Predictors of Early Death Risk in Older Patients Treated With First-Line Chemotherapy for Cancer

Purpose Objective factors for making choices about the treatment of elderly patients with cancer are lacking. This investigation aimed to help physicians select appropriate treatments through the identification of factors that predict early death (< 6 months) after initiation of chemotherapy treatment. Patients and Methods Previously untreated patients greater than 70 years of age who were scheduled for first-line chemotherapy for various types of cancer were included. Baseline abbreviated comprehensive geriatric assessment (aCGA), including the Mini-Mental State Exam, Timed Get Up and Go (GUG), Activities of Daily Living (ADL), Instrumental Activities in Daily Living (IADL), Mini Nutritional Assessment (MNA), Geriatric Depression Scale (GDS15), and comorbidities index (Cumulative Index Rating Scale-Geriatric), was carried out. Prognostic factors of early death were sought from aCGA results and traditional oncology measures. Results A total of 348 patients were included across 12 centers in Southwest France (median age, 77.45 years; ratio of men to women, 1.47; advanced disease, 65%). Abnormal aCGA scores were observed for 18.1% of patients on the ADL, 73.0% of patients on the IADL, 24.1% of patients on the GUG, 19.0% of patients on the MMS, 44.0% of patients on the GDS15, and 64.9% of patients on the MNA. Advanced disease (odds ratio [OR], 3.9; 95% CI, [1.58 to 9.73]), a low MNA score (OR 2.77; 95% CI, [1.24 to 6.18]), male sex (OR, 2.40; 95% CI, [1.2 to 4.82]), and long GUG (OR, 2.55; 95% CI, [1.32 to 4.94] were associated with higher risk of early death. Conclusion In patients greater than 70 years of age with cancer, advanced disease, a low MNA score, and poor mobility predicted early death. We recommend that the MNA and GUG, performed by a trained nurse, be maintained as part of routine pretreatment workup in these patients to identify at-risk patients and to inform the decision-making process for chemotherapy.

Download Full-text

Depression among the oldest old: the Umeå 85+ study

International Psychogeriatrics ◽

10.1017/s1041610205002267 ◽

2005 ◽

Vol 17 (4) ◽

pp. 557-575 ◽

Cited By ~ 71

Author(s):

Ellinor Bergdahl ◽

Janna M. C. Gustavsson ◽

Kristina Kallin ◽

Petra von Heideken Wågert ◽

Berit Lundman ◽

...

Keyword(s):

Rating Scale ◽

Nutritional Assessment ◽

Oldest Old ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Mini Nutritional Assessment ◽

Well Being ◽

Structured Interviews ◽

Cross Sectional ◽

Prevalence Of Depression

Objectives: To investigate the prevalence of depression among the oldest old and to analyze factors associated with depression.Methods:A cross-sectional, population-based study was undertaken in Umeå, Sweden. Out of 319 eligible participants aged 85, 90 and 95 years and older, it was possible to evaluate 242 people (75.9%) for depression. Data were collected from structured interviews and assessments in the participants’ homes, and from medical charts, relatives and caregivers. Depression was screened for using the Geriatric Depression Scale-15 and further assessed with the Montgomery–Åsberg Depression Rating Scale. Cognition was assessed using the Mini-mental State Examination, activities of daily living (ADL) using the Barthel ADL Index, nutrition using the Mini Nutritional Assessment and well-being using the Philadelphia Geriatric Center Morale Scale.Results:The 85-year-olds had a significantly lower prevalence of depression than the 90- and 95-year-olds (16.8% vs. 34.1% and 32.3%). No sex differences were found. One-third of those with depression had no treatment and among those with ongoing treatment 59% were still depressed. Persons diagnosed with depression had a poorer well-being and a higher 1-year mortality. Logistic regression analyses showed that depression was independently associated with living in institutions and number of medications.Conclusion:Depression among the oldest old is common, underdiagnosed and inadequately treated, and causes poor well-being and increased mortality. More knowledge about depression is essential to improve the assessment and treatment of depression among the oldest old.

Download Full-text

Functional Decline in Older Patients With Cancer Receiving First-Line Chemotherapy

Journal of Clinical Oncology ◽

10.1200/jco.2012.47.7430 ◽

2013 ◽

Vol 31 (31) ◽

pp. 3877-3882 ◽

Cited By ~ 129

Author(s):

Stéphanie Hoppe ◽

Muriel Rainfray ◽

Marianne Fonck ◽

Laurent Hoppenreys ◽

Jean-Frédéric Blanc ◽

...

Keyword(s):

Older Patients ◽

Rating Scale ◽

Univariate Analysis ◽

Functional Decline ◽

Depression Scale ◽

Mini Nutritional Assessment ◽

First Line ◽

Factors Associated ◽

Increased Risk ◽

Line Chemotherapy

Purpose To determine factors associated with early functional decline during first-line chemotherapy in older patients. Patients and Methods Patients age ≥ 70 years receiving first-line chemotherapy for cancer were prospectively considered for inclusion across 12 centers in France. Functional decline was defined as a decrease of ≥ 0.5 points on the Activities of Daily Living (ADL) scale between the beginning of chemotherapy and the second cycle. Factors associated with functional decline were sought from pretreatment abbreviated comprehensive geriatric assessment, including ADL, Instrumental ADL (IADL), Mini-Nutritional Assessment (MNA), Mini–Mental State Examination (MMSE), Geriatric Depression Scale (GDS15), and Timed Get Up and Go (GUG) test, and from comorbidities (Cumulative Illness Rating Scale–Geriatrics), MAX2 index, and baseline biologic and clinical information. Results Of 364 included patients, 50 experienced functional decline (16.7%; median, 0.5 points). Abnormal preadmission performance status, IADL, GDS15, MMSE, GUG, and MNA were associated with increased likelihood of functional decline (univariate analysis). In the multivariate model adjusted for baseline ADL and MAX2 index, high baseline GDS (odds ratio [OR], 2.16; 95% CI, 1.09 to 4.30; P = .03) and low IADL scores (OR, 2.87; 95% CI, 1.06 to 7.79; P = .04) were independently associated with increased risk of functional decline. Conclusion Our results outline associations between baseline depression, instrumental dependencies, and early functional decline during chemotherapy for older patients. ADL should be sequentially evaluated early during treatment. Baseline evaluation of GDS15 and IADL may be proposed to anticipate this event.

Download Full-text

Evaluation of Malnutrition and Depression in Elderly People: An Epidemiological Study in Turkey

European Journal of Public Health ◽

10.1093/eurpub/ckz187.033 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

S Aydoğan ◽

A Ünsal ◽

D Arslantaş

Keyword(s):

Health Care Providers ◽

Nutritional Assessment ◽

Short Form ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Mini Nutritional Assessment ◽

The Elderly ◽

Cluster Sampling ◽

Care Providers ◽

Cross Sectional

Abstract Background Malnutrition is an important cause of morbidity and mortality. Malnutrition increases the number of hospitalizations and prolongs the length of hospitalization by disrupting organ functions, increasing the number and severity of infections and delaying wound healing. The aim of this study was to determine the frequency of suspected malnutrition in the elderly, to examine some related variables and to evaluate the depression. Methods The study is a cross-sectional study conducted between March-April 2019 in individuals aged 60 years and older living in Sivrihisar. Sample size was calculated as 579. Cluster sampling method used. Data was collected by door to door in 4 neighborhoods determined by randomly. Mini Nutritional Assessment Test-Short Form (for malnutrition), Katz Daily Living Activities Scale (for dependency) and Geriatric Depression Scale-Short Form (for depression) were used. Chi-square test, Mann Whitney U test and logistic regression analysis were used for the analyzes. Results The study group consisted of 220 (38%) women and 359 (62%) men. The mean age was 68.9±6.4 (ranged 60-93). Frequency of suspected malnutrition was 25% (n = 145). Being 80 years of age or older (OR:3.24, CI:1.53-6.85), having a primary and lower education level (OR:2.54, CI:1.32-4.90), history of chronic illness (OR:2.34, CI:1.33-4.03), using dentures (OR:1.62, CI:1.03-2.55) and suspected depression (OR:4.97, CI:3.17-7.78) are important risk factors for malnutrition. Those with suspicion of malnutrition had lower scores on DLA (z = 8.982;p=0.001). Conclusions Malnutrition was found to be an important health problem for the elderly. The frequency of suspected malnutrition is higher in individuals with depression. Those with suspected malnutrition have higher level of dependency. In order to reduce the frequency of malnutrition, it may be beneficial to increase the awareness of the elderly and caregivers and to give importance to the elderly nutrition of primary health care providers. Key messages Depression is an important risk factor for malnutrition. Malnutrition increases the dependence of the individual on daily activities.

Download Full-text

A comparison of anticholinergic burden in older patients with and without cancer

Future Oncology ◽

10.2217/fon-2021-0469 ◽

2021 ◽

Author(s):

Ayse Irem Yasin ◽

Atakan Topcu ◽

Meysere Nur Akuc ◽

Hacı Mehmet Türk ◽

Pinar Soysal

Keyword(s):

Older Patients ◽

Nutritional Assessment ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Mini Nutritional Assessment ◽

Patients With Cancer ◽

Cancer Management ◽

Rational Drug ◽

Geriatric Clinic ◽

Anticholinergic Burden

Aim: To compare anticholinergic burden (ACB) in older patients with and without cancer and evaluate the effects of ACB on geriatric syndromes. Methods: A total of 291 patients from the geriatric clinic and 301 patients from the oncology clinic were evaluated. ACB <2 was categorized as low ACB and ACB ≥2 was categorized as high ACB. A comprehensive geriatric assessment was performed on patients from the geriatric clinic. Results: ACB scores were significantly higher in patients without cancer compared with those with cancer (p < 0.005). Number of falls and Geriatric Depression Scale 15 scores were higher and Mini-Nutritional Assessment and Barthel/Lawton activities of daily living scores were lower in geriatric patients with high ACB scores compared with those with low ACB scores (p < 0.005). Conclusion: It is crucial to understand the potential effects of ACB for rational drug use and optimum cancer management in older patients with cancer.

Download Full-text

Pengaruh Status Nutrisi terhadap Kesintasan 30 Hari Pasien Geriatri yang Dirawat di Rumah Sakit

Jurnal Penyakit Dalam Indonesia ◽

10.7454/jpdi.v2i3.81 ◽

2017 ◽

Vol 2 (3) ◽

pp. 160

Author(s):

Nata Pratama Hardjo Lugito ◽

Czeresna Heriawan Soejono ◽

Edy Rizal Wahyudi ◽

Esthika Dewiasty

Keyword(s):

Regression Model ◽

Nutritional Assessment ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Mini Nutritional Assessment ◽

Proportional Hazard ◽

Geriatric Depression ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Cox Proportional Hazard Regression

Pendahuluan. Dengan meningkatnya jumlah populasi usia lanjut, masalah kesehatan yang dialami juga semakin banyak, salah satunya malnutrisi. Studi di luar negeri menunjukkan malnutrisi pada pasien geriatri yang dirawat di rumah sakit menurunkan kesintasan. Pasien usia lanjut di Indonesia mempunyai karakteristik yang berbeda dengan pasien usia lanjut di luar negeri. Di Indonesia belum ada studi tentang status nutrisi pasien usia lanjut yang dirawat di rumah sakit dan pengaruhnya terhadap kesintasan. Penelitian ini bertujuan mengetahui pengaruh status nutrisi terhadap kesintasan 30 hari pasien usia lanjut yang dirawat di ruang rawat akut geriatri dan ruang rawat penyakit dalam rumah sakit.Metode. Penelitian kohort retrospektif, dengan pendekatan analisis kesintasan, dilakukan terhadap 177 pasien geriatri yang dirawat di ruang rawat akut geriatri dan ruang rawat penyakit dalam Rumah Sakit Cipto Mangunkusumo selama bulan April–September 2011. Data demografis, diagnosis medis, kadar albumin, indeks ADL Barthel, geriatric depression scale, status nutrisi dengan mini nutritional assessment (MNA) dikumpulkan, dan diamati selama 30 hari sejak mulai dirawat untuk melihat ada tidaknya mortalitas. Perbedaan kesintasan kelompok pasien dengan status nutrisi baik, berisiko malnutrisi dan malnutrisi ditampilkan dalam kurva Kaplan-Meier, diuji dengan uji Log-rank, serta analisis multivariat dengan Cox proportional hazard regression model untuk menghitung adjusted Hazard Ratio dan interval kepercayaan 95% terjadinya mortalitas 30 hari dengan memasukkan variabel-variabel perancu sebagai kovariat.Hasil. Kesintasan antara subyek yang status nutrisinya baik, berisiko malnutrisi dan malnutrisi ialah 94,7% dengan 89,0% dan 80,7%, namun perbedaan kesintasan 30 hari tak bermakna dengan uji Log-rank (p=0,106). Pada analisis multivariat didapatkan adjusted HR setelah penambahan variabel perancu sebesar 1,49 (IK 95% 0,29 – 7,77) untuk kelompok berisiko malnutrisi dan 2,65 (IK 95% 0,47 – 14,99) untuk kelompok malnutrisi dibandingkan dengan pasien nutrisi baikSimpulan. Perbedaan kesintasan 30 hari pasien geriatri yang dirawat di rumah sakit yang menderita malnutrisi dan berisiko malnutrisi dibandingkan dengan status nutrisi baik pada awal perawatan belum dapat dibuktikan.

Download Full-text

The Desire to Better Understand Older Adults with Solid Tumors to Improve Management: Assessment and Guided Interventions—The French PACA EST Cohort Experience

Cancers ◽

10.3390/cancers11020192 ◽

2019 ◽

Vol 11 (2) ◽

pp. 192 ◽

Cited By ~ 7

Author(s):

Rabia Boulahssass ◽

Sebastien Gonfrier ◽

Noémie Champigny ◽

Sandra Lassalle ◽

Eric François ◽

...

Keyword(s):

Solid Tumors ◽

Nutritional Assessment ◽

Geriatric Depression Scale ◽

Geriatric Oncology ◽

Depression Scale ◽

Mini Nutritional Assessment ◽

Factors Associated ◽

Independent Risk Factors ◽

State Examination

Todays challenge in geriatric oncology is to screen patients who need geriatric follow-up. The main goal of this study was to analyze factors that identify patients, in a large cohort of patients with solid tumors, who need more geriatric interventions and therefore specific follow-up. Between April 2012 and May 2018, 3530 consecutive patients were enrolled in the PACA EST cohort (France). A total of 3140 patients were finally enrolled in the study. A Comprehensive Geriatric Assessment (CGA) was performed at baseline. We analyzed the associations between factors at baseline (geriatric and oncologic factors) and the need to perform more than three geriatric interventions. The mean age of the population was 82 years old with 59% of patients aged older than 80 years old. A total of 8819 geriatric interventions were implemented for the 3140 patients. The percentage of patients with three or more geriatric interventions represented 31.8% (n = 999) of the population. In multivariate analyses, a Mini Nutritional assessment (MNA) <17, an MNA ≤23·5 and ≥17, a performans status (PS) >2, a dependence on Instrumental Activities of Daily Living (IADL), a Geriatric Depression Scale (GDS) ≥5, a Mini Mental State Examination (MMSE) <24, and a Screening tool G8 ≤14 were independent risk factors associated with more geriatric interventions. Factors associated with more geriatric interventions could assist practitioners in selecting patients for specific geriatric follow-up.

Download Full-text

Association Between Walking Speed and Urinary Incontinence in the Older Women. Which Patients Should be Referred to Geriatricians?

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2019.1019 ◽

2019 ◽

pp. 1

Author(s):

Volkan Atmis ◽

Basak Guler

Keyword(s):

Urinary Incontinence ◽

Activities Of Daily Living ◽

Mental State ◽

Daily Living ◽

Walking Speed ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Mini Nutritional Assessment ◽

Geriatric Depression ◽

State Evaluation

OBJECTIVE: Primary end-point of this study was to detect if there is an association between walking speed and urinary incontinence in older women and secondarily to detect an association between urinary incontinence with other geriatric syndromes.STUDY DESIGN: This is a prospective and cross-sectional study. Three hundred and eighty-nine old aged women admitted to the Geriatrics Department of Ankara University were enrolled and urinary incontinence and type of urinary incontinence, Handgrip strength test, Timed up and Go test, Katz Index of Independence in Activities of Daily Living, Lawton Index of Instrumental Activities of Daily Living, Mini Nutritional Assessment, Mini-Mental State Evaluation, Geriatric Depression Scale, Body Mass Index (BMI) of these participants were recorded. Association of urinary incontinence and these parameters were analyzed. RESULTS: The median age of the study population was 68 (58-86 years of age). Two hundred and fifty-eight (66.32%) had hypertension, 122 (31.36%) had diabetes mellitus, 51 (13.11%) had asthma/Chronic obstructive lung disease, 49 (12.59%) had coronary artery disease and 9 (2.31%) had cerebrovascular disease. One hundred and seventy-eight (45.7%) patients had urinary incontinence (88 urge, 55 stress, 35 mixed). One hundred and eight (27.76%) of patients had Mini-Mental State Evaluation score ≤23. Patients with urinary incontinence detected to have a longer duration of Timed Up and Go test, higher Geriatric Depression Scale score and BMI with p-values 0.005, 0.004, and <0.01 respectively; and lower Activities of Daily Living (Katz-Activities of Daily Living) score with a p-value of <0.01 results. Mini-Mental State Evaluation and Mini Nutritional Assessment scores were not statistically different between the continent and incontinent group.CONCLUSION: Whenever urinary incontinence is detected in an older woman, geriatrician referral should be considered since urinary incontinence is associated with decreased walking speed, Handgrip strength test, Activities of Daily Living, Instrumental Activities of Daily Living or increased Geriatric Depression Scale; any of which is a symptom or result of at least one geriatric syndrome.

Download Full-text

Cognitive Impairment in Older Cancer Patients Treated with First-Line Chemotherapy

Cancers ◽

10.3390/cancers13246171 ◽

2021 ◽

Vol 13 (24) ◽

pp. 6171

Author(s):

Mélanie Dos Santos ◽

Idlir Licaj ◽

Carine Bellera ◽

Laurent Cany ◽

Giulia Binarelli ◽

...

Keyword(s):

Cognitive Impairment ◽

Cancer Patients ◽

Predictive Factors ◽

Depression Scale ◽

Mini Nutritional Assessment ◽

First Line ◽

European Organization ◽

Elderly Cancer Patients ◽

Older Cancer Patients ◽

Line Chemotherapy

Older cancer patients are vulnerable to chemotherapy-related cognitive impairment. We prospectively evaluated cognitive impairment and its predictive factors during first-line chemotherapy in elderly cancer patients (≥70 years). Cognitive function was evaluated by the Mini-Mental State Examination (MMSE) with adjusted scores for age and sociocultural level. Multidimensional geriatric assessment was performed at baseline and during chemotherapy including the MMSE, Instrumental Activities in Daily Living (IADL), Mini-Nutritional Assessment (MNA), and the Geriatric Depression Scale (GDS15). Quality of life (QoL) was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire (QLQ-C30). Of 364 patients included, 310 had two MMSE evaluations including one at baseline and were assessed. Among these patients, 86 (27.7%) had abnormal MMSE, 195 (62.9%) abnormal MNA, 223 (71.9%) abnormal IADL, and 137 (43.1%) had depressive symptoms at baseline. MMSE impairment during chemotherapy was observed in 58 (18.7%) patients. Abnormal baseline MNA (odds ratio (OR) = 1.87, p = 0.021) and MMSE (OR = 2.58, p = 0.022) were independent predictive factors of MMSE impairment. These results suggest that pre-existing cognitive impairment and malnutrition are predictive factors for cognitive decline during chemotherapy in elderly cancer patients. Detection and management of these risk factors should be systematically considered in this population before starting chemotherapy.

Download Full-text

Malnutrition and Depressive Symptoms in Elderly Palliative Care Patients

Journal of Palliative Care ◽

10.1177/08258597211045500 ◽

2021 ◽

pp. 082585972110455

Author(s):

Eyyup M. Efendioglu ◽

Ahmet Cigiloglu ◽

Ibrahim H. Turkbeyler

Keyword(s):

Palliative Care ◽

Depressive Symptoms ◽

Nutritional Assessment ◽

Short Form ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Mini Nutritional Assessment ◽

Nutrition Status ◽

Strong Negative Correlation ◽

State Examination

Objective: The aim of this study is to determine the prevalence of and relationship between malnutrition and depressive symptoms in older palliative care inpatients. Methods: One hundred and thirty-six older adults were included in the study. The Geriatric Depression Scale, Mini Nutritional Assessment Short Form, Mini Mental State Examination, Barthel index, and Lawton & Brody index were used to evaluate the mood, nutrition status, mental status, and activities of daily living of the patients. Results: The mean age of the patients was 74.88 ± 8.82 years, and 63.2% of the patients were female. According to the nutritional assessment, 39.7% of the patients suffered from malnutrition, while 47.1% were at risk for it, and depressive symptoms were detected in 79.4% of the patients. A strong negative correlation was found between the scores for nutritional and depressive symptoms (r = −.750, 95% CI = −.834 to −.668). Conclusion: Malnutrition, risk of malnutrition, and depressive symptoms were found to occur often among the patients, and the relationship between them was statistically significant. Our results highlight that the quality of life of palliative care patients could be improved by providing adequate nutrition and psychological support.

Download Full-text

Impact of anticholinergic burden on cognitive impairment, disability and malnutrition: a cross-sectional study among hospitalized older patients

Geriatric Care ◽

10.4081/gc.2019.8473 ◽

2019 ◽

Vol 5 (2) ◽

Author(s):

Mariapaola Nastri ◽

Giulio Bartoli ◽

Paolo De Colle

Keyword(s):

Activities Of Daily Living ◽

Daily Living ◽

Rating Scale ◽

Nutritional Assessment ◽

Mini Nutritional Assessment ◽

Cross Sectional Study ◽

Cognitive Status ◽

Cross Sectional ◽

Anticholinergic Medications ◽

Anticholinergic Burden

The anticholinergic burden (ACB) is known to be associated with the worsening of functional and cognitive status. This study aims at demonstrating a correlation between the ACB and the malnutrition, given the widespread effect on the digestive tract of anticholinergic medications. From 2012 to 2018, 2843 patients were recruited among the new admissions to our Geriatric Unit. For each patient the activities of daily living (ADL), the instrumental activities of daily living (IADL), the mini mental state examination (MMSE), the cumulative illness rating scale (CIRS), the mini nutritional assessment (MNA) and the ACB of medications were evaluated. The correlations between the ACB and the ADL (P<0.001), the IADL (P<0.001), the MMSE (P<0.001) scores were confirmed, and a significant correlation was also found between the ACB and the MNA (P<0.001) score. The CIRS and the ACB scores resulted to be independent predictors of all outcomes considered, in a linear regression model adjusted for age, sex, comorbidity and number of prescribed drugs. Therefore, ACB seems to have by itself an impact on physical and cognitive functions and on nutritional status.

Download Full-text