Cognitive Impairment in Older Cancer Patients Treated with First-Line Chemotherapy

Older cancer patients are vulnerable to chemotherapy-related cognitive impairment. We prospectively evaluated cognitive impairment and its predictive factors during first-line chemotherapy in elderly cancer patients (≥70 years). Cognitive function was evaluated by the Mini-Mental State Examination (MMSE) with adjusted scores for age and sociocultural level. Multidimensional geriatric assessment was performed at baseline and during chemotherapy including the MMSE, Instrumental Activities in Daily Living (IADL), Mini-Nutritional Assessment (MNA), and the Geriatric Depression Scale (GDS15). Quality of life (QoL) was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire (QLQ-C30). Of 364 patients included, 310 had two MMSE evaluations including one at baseline and were assessed. Among these patients, 86 (27.7%) had abnormal MMSE, 195 (62.9%) abnormal MNA, 223 (71.9%) abnormal IADL, and 137 (43.1%) had depressive symptoms at baseline. MMSE impairment during chemotherapy was observed in 58 (18.7%) patients. Abnormal baseline MNA (odds ratio (OR) = 1.87, p = 0.021) and MMSE (OR = 2.58, p = 0.022) were independent predictive factors of MMSE impairment. These results suggest that pre-existing cognitive impairment and malnutrition are predictive factors for cognitive decline during chemotherapy in elderly cancer patients. Detection and management of these risk factors should be systematically considered in this population before starting chemotherapy.

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

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.

Drug–drug interaction in elderly patients with cancer

Background Elderly cancer patients have a high risk of exposure to potential drug-drug interactions (pDDIs), given the therapeutic complexity to which they are subjected. The study of pDDIs is very important to enable more effective treatments, with the least possible number of complications.The aim of this study was to identify and characterize pDDIs in elderly cancer patients treated at the Day Hospital of IPO-Porto. Methods Information about patients sociodemographic data and chronic medication were collected through an interview with application of a questionnaire to the elderly patient. Patient’s clinical files were also consulted to complement information needed for the study. The ATC classification of drugs was performed and Micromedex® tool was used to identify and characterize pDDIs. The most prevalent pDDIs were analyzed and discussed. Results A total of 335 elderly patients with cancer were enrolled in the study. The prevalence of polymedication was 88.10% and excessive polymedication was 46.60%. A total of 1125 pDDIs were identified in 248 patients (74.03%) and 211 pDDIs involved at least one antineoplastic drug. The pDDIs that were detected more frequently were: Fluorouracil - Leucovorin Calcium (N = 28), Cyclophosphamide - Ondansetron (N = 27) and Metoclopramide - Tramadol (N = 20). A significant association was detected between the number of drugs consumed and the number of pDDIs. Conclusions Elderly patients with cancer have a high risk of drug interactions, given the polymedication they are exposed. It's crucial to implement measures to monitor their therapy in order to reduce the potential for drug interactions and improve the quality of patient's life.

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

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.