Lodovico Balducci

Moffitt Cancer Center, Tampa, Florida, United States

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Publications (206)937.35 Total impact

  • Lodovico Balducci
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    ABSTRACT: This article explores the treatment of cancer of the stomach and of the lower esophagus in older individuals. The incidence of both malignancies increases with age and, at present, the biology of the diseases, including sensitivity to chemotherapy, does not seem to change with age. The treatment of these cancers in patients 70 and over includes assessment of life expectancy secondary to physiologic age and evaluation of the individual's tolerance to stress. For this purpose a comprehensive geriatric assessment (CGA) is the best validated instrument. For individuals whose life expectancy without cancer exceeds that with cancer, the estimate of the risk of chemotherapy complications may reveal those patients in need of additional care and those patients in whom the risk of treatment may exceed the potential benefits. All older individuals receiving chemotherapy may need adjustment of the doses to the glomerular filtration rate, support with myelopoietic growth factors, and special care to prevent severe and irreversible neurotoxicity.
    Journal of gastrointestinal oncology 02/2015; 6(1):75-8. DOI:10.3978/j.issn.2078-6891.2014.093
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    ABSTRACT: Pain is one of the most frequent reasons for consultations in general practice, presenting either alone or associated at some comorbidity. In all care settings for older and oldest old patients, exists a gap between best-practice recommendations and current clinical practice. Clinical manifestations of persistent pain are often complex and multifactorial in the frail population, so the approach to pain management in older persons differs from that for younger people. The purpose of this review is to describe the best approach to assess and manage the persistent cancer and no-cancer pain in elderly, to explain the principles of pain treatment in this so often frail and complex population, to compare the different drugs that should be used or avoided in older and oldest old patients considering the age-related physiologic changes. Considerable emphasis is placed to conditions more common in elderly such as neuropathic pain or typical subsets of the aging population such as the assessment of pain in people with dementia.
    Current Pharmaceutical Design 01/2015; 21(13). DOI:10.2174/1381612821666150130124926 · 3.29 Impact Factor
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    ABSTRACT: The so-called "silver tsunami" is a metaphor that the individuals 65 and older represent the most rapidly growing segment of the Western world population. Aging is an ongoing process that leads the loss of functional reserve of multiple organ systems, increased susceptibility to stress, it is associated with increased prevalence of chronic disease, and functional dependence. Determined by a combination of genetic and environmental factors, this process is highly individualized and poorly reflected in chronologic age. The heterogeneity and the complexity of the older old population represent the main challenge to the treatment of cancer in those patients. We should discern "fit" elderly in whom standard cancer treatment appears to be comparable to a younger population and "unfit" or "frail" elderly, in which the risks of the treatment may overwhelm potential benefits. There are many aspects that have to be assessed before treating an elderly patient, or before to choose the treatment itself. In our review we will try to explain and describe the meaning and the most important aspects related to the oldest old complex patients, and how to manage those patients.
    Current Pharmaceutical Design 01/2015; 21(13). DOI:10.2174/1381612821666150130122536 · 3.29 Impact Factor
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    ABSTRACT: To determine if age affects outcome in patients with resected pancreatic head cancer. An IRB-approved pancreatic cancer database was queried for patients with upfront resected pancreatic head cancer treated at our institution between 2000 and 2012. Overall survival (OS) curves were calculated according to the Kaplan-Meier method and log-rank analysis. Multivariate analysis was performed using the Cox proportional hazard model. We identified 193 patients. Patients ≥70years were less likely to receive adjuvant treatment (p=0.002); however there were no other significant differences between age groups. There was a trend towards increased pancreatic leaks in the elderly group (p=0.06), but no difference in post-operative complications or mortality. There was no difference in overall survival based on age. Median and 5-year OS were 23months and 26.7% in patients <70years, 23.4months and 23% in those 70-75, 16.1months and 0% in those 76-80, and 18.7months and 15.4% in those >80years (p=0.62). On univariate analysis, there was increased OS in patients with lower T stage, N0 status, post-operative CA19-9 level <90, and use of chemoradiotherapy (p<0.05). Multivariate analysis revealed that lower tumor stage, N0, post-operative CA19-9 level <90, and use of any adjuvant therapy predicted decreased mortality (p<0.05). Age, gender, tumor site, tumor grade, and positive margins were not prognostic on multivariate analysis. There is no difference in outcomes when comparing elderly patients with resected pancreatic cancer to those patients <70years of age. Copyright © 2014 Elsevier Inc. All rights reserved.
    Journal of Geriatric Oncology 12/2014; 6(2). DOI:10.1016/j.jgo.2014.11.005 · 1.15 Impact Factor
  • Lodovico Balducci · May Mo · Esteban Abella · Alan Saven
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    ABSTRACT: Objectives: To evaluate primary prophylaxis with pegfilgrastim, a recombinant human granulocyte colony-stimulating factor, on maintaining relative dose intensity (RDI) in patients with non-Hodgkin lymphoma (NHL) receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-rituximab (CHOP-R). Methods: This retrospective analysis pooled data from pegfilgrastim NHL clinical trials. Patients received up to 6 cycles of CHOP/CHOP-R every 2 (Q2W) or 3 (Q3W) weeks. RDI and the patient incidence of dose delay, reduction, discontinuation, and adverse events leading to dose alteration/discontinuation were summarized overall and by age group (below 65, 65 to 75, and above 75 y) and treatment schedule. RDI during treatment exposure and RDI adjusted by the planned 6 cycles of treatment were calculated. The adjusted RDI was also evaluated with multiple regression analysis. Results: Mean RDI during treatment exposure was 93% and 94% in overall patients in the Q2W and Q3W regimens, respectively. Mean adjusted RDI was 88% and 80%, respectively. The incidence of patients with RDI>85% was lower in older patients (65 y and above). In older patients, the incidence of dose reduction and discontinuation were higher regardless of treatment schedule, whereas dose delay was higher in the Q2W regimen. Multiple regression analysis identified age and cancer stage as potential factors associated with RDI. Adverse events leading to dose alteration/discontinuation were spread across hematological and nonhematological toxicities; older patients had a higher incidence of these adverse events. Conclusions: Pegfilgrastim primary prophylaxis maintained RDI in NHL patients receiving CHOP/CHOP-R during treatment. Adjusted RDI was lower in elderly patients because of early termination of chemotherapy.
    American Journal of Clinical Oncology 10/2014; 37(6). DOI:10.1097/COC.0000000000000141 · 2.61 Impact Factor
  • Journal of Geriatric Oncology 10/2014; 5:S26. DOI:10.1016/j.jgo.2014.09.034 · 1.15 Impact Factor
  • Journal of Geriatric Oncology 10/2014; 5:S44. DOI:10.1016/j.jgo.2014.09.073 · 1.15 Impact Factor
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    ABSTRACT: Background: Senescence-associated genes (SAGs) are responsible for the senescence-associated secretory phenotype, linked in turn to cellular aging, the aging brain, and the pathogenesis of cancer. Objective: We hypothesized that senescence-associated genes are overexpressed in older patients, in higher grades of glioma, and portend a poor prognosis. Methods: Forty-seven gliomas were arrayed on a custom version of the Affymetrix HG-U133 + 2.0 GeneChip, for expression of fo(u)rteen senescence-associated genes: CCL2, CCL7, CDKN1A, COPG, CSF2RB, CXCL1, ICAM-1, IGFBP-3, IL-6, IL-8, SAA4, TNFRSF-11B, TNFSF-11 and TP53. A combined "senescence score" was generated using principal component analysis to measure the combined effect of the senescence-associated gene signature. Results: An elevated senescence score correlated with older age (r = 0.37; P = .01) as well as a higher degree of malignancy, as determined by WHO, histological grade (r = 0.49; P < .001). There was a mild association with poor prognosis (P = .06). Gliosarcomas showed the highest scores. Six genes independently correlated with either age (IL-6, TNFRSF-11B, IGFBP-3, SAA4, and COPG), prognosis (IL-6, SAA4), or the grade of the glioma (IL-6, IL-8, ICAM-1, IGFBP-3, and COPG). Conclusion: We report: 1) a novel molecular signature in human gliomas, based on cellular senescence, translating the concept of SAG to human cancer, 2) the senescence signature is composed of genes central to the pathogenesis of gliomas, defining a novel, aggressive subtype of glioma; and 3) these genes provide prognostic biomarkers, as well as targets, for drug discovery and immunotherapy.
    Journal of Geriatric Oncology 09/2014; 5(4). DOI:10.1016/j.jgo.2014.08.003 · 1.15 Impact Factor
  • International journal of radiation oncology, biology, physics 09/2014; 90(1):S361. DOI:10.1016/j.ijrobp.2014.05.1172 · 4.18 Impact Factor
  • International journal of radiation oncology, biology, physics 09/2014; 90(1):S356. DOI:10.1016/j.ijrobp.2014.05.1157 · 4.18 Impact Factor
  • Armando Santoro · Lodovico Balducci
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    ABSTRACT: This article reviews the Grandangolo conference on cancer survivorship and highlights the major findings. These include the improvement in survivorship, and the emergence of survivorship related syndromes, such as new neoplasms, cardiomyopathy, neutorpathy fatigue and memory loss. Emotional disorders may include the Lazarus’ Syndrome and the post-traumatic stress disorder. An open question is whether we should have specialists of survivorship or primary care physicians or oncologists could fulfill this role.
    08/2014; 12(2):37-43. DOI:10.1007/s12682-014-0182-5
  • Lodovico Balducci
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    ABSTRACT: Data relating to cancer treatment in the older patient population are limited because older individuals have been under-represented in clinical trials. The goal of this review was to establish which factors hinder the participation of older individuals to clinical trials and to examine possible solutions.
    Cancer control: journal of the Moffitt Cancer Center 07/2014; 21(3):215-20. · 2.66 Impact Factor
  • Lodovico Balducci
    Internal and Emergency Medicine 06/2014; 9(5). DOI:10.1007/s11739-014-1083-6 · 2.41 Impact Factor
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    Lodovico Balducci
    06/2014; 12(2). DOI:10.1007/s12682-014-0180-7
  • Lodovico Balducci · Alessandro Pini · Corrado Italia
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    ABSTRACT: Dear Readers,We are at a critical juncture for the Journal of Medicine and the Person and we cannot survive without your help! Facing enormous economic and administrative challenges we decided to keep the journal alive, because we believe that no other publication emphasizes the centrality of the person in medical research and medical practice. If you believe in our mission it is time for you to step up to the plate.In addition to traditional medical research there are new areas of the Journal that offer the opportunity for a fruitful and continuous cooperation:This, the first issue of 2014, presents a unique example of the vitality of qualitative research. Ellen W Klein opens a new horizon to medical communication based on solid, patient-based research which encompasses all human dimensions. Her article represents a most needed transfusion of care and compassion and we wish it would inspire all of you to share your personal experience in the practice of medicine where the care of th ...
    04/2014; 12(1):3-4. DOI:10.1007/s12682-014-0163-8
  • Lodovico Balducci
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    ABSTRACT: Communication is both at the heart and constitutes the art of person-centered medical care. Communication is also a paradox of our time. With the proliferation and increased sophistication of communication media, communication has become confusing and disrupted. Certainly, the difficulty to manage a barrage of information, the absence of mechanisms that control truthfulness and prioritize relevance, and the marketing “pop ups” that intrude and invade our internet searches are partly to blame. Just a few minutes ago, as I Googled the DSM IV definition of depression, I had to navigate through the advertisement of alternative medications, children and adult psychiatric clinics, pet psychiatrists, and the forecast of economic depression by conservative politicians. Yet I believe that the source of confusion is deeper than the flood of wanted and unwanted information; it may be found in what Michael Tobin referred to as “disincarnation” [1].Disincarnation is the pretense to share objective ...
    04/2014; 12(1):1-2. DOI:10.1007/s12682-014-0164-7
  • Nicole Brighi · Lodovico Balducci · Guido Biasco
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    ABSTRACT: Persons aged 65 and over are the fastest growing segment of the population in most Western countries. Although cancer-related death occurs far more commonly in older people than in any age group, studies on palliative care in older adults are lacking. This paper aims at evaluating the needs in elderly patients affected by cancer and the state of the art of the research in palliative care in this setting. A literature search was performed (PubMed) to identify relevant studies. Papers were reviewed for relevance to palliative care in the elderly. Results Elderly who need palliative care are frequently disregarded as individuals and may experience discrimination because of their age. Palliative care for older patients relates particularly to multiple treatments for various conditions. This causes extra complexities for the researchers. Conclusions The aim of the study was not fully achieved due to the paucity of literature focusing upon these issues. The areas of investigation that need to be addressed comprise: establishing the prevailing symptoms in elderly patients, understanding patients' psychological/spiritual well-being and quality of life and elucidating the sources of caregiver burden, adapting research methodologies specifically for palliative care and comparing the needs and the outcomes of this age group to younger patients.
    Journal of Geriatric Oncology 04/2014; 5(2). DOI:10.1016/j.jgo.2014.01.007 · 1.15 Impact Factor
  • Lodovico Balducci · Matti Aapro
    Journal of Geriatric Oncology 01/2014; 5(1):116-118. DOI:10.1016/j.jgo.2013.11.003 · 1.15 Impact Factor
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    Lodovico Balducci · Dawn Dolan
    Mediterranean Journal of Hematology and Infectious Diseases 01/2014; 6(1):e2014037. DOI:10.4084/MJHID.2014.037
  • L Balducci · D Goetz-Parten · M A Steinman
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    ABSTRACT: Aging is associated with polymorbidity and polypharmacy. In the absence of a consensual definition, polypharmacy has been defined according to the number of drugs that an individual takes or to the presence of the risk of at least one severe drug interaction. In older cancer patients, polypharmacy is at least as common as it is in individuals of the same age without cancer. The management of cancer itself may result in the addition of more medications to counteract the adverse effects of antineoplastic treatment. Polypharmacy may be necessary to control the multiple health conditions of the older person, but it may represent a risk factor for more complications from antineoplastic therapy, and it may affect the outcome of cancer treatment. Polypharmacy is also associated with increased cost. The criteria proposed for the management of polypharmacy include the assessment that all medical conditions are properly treated, the avoidance of drug interactions, and of drugs that may compromise the outcome of antineoplastic treatment and the choice of drugs with the lowest risk of complications in older individuals.
    Annals of Oncology 10/2013; 24 Suppl 7:vii36-vii40. DOI:10.1093/annonc/mdt266 · 6.58 Impact Factor

Publication Stats

5k Citations
937.35 Total Impact Points

Institutions

  • 1970–2015
    • Moffitt Cancer Center
      • Department of Cancer Epidemiology
      Tampa, Florida, United States
  • 1992–2014
    • University of South Florida
      • • Morsani College of Medicine
      • • Department of Internal Medicine
      • • Florida Policy Exchange Center on Aging
      Tampa, Florida, United States
  • 2007
    • Georgetown University
      Washington, Washington, D.C., United States
  • 1991–1993
    • James A. Haley Veterans Hospital
      Tampa, Florida, United States
  • 1978–1992
    • University of Mississippi Medical Center
      • • Department of Medicine
      • • Division of Oncology
      Jackson, Mississippi, United States