[Show abstract][Hide abstract] ABSTRACT: Objective:
To determine outcomes of patients ≥70 years with resected pancreatic cancer.
A study was conducted to identify pancreatic cancer patients ≥70 years who underwent surgery for pancreatic carcinoma from 2000 to 2012. Patients were excluded if they had neoadjuvant therapy. The primary endpoint was overall survival (OS).
We identified 112 patients with a median follow-up of surviving patients of 36 months. The median patient age was 77 years. The median and 5 year OS was 20.5 months and 19%, respectively. Univariate analysis (UVA) showed a significant correlation for increased mortality with N1 (P=0.03) as well as post-op CA19-9 >90 (P<0.001), with a trend towards decreased mortality with adjuvant chemoradiation (P=0.08). Multivariate analysis (MVA) showed a statistically significant increased mortality associated with N1 (P=0.008), post-op CA19-9 >90 (P=0.002), while adjuvant chemoradiation (P=0.04) was associated with decreased mortality.
These data show that in patients ≥70, nodal status, post-op CA19-9, and adjuvant chemoradiation, were associated with OS. The data suggests that outcomes of patients ≥70 years who undergo upfront surgical resection are not inferior to younger patients.
Journal of gastrointestinal oncology 10/2015; 6(5):498-504. DOI:10.3978/j.issn.2078-6891.2015.038
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] 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 · 3.45 Impact Factor
[Show abstract][Hide abstract] 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 · 3.45 Impact Factor
[Show abstract][Hide abstract] 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).
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.
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.
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 · 3.06 Impact Factor
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] ABSTRACT: Background:
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.
The literature relating to cancer treatment in the older patient population was reviewed.
The benefit of systemic cancer treatment may decrease with age, and risks may be increased due to reduced life expectancy and reduced tolerance of stress in the older population. Therefore, a multipronged approach is recommended for clinical studies in these patients, including phase 2 studies limited to persons 70 years of age and older, stratification by life expectancy and predicted treatment tolerance in phase 3 studies, and registration studies to establish predictive variables for treatment-related toxicity in older individuals.
A combination of prospective and registration studies may supply adequate information to study cancer treatments in the older patient population.
Cancer control: journal of the Moffitt Cancer Center 07/2014; 21(3):215-20. · 3.50 Impact Factor
[Show abstract][Hide abstract] 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 ...
[Show abstract][Hide abstract] 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” .Disincarnation is the pretense to share objective ...
[Show abstract][Hide abstract] 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.
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.
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.