into teaching, curriculum, assessments and exams.

29 citations


Journal ArticleDOI
15 Jun 2020-Cancer
TL;DR: This research highlights the need to understand more fully the role of emotion in the decision-making process and the role that emotion plays in the development of new treatments for depression.
Abstract: There are approximately 17 million cancer survivors living in the United States and by 2040 this estimate is predicted to increase to 26.1 million.1 Exercise provides a myriad of health benefits to individuals during and after cancer treatment by reducing treatment-related symptoms, improving functional status and quality of life, and lowering risk of disease recurrence.2,3 Despite the established benefits, an individual’s level of physical activity often decreases during treatment and does not return to pre-diagnosis levels after treatment completion.4,5 While exercise is regarded as safe and beneficial for individuals with cancer, promoting exercise for this population is complex. A patient-centered pathway is needed that can guide oncology and primary care professionals in efficient assessment of an individual’s condition and enable personalized referrals for exercise interventions that promote physical activity. The purpose of this manuscript is to provide a framework for clinical decision making that enables personalized condition assessment, risk stratification, and referral to optimal settings for exercise promotion for cancer survivors. Implementation strategies are also offered to support the integration of this model into an oncology clinical workflow. With guidance from their medical provider, individuals are more likely to engage in exercise and maintain levels of physical activity during cancer treatments.6 However, the number of individuals with cancer who report receiving exercise-specific guidance from their health care providers is low.7 Of particular concern is the lack of knowledge and training among health care professionals about exercise prescription for this complex population.8

15 citations


References
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Journal ArticleDOI
Abstract: It has been stated in this article and elsewhere that cancer patients aged 65 years and older deserve special attention as a target group for research efforts across the cancer-control spectrum. The available data show that the vulnerability of older persons to cancer is unmistakable. Clinicians will be treating more older patients as the nation ages. The future needs of this segment of the population must be anticipated. In this context, the following generic treatment questions are pertinent. What are the peculiarities of the aged host of which clinicians must be aware in evaluating the older cancer patient? Do various forms of cancer present differently in the elderly? How can be complications caused by the multiple pathologies inherent in the older patient be anticipated? What are the potential hazards and limitations of surgery, radiotherapy, and chemotherapy for older persons with cancer? What is known regarding increased risk of adverse reactions to medications, drugs, and interaction of drugs in older patients? The surveillance data and population estimates and projections presented in this article illustrate the extent of the problems of cancer in the elderly at the macro level. For the individual patient, the special knowledge of aging individuals and their health status based on geriatric medicine and gerontology that has been accumulating for the past several decades needs to be incorporated into the oncology armamentarium that has developed during the same period. The information and expertise from both fields must converge, and new knowledge must be developed at the aging/cancer interface and applied for the optimal treatment of cancer in the elderly.

370 citations


Journal ArticleDOI
TL;DR: Current and future demographic transitions in America in comparison with six industrial nations are illustrated, and cancer mortality in older persons across the selected nations--Denmark, France, Italy, Japan, Sweden, and United Kingdom are profiles.
Abstract: Persons age 65 years and older bear the greater burden of cancer in the United States and other industrial nations. A cross-national perspective using data from several population-based resources (eg, the NCI Surveillance, Epidemiology, and End Results Program; US Bureau of Census; World Health Organization; and International Association for Research on Cancer) illustrates current and future demographic transitions in America in comparison with six industrial nations, and profiles cancer mortality in older persons across the selected nations--Denmark, France, Italy, Japan, Sweden, and United Kingdom. Mortality rates, age-standardized to the world population, are presented for major tumors. US aging and cancer profiles are highlighted. Demographic projections portend a substantial increase in numbers of older persons, and thus, imply resultant increases in cancer incidence and mortality in the elderly. By 2030, there will be larger proportions of persons in the age group most vulnerable to cancer. Information is needed on how age-related health problems affect cancer prevention, detection, prognosis, and treatment. A knowledge base as guidance in management of cancer in the elderly is lacking. Planning for effective prevention measures and improvement of treatment for the elderly is imperative to meet current and future quality cancer care needs.

310 citations


"Geriatric Oncology: Past, Present, ..." refers background in this paper

  • ...... set the tone for further discussions and research in this area.4 This conference was attended by now-known pioneers in the field of geriatric oncology, who addressed a number of important issues, including: (1) existing discrepancies between physiologic and chronologic age; (2) changes in age structure of the nation’s population and cancer control in the elderly; (3) the role of cancer prevention and treatment in older adults; and ( 4 ) ......

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Journal ArticleDOI
TL;DR: Clinical trials need to incorporate an analysis of chemotherapy in terms of the pharmacokinetic and pharmacodynamic effects of aging, and data already accumulated need to be reanalyzed by age to aid in the management of the older cancer patient.
Abstract: The elderly comprise the majority of patients with cancer and are the recipients of the greatest amount of chemotherapy. Unfortunately, there is a lack of data to make evidence-based decisions with regard to chemotherapy. This is due to the minimal participation of older patients in clinical trials and that trials have not systematically evaluated chemotherapy. This article reviews the available information with regard to chemotherapy and aging provided by a task force of the International Society of Geriatric Oncology (SIOG). Due to the lack of prospective data, the conclusions and recommendations made are a consensus of the participants. Extrapolation of data from younger to older patients is necessary, particularly to those patients older than 80 years, for which data is almost entirely lacking. The classes of drugs reviewed include alkylators, antimetabolites, anthracyclines, taxanes, camptothecins, and epipodophyllotoxins. Clinical trials need to incorporate an analysis of chemotherapy in terms of the pharmacokinetic and pharmacodynamic effects of aging. In addition, data already accumulated need to be reanalyzed by age to aid in the management of the older cancer patient.

217 citations



Journal ArticleDOI
TL;DR: Physicians and oncologists need to be prepared for the projected increase of cancer in older persons and a new subspecialty is evolving: geriatric oncology.
Abstract: The world's population is aging. Older age is associated with an increase in the incidence of cancer, especially cancer of the breast, lung, prostate, and colon. The management of older patients with cancer is biased by the simple fact of their chronologic age. Underscreening, understaging, less aggressive therapy, lack of participation in clinical trials, or no treatment at all reflect this bias. Although an age-related reduction in the physiologic function of many organs occurs with age, these are not contraindications to treatment with surgery, radiation therapy, or chemotherapy. Chronologic age alone should not be used as a guide for cancer management. Rather, physiologic function or existence of comorbid conditions should be major factors in determining treatment. As a result of the impending need for improved cancer management in older persons, a new subspecialty is evolving: geriatric oncology. This field stresses an important interaction between geriatricians and oncologists, development of research directed at the problems of cancer in older persons, and education at all levels with respect to cancer prevention, cancer detection, and cancer therapy. Physicians and oncologists need to be prepared for the projected increase of cancer in older persons.

143 citations