Dose Intensity and Hematologic Toxicity in Older Cancer Patients Receiving Systemic Chemotherapy.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3124-3124
Author(s):  
Michelle Shayne ◽  
Eva Culakova ◽  
Marek S. Poniewierski ◽  
Debra Wolff ◽  
David C. Dale ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cancer Patients ◽  
Older Patients ◽  
Age Groups ◽  
Dose Intensity ◽  
Disease Stage ◽  
Severe Neutropenia ◽  
Hematologic Toxicity ◽  
Significant Difference ◽  
Older Cancer Patients

Abstract Introduction: Controlled clinical trials have provided limited data on hematologic toxicity and dose intensity of chemotherapy in the elderly. This study evaluated patient and treatment characteristics that contributed to hematologic toxicity in older cancer patients. Methods: A prospective study of 115 randomly selected U.S. community oncology practices was undertaken between March 2002 and March 2005 that included 999 consecutive patients age 70 and older. Major malignancies included cancers of lung (26%), colorectal (15%), lymphoma (13%), breast (13%), ovary (9%), genitourinary (7%), other gastrointestinal (6%), other gynecologic (3%) and head and neck (2%). Primary outcome measures included: anemia (Hgb <10 gm/dL), thrombocytopenia (plts <75k/mm3), severe neutropenia (SN) (neutrophils <500 cells/mm3, or WBC count <1000/mm3), febrile neutropenia (FN) and both planned and actual relative dose intensity (RDI) compared to standard regimens. Univariate and multivariate logistic regression analyses were performed to compare the difference among patients age 70–74 (45%), 75–79 (34%), ≥ 80 (21%). Results: Increasing age was associated with lower actual RDI (P<001), although planned RDI did not differ among age groups. Along with reduced actual RDI in elderly patients, progressively fewer SN or FN events (25%, 24%, and 16%, respectively) occurred across chemotherapy cycles (P=0.036). More advanced stage of disease at the time of treatment was associated with fewer SN or FN events in all cycles (35%, 27%, 21%, and 19% for stages 1–4, respectively) (P=0.017) along with lower RDI (P=.041). Use of taxane-containing regimens decreased with advancing age (37%, 34%, 27%, respectively) (P=0.034). Among the 50% of patients receiving ≥ 85% RDI, there was no significant difference in SN or FN based on age group or stage. Use of anthracycline-containing regimens was associated with development of SN or FN compared to non-anthracycline regimens (P<0.001). Older patients who received ≥ 85% actual RDI experienced more frequent SN or FN in all cycles of chemotherapy (27%) compared with patients who received <85% (22%) (P=.041) although no significant increase with age was observed. There was no statistically significant difference in anemia or thrombocytopenia among the different age groups. Anemia and thrombocytopenia were more prevalent in older patients receiving an anthracycline or platinum-containing regimen. In multivariate analysis, lower risk of SN or FN remained significantly associated with increasing age (P=.044) after adjustment for stage (P=.115) and actual RDI (P=.066). Prophylactic colony-stimulating factor was used in 5% of patients with no significant difference observed among the age groups. Conclusion: This report represents one of the largest studies to date of elderly cancer patients receiving chemotherapy. Neutropenic events increased with actual RDI while decreasing with age and disease stage. Advancing age alone does not appear to increase the risk of hematologic toxicity in older patients receiving full dose intensity chemotherapy. Nevertheless, half of elderly patients in this study received major reductions in actual dose intensity. More information is needed on the impact of reduced dose intensity chemotherapy on long term clinical outcomes in this population.

scholarly journals Older Patients Are Less Affected by Radiochemotherapeutic Treatment than Younger

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Max J. Weiling ◽  
Wencke Losensky ◽  
Katharina Wächter ◽  
Teresa Schilling ◽  
Fabian Frank ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Older Patients ◽  
Normative Data ◽  
Age Groups ◽  
German Population ◽  
Younger Patients ◽  
Significant Difference

Purpose. The general assumption is that cancer therapy impairs the quality of life in elderly patients more than in younger ones. We were interested in the effects of radiochemotherapeutic treatment on the quality of life of elderly patients compared to younger patients and compared to normative data of a general German population. Methods and Materials. A total of 465 patients completed the EORTC QLQ-C30 questionnaire. Repetitive completion of the questionnaire over time led to 1407 datasets. Our patient cohort contained 197 (42.4%) patients with colorectal cancer followed by 109 (23.4%) patients with head and neck cancer, 43 (9.2%) patients with lung cancer, and 116 (25%) with other types of cancer. Patients were categorized into five age groups, the respective cut-offs being 40, 50, 60, and 70 years. Normative data were drawn from a population study of a general German population. Results. Functional scores and symptom scores were approximately stable between the different age groups. Our data does not suggest a significant difference between the investigated age groups. Advancing age evened out the differences between the normative data of the general German population and the cancer patients in 11 of 15 scores. Conclusions. The general belief about younger patients having fewer physical and psychological problems related to radiochemotherapy needs to be reconsidered. Overall resilience of older patients is apparently underestimated.

Disease Characteristics and Patterns of Care In Elderly Patients (80+ years) with Follicular Lymphoma (FL) In the United States (US); Are Older Patients Treated Differently? Report From the National LymphoCare Study (NLCS)

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4152-4152
Author(s):  
Chadi Nabhan ◽  
Michelle Byrtek ◽  
Michael Taylor ◽  
Jill Tydell ◽  
Jamie H. Hirata ◽  
...  
Keyword(s):  
Older Patients ◽  
Research Funding ◽  
Age Groups ◽  
Treatment Patterns ◽  
Disease Stage ◽  
Younger Patients ◽  
Disease Characteristics ◽  
Significant Difference ◽  
The Difference ◽  
Grade 3

Abstract Abstract 4152 Background: While FL is the most common low-grade lymphoma in the US, median age was less than 60 in patients enrolled on pivotal studies that led to our understanding of disease biology and optimal therapy. It remains unclear whether similar disease characteristics, presentation, prognostic factors, treatment patterns, and outcomes pertain to older patients with FL. No clear guidelines exist on how older patients should be treated and data is lacking as to whether current practice patterns affect their survival and progression. Previous reports on FL in the elderly have been retrospective and single center-based. Methods: The NLCS is a prospective, longitudinal multicenter, observational study that enrolled consecutive newly diagnosed FL patients from 3/2004 through 3/2007 collecting data on disease and patients' characteristics, treatment patterns, and outcome. Using the NLCS data we analyzed information on disease stage, grade, FL International Prognostic Index (FLIPI), B symptoms, and treatment choice for patients <60 years, 60–69 years, 70–79 years, and 80+ years. Either Chi-square or Fisher's exact comparison was used to assess the correlations depending on the sample size of the test. Results: A total of 2,736 pts were enrolled, of which 1,215 (44%) were < 60, 708 (25%) were between 60–69, 549 (20%) were between 70–79, and 264 (9%) were >80. There was a significant difference in grade distribution across the different age groups (p < 0.0001), with 22% of pts 80+ having grade 3 FL vs 17% pts <60. No significant differences across age groups in B symptoms, extra nodal sites, or LDH values were observed. A significant difference in FLIPI score was seen across the age groups (p < 0.0001) where high-score FLIPI was present in 48% of pts 80+ as opposed to 16% of pts <60, although calculating FLIPI might be confounded by the fact that older patients were more likely to not have received a bone marrow (BM) exam with 66% of pts 80+ not having BM exam vs. only 40% of those <60 (p < 0.0001). The difference in FLIPI was mainly due to lower Hgb values as older patients were more likely to have had Hgb < 12 g/dL than younger patients (31% of pts 80+ vs. 15% of pts <60) and to age being a component of the FLIPI index. The difference in FLIPI score across age groups was also observed in patients with grade 3 FL where 53% of pts 80+ had poor FLIPI vs. 15% of pts <60 (p < 0.0001). A statistically significant difference in treatment patterns was found across age groups (p <0.0001). When treatment was implemented, older patients were more likely to have received rituximab (R) monotherapy (37% of 80+ vs. 12% of <60) and less likely to have received R+Chemotherapy (40% of pts 80+ vs. 64% of pts<60). In addition, more pts 80+ were observed compared to those <60 (23% vs. 16%). These differences persisted even in those with advanced stage (III/IV), grade 3 disease, region of diagnosis, and in poor-risk FLIPI. When chemotherapy was used, older patients were less likely than younger patients to receive anthracyclines (p < 0.0001) (31% of pts 80+ vs. 69% of pts<60). Anthracycline use remained significantly different regardless of disease stage, grade, or FLIPI score. Conclusions: To our knowledge, this is the largest prospective data collection available for FL pts 80+ years of age. We demonstrate that these pts have higher FLIPI score and grade 3 disease. When treatment is initiated, these patients receive R monotherapy more often than their younger counterpart. Anthracycline use in this population is also less common regardless of disease stage, grade, or risk profile. Whether these baseline differences translate into different outcomes remains to be seen. Disclosures: Nabhan: genentech: Research Funding, Speakers Bureau. Byrtek:Genentech: Employment. Taylor:Genentech: Employment. Hirata:Genentech: Employment. Flowers:Genentech/Biogen-Idec (unpaid): Consultancy; Celgene, Intellikine: Consultancy; Millennium: Research Funding.

Barriers to Clinical Trial Participation by Older Women With Breast Cancer

2003 ◽  
Vol 21 (12) ◽  
pp. 2268-2275 ◽  
Author(s):  
M. Margaret Kemeny ◽  
Bercedis L. Peterson ◽  
Alice B. Kornblith ◽  
Hyman B. Muss ◽  
Judith Wheeler ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Women ◽  
Cancer Patients ◽  
Older Patients ◽  
Disease Stage ◽  
Trial Participation ◽  
Breast Cancer Patients ◽  
Retrospective Case ◽  
Younger Patients ◽  
Significant Difference

Purpose: Although 48% of breast cancer patients are 65 years old or older, these older patients are severely underrepresented in breast cancer clinical trials. This study tested whether older patients were offered trials significantly less often than younger patients and whether older patients who were offered trials were more likely to refuse participation than younger patients. Patients and Methods: In 10 Cancer and Leukemia Group B institutions, using a retrospective case-control design, breast cancer patients eligible for an open treatment trial were paired: less than 65 years old and ≥ 65 years old. Each of the 77 pairs were matched by disease stage and treating physician. Patients were interviewed as to their reasons for participating or refusing to participate in a trial. The treating physicians were also given questionnaires about their reasons for offering or not offering a trial. Results: Sixty-eight percent of younger stage II patients were offered a trial compared with 34% of the older patients (P = .0004). In multivariate analyses, disease stage and age remained highly significant in predicting trial offering (P = .0008), when controlling for physical functioning and comorbidity. Of those offered a trial, there was no significant difference in participation between younger (56%) and older (50%) patients (P = .67). Conclusion: In a multivariate analysis including comorbid conditions, age and stage were the only predictors of whether a patient was offered a trial. The greatest impediment to enrolling older women onto trials in the setting of this study was the physicians’ perceptions about age and tolerance of toxicity.

Toxicity and Response Among Octogenarians and Nonagenarians with Diffuse Large B Cell Lymphoma Treated with Rituximab-CHOP Therapy

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1778-1778
Author(s):  
Scott F Huntington ◽  
Mahsa Sharifi ◽  
John P Greer ◽  
David Morgan ◽  
Nishitha Reddy
Keyword(s):  
Elderly Patients ◽  
Performance Status ◽  
Age Groups ◽  
Dose Intensity ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Disease Stage ◽  
Aged Patients ◽  
Dose Reductions ◽  
Two Age Groups

Abstract Abstract 1778 Background: Diffuse large B-cell lymphoma (DLBCL) is the most common histological subtype of lymphoma diagnosed in the United States. Majority of patients diagnosed with DLBCL are in their seventh decade at the time of presentation. Previous studies demonstrate that relative dose intensity (RDI) is an important prognostic factor for survival in patients with DLBCL. Elderly patients who receive chemotherapy intensity comparable to younger patients demonstrate similar outcomes. In our experience, elderly patients appear to receive lower doses of anthracycline based chemotherapy secondary to significant toxicity, poor performance status, or comorbid conditions. We present our experience of RCHOP chemotherapy in the treatment of DLBCL among octogenarians and nonagenarians. Methods: The study population was selected using the Vanderbilt electronic medical record database. After obtaining IRB approval, 102 patients undergoing RCHOP therapy at a single institution between January 2000 and January 2010 were included in our analysis. Patients who were treated with RCHOP elsewhere were excluded from the study. Pre-treatment co-morbidities were identified and scored using the Cumulative Illness Rating Scale (CIRS). All data was compiled using Research Electronic Data Capture (REDCap). Descriptive statistics and multivariate logistic regression modeling were performed using SPSS software. Results: Of the 102 identified patients, 37 (36%) were aged 70 years or greater with a median age of 79 years (range 70–90). The median age of patients <70 years was 59 years (range 20–70). The majority had a diagnosis of DLBCL while eight (7.8%) patients had follicular grade 3b lymphoma. Differences in baseline BMI and body surface area (BSA) were statistically significant between age groups (70 years or greater: less than 70 years). All baseline laboratory data including absolute neutrophil count, absolute lymphocyte count, hemoglobin, blood albumin level, and LDH level were similar between groups. In addition, disease stage, International Prognostic Index (IPI), and age-adjusted IPI were not statistically different between the two age groups. Baseline comorbidities quantified with CIRS scoring showed that pts >70 had a higher average CIRS score (7.5 vs. 5.8, p <0.005), and a greater proportion had severe or not optimally controlled chronic baseline conditions (43% vs. 23 %, OR 2.5, p< 0.03). The two groups had a similar average number of chemotherapy cycles (5.8 vs. 5.7). The average chemotherapy dose intensity was lower in pts> 70 and experienced a greater frequency of dose reductions during treatment (73% vs. 18%, OR 12, p<0.001). The average relative dose intensity however remained greater than 70% of reference standard intensity in 32 of 37 aged patients (86%). Furthermore, only 4 of the aged patients (11%) received doxorubicin at an RDI < 10mg/m2/week. A complete response was observed in 92% of the patients and a difference was not observed between the two age groups (95% vs 91%). Frequency of neutropenia (grade 3–4) and febrile neutropenia was similar between age groups (43% vs. 45% for neutropenia, 22% vs. 17% febrile neutropenia). Prophylactic colony stimulating factors from the onset of RCHOP was more commonly administered among the elderly (92% vs. 28%, OR 29, p<0.001). Despite the use of early growth factors and dose reductions, the frequency of at least one hospitalization during chemotherapy was significantly higher among the octogenarians and nonagenarians (54% vs. 32%, OR 2.5, p<0.03). Multivariate logistic regression analysis was performed to identify age, BSA and comorbidity scoring as statistically significant predictors of any dose reduction after controlling for sex, LDH level, disease stage, performance status, and prophylactic G-CSF use. Conclusion: Our study identifies age as a predictor of dose reduction in RCHOP used to treat patients with aggressive lymphoma. The RDI of anthracycline among the vast majority of patients was maintained at greater than 10mg/m2/week and may help explain the high frequency of complete response observed in both age groups. We conclude that patients over the age of 70 years can receive an attenuated dose of chemotherapy without compromising the response rates while experiencing similar toxicities. Additional studies with expanded population size and extended outcome data could help identify target RCHOP intensity for elderly patients with DLBCL. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Dose intensity and hematologic toxicity in older cancer patients receiving systemic chemotherapy

Cancer ◽  
2007 ◽  
Vol 110 (7) ◽  
pp. 1611-1620 ◽  
Author(s):  
Michelle Shayne ◽  
Eva Culakova ◽  
Marek S. Poniewierski ◽  
Debra Wolff ◽  
David C. Dale ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Systemic Chemotherapy ◽  
Dose Intensity ◽  
Hematologic Toxicity ◽  
Older Cancer Patients

scholarly journals 1244. Evaluation of Antibiotic Prescribing Practices for Geriatric Patients in the Outpatient Setting in a Veterans Affairs Hospital: Identification of Stewardship Targets

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S378-S379
Author(s):  
Collin Clark ◽  
Alexis White ◽  
John Sellick ◽  
Kari Mergenhagen
Keyword(s):  
Elderly Patients ◽  
Older Patients ◽  
Hospital Admissions ◽  
Multivariable Analysis ◽  
Age Groups ◽  
Outpatient Setting ◽  
Multivariate Logistic Regression Model ◽  
Antibiotic Prescribing ◽  
Significant Difference ◽  
Two Age Groups

Abstract Background Antibiotics are frequently overused in the outpatient setting, however it is unknown how antibiotic use differs with age. Infections are a leading cause of hospitalization in elderly patients. Prescribing appropriateness for patients less than 65 years old was compared with patients at or above ≥65 years old in order to identify targets for antimicrobial stewardship in this population. Methods A retrospective review of all outpatient antibiotic prescriptions between June and September of 2017. Prescriptions were reviewed based on alerts in the electronic medical record when orders for antibiotics were signed by the provider. Appropriateness of antibiotics was assessed based on clinical practice guidelines. Retreatment and hospital admissions were documented. Those aged &lt;65 were compared with those ≥65 years of age using Student’s t-test and chi-squared tests. A multivariate logistic regression model was constructed to identify risk factors for inappropriate use of antibiotics between the two age groups. Results The study period yielded 1,700 prescriptions after exclusions 1,063 were included in the analysis. Patients aged ≥65 comprised 51% of the population. Older patients had significantly more comorbidities than the younger population. No significant difference was observed for antibiotic indicated (60%), correct drug (50%), or correct duration (75%) between the two age groups. Patients in the ≥65 cohort were statistically significantly more likely to receive an inappropriate dose (86% vs. 76%, P &lt; 0.002). In the multivariable analysis, patients with COPD were more likely to be appropriately with antibiotics OR 1.4 (95% CI: 1.03–1.9) compared with those without COPD. Older patients were not more likely to be retreated or admitted for the same indication within 30 days. Conclusion Antibiotics were frequently overused in the outpatient setting; however, they were not more frequently used in elderly patients. However, older adults were more likely to be prescribed an antibiotic at an inappropriate dose highlighting the need for increased caution with dosage selection in this population. Stewardship teams caring for elderly patients should be cognizant of dosing in this population. Disclosures All authors: No reported disclosures.

scholarly journals Excess mortality and undertreatment in elderly lung cancer patients: treatment nihilism in the modern era?

2021 ◽  
pp. 00393-2020
Author(s):  
Jonathan Pham ◽  
Matthew Conron ◽  
Gavin Wright ◽  
Paul Mitchell ◽  
David Ball ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Elderly Patients ◽  
Mortality Risk ◽  
Excess Mortality ◽  
Cox Regression ◽  
Performance Status ◽  
Age Groups ◽  
Disease Stage ◽  
Cancer Treatments ◽  
Significant Difference

BackgroundTreatment of elderly patients with lung cancer is significantly hindered by concerns about treatment tolerability, toxicity and limited clinical trial data in the elderly – potentially giving rise to treatment nihilism amongst clinicians. This study aims to describe survival in elderly patients with lung cancer and explore potential causes for excess mortality.MethodsPatients diagnosed with lung cancer in the Victorian Lung Cancer Registry between 2011–2018 were analysed (n=3481). Patients were age-categorised and compared using Cox-regression modelling to determine mortality risk, after adjusting for confounding. Probability of being offered cancer treatments was also determined, further stratified by disease stage.ResultsThe eldest patients (≥80 years old) had significantly shorter median survival compared to younger age groups (<60: 2.0 years; 60–69: 1.5 years; 70–79: 1.6 years; ≥80: 1.0 years; p<0.001). Amongst those diagnosed with stage 1 or 2 lung cancer, there was no significant difference in adjusted-mortality between age groups. However, in those diagnosed with stage 3 or 4 disease, the eldest patients had an increased adjusted-mortality risk of 28% compared to patients younger than 60 years (p=0.005), associated with markedly reduced probability of cancer treatment, after controlling for sex, performance status, comorbidities and histology type (OR 0.24, compared to <60 years old strata, p<0.001).ConclusionCompared to younger patients, older patients with advanced-stage lung cancer have a disproportionately higher risk of mortality and lower likelihood of receiving cancer treatments, even when performance status and comorbidity are equivalent. These healthcare inequities could be indicative of widespread treatment nihilism towards elderly patients.

Are Older Cancer Patients Being Referred to Oncologists? A Mail Questionnaire of Ontario Primary Care Practitioners to Evaluate Their Referral Patterns

2003 ◽  
Vol 21 (24) ◽  
pp. 4627-4635 ◽  
Author(s):  
Carol A. Townsley ◽  
Kendra Naidoo ◽  
Gregory R. Pond ◽  
Wendy Melnick ◽  
Sharon E. Straus ◽  
...  
Keyword(s):  
Primary Care ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Cancer Care ◽  
Older Patients ◽  
Early Stage ◽  
Care Physician ◽  
Cancer Symptoms ◽  
Referral Decisions ◽  
Older Cancer Patients

Purpose: Understanding why older patients are frequently underrepresented in cancer services use and clinical research may help to increase their participation in clinical trials and eventually result in better cancer care for this vulnerable population. Methods: To identify potential barriers that may prevent older cancer patients from being referred from a primary care physician (PCP) to an oncology specialist, a self-administered questionnaire was mailed to 9,312 PCPs throughout Ontario. Results: With a one-time mailing, 2,240 questionnaires were returned (response rate, 24%) of which 2,089 (93%) were assessable. Although 86% of respondents would refer most older patients with early-stage, potentially curable cancers to oncologists, only 65% would refer those with advanced-stage, potentially incurable cancers. The factors that most influence referral decisions of PCPs are patient’s desire to be referred (69%), type (54%) and stage (49%) of cancer, and severity of cancer symptoms (49%). Other factors including age do not seem to influence the referral decision. Approximately 9% of respondents found it difficult to refer older cancer patients to oncology specialists, with the most commonly cited barriers being the length of waiting lists, mandatory tissue diagnosis before referral, and the belief that oncologists seldom relate to PCPs. Conclusion: Most PCPs stated that they would refer all elderly patients with cancer to oncologists and that referral decisions were based mainly on patients’ wishes. Continued efforts are needed to overcome barriers in the referral process and to understand the perspectives of elderly patients to enhance their cancer care.

ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

2019 ◽  
Vol 72 (8) ◽  
pp. 1466-1472
Author(s):  
Grażyna Kobus ◽  
Jolanta Małyszko ◽  
Hanna Bachórzewska-Gajewska
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Elderly Patients ◽  
Older Patients ◽  
Age Groups ◽  
Kidney Injury ◽  
The Elderly ◽  
Younger Patients ◽  
Common Cause

Introduction: In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. The aim: To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. Materials and methods: A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. Results: The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. Conclusions: The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.

scholarly journals Report of clinico-pathological features of breast cancer in HIV-infected and uninfected women in Botswana

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Rohini K. Bhatia ◽  
Mohan Narasimhamurthy ◽  
Yehoda M. Martei ◽  
Pooja Prabhakar ◽  
Jeré Hutson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Stage Iii ◽  
Disease Stage ◽  
Breast Cancers ◽  
Pathological Features ◽  
Breast Cancer Patients ◽  
Hiv Status ◽  
Receptor Status ◽  
Significant Difference

Abstract Background To characterize the clinico-pathological features including estrogen receptor (ER), progesterone receptor (PR) and Her-2/neu (HER2) expression in breast cancers in Botswana, and to compare them by HIV status. Methods This was a retrospective study using data from the National Health Laboratory and Diagnofirm Medical Laboratory in Gaborone from January 1, 2011 to December 31, 2015. Clinico-pathological details of patients were abstracted from electronic medical records. Results A total of 384 unique breast cancer reports met our inclusion criteria. Of the patients with known HIV status, 42.7% (50/117) were HIV-infected. Median age at the time of breast cancer diagnosis was 54 years (IQR 44–66 years). HIV-infected individuals were more likely to be diagnosed before age 50 years compared to HIV-uninfected individuals (68.2% vs 23.8%, p < 0.001). The majority of patients (68.6%, 35/51) presented with stage III at diagnosis. Stage IV disease was not presented because of the lack of data in pathology records surveyed, and additionally these patients may not present to clinic if the disease is advanced. Overall, 68.9% (151/219) of tumors were ER+ or PR+ and 16.0% (35/219) were HER2+. ER+ or PR+ or both, and HER2- was the most prevalent profile (62.6%, 132/211), followed by triple negative (ER−/PR−/HER2-, 21.3%, 45/211), ER+ or PR+ or both, and HER2+, (9.0%, 19/211) and ER−/PR−/HER2+ (7.1%, 15/211). There was no significant difference in receptor status noted between HIV-infected and HIV-uninfected individuals. Conclusions Majority of breast cancer patients in Botswana present with advanced disease (stage III) at diagnosis and hormone receptor positive disease. HIV-infected breast cancer patients tended to present at a younger age compared to HIV-uninfected patients. HIV status does not appear to be associated with the distribution of receptor status in breast cancers in Botswana.

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