Efficacy and safety of pemetrexed (P) in elderly cancer patients (pts)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8544-8544
Author(s):  
P. M. Kulkarni ◽  
R. Chen ◽  
M. Monberg ◽  
C. K. Obasaju
Keyword(s):  
Elderly Population ◽  
Age Groups ◽  
Safety Data ◽  
Advanced Pancreatic Cancer ◽  
The Elderly ◽  
Disease Stage ◽  
Efficacy And Safety ◽  
Similar Treatment ◽  
Younger Patients ◽  
Two Age Groups

8544 Background: P, a novel multitargeted antifolate, has demonstrated antitumor activity in a broad range of tumor types. Approximately 60% of all new cases of cancer and 70% of all cancer-related deaths occur in the elderly population. However, few studies have specifically analyzed the utility of chemotherapy in this population. The objective of this posthoc analysis was to understand the efficacy and tolerability of pemetrexed (alone or in combination) when used in the elderly cancer population. Methods: Data from three pemetrexed registration trials conducted between April 1999 and February 2003 were pooled together. Pts in these studies were diagnosed with malignant pleural mesothelioma, NSCLC, or advanced pancreatic cancer. Pts receiving P as monotherapy or in combination with another drug (gemcitabine or cisplatin) who received at least one cycle of therapy were included in this analysis (n=764). In all studies, P 500 mg/m2 was administered every 21 days. Demographics, efficacy, and safety data from pts receiving P were stratified by age ± 65 years. Kaplan-Meier method was used to estimate survival and time to PD. Cox regression model was also used to test the survival effect of pemetrexed on age after adjusting for disease stage, performance status, gender, and type of tumors, the prognostic factors considered to influence survival. Results: * P<.05 from fisher’s exact test. The adjusted hazard ratio of elderly patients over younger patients was 1.074 with p-value 0.42. Conclusions: P produced similar treatment effects in older and younger patients and appeared to be well tolerated in the elderly population. CTC grade 3/4 Lab and Non-Lab toxicity between two age groups were similar except, as expected, the elderly group had modestly higher myelosuppression. Non-hematologic toxicities were similar between the two age groups. [Table: see text] [Table: see text]

Comparative efficacy and safety of sorafenib in elderly versus non-elderly patients with advanced hepatocellular carcinoma (HCC) with varying liver dysfunction.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 430-430 ◽  
Author(s):  
Sukeshi Patel Arora ◽  
Norma S. Ketchum ◽  
Jonathan Gelfond ◽  
Joel Michalek ◽  
Devalingam Mahalingam
Keyword(s):  
Adverse Events ◽  
Age Groups ◽  
Safety Data ◽  
The Elderly ◽  
Rank Test ◽  
Advanced Hepatocellular Carcinoma ◽  
Efficacy And Safety ◽  
Exact Test ◽  
Advanced Hcc ◽  
Vein Thrombosis

430 Background: Sorafenib is the only FDA-approved systemic therapy for advanced HCC. The incidence of HCC increases with age, peaking above 70 years; however, we have limited efficacy and safety data in the elderly. Given the prevalence of HCC in South Texas, we assessed the efficacy and safety of sorafenib in the elderly. Methods: Retrospective analysis of HCC patients (pts) receiving sorafenib from 2008-2013. PFS and OS were estimated from Kaplan-Meier curves and groups were statistically compared with the log rank test. The magnitude of association between dichotomous factors and survival was estimated with the hazard ratio (HR). Adverse events (AEs) were graded according to the Common Terminology Criteria for Adverse Events version 4.0. Differences between age groups (65+, < 65) for dose reduction (yes, no), and AEs were analyzed using Fisher’s Exact Test. Results: A total of 118 pts were included. Median age 57 (range 41-93; 65+ 26%). males 81%. Hispanic 73%, Non-Hispanic White 24%. ECOG PS 0–1 93 %. Causes of cirrhosis: Hepatitis C 66%, Hepatitis B 4%, EtOH 58%. Portal vein thrombosis 36%, Extrahepatic disease 38%. Child-Pugh score: A 56%, B 44%. BCLC class: B 13%, C 87%. Among 113 pts 34% were started at 400 mg daily versus 66% started at 800 mg daily. mOS was 11.2 months (mo) (95% CI: 7.8-14.0), mPFS 5.2 mo (95% Cl: 3.9-7.1). In subgroup analysis, mOS for < 65 was 10.2 mo vs 13.5 mo for 65+ (HR 0.67, 95% CI: 0.39-1.16, p = 0.15). mPFS for < 65 was 4.6 mo vs 6.2 mo for 65+ (HR 0.92, 95% CI: 0.58-1.45, p = 0.71). Among 109 pts, dose reductions in < 65 vs 65+ were 64.6 vs 70% (P = 0.66); survival differences were not statistically significant. Among 75 pts there was a trend to improved survival in 65+ patients with AST/Platelet Ratio (APRI) < / = 1.68, but not statistically significant. Sorafenib was tolerated in the elderly. In regards to nausea, fatigue, diarrhea and hand foot syndrome, difference in toxicity was not statistically significant in < 65 versus 65+. Conclusions: In advanced HCC, elderly pts should be offered sorafenib, as it has efficacy and is tolerated in the elderly. Further prospective studies in the elderly are warranted, with evaluation of APRI as a prognostic marker.

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 Letter to the Editor: Microbiota in the Respiratory System—A Possible Explanation to Age and Sex Variability in Susceptibility to SARS-CoV-2

2021 ◽  
Vol 14 ◽  
pp. 117863612098860
Author(s):  
Vishal Shah
Keyword(s):  
Respiratory System ◽  
Elderly Population ◽  
Age Groups ◽  
The Elderly ◽  
Elderly Adult ◽  
Human Respiratory Tract ◽  
System A ◽  
Number Of Patients ◽  
Children And Young Adults ◽  
Age And Sex

The Human respiratory tract is colonized by a variety of microbes and the microbiota change as we age. In this perspective, literature support is presented for the hypothesis that the respiratory system microbiota could explain the differential age and sex breakdown amongst COVID-19 patients. The number of patients in the older and elderly adult group is higher than the other age groups. The perspective presents the possibility that certain genera of bacteria present in the respiratory system microbiota in children and young adults could be directly or through eliciting an immune response from the host, prevent full-fledged infection of SARS-CoV-2. The possibility also exists that the microbiota in older adults and the elderly population have bacteria that make it easier for the virus to cause infection. I call upon the scientific community to investigate the link between human microbiota and SARS-CoV-2 susceptibility to further understand the viral pathogenesis.

scholarly journals P22 Are Elderly Patients at Increased Perioperative Morbidity and Mortality from Oesophagectomy for Oesophageal Cancer? A Systematic Mapping Review and Meta-Analysis

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Rohan R Gujjuri ◽  
Muhammed Elhadi ◽  
Hamza Umar ◽  
Manjunath S Subramanya ◽  
Richard P T Evans ◽  
...  
Keyword(s):  
Elderly Population ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
The Elderly ◽  
Pulmonary Complications ◽  
Cardiac Complications ◽  
Anastomotic Leaks ◽  
Free Survival ◽  
Younger Patients ◽  
Disease Free

Abstract Introduction Oesophagectomy is being increasingly performed in an ageing population that is observing a concomitant growth in the life expectancy. However, the risks are poorly quantified, and this study aims to review current evidence to further quantify the postoperative of oesophagectomy in the elderly population compared to younger patients. Methods A systematic electronic search was conducted for studies reporting oesophagectomy in the elderly population. Meta-analysis was performed using random-effects modelling to compute odds ratios (OR) and 95% confidence intervals (CI). Primary outcome was overall complications and secondary outcomes included anastomotic leaks, cardiac complications, pulmonary complications, overall and disease-free survival. Meta-regression was performed to identify study-, hospital- and patient-level factors confounding study findings. Results This review included 37 eligible studies involving 61,723 patients. Increasing age was significantly associated with increased rates of overall complications (OR: 1.67, CI 95%: 1.42 – 1.97), cardiac complications (OR: 1.62, CI 95%: 1.10 – 2.40), pulmonary complications (OR: 1.44, CI 95%: 1.11 – 1.87) and decreased 5-year overall survival (OR: 1.36, CI 95%: 1.11 – 1.66) and 5-year disease-free survival (OR: 1.66, CI 95%: 1.40 – 1.97). Rates of anastomotic leaks showed no difference between elderly and younger patients (OR: 1.06, CI 95%: 0.71 – 1.59). Conclusion Postoperative outcomes such as overall complications, 5-year overall survival and disease-free survival appear to significantly worse in all age cut-offs in this meta-analysis. Sarcopenia and frailty act as better predictors of postoperative outcomes than chronological age. This study confirms the preconceived suspicions of increased risks in elderly patients following oesophagectomy and will aid future pre-operative counselling and informed consent.

Cochlear implantation in elderly patients: stability of outcome over time

2016 ◽  
Vol 130 (8) ◽  
pp. 706-711 ◽  
Author(s):  
O Hilly ◽  
E Hwang ◽  
L Smith ◽  
D Shipp ◽  
J M Nedzelski ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cochlear Implantation ◽  
Short Form ◽  
Age Groups ◽  
The Elderly ◽  
Long Term Results ◽  
Profound Hearing Loss ◽  
Younger Patients ◽  
Over Time

AbstractBackground:Cochlear implantation is the standard of care for treating severe to profound hearing loss in all age groups. There is limited data on long-term results in elderly implantees and the effect of ageing on outcomes. This study compared the stability of cochlear implantation outcome in elderly and younger patients.Methods:A retrospective chart review of cochlear implant patients with a minimum follow up of five years was conducted.Results:The study included 87 patients with a mean follow up of 6.8 years. Of these, 22 patients were older than 70 years at the time of implantation. Hearing in Noise Test scores at one year after implantation were worse in the elderly: 85.3 (aged under 61 years), 80.5 (61–70 years) and 73.6 (aged over 70 years;p= 0.039). The respective scores at the last follow up were 84.8, 85.1 and 76.5 (p= 0.054). Most patients had a stable outcome during follow up. Of the elderly patients, 13.6 per cent improved and none had a reduction in score of more than 20 per cent. Similar to younger patients, elderly patients had improved Short Form 36 Health Survey scores during follow up.Conclusion:Cochlear implantation improves both audiometric outcome and quality of life in elderly patients. These benefits are stable over time.

scholarly journals Comparison of esophageal motility impairment caused by Chagas' disease in two age groups

2006 ◽  
Vol 43 (3) ◽  
pp. 196-200 ◽  
Author(s):  
Roberto Oliveira Dantas ◽  
Lilian Rose Otoboni Aprile
Keyword(s):  
Chagas Disease ◽  
Esophageal Motility ◽  
Older Patients ◽  
Aging Process ◽  
Age Groups ◽  
Upper Esophageal Sphincter ◽  
Control Group ◽  
Younger Patients ◽  
Lower Amplitude ◽  
Two Age Groups

BACKGROUND: Chagas' disease and the aging process cause loss of neurons of the esophageal myenteric plexus. AIM: To evaluate the esophageal motility impairment caused by Chagas' disease in two age groups. Our hypothesis was that the aging process may cause further esophageal motility impairment in patients with Chagas' disease. METHODS: We studied the esophageal motility of 30 patients with Chagas' disease and dysphagia, with esophageal retention of barium sulfate and an esophageal diameter within the normal range. Fifteen were 34 to 59 years old (younger group, median 51 years) and 15 were 61 to 77 years old (older group, median 66 years). As a control group we studied 15 subjects aged 33 to 58 years (median 42 years) and 7 subjects aged 61 to 73 years (median 66 years). The esophageal contractions were measured by the manometric method with continuous perfusion after five swallows of a 5 mL bolus of water at 2, 7, 12 and 17 cm below the upper esophageal sphincter. RESULTS: Patients with Chagas' disease had lower amplitude of contractions and fewer peristaltic, more simultaneous, and more non-conducted contractions than controls. Older patients with Chagas' disease had lower amplitude of contractions in the distal esophagus (mean ± SE: 30.8 ± 4.3 mm Hg) than younger patients (51.9 ± 8.6 mm Hg). From 12 to 17 cm, older patients had more non-conducted (41%) and fewer peristaltic (8%) contractions than younger patients (non-conducted: 16%, peristaltic: 21%). CONCLUSION: Older patients with Chagas' disease with clinical and radiological examinations similar to those of younger patients had motility alterations suggesting that the aging process may cause further deterioration of esophageal motility.

Abstract T MP48: Androgen Suppression in Patients with Prostate Cancer Increases Incidence of Combined Cardiovascular Outcomes

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Zuber S Ali ◽  
Danielle M Greere ◽  
Robyn L Shearer ◽  
Syed Ali Gardezi ◽  
Arshad Jahangir
Keyword(s):  
Prostate Cancer ◽  
Proportional Hazards ◽  
Age Groups ◽  
The Elderly ◽  
Cox Proportional Hazards ◽  
Cardiovascular Outcomes ◽  
Elevated Risk ◽  
Disease Stage ◽  
Cox Proportional Hazards Models ◽  
Androgen Suppression

Introduction: Androgen suppression therapy for prostate cancer is controversial due to adverse fatal and non-fatal cardiovascular outcomes reported in some studies. However, effects of androgen suppression on stroke have not been fully assessed in the elderly. Methods: Patients diagnosed with prostate cancer during 2007-2013 in a large community-based healthcare system were identified from the Cancer Registry, electronic records, and billing codes. Those who underwent androgen suppression therapy with Gonadotropin-releasing hormone agonist (GnRH) were propensity-matched to patients treated without androgen suppression therapy by age at cancer diagnosis, race/ethnicity, disease stage and outcome, body mass index and use of surgery, radiation, and chemotherapy. Tests of independence and Cox proportional hazards models were used to examine effects of hormone therapy on acute myocardial infarction (AMI), stroke, and mortality outcomes. Models also adjusted for patient comorbidities. Results: A total of 1282 patients and 641 matched-pairs were identified, with mean diagnosis age of 69 yr and follow-up period of 3.05 yr. Effects of androgen suppression therapy on AMI (P=0.051) and stroke (P=0.062) were of marginal to non-significance, but adjusted-odds of death and combined AMI, stroke, and death were 1.61 times (P=0.002; odds ratio [OR] 95% CI: 1.19-2.18) and 1.70 times (P<0.001; OR 95% CI: 1.26-2.28) greater, respectively, for men with than without androgen suppression. An interaction of androgen suppression and age-group (<65 yr, 65-74 yr, >74 yr) was discovered for combined outcomes, suggesting increased probability of AMI, stroke, and/or death with age (8.6-20.0%; P=0.003) for patients without androgen suppression but elevated risk of outcomes across all age groups (18.3-22.4%; P=0.546) for men treated with androgen suppression therapy. Conclusion: Endogenous androgen suppression presents elevated risk of combined cardiovascular and death outcomes, especially for men <65 yr.

Acceptance and use of communication technology by the elderly (Preprint)

2021 ◽  
Author(s):  
Malcolm Clarke ◽  
Precious Onyeachu
Keyword(s):  
Elderly Population ◽  
Population Aging ◽  
Age Groups ◽  
Smart Phone ◽  
The Elderly ◽  
Accurate Information ◽  
Target Groups ◽  
Flu Vaccination ◽  
Use Of Technology ◽  
Working Age

BACKGROUND Population aging is a global phenomenon, with the proportion of the population over the age of 60 increasingly rapidly. However ownership and use of technology by people in this age group remains low, which impacts on introduction of and the assumptions made for, technology-based activities such as telehealth and telemedicine. It is essential to gain accurate information on the level of technology ownership in target groups. However, many studies on levels of technology ownership and use report using electronic methods for their survey, which introduces bias and may result in a higher value. OBJECTIVE To determine the level of ownership of technology in the elderly population using an unbiased data collection methodology. METHODS Our study collects data from patients invited to attend a clinic for their annual flu vaccination, and thereby captures a cross section of the population that is unbiased by the collection method. 309 patients completed a questionnaire, and were considered in three (3) age groups; young adults (25 to 45) (n=72), working-age (46 to 59) (n=80) and older adults (60 and above) (n=157). RESULTS In the older adult group (60+), 50 people (32%) out of 157 respondents had a mobile or smart phone and 107 (68%) did not; 38 people (24%) out of 157 respondents owned and used a computer and 119 (76%) had never used or owned a computer or tablet CONCLUSIONS Our results show a significantly lower ownership of technology in the elderly than found in other similar studies, which we attribute to the method of collection of the data, and consider to be a true reflection of the ownership in the general population.

Noise-Limited Detection in Young and Old Observers

1997 ◽  
Vol 84 (3) ◽  
pp. 829-830 ◽  
Author(s):  
Filippo Speranza ◽  
Giampaolo Moraglia ◽  
Bruce A. Schneider
Keyword(s):  
Additive Noise ◽  
Age Groups ◽  
Internal Noise ◽  
The Elderly ◽  
Visual Noise ◽  
Processing Efficiency ◽  
Limited Bandwidth ◽  
Lower Performance ◽  
A Current ◽  
Two Age Groups

11 young ( M age = 24.3 yr.) and 11 old ( M age = 67.4 yr.) observers attempted to detect signals of limited bandwidth in visual noise. The older observers did not perform as well as the young ones. We considered whether, as suggested by a current hypothesis, these differences could be attributed to higher internal additive noise in the elderly observers. The results suggested that internal noise did not differ across the two age groups and that the lower performance of the older observers stemmed instead from reduced processing efficiency.

Worldwide Experiences with Assisted Peritoneal Dialysis

2017 ◽  
Vol 37 (5) ◽  
pp. 503-508 ◽  
Author(s):  
Anna Giuliani ◽  
Akash Nayak Karopadi ◽  
Mario Prieto-Velasco ◽  
Sabrina Milan Manani ◽  
Carlo Crepaldi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Elderly Patients ◽  
Elderly Population ◽  
Age Groups ◽  
The Elderly ◽  
Clinical Results ◽  
Social Barriers ◽  
Stage Renal Disease ◽  
End Stage ◽  
Assisted Peritoneal Dialysis

End-stage renal disease (ESRD) is common in the elderly population, and renal replacement therapy (RRT) is often required. However, in this particular subgroup of patients, the choice between hemodialysis (HD) and peritoneal dialysis (PD) is often not an easy decision to make. Published literature has adequately demonstrated that PD prevalence is significantly less than HD across all patient age groups despite several advantages. We also know that elderly patients are less likely to complete a PD assessment, due to both medical and social barriers. Additionally, elderly patients are often reluctant to go ahead with PD despite being eligible PD candidates, mainly due to the fear of performing self-therapy. Recently, many new assisted PD (asPD) programs have cropped up in several countries. The main aim of these programs is to overcome barriers to PD and to promote PD utilization among elderly and non-self-sufficient patients. Although asPD has proven to be associated with good clinical results, there still remain concerns about its greater use. In this review, we will first describe an ideal asPD model and then enumerate examples of strategies and outcomes associated with successful asPD programs worldwide.

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