scholarly journals Current Status and Problems of Preoperative Assessment for Elderly Cancer Surgery Patients in Japan: A Nationwide Survey

2021 ◽  
Author(s):  
Daisuke Inoue ◽  
Makoto Yamamoto ◽  
Hisatomi Arima ◽  
Kazuo Tamura ◽  
Yoshio Yoshida
Keyword(s):  
Medical Education ◽  
Surgical Treatment ◽  
Cancer Patients ◽  
Treatment Plan ◽  
Performance Status ◽  
Geriatric Oncology ◽  
Preoperative Assessment ◽  
Current Status ◽  
Department Heads ◽  
Elderly Cancer Patients

Abstract Elderly cancer patients requiring surgical treatment are increasing, and the deterioration of quality of life and shortening of healthy life expectancy due to postoperative complications represent major problems. This study investigated the current status of medical treatment, including perioperative evaluations, for elderly cancer patients requiring surgical treatment at cancer treatment facilities nationwide. A total of 436 cancer care facilities around Japan were invited to participate in this web-based survey regarding management of cancer patients ≥65 years old who had undergone surgical treatment in 2018. A total of 919 department heads from 245 facilities agreed to participate. Although most respondents answered that performance status, preoperative examinations, and comorbidities were important when deciding on a treatment plan, age, Geriatric Assessment (GA), and guidelines were "not important" for >10% of all respondents. GA was familiar to 195 department heads (21%), and awareness of GA was significantly lower among respondents from medical education institutions than the other types of hospitals (18.5% vs 26.3%; P = 0.006). This large survey revealed that the use of GA is not widespread, and its awareness in medical education institutions remains low. We believe that accumulating evidence of geriatric oncology surgery is an urgent issue in Japan.

scholarly journals A nationwide web-based survey of oncologic surgeons to clarify the current status of preoperative assessment for elderly cancer surgery patients in Japan

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Daisuke Inoue ◽  
Makoto Yamamoto ◽  
Hisatomi Arima ◽  
Kazuo Tamura ◽  
Yoshio Yoshida
Keyword(s):  
Medical Education ◽  
Surgical Treatment ◽  
Cancer Patients ◽  
Treatment Plan ◽  
Performance Status ◽  
Geriatric Oncology ◽  
Current Status ◽  
Department Heads ◽  
Web Based ◽  
Elderly Cancer Patients

AbstractElderly cancer patients requiring surgical treatment are increasing, and the deterioration of quality of life and shortening of healthy life expectancy due to postoperative complications represent major problems. This study investigated the current status of medical treatment, including perioperative evaluations, for elderly cancer patients requiring surgical treatment at cancer treatment facilities nationwide. A total of 436 cancer care facilities around Japan were invited to participate in this web-based survey regarding management of cancer patients ≥ 65 years old who had undergone surgical treatment in 2018. A total of 919 department heads from 245 facilities agreed to participate. Although most respondents answered that performance status, preoperative examinations, and comorbidities were important when deciding on a treatment plan, age, Geriatric Assessment (GA), and guidelines were "not important" for > 10% of all respondents. GA was familiar to 195 department heads (21%), and awareness of GA was significantly lower among respondents from medical education institutions than the other types of hospitals (18.5% vs 26.3%; P = 0.006). This large survey revealed that the use of GA is not widespread, and its awareness in medical education institutions remains low. We believe that accumulating evidence of geriatric oncology surgery is an urgent issue in Japan.

Comprehensive Geriatric Assessment Adds Information to Eastern Cooperative Oncology Group Performance Status in Elderly Cancer Patients: An Italian Group for Geriatric Oncology Study

2002 ◽  
Vol 20 (2) ◽  
pp. 494-502 ◽  
Author(s):  
Lazzaro Repetto ◽  
Lucia Fratino ◽  
Riccardo A. Audisio ◽  
Antonella Venturino ◽  
Walter Gianni ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Daily Living ◽  
Group Performance ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Geriatric Oncology ◽  
Oncology Group ◽  
Elderly Cancer Patients

PURPOSE: To appraise the performance of Comprehensive Geriatric Assessment (CGA) in elderly cancer patients (≥ 65 years) and to evaluate whether it could add further information with respect to the Eastern Cooperative Oncology Group performance status (PS). PATIENTS AND METHODS: We studied 363 elderly cancer patients (195 males, 168 females; median age, 72 years) with solid (n = 271) or hematologic (n = 92) tumors. In addition to PS, their physical function was assessed by means of the activity of daily living (ADL) and instrumental activities of daily living (IADL) scales. Comorbidities were categorized according to Satariano’s index. The association between PS, comorbidity, and the items of the CGA was assessed by means of logistic regression analysis. RESULTS: These 363 elderly cancer patients had a good functional and mental status: 74% had a good PS (ie, lower than 2), 86% were ADL-independent, and 52% were IADL-independent. Forty-one percent of patients had one or more comorbid conditions. Of the patients with a good PS, 13.0% had two or more comorbidities; 9.3% and 37.7% had ADL or IADL limitations, respectively. By multivariate analysis, elderly cancer patients who were ADL-dependent or IADL-dependent had a nearly two-fold higher probability of having an elevated Satariano’s index than independent patients. A strong association emerged between PS and CGA, with a nearly five-fold increased probability of having a poor PS (ie, ≥ 2) recorded in patients dependent for ADL or IADL. CONCLUSION: The CGA adds substantial information on the functional assessment of elderly cancer patients, including patients with a good PS. The role of PS as unique marker of functional status needs to be reappraised among elderly cancer patients.

scholarly journals Framing the preoperative assessment of the oncogreriatric patient. The surgeon’s point of view

2017 ◽  
Vol 6 (4) ◽  
Author(s):  
Dimitris Papagoras ◽  
Maria Kanara ◽  
Stella Ntouvli
Keyword(s):  
Decision Making ◽  
Cancer Patients ◽  
Treatment Plan ◽  
Preoperative Evaluation ◽  
Social Dilemmas ◽  
Preoperative Assessment ◽  
Point Of View ◽  
Decision Making Process ◽  
Evidence Based ◽  
Elderly Cancer Patients

<p align="justify"><em>Elderly cancer patients represent a steadily rising population constituting a daily problem for any physician, who is confronted not only with medical questions but also with ethical and social dilemmas. In addition oncogeriatric patients are underrepresented or excluded from trials especially in surgery which results in a gap in practical and evidence based knowledge regarding their preoperative evaluation and treatment. Therefore the authors outline the framework a decision making process for a meaning – and success- full treatment plan has to rely on.</em><em></em></p>

Status of geriatric oncology in India: A national multicentric survey of oncology professionals

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 16035-16035
Author(s):  
B. Arora ◽  
P. M. Parikh ◽  
R. Nair ◽  
A. Vora ◽  
S. Gupta ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Clinical Care ◽  
Performance Status ◽  
Geriatric Oncology ◽  
Standard Of Care ◽  
Poor Performance Status ◽  
Elderly Cancer Patients ◽  
Medical Oncologists

16035 Background: Elderly cancer patients are underrepresented in cancer services utilization and clinical research in India. National data on providers’ knowledge, attitude and practices with regard to elderly cancer patients is sparse and is urgently required to address needs of this vulnerable and growing population. Methods: A self administered questionnaire was mailed to nationally representative sample of practicing oncologists all over India. 112 Oncologists (Medical Oncologists-51%; Radiation Oncologists-25%; Surgical Oncologists-20%; allied fields-4%) responded out of 250 mailed Questionnaires. Results: A designated Geriatric Oncology unit is in existence in very few (<5%) centers. Majority (51%) considered patients with chronological age of >60 years as elderly for India. Although 75% of elderly patients receive some therapy, only 50% of potentially curable patients and a similar percentage of potentially incurable patients receive standard of care. Also, 50% patients require modification in their treatment and only two-third of treated patients complete therapy. The existent barriers to treatment included poor performance status (53%), advanced stage (16%), and co-morbidities (15%). Only 51% Oncologists always discussed and 28% always enrolled elderly patients in clinical trials. Standard of care and evidence based recommendations for elderly patients were felt to be lacking by 49% and 92% of respondents respectively. The need of separate trials for elderly and a separate discipline of Geriatric Oncology was voiced by 93% and 89% of respondents respectively. Major differences in treatment practice between medical oncologists and non medical oncologists are shown in table . Conclusions: Treatment practices and accrual of elderly cancer patients in clinical trials in India is far from optimal. Formation of a National Geriatric Oncology society and creation of designated Geriatric oncology services at key centers may enhance the understanding and clinical care of this population. [Table: see text] No significant financial relationships to disclose.

Weekly Low Dose Epirubicin in Elderly Cancer Patients

1996 ◽  
Vol 82 (4) ◽  
pp. 369-371 ◽  
Author(s):  
Dario Nicolella ◽  
Giuseppe Grimaldi ◽  
Giuseppe Colantuoni ◽  
Mario Belli ◽  
Giuseppe Frasci ◽  
...  
Keyword(s):  
Side Effects ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Combination Chemotherapy ◽  
Clinical Studies ◽  
Low Dose ◽  
Performance Status ◽  
Elderly Cancer Patients ◽  
Grade 3 ◽  
Severe Mucositis

Aims and background The treatment of elderly patients with metastatic solid tumours is still a debated problem. Patients over 75 years are generally excluded from combination chemotherapy trials because of higher toxicity. Several clinical studies have shown that weekly low dose epirubicin is a well tolerated and effective treatment for elderly cancer patients (breast, prostate, lung). Methods We report a study of patients aged between 75 and 85 years affected by metastatic anthracyclines-sensible carcinomas, to assess the tolerance of epirubicin given weekly at a dose of 25 mg/m2. Results 25 patients (13 males, 12 females; ECOG P.S. 0-2) entered the study and were evaluable for side effects. One-hundred and ninety-six cycles of therapy have been administered. Side effects were never severe. Mucositis (9 patients), leucopenia (7 patients), anemia (5 patients) were usually of grade 1 or 2. Grade 1 cardiotoxicity (tachycardia) was observed in only one case. Grade 3 toxicity consisted in anemia (1 patient) and mucositis (1 patient), while grade 4 toxicity never occurred. Nineteen patients were evaluable for response: 0 CR, 4 PR (1 lung, 3 breast), 8 SD (3 lung, 3 breast, 2 prostate) have been observed. Compliance was encouraging and the majority of patients showed a decrease in symptoms and an improvement in performance status. Conclusions Weekly low-dose epirubicin is a very well tolerated treatment in elderly cancer patients. In view of the negligible toxicity encountered, it could be of utility to test this regimen in patients aged 75 years or older, affected by anthracyclines-sensible metastatic tumors, also to assess activity.

Management and survival of frail elderly cancer patients within a Geriatric Oncology Program

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8547-8547 ◽  
Author(s):  
U. Basso ◽  
L. Vamvakas ◽  
C. Falci ◽  
E. Lamberti ◽  
L. M. Pasetto ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Endocrine Therapy ◽  
Frail Elderly ◽  
Geriatric Oncology ◽  
Drop Out ◽  
Geriatric Syndromes ◽  
Elderly Cancer Patients ◽  
Frail Patients

8547 Background: Abstention from administration of either chemo- or endocrine therapy to elderly cancer patients deemed frail at the Multidimensional Geriatric Assessment is still controversial, and few data are available concerning the actual survival of such patients. Methods: To evaluate the management and survival of all consecutive frail cancer patients older than 70 years, seen from October 2004 to December 2005 within our Geriatric Oncology Program. Frailty was defined by one or more of the following: age ≥ 85 years, dependence in one or more Activity of Daily Living (ADL), presence of at least three comorbidity of grade 3 or one of grade 4 according to CIRS-G, one or more geriatric syndromes [Balducci L, Cancer Control 2001]. Results: A total of 364 elderly patients were divided into three categories: fit (26.4%), vulnerable (49.5%) and frail patients (24.2%). These 88 frail patients had a median age of 79 years (range, 70–93), 43.2% males. Motives for being considered frail were age alone (13.6% of patients), ADL dependence (25%), comorbidity (14.8%), geriatric syndromes (6.8%) or, more frequently, the co-existence of two or more of these factors (39.8%). Thirty patients (34.1%) underwent chemotherapy: 8 for gastro-intestinal tumors, 7 lung, 7 hematological and 8 other sites. Patients received standard regimens at standard doses (27.6%) or with ≥ 25% dose reduction (24.1%), age-adapted regimens at standard doses (44.8%) or with reduced doses (6.9%). Six patients (20%) derived some clinical benefit but only two (6.7%) showed radiological response. Twenty-two patients interrupted chemotherapy prematurely due to toxicity/death (23.3%) or refusal/drop out (26.7%). All twenty-eight women with estrogen receptor positive breast cancer (31.9% of all frail patients) were prescribed endocrine therapy either adjuvantly, neo-adjuvantly or for metastatic disease, with a predominance of aromatase inhibitors (82.1%) compared to tamoxifen. Thirty out of 88 patients have died, with a 2-year overall survival of 35%. Conclusions: Frailty was observed in one fourth of all our elderly patients, but it did not prevent treatment of tumor with either chemo- or endocrine therapy in 66% of cases. Overall survival of frail elderly patients with cancer appears worse than in geriatric series. No significant financial relationships to disclose.

Outcomes that matter to patients: The Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery (GOSAFE) study—Analysis of 471 patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11511-11511 ◽  
Author(s):  
Isacco Montroni ◽  
Giampaolo Ugolini ◽  
Antonino Spinelli ◽  
Giorgio Ercolani ◽  
Michael T. Jacklitsh ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Functional Recovery ◽  
Functional Capacity ◽  
Comprehensive Evaluation ◽  
Geriatric Oncology ◽  
Preoperative Assessment ◽  
Cancer Surgery ◽  
Major Surgery ◽  
Timed Up And Go ◽  
Older Cancer Patients

11511 Background: Older cancer patients value functional outcomes as much as survival but surgical studies lack functional recovery (FR) data. The international, multicenter GOSAFE study (ClinicalTrials.gov NCT03299270) aims to evaluate patients’ quality of life (QoL)and FR after cancer surgery and to assess predictors of FR. Methods: GOSAFE prospectively collects functional and clinical data before and after major elective cancer surgery on senior adults (≥70 years). Surgical outcomes are recorded (30 days, 90 days, and 180 dayspost-operatively) with QoL(EQ-5D-3L) and FR (Activities of Daily Living (ADL) + Timed Up and Go (TUG) + MiniCog), 28centers are prospectively enrolling patients; accrual ends February 2019. Results: 643 patients underwent major cancer surgery with curative(94%) or palliative (6%) intent (February 2017-September 2018). Median age was 78(range 70-94); 51.6% males, ASA III-IV 52%. Patients dependent (ADL < 5) were 8%. Frailty was detected by G8 > 14 in 32% and fTRST≥2 in 36% of patients. 639 (99%) lived at home, 32% lived alone, and 88% were able to go out. Major comorbidities (CCI > 6) were detected in 36% and 22% had cognitive impairment according to MiniCog (5% self-reported). 26% had > 3 kg weight loss, 30% were hospitalized in the last 90 days, 45% had ≥3 medications (6% none). For 471 patients, a 90-day comprehensive evaluation was available. Postoperative morbidity was 42% (30 day) and 63.3% (90 day), but Clavien-Dindo III-IV complications were only 11.2% and 17.6%. 90-day mortality was 7.4% (5% 30-day). QoL improved 90 days after surgery (mean EQ-5D index from 0.76 to 0.80). Patients with EQ-5D VAS score > 60 raised from 73.9% at baseline to 82.8% at 90 days. 29% had complete FR (ADL score > 4, MiniCog > 2, TUG < 20). Decreased functional capacity was seen in 23.4% of patients alive at 90-days. Conclusions: GOSAFE is the largest prospective study on older cancer patients undergoing major surgery. Interim analysis reports decreased functional capacity in a quarter of patients. The study will allow clinicians to associate clinical outcomes with individual factors of the preoperative assessment and create a user-friendly tool to predict outcomes that matter to patients.

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