Prognostic Value of the B12/CRP Index in Older Systemically Treatable Cancer Patients

Background: While comprehensive geriatric assessment (CGA) in older patients treated for cancer assesses several related domains, it does not include standardized biological tests. The present study aimed to: (1) assess the prognosis value of the B12/CRP index (BCI) in a population of systemically treatable older patients with cancer and (2) analyze the association between BCI value and pre-existing geriatric frailty. Method: We conducted a retrospective observational study between January 2016 and June 2020 at Marseille University Hospital. All consecutive cancer patients aged 70 years and over before initiating systemic therapy were included. Results: Of the 863 patients included, 60.5% were men and 42.5% had metastatic stage cancer. Mean age was 81 years. The low-BCI group (≤10,000) had a significantly longer survival time than the mid-BCI (10,000 < BCI ≤ 40,000) and high-BCI (BCI > 40,000) groups (HR = 0.327, CI95% [0.26–0.42], p-value = 0.0001). Mid- and high-BCI (BCI > 40,000) values were associated with impaired functional status and malnutrition. Conclusion: A BCI > 10,000 would appear to be a good biological prognostic factor for poor survival times and pre-existing geriatric impairment in older cancer patients before they initiate systemic treatment.

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Faculty Opinions recommendation of The role of comorbidities on the uptake of systemic treatment and 3-year survival in older cancer patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717960952.793463792 ◽

2012 ◽

Author(s):

Giordano Beretta ◽

Chiara Maria La Spina

Keyword(s):

Cancer Patients ◽

Systemic Treatment ◽

Older Cancer Patients

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Short-Course Versus Long-Course Colistin for Treatment of Carbapenem-Resistant A.baumannii in Cancer Patient

Antibiotics ◽

10.3390/antibiotics10050484 ◽

2021 ◽

Vol 10 (5) ◽

pp. 484

Author(s):

Wasan Katip ◽

Suriyon Uitrakul ◽

Peninnah Oberdorfer

Keyword(s):

Clinical Response ◽

Cancer Patients ◽

Therapy Group ◽

University Hospital ◽

P Value ◽

Chiang Mai ◽

Carbapenem Resistant ◽

Short Course ◽

Significant Difference ◽

Long Course

Carbapenem-resistant Acinetobacter baumannii (CRAB) is one of the most commonly reported nosocomial infections in cancer patients and could be fatal because of suboptimal immune defenses in these patients. We aimed to compare clinical response, microbiological response, nephrotoxicity, and 30-day mortality between cancer patients who received short (<14 days) and long (≥14 days) courses of colistin for treatment of CRAB infection. A retrospective cohort study was conducted in cancer patients with CRAB infection who received short or long courses of colistin between 2015 to 2017 at Chiang Mai University Hospital (CMUH). A total of 128 patients met the inclusion criteria. The results of this study show that patients who received long course of colistin therapy had a higher rate of clinical response; adjusted odds ratio (OR) was 3.16 times in patients receiving long-course colistin therapy (95%CI, 1.37–7.28; p value = 0.007). Microbiological response in patients with long course was 4.65 times (adjusted OR) higher than short course therapy (95%CI, 1.72–12.54; p value = 0.002). Moreover, there was no significant difference in nephrotoxicity (adjusted OR, 0.91, 95%CI, 0.39–2.11; p value = 0.826) between the two durations of therapy. Thirty-day mortality in the long-course therapy group was 0.11 times (adjusted OR) compared to the short-course therapy group (95%CI, 0.03–0.38; p value = 0.001). Propensity score analyses also demonstrated similar results. In conclusion, cancer patients who received a long course of colistin therapy presented greater clinical and microbiological responses and lower 30-day mortality but similar nephrotoxicity as compared with those who a received short course. Therefore, a long course of colistin therapy should be considered for management of CRAB infection in cancer patients.

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Hubungan Perilaku Caring Perawat Dengan Tingkat Harapan Sembuh Pada Pasien Kanker Yang Menjalani Program Kemoterapi Di Rumah Sakit Baladhika Husada Jember

Buletin Penelitian Sistem Kesehatan ◽

10.22435/hsr.v23i3.3123 ◽

2020 ◽

Vol 23 (3) ◽

pp. 169-177

Author(s):

Alvinda Apriliatul Jannah ◽

Anisah Ardiana ◽

Retno Purwandari

Keyword(s):

Social Support ◽

Cancer Patients ◽

Cross Sectional Study ◽

Patient Comfort ◽

P Value ◽

Cross Sectional ◽

Patients With Cancer ◽

Caring Behavior ◽

Nurse Caring ◽

The Relationship

Hope is a crucial issue in patients with cancer. Hope can be increased by providing social support. Social support can be obtained from the nurses caring behavior. This research aimed to analyze the relationship between nurses caring behavior and recovery hope level of cancer patients undergoing chemotherapy program at Baladhika Husada Hospital in Jember. A cross-sectional study was conducted to 112 respondents using the Caring Behavior Inventory (CBI-24) questionnaire and Scale of Hope. The data were analyzed applying the Kendall Tau B (τ) correlation. The results showed that there was a relationship between nurses caring behavior with the level of recovery expectancy of cancer patients undergoing chemotherapy programs at Baladhika Husada Hospital in Jember (p-value <0.001; τ = 0.375). Nurse caring behavior increases patient comfort and makes patients more enthusiastic about undergoing therapy. Patients feel valued and get more information from nurses. Therefore, the patient's recovery hopes can increase. This study concludes that nurses caring behavior can increase the expectation of recovery of cancer patients. Abstrak Harapan adalah hal krusial pada pasien kanker. Harapan dapat ditingkatkan dengan pemberian dukungan sosial yang bisa didapat dari perilaku caring perawat. Tujuan dari penelitian ini adalah untuk menganalisis hubungan perilaku caring perawat dengan tingkat harapan sembuh pasien kanker yang menjalani program kemoterapi di Rumah Sakit Baladhika Husada Jember. Penelitian ini menggunakan metode cross sectional dan 112 responden didapatkan dengan teknik sampel purposive samping. Data didapatkan melalui kuesioner CBI-24 dan kuesioner skala harapan. Analisis pada penelitian ini menggunakan uji korelasi Kendall Tau B (τ). Hasil menunjukkan terdapat hubungan antara perilaku caring perawat dengan tingkat harapan sembuh pasien kanker yang menjalani program kemoterapi di Rumah Sakit Baladhika Husada Jember (p value < 0,001; τ = 0,375). Perilaku caring perawat dapat meningkatkan kenyamanan pasien dan membuat pasien lebih semangat menjalankan terapi yang dijalani. Pasien merasa dinilai dan mendapatkan informasi lebih dari perawat. Maka dari itu, harapan sembuh pasien dapat meningkat. Kesimpulan dari penelitian ini adalah perilaku caring perawat dapat meningkatkan harapan sembuh pasien kanker.

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Multidimensional geriatric evaluation in elderly cancer patients and its relationship with age

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19651 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19651-19651

Author(s):

M. Molina-Garrido ◽

C. Guillén-Ponce ◽

A. Carrato

Keyword(s):

Health Status ◽

Activities Of Daily Living ◽

Cancer Patients ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Daily Living ◽

Older Patients ◽

Patients With Cancer ◽

Medication Intake ◽

Oncologic Patients

19651 Background: Age is the major risk factor for the majority of patients with cancer. More than 50% of cancers occurs after the age of 60. Older patients are not simply old, but are geriatric patients because of interacting psychosocial and physical problems. As a consequence, the health status of old persons cannot be evaluated by merely describing the single disease or the group of age. We tested the performance of a new Comprehensive Geriatric Assessment (CGA) and its relationship with groups of age in cancer patients. Methods: Between June 2006 and December 2006, a total of 64 oncologic patients older than 75 years were approached to enrol in our study to analyze their functional, physical, mental, pharmacotherapeutic and socio-economic status and to correlate them to some groups of age: youngest-old (75 to 80 years-old), old-old (80 and 85 years-old) and oldest-old (older than 85 years). They were analysed Activities of Daily Living (ADL) measured by Barthel Scale, Instrumental Activities of Daily Living (IADL) measured by Lawton-Brody Scale, Grade of Fragility measured by Barber Scale, cognitive evaluation measured by Pfeiffer Test, and medication intake. A Chi Squared test was used for statistical analysis; p-value <0,05 was considered significative. Results: Sixty-four oncologic patients age > or = 75 years were recruited. Median age was 80.24 years (range 73.88 to 86.94). 51.6% female. Breast cancer was the most frequent diagnosis (30.2%), followed by lung cancer (19%). 29 patients (45.3%) were aged between 75 and 80 years old; 27 patients (43.5%) were between 80 and 85 years- old. There were statistic significative association between groups of age and Pfeiffer Test (p=0.037), Barber Scale (p=0.031) and medication intake (p=0.021). However, there was not a significative relationship between groups of age and Barthel Scale (p=0.052), Lawton-Brody Scale (p=0.2425), Cruz-Roja Scale (p=0,1485) or number of geriatric syndromes (p=0.129). Conclusions: This abstract reviews the findings regarding the correlation between a comprehensive geriatric assessment (CGA) and groups of age in older patients with cancer. Age per se must not be the only criterion for medical decision as it is not correlated to the health status of older cancer patients. No significant financial relationships to disclose.

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Prognostic significance of geriatric assessment.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18140 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18140-e18140 ◽

Cited By ~ 2

Author(s):

Beatrice Jara-Almonte Edwards ◽

Xiaotao Zhang ◽

Ming Sun ◽

Juhee Song ◽

Colin P.N. Dinney ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Major Depression ◽

Cancer Patients ◽

Geriatric Assessment ◽

Metastatic Disease ◽

Functional Impairment ◽

Comprehensive Cancer Center ◽

P Value ◽

Older Cancer Patients

e18140 Background: More than 60% of cancer patients are older adults, and by 2020 the proportion of older adults with cancer will rise to 70%. Objective: To assess risk factors for overall survival (OS) in older cancer patients seen in a comprehensive cancer center. Methods: This is a single center, retrospective cohort study of older cancer patients (65 years of age and older). Patients receiving active cancer care underwent comprehensive geriatric assessment (including cognitive, mood, functional, nutritional, physical, and comorbidity assessment using validated scales). Hematologic, and solid tumors (urologic, breast, gastrointestinal cancers) were evaluated. Targeted interventions were implemented. Analysis: Univariate and multivariable Cox proportional hazards regression analysis were performed to identify factors associated with OS (SAS 9.4). Results: Among 304 eligible patients, the median follow-up was 12.7 months, 98 (32%) died, the median OS was 25.4 months. Median age is 78 years. Univariate analysis revealed known risk factors for mortality (advanced age [p = 0.004], and metastatic disease [p = 0.002]), functional impairment (ADL scores 0-4, p = 0.02), and major depression (p = 0.005). Comorbidity (p = 0.07) and functional impairment showed a marginal significance on OS. Factors with a univariate p-value less than 0.1 were considered in multivariable regression models. A final multivariable model included age group, cancer stage, functional impairment, and major depression. Risk factors for OS include major depression (HR 1.88 (95% CI, 1.12, 3.15), p-value = 0.02), functional impairment (HR 2.47 (95% C.I. 1.28, 4.74), p = 0.007), and metastatic disease (HR 2.2 (95% C.I. 1.30, 3.97), p = 0.004). Conclusions: Major depression and functional impairment were identified as risk factors for OS in older cancer patients. Prospective studies are recommended.

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Faculty Opinions recommendation of Performance of four frailty classifications in older patients with cancer: prospective elderly cancer patients cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727215510.793528725 ◽

2017 ◽

Author(s):

Maria-José Molina-Garrido

Keyword(s):

Cohort Study ◽

Cancer Patients ◽

Older Patients ◽

Elderly Cancer Patients ◽

Patients With Cancer

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A multicenter analysis of the outcome of cancer patients with neutropenia and COVID-19 infection optionally treated with granulocyte colony-stimulating factor (G-CSF).

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12105 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12105-12105

Author(s):

Ana M. Jimenez Gordo ◽

Gonzalo Colmenarejo ◽

Javier Baena Espinar ◽

Carlos Aguado ◽

Xabier Mielgo ◽

...

Keyword(s):

Logistic Regression ◽

Respiratory Failure ◽

Cancer Patients ◽

P Value ◽

Tumor Type ◽

Patients With Cancer ◽

Patient Status ◽

Multicenter Analysis ◽

Multiple Variables ◽

Stimulating Factor

12105 Background: Infection by SARS-CoV-2 can turn into an acute respiratory infection. Approximately 15% of patients will develop a distress syndrome responsible in most cases of mortality. A host hyperinflammatory response induced by a cytokine storm, is the main cause of this severe complication. Chemotherapy myelosuppression is associated with higher risk of infections and mortality in cancer patients. There have been no previous reports about the clinical management of patients with neutropenia and concomitant COVID-19. Herein, we present a multicenter experience in several hospitals during COVID-19 outbreak in neutropenic cancer patients infected by SARS-Cov-2. Methods: Retrospective clinical data were collected from clinical reports. Protocol was approved by a Clinical Research Ethics Committee (HULP: PI-4194). Inclusion criteria were cancer patients with neutropenia (<1500 cells/mm3) and concomitant COVID-19 infection. Comorbidities, tumor type and stage, treatment, neutropenia severity, filgrastim (G-CSF), COVID-19 parameters and mortality were analyzed. Exploratory analysis included a description of all data collected and bivariate analyses among different pairs of variables, including their impact in mortality in this cohort. In addition, multivariable logistic regression was used to predict respiratory failure and death as a function of multiple variables. Results: Among 943 patients with cancer screened in 14 hospitals in Spain, eighty-three patients (8%) had a febrile neutropenia and COVID-19 infection. Lung (26%), breast (22%), colorectal (13%) and digestive non-colorectal (17%) cancers were the main locations and most patients had advanced disease (67%). Fifty-three (63%) of patients included died because respiratory failure. Neumonia was presented in 76% of patients, bilateral in 47% and 12% of all patients had thrombotic events. The median of neutrophils was 650cls/mm3 and 49% received G-CSF with a median of days on treatment around 4,5 days. Among all variables related with mortality in neutropenic cancer patients with COVID-19 infection, we found that the number of days with G-CSF showed a significant trend toward worse outcome and higher mortality. In particular, a logistic regression model was developed to predict respiratory failure, as a function of the number of days of G-CSF treatment. As adjusting covariates, sex, age, treatment purpose (palliative vs curative, to adjust for patient status), tumor type, and the lowest level of neutrophils in the patient (to adjust for neutropenic status) were used. A significant effect was obtained for the days of G-CSF treatment (OR = 1.4, 95% CI [1.03, 1.92], p-value = 0.01). Conclusions: Our findings suggest that a prolonged G-CSF treatment could be disadvantageous for these cancer patients with COVID-19, with a higher probability of worse outcome.

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Immunotherapy and Radiotherapy for Older Cancer Patients during the COVID-19 Era: Proposed Paradigm by the International Geriatric Radiotherapy Group

Gerontology ◽

10.1159/000514451 ◽

2021 ◽

pp. 1-7

Author(s):

Nam Phong Nguyen ◽

Brigitta G. Baumert ◽

Eromosele Oboite ◽

Micaela Motta ◽

Gokula Kumar Appalanaido ◽

...

Keyword(s):

Cancer Patients ◽

Local Control ◽

Older Patients ◽

Locally Advanced ◽

The Elderly ◽

New Paradigm ◽

Radiotherapy Group ◽

Potential Synergy ◽

Physician Bias ◽

Older Cancer Patients

Background: Older cancer patients with locally advanced or metastatic disease may benefit from chemotherapy alone or combined with radiotherapy. However, chemotherapy is often omitted either because of physician bias or because of its underlying comorbidity, thus compromising their survival. The coronavirus disease 19 (COVID-19) pandemic is compounding this issue because of the fear of immunosuppression induced by chemotherapy on the elderly which makes them more vulnerable to the virus. Summary: Immunotherapy has less effect on the patient bone marrow compared to chemotherapy. The potential synergy between radiotherapy and immunotherapy may improve local control and survival for older patients with selected cancer. Preliminary data are encouraging because of better survival and local control in diseases which are traditionally resistant to radiotherapy and chemotherapy such as melanoma and renal cell carcinoma. Key Message: We propose a new paradigm combining immunotherapy at a reduced dose and/or extended dosing intervals and hypofractionated radiotherapy for older patients with selected cancer which needs to be tested in future clinical trials.

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