Poor surgical outcomes in frail older patients with pancreatic cancer when using VMS as frailty score

Abstract Introduction It was anticipated that the COVID-19 pandemic would put a strain on our healthcare system, disproportionately affecting older people. NICE guidance recommended using frailty scoring to support decision making around escalation of care. This study aimed to assess frailty, demographics and COVID-19 infection and to investigate how these related to outcomes of patients aged over 65 years admitted to hospital. Methods A single centre retrospective cohort study was carried out by reviewing the electronic health records of all admissions over 65 years. Data points collected included length of stay (LOS), frailty score using the Rockwood Clinical Frailty Scale (CFS) and mortality. Patients were stratified into COVID and non-COVID based on health records and into non-frail (CFS 1–4) and frail (CFS 5–9). Results A total of 257 patients admitted between 30th March and 30th April 2020 were included in the study (mean age 79 years, 43% female). 141 (54.9%) of patients were diagnosed with COVID-19 infection. 120 patients had CFS 1–4 and 136 has CFS 5–9. 1 patient did not have a frailty score due to insufficient information. 68 (26.8%) of all patients died during the admission. The relative risk (RR) of mortality of patients with coronavirus was 6.3 (95% CI 3.1–12.6, p < 0.0001). The RR of mortality for frail patients compared to the non-frail was 2.1 (95% CI 1.3–3.2, p = 0.002). The median LOS for patients with COVID-19 was 5 days, compared to 4 days for patients who did not have coronavirus. Frailty did not predict longer admission, with median LOS of 5 days for both non-frail and frail patients. Conclusion The results demonstrated in this study show that COVID-19 infection and frailty were significantly associated with increased mortality in older patients. This validates the continued use of frailty scoring of older patients on admission to support care planning.

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Gemcitabine plus nab-paclitaxel in older patients with metastatic pancreatic cancer: A post-hoc analysis of the real-world data of a multicenter study (the NAPOLEON study)

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2021.06.011 ◽

2021 ◽

Author(s):

Futa Koga ◽

Yasunori Kawaguchi ◽

Mototsugu Shimokawa ◽

Kenichiro Murayama ◽

Shunya Nakashita ◽

...

Keyword(s):

Pancreatic Cancer ◽

Multicenter Study ◽

Real World ◽

Older Patients ◽

Metastatic Pancreatic Cancer ◽

Real World Data ◽

World Data ◽

The Real ◽

Post Hoc Analysis ◽

Post Hoc

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Abdominal hysterectomy and high frailty score are associated with complications among older patients

International Journal of Gynecology & Obstetrics ◽

10.1002/ijgo.14029 ◽

2021 ◽

Author(s):

Julia J. Wainger ◽

Golsa Yazdy ◽

Victoria L. Handa

Keyword(s):

Older Patients ◽

Abdominal Hysterectomy ◽

Frailty Score

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Frailty Screening and Pre-habilitation in Older Spine Patients – Reversing the Effects of Sedentary Life-styles to Improve Surgical Outcomes for Older Patients and Reduce Healthcare Costs

Journal of Osteoporosis and Physical Activity ◽

10.4172/2329-9509.1000171 ◽

2016 ◽

Vol 4 (2) ◽

Author(s):

Yonge RP ◽

Berven SH

Keyword(s):

Surgical Outcomes ◽

Healthcare Costs ◽

Older Patients ◽

Life Styles ◽

Sedentary Life

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Upfront Chemotherapy Followed by Stereotactic Body Radiation Therapy with or without Surgery in Older Patients with Localized Pancreatic Cancer: A Single Institution Experience and Review of the Literature

Current Oncology ◽

10.3390/curroncol29010028 ◽

2022 ◽

Vol 29 (1) ◽

pp. 308-320

Author(s):

Abhinav V. Reddy ◽

Shuchi Sehgal ◽

Colin S. Hill ◽

Lei Zheng ◽

Jin He ◽

...

Keyword(s):

Pancreatic Cancer ◽

Radiation Therapy ◽

Clinical Outcomes ◽

Older Patients ◽

Stereotactic Body Radiation Therapy ◽

Progression Free Survival ◽

Radiation Toxicity ◽

Free Survival ◽

Stereotactic Body Radiation ◽

Resection Status

Objective: To report on clinical outcomes and toxicity in older (age ≥ 70 years) patients with localized pancreatic cancer treated with upfront chemotherapy followed by stereotactic body radiation therapy (SBRT) with or without surgery. Methods: Endpoints included overall survival (OS), local progression-free survival (LPFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and toxicity. Results: A total of 57 older patients were included in the study. Median OS was 19.6 months, with six-month, one-year, and two-year OS rates of 83.4, 66.5, and 42.4%. On MVA, resection status (HR: 0.30, 95% CI 0.12–0.91, p = 0.031) was associated with OS. Patients with surgically resected tumors had improved median OS (29.1 vs. 7.0 months, p < 0.001). On MVA, resection status (HR: 0.40, 95% CI 0.17–0.93, p = 0.034) was also associated with PFS. Patients with surgically resected tumors had improved median PFS (12.9 vs. 1.6 months, p < 0.001). There were 3/57 cases (5.3%) of late grade 3 radiation toxicity and 2/38 cases (5.3%) of Clavien-Dindo grade 3b toxicity in those who underwent resection. Conclusion: Multimodality therapy involving SBRT is safe and feasible in older patients with localized pancreatic cancer. Surgical resection was associated with improved clinical outcomes. As such, older patients who complete chemotherapy should not be excluded from aggressive local therapy when possible.

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