Application of interdisciplinary collaborative hospice care for terminal geriatric cancer patients: A prospective randomised controlled study

Background Hospice care (HC) is specialized medical care for terminal patients who are nearing the end of life. Interdisciplinary collaborative hospice care (ICHC) is where experts from different disciplines and patients/caregivers form a treatment team to establish shared patient care goals. However, the ICHC efficacy has not been frequently studied in the terminal geriatric cancer patients (TGCPs) population. This study aimed to gain insight into ICHC provided to TGCPs by an ICHC team and identify factors to ameliorate multidimensional HC. Methods 166 TGCPs were equally divided into ICHC group and life-sustaining treatments (LSTs) group as control. The scores of these questionnaires [such as EORTC QLQ-C30, Hamilton Anxiety Scale], the median survival time (MST), symptoms improvement, the median average daily cost of drugs (MADDC), the median total cost of drugs (MTDC) in the last 2 days, and medical care satisfaction were observed in both groups. Results After treatment, the emotional function and symptoms in the ICHC group were statistically higher improvement than those in the LSTs group (P < 0.05). The MADDC and the MTDC in the last 2 days were statistically lower in the ICHC group than those in the LSTs group (P < 0.01). In addition, the overall satisfaction situation and the cooperation ability in the ICHC group were statistically higher than those in the LSTs group (P < 0.01). Conclusion The ICHC could provide TGCPs with coordinated, comfortable, high-quality, and humanistic care.

Epidemiological and Pathologic Characteristics of Cancer Morbidity in Elderly Nigerians: A Call for Action

Objective: Geriatric cancer is a major public health problem with increasing incidence due to population growth and ageing.This study hopes to analyze the epidemiology and pathology of geriatric cancer in a Nigerian tertiary healthcare center. Method: The study is a ten-year (2010-2019) descriptive retrospective study of histopathologically confirmed geriatric cancer cases in the University of Benin Teaching Hospital, Nigeria. The age, gender, anatomic site and histological diagnosis were used for the study. Analysis was with Microsoft Excel spreadsheet and results summarized in tables and figures. Result: Geriatric cancer accounted for 33.7% of all cancers, affecting 871 males and 593 females with mean age and age range of 70.4 and 60-101 years respectively. Cases in 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017, 2018 and 2019 were 7.9%, 10.5%, 10.7%, 11.3%, 7.0%, 8.5%, 8.55%, 10.5%, 11.8% and 12.4% respectively. Exactly 26.0%, 25.4%, 19.1%, 15.0%, 9.0%, 3.2%, 1.3%, 0.8%, and 0.2% of cancer cases were encountered among the 60-64, 65-69, 70-74, 80-84, 85-89, 90-94, 95-99 and 100-104 years age groups respectively. Prostate, cervical, breast, colorectal and gastric cancer accounted for 41.3%, 12.3%, 12.3%, 5.8% and 3.1% of the cases respectively. Conclusion: Geriatric cancer incidence is on the increase with male predominance and a peak at 60-64 years. About 75% of geriatric cancer affected the prostate, uterine cervix, breast, stomach and colorectum. Geriatric cancer care is still a low priority in Nigeria. A stronger health and social system is desirable for the worsening geriatric cancer burden in this region.

Efficiency and tolerability of abemaciclib in elderly patients

Elderly cancer patients represent a very heterogeneous population not only in chronological age, but also in functional status, concomitant diseases and therapy, geriatric syndromes, and, as a consequence, in the tolerability of cancer treatment. The choice of treatment for metastatic breast cancer (mBC) in this category of patients is often a difficult task for oncologists. The emergence of a new class of drugs, inhibitors of cyclin-dependent kinases 4/6 (CDK4/6), has changed the paradigm of treatment of patients with luminal HER2 negative mBC (ER + HER2mBC); however, data on the efficacy and tolerability of these drugs in elderly patients are limited. Pooled subgroup analyzes of studies with CDK4/6 have shown that elderly patients with ER + HER2breast cancer have a clear PFS benefit from the addition of targeted drugs to hormonal therapy. Adverse events are observed more often in combination therapy with increasing age, which requires dose modification and appropriate therapy. In this regard, the drug abemaciclib is very attractive, which is characterized by a lower frequency of neutropenia compared to other CDK4/6 inhibitors, but a higher incidence of diarrhea, which can be controlled by taking appropriate drugs and is not a reason for treatment discontinuation. Careful selection of patients is necessary when deciding on the appointment of any therapy to geriatric cancer patients. Only a comprehensive multidisciplinary approach will make it possible to maximally individualize the approach to the treatment of this difficult category of patients and minimize the likelihood that they will receive excessive or insufficient oncological treatment.