Curative Surgery for Gastric Cancer in the Elderly: Treatment Decisions, Surgical Morbidity, Mortality, Prognosis and Quality of Life

2007 ◽  
Vol 93 (5) ◽  
pp. 478-484 ◽  
Author(s):  
Adolfo Pisanu ◽  
Alessandro Montisci ◽  
Sara Piu ◽  
Alessandro Uccheddu
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Elderly Patients ◽  
Subtotal Gastrectomy ◽  
The Elderly ◽  
Tumor Stage ◽  
Curative Surgery ◽  
Curative Gastrectomy ◽  
Younger Patients

Aims and Background Surgical risk is deemed to be higher in the aged population because there are often comorbidities that may affect the postoperative result. This consideration is important for the treatment decision-making for gastric cancer in the elderly. The aim of this study was to identify factors influencing mortality, morbidity, survival and quality of life after curative surgery for gastric cancer in patients aged 75 years and older, and to plan their appropriate management. Methods and Study Design From January 1993 to December 2004, 135 patients underwent surgery at our department because of gastric cancer. Ninety-four of these patients (69.6%) underwent potentially curative gastrectomy. A cross-sectional study of 23 patients aged 75 years and older and 71 younger patients who underwent curative gastrectomy was carried out: patient characteristics, tumor characteristics, management, morbidity, mortality, survival, and quality of life were evaluated. Results Elderly patients had significantly more comorbidities and a poorer nutritional status than younger patients. The surgical procedures were similar in both groups and the overall morbidity rate was 27.9% and the overall mortality rate 8.5%. Medical mortality was significantly higher in elderly patients, and the presence of comorbidities was the only independent factor affecting mortality. The 5-year survival rate was 56.2% in the older group versus 62.1% in the younger group and tumor stage was the only prognostic factor influencing survival. Quality of life after surgery was similar in both groups. The significantly better postoperative functional outcome after subtotal gastrectomy suggested a better compliance of elderly patients with subtotal than total gastrectomy. Conclusions In the elderly, surgical strategies must be modulated on the basis of comorbidities, tumor stage and future quality of life. Since elderly patients have no worse prognosis than younger patients, age is not a contraindication to curative resection for gastric cancer. Subtotal gastrectomy should be the procedure of choice mainly in elderly patients as it offers better quality of life.

scholarly journals Tapentadol Prolonged Release for Severe Chronic Osteoarthritis Pain in the Elderly—A Subgroup Analysis of Routine Clinical Practice Data

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Andreas Schwittay ◽  
Melanie Sohns ◽  
Birgit Heckes ◽  
Christian Elling
Keyword(s):  
Quality Of Life ◽  
Clinical Practice ◽  
Elderly Patients ◽  
Subgroup Analysis ◽  
The Elderly ◽  
Routine Clinical Practice ◽  
Prolonged Release ◽  
Younger Patients ◽  
Quality Of Life Measures

Background. Tapentadol prolonged release (PR) has been shown effective and generally well tolerated in a broad range of chronic pain conditions. This subgroup analysis investigated its benefits for elderly patients with severe chronic osteoarthritis (OA) pain in routine clinical practice. Patients and Methods. Data of all patients with chronic OA pain were extracted from the database of a prospective, 3-month noninterventional tapentadol PR trial. The data of elderly OA patients (>65 years of age; n = 752) were compared with the data of younger OA patients (≤65 years; n = 282). Results. Almost all patients (elderly 98.7% and younger patients 99.3%) had received long-term analgesic medication prior to the start of tapentadol PR treatment but presented with severe pain accompanied by considerable impairments in sleep quality and quality of life measures. Tapentadol PR provided effective pain relief in both patient groups, with slightly better outcomes in younger patients. However, the mean baseline pain intensity of 7.1 (SD 1.5) was reduced by 3.8 points (p≤0.001), and sleep and quality of life measures had also markedly improved in the elderly: quality of sleep by 3 points, quality of life by 3.4 points, social activities by 3 points, and independence by 2.7 points (p≤0.001 for all measures; 11-point scale). At the end of observation, 68% of the elderly had clinically relevant pain reductions of at least 50% (vs baseline), and 87.9% attained either their intended pain reduction target and/or an additional individual treatment target (both predefined during baseline examination). Only 8.4% of the elderly experienced adverse drug reactions, most frequently nausea (2.7% of patients) and dizziness (1.5%). Conclusion. Tapentadol PR provided effective and well-tolerated treatment of severe chronic OA pain for elderly patients in routine clinical practice. The favorable tolerability profile in particular suggests tapentadol PR as a treatment option before classical strong opioids are considered.

scholarly journals QUALITY OF LIFE IN THE ELDERLY PATIENTS AFTER SURGERY FOR GASTRIC CANCER

2017 ◽  
Vol 22 (6) ◽  
pp. 313-315 ◽  
Author(s):  
Sergey N. Nered ◽  
I. S Stilidi ◽  
G. A Rokhoev
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Surgical Treatment ◽  
Elderly Patients ◽  
Gastric Resection ◽  
Functional Results ◽  
The Elderly ◽  
Significant Deterioration ◽  
Eortc Qlq

The problem of the quality of life of elderly gastric cancer patients after surgical treatment, is still insufficiently studied. Functional results of the management of 91 patients, underwent surgical treatment at the age of 75 years and older, are represented. 35 patients underwent gastrectomy, 56 patients - subtotal distal resection. The quality of life was assessed at the second year after surgery according to both the Performance Scales for the Karnofsky & ECOG Scores, as well as the modified form of EORTC QLQ-STO 22. Only 40% of patients were fully recovered after total gastrectomy and 57.1% of cases - after gastric resection. 28.6% and 35.7% of patients respectively were incapable for full activity and required support. Patients with severe disability and cases needed a significant care amounted to 28.6% and 2.8% in the group of patients after gastrectomy and only 3.6% in the group of cases after the gastric resection. Thus, in elderly patients with gastric cancer after surgical treatment, a significant deterioration of the quality of life is observed, and therefore the tactic of minimization of the radical surgical intervention in this age group is reasonable.

scholarly journals Impact of clinical pharmacist’s interventions on pharmacotherapy management in elderly patients on polypharmacy with mental health problems including quality of life: A prospective non-randomized study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Matej Stuhec ◽  
Nika Bratović ◽  
Aleš Mrhar
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Elderly Patients ◽  
Mental Health Problems ◽  
Randomized Study ◽  
The Elderly ◽  
Health Problems ◽  
Potentially Inappropriate Medications ◽  
The Impact

AbstractMental health problems (MHPs) are very common in the elderly and can have an important influence on their quality of life (QoL). There is almost no data on the impact of clinical pharmacists’ (CPs) interventions on the QoL including elderly patients and MHPs. The main aim of this study was to determinate the impact of (CP’s) interventions on the QoL and quality of pharmacotherapy. A prospective non-randomized pre-post study was designed which included residents of a nursing home aged 65 age or more with at least one MHP. Each patient also filled out the EQ-5D questionnaire. The medical review MR included drug-related problems (DRPs) and potentially drug-drug interactions (pDDIs), as well as potentially inappropriate medications (PIMs). After 2 months, the participants were interviewed again. The mean number of medications before the intervention was 12,2 ± 3,1 per patient and decreased to 10,3 ± 3,0 medications per patient (p < 0,05) (n = 24). The total number of PIMs and pDDIs was also reduced and QoL was also significantly higher (p < 0,05). A collaborative care approach with a CP led to a decrease of DRPs, pDDIs, PIMs, the total number of medications and to an improvement in the patients’ QoL.

scholarly journals Health-related quality of life and distress in elderly vs. younger patients with high-grade glioma—results of a multicenter study

2020 ◽  
Vol 28 (11) ◽  
pp. 5165-5175 ◽  
Author(s):  
Mirjam Renovanz ◽  
Anne-Katrin Hickmann ◽  
Minou Nadji-Ohl ◽  
Naureen Keric ◽  
Elke Weimann ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Elderly Patients ◽  
High Grade Glioma ◽  
High Grade ◽  
Health Related Quality ◽  
Younger Patients ◽  
Patient Reported ◽  
Related Quality ◽  
Health Related

Abstract Objective Half of all newly diagnosed patients with glioblastoma are > 65 years still with a poor prognosis. Preserving quality of life is of high importance. However, patient reported outcome (PRO) data in this patient group is rare. The aim was to compare health-related quality of life (HRQoL) and distress between elderly and younger patients with high-grade glioma (HGG). Methods We used baseline data of a prospective study where HGG patients were enrolled from 4 hospitals. Distress was measured using the distress thermometer (DT), HRQoL using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) plus brain module (BN20). We compared distress and HRQoL by age (≥ 65 vs. < 65 years), gender, performance score, and time since diagnosis using multivariate linear and logistic regressions. Results A total of n = 93 (30%) out of n = 309 patients were ≥ 65 years (mean 70 years, range 65–86 years). Mean DT score of elderly patients (5.2, SD 2.6) was comparable with younger patients (4.9, SD 2.6). Elderly patients reported significantly lower global health (GHS, mean elderly vs. younger; 50.8 vs. 60.5, p = 0.003), worse physical (56.8 vs. 73.3, p < 0.001) and lower cognitive functioning (51.1 vs. 63.2, p = 0.002), worse fatigue (52.5 vs. 43.5, p = 0.042), and worse motor dysfunction (34.9 vs. 23.6, p = 0.030). KPS and not age was consistently associated with HRQoL. Conclusion Physical functioning was significantly reduced in the elderly compared with younger HGG patients, and at the same time, emotional functioning and DT scores were comparable. KPS shows a greater association with HRQoL than with calendric age in HGG patients reflecting the particular importance for adequate assessment of HRQoL and general condition in elderly patients.

PS01.162: IS THERE A DIFFERENCE IN SURVIVAL BETWEEN YOUNGER AND OLDER GASTRIC CANCER (INCLUDING AEG II AND AEG III) PATIENTS AFTER GASTRECTOMY?

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 95-95
Author(s):  
Benjamin Babic ◽  
Florian Matthias Corvinus ◽  
Edin Hadjijusufovic ◽  
Evangelos Tagkalos ◽  
Hauke Lang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Survival Rate ◽  
Elderly Patients ◽  
Conflicts Of Interest ◽  
Subtotal Gastrectomy ◽  
Young Patients ◽  
Western World ◽  
Old Patients ◽  
Younger Patients ◽  
Significant Difference

Abstract Background The incidence of gastric cancer decreases in the western world, however, it remains one of the most common diseases (1). There is just little data from Europe comparing the outcome of young and elderly gastric cancer patients. This study compares, depending on the age of 266 patients, the outcome of 266 consecutive gastrectomy cases due to gastric cancer Methods 266 consecutive patients with gastric cancer received a gastrectomy between 2008–2016 at our comprehensive cancer centre. The mean age of the patients in this study was 64 years old (21- 93 years). All patients were followed up regarding survival. The patients were separated in 6 different groups, depending on the age at the time of operation. The different groups were re-analysed and compared to each other regarding median and 5-year survival. Results In this collective the 5-year survival rate for all patients was 43%. There were more diffuse type adenocarcinomas in Patients < 40 years. In younger patients the tumour was staged in an advanced stadium compared to the elderly patients group. There is a significantly higher 5-year survival rate for younger patients after gastrectomy. There is no significant difference, when separating patient groups in to decades of age. Conclusion Young patients have a higher 5-year survival rate after gastrectomy compared to old patients. However, comparing patients from chronologic age in decades, the significance is not reproducible. Therefore gastrectomy or subtotal gastrectomy is the determining therapeutic approach for gastric cancer with an acceptable outcome in both young and elderly patients. Older patients might have an lower 5 year survival rate not only due to the cancer or the surgical therapy itself, it is related to comorbidities and a lower rate in neoadjuvant therapy as well Disclosure All authors have declared no conflicts of interest.

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