Oncologists' perception of frailty.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24012-e24012
Author(s):  
Zuhair Alam ◽  
Brian Patrick Singeltary
Keyword(s):  
Older Adults ◽  
Professional Education ◽  
Online Survey ◽  
Performance Status ◽  
Geriatric Oncology ◽  
Screening Tools ◽  
Quality Improvement Initiative ◽  
Community Oncology ◽  
Oncology Providers

e24012 Background: Frailty is an under recognized yet clinically important consideration in treatment decision making for older adults with cancer. The Comprehensive Geriatric Assessment (CGA) is considered gold standard for recognition of frailty and is endorsed by the International Society of Geriatric Oncology. Additionally, multiple screening tools have been validated to reliably detect frailty. Nevertheless, studies suggest that formal screening for frailty is not prevalent in community oncology practices and that oncologists’ clinical judgement is not as sensitive in identifying frailty as CGA. This survey was designed to assess the perceptions of frailty amongst oncology providers, as well as the prevalence and method of frailty screening in these practices. Methods: After approval by an independent research ethics board, a secure online survey was circulated amongst community oncology providers within the TriHealth Cancer Institute, including MD’s, DO’s, and NP’s, via email. Survey was live from January 24th to February 12th. Data was analyzed using descriptive statistics. Results: There were 20 total respondents from medical, surgical, gynecologic, and radiation oncology, 70% MD/DO. 70% of total respondents reported having > 50% of their patients over the age of 65. All respondents reported being familiar with the concept of frailty and the ECOG performance status, while only 45% had heard of CGA. 40% respondents reported that they screen for frailty and all used ECOG alone or along with Karnofsky, none used CGA or other validated screening tools. 60% respondents did not formally assess frailty, however all but one felt frailty assessment to be beneficial. Most commonly cited barriers to screening were time restraints and lack of availability of follow up services. Conclusions: Despite proven clinical benefit of CGA and various validated screening tools, few oncology providers screen for frailty. Furthermore, only 45% report having heard of CGA while none incorporate it in their practice. This shows that professional education amongst oncology providers is needed to promote the use of CGA or alternative frailty screening measures to improve outcomes in older adults with cancer. Additionally, strategies must be implemented that would mitigate time restraints and lack of access to follow up services so that these providers may be more inclined to conduct such frailty assessments. Limitations of this study include potential for reporting bias and indeterminate generalizability. Next steps include quality improvement initiative of implementing a frailty screening tool in these practices.

scholarly journals How Is Geriatric Assessment Used in Clinical Practice for Older Adults With Cancer? A Survey of Cancer Providers by the American Society of Clinical Oncology

2020 ◽  
pp. OP.20.00442
Author(s):  
William Dale ◽  
Grant R. Williams ◽  
Amy R. MacKenzie ◽  
Enrique Soto-Perez-de-Celis ◽  
Ronald J. Maggiore ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Online Survey ◽  
Task Force ◽  
Statistical Significance ◽  
Geriatric Oncology ◽  
Perceived Barriers ◽  
Patients With Cancer ◽  
Change Behavior ◽  
American Society

PURPOSE: For patients with cancer who are older than 65 years, the 2018 ASCO Guideline recommends geriatric assessment (GA) be performed. However, there are limited data on providers’ practices using GA. Therefore, ASCO’s Geriatric Oncology Task Force conducted a survey of providers to assess practice patterns and barriers to GA. METHODS: Cancer providers treating adult patients including those ≥ 65 years completed an online survey. Questions included those asking about awareness of ASCO’s Geriatric Oncology Guideline (2018), use of validated GA tools, and perceived barriers to using GA. Descriptive statistics and statistical comparisons between those aware of the Guideline and those who were not were conducted. Statistical significance was set at P < .05. RESULTS: Participants (N = 1,277) responded between April 5 and June 5, 2019. Approximately half (53%) reported awareness of the Guideline. The most frequently used GA tools, among those aware of the Guideline and those who were not, assessed functional status (69% v 50%; P < .001) and falls (62% v 45%; P < .001). Remaining tools were used < 50% of the time, including tools assessing weight loss, comorbidities, cognition, life expectancy, chemotherapy toxicity, mood, and noncancer mortality risk. GA use was two to four times higher among those who are aware of the Guideline. The most frequent barriers for those who reported being Guideline aware were lack of resources, specifically time (81.7%) and staff (77.0%). In comparison, those who were unaware of the Guideline most often reported the following barriers: lack of knowledge or training (78.4%), lack of awareness about tools (75.2%), and uncertainty about use of tools (75.0%). CONCLUSION: Among providers caring for older adults, 52% were aware of the ASCO Guideline. Some domains were assessed frequently (eg, function, falls), whereas other domains were assessed rarely (eg, mood, cognition). Guideline awareness was associated with two to four times increased use of GA and differing perceived barriers. Interventions facilitating Guideline-consistent implementation will require various strategies to change behavior.

A systematic review of evidence-based aftercare for older adults following self-harm

2022 ◽  
pp. 000486742110671
Author(s):  
Anne PF Wand ◽  
Roisin Browne ◽  
Tiffany Jessop ◽  
Carmelle Peisah
Keyword(s):  
Older Adults ◽  
Qualitative Studies ◽  
Assessment Tools ◽  
Screening Tools ◽  
Safety Planning ◽  
Level Of Evidence ◽  
Heritage Foundation ◽  
Quality Ratings ◽  
Self Harm

Objective: Self-harm is closely associated with suicide in older adults and may provide opportunity to intervene to prevent suicide. This study aimed to systematically review recent evidence for three components of aftercare for older adults: (1) referral pathways, (2) assessment tools and safety planning approaches and (3) engagement and intervention strategies. Methods: Databases PubMed, Medline, PsychINFO, Embase and CINAHL were searched from January 2010 to 10 July 2021 by two reviewers. Empirical studies reporting aftercare interventions for older adults (aged 60+) following self-harm (including with suicidal intent) were included. Full text of articles with abstracts meeting inclusion criteria were obtained and independently reviewed by three authors to determine final studies for review. Two reviewers extracted data and assessed level of evidence (Oxford) and quality ratings (Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative and Attree and Milton checklist for qualitative studies), working independently. Results: Twenty studies were reviewed (15 quantitative; 5 qualitative). Levels of evidence were low (3, 4), and quality ratings of quantitative studies variable, although qualitative studies rated highly. Most studies of referral pathways were observational and demonstrated marked variation with no clear guidelines or imperatives for community psychiatric follow-up. Of four screening tools evaluated, three were suicide-specific and one screened for depression. An evidence-informed approach to safety planning was described using cases. Strategies for aftercare engagement and intervention included two multifaceted approaches, psychotherapy and qualitative insights from older people who self-harmed, carers and clinicians. The qualitative studies identified targets for improved aftercare engagement, focused on individual context, experiences and needs. Conclusion: Dedicated older-adult aftercare interventions with a multifaceted, assertive follow-up approach accompanied by systemic change show promise but require further evaluation. Research is needed to explore the utility of needs assessment compared to screening and evaluate efficacy of safety planning and psychotherapeutic approaches.

Use of the geriatric assessment in clinical practice in Mexico: A survey of cancer providers.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24013-e24013
Author(s):  
Haydee Cristina Verduzco-Aguirre ◽  
Laura Margarita Bolano Guerra ◽  
Hector Martínez-Said ◽  
Gregorio Quintero Beulo ◽  
Eva Culakova ◽  
...  
Keyword(s):  
Older Adults ◽  
Clinical Practice ◽  
Geriatric Assessment ◽  
Geriatric Oncology ◽  
Public Institution ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Qualified Personnel ◽  
Medical Oncologists ◽  
Oncology Providers

e24013 Background: Despite the growing burden of cancer in older adults in Mexico, it is unknown how many cancer care providers in Mexico use information obtained through a geriatric assessment (GA) and/or geriatric oncology principles in their everyday clinical practice. Methods: We administered a cross-sectional survey to oncology providers in Mexico via the Mexican Society of Oncology mailing list (n = 1240). The survey included questions on demographics, awareness about geriatric oncology principles, and the use of the GA and other geriatric clinical tools. The primary outcome was to estimate the proportion of providers using GA tools through the question: “For your patients ≥65 years, do you perform a multidimensional geriatric assessment using validated tools?”. We hypothesized that ≤10% of respondents would give a positive answer. We used descriptive statistics and X2 tests to compare groups of respondents. Results: We obtained 196 answers (response rate 15.8%). 121 (62%) respondents were male; median age 42. 98 (50%) were surgical oncologists, 59 (30%) medical oncologists, and 38 (19%) radiation oncologists. Median time in practice was 8 years, with 39% practicing in Mexico City. A third had their practice at a public institution, 26% at a private institution, and 38% in both. The proportion of patients aged 65-79 and ≥80 seen on an average clinic day by the respondents was 30% and 10%, respectively. 121 (62%) reported having a geriatrician available at their practice site. 37 respondents (19%) reported using validated GA tools to evaluate older adults with cancer in their practice. The proportion of respondents who evaluated each GA domain is shown in Table 1. Male respondents (p=0.03), medical oncologists (p<0.01), and those with a less busy practice (≤10 patients/day) (p=0.01) were more likely to use validated tools to perform a GA. Regarding barriers for implementing GA, 37% reported lack of time, 49% lack of qualified personnel, 44% lack of knowledge of geriatric tools, 6% patient unwillingness to undergo a GA, and 8% prohibitive cost. Only 17 (9%) thought that information obtained through a GA would not lead to practice changes. Conclusions: According to our survey, the proportion of Mexican oncology providers using validated tools to perform a GA is 19%, which is higher than expected. Some GA domains, such as comorbidity and functional status, were commonly assessed, while others, such as fall history, were seldom evaluated. Common barriers for GA implementation were lack of qualified personnel and of knowledge about geriatric tools. We plan to further explore these barriers and potential facilitators through focused interviews in order to guide future interventions.[Table: see text]

scholarly journals Validation of the detection of elder abuse through emergency care technicians (DETECT) screening tool: a study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037170
Author(s):  
Brad Cannell ◽  
Julie Weitlauf ◽  
Melvin D Livingston ◽  
Jason Burnett ◽  
Megin Parayil ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Care ◽  
Screening Tool ◽  
Elder Abuse ◽  
Well Being ◽  
Living Environment ◽  
Community Dwelling ◽  
Screening Tools ◽  
Semistructured Interview

IntroductionElder mistreatment (EM) is a high prevalence threat to the health and well-being of older adults in the USA. Medics are well-positioned to help with identification of older adults at risk for EM, however, field robust screening tools appropriate for efficient, observation-based screening are lacking. Prior work by this team focused on the development and initial pilot testing of an observation-based EM screening tool named detection of elder abuse through emergency care technicians (DETECT), designed to be implemented by medics during the course of an emergency response (911) call. The objective of the present work is to validate and further refine this tool in preparation for clinical dissemination.Methods and analysisApproximately 59 400 community-dwelling older adults who place 911 calls during the 36-month study observation period will be screened by medics responding to the call using the DETECT tool. Next, a random subsample of 2520 of the 59 400 older adults screened will be selected to participate in a follow-up interview approximately 2 weeks following the completion of the screening. Follow-up interviews will consist of a medic-led semistructured interview designed to assess the older adult’s likelihood of abuse exposure, physical/mental health status, cognitive functioning, and to systematically evaluate the quality and condition of their physical and social living environment. The data from 25% (n=648) of these follow-up interviews will be presented to a longitudinal, experts and all data panel for a final determination of EM exposure status, representing the closest proxy to a ‘gold standard’ measure available.Ethics and disseminationThis study has been reviewed and approved by the Committee for the Protection of Human Subjects at the University of Texas School of Public Health. The results will be disseminated through formal presentations at local, national and international conferences and through publication in peer-reviewed scientific journals.

Acute Myeloid Leukemia (AML). Diagnosis, Therapy and Outcome Results from Tawam Hospital. a Retrospective Review

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5254-5254
Author(s):  
Arif Alam ◽  
Ali Tahir ◽  
Masood H Syed ◽  
Sabir Hussain ◽  
Amar Lal ◽  
...  
Keyword(s):  
Older Adults ◽  
Acute Myeloid Leukemia ◽  
Supportive Care ◽  
Induction Therapy ◽  
Myeloid Leukemia ◽  
Performance Status ◽  
High Dose ◽  
Lost To Follow Up ◽  
Acute Myeloid

Abstract Introduction Acute Myeloid leukemia (AML) is a heterogeneous group of malignant disorders of myeloid hematopoetic cells. These cells have a maturation arrest in different stages of development leading to accumulation of immature cells. This gives rise to the different symptoms and signs of disease secondary to anemia, thrombocytopenia and neutropenia. The current WHO classification broadly divides AML into 4 main groups based on morphology, immunophenotyping, genetics and clinical features. These include AML with recurrent genetic abnormalities, AML with myelodysplasia related changes; therapy related AML and AML not otherwise specified (NOS). Therapeutically AML can be divided into 2 main groups; Acute promyelocytic leukemia (APML) and non APML. Methods Tawam Tumor registry was searched for patients with diagnosis of AML from January 2010 till December 2012. Patient records were then reviewed and data was collected. Results We identified 49 patients with pathologically confirmed diagnosis of AML. 19/49 patients were diagnosed with AML with recurrent cytogenetic, 5/49 with MDS related or therapy related and 25 with AML NOS Cytogenetic Analysis of this cohort of 49 patients with AML showed that 15 patients (30%) had APML with 15;17 translocation, 4 patients had 8;21 translocation, 5 had complex or poor risk cytogenetic while 13 had normal karyotype. In 12/49 patients Karyotyping failed due to growth failure. Status of FLT3 and NPM1 are not known for the entire cohort. Demographics The median age of the cohort was 38 years (range 20 to 84 years). Older adults (age 65 years or more) make a minority of this cohort (8%). Male to female ration was 3.5:1. Treatment In patients with Non APML Induction therapy was a combination of Cytarabine and Idarubicin for adults < 65 years of age and with good performance status. Older adults or adults with poor performance status or co-morbidities were either given hypomehtylating agents, Clofarabine or supportive care. Patients achieving complete remission (CR) were given consolidation with High Dose Cytarabine (HIDAC) as per CALGB protocol. Only a minority of patients were able to go for allogeneic stem cell transplantation in CR1 Patients with APML were treated with ATRA, Idarubicin/Mitoxantrone and Cytarabine as per PETHEMA protocol on a risk adjusted plan. This was followed by 2 year maintenance with ATRA, 6 MP and Methotrexate. Outcome of Treatment In non APML patients 62 % (17) achieved CR with induction therapy. Induction therapy failure was observed in 18 % (5) while there were 5 early deaths observed (during aplasia). 7 patients were treated with hypomethylating agents or best supportive care. Only 1patient was able to achieve CR (after cycle 4 of 5-azacitidine). Consolidation therapy was given to 17 patients achieving CR. With a median follow up of 15 months (range 9-24 months) 9 patients are alive and disease free while 17 patients have been lost to follow up. 8 out of these 17 patients were in remission at their last follow up. In APML patients the CR rate was 93%. There were no cases of induction failure and only 1 case of early death (7%) due to hemorrhage. With a median follow up of 17 months (range 11-41 months) 11 patients are in molecular CR while 3 have been lost to follow up. Conclusion This is the first analysis of patients who were diagnosed with AML in a tertiary care center in UAE. The results show that the median age of patients our cohort is low as compared to international reports (approximately 38 vs. 65 years). Older adults (> 65 years of age) make only a minority of the AML cohort in Tawam Hospital. Response to induction therapy is comparable to international standards (60-80%) for AML and > 90% for APML. We also report a twofold higher incidence of APML as compared to internationally reported data (30% vs.12%). This has a very significant diagnostic and therapeutic impact on the management of AML patients at our institute leading to increase vigilance and institution of ATRA at the earliest clinical suspicion of APML. Disclosures Alam: BMS: Consultancy, Honoraria; Novartis: Consultancy, Honoraria. Hussain:BMS: Honoraria; Novartis: Honoraria. Lal:BMS: Honoraria; novartis: Honoraria.

Predictive Validity of Health-Related Fitness Tests on Back Pain and Related Disability: A 6-Year Follow-Up Study Among High-Functioning Older Adults

2012 ◽  
Vol 9 (2) ◽  
pp. 249-258 ◽  
Author(s):  
Pauliina Husu ◽  
Jaana Suni
Keyword(s):  
Older Adults ◽  
Back Pain ◽  
Community Dwelling ◽  
Screening Tools ◽  
Increased Risk ◽  
Fitness Tests ◽  
Health Related ◽  
Side Bending ◽  
Health Related Fitness

Background:Back pain and related disability seem to be increasing among older adults. Health-related fitness tests have been developed to identify individuals at risk for mobility difficulties. However, poor fitness as a risk factor for back problems has seldom been studied. The purpose of the current study was to investigate whether performance in fitness tests predicts back pain and related disability during 6 years of follow-up.Methods:Study population consisted of community-dwelling men and women, born 1927 to 1941, who participated in assessment of health-related fitness and reported no long-term back pain or related disability at baseline (n = 517). The assessment included measurements of body mass index (BMI), one-leg stand, backward tandem walk, trunk side-bending, dynamic back extension, forward squat, 6.1-m walking speed and 1-km walk time.Results:Prospective analyses indicated that poor fitness (poorest-third) in one-leg stand and trunk side-bending tests were the most powerful predictors of back pain. Regarding disability, poor fitness in dynamic back extension and overweight in terms of BMI ≥ 27 increased the risk.Conclusions:Tests of balance, trunk flexibility and trunk muscle endurance, as well as BMI can be implemented as screening tools for identifying persons with increased risk of back pain and related disability.

scholarly journals Coping With the Oncology Workforce Shortage: Transitioning Oncology Follow-Up Care to Primary Care Providers

2010 ◽  
Vol 6 (4) ◽  
pp. 203-205 ◽  
Author(s):  
David Debono
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Cancer Center ◽  
Care Providers ◽  
Effective Response ◽  
Medical Societies ◽  
Community Oncology ◽  
Follow Up Care ◽  
Oncology Providers

An effective response to the impending shortage of oncology services will require different actions from governmental bodies, academic cancer center leaders, medical societies, and community oncology providers.

Geriatric oncology: The ultimate personalized cancer care

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. s2a-s2a
Author(s):  
Martine Extermann
Keyword(s):  
Cancer Care ◽  
Older Patients ◽  
Performance Status ◽  
Geriatric Oncology ◽  
Cancer Prognosis ◽  
Screening Tools ◽  
World Population ◽  
Related Factors ◽  
Aging Research ◽  
Treatment Tolerance

s2a In many aspects, geriatric oncology is the quintessential expression of ASCO's 2009 theme: personalizing cancer care (PCC). PCC has two aspects: the tumor and the patient. Major efforts are conducted to identify mechanisms in an individual tumor that could be targeted more effectively by therapies. This research generates huge amounts of data, which creates a challenge in selecting the best therapeutic targets. As senescence has aspects that both prevent and favor cancer, we could take advantage of basic aging research to identify more effectively which mechanisms are key, and which are epiphenomena. Increasingly recognized also is the role of the microenvironment and macroenvironment—the patient—in influencing cancer prognosis and treatment tolerance. Here again, we can learn much from older patients. Seventy-five-year-olds are much more diverse than 25-year-olds. This provides higher sensitivity to detect patient-related factors. The last decade of work in geriatric oncology has demonstrated that geriatric instruments improve prognostic assessment beyond classic oncology predictors. Tantalizing data show that a geriatric intervention might even improve significantly the survival of patients with cancer. We now have screening tools simple enough to be used in oncology practice. In the same way that we are moving away from, for example, lumping all non-small cell lung cancers together, we are moving away from considering the patient condition as a relatively neutral background summarized by an ECOG Performance Status. Older patients also have remarkably diverse life experiences and patterns of functioning. This has enabled significant learning about individualizing the prediction of treatment tolerance and of willingness to undertake it. Geriatric oncology is an ideal terrain to explore end points such as the maintenance of independence and personal goals by cancer survivors. As the world population ages, we are progressing toward providing cancer care tailored to both the tumor and the older cancer patient.

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