Karim Malek

Cancer in the oldest old

Our previous work revealed that 88% of centenarians delay or escape the age-related lethal diseases cardiac disease, stroke and diabetes. In the cases of those having a history of cancer we have observed anecdotes of centenarians presenting with large primary tumors that would have otherwise been expected to have metastasized and to have been lethal. However, these tumors were removed without consequence. To better understand the relationship between cancer and exceptional longevity, we quantified age of cancer diagnoses, life-time clinically evident cancer prevalence, tobacco use and family histories through medical record review and interviews. One thousand one hundred and forty-three subjects were studied revealing 20% (N=152) of female and 22% (N=80) of male centenarians with a history of non-skin cancer. The most common cancers were prostate (11.7% of males), breast (8.2% of females), and colon (5.7%). The average age of diagnosis was 80.5 years compared to 63.2 years in the general population according to National Cancer Institute SEER data. Similar delays were noted when age of onset was examined according to specific type of cancer. In conclusion, the age of diagnosis of cancer is relatively delayed in those who live to 100 years. Some cancers are very rare among these individuals suggesting that there are certain cancers that may be incompatible with survival to extreme old age.

Predictive factors for hematopoietic engraftment after autologous peripheral blood stem cell transplantation for AL amyloidosis

Summary:Treatment of patients with AL amyloidosis with high-dose melphalan and autologous peripheral blood stem cells (PBSC) produces hematologic remissions in approximately 40% of evaluable patients, accompanied by improvements in organ disease and quality of life. These patients, who frequently have amyloid deposits in bone marrow blood vessels and interstitium and impaired function of kidneys, liver, spleen, and heart, represent an unusual population for stem cell transplantation, with unique problems. To identify factors influencing engraftment rates after chemotherapy and autologous granulocyte colony-stimulating factor (G-CSF)-mobilized PBSC reinfusion, we studied a group of 225 patients. The median time to neutrophil engraftment was 10 days (range, 8–17 days). In a multivariate analysis, the factors positively affecting the rate of neutrophil engraftment were CD34+ stem cell dose, female gender, and minimal prior alkylator therapy. The median time to platelet engraftment was 13 days (range, 7–52 days). Factors positively affecting platelet engraftment, in addition to CD34+ cell dose, included preserved renal function and the absence of neutropenic fever. The conditioning dose of intravenous melphalan was not found to be an independent predictive factor for hematopoietic recovery. Thus, in this patient population, organ function and host and hematopoietic factors influence engraftment after PBSC rescue.

The Relationship Among Physicians’ Specialty, Perceptions of the Risks and Benefits of Adjuvant Tamoxifen Therapy, and Its Recommendation in Older Patients With Breast Cancer

Objectives:The objectives of this study were to determine whether tamoxifen recommendation differs by physician specialty, to determine whether perception affects tamoxifen recommendation, and to investigate the association between the physicians specialty and the perception of risks and benefits of tamoxifen. Methods:We enrolled a cohort of geographically diverse women aged 65 and older with stage I through IIIa breast cancer in a prospective cohort study. We recruited their surgeons and, when applicable, their medical oncologists to provide patient-specific information about their perceptions of the risks and benefits of tamoxifen and whether they recommended tamoxifen. Each physician also completed a questionnaire regarding his or her demographic and practice characteristics. Patient data were collected through medical record review and a patient interview 3 months after definitive breast cancer surgery. Results:We collected physician treatment recommendation forms for 585 women. Oncologists were 2.5 times more likely to recommend tamoxifen, compared with surgeons, after adjusting for patient and tumor characteristics (95% confidence interval, 1.5–4.2). For both specialties, their perceptions of the risks and benefits of tamoxifen were strong predictors of tamoxifen recommendation. However, there were differences in perception by physician specialty. Distant metastases and tolerance of tamoxifen side effects were more important to oncologists, whereas local recurrence and risk of cataracts were more important to surgeons. Conclusion:Physicians’ perceptions of the risks and benefits of tamoxifen therapy for older women are important in their decision-making process.

Cancer Survivorship Issues in Older Adults

Advancing age comes bundled with increased cancer incidence and mortality.1,2 Indeed, the median age at diagnosis of all cancers combined is 69 years for men and 67 years for women.3 Age-adjusted cancer incidence is ten times higher in the 65+ population compared to their younger counterparts (2,151.2 versus 208.8/100,000 persons).2 Similarly, age-adjusted cancer mortality is 15-fold higher in the 65+ population (1,068.2 versus 67.3/100,000 persons).2 Figures 16.1 and 16.2 illustrate the proportions of the commonest cancers incidence and mortality in the 65+ population.2 As a result, while the total US population is expected to grow by 9% between 1990 and 2010, the incidence of cancer is expected to increase by a disproportionate 32% in the same timeframe.4,5 These trends are mirrored in countries across the globe.6,7

Cancer in the Older Population

Advancing age comes bundled with increased cancer incidence and mortality. Indeed, the median age at diagnosis of all cancers combined is 69 years for men and 67 for women.3 Age-adjusted cancer incidence is 10 times higher in the 65+ population compared to their younger counterparts (2,151.2 versus 208.8/100,000 persons).2 Similarly, age-adjusted cancer mortality is 15-fold higher in the 65+ population (1,068.2 versus 67.3/100,000 persons). Figure 97.1 illustrates the proportions of the commonest cancers incidence and mortality in the 65+ population. As a result, although the total U.S. population is expected to grow by 9% between 1990 and 2010, the incidence of cancer is expected to increase by a disproportionate 32% in the same time frame. These trends are mirrored in countries across the globe.

Erratum: Predictive factors for hematopoietic engraftment after autologous peripheral blood stem cell transplantation for AL amyloidosis (Bone Marrow Transplatation (2005) vol. 35 (567-575) 10.1038/sj.bmt.1704826)

Correction to: Bone Marrow Transplantation (2005) 35, 567–575. doi:10.1038/sj.bmt.1704826 Figure 2a has been published incorrectly, the correct version is shown below.