Treating nonagenarians with cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8542-8542
Author(s):  
E. J. Crane ◽  
M. Extermann
Keyword(s):  
General Anesthesia ◽  
Cancer Patients ◽  
Patient Population ◽  
Treatment Plan ◽  
Performance Status ◽  
Cancer Center ◽  
Preliminary Evaluation ◽  
Ecog Performance Status ◽  
Patients Âgés ◽  
One Year

8542 Background: In the U.S., the number of cancer patients who are greater than age 85 is expected to quadruple in the next 50 years. Barriers exist to treating this patient population because of concerns of frailty, lack of inclusion in clinical trials, and unknown outcomes when treating this patient population. This single institution retrospective evaluation provides data regarding treatment outcomes for cancer patients ages 90 or older at the time of their treatment at this cancer center. Methods: The charts of all patients registered at the Moffitt Cancer Center who were age 90 or older at during their treatment/evaluation were eligible to be reviewed. The total number of charts eligible was 643. Included patients: 1) had a diagnosis of cancer, 2) had a clear treatment plan with at least two follow-up visits over a one month time period, 3) patients with only one evaluation would be eligible if a clear treatment plan was outlined and their death occurred within 6 months of their evaluation at this cancer center. To date, 329 charts have been reviewed which has yielded 121 patients who meet the inclusion criteria. Results: Preliminary evaluation of reveals that the most common diagnoses are breast cancer (14%), malignant melanoma (11%), head and neck cancer (9%), SCC of the skin (9%), and prostate cancer (8%). Treatment plans included surgery for 45% of the patients with 36% of the patients undergoing general anesthesia. Chemotherapy was administered to 6.8% of the patients, and hospice was recommended to 7.8%. One year after evaluation at this cancer center 54% of the patients were alive, and 42% were alive at 2 years. The average number of medications that these patients used was 5.5 and greater than 95% of the patients had an ECOG performance status of 1. Conclusions: These preliminary results indicate that the nonagenarian cancer patients are probably healthy given the low number of medications taken, indicating fewer comorbid conditions. These patients do have months to years of survival after their therapies which included surgery under general anesthesia and chemotherapy. Although the nonagenarian cancer patient population found at a referral center is likely to be healthier than that found in the community, these findings indicate that nonagenarians with few comorbidities and a good performance status can be successfully treated for their cancer. No significant financial relationships to disclose.

Concordance Study Between IBM Watson for Oncology and real clinical practice for Cervical cancer patients in China：a Retrospective analysis. (Preprint)

2018 ◽  
Author(s):  
Fangwen Zou ◽  
Chao-Yuan Liu ◽  
Xu-Hong Liu ◽  
Yi-Fang Tang ◽  
Jin-An Ma ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Clinical Practice ◽  
Cancer Patients ◽  
Performance Status ◽  
Treatment Options ◽  
Clinical Decision Support Systems ◽  
Chinese Patients ◽  
Cancer Center ◽  
Ecog Performance Status ◽  
Real Clinical Practice

BACKGROUND Watson for Oncology (WFO) is a artificial intelligence clinical decision-support systems with evidence-based treatment options for oncologists. WFO has been gradually used in China, but limited reports on whether WFO is suitable for Chinese patients. OBJECTIVE This study aims to investigate the concordance of treatment options between WFO and real clinical practice at the Second Xiangya Hospital Cancer Center for Cervical cancer patients retrospectively. METHODS We retrospectively enrolled 300 cases of cervical cancer patients who were hospitalized at the Second Xiangya Hospital Cancer Center from May 2017 to August 2018. WFO provide treatment options for 246 supported cases. Real clinical practice were defined as concordant if treatment options were designated “recommended” or “for consideration” by WFO. Concordance of treatment option between WFO and real clinical practice was analysed statistically. RESULTS Treatment concordance between WFO and real clinical practice occurred in 72.8% (179/246) of cervical cancer cases.Logistic regression analysis showed that rural registration residence [0.64(0.427-0.946), P=0.025], advanced age [0.08(0.03-0.28), P=0.032], poor ECOG performance status [0.29(0.083-1.058), P=0.048], stages II-IV disease ([2.08 (1.002-4.325), P=0.046], [2.09(1.001-4.381), P=0.047], [0.19(0.038-0.91), P=0.025], respectively) have remarkable impact on consistency.Pathological type, differentiation degree, lymphatic and distant metastasis were not found to affect concordance.The main reasons attributed to the 27.2% (67/246) of the discordant cases were the substitution of nedaplatin for cisplatin,reimbursement plan of bevacizumab, surgical preference,and absence of neoadjuvant/adjuvant chemotherapy and PD-1/PD-L1 antibodies recommendations. CONCLUSIONS WFO recommendations were in 72.8% of concordant with real clinical practice for cervical cancer patients in China. However, several localization and individual factors limit its wider application. So,WFO could be an essential tool but it cannot currently replace oncologists.To be rapidly and fully apply to cervical cancer patients in China, accelerate localization and improvement were needed for WFO.

scholarly journals Cancer related fatigue: A ubiquitous problem yet so under reported, under recognized and under treated

2015 ◽  
Vol 04 (01) ◽  
pp. 021-023 ◽  
Author(s):  
Akhil Kapoor ◽  
Mukesh Kumar Singhal ◽  
Puneet Kumar Bagri ◽  
Satya Naraya ◽  
Surender Beniwal ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Pearson Correlation ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Cancer Center ◽  
Common Side Effect ◽  
Ecog Performance Status ◽  
Cancer Related Fatigue ◽  
Chronic Illness Therapy ◽  
Coefficient Of Concordance

Abstract Background: Cancer related fatigue (CRF) is a problem that is highly under reported, under recognized and thus, under treated. About 80% of patients receiving chemotherapy/radiotherapy experience CRF, making it the most common side effect of cancer treatment. Functional assessment of chronic illness therapy fatigue (FACIT-F) version-4 is a 13 item questionnaire that has been used to measure the level of fatigue of cancer patients during their daily activities over the past 7 days. Materials and Methods: 92 patients of age 18 years and above attending the oncology Out Patient Department (OPD) of a regional cancer center were recruited in this study and were given FACIT-F questionnaire. The relevant sociodemographic parameters were obtained from the medical records of the patients. The internal consistency of the 13 items was measured using the Cronbach′s alpha. Results: The Cronbach alpha coefficient for FACIT-F scale in our study was found to be 0.74. Kendall′s coefficient of concordance was estimated to be 0.080. The correlation between Eastern Cooperative Oncology Group (ECOG) performance status and mean score of FACIT-F was studied, Pearson correlation coefficient was estimated to be 0.271 (P = 0.009). Conclusions: FACIT-F is a brief, simple, easy to administer and patient friendly tool to measure the fatigue in last 7 days. CRF should be given adequate attention from the beginning of the treatment to improve the quality of life of cancer patients.

scholarly journals Clinical factors and outcomes of subsegmental pulmonary embolism in cancer patients

2021 ◽  
Vol 5 (4) ◽  
pp. 1050-1058
Author(s):  
Melissa Yan ◽  
Ryan Kieser ◽  
Carol C. Wu ◽  
Wei Qiao ◽  
Cristhiam M. Rojas-Hernandez
Keyword(s):  
Pulmonary Embolism ◽  
Cancer Patients ◽  
Metastatic Cancer ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Pulmonary Arteries ◽  
Cancer Center ◽  
Ecog Performance Status ◽  
Randomized Controlled Clinical Trials ◽  
Increased Risk

Abstract In the cancer population, patients diagnosed with venous thromboembolism (VTE) are considered to have a threefold increased risk of mortality compared with those without VTE. With the advent of modern computed tomography (CT), the rate of diagnosis of subsegmental pulmonary embolism (SSPE) has increased, likely as a result of improved visualization of the peripheral pulmonary arteries. The clinical significance of SSPE remains unclear because of the lack of randomized controlled clinical trials. The aim of this study was to identify the incidence and risk factors of recurrent proximal PE within 12 months of diagnosis of SSPE in cancer. We performed a retrospective analysis of 206 adult cancer patients who were diagnosed with SSPE from 2014 to 2016 at the University of Texas MD Anderson Cancer Center. At the time of SSPE diagnosis, the majority had metastatic cancer, 108 patients (53.2%) were undergoing chemotherapy, and 23 patients (11.2%) had a history of VTE. Most patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2. Sixty-seven percent of SSPE was discovered incidentally on restaging CT scans, with the majority being a single and isolated event (70.9%). Within 12 months of SSPE diagnosis, 18 patients (8.7%) were found to have a recurrent PE. The patients treated with anticoagulation had a lower rate of PE recurrence (8% vs 13% in those not treated with anticoagulation). Treatment with anticoagulation did not appear to have a significant impact on overall survival (P = .48) when adjusted for ECOG performance status and cancer stage.

Development of an aid to decision-making form (ADF) integrated into a major institutional program in oncology: A tool to support care goal identification.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18646-e18646
Author(s):  
Laurence Vigouret-Viant ◽  
Clemence Legoupil ◽  
Aurelie Bardet ◽  
Celine Laurent ◽  
Michel Ducreux ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Intensive Care ◽  
Performance Status ◽  
Medical Decision ◽  
Cancer Center ◽  
P Value ◽  
Ecog Performance Status ◽  
Advance Care ◽  
Aggressive Care

e18646 Background: For cancer patients, life-threatening complications may be difficult to anticipate, leading to complex medical decision-making processes. Since 2015, the Gustave Roussy Cancer Center has implemented a major institutional program including a Decision-Aid Form (ADF), outlining the anticipation of appropriate care for patient in case of worsening evolution. Methods: Between January and May 2017, all patients transferred from Site 1 to Site 2 of the hospital were prospectively included. In this study, we assessed the acceptability of the ADF, its using and its impact on the patient’s becoming. Results: Out of 206 patients included, 89.3% had an ADF. The planned stratification of care was notified in practically all cases. Conversely, the involvement of the palliative care team was notified in only 29% of the ADF. The value of the WHO/ECOG Performance Status was limited, varying between physicians. Finally, the field “information for patients and relatives” was insufficiently completed. Although a possible transfer to Intensive Care Unit was initially proposed in two-thirds of the patients, the majority (76%) of the 35 patients experiencing an acute event received exclusive medical or palliative care. The level of therapeutic commitment suggested by the ADF was never upgraded, and often revised towards less aggressive care, and especially without excess mortality for the patients who were initially designated to be eligible for intensive care. Moreover, the patient's survival at 6 months seems to be correlated with the anticipated level of care recorded on the FAD (Log-rank P value < 0,0001). Conclusions: The results of our study suggest that setting up a care stratification file in advance is possible in a French cultural setting and it could be helpful for clarifying prognosis assessment. To achieve complete acculturation, our extensive institutional program remains a cornerstone for the development of advance care planning. Since 2017, this program has widely spreaded ADF which is now integrated into the electronic medical record. Each physician can complete and modify the patient's ADF at any stage of the patient's disease course.

A randomized comparison of carboplatin/vinorelbine versus carboplatin/gemcitabine in advanced non-small cell lung cancer (NSCLC)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7033-7033
Author(s):  
N. Helbekkmo ◽  
S. H. Sundtroem ◽  
U. Aaseboe ◽  
P. F. Brunsvig ◽  
C. L. Von Plessen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Performance Status ◽  
Stage Iiib ◽  
Phase Iii ◽  
Ecog Performance Status ◽  
Intention To Treat ◽  
Primary Endpoints ◽  
Secondary Endpoints ◽  
Grade 3 ◽  
One Year

7033 Background: Carboplatin/vinorelbine (CV) and carboplatin/gemcitabine (CG) are novel 2-drug combinations in the treatment of NSCLC. In a randomized national multicenter phase III study in stage IIIB and IV patients (pts), we compared these regimens with respect to efficacy, toxicity and quality of life (QoL). Methods: Chemonaive pts with histologically or cytologically proven NSCLC, stage IIIB or IV and ECOG performance status (PS) 0–2 were eligible. There was no upper age limit. Pts received vinorelbine 25 mg/m2 or gemcitabine 1000 mg/m2, both administered on day 1 and 8, in combination with carboplatin (Chatelut AUC 4) at day 1. Three courses were administered in 3-week cycles. QoL questionnaires were completed at baseline, before each cycle and then every 8 weeks up to one year. Primary endpoints were survival and QoL and secondary endpoints toxicity and time to progression (TTP). Stratification was done for age, stage and PS, and the planned sample size per arm was minimum 200. The analyses were performed on an intention-to-treat basis Results: From Oct 2003 through Dec 2004, 433 pts from 33 institutions were randomized to CV (n=218) or CG (n=215). Follow-up was minimum one year. There was no difference in overall survival between the two arms (p=0.89). Median survival was 7.3 vs. 6.5 months and 1-year survival 28% and 31% in the CV and CG arm respectively. TTP was significantly longer in the CG arm (p=0.006) with median TTP 4.2 vs. 3.9 months. There was significantly more grade 3–4 anemia and thrombocytopenia in the CG arm (p<0.001) and more grade 3–4 leucopenia in the CV arm (p= 0.001). More pts in the CG arm needed transfusions of blood (p=0.003) or platelets (p=0.001). There was no difference between the arms with respect to neutropenic infections (p=0.87). QoL data are still being analyzed and will be presented at ASCO. Conclusions: Overall survival was similar in the two treatment arms. In the CG arm, the median TTP was longer, but grade 3–4 toxicity requiring interventions, was more frequent when compared to the VC arm. No significant financial relationships to disclose.

Ineligibility of prostate cancer patients in the VA Connecticut Healthcare System (VACHS) to participate in clinical trials due to comorbidities

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5169-5169
Author(s):  
T. M. Mayer ◽  
W. K. Kelly ◽  
J. Concato ◽  
H. Chao
Keyword(s):  
Prostate Cancer ◽  
Clinical Trials ◽  
Cancer Patients ◽  
Healthcare System ◽  
Patient Population ◽  
Performance Status ◽  
Phase Iii ◽  
Medical Conditions ◽  
Eligibility Criteria ◽  
Major Phase

5169 Background: A large proportion of prostate cancer patients receive their care within the VA Healthcare System. As this is a population affected by complex comorbidities, they may be underrepresented in oncology clinical trials. Our objective was to quantify the frequency with which castrate resistant prostate cancer (CRPC) patients in VACHS would be excluded from major phase III randomized controlled trials. Methods: We reviewed records of all prostate cancer patients at the VACHS between 2004–2007 and identified patients with CRPC. We reviewed eligibility criteria of 24 major phase III clinical trials, from 2006 onwards, studying investigational drugs for CRPC and created a “master list” (ML) of the most pertinent criteria. We analyzed our patient population according to both the ML criteria and to the TAX327 study criteria. Results: We identified 106 patients with CRPC, excluded 7 patients with insufficient medical records, and analyzed 99 patients. Performance status and life expectancy could not be accurately assessed from most charts and were excluded as specific criteria (though reflected in other serious medical condition). Major reasons for exclusion according to ML/TAX327 criteria include: 10/10 other malignancy within 5 years; 11/14 abnormal laboratory parameters; 27/30 other serious medical conditions; 3/4 abnormal cardiac function. ML list only exclusions: 5 active angina; 1 unstable DM; 1 major GI surgery; 1 contraindication to steroids. Serious medical conditions included: active cardiac disease, dementia, serious neurologic, psychiatric, vascular, pulmonary or hematologic disease, and poor performance status or compliance. Overall, 45% (45/99) of patients were excluded when using both the ML and TAX327 criteria. Conclusions: Approximately half of CRPC patients in the VACHS between 2004–2007 did not meet eligibility criteria for major therapeutic trials for CRPC. This retrospective review demonstrates that VA patients are underrepresented in randomized clinical trials for CRPC and are a special population due to their complex comorbidities. These findings underscore the importance of designing better clinical trials for CRPC with less barriers for this underrepresented but common patient population. No significant financial relationships to disclose.

Cisplatin (CDDP) and radiation versus cetuximab (Cx) and radiation in locally advanced head and neck squamous cell cancer (SCHNC): A retrospective review.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16009-e16009 ◽  
Author(s):  
Prakash Peddi ◽  
Runhua Shi ◽  
Lori Panu ◽  
Fred Ampil ◽  
Cherie-Ann Nathan ◽  
...  
Keyword(s):  
Performance Status ◽  
Cell Cancer ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Complete Response ◽  
Rank Test ◽  
Cancer Center ◽  
Ecog Performance Status ◽  
Chi Square ◽  
Group A

e16009 Background: SCHNC is a common malignancy and approximately 60% of patients present with locally advanced disease. There is paucity of data directly comparing Cx and CDDP with concurrent radiation in locally advanced SCHNC. We retrospectively reviewed charts of patients treated with CDDP and/or Cx along with radiation in locally advanced SCHNC comparing efficacy and outcomes in an academic cancer center. Methods: Ninety-five patients with locally advanced SCHNC were treated with concurrent CDDP (100 mg/m2 day 1, 22, 43) or Cx (400mg/m2 on day -7 and 250mg/m2 weekly) at our institution between January 2006 and June 2011. Forty-four patients were treated with CDDP (group A), 24 with Cx (group B) and 27 were initially started on CDDP but were switched to Cx secondary to toxicity (group C). All patients received concurrent radiation treatments (66-70 Gy, 2.0 Gy/fraction). The selection of CDDP versus Cx was largely based on ECOG performance status (PS) and baseline renal function of the patients. Chi-square test, analysis of variance, and log-rank test was used for analysis. The three groups had similar baseline characteristics except for mean age of 61, 56 and 55 years in group A, B and C respectively; T4 tumors consisted of 44%, 75% and 41% in groups A, B and C respectively. Groups A, B and C had a combined ECOG 0 and I (PS) of 93%, 75% and 92%. Patients with ECOG III PS were excluded. Results: Oropharynx was the most common treated site (38%) followed by Larynx (35%). Complete response (CR) was seen in 77%, 17% and 67% in groups A, B and C respectively (P<0.001). Median progression free survival (PFS) was 16.6, 4.3 and 22.8 in groups A, B and C respectively (P<0.001) and median overall survival (OS) was >35, 11.6 and >32 months in groups A, B and C respectively (P<0.0001). Conclusions: Concurrent CDDP with radiation leads to better response rate PFS and OS as opposed to Cx though many patients treated with CDDP could not complete treatment due to toxicity. Randomized trial comparing the two should be considered.

Referral trends for reproductive-age patients with breast cancer to a reproductive endocrinology clinic for fertility preservation counseling between 2004 and 2012.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 129-129
Author(s):  
Jonathan David Kort ◽  
Kira Seiger ◽  
Solomon Henry ◽  
Lynn Westphal
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Reproductive Age ◽  
Oocyte Cryopreservation ◽  
Cancer Center ◽  
Research Database ◽  
Breast Cancer Patients ◽  
Reproductive Endocrinology ◽  
Patients Âgés

129 Background: As of October 2012, both embryo and oocyte cryopreservation are considered non-experimental fertility preservation (FP) options for cancer patients facing potentially gonadotoxic therapy. This study aims to assess the historical referral frequency of reproductive aged breast cancer patients from a major cancer center to an associated reproductive endocrinology and infertility (REI) clinic for counseling regarding FP and also assess how frequently these patients underwent FP after referral. Methods: Using the Stanford Cancer Center Research Database in conjunction with our EMR, a query was made for patients of reproductive age (13-45) who were seen at the Stanford Cancer Center for a new breast cancer diagnosis between 2004 and 2012. These patients’ records were then searched for referral encounters in the REI department. Those who were seen by REI were assessed for having undergone FP via embryo or oocyte cryopreservation prior to starting chemotherapy. Results: 420 women, ages 20 to 45, were seen at our cancer center for a new diagnosis of breast cancer between 2004 and 2012. Sixty (14.3%) of these patients, ages 20 to 42 at diagnosis, were referred to the REI department for FP counseling. Patients who were referred for FP counseling were 5.1 years younger at diagnosis than those who were not (p<.005). Of those referred, 33.3% underwent FP with embryo (77%) or oocyte cryopreservation (23%) under an experimental protocol. Among breast cancer patients ≤35 years old, 35% were referred to our REI department for FP counseling and 53.5% of those referred underwent FP. Conclusions: Despite advances in FP technology, the majority of reproductive aged breast cancer patients are still not referred for FP counseling by a reproductive endocrinologist. This trend was also seen among patients younger than 35—a subgroup who is more likely to undergo and benefit most from FP. This study does not reflect patients who decline this opportunity or seek FP elsewhere, however additional study and outreach is needed to improve referral rates, which are now a measure of the Quality Oncology Practice Initiative (QOPI).

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