Geriatric oncology research to improve clinical care

James Wilmot Cancer Center, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA.
Nature Reviews Clinical Oncology (Impact Factor: 14.18). 07/2012; 9(10):571-8. DOI: 10.1038/nrclinonc.2012.125
Source: PubMed


Cancer incidence increases with advanced age. The Cancer and Aging Research Group, in partnership with the National Institute on Aging and NCI, have summarized the gaps in knowledge in geriatric oncology and made recommendations to close these gaps. One recommendation was that the comprehensive geriatric assessment (CGA) should be incorporated within geriatric oncology research. Information from the CGA can be used to stratify patients into risk categories to better predict their tolerance of cancer treatment, and to follow functional consequences from treatment. Other recommendations were to design trials for older adults with study end points that address the needs of the older and/or vulnerable adult with cancer and to build a better infrastructure to accommodate the needs of older adults to improve their representation in trials. We use a case-based approach to highlight gaps in knowledge regarding the care of older adults with cancer, discuss our current state of knowledge of best practice patterns, and identify opportunities for research in geriatric oncology. More evidence regarding the treatment of older patients with cancer is urgently needed.

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    • "Such assessment may signalize indicators that have the potential to guide oncologic care optimization, stratify patients into risk categories, and appear to have value as prognostic predicting outcome in cancer patients. Moreover, the survivors face physical, psychological, and social impairments that patient-reported outcomes can signalize [7]-[11]. The relationships between demographic, clinical characteristics and patient-reported outcomes have been evaluated in oncology. "

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    • "Rare situations are related to microinvasion (Schnitt, 1998) and neoadjuvant situations (Fumagalli et al, 2012). More frequent non-compliance points out the need for a better integration of guideline-based care in oncogeriatry (Biganzoli et al, 2012; Parks et al, 2012) and the need for specific clinical research (Mohile et al, 2012). They further support the importance of patient choice in shared decisions (Leonard et al, 2011), and illuminate populations for which management is still unclear (e.g., HRþ /HER2þ ) (Prat and Perou, 2011). "
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    ABSTRACT: Background: Despite multidisciplinary tumour boards (MTBs), non-compliance with clinical practice guidelines is still observed for breast cancer patients. Computerised clinical decision support systems (CDSSs) may improve the implementation of guidelines, but cases of non-compliance persist. Methods: OncoDoc2, a guideline-based decision support system, has been routinely used to remind MTB physicians of patient-specific recommended care plans. Non-compliant MTB decisions were analysed using a multivariate adjusted logistic regression model. Results: Between 2007 and 2009, 1624 decisions for invasive breast cancers with a global non-compliance rate of 8.3% were analysed. Patient factors associated with non-compliance were age>80 years (odds ratio (OR): 7.7; 95% confidence interval (CI): 3.7–15.7) in pre-surgical decisions; microinvasive tumour (OR: 5.2; 95% CI: 1.5–17.5), surgical discovery of microinvasion in addition to a unique invasive tumour (OR: 4.2; 95% CI: 1.4–12.5), and prior neoadjuvant treatment (OR: 4.2; 95% CI: 1.1–15.1) in decisions with recommendation of re-excision; age<35 years (OR: 4.7; 95% CI: 1.9–11.4), positive hormonal receptors with human epidermal growth factor receptor 2 overexpression (OR: 15.7; 95% CI: 3.1–78.7), and the absence of prior axillary surgery (OR: 17.2; 95% CI: 5.1–58.1) in adjuvant decisions. Conclusion: Residual non-compliance despite the use of OncoDoc2 illustrates the need to question the clinical profiles where evidence is missing. These findings challenge the weaknesses of guideline content rather than the use of CDSSs.
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