Elderly patients with cancer in the ICU

Background: The administration of chemotherapy at the end of life is considered an aggressive life-prolonging treatment. The use of unnecessarily aggressive therapy in elderly patients at the end of life is an important health-care concern. Objective: To explore the impact of palliative care consultation (PCC) on chemotherapy use in geriatric oncology inpatients in Japan by analyzing data from a national database. Methods: We conducted a multicenter cohort study of patients aged ≥65 years, registered in the Japan National Administrative Healthcare Database, who died with advanced (stage ≥3) lung, stomach, colorectal, liver, or breast cancer while hospitalized between April 2010 and March 2013. The relationship between PCC and chemotherapy use in the last 2 weeks of life was analyzed using χ2 and logistic regression analyses. Results: We included 26 012 patients in this analysis. The mean age was 75.74 ± 6.40 years, 68.1% were men, 81.8% had recurrent cancer, 29.5% had lung cancer, and 29.5% had stomach cancer. Of these, 3134 (12%) received PCC. Among individuals who received PCC, chemotherapy was administered to 46 patients (1.5%) and was not administered to 3088 patients (98.5%). Among those not receiving PCC, chemotherapy was administered to 909 patients (4%) and was not administered to the remaining 21 978 patients (96%; odds ratio [OR], 0.35; 95% confidence interval, 0.26-0.48). The OR of chemotherapy use was higher in men, young–old, and patients with primary cancer. Conclusion: Palliative care consultation was associated with less chemotherapy use in elderly Japanese patients with cancer who died in the hospital setting.

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Analysis of Prognostic Factors of Comprehensive Geriatric Assessment and Development of a Clinical Scoring System in Elderly Asian Patients With Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2010.32.0796 ◽

2011 ◽

Vol 29 (27) ◽

pp. 3620-3627 ◽

Cited By ~ 120

Author(s):

Ravindran Kanesvaran ◽

Huihua Li ◽

Khai-Nee Koo ◽

Donald Poon

Keyword(s):

Prognostic Factors ◽

Elderly Patients ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Scoring System ◽

Group Performance ◽

Eastern Cooperative Oncology Group ◽

Disease Stage ◽

Patients With Cancer ◽

The Impact

Purpose To determine the impact of each comprehensive geriatric assessment (CGA) domain on overall survival (OS) and develop a prognostic scoring system for elderly patients with cancer. Patients and Methods A retrospective analysis of CGA data collected from 249 consecutive patients with cancer who attended the outpatient geriatric oncology clinic at the National Cancer Center Singapore age 70 years or older was performed. Univariate and multivariate analyses were performed using Cox proportional hazards method to identify significant prognostic factors within the CGA. A simple nomogram to predict OS was developed using regression coefficients from the multivariate model. Concordance between predicted and observed response of the individual patient score was evaluated by means of Harrell's c-index. Calibration was performed using simulated data via bootstrap. Results Median age of the patients was 77 years (range, 70 to 94 years). In our model, age (hazard ratio [HR], 1.04; 95% CI, 1.01 to 1.07), abnormal albumin level (HR, 1.97; 95% CI, 1.23 to 3.15), poor Eastern Cooperative Oncology Group performance status (≥ 2 v < 2: HR, 1.77; 95% CI, 1.15 to 2.72), abnormal geriatric depression scale status (HR, 1.81; 95% CI, 1.29 to 2.56), high malnutrition risk (high v low risk: HR, 1.84; 95% CI, 1.17 to 2.87), and advanced disease stage (late v early: HR, 1.71; 95% CI, 0.98 to 2.95) were independent predictors of survival. Conclusion Results confirm the importance of the CGA in assessment of elderly patients with cancer. The development of this nomogram incorporating these prognostic factors helps predict OS of patients, for further intervention.

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P31 The impact of a Comprehensive Geriatric Assessment (CGA) on medical oncology treatment decisions for elderly patients with cancer

Critical Reviews in Oncology/Hematology ◽

10.1016/s1040-8428(09)70069-1 ◽

2009 ◽

Vol 72 (1) ◽

pp. S29-S30

Author(s):

A.M. Horgan ◽

N.B. Leighl ◽

S.M.H. Alibhai

Keyword(s):

Elderly Patients ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Medical Oncology ◽

Treatment Decisions ◽

Patients With Cancer ◽

Oncology Treatment ◽

The Impact

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

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.7_suppl.133 ◽

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.

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