Toll like receptors as a risk factor for early death in elderly cancer patients.

2017 ◽  
Vol 35 (7_suppl) ◽  
pp. 133-133
Author(s):  
Jurema Telles O Lima ◽  
Maria Julia Gonçalves Mello ◽  
Luiz Claudio Santos Thuler ◽  
Letícia Telles Sales ◽  
Marina Santaliz de Godoy Moreno ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Peripheral Blood ◽  
Skin Color ◽  
Protective Factor ◽  
Early Death ◽  
The Elderly ◽  
Nutritional Risk ◽  
Toll Like Receptors ◽  
Patients With Cancer ◽  
Incident Cancer

133 Background: the elderly cancer group is a heterogeneous and growing one. In the elderly, the genes of toll-like receptors (TLR) have been described as related to the immunosenescence process and carcinogenesis. The relationship of this gene family with carcinogenesis and immunoregulatory responses seems a promising field. Methods: Between 2015 and 2016, a prospective cohort study in 445 elderly patients with incident cancer ( ≥ 60 years) at the time of admission, assessed and collected sociodemographic and clinical variables and collected analysis of peripheral blood in translational exploratory study. Determination of TLR2 and TLR9 was performed by flow cytometry with monoclonal antibodies anti-TLR2 and TLR9 in the peripheral blood at the beginning of anti-cancer therapy in older patients with cancer. Results: 445 elderly patients were included with incident cancer, age of 71.13 years (SD 7.41) means. Most were male (50.9%) and self-reported black or brown skin color (71.4%). The topography of prostate cancer was more frequent (29.4%), followed by the digestive system (24.3%). They were mostly patients with advanced stage (III and IV) at nutritional risk (52.6%) and reported using up to 5 medications (77.2%). Patients were followed for an average of 128 days (SD 54.37). During this period, there were 62 deaths (13.9 %) with a mean overall survival of 165 days (95% CI 161.25 to 170.02). There are significant differences in the percentage values of TLR9 (p = 0.0009) and TLR2 (p = 0.04) in monocytes between the groups of patients who died in less than 6 months of treatment and those who survived. Conclusions: Overexpression of TLR9 and TLR2 may be a protective factor for the occurrence of early death in elderly patients with cancer.

scholarly journals Cancer Surgery in the Elderly

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Gopal C. Kowdley ◽  
Nishant Merchant ◽  
James P. Richardson ◽  
Justin Somerville ◽  
Myriam Gorospe ◽  
...  
Keyword(s):  
Decision Making ◽  
Elderly Patients ◽  
The Elderly ◽  
Cancer Surgery ◽  
Decision Making Process ◽  
Benefit Ratio ◽  
Patients With Cancer ◽  
The World ◽  
Surgery In The Elderly ◽  
Surgical Treatments

The proportions both of elderly patients in the world and of elderly patients with cancer are both increasing. In the evaluation of these patients, physiologic age, and not chronologic age, should be carefully considered in the decision-making process prior to both cancer screening and cancer treatment in an effort to avoid ageism. Many tools exist to help the practitioner determine the physiologic age of the patient, which allows for more appropriate and more individualized risk stratification, both in the pre- and postoperative periods as patients are evaluated for surgical treatments and monitored for surgical complications, respectively. During and after operations in the oncogeriatric populations, physiologic changes occuring that accompany aging include impaired stress response, increased senescence, and decreased immunity, all three of which impact the risk/benefit ratio associated with cancer surgery in the elderly.

Supportive Care Considerations for Older Adults With Cancer

2014 ◽  
Vol 32 (24) ◽  
pp. 2627-2634 ◽  
Author(s):  
Arash Naeim ◽  
Matti Aapro ◽  
Rashmi Subbarao ◽  
Lodovico Balducci
Keyword(s):  
Elderly Patients ◽  
Supportive Care ◽  
Chronic Conditions ◽  
Treatment Options ◽  
The Elderly ◽  
Strongly Correlated ◽  
Lifestyle Management ◽  
Patients With Cancer ◽  
Age Appropriate

The treatment of cancer presents specific concerns that are unique to the growing demographic of elderly patients. Because the incidence of cancer is strongly correlated with aging, the expansion of supportive care and other age-appropriate therapies will be of great importance as the population of elderly patients with cancer increases in the coming years. Elderly patients are especially likely to experience febrile neutropenia, complications from chemotherapy-induced nausea, anemia, osteoporosis (especially in patients diagnosed with breast or prostate cancer), depression, insomnia, and fatigue. These issues are often complicated by other chronic conditions related to age, such as diabetes and cardiac disease. For many patients, symptoms may be addressed both through lifestyle management and pharmaceutical approaches. Therefore, the key to improving quality of life for the elderly patient with cancer is an awareness of their specific needs and a familiarity with emergent treatment options.

scholarly journals Autoreactive Peripheral Blood T Helper Cell Responses in Bullous Pemphigoid and Elderly Patients With Pruritic Disorders

2021 ◽  
Vol 12 ◽  
Author(s):  
Dario Didona ◽  
Luca Scarsella ◽  
Milad Fehresti ◽  
Farzan Solimani ◽  
Hazem A. Juratli ◽  
...  
Keyword(s):  
T Cells ◽  
T Cell ◽  
Elderly Patients ◽  
Bullous Pemphigoid ◽  
Peripheral Blood ◽  
The Elderly ◽  
Area Index ◽  
Cell Responses ◽  
Autoreactive T Cell ◽  
Serum Igg

Bullous pemphigoid (BP) is a prototypic autoimmune disorder of the elderly, characterized by serum IgG autoantibodies, namely anti-BP180 and anti-BP230, directed against components of the basal membrane zone that lead to sub-epidermal loss of adhesion. Pruritus may be indicative of a pre-clinical stage of BP, since a subset of these patients shows serum IgG autoantibodies against BP230 and/or BP180 while chronic pruritus is increasingly common in the elderly population and is associated with a variety of dermatoses. Clinical and experimental evidence further suggests that pruritus of the elderly may be linked to autoimmunity with loss of self-tolerance against cutaneous autoantigens. Thus, the objective of this study was to determine autoreactive T cell responses against BP180 in elderly patients in comparison to patients with BP. A total of 22 elderly patients with pruritic disorders, 34 patients with bullous or non-bullous BP and 34 age-matched healthy controls were included in this study. The level of anti-BP180 and anti-BP230 IgG serum autoantibodies, Bullous Pemphigoid Disease Area Index (BPDAI), and pruritus severity were assessed for all patients and controls. For characterization of the autoreactive T cell response, peripheral blood mononuclear cells were stimulated ex vivo with recombinant BP180 proteins (NH2- and COOH-terminal domains) and the frequencies of BP180-specific T cells producing interferon-γ, interleukin (IL)-5 or IL-17 were subsequently determined by ELISpot assay. Patients with BP showed a mixed Th1/Th2 response against BP180 while autoreactive Th1 cells were identified in a minor subset of elderly patients with pruritic disorders. Furthermore, our T cell characterization revealed that therapeutic application of topical clobetasol propionate ointment in BP patients significantly reduced peripheral blood BP180-specific T cells, along with clinically improved symptoms, strongly suggesting a systemic immunosuppressive effect of this treatment.

Acute Myeloid Leukemia in Elderly Patients: Experience of the Antoine Lacassagne Center and a New Score to Define Fit Patients

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1317-1317 ◽  
Author(s):  
Bailleux Caroline ◽  
Fieux Thomas ◽  
Doyen Jerome ◽  
Gastaud Lauris ◽  
Gallamini Andrea ◽  
...  
Keyword(s):  
Palliative Care ◽  
Elderly Patients ◽  
Induction Chemotherapy ◽  
Death Rate ◽  
Myeloid Leukemia ◽  
Early Death ◽  
The Elderly ◽  
Charlson Score ◽  
Entire Cohort ◽  
Advisory Role

Abstract Management of Acute Myeloid Leukemia (AML) in the elderly is particularly difficult as life expectancy is highly variable and the benefit-risk ratio of treatment depends on comorbidities and age-related pharmacological specificities. Objective : To define the prognostic factors for overall survival (OS) and complete remission (CR) and establish a feasible and efficient new prognostic scoring system to assist clinicians in an age-adapted treatment strategy. Methods : From January 2000 to December 2014, 163 patients (pts) presenting an AML in a French regional cancer center in Nice were retrospectively analyzed. According to functional status, patients were treated with induction chemotherapy, azacitidine or palliative care. Complete remission rate (CR) and early-death rate were calculated. Six-month, 1-year and 2-year overall survival (OS) were analyzed with the Kaplan-Meier method and log-rank test. Univariate and multivariate logistic regression analyses were done and a p-value <0.1 and 0.05, respectively, were considered statistically significant. Population : From January 2000 to December 2014, 163 pts ³ 65 years were included; median age was 73.3 years (65-94.6), with 94 men (57.7%). PS was 0, 1, 2, 3 or 4 for 33 pts (20.3%), 77 pts (47.2%), 22 pts (13.5%), 20 pts (12.3%) and 6 pts (3.7%), respectively. Modified Charlson Score (calculated without considering age and leukemia criteria) was 0-1 and ³2 for 83 pts (50.9%) and 77 pts (47.2%), respectively. Secondary AML represented 44.2% of this elderly population. Induction chemotherapy was either full-dose cytarabin-daunorubicin 3+7, or cytarabin-idarubicin or cytarabin-clofarabine. Palliative care consisted of hydroxyurea and etoposid chemotherapy and best supportive care. Then, 112 pts (68.7%), 21 pts (12.9%) and 30 pts (18.4%) were treated with induction chemotherapy, azacitidine and palliative care, respectively. Among the 112 pts (68.7%) induced, 56 pts (35.9%) reached CR, 42 pts (25.8%) with a first induction and 14 pts (10.1%) with salvage chemotherapy. Otherwise, 39 pts (23.9%) ended up relapsing. Taking into account the entire treatment, 42 pts (25.8%) received azacitidine. Results : The 6-month, 1-year and 2-year OS for the entire cohort of 163 patients were 64.3%, 46.7% and 24.4%, respectively. Administration of induction chemotherapy was significantly predictive of CR (50% vs 2.0%, p<0.001) and almost predictive of 2-year OS (29% vs 12.5%, p=0.07). With or without induction chemotherapy, early-death rate (<8 weeks) was 12.5% and 37.3%, respectively. Thus, induction remained the best treatment for physically-fit elderly patients. Using azacitidine at any time of the treatment was a predictive factor of longer survival (1-year OS: 67.8% vs 36.9%, p=0.004). Otherwise, no impact was found on 2-year OS (25.6% vs 25.9%, NS). We tried to define a prognostic score to select elderly patients likely to benefit from induction chemotherapy. In univariate analysis, the significant prognostic factors of OS in the elderly population treated with induction chemotherapy was: age³ 75, unfavorable karyotype, creatinine clearance using the MDRD equation< 60ml/min/1.73m2, Modified Charlson Score ³2 and PS³2. In a multivariate analysis, only Charlson score and PS remained significant in terms of OS. Patients with Charlson Score ²1 and PS ²1 (0 unfavorable factor, n=60) or Charlson Score ³2 or PS ³2 (1 unfavorable factor, n=69) were considered to be at low risk (fit) for induction chemotherapy whereas patients with Charlson Score ³2 and PS³2 (2 unfavorable factors, 29 pts) were considered to be at high risk (frail). In the entire cohort (n=158 pts, data missing for 5 pts), Fit patients and Frail patients had an early-death rate of 10.8% vs 30.8% (p=0.048), a CR rate of 40.3% vs 3.8% (p<0.001), six-month OS 69.7% vs 39%, 1-year OS 53.7% vs 0% and 2-year OS 28.8% vs 0% (p<0.001), respectively. No survivors were observed in the frail group after one year of follow-up. Sub-group analysis found the same results for patients initially treated with induction chemotherapy or palliative treatment. Conclusion: We present a prognostic model composed of two easy-to-operate parameters that stratify patients into Fit or Frail groups. Patients with a Modified Charlson Score ³2 and a PS ³2 did not benefit from induction chemotherapy and had a high risk of death. In such cases, treatment should be azacitidine or palliative treatment. External validation is needed. Disclosures Nicolini: Novartis: Honoraria, Other: Consulting & Advisory Role, Research Funding, Speakers Bureau; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Consulting or Advisory Role, Speakers Bureau; ARIAD: Honoraria, Research Funding, Speakers Bureau; BMS: Other: Travel/Accommodations/Expenses; Novartis: Other: Travel, Accommodations, Expenses.

Nutritional risk as predictor for short-term outcomes in a prospective cohort of elderly patients with cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21533-e21533
Author(s):  
Jose Iran Costa ◽  
Jurema Telles O Lima ◽  
Anke Bergmann ◽  
Maria Julia Gonçalves Mello ◽  
Mirella Rebello Bezerra ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Geriatric Assessment ◽  
Cox Model ◽  
Short Form ◽  
Mini Nutritional Assessment ◽  
Premature Death ◽  
Nutritional Risk ◽  
Rank Test ◽  
Short Term ◽  
Patients With Cancer

e21533 Background: To determine if the nutritional risk according Mini Nutritional Assessment Short-Form (MNA®-SF) is an independent factor for short-term outcomes (infection, un programmed hospitalization and premature death) within the first six months after study entry. Methods:Prospective cohort study of elderly patients (≥ 60 years) with a recent diagnosis of cancer admitted to an outpatient oncology unit. At baseline sociodemographic and clinical variables were determined and comprehensive geriatric assessment (CGA) was conducted including MNA-SF. The outcomes were first Healthcare-associated Infection, un programmed hospitalization and death. Data were analyzed using multivariate Cox proportional hazards models; overall survival was estimated using the Kaplan–Meier method and survival curves were compared using the Log rank test. Results:The cohort consisted of 608 elderly patients followed for 180 days or until the censured data. Mean age was 71.9 years (range: 60‒96), 305 (50.2%) participants were at risk of malnutrition. During this period, 216 (35.5%) participants were hospitalized, 179 (29.4%) HAI and 100 (16.4%) died. After adjustment for age, site of cancer and cancer stage the multivariate regression Cox model showed that being undernourished was an independent predictor of infection (HR = 1.88, 95%CI 1.32-2.67, p < 0.001) hospitalization (HR = 1.5, 95% CI:1.10- 2.06, p = 0.012) and death (HR = 3.12, 95% CI: 1.74‒ 5.78, p < 0.001) Conclusions:Nutritional risk at admission was identified as a significant predictor of risk for premature death, infection, and need for hospitalization in elderly cancer patients. The use of MNA-SF should be incorporated into regular geriatric assessment of older patients with cancer

scholarly journals Nutritional risk as a predictor of short-term outcomes in a prospective cohort of elderly patients with cancer

2017 ◽  
Vol 28 ◽  
pp. v549
Author(s):  
L.T. Sales ◽  
J.T. Oliveira Lima ◽  
A. Bergmann ◽  
M.J.G. Mello ◽  
M. Rebello ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Prospective Cohort ◽  
Nutritional Risk ◽  
Short Term ◽  
Patients With Cancer

scholarly journals Sex Differences in the Outcomes of Elderly Patients with Acute Coronary Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Shi Tai ◽  
Xuping Li ◽  
Hui Yang ◽  
Zhaowei Zhu ◽  
Liang Tang ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Mortality Rate ◽  
Elderly Patients ◽  
Protective Factor ◽  
Multivariable Analysis ◽  
The Elderly ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
The Impact

Background. The impact of sex on the outcome of patients with acute coronary syndrome (ACS) has been suggested, but little is known about its impact on elderly patients with ACS. Methods. This study analyzed the impact of sex on in-hospital and 1-year outcomes of elderly (≥75 years of age) patients with ACS hospitalized in our department between January 2013 and December 2017. Results. A total of 711 patients were included: 273 (38.4%) women and 438 (61.6%) men. Their age ranged from 75 to 94 years, similar between women and men. Women had more comorbidities (hypertension (79.5% vs. 72.8%, p=0.050), diabetes mellitus (35.2% vs. 26.5%, p=0.014), and hyperuricemia (39.9% vs. 32.4%, p=0.042)) and had a higher prevalence of non-ST-segment elevation ACS (NSTE-ACS) (79.5% vs. 71.2%, p=0.014) than men. The prevalence of current smoking (56.5% vs. 5.4%, p<0.001), creatinine levels (124.4 ± 98.6 vs. 89.9 ± 54.1, p<0.001), and revascularization rate (39.7% vs. 30.0%, p=0.022) were higher, and troponin TnT and NT-proBNP tended to be higher in men than in women. The in-hospital mortality rate was similar (3.5% vs. 4.4%, p=0.693), but the 1-year mortality rate was lower in women than in men (14.7% vs. 21.7%, p=0.020). The multivariable analysis showed that female sex was a protective factor for 1-year mortality in all patients (OR = 0.565, 95% CI 0.351–0.908, p=0.018) and in patients with STEMI (OR = 0.416, 95% CI 0.184–0.940, p=0.035) after adjustment. Conclusions. Among the elderly patients with ACS, the 1-year mortality rate was lower in women than in men, which could be associated with comorbidities and ACS type.

scholarly journals Between spiritual wellbeing and spiritual distress: possible related factors in elderly patients with cancer

2014 ◽  
Vol 22 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Sílvia Caldeira ◽  
Emilia Campos de Carvalho ◽  
Margarida Vieira
Keyword(s):  
Elderly Patients ◽  
Spiritual Care ◽  
The Elderly ◽  
Clinical Validation ◽  
Spiritual Wellbeing ◽  
Methodological Study ◽  
Related Factors ◽  
Spiritual Distress ◽  
Patients With Cancer ◽  
Nursing Diagnosis

OBJECTIVE: this article describes the assessment of the spiritual wellbeing of elderly patients with cancer submitted to chemotherapy and possible predictive factors of the spiritual distress diagnosis. METHODOLOGY: this is a methodological study for clinical validation of a nursing diagnosis, using interviews to assist in completing the form. RESULTS: 45 elderly patients participated in this study, Catholics, mostly female, diagnosed with breast cancer, average age of 70.3 years. The prevalence of spiritual distress was of 42%; 24.4% of the elderly patients were under anti-depressant medication. A significant association was noted between spiritual distress, anti-depressant medication and level of education; an increase (not significant) was acknowledged at the start of the treatment. CONCLUSION: these results emphasize the relevance of clarifying this diagnosis and the responsibility of nurses to provide spiritual care to patients. Interventions should be planned appropriately every time a nursing diagnosis is identified as a complex answer and for which pharmacological treatment is not sufficient.

Surgical Considerations in Older Adults With Cancer

2014 ◽  
Vol 32 (24) ◽  
pp. 2647-2653 ◽  
Author(s):  
Beatriz Korc-Grodzicki ◽  
Robert J. Downey ◽  
Armin Shahrokni ◽  
T. Peter Kingham ◽  
Snehal G. Patel ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Functional Decline ◽  
The Elderly ◽  
Treatment Decisions ◽  
Morbidity And Mortality ◽  
Limiting Factor ◽  
Patients With Cancer ◽  
Cognitive Limitations ◽  
Appropriate Treatment ◽  
Safe Performance

Purpose The aging of the population is a real concern for surgical oncologists, who are increasingly being asked to treat patients who would not have been considered for surgery in the past. In many cases, decisions are made with relatively little evidence, most of which was derived from trials in which older age was a limiting factor for recruitment. Methods This review focuses on risk assessment and perioperative management. It describes the relationship between age and outcomes for colon, lung, hepatobiliary, and head and neck cancer, which are predominantly diseases of the elderly and are a major cause of morbidity and mortality. Results Effective surgery requires safe performance as well as reasonable postoperative life expectancy and maintenance of quality of life. Treatment decisions for potentially vulnerable elderly patients should take into account data obtained from the evaluation of geriatric syndromes, such as frailty, functional and cognitive limitations, malnutrition, comorbidities, and polypharmacy, as well as social support. Postoperative care should include prevention and treatment of complications seen more frequently in the elderly, including postoperative delirium, functional decline, and the need for institutionalization. Conclusion Surgery remains the best modality for treatment of solid tumors, and chronologic age alone should not be a determinant for treatment decisions. With adequate perioperative risk stratification, functional assessment, and oncologic prognostication, elderly patients with cancer can do as well in terms of morbidity and mortality as their younger counterparts. If surgery is determined to be the appropriate treatment modality, patients should not be denied this option because of their age.

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