bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining an abnormal geriatric assessment for older adults with cancer: Which deficits matter most?
Authors: Carrozzi Anthony , Alibhai Shabbir M.H. 
Published: June 2023

12039 Background: At present, there is no universal, objective, and evidence-based definition of what constitutes an abnormal geriatric assessment (GA) in geriatric oncology (GO). In the literature, a threshold number of abnormal GA domains (ranging from 1-4) is often used to define an abnormal GA. However, it is not well-established whether having a specific number of abnormal domains more frequently leads to treatment plan modification (TPM), a key goal of GA, or if particular domains have a greater impact on TPM. The primary objectives of this study are: (1) to determine how well the current definitions of an abnormal GA predict TPM following GA, and (2) to identify particular GA domains associated with TPM. Methods: A retrospective review of the GO clinic database at Princess Margaret Cancer Centre was conducted. All new patients seen in clinic from May 22, 2015 to June 10, 2022 who met the following criteria were included: (1) referred for treatment decision making, (2) received a complete GA, and (3) had a proposed oncologic treatment plan. Demographic, oncologic, and GA-domain variables were extracted. Univariate and multivariate logistic regression modelling was conducted using SPSS to determine each variable’s association with TPM; age, sex, frailty (VES-13) score, and treatment intent were included in all multivariate models. Area under the curve (AUC) was calculated for each model. Results: The study cohort (n = 736) had a mean age of 80.7 years (61-100), 46.1% was female, and 78.3% had a VES-13 score indicating vulnerability. In univariate analysis, age, VES-13 score, disease stage, treatment intent, all GA domains (except Medication Optimization and Social Supports), and all threshold numbers of abnormal domains (except 1 and 7) were significantly associated (p-value < 0.050) with TPM. The best-performing threshold number of abnormal domains in univariate analysis was 4 (AUC 0.628). Overall, the best-performing multivariate model based on AUC was the model containing all 6 significant GA domains (AUC 0.710). In this model, age, treatment intent, Comorbidities, Falls Risk, and Cognition were independently associated with TPM (p-value < 0.05). The multivariate model with a threshold of 4 abnormal domains alone had an AUC of 0.689 and age, VES-13 score, treatment intent, and the threshold were independently associated with TPM. Of the models which included a single GA domain plus the threshold, the models with Comorbidities and Cognition performed best, having AUCs of 0.699 and 0.700, respectively. Conclusions: Overall, our results suggest that an abnormal GA (leading to TPM) may be best defined as one with abnormalities in the domains of Comorbidities, Falls Risk, and Cognition. In terms of a strictly numerical threshold, a GA may be best defined as abnormal if at least 4 GA domains are abnormal. When at least 4 GA domains are abnormal, abnormalities in Comorbidities and Cognition appear to best predict TPM.
Satisfaction in older patients by geriatric assessment using a novel tablet-based questionnaire system: A cluster-randomized, phase III trial of patients with non–small-cell lung cancer (ENSURE-GA study; NEJ041/CS-Lung001).
Authors: Soda Sayo , Mirokuji Kie , Saito Ryota , Takamura Kei , Morita Ryo , Furuya Naoki , Kuyama Shoichi , Shiono Ayako , Arai Daisuke , Hosokawa Shinobu , Masubuchi Ken , Matsumoto Naoko , Asahina Hajime , Kondo Haruka , Honda Ryoichi , Hattori Noboru , Yokoyama Akihito , Kobayashi Kunihiko , Isobe Takeshi , Tsubata Yukari 
Published: June 2023

12041 Background: To provide optimal treatment for older cancer patients, it is necessary to carry out a geriatric assessment (GA) to evaluate geriatric syndrome. However, GA is not widely performed because it requires expertise. In this ENSURE-GA study, we evaluated if providing a GA summary and recommendations for GA-guided interventions using a novel tablet-based questionnaire system improved satisfaction about communication with physicians for older patients with non-small-cell lung cancer (NSCLC). Methods: Patients with NSCLC who were incapable of radical treatment aged 75 or older were enrolled. All patients underwent a standardized GA using a tablet before starting treatment. Participating institutions were cluster-randomized into the intervention group and the control group. In the intervention group, GA summary and recommendations for GA-guided interventions were immediately returned to guide physicians in selecting treatments and interventions. The control group did not provide a GA summary. The primary outcomes were difference in patient satisfaction pre-treatment and percent change pre- and post-treatment according to the HCCQ questionnaire. Results: A total of 1,021 patients from 78 institutions in Japan were enrolled between 2019–2022. There were no differences in patient backgrounds between the intervention group and the control group: mean age 80.1 yrs. vs. 80.0 yrs.; male 64.1% vs. 66.8%; adenocarcinoma 70.4% vs. 64.8%; and performance status 0-1, 82.4% vs. 79.0%, respectively. All GA domain evaluation results, such as ADL and cognitive function, also did not differ between the two groups. Pre-treatment satisfaction scores were significantly higher in the intervention group than in the control group (29.9 vs. 29.1, p = 0.003). There was no significant difference in the mean percent change between the two groups (-0.13 vs. 2.38, p = 0.165). Conclusions: Providing the oncologist with a GA summary and recommendations for GA-guided interventions improved patient satisfaction from the start of treatment. A novel system using a tablet may be effective at promoting GA more widely. Clinical trial information: UMIN0000037590 .
Association of nutrition with psychological health and quality of life among older adults with advanced cancer.
Authors: Singhal Surbhi , Qin Zhaoyang , Peterson Derick R. , Dunne Richard Francis , Wang Ying , Culakova Eva , Targia Valerie , Melnyk Nataliya , Onitilo Adedayo A. , Conlin Alison Katherine , Mohile Supriya Gupta , Loh Kah Poh 
Published: June 2023

12043 Background: Impaired nutrition is associated with greater treatment toxicity and reduced overall survival in patients with advanced cancer. We aimed to evaluate the association of impaired nutrition with psychological health and quality of life among older adults with advanced cancer who were starting cancer treatment with palliative intent. Methods: This secondary analysis was performed on baseline data from a nationwide cluster randomized clinical trial (ClinicalTrials.gov identifier: NCT02107443; PI: Mohile; funding NCI UG1CA189961). Adults age ≥70 with advanced cancer and≥1 geriatric assessment impairment were enrolled from 2014 to 2017. Patients with BMI < 21 kg/m2, > 10% involuntary weight loss in the past 6 months, or Mini Nutritional Assessment Short Form (MNA-SF) score of ≤11 were considered to have impaired nutrition. We used separate multivariable linear regressions to evaluate the association of impaired nutrition with each measure of psychological health and quality of life, which included Geriatric Depression Scale (GDS-15, range 0-15), Generalized Anxiety Disorder-7 (GAD-7, range 0-21), NCCN Distress Thermometer (NCCN DT, range 0-10) and Functional Assessment of Cancer Therapy-General (FACT-G, range 0-108). Analyses were adjusted for baseline patient demographics, clinical characteristics, and geriatric assessment. Results: Among 541 patients, mean age was 77 (range 70-96) and 60% had impaired nutrition. Among the 326 patients with impaired nutrition, 95% had MNA-SF ≤11, 23% had > 10% weight loss in the last six months, and 20% had BMI < 21 kg/m2. Mean baseline GDS-15 was 3.1 (standard deviation [SD] 2.7), GAD-7 was 2.9 (SD 4.0), NCCN DT was 2.9 (SD 2.7), and FACT-G was 80 (SD 14). In the adjusted model, compared to those with normal nutrition, older adults with impaired nutrition had greater depression (mean 0.65 points higher on the GDS-15, p < 0.01) and lower quality of life (mean 6.0 points lower on the FACT-G, p < 0.01). There was insufficient evidence of an association between nutrition and anxiety (β = 0.67, p = 0.06) or distress (β = 0.26, p = 0.28). Conclusions: Recognition of malnutrition by oncology providers is crucial for older adults with advanced cancer. Impaired nutrition is associated with greater depression and lower quality of life among older adults with advanced cancer. Tailored resources to improve psychological health and quality of life are needed to support older adults with impaired nutrition receiving cancer treatment.
An evaluation of the financial toxicity amongst older patients with cancer in India.
Authors: Ramaswamy Anant , Rao Abhijith Rajaram , Noronha Vanita , Basu Renee , Kumar Anita , Pillai Anupa , Sehgal Arshiya , Kumar Sharath , Gota Vikram , Banavali Shripad Dinanath , Prabhash Kumar , Badwe Rajendra A. 
Published: June 2023

12048 Background: Financial toxicity (FT) of cancer is prevalent among older patients in high-income countries, but there is no data about the financial burden faced by older patients in India. This study aimed to explore the FT of cancer among older Indian patients. Methods: This was a cross-sectional observational study conducted in the geriatric oncology clinic of Tata memorial hospital (Mumbai, India). Patients aged 60 years and above with cancer were included. Patients and their relatives were enquired regarding their occupations, monthly income, and source of funding for cancer treatment. The modified Kuppuswamy scale was used for stratification of socio-economic status (SES). The financial burden was evaluated using the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) scale. In addition, the Consumer Financial Protection Bureau Financial Well-Being Scale and the 28th question of QORTC QLQ-C30 were used to assess the financial quality of life. Results: Between June 2022 and January 2023, 498 patients were included. The median age was 67 (IQR, 63-72) years, and 360 (72.3%) were male. Common malignancies included gastrointestinal (199, 40.0%), lung (169, 34.0%) and urological (63, 12.7%); 320 (64.4%) had metastatic disease. According to the modified Kuppuswamy scale, most of the participants belonged to upper-lower SES (223, 44.8%), followed by lower-middle (115, 23.1%), upper-middle (97, 19.5%), lower (59,11.8%) and only 4 (0.8%) belonged to upper SES. The source of funding was mostly from family members (264, 53.9%), insurance (72, 14.7%), while 59 patients (12.0%) did not require external support. Sixty-one (12.4%) had to borrow money, twenty-one (4.3%) participants had taken a loan, and 13 (2.6%) had sold their assets for the purposes of treatment. Moderate-severe burden on COST-FACIT was present in 165 (33.1%), whereas 333 (66.9%) experienced no or mild burden. High FT was associated with lower socioeconomic status (OR: 4.69, 95%CI 2.47-8.91, p-value < 0.001), poor financial well-being (OR: 9.35, 95%CI 5.52-16.46, p-value < 0.001) and poor score on Financial quality of life (OR: 5.16, 95%CI 3.39-7.86, p-value < 0.001). Conclusions: In older Indian patients with cancer, there is a high prevalence of financial burden and is associated with poor socioeconomic status, poor financial well-being and poor financial quality of life. More than half the patients depended on their family members to meet the cost of cancer treatment.
Feasibility of daily physical activity monitoring and associations with treatment toxicity in older adults with metastatic prostate cancer.
Authors: Feng Gregory , Parthipan Milothy , Breunis Henriette , Timilshina Narhari , Soto Pérez de Celis Enrique , Santa Mina Daniel , Emmenegger Urban , Hansen Aaron Richard , Finelli Antonio , Tomlinson George , Krzyzanowska Monika K. , Matthew Andrew , Clarke Hance , Puts Martine , Alibhai Shabbir M.H. 
Published: June 2023

12055 Background: Accelerometry research suggests physical activity may be associated with treatment toxicity, but generalizability to geriatric oncology is unclear. As many older adults have low levels of physical activity and technology use, further exploration is warranted. This study explores the feasibility of daily physical activity monitoring and the association between step counts and symptoms. Methods: Older adults aged 65+ starting treatment (chemotherapy, enzalutamide/abiraterone, or Radium-223) for metastatic prostate cancer were enrolled in a prospective cohort study. Participants reported step counts (measured via smartphone and a free commercial app) and symptoms (Edmonton Symptom Assessment Scale (ESAS)) daily for their first treatment cycle (~1 month). The feasibility of daily monitoring was assessed with descriptive statistics and thematic analysis. The association between a 15% decline in steps (compared to pre-treatment baseline) and the emergence of moderate-to-severe symptoms and pain (ESAS ≥4) in the next 24 hours was assessed using logistic regression. The utility of a 15% step count decline in predicting the development of moderate-to-severe symptoms and pain was evaluated using sensitivity and positive predictive value (PPV). Results: Of 90 participants, 47 engaged in step count monitoring (mean age 75y; 52.2% participation rate). Daily physical activity monitoring was found to be feasible (90.5% median response rate; 94% retention rate) with numerous patient-reported benefits including increased self-awareness and motivation to engage in physical activity. During the first treatment cycle, instances of a 15% decline in steps were common (n=37, 78.7%), as was the emergence of moderate-to-severe symptoms overall (n=40, 85.1%) and pain (n=26, 55.3%). Overall, daily physical activity did not appear to be significantly predictive of symptoms (OR=1.8, 95% CI=0.42-7.74) overall or pain (OR=0.95, 95% CI=0.22-3.81). Predictive validity estimates revealed reasonable sensitivity for both moderate to severe symptoms overall (sensitivity=88.8%, 95% CI=68.7-95.0; PPV=73.0%, 95% CI=58.7-87.3) but poor PPV for pain (sensitivity=77.8%, 95% CI=58.6-97.0; PPV=37.8%, 95% CI=22.2-53.5). Conclusions: Despite recent studies framing physical activity changes as predictive of toxicity, PPV was only poor to fair. However, daily activity monitoring in older cancer patients appears feasible and may have other uses. Clinical trial information: NCT04193657 .
A study of frontline therapy in adults >80 years with chronic lymphocytic leukemia (CLL).
Authors: Tsang Mazie , Hampel Paul Joseph , Rabe Kari G. , Ding Wei , Leis Jose Francisco , Kenderian Saad , Wang Yucai , Muchtar Eli , Koehler Amber , Hanson Curtis A , Shi Min , Slager Susan L. , Kay Neil E. , Parikh Sameer Ashok 
Published: June 2023

12057 Background: AlthoughCLL primarily affects older adults (median age 71 years), limited data exists about the outcomes of adults who are ≥80 years old because they are under-enrolled on clinical trials. Methods: The Mayo Clinic CLL Database was used to conduct a retrospective cohort study of adults ≥80 years at the time of frontline CLL treatment. Kaplan-Meier analysis was used to plot OS, and cumulative incidence was used to plot TTNT, accounting for competing risk of death. The Mayo Clinic IRB approved the study. Results: Our study included 216 patients with CLL who were age ≥80 years at the time of frontline CLL therapy between 1/1995 and 11/2022 (Table). The median time from CLL diagnosis to initiation of frontline therapy was 3.1 years. The median OS after start of frontline therapy was 3.9 years. The median OS was 3.3 years (95% CI 2.6–4.2) for patients who received alkylating agents (e.g., chlorambucil, n=96), 3.8 years (95% CI 2.8–not reached [NR]) for purine analogues (e.g., fludarabine, n=11), 3.9 years (95% CI 3.2–4.9) for anti-CD20 monoclonal antibody monotherapy (e.g., obinutuzumab, n=64), and not reached (95% CI 3.3-NR) for novel agents (n=43) (P=0.02). The types of novel agents included ibrutinib (n=19), acalabrutinib (n=16), venetoclax (n=7), and orelabrutinib (n=1). There was no difference in OS between 36 patients who received a BTKi compared to the 7 patients who received venetoclax-based therapy. At a median follow-up time of 6.7 years from the first visit, 143 patients died from the following: progressive CLL (n=63), infections (n=12), other cancer (n=11), non-CLL reasons (n=21). Cause of death was unavailable for 36 patients. On multivariable analyses, older age (i.e., any 5-year increase in age) was associated with a 50% increased risk of death (HR 1.5, 95% CI 1.2-1.9, p=0.001), and treatment with non-novel agents was associated with 3.2 times increased risk of death (HR 3.2, 95% CI 1.2-8.9, p=0.02). Of the 216 patients, 76 patients required second-line therapy; the median TTNT was 4.2 years (95% CI 2.9-NE). The most used second-line agents were monoclonal antibodies alone (20/76, 26%) and single-agent alkylators (18/76, 24%). Conclusions: When compared to all other CLL treatments, novel agents such as BTKi and venetoclax-based treatments are associated with significantly improved OS in patients with CLL ≥80 years old when used in the frontline setting. [Table: see text]
Dissecting the prognostic role of baseline body mass index (BMI) in early breast cancer (BC): Individual patient-level analysis from five mammella interGruppo (MIG) and gruppo italiano mammella (GIM) randomized clinical trials (RCTs).
Authors: Soldato Davide , Blondeaux Eva , Bruzzone Marco , Mura Silvia , De Laurentiis Michelino , Turletti Anna , De Placido Sabino , Bisagni Giancarlo , Rimanti Anita , Michelotti Andrea , Fabi Alessandra , Russo Antonio , Gori Stefania , Durando Antonio , Nader Marta Guilherme , de Azambuja Evandro , Di Meglio Antonio , Vaz-Luis Ines , Lambertini Matteo , Del Mastro Lucia 
Published: June 2023

12067 Background: Nearly half of patients (pts) are overweight or obese at BC diagnosis (dx). Higher BMI at dx has been associated with cardiometabolic comorbidities, higher risk of severe treatment-related sequelae, and worse quality of life. Previous studies showed inferior survival outcomes among patients with early BC and high BMI, although not consistently. The aim of this study was to explore the prognostic role of BMI at dx using data from five RCTs of adjuvant therapy for early stage BC with long-term follow-up. Methods: Pts with known BMI at dx, randomized in the MIG-1, MIG-5, GIM-2, GIM-3 and GIM-6 phase III RCTs were included. BMI was categorized as lean ( < 25 kg/m2), overweight (25-30 kg/m2) or obese (≥ 30 kg/m2). Outcomes included disease-free survival (DFS), breast cancer free-interval (BCFI) and overall survival (OS). Survival estimates were compared using the Kaplan-Meier method and log-rank test. Multivariable Cox proportional hazard models stratified by trial and relevant prognostic factors assessed associations between BMI and outcomes. Results: Among 7334 pts in the overall population, mean age was 56.4 years (SD 11.2), 67.8% had node-positive disease, 76.9% received chemotherapy and 83.0% endocrine therapy. Most pts were overweight (33.1%) or obese (21.0%) and 45.9% were lean. Higher BMI was associated with older age, larger tumor size, higher nodal status, and HR+/HER2- subtype. At a median follow-up of 10.0 years (IQR 6.1-15.1) there were 2165 DFS, 1674 BCFI and 1354 OS events. Pts with higher BMI had worse DFS and OS (log-rank p = 0.007 and p < .0001, respectively), but similar BCFI (p = 0.48). BMI at dx was an independent risk factor for worse OS, but not for DFS and BCFI (Table). Results in the HR+/HER2- population (n = 4093) were consistent: pts with higher BMI had worse DFS, BCFI, and OS (log-rank p = 0.001, p < .006, and p < .0001, respectively) and BMI at dx was an independent risk factor only for worse OS (aHR [95%CI] 1.06 [0.84-1.32] and 1.31 [1.02-1.67] for overweight and obese vs lean pts, respectively). Conclusions: In this large study of pts with early BC treated in RCTs with long-term follow-up, higher BMI at dx was an independent risk factor for overall mortality but not for BC-specific outcomes. Weight loss interventions may mitigate the detrimental effect of excess body weight on outcomes of BC survivors, including by reducing the burden and risks of associated cardiometabolic comorbidities. [Table: see text]
Dietary and lifestyle profiles between patients with and without cancer in the national health interview survey.
Authors: Gong Emma , Song Mingyang , Allar Benjamin G , Seto Darren , Ma Wenchao 
Published: June 2023

12073 Background: Although poor diet and lifestyle has been associated with cancer development and progression, it is unclear how the diagnosis of cancer impacts diet and lifestyle. We examined the dietary patterns and overall nutrition of adults diagnosed with cancer versus those never diagnosed with cancer in the 2015 National Health Interview Survey (NHIS). Methods: NHIS adults who reported having cancer (n=2,853) and not having cancer (n=27,002) were identified. A dietary/lifestyle score was developed based on World Cancer Research Fund and American Institute for Cancer Research Cancer Prevention Recommendations (Table). Participants were given a score for each recommendation which was then summed as an overall score, with seven meeting all requirements fully and zero meeting none of the requirements. Results: The mean composite score for the cancer population was 4.28 ± 0.88 and for the noncancer population was 4.30 ± 0.90 (p = 0.18). Compared to patients without cancer, those with a cancer diagnosis had higher rates of adherence to recommendations for fruit/vegetable consumption (0.08 vs. 0.07, p <0.001) and limitation of sugar-sweetened beverages (0.77 vs. 0.74, p <0.001), but had lower rates of the recommended physical activity (0.43 vs. 0.49, p <0.001). Conclusions: Patients with and without diagnosis of cancer had mediocre adherence (4.3 out of 7) to lifestyle recommendations, although those with diagnosis of cancer had a higher consumption of fruits/vegetables, lower consumption of sugary beverages, and lower level of physical activity than those without cancer. The data suggests a cancer diagnosis may prompt change in people’s diet, but may limit their ability to exercise. The magnitude of lifestyle change that one can make after a cancer diagnosis may also be influenced by age or social connections. There is great opportunity for integrating healthy lifestyle interventions into routine cancer care. [Table: see text]