scholarly journals Frailty-independent Undertreatment Negative Impact on Survival in Older Patients With Breast Cancer

2021 ◽  
Author(s):  
Fernando Osório ◽  
António Barros ◽  
Bárbara Peleteiro ◽  
Ana Rita Barradas ◽  
Joana Urbano ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Patients ◽  
Negative Impact ◽  
Treatment Options ◽  
Daily Practice ◽  
Screening Tools ◽  
Impact On Survival ◽  
Causes Of Mortality ◽  
Ecog Ps ◽  
Self Examination

Abstract Introduction: The management of older patients with breast cancer remains controversial. The difficult assessment of ageing idiosyncrasies and the insufficient evidence of therapeutic guidelines can lead to undertreatment. Our goal was to measure undertreatment and assess its impact on survival.Materials and methods: Consecutive patients with breast cancer aged 70 years or older were prospectively enrolled in 2014. Three frailty screening tools (G8, fTRST, GFI) and two functional status scales (KPS, ECOG-PS) were applied. Disease characteristics, treatment options and causes of mortality were recorded in a 5-year follow-up. We defined undertreatment and correlated its survival impact with frailty. Results: A total of 92 patients were included. Median age was 77 (range 70-94) years. The prevalence of frailty was discordant (G8: 41,9%, fTRST: 74.2%, GFI: 32.3%). A low-risk disease was not found (51.2% were N+) probably due to a late diagnosis (76.1% based on self-examination). Thirty-three patients (35.6%) died 15 of them from breast cancer. We found a considerable high proportion (53.3%) of undertreatment, which had a frailty-independent negative impact on 5-year survival (HR=5.1 [95% CI: 2.1-12.5]). Additionally, omission of surgery had a frailty-independent negative impact on overall survival (HR=3.9 [95% CI: 1.9-7.9]). Conclusion: Breast cancer treatment in older adults ought to be individualized. More important than assessing frailty (not to treat) is essential to be aware of the risk-benefit profile and the patient's well-informed willingness to be treated. The undertreatment in daily practice is frequent and might have, as we report, a negative impact on survival.

scholarly journals Frailty-Independent Undertreatment Negative Impact on Survival in Older Patients with Breast Cancer

2021 ◽  
Vol 24 ◽  
Author(s):  
Fernando Osório ◽  
António S. Barros ◽  
Bárbara Peleteiro ◽  
Ana Rita Barradas ◽  
Joana Urbano ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Patients ◽  
Negative Impact ◽  
Impact On Survival

Considerations and Controversies in the Management of Older Patients with Advanced Cancer

2012 ◽  
pp. 321-328 ◽  
Author(s):  
Supriya Gupta Mohile ◽  
Heidi D. Klepin ◽  
Arati V. Rao
Keyword(s):  
Advanced Cancer ◽  
Older Patients ◽  
Clinical Care ◽  
Treatment Options ◽  
Screening Tools ◽  
Patients With Cancer ◽  
Functional Consequences ◽  
Oncology Practice ◽  
Combined Data

Overview: The incidence of cancer increases with age. Oncologists need to be adept at assessing physiologic and functional capacity in older patients in order to provide safe and efficacious cancer treatment. Assessment of underlying health status is especially important for older patients with advanced cancer, for whom the benefits of treatment may be low and the toxicity of treatment high. The comprehensive geriatric assessment (CGA) is the criterion standard for evaluation of the older patient. The combined data from the CGA can be used to stratify patients into categories to better predict risk for chemotherapy toxicity as well as overall outcomes. The CGA can also be used to identify and follow-up on possible functional consequences from treatment. A variety of screening tools might be useful in the oncology practice setting to identify patients who may benefit from further testing and intervention. In this chapter, we discuss how the principles of geriatrics can help improve the clinical care of older adults with advanced cancer. Specifically, we discuss assessing tolerance for treatment, options for chemotherapy scheduling and dosing for older patients with advanced cancer, and management of under-recognized symptoms in older patients with cancer.

scholarly journals PREDICTORS OF BREAST SELF-EXAMINATION UPTAKE AMONG WOMEN IN MALE’ REGION, MALDIVES

2021 ◽  
Vol 21 (2) ◽  
pp. 440-448
Author(s):  
Aishath Niyaf ◽  
Sairah AK ◽  
Mohammed Abdalqader
Keyword(s):  
Breast Cancer ◽  
Early Detection ◽  
Clinical Breast Examination ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Breast Self Examination ◽  
Continued Education ◽  
Clinical Breast ◽  
Causes Of Mortality ◽  
Self Examination

Breast cancer (BC), is the most common cancer that affects women, and one of the significant causes of mortality among them. Screening and early detection of the disease are encouraged as a means of reducing mortality and enhancing the prognosis. The purpose of the study is to determine the prevalence of Breast Self-Examination (BSE) uptake and to identify the factors that are associated with the BSE uptake among Maldivian women in the Male’ region. The cross-sectional study was carried out over a period of 3 months in the Male’ region, of the Maldives. A total of 600 female citizens aged 20-79 years were selected using stratified random sampling method. Data were collected using an interviewer-administered questionnaire. About 82.70%, 54.80%, and 63.30% of the respondents had heard about BC, breast cancer screening (BCS), and BSE respectively. 50.80% of the respondents had ever performed BSE with only 22.00% performed it regularly. The significant predictors for BSE uptake were: ever heard about BC [OR=2.069, 95% CI(1.081-3.959)], ever heard about BSE [OR=2.342, 95% CI(1.326-4.137)], ever heard about clinical breast examination (CBE) [OR=1.946, 95% CI(1.117-3.390)], knowledge on early detection of BC [OR=1.077, 95% CI(1.011-1.148)], perceptions on the severity of BC [OR=1.062, 95% CI(1.010-1.116)], perceptions on barriers towards BSE [OR=0.900, 95% CI(0.846-0.958)] and self-efficacy [OR=1.112, 95% CI(1.076-1.150)]. The findings indicated that there is a pressing need for continued education and behaviour modification intervention programs using theories and models to increase women’s overall knowledge and awareness of BC and BCS and modify the long-held incorrect beliefs and misconceptions. In particular, the relevant authorities should play a proactive role in raising awareness of BC and promote BCS.

scholarly journals Breast Developmental Anomalies in Dormaa Municipality of Ghana: Prevalence and Impact on the Life of the Individual

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
P. Agbenorku ◽  
E. Otupiri ◽  
S. Fugar
Keyword(s):  
Breast Cancer ◽  
Breast Tissue ◽  
Health Workers ◽  
Negative Impact ◽  
Descriptive Study ◽  
Educational Programs ◽  
Breast Development ◽  
Developmental Anomalies ◽  
The Individual ◽  
Self Examination

Background. Breast developmental anomalies (BDAs) are abnormalities of breast tissue that arise during breast development. Some of the anomalies can have negative impact on the person's life. This study seeks to assess the prevalence of BDA in the Dormaa Municipality in Ghana and its impact on the life of the individual. Materials and Methods. A descriptive study involving 500 female respondents aged between 11 and 25 years from selected schools in the Dormaa Municipality using self-administered questionnaires and interviews. Results. From the study, it was found that the prevalence of BDA in the municipality was 12.8%. The commonest BDA was bilateral hypoplasia which accounted for 31.3% of the BDAs found in the study. Nine (14.1%) complained of the BDA affecting their lives with most being teased in school. Twenty-two (34.4%) girls out of the 64 with BDAs had a family member with a BDA. Conclusion. BDA is a worry; therefore, comprehensive educational programs for health workers and the general public are needed to increase awareness. Also, work should be done to include education on BDA when awareness is being raised about breast cancer and on the importance of breast self-Examination (BSE).

scholarly journals An Overview of Treatment of Crush Syndrome.

2021 ◽  
Vol 5 (1) ◽  
pp. 797-801
Author(s):  
Merita Rroji ◽  
Saimir Seferi ◽  
Myftar Barbullushi
Keyword(s):  
Acute Kidney Injury ◽  
Building Materials ◽  
Negative Impact ◽  
Kidney Diseases ◽  
Kidney Injury ◽  
Daily Practice ◽  
Crush Syndrome ◽  
Impact On Survival ◽  
Complex Technology ◽  
Mass Disasters

Natural mass disasters directly or indirectly affect huge populations, who need basic infrastructural help and assistance to survive. However, despite the potentially negative impact on survival chances, the authorities often dismiss these health care issues. This impact is of great importance, especially in the emerging world, where the casualty rates are much higher because of inappropriate building materials and lack of appropriate construction standards. Thus, massive destruction can occur with earthquakes of even moderately low magnitude.  The first description of the crush syndrome appeared in the modern medical literature after the Messina earthquake in 1909. Since crush syndrome is quite rare in daily practice, mistakes are frequent in treating these cases. This review summarizes the etiopathogenesis of traumatic rhabdomyolysis and crush syndrome based acute kidney injury. The clinical and laboratory features, prophylaxis, and treatment of crush cases are described as well. The importance of early and dynamic fluid resuscitation is indicated for the prophylaxis of acute kidney injury. Treatment of both acute and chronic kidney diseases (CKDs) is especially problematic after disasters because they almost always require complex technology and equipment, whereas specific drugs may be difficult to obtain to treat chronic kidney patients. Although crush syndrome is a major cause of mortality in the rescued victims of massive earthquakes, the number of deaths due to crush syndrome (or fatalities of renal disaster) can be decreased by appropriate management. plaints.

scholarly journals Undertreatment or overtreatment – how far from each other in geriatric oncology?

2020 ◽  
Vol 2 (1) ◽  
pp. 18-25
Author(s):  
Janusz Kocik
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Older Patients ◽  
Cancer Survival ◽  
Treatment Options ◽  
Geriatric Oncology ◽  
Premature Death ◽  
Screening Methods ◽  
Breast Cancer Patients ◽  
Choice Of Treatment

The mortality due to cancers of older patients, in age above 65 years of life, in comparison to younger is higher in majority of these diseases. It has been also reported that seniors are frequently denied the treatment according to current standards of therapy, thus suffer from undertreatment. There is solid evidence from controlled trials that older patients may tolerate pharmacological therapies in some cancers as well as young, providing they are under good supportive care. At the same time aggressive multimodal treatment may cause immediate or delayed side effects and exhaustion of reserves of the vital organs in elderly. This may cause a general deterioration, a decompensation of comorbidities, an evolution of geriatric syndromes and premature death, not directly caused by cancer. Such situation in aged cancer patients should be called the overtreatment. In diseases with better prognosis, with effective screening methods and large choice of treatment options like breast cancer, survival is getting better, although not in the eldest. The worse prognosis in old breast cancer patients may be caused to some extent by undertreatment. More fatal tumors like NSCLC await further optimization of cancer therapy towards better toxicity profile to avoid overtreatment.

P211 COMPARISON OF PROGNOSTIC VALUE FOR G8 SCREENING TOOLS WITH FTRST IN OLDER PATIENTS OF ESOPHAGEAL CANCER

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Terayama Masayoshi ◽  
Yamada Kazuhiko ◽  
Saito Noriyuki ◽  
Wake Hitomi ◽  
Kataoka Atsuko ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Predictive Value ◽  
Older Patients ◽  
Prognostic Value ◽  
Postoperative Outcome ◽  
The Elderly ◽  
Screening Tools ◽  
Ecog Ps

Abstract Aim We investigated two prognostic value of geriatric screening tools, G8 and Flemish version of the Triage Risk Screening Tool (fTRST), for overall survival and postoperative outcome in older patients undergoing esophagectomy for esophageal cancer (EC). Backgrounds&Method The elderly cancer population is a very heterogeneous group due to differences in comorbidities and functional status. G8 and fTRST are short and easy tools to administer in clinical settings and reported to be useful for identifying patients with geriatric risks. However, the prognostic value of G8 and fTRST has not been compared in EC patients after surgery. Patients aged ≥ 70 years old with EC were retrospectively included who received an operation at National Center for Global Health and Medicine from April 2014 to December 2017. G8 and fTRST were administered to all patients. The impaired were defined as a G8 ≤ 14 and fTRST ≥ 2. We evaluated overall survival (OS) and 30-day postoperative complications classified into Clavien-Dindo (CD) severity grade. Results 63 patients were included. Median age was 76 years (range, 70 to 89 years), and 84% of patients were men. 44 patients (69%) were G8 impaired, 22 patients (34%) were fTRST impaired, 23 patients (36%) were impaired on both screening tools. G8 was an independent predictor of overall survival (hazard ratio 9.9; 95% confidence interval 1.24-79.4, p=0.02), while fTRST was not. The CD≥3 postoperative complications occurred in 33 patients (52%). In univariable logistic regressions, ECOG-PS, G8 and fTRST were associated with CD≥3 complications. G8 alone was not independently predictive for CD≥3 complications, however combined with fTRST, the predictive value of G8 was increased (p=0.001). Conclusions G8 is useful for prognostic value of OS and prior to fTRST in EC. G8 combined with Ftrst has the strongest predictive value for postoperative CD≥3 complications. Further studies are needed to design interventions to improve outcomes for those frail patients.

scholarly journals Prevalence of cognitive impairment following chemotherapy treatment for breast cancer: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Alexandra L Whittaker ◽  
Rebecca P George ◽  
Lucy O’Malley
Keyword(s):  
Breast Cancer ◽  
Cognitive Impairment ◽  
Neuropsychological Tests ◽  
Negative Impact ◽  
Self Report ◽  
Screening Tools ◽  
Low Grade ◽  
Chemotherapy Treatment ◽  
Time Points

AbstractBreast cancer survival rates have markedly improved. Consequently, survivorship issues have received increased attention. One common sequela of treatment is chemotherapy- induced cognitive impairment (CICI). CICI causes a range of impairments that can have a significant negative impact on quality of life. Knowledge of the prevalence of this condition is required to inform survivorship plans, and ensure adequate resource allocation and support is available for sufferers.ObjectiveTo estimate the prevalence of cognitive impairment following chemotherapy treatment for breast cancer.MethodsMedline, Scopus, CINAHL and PSYCHInfo were searched for eligible studies which included prevalence data on CICI, as ascertained though the use of self-report, or neuropsychological tests. Methodological quality of included studies was assessed. Findings were synthesised narratively, with meta-analyses being used to calculate pooled prevalence when impairment was assessed by neuropsychological tests.Results and discussionThe review included 52 studies. Time-points considered ranged from the chemotherapy treatment period to greater than 10 years after treatment cessation. Summary prevalence figures (across time-points) using self-report, short cognitive screening tools and neuropsychological test batteries were 44%, 16% and 21-34% respectively (very low GRADE evidence).ConclusionSynthesised findings demonstrate that 1 in 3 breast cancer survivors may have clinically significant cognitive impairment. Prevalence is higher when self-report based on patient experience is considered. This review highlights a number of study design issues that may have contributed to the low certainty rating of the evidence. Future studies should take a more consistent approach to the criteria used to assess impairment. Larger studies are urgently needed.Summary of Findings Table

Breast cancer awareness among pharmacy and physiotherapy students of medical university Nawabshah

2020 ◽  
pp. 1-12
Author(s):  
Rao Irfan ◽  
Hisbullah Memon ◽  
Ishfaque Nazeer Umrani ◽  
Habibullah Soomro
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Risk ◽  
Treatment Options ◽  
Cancer Awareness ◽  
Cross Sectional ◽  
Breast Self Examination ◽  
Cancer Risk Factors ◽  
Medical University ◽  
Self Examination

Abstract Objective: To evaluate the knowledge and awareness of students at a medical university regarding possible risk factors and screening modalities of breast cancer. Methods: The cross-sectional study was conducted from January to April 2019 at the People’s University of Medical and Health Sciences for Women, Nawabshah, Pakistan, and compried young female students from first year to final year at the Institute of Pharmaceutical Sciences and the Institute of Physiotherapy and Rehabilitation Sciences of the university. Data was collected using a predesigned questionnaire, and was analysed using SPSS 21. Results: Of the 450 students approached, 375(84%) completed the questionnaire. The mean age of the participants was 21.06±1.164 years (range: 18-26 years). Overall, 225(60%) students said contraceptive pills could increase the risk of breast cancer, 267(71.2%) agreed that breast-feeding could reduce cancer risk, while 361 (96.27%) of the students had good mammography and clinical breast examination knowledge. Also, 308(82.13%) respondents knew about breast self-examination, but were not aware of its procedure. Conclusion: Majority of the subjects had knowledge and awareness about breast cancer, its risk factors, diagnostic parameters and possible treatment options, but they did not have knowledge regarding the procedures of breast self-examination. Key Words: Breast cancer, Risk factors, Mammography, Breast self-examination. Continuous...

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