bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term outcomes of adolescents and young adults with testicular germ cell tumors: A population-based retrospective matched cohort study.
Authors: Ajaj Rand , Lau Cindy , Gupta Sumit , Baxter Nancy N. , Shaikh Furqan , Nathan Paul C.
Published: June 2023

12016

Background: Testicular germ cell tumor (TGCT) survival exceeds 90%, but survivors of adult TGCT are at risk of developing late effects. Little is known about the risk for late effects in survivors of TGCT in children, adolescents, or young adults (CAYA). Methods: We identified all CAYA aged 11-21 years at TGCT diagnosis in Ontario, Canada, between 1992-2021. Those with complete treatment records were matched 1:5 by birth date and postal code at diagnosis to individuals from the general population (controls). Controls’ index date was defined as the diagnosis date of their survivor match. Participants were linked to health administrative databases to identify second malignant neoplasms (SMN); cardiovascular disease (CVD: congestive heart failure [CHF], myocardial infarction, coronary artery disease, pericardial disease, valvular abnormalities, arrhythmia, stroke, hypertension); renal disease (dialysis, kidney transplant); and hearing loss (physician-diagnosed hearing loss, hearing aid use). Cumulative incidences were compared between survivors and controls, and between chemotherapy and surgery treated survivors using Gray’s test. Cox proportional hazard models compared the risk of late effects between survivors and controls. Results: 521 TGCT survivors (296 chemotherapy treated, 225 treated with surgery only) were matched to 2605 controls. Median age at diagnosis/index date was 19 years. Survivors’ median follow-up time was 14.8 years (interquartile range: 10.7-21.7). Compared to controls, survivors had higher 15-year incidence and hazard ratio (HR) of all SMN (5.0% vs 0.5%; HR 8.4, p < .0001), non-testicular SMN (2.1% vs 0.5%; HR 3.8, p = 0.0003), dialysis (1.0% vs 0.04%; HR 12.4, p = 0.003), kidney transplant (0.4% vs 0.0%, p = 0.002), hearing loss (7.1% vs 3.1%; HR 1.8, p = 0.005), and hearing aid use (1.0% vs 0.2%; HR 4.1, p = 0.02). Survivors were at substantially increased risk of any CVD (8.2% vs 5.5%; HR 1.4, p < 0.03), CHF (1.2% vs. 0.2%; HR 5.0, p = 0.006), arrhythmia (1.8% vs 0.5%; HR 3.4, p = 0.002), and stroke (0.8% vs 0.05%; HR 8.7, p = 0.0006) despite no anthracycline exposure. Compared to surgery only treated survivors, chemotherapy treated survivors had higher 15-year incidence of any CVD (13.1% vs 2.0%, p < 0.0001), CHF (2.1% vs 0.0%, p = 0.03), arrhythmia (3.3% vs 0.0%, p = 0.02), stroke (1.4% vs 0.0%, p = 0.02), hypertension (7.4% vs 2.0%, p = 0.009), and hearing loss (10.2% vs 3.0%, p = 0.02). Conclusions: Survivors of TGCT during CAYA are at considerable risk for late effects affecting multiple organ systems. In addition to previously described morbidities like hearing loss, survivors (particularly those who received chemotherapy) are at higher risk of CVD. Despite excellent rates of cure, TGCT survivors diagnosed at a young age require life-long risk-directed follow-up to maximize their long-term health.
Social determinants of health burden among adolescent and young adult cancer patients and impact on overall survival.
Authors: Rodriguez Elizabeth , Tonn Tori , Jafry Midhat , Xiao Qian , Cuglievan Branko , Ahmed Sairah , Livingston J Andrew Andrew , Aune Gregory John , Albritton Karen H. , Flowers Christopher , Roth Michael , Hildebrandt Michelle Ann Theobald
Published: June 2023

12017

Background: The 5-year survival rates for adolescents and young adults (AYA) with cancer have steadily improved, yet disparities by race/ethnicity persist. The drivers of these disparities remain unclear. Neighborhood socioeconomic deprivation has been linked to adverse health outcomes independent of the effects of individual-level measures of social determinants of health (SDOH). We evaluated the impact of neighborhood SDOH on overall survival (OS) in a diverse AYA cancer patient population treated in a single academic setting. Methods: This study utilized a multi-ethnic cohort of AYA cancer survivors (N=10,261) diagnosed between ages 15-39 seen at MD Anderson Cancer Center between 2000 and 2016. Patient demographics, zip code at presentation, cancer characteristics, and follow-up were obtained from our institutional tumor registry. Zip codes were linked to Area Deprivation Index (ADI) values, a validated neighborhood-level SDOH measure, with higher ADI representing worse SDOH. Results: The cohort included 6,361 (62%) non-Hispanic White, 1,112 (10.8%) non-Hispanic Black, and 2,133 (20.8%) Hispanic AYA cancer patients, with 655 (6.4%) of other ethnicities or missing information. The mean ADI value was significantly higher (p<0.05) for Black (61.7) and Hispanic (65.3) patients, compared to White (51.2) patients. Analysis of ADI by cancer type showed significant differences, mainly driven by the significantly higher ADI in patients with cervical cancer (62.3) than other cancer types. In contrast, AYA patients diagnosed with breast cancer (53.0) and CNS tumors (52.9) resided in neighborhoods with the lowest ADI values. ADI was a significant predictor of OS overall. In multivariable models that included gender, age at diagnosis, cancer diagnosis, and race/ethnicity, risk of death for AYA cancer patients residing in neighborhoods with ADI in the highest quartile was greater than that for patients in the lowest quartile (HR: 1.09, 95% CI: 1.00-1.19, p=0.043). Conclusions: Our results in this large multi-ethnic cohort indicate that non-White AYA patients with cancer more commonly live in neighborhoods associated with higher ADI compared to their White counterparts. Even when treated in the same academic setting, AYA cancer patients with higher ADI experienced worse OS across cancers. Although the magnitude of the effect was moderate, the presence of this effect within a tertiary cancer center with existing barriers to care suggests that ADI is a meaningful risk factor impacting survival. Further analysis is warranted to determine the generalizability of these findings to the patient population more broadly. However, the results provide intriguing evidence for potential interventions aimed at supporting AYA cancer patients from disadvantaged backgrounds.
Predicting therapy-induced cardiomyopathy in long-term survivors of childhood cancer: A report from the St. Jude Lifetime Cohort (SJLIFE) and the Childhood Cancer Survivor Study (CCSS).
Authors: Petrykey Kateryna , Wang Huiqi , Dixon Stephanie B , Im Cindy , Ehrhardt Matthew J. , Mulrooney Daniel A. , Sharafeldin Noha , Wang Xuexia , Jefferies John L. , Burridge Paul , Oeffinger Kevin C. , Gramatges Maria Monica , Bhatia Smita , Robison Leslie L. , Ness Kirsten K. , Hudson Melissa M. , Chow Eric Jessen , Armstrong Gregory T. , Yasui Yutaka , Sapkota Yadav
Published: June 2023

12018

Background: Cancer-therapy-induced cardiomyopathy (CCM) is the leading noncancer cause of mortality among long-term survivors of childhood cancer, the prevalence of which increases with age. Early identification of survivors at risk provides opportunities for targeted prevention strategies. Here, we developed and validated a clinically applicable CCM prediction model based on survivor characteristics, treatment exposures and inherited genetic variation among long-term survivors of childhood cancer. Methods: Long-term survivors from SJLIFE (training cohort; n = 3,350; median age 34 years, range 8-72 years) and CCSS (validation cohort; n = 7,008; median age 36 years, range 11-64 years) were assessed by the five different general population polygenic risk scores (multiPRS) for dilated cardiomyopathy, hypertrophic cardiomyopathy, heart failure, ejection fraction and left ventricular end systolic volume. Multivariable logistic regression was used to predict 15-year risk of the CCM (defined as CTCAE grade ≥3 cardiomyopathy requiring heart failure medications or heart transplantation or leading to death). Model performance was assessed by the area under the receiver operating characteristic curve (AUC). Results: CCM was clinically identified in 150 (4.5%) SJLIFE and self-reported in 156 (2.1%) CCSS survivors, respectively. AUC of clinical models with attained age, sex, age at primary cancer diagnosis, cumulative anthracycline dose, mean heart radiation dose (heart RT), and genetic ancestry was 0.81 (95% CI, 0.78-0.85) in SJLIFE and 0.78 (95% CI, 0.74-0.81) in CCSS. Inclusion of cardiovascular risk factors (hypertension, dyslipidemia, and diabetes) significantly increased AUC to 0.83 (95% CI, 0.80-0.87; P= 0.011; SJLIFE) and 0.84 (95% CI, 0.80-0.87; P< 0.001; CCSS). The addition of the multiPRS further provided significant but modest increases in AUC in SJLIFE (0.84; 95% CI, 0.81-0.87; P= 0.022) and CCSS (0.85; 95% CI, 0.81-0.88; P= 0.031). In low-risk survivors (exposed to < 100 mg/m2 anthracyclines and < 15 Gray heart RT), we observed a possibly larger magnitude AUC increase after adding multiPRS, 0.73 (95% CI, 0.65-0.82) to 0.76 (95% CI, 0.68-0.83; P= 0.11) in SJLIFE and 0.77 (95% CI, 0.65-0.90) to 0.82 (95% CI, 0.69-0.94; P= 0.073) in CCSS. Conclusions: Inherited polygenic factors contributed significantly to improve CCM prediction over available clinical risk factors and may be of benefit to low-risk survivors for whom routine cardiac surveillance is not currently recommended.
Cannabis extract for secondary prevention of chemotherapy-induced nausea and vomiting: Results of a phase II/III, placebo-controlled, randomised trial.
Authors: Mersiades Antony , Kirby Adrienne , Stockler Martin R. , Tognela Annette , Olver Ian N. , Morton Rachael L. , Haber Paul , Walsh Anna , Lee Yvonne , Abdi Ehtesham A. , Della-Fiorentina Stephen , Aghmesheh Morteza , Fox Peter , Briscoe Karen P. , Sanmugarajah Jasotha , Marx Gavin M. , Kichenadasse Ganessan , Wheeler Helen , Simes John , Grimison Peter S.
Published: June 2023

12019

Background: The aim of this multi-centre, randomised, placebo-controlled, phase II/III trial was to determine the efficacy of adding an oral THC/CBD (tetrahydrocannabinol/cannabidiol) cannabis extract in adults who experience CINV during moderate and highly emetogenic intravenous chemotherapy regimens despite guideline-consistent anti-emetic prophylaxis. The phase II crossover component has been published (Grimison et al, AnnOnc 2020). Here we report the definitive results from the combined phase II/III components with a planned sample size of 250 patients. Methods: For the definitive phase III component, participants were randomised 1:1 to receive, oral THC 2.5mg/CBD 2.5mg (Tilray TN-TC11M) capsules TDS days -1 to 5, or placebo (in addition to guideline-consistent anti-emetics including rescue medications) for cycles A, B and C. Primary endpoint was the difference in gaining a ‘complete response’ (no emesis and no use of rescue medications) during 0-120 hours from chemotherapy for cycle A. Results: Complete response was achieved in 24% and 8% with THC/CBD and placebo, respectively (absolute difference 16%, P-value 0.01). The study closed early due to slow accrual without knowledge of study outcomes, with a total of 147 patients recruited 2016-22 (pilot n=78, definitive n=69). Median age was 56 years (range 25 to 80), 78% were females, 39% reported historic cannabis use, 65% were treated with curative intent. Most common regimens were doxorubicin/cyclophosphamide (AC, 31%), and fluorouracil/oxaliplatin (FOLFOX, 17%), 97% received corticosteroid & 5-HT3 antagonist, 80% received NK-1 antagonist, 10% received olanzapine. Efficacy and safety are shown in the table. No SAEs were attributed to THC/CBD. Conclusions: Oral THC/CBD was associated with a significant increase in the proportion of patients achieving a complete response in chemotherapy-induced nausea and vomiting and was well tolerated, representing an effective new treatment in the management of this condition. Future analyses will report quality of life and cost-effectiveness. Funding from NSW Government Dept of Health. Drug supply by Tilray. Clinical trial information: ACTRN12616001036404 . [Table: see text]
End-of-life outcomes of patients with advanced cancer enrolled in palliative care.
Authors: Lynch Andrew , Lyon Liisa , Ramalingam Nirmala D. , Whitehead Hannah , Chang Mina , Liu Raymond
Published: June 2023

12030

Background: Palliative Care (PC) integration improves end-of-life (EOL) outcomes for patients with advanced cancer. However, there is limited evidence in real world settings of the impact of PC enrollment on EOL outcomes and the presence of racial disparities in PC enrollment. We sought to understand how PC enrollment differs between certain patient demographics and whether enrollment affects EOL outcomes in a large integrated health system. Methods: This retrospective cross-sectional study included adults 18 years and older diagnosed with Stage IV solid cancers who died within 1 year of diagnosis at 21 cancer centers within Kaiser Permanente Northern California between 2018-2020. Demographics, clinical variables and EOL outcomes were compared by PC enrollment status. Categorical and continuous comparisons were made using Chi-squared and t-tests, respectively. Results: Among 3,575 patients diagnosed with stage IV solid cancers who died within 1 year of diagnosis (mean age 73.2), 52.8% were male; 8.2% were Black, 11.0% Hispanic, 12.3% Asian, and 67.7% non-Hispanic White. Most patients (93.0%) selected English as their preferred language. The most common cancer subtypes were thoracic (33.2%), upper GI (32.4%), and lower GI (10.6%). Overall, 1613 patients (45.1%) were enrolled in PC. Baseline demographics were similar between the PC and no-PC groups including gender (p = 0.58), race (p = 0.32), and preferred language (p = 0.23). There was a difference in mean age between groups (72.0 vs. 74.2, p < 0.01). Patients enrolled in PC were more likely to enroll in hospice (42.9% vs. 25.7%, p < 0.01, Table) and less likely to be hospitalized in the last 30 days of life (35.5% vs. 45.7%, p < 0.01, Table). Short hospice stays (< 3 days) were uncommon in both groups, and there was no statistically significant difference between groups (4.5% vs. 5.4%, p = 0.49, Table). There was no significant difference in the proportion of patients with multiple ED visits in the last 30 days of life between groups (21.0% vs. 21.8%, p = 0.56, Table). Conclusions: PC enrollment is associated with significant improvement in some EOL outcomes with higher rates of hospice enrollment and lower rates of hospitalization at the EOL. These outcomes were seen without racial disparities in PC enrollment. Future studies are needed to assess other outcomes related to goal-concordant care and to determine which patients benefit most from PC enrollment. [Table: see text]
Risk of malnutrition and predisposing factors among Mexican patients with advanced cancer.
Authors: Contreras Sergio , Covarrubias-Gómez Alfredo , Ramos-Lopez Wendy Alicia , Carrillo-Bedoya Araceli , Gonzalez Salazar Roberto , De la Puente-Tawil Ilana , Morales Alfaro Andrea , Amaya Caballero Montserrat , Lagarde-Santillán Laura Kay , Ramos-Ruelas Gloria Lizbeth , Acevedo-Silva Jaziel Simón , Milke Garcia Maria del Pilar , Esparza-Orozco María Fernanda , Soto Pérez de Celis Enrique , Chavarri Guerra Yanin
Published: June 2023

12033

Background: Malnutrition is a predictor of cancer survival independent of cancer site. However, routine screening for malnutrition is underutilized. Advanced cancer accounts for 60% of cancer cases in developing countries of which approximately 52 % have malnutrition. This study aimed to describe factors associated with risk of malnutrition among patients with advanced cancer. Methods: We conducted a cross-sectional analysis of baseline data from patients with recently diagnosed advanced cancer included in a multidisciplinary patient navigator-led supportive care program in Mexico City (Te Acompañamos). At the time of enrollment in the program, patients completed a series of questionnaires including assessments of quality of life (FACT-G), various symptoms and the validated malnutrition screening tool (MST). Clinic and demographic characteristics were obtained from the patient chart. Descriptive statistics were used for analysis and factors associated with risk of malnutrition were analyzed by bivariate testing. Results: Between August 2017 and December 2022, a total of 601 patients were included. Mean age was 62 years (range 18-94), 57.2% were women, 56% had gastrointestinal and 28% gynecological malignancies. 72 % screened positive for malnutrition on the MST and 49 % reported nausea on FACT-G. Patients with an ECOG performance status ≥3 were more likely to screen positive for malnutrition (OR 5.9 95%CI 2.5- 13) as well as those with baseline nausea (OR 2.99; 95%CI 1.9-4.7). On the other hand, patients with active chemotherapy (OR 1.4 95%CI, 1.016-1.95) and those receiving antiemetic treatment with a single medication (OR 1.63 95%CI, 1.1-2.4) were more likely to have nausea. No other clinical or demographic characteristics were significantly associated with screening positive for malnutrition or reporting nausea, including gender, age, history of smoking or alcohol abuse, type of neoplasia, or oncologic treatment. Conclusions: Our results show that a high proportion of patients with advanced cancer are at increased risk for malnutrition and report nausea. Poor functional status and nausea were strongly associated with a higher risk of malnutrition, while receiving insufficient antiemetic medication was associated with increased odds of nausea. This suggests that appropriate treatment of nausea and nutritional interventions should be prioritized early in the management of patients with advanced cancer regardless of the type of cancer treatment in order to avoid malnutrition and improve patient well-being.
The impact of patient age on palliative care utilization and end-of-life outcomes among patients with metastatic breast cancer.
Authors: Mitchell Carley , Stabellini Nickolas , Chen Zhengyi , Fu Pingfu , Montero Alberto J.
Published: June 2023

12034

Background: Among patients with advanced cancer, palliative care (PC) utilization is frequently associated with improved quality of life, less aggressive end of life (EOL) measures, and hospice enrollment at the time of death. While older age is often associated with less PC utilization. The interplay between patient age, site and timing of PC with resultant EOL trends is not well understood. We aimed to assess these variations within a single institution’s metastatic breast cancer (mBC) population. Methods: An IRB approved retrospective study was conducted. All adult, decedent, mBC patients from 2011-2022 were analyzed. Manual chart review extracted demographic and clinical data related to diagnosis, treatment, PC utilization and death. The relationship of patient age with PC utilization (including setting and timing), aggressive EOL measures, hospice care at the time of death, and hospice duration were evaluated. Univariate analyses were conducted and factors with a significance level p < 0.15 were further evaluated on multivariable logistic regression. Results: 278 decedent mBC patients met inclusion criteria. Any form of PC interaction from date of metastatic diagnosis to date of death, and utilizing outpatient (OP) PC (i.e., only OP or OP + inpatient (IP)) during the last year of life were significantly associated with hospice enrollment at the time of death. Similarly, utilizing only OP PC (i.e., no IP) was significantly associated with a longer time on hospice care. There was a trend toward shorter hospice durations in mBC patients who received only IP PC, and patients who received any IP PC or had their first PC interaction < 4 months prior to the time of death were more likely to experience ≥ 1 aggressive EOL measure. Young adults (< 40) were significantly more likely to receive some form of PC throughout their disease course, with a trend toward receiving only IP PC. While no significant relationships were identified between age and EOL factors, there were trends toward young and middle-aged adults (40-64) receiving ≥ 1 aggressive EOL measure and less time on hospice compared to older adults (≥ 65). Conclusions: This study gives important insight into a breast cancer-specific female population. Results highlight the importance of PC, especially in the OP setting, and its effect on hospice enrollment prior to death. However, there appears to be an interesting dichotomy between young adults receiving more PC and worse EOL experiences compared to older adults receiving less PC and better EOL experiences. These results should guide and promote, early OP focused PC specifically for young and middle-aged adults to help improve challenging EOL transitions. [Table: see text]
The association of the comorbidity polypharmacy score (CPS) with functional limitations, frailty, and mortality in older adults with gastrointestinal malignancies.
Authors: Westbrook Brian , Giri Smith , Harmon Christian , Jin Jing , Al-Obaidi Mustafa , Williams Grant Richard , Outlaw Darryl Alan
Published: June 2023

12036

Background: Older adults share a growing burden of cancer morbidity and mortality. The presence of comorbid medical conditions and polypharmacy may present significant challenges to cancer management for older adults. Although geriatric assessment (GA) is recommended to personalize treatment for older adults with cancer, it remains underutilized in routine oncology practice, and how best to measure comorbidity and polypharmacy remain unknown. The Comorbidity Polypharmacy Score (CPS), which is the sum of the number of comorbid medical conditions and medications for a patient, has been validated in other medical fields. Here we review the association of CPS with key outcomes among older adults with gastrointestinal (GI) malignancy. Methods: The Cancer and Aging Resilience Evaluation (CARE) tool is a brief, patient-completed GA developed for older adults with cancer at the University of Alabama at Birmingham (UAB). For patients enrolled in the CARE registry, diagnosed with a new GI malignancy between September 2017 and April 2021, we calculated a CPS based upon the number of patient-reported medical comorbid conditions and daily medications. Patients were separated into two groups, those with CPS ≥ 15, or high-risk, and those with CPS < 15. Multivariable analyses were adjusted for age, sex, race, cancer type, and cancer stage, and were performed to examine the potential association between high-risk CPS and falls, functional limitations, frailty, and mortality. Results: 548 patients were included in this study with a mean age of 69.7 years; 44.9% female and 23.9% Black. Common GI malignancies included colorectal (30.8%), pancreatic (25.5%), hepatobiliary (17.7%), and gastroesophageal (10.8%). Patients with CPS ≥ 15 were more likely to report falls (adjusted odds ratio [aOR] 3.39, 95% CI 1.91-6.02), dependence in activities of daily living (ADL) (aOR 3.07, 95% CI 1.67-5.66) and instrumental ADL (aOR 3.81, 95% CI 2.02-7.20), and have frailty (aOR 5.17, 95% CI 2.84-9.39). There was not a statistically significant association with either six-month or twelve-month survival. Conclusions: CPS was associated with falls, functional limitations, and frailty, but not survival, among older adults with GI malignancies. This association highlights the potential role of CPS as an efficient screening tool for older adults with cancer who would benefit from more comprehensive comorbidity and medication review.
Racial differences in muscle measures and survival among older adults with GI malignancies.
Authors: Aleixo Gabriel , Hess Daniel L. , Giri Smith , Williams Grant Richard
Published: June 2023

12044

Background: Sarcopenia (low muscle mass) and myosteatosis (fat infiltration of muscle) can be assessed from routinely obtained Computed tomography (CT) images and are independent predictors of chemotherapy toxicities and survival among patients with gastrointestinal (GI) malignancies. However, most studies to date have consisted of predominantly white populations. Therefore, the role of sarcopenia and myosteatosis among racial minority populations is unknown. Our objective was to examine racial differences in muscle measures and their association with survival among older adults with GI malignancies. Methods: This is a prospective cohort study of older adults with GI cancers from the University of Alabama at Birmingham. Single slices of axial CT images from L3 segments were analyzed using Slice-O-Matic software. Skeletal muscle area (cm2) was divided by height to obtain the skeletal muscle index (SMI, cm2/m2). Skeletal muscle radiodensity (SMD) in Hounsfield units (HU) was used to approximate muscle composition. Sarcopenia (low SMI) and myosteatosis (low SMD) were defined based on standard cut-offs developed in a cohort of GI malignancies (Martin et al., JCO 2013). We compared differences in muscle measures between non-Hispanic (NH) White and NH Black participants. We utilized Cox models, separated by race, to examine the impact of muscle measures on survival. We adjusted for age, sex, education, cancer type, cancer stage, lines of therapy, and comorbidities. Results: Six hundred sixty patients were included, 76% NH White and 24% NH Black. The median age was 69.4 years, 35% had colorectal cancer, and 42% had stage IV disease. NH Black patients had higher SMD (41.7 vs. 38.3 HU; p < 0.001) and lower rates of myosteatosis (40% vs. 27%; p = 0.04) but similar SMI (42.3 vs. 41.1 cm2/m2) and rates of sarcopenia (58% vs. 55%). In stratified Cox models, each 5 HU unit increase in SMD was associated with reduced risk of all-cause mortality of NH black patients (HR 0.88; 95% CI 0.80-0.98 p = 0.02) and not in NH White patients (HR 0.95; 95% CI-0.88-1.01; p = 0.14). Meanwhile, each 5-unit increase in SMI was associated with improved survival in NH White patients (HR 0.91; CI 0.85-0.98; p = 0.03) but not in NH Black patients (HR 0.89 CI0.78-1.03 p = 0.13). When using existing cut points for sarcopenia and myosteatosis, NH White patients with sarcopenia had worse survival (HR 1.42; CI 1.04-1.92; p = 0.02), but sarcopenia among NH black patients was not associated with worse survival (HR 1.16 95% CI 0.62-2.16 p = 0.64). Myosteatosis was not associated with worse survival in either NH white (HR 95%CI 0.95-1.68 p = 0.10) or NH black patients (HR 1.61 95%CI 0.88-2.95 p = 0.12). Conclusions: Muscle measures may differ by race and have different associations with survival by racial group. Therefore, it is essential to develop cut points for muscle measures incorporating race.
Peaceful acceptance of illness among older adults with cancer.
Authors: Gilbride Elizabeth , Hryniv Sofiia , Consagra William , Mohile Supriya Gupta , Yilmaz Sule , Culakova Eva , Canin Beverly , Malhotra Arul , Dib Elie G. , Onitilo Adedayo A. , Berenberg Jeffrey L. , LoCastro Marissa , Anand Maya , Magnuson Allison , Loh Kah Poh
Published: June 2023

12045

Background: Greater illness acceptance is associated with lower levels of psychological distress and higher rates of completion of advance care planning in adults with advanced cancer. However, studies on factors associated with illness acceptance among older adults with advanced cancer are limited and historically have not explored its relationship with caregiver or physician characteristics, despite the important role caregivers and oncologists play in patient illness acceptance. We aimed to evaluate the associations of patient, caregiver, and physician-related factors with illness acceptance among older adults with cancer. Methods: We utilized data from a national geriatric assessment cluster-randomized trial (NCT 02054741; PI: Mohile; funding NCI UG1CA189961). We recruited patients aged 70 years or over with stage III or IV incurable solid tumors or lymphoma and at least one geriatric assessment domain impairment as well as their caregivers. Illness acceptance was assessed using the 5-item Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE) questionnaire (range 5-20). Higher PEACE score indicates greater illness acceptance. Multiple linear regression was used to assess the associations of patient, caregiver, and physician-related variables with PEACE. Variables included patient sociodemographic factors, geriatric assessment variables, and estimated life expectancy; caregiver sociodemographic variables, anxiety, depression, and physical function; and oncologist years in practice and comfort with geriatrics. Results: We included 333 patient-caregiver dyads; mean age (SD) of patients and caregivers, respectively, were 76.8 (5.4) and 66.6 (12.1). Approximately 27%, 26%, and 16% of patients had lung, gastrointestinal, and genitourinary cancers, respectively. Mean PEACE score was 17.4 (2.5), indicating relatively high illness acceptance (Table). On regression analysis, patient psychological impairment domain (including both anxiety and depression) (B=-0.89; p>0.01), patient’s lower estimated life expectancy (≤1 vs. >5 years, B=-1.19, p=0.02), and lower caregiver education attainment (≤high school vs. college; B=-0.86; p<0.01) were associated with a lower illness acceptance. No physician variables were associated with PEACE. Conclusions: A better understanding of illness acceptance and its associated factors can facilitate patient-caregiver dyadic interventions to improve illness acceptance. [Table: see text]
Association between food insecurity and frailty among older adults with gastrointestinal malignancies: The CARE Registry.
Authors: Fowler Mackenzie Elisha , Harmon Christian , Sharafeldin Noha , Giri Smith , Williams Grant Richard
Published: June 2023

12046

Background: Food insecurity is associated with higher gastrointestinal (GI) cancer mortality, but its association with frailty, a known predictor of premature mortality among older adults with cancer, is less understood. Our objective was to evaluate the association between food insecurity and frailty among older adults with GI malignancies. Methods: In this cross-sectional analysis, we included 424 older adults ≥60y recently diagnosed with GI cancer undergoing self-reported geriatric assessment (GA) at their first pre-chemotherapy visit to the University of Alabama at Birmingham oncology clinic. Food insecurity was the exposure of interest, defined using the 2019 United States Department of Agriculture Economic Research Service (USDA ERS) Low-Income, Low-Access (LILA) measure, which classifies census tracts based on income and/or access to food stores at various distances by urban-rural status. The primary outcome was frailty measured via the CARE Frailty Index, a composite measure based on the proportion of deficits across several GA measures (44 items in total). Frailty was dichotomized as frail or robust/pre-frail. We examined the association between LILA and frailty with modified Poisson regression accounting for census tract clustering. Results: Median age at study participation was 69 (IQR: 64, 76), 56.6% were male, 27.2% were non-Hispanic black, 31.4% had colorectal, 28.1% had pancreatic cancer, and 71.7% presented with stage III/IV disease. LILA versus non-LILA had a higher proportion of participants who were non-Hispanic Black (52.1% vs. 11.0%, p: < 0.001) and lower educated (high school or less: 50.6% vs. 35.0%, p: 0.020). After adjustment for age, race, sex, cancer type and stage, LILA was associated with 37% higher risk of frailty (RR: 1.37, 95% CI: 1.05, 1.80) versus non-LILA. Analysis of LILA sub-categories revealed that the overall effect may be driven by low income + low access at 1 mile for urban/10 miles for rural areas (RR: 1.47, 95% CI: 1.12, 1.94) and low income + low access at 0.5 mile for urban/10 miles for rural areas (RR: 1.39, 95% CI: 1.05, 1.85). Low income + low access at 1 mile for urban/20 miles for rural areas, low income + low access with a vehicle or at 20 miles, low income only, or low access only did not demonstrate a significant difference. Conclusions: Low income and low access to food stores is associated with higher risk of frailty among newly diagnosed older adults with GI cancers prior to systemic treatment. Intervening on food insecurity at the local level, particularly in areas with low income and low access, may be a target for improving rates of frailty among older adults with GI cancers. Future studies are needed to determine causality.
Overall survival outcomes in older patients with metastatic breast cancer: A National Cancer Database analysis.
Authors: Patel Rima , Kwon Deukwoo , Tiersten Amy
Published: June 2023

12049

Background: Over the last few decades, improvements in healthcare have increased life expectancy by nearly 10 years resulting in a rise in America’s older population. As age is one of the most significant risk factors for the development of cancer, there is a projected increase in the incidence of cancer in the elderly population, with the largest absolute and relative increases in breast cancer (BC). Although treatment advances have improved outcomes for patients with metastatic breast cancer (MBC), patients in clinical trials are often younger and there is limited data for the older population. The goals of this study were to use the National Cancer Database (NCDB) to assess overall survival (OS) in older patients over 75 years of age with MBC and evaluate the impact of tumor features and demographic factors. Methods: Women with a diagnosis of BC at age ≥75 years and with metastases at time of initial diagnosis from 2010 to 2019 were identified from the NCDB. Patients were stratified into age subgroups of 75-79, 80-84, and ≥85 years. Chi-square tests were used to compare categorical variables. Kaplan Meier curves were used to determine OS distributions for patients by age, BC subtype and year of diagnosis. Log-rank tests and multivariable cox proportional hazards modeling was performed to assess the difference in OS by BC subtype. Results: Of 17,325 eligible women included in the final analysis, 39.4% were 75-79, 30.1% 80-84, and 30.4% ≥85 years of age. We observed an improvement in OS over time, with 5-year OS rates improving from 13.7% in 2010 to 15.2% in 2015, p = 0.017. Three-year OS rates were higher in patients aged 75-79 (34.2%) compared with patients aged 80-84 (28.7%) and ≥85 years (18.6%), p < 0.001. Outcomes varied by BC subtype with better prognosis in patients with hormone receptor (HR)+, HER2-negative BC (3-year OS 35.1%), followed by HR+, HER2+ (32.8%), HER2+, HR-negative (20.6%) and lastly, HR-negative, HER2-negative BC (9.7%), p < 0.001. Based on multivariable analyses, a higher comorbidity index was associated with worse outcomes (HR 1.654 [1.48-1.849], p < 0.0001). Higher income (≥$63,000) was associated with decreased mortality (HR 0.859 [0.784-0.941], p = 0.0011) compared with lower income ( < $38,000). While the type of cancer facility (academic, community, etc) did not impact mortality, older patients living in metropolitan areas ( > 1 million) had improved outcomes (HR 0.829 [0.689-0.996], p = 0.046), compared to those in rural areas. Conclusions: We observed a modest though significant improvement in survival outcomes over time in older patients with MBC. Prognosis was better in patients with HR+ BC compared with HR-negative, HER2+, and HR-negative, HER2-negative subtypes. However, outcomes in patients ≥85 years remain poor. Given the lack of clinical trial data in older patients with cancer, future studies should specifically focus on improving outcomes in this population.
Sedentary lifestyle as a predictor of early death in older adults with cancer: A prospective cohort study with 2692 patients.
Authors: Telles O Lima Jurema , Mello Maria Julia Gonçalves , Sales Letícia telles , Miranda DOS Santos Luis Filipe , Silva Fernanda R de Melo , Rayol Rafael M M C , sILVA José Roberto , Costa José Iran , Rebello Mirella , Cavalcanti Zilda , Thuler Luiz Claudio Santos ,   BLOGG - BRAZILIAN ONCOLOGY GERIATRIC GROUP
Published: June 2023

12058

Background: Physical activity is an important aspect of the global health of older adults with cancer (OAC). The aim of this study was to determine sedentary lifestyle as a predictor of early death in OAC. Methods: Prospective cohort involving elderly (60+) with cancer, cared for in a public hospital in Pernambuco, from January 2015 to December 2021. Sociodemographic, clinical, and lifestyle variables were considered. The level of physical activity was assessed before cancer treatment by the International Physical Activity Questionnaire (IPAQ), short version, with classification into active (active/very active) and inactive (sedentary/inadequately active) and comprehensive geriatric assessment (CGA). The outcome was death within 180 days. Kaplan-Meier survival curves and Cox multivariate analysis were performed. Results: 2692 patients were included, most were men, with family income less than 01 minimum wage in almost 30%. The presence of two or more comorbidities was observed in 70.1% of patients. The main primary sites were prostate (30.8%), breast (17%) and digestive system (25.8%), gynecological system (10.6%), lung (5.9%), and the majority (67.6%) had no metastatic disease. There were 461 deaths (25.7% sedentary and 9.7% non-sedentary). Sedentary lifestyle was an independent risk factor for early death (HR=1.28,95% CI=1.07-1.64 p< 0.036), controlled by tumor topography and presence or absence of metastasis, presence of polypharmacy and Karnofsky performance scale, recent hospitalization and nutritional status. At 180 days, survival among patients with some level of physical activity was higher (90% (0.88 - 0.92)) than among sedentary patients (74% (0.72 - 0.77, p < 0.01). Conclusions: Sedentary lifestyle at the time of cancer diagnosis was an independent risk factor for early death among Older adults with cancer. Encouraging physical activity is an important public health action to face aging-related health problems, such as cancer.
Older patients with early-stage triple-negative breast cancer: The Memorial Sloan Kettering Cancer Center experience.
Authors: Zhi Iris , Lake Diana E , Ehrich Fiona , Chen Yuan , Korc-Grodzicki Beatriz , Norton Larry , Robson Mark E. , Singh Jasmeet Chadha
Published: June 2023

12063

Background: Approximately 15% of cases of early-stage triple-negative breast cancer (TNBC) are diagnosed in individuals over the age of 70. Despite studies indicating that older patients derive similar benefits from polychemotherapy as younger patients, breast cancer specific mortality among older patients remains disproportionately high. Use of the comprehensive geriatric assessment (CGA) and individualized risk tools can help tailor treatment and minimize negative side effects while preserving quality of life. We performed a retrospective analysis of patients ≥ 70 years of age diagnosed with stage I-III TNBC at Memorial Sloan Kettering Cancer Center between 2015 and 2019 to describe clinical practices for managing this population. Methods: Demographics, CGA, systemic therapy data were collected from electronic medical records. A multivariable logistic regression model was used to identify factors that were independently associated with the probability of receiving chemotherapy. Results: We included 159 women, with a median age of 74.5 years (range 70-96). 67 (42%) had stage I disease, 71 (45%) had stage II, and 21 (13%) had stage III. 29 (18%) reported difficulty in Activities of Daily Living (ADL), 34 (21%) reported difficulties in Instrumental Activities of Daily Living (iADL), and 40 (26%) were identified as having a high risk for falls. 25 (17%) patients underwent CGA per physician’s choice. The prevalence of cardiac risk factors was as follows: hypertension in 80 patients (50%), diabetes in 25 (16%), obesity in 7 (4.4%), heart failure in 1 (0.6%). 147 underwent breast surgery, with 106 (67%) receiving lumpectomy and 41 (26%) mastectomy. 97 (61%) patients received chemotherapy: 35 (22%) neoadjuvant and 62 (40%) adjuvant. Anthracycline, Cyclophosphamide, Paclitaxel (AC-T) and Cyclophosphamide, Methotrexate, Fluorouracil (CMF) were the most common regimens. In multivariable logistic regression analysis, use of chemotherapy was associated with younger age (odds ratio [OR] 0.84 for one year increase in age, 95% confidence interval [CI] 0.75-0.93, p = 0.001) and higher disease stage (stage II vs. I OR 4.97, 95% CI 1.66-16.4, p = 0.006; stage III vs. I OR 22.0, 95% CI 3.3-312, p = 0.006). No significant difference was found in geriatric referrals, cardiovascular risk factors, or difficulties with ADL or iADL between those receiving or not receiving chemotherapy. Conclusions: In our single center experience, 61% of older patients with early-stage TNBC received chemotherapy, with AC-T and CMF being the most common regimens. The referral rate for CGA was low. Age < 75 years and higher disease stage were significantly associated with receiving chemotherapy. Overcoming barriers to incorporating CGA and toxicity prediction into routine clinical practice is crucial for personalized treatment in this population.
Frailty and pre-frailty associated with physical functional performance and quality of life in breast cancer and bone marrow transplant survivors.
Authors: Wang Shuo , Te Hok Sreng , Cao Qing , Yousefzadeh Matthew J. , Napurski Char , Arora Mukta , Barcelo Helene , Niedernhofer Laura , Thyagarajan Bharat , Prizment Anna , El Jurdi Najla H. , Blaes Anne Hudson
Published: June 2023

12064

Background: Frailty in cancer survivors poses a great challenge to health care providers. Frailty is associated with premature mortality, functional decline, and poor quality of life (QOL). We aimed to examine the associations of frailty and pre-frailty with physical functional performance and QOL in breast cancer survivors and bone marrow transplant (BMT) survivors. Methods: 43 breast cancer survivors and 55 BMT survivors who had received chemotherapy and did not have active cancer were recruited to the study. Based on Fried frailty phenotype, survivors were classified as frail if 3 or more criteria were present: unintentional weight loss, exhaustion, slow walking speed, low physical activity, and weakness. Pre-frail was classified if 1 or 2 criteria were present. Physical functional performance was assessed by Karnofsky performance scale (KPS) and continuous summary performance score (CSPS, comprises walking speed, standing balance, and repeated chair stands tests). p16INK4a, a marker for cellular senescence, was measured from survivors’ blood samples. QOL was measured using the 36-Item Short Form Survey. Groups were compared using chi-square test for categorical variables and rank-sum test for continuous variables. Results: Median age of survivors was 59 yrs (39% male). 13% of survivors (N = 13) were frail and 26% (N = 25) were pre-frail. Frail/pre-frail survivors tended to be older, male, and BMT survivors and had worse results for KPS, walking speed, repeated chair stands, and CSPS (p-values<0.03). Frail/pre-frail versus non-frail survivors had a higher p16INK4a expression (p-value<0.01). For QOL, frail/pre-frail survivors had lower median scores of physical functioning, role limitations due to physical health, role limitations due to emotional problems, energy/fatigue, social functioning, bodily pain, and general health (p-values<0.04), but the median scores of emotional well-being for frail/pre-frail and non-frail survivors were similar (p-value=0.06). Conclusions: Frailty and pre-frailty in a study of breast cancer and BMT survivors were associated with worse physical functional performance, higher p16INK4a expression, and lower quality of life. [Table: see text]
Geriatric-assessment-guided interventions for older adults with multiple myeloma: A feasibility study.
Authors: Jensen Christopher Edward , Nyrop Kirsten A. , Logan Maya , Strayhorn Martha Dell , Deal Allison Mary , Miller Jordan , Muss Hyman B. , Lichtman Eben I. , Rubinstein Sam , Tuchman Sascha Alexander
Published: June 2023

12065

Background: Multiple myeloma (MM) is disproportionately a disease of older adults, and aging-related impairments are common in this population. Geriatric assessment (GA) guided supportive care programs have been linked to improved treatment outcomes among older adults with solid-organ cancers. We sought to evaluate the feasibility of a GA-guided supportive care program among older adults treated for MM. Methods: We leveraged an existing registry of adults with plasma cell disorders at the University of North Carolina. Registry participants meeting inclusion criteria were offered referrals to supportive care resources by their MM provider during routine visits in 2021-2022. Inclusion criteria were diagnosis of MM, age ≥60, and presence of ≥1 selected problem areas (physical function, polypharmacy, mental health) on the GA. Function deficits were defined as self-report of requiring assistance with ≥1 instrumental activities of daily living or recent fall(s), polypharmacy as ≥10 daily medications, and anxiety/depression on the Mental Health Index 13. Individuals with physical function deficits were offered referral to physical therapy (PT). Those with polypharmacy were offered referral to an oncology Clinical Pharmacist Practitioner (CPP) for comprehensive medication reconciliation and evaluation for de-prescribing. Patients with mental health symptoms were offered referral to our center’s Comprehensive Cancer Support Program (CCSP). Results: 59 individuals were identified as having at least one deficit on the GA (Table). Of these, 14 were already utilizing all relevant resources, leaving 45 individuals eligible for a new resource. Among these, 16 accepted a referral to at least one resource. An additional 16 were approached and declined all offered referrals. For the remaining 13 screened individuals, providers were prompted regarding a referral recommendation prior to the patient’s visit, but a referral was not offered during the visit. Physical therapy was the most commonly identified relevant resource (n = 46), followed by CPP visits (n = 33). Referral acceptance rates were highest among those recommended for a pharmacy visit (55% of those approached) and lowest for CCSP (0%). Conclusions: Given the prevalence of polypharmacy or physical function deficits and acceptance rates for related interventions, future interventions focusing on collaboration with CPPs or physical therapists appear feasible in this setting. Methods to direct patients to supportive care resources that do not rely on provider recommendations during the limited window of clinic visits may also be beneficial. Clinical trial information: NCT04999085 . [Table: see text]