M. Monette

Does frailty predict hospitalization, emergency department visits, and visits to the general practitioner in older newly-diagnosed cancer patients? Results of a prospective pilot study

Research on the use of health care by older newly-diagnosed cancer patients is sparse. We investigated whether frailty predicts hospitalization, emergency department (ED) and general practitioner (GP) visits in older cancer patients in a prospective pilot study. Newly-diagnosed cancer patients aged 65 years and over were recruited in the Segal Cancer Centre, Jewish General Hospital, Montreal, Canada. One hundred ten patients participated, mean age 74.1, 70% women. During 1 year follow-up, 52 patients (47.3%) had cancer-related hospitalizations, 23 patients (20.9%) had ED visit and 17 patients (15.5%) had GP visit. No frailty marker predicted hospitalization or visits to the GP. Cognitive impairment suspicion was the only frailty marker that predicted ED visits (odds ratio 4.97; 95%CI 1.14-21.69). Although health care use was considerable in this sample, most frailty markers were not associated with health care use in this pilot study.

The fall rate of older community-dwelling cancer patients

PurposeLittle is known about the incidence of falls in cancer patients receiving cancer treatment. The aims were to explore the number of falls older adults report in the 6xa0months after cancer diagnosis, and if those with a fall were more frail than those who did not fall.MethodsSecondary data analysis of a prospective pilot study that recruited patients aged 65 and older with a new cancer diagnosis. At each interview (baseline, 3- and 6-month follow-up), participants were asked if they had a fall in the previous 3xa0months. The frailty markers and functional status were obtained at baseline, 3- and 6-month follow-up. Chi-square and t tests were used to compare those who had a fall to those who had no fall. Univariate logistic regression analysis was conducted to explore the association between sociodemographic and health characteristics and reporting a fall.ResultsSeventeen participants (18.7xa0%) reported one or more falls in the first 6xa0months after cancer diagnosis. Fifteen participants reported one or more falls in the 3xa0months prior to the cancer diagnosis. Those who had a fall and those with no fall were not different in terms of health and functioning. None of the sociodemographic and health characteristics including the frailty markers were associated with a fall.ConclusionA fall is common in cancer patients. More research is needed to examine the risk factors for a fall in older adults receiving cancer treatment.

Quality of life during the course of cancer treatment in older newly diagnosed patients. Results of a prospective pilot study

BACKGROUNDnThe aim of this prospective study was to report the quality of life (QoL) of older cancer patients during the first year after diagnosis and factors influencing QoL.nnnPATIENTS AND METHODSnNewly diagnosed patients aged ≥65 years were recruited for a pilot prospective cohort study at the Jewish General Hospital, Montreal, Canada. Participants were interviewed at baseline, and at 1.5, 3, 4.5, 6, and 12 months. QoL was assessed at each interview using the European Organization for the Research and Treatment of Cancer Quality of Life Core Questionnaire with 30 items. Logistic regression was conducted to determine which sociodemographic, health, and functional status characteristics were associated with decline in global health status/QoL between baseline and 12-month follow-up.nnnRESULTSnThere were 112 participants at baseline (response rate 72%), median age of 74.1, and 70% were women. Between baseline and 12-month follow-up (n=78), 18 participants (23.1%) declined ≥10 points in global health status/QoL, while 34 participants (43.6%) remained stable and 23 participants (33.3%) improved ≥10 points. None of the sociodemographic, health, and functional status variables were associated with decline in logistic regression analyses.nnnCONCLUSIONnAlmost 25% of older adults experienced clinically relevant decline in their QoL. Further research is needed on which factors influence decline in QoL in older adults.

Characteristics of older newly diagnosed cancer patients refusing cancer treatments

PurposeWith the aging of the population, there will be an increase in the number of older adults diagnosed with cancer. Little is known about the characteristics of older newly diagnosed cancer patients who refuse cancer treatment and how often they refuse. The aim of this paper was to describe the health and functional status characteristics of patients who refused cancer treatment.MethodsA prospective pilot study on health and vulnerability in older newly diagnosed cancer patients was conducted in the Segal Cancer Centre, Jewish General Hospital, Montreal, Canada. One hundred-twelve patients agreed to participate (response 72%). Health and functional status were assessed during the baseline interview; information on cancer treatment was obtained from the medical chart at baseline, 3 and 6xa0months follow-up. Descriptive techniques such as frequencies and means were used to describe the health and functional status of patients who refused treatment.ResultsOf the 112 participants, 17 (15.2%) refused cancer treatment partially or completely. Of those 17, 15 were women and 2 men. Fifteen participants refused a part of their treatment upfront. Two refused all further treatment after severe toxicity. The majority of participants refusing cancer treatment were women with breast cancer and they mostly refused adjuvant chemotherapy. Participants who refused often lived alone, were less often married/living common-law, had activities of daily living disability, and often had early disease.ConclusionThe majority of older newly diagnosed cancer patients underwent the recommended cancer treatment but partial or complete cancer treatment refusal in older newly diagnosed cancer patients was not uncommon.

Effect of an interdisciplinary educational program on antipsychotic prescribing among residents with dementia in two long-term care centers.

The effect of an educational program on antipsychotic prescribing was assessed in two Canadian long-term care centers (LTCC). In each center (Center A residents, n = 258 and Center B residents, n = 191, with dementia at program inception), the rate of change in the odds of using antipsychotics in residents was estimated using mixed-effects logistic regression during a 6-month program period and a 4-month postprogram period, with baseline proportions of use estimated during the 6 months prior to the program. Preprogram proportions of antipsychotic use were 41.6% and 46.2%, respectively. Antipsychotic use decreased during the program in both centers: (odds ratio with 95% CI: 0.943 per week [0.921, 0.965] and 0.969 per week [0.944, 0.994], respectively). During the postprogram period, antipsychotic use increased in Center A (1.039 per week [1.007, 1.072]) but decreased progressively in Center B. The study results suggest the need to implement an ongoing educational program in LTCC.

The relationship of self-rated health with functional status, toxicity and mortality: Results of a prospective pilot study of older patients with newly-diagnosed cancer

OBJECTIVESnTo determine the association between self-rated health (SRH) and functional status, comorbidity, toxicity of treatment and mortality in older patients with newly-diagnosed cancer.nnnMATERIALS AND METHODSnPatients aged 65 and over, newly diagnosed were recruited at the Jewish General Hospital, Montreal, Canada. SRH and functional status [instrumental activities of daily living (IADL), basic activities of daily living (ADL), Eastern Cooperative Oncology Group performance status (ECOG PS), frailty markers and number of comorbid conditions] were evaluated prior to the start of treatment, and at 3, 6 and 12 months (SRH only). Treatment toxicity and mortality data were abstracted from the chart. Logistic regression was also used to examine the relationship between functional status, comorbidity and SRH at baseline. Logistic and Cox regression were used to examine the association between baseline SRH and treatment toxicity/time to death.nnnRESULTSnThere were 112 participants enrolled on this study (median age 74.1). At baseline, 74 patients (66.1%) had a good SRH and 38 patients (33.9%) had poor SRH. Only an increasing number of comorbid conditions was associated with poor SRH at baseline in both univariate and multivariable analysis. We found no association between SRH and toxicity or mortality.nnnCONCLUSIONnA substantial proportion had poor SRH prior to and during cancer treatment. An increasing number of comorbidities was associated with poor SRH at baseline. SRH did not predict toxicity or mortality. Attention to comorbid conditions in older patients with cancer is warranted considering their impact on SRH in this population.

O9 Usefulness of frailty markers in the assessment of the health and functional status in older cancer patient referred for chemotherapy: a pilot study

BACKGROUNDnOlder cancer patients seen in an oncology clinic seem to be healthier and less disabled than traditional geriatric patients. Choosing the most sensitive tools to assess their health status is a major issue. This cross-sectional study explores the usefulness of frailty markers in detecting vulnerability in older cancer patients.nnnMETHODSnThe study included cancer patients >or=70 years old referred to an oncology clinic for chemotherapy. Information on comorbidities, disability in instrumental activities of daily living (IADL) and activities of daily living (ADL), and seven frailty markers (nutrition, mobility, strength, energy, physical activity, mood, and cognition) was collected. Patients were classified into four hierarchical groups: 1- No frailty markers, IADL, or ADL disability; 2- Presence of frailty markers without IADL or ADL disability; 3- IADL disability without ADL disability; 4- ADL disability.nnnRESULTSnAmong the 50 patients assessed, 6 (12.0%) were classified into Group 1, 21 (42.0%) into Group 2, 15 (30.0%) into Group 3, and 8 (16.0%) into Group 4. In Group 2, 7 patients (33.3 %) had one frailty marker, and 14 (66.7%) had two or more. The most prevalent of the frailty markers were nutrition, mobility, and physical activity.nnnCONCLUSIONnThe assessment of seven frailty markers allowed the detection of potential vulnerability among 42% of older cancer patients that would not have been detected through an assessment of IADL and ADL disability alone. A longitudinal study is needed to determine whether the use of frailty markers can better characterize the older cancer population and predict adverse outcomes due to cancer treatment.