Theodora Karnakis

International Society of Geriatric Oncology Consensus on Geriatric Assessment in Older Patients With Cancer

PURPOSE To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. METHODS SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment–related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. RESULTS GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. CONCLUSION There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base.

Correlação entre o estresse do cuidador e as características clínicas do paciente portador de demência

OBJECTIVE: To verify the correlation between caregiver burden in dementia and characteristics of patients and caregivers. METHODS: Analysis of medical records. Patient data: socio-demographic characteristics, comorbidities, medications (previous and current), onset of diagnosis and symptoms, type of dementia and severity (cognitive impairment and functional abilities), behavioral disorders. Caregiver data: socio-demographic characteristics, kinship, duration of caregiving and co-residency with the patient. Caregiver burden assessed by the Zarit interview. RESULTS: Sixty seven patients (76.8 years (± 6.2), 53.7% women) and 82% female caregivers were surveyed. Correlation between burden and behavior disorders (p<0.001), dependencies (p=0.003), onset of symptoms (p=0.016) and of caregiving (p<0.001), previous diagnosis (p=0.016) and co-residency (p=0.002) was studied. Cognitive test scores (Mini Mental and CAMCOG) were inversely proportional to distress (p=0.005 and p=0.023). Black caregivers demonstrated lower levels of stress (p=0.012). CONCLUSION: Burden was associated with behavioral disorders, dependencies, cognitive impairment, and onset of symptoms, caregiving and co-residency. Black caregivers demonstrated lower levels of stress.

The geriatrician's perspective on practical aspects of the multidisciplinary care of older adults with cancer

Multidisciplinary teams (MDTs) have been incorporated into the practical care of elderly patients with cancer. Several geriatric oncology centres have attempted to determine the best way to implement MDTs by using geriatric assessment (GA). Developing a geriatric oncology service is a feasible work, which requires significant resources. The challenges of MDTs must be known so that better care planning for elderly patients with cancer can be devised. The aim of this paper is to discuss the practical aspects of the multidisciplinary care of older adults with cancer by considering a geriatric point of view and the recent literature. Reviewing data from recent studies helps enumerate the major challenges in establishing collaboration in geriatric oncology: evaluating the resources of your centre, knowing the role of each member of the team, establishing good communication both within the team and with the patients, and determining referral criteria and using screening tests to select which patients can benefit the most from the multidisciplinary evaluation and a more thorough GA.

Treatment of a frail older patient with diffuse large B-cell lymphoma on maintenance dialysis: Attenuated immunochemotherapy and adapted care plan

Purpose of the Study: Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoid malignancy worldwide. Its incidence increases with age and about 40% of cases occur in patients over 70 years. Herein, we describe a case of a frail elderly patient with renal insufficiency and DLBCL treated with R-mini-CHOP. Case Report: A 77-year-old man on maintenance hemodialysis started experiencing persistent fatigue. He was diagnosed with a large mass on the left lobe of the lung. Biopsy demonstrated a DLBCL, CD20 positive. The patient was assigned clinical stage IIBX, with a high age-adjusted international prognosis index. A proper geriatric assessment revealed a frail patient. Thus, an adapted chemotherapy regimen was proposed which consisted of R-mini-CHOP every 21 days, with a reduction of 10% in the doses of doxorubicin and cyclophosphamide. During the treatment, the patient went through regular dialysis sessions, 3 times per week, with an extra session performed 12 h after each chemotherapy administration. The patient experienced no adverse events or grade 3/4 toxicities. After 6 cycles of R-mini-CHOP, the patient achieved unconfirmed complete remission, and consolidation radiotherapy was performed. At the last follow-up, he was still in unconfirmed complete remission, with a progression-free survival of 11.3 months. Conclusions: R-mini-CHOP represented a reasonable treatment option for this patient with renal failure. The oncogeriatric approach led to a successful management of this frail patient, highlighting that an adapted plan of care is a key issue to improve the outcomes of elderly cancer patients.

Glioblastoma: approach to treat elderly patients

Treating elderly cancer patients is a challenge for oncologists, especially considering the several therapeutic modalities in glioblastoma. Extensive tumor resection offers the best chance of local control. Adequate radiotherapy should always be given to elderly patients if they have undergone gross total resection and have maintained a good performance status. Rather than being ruled out, chemotherapy should be considered, and temozolomide is the chosen drug. A comprehensive geriatric assessment is a valuable tool to help guiding treatment decisions in elderly patients with glioblastoma.

Patterns of care and outcomes in elderly patients with glioblastoma in Sao Paulo, Brazil: a retrospective study.

OBJECTIVE To analyze how elderly patients with glioblastoma are managed in Brazil. MATERIAL AND METHODS We identified 30 patients aged ≥ 65 years treated between 2003 and 2011 at Albert Einstein Hospital in Sao Paulo. We retrospectively reviewed medical records to obtain data on clinical variables, treatment and outcomes. Overall survival (OS) was evaluated using Kaplan-Meier methods and compared using a Wilcoxon log-rank test. RESULTS The median age was 73 years. The majority of patients (73.2%) underwent surgical intervention. Following surgery, 80% received radiotherapy (RT), and of those, 79.2% were treated with concurrent temozolomide (TMZ). The median progression free survival and OS were 5 and 10.6 months, respectively. Patients with a KPS ≥ 70 had a median OS of 16.2 months, compared to 6.4 months for those with a KPS <70 (p=0.032). For those patients in whom biopsy only was performed, the median OS was 5.3 months, as compared to 7.8 months for those who underwent partial resection and 18.6 months for those treated with gross total resection (p=0.021). A longer survival was found among patients who received RT versus those who did not (11 months vs. 1 month, p=0.003), as well as for those treated with chemoradiation (13.6 months vs. 6.4 months, p<0.0001). CONCLUSIONS This study brings new information about the management of elderly patients with glioblastoma in Brazil. Our data may suggest that elderly patients who undergo cytoreductive surgery and adjuvant RT with concurrent TMZ can do better than those with less aggressive treatment.

Treatment of breast cancer patients from a public healthcare system in a private center: costs of care for a pilot public-private partnership in oncology

ABSTRACT Objective: To describe the flow and costs associated with the diagnosis and treatment of patients with breast cancer who come from the public healthcare system and were treated at Hospital Israelita Albert Einstein. Methods: Between August 2009, and December 2011, 51 patients referred by the Unified Public Healthcare System (SUS) had access to Hospital Israelita Albert Einstein for diagnostic radiology, medical oncology, radiotherapy, and oncologic/ breast reconstruction surgery. The data were collected retrospectively from the hospital records, patient charts, pharmacy records, and from the hospital billing system. Results: The total sum spent for diagnosis and treatment of these 51 patients was US

Prevalence of renal insufficiency in elderly cancer patients in a tertiary cancer center

1,457,500.00. This value encompassed expenses with a total of 85 hospitalizations, 2,875 outpatient visits, 16 emergency room visits, and all expenses associated with these stays at the hospital. The expenditure for treatment of each patient submitted to biopsy, breast conserving surgery, adjuvant chemotherapy without trastuzumab (a regime with taxane followed by anthracycline), radiotherapy, and 5 years of tamoxifen was approximately US

Clinical features and overall survival among elderly cancer patients in a tertiary cancer center

25,500.00. Conclusion: Strategies for cost-reduction of treatment in the private setting are necessary to enable future large-scale public-private partnerships in oncology.

Quimioterapia em idosos: tradução do escore de toxicidade de hurria para o português

Objective To estimate the prevalence of abnormal glomerular filtration rate in elderly patients with solid tumors. Methods A retrospective study with patients aged >65 years diagnosed with solid tumors between January 2007 and December 2011 in a cancer center. The following data were collected: sex, age, serum creatinine at the time of diagnosis and type of tumor. Renal function was calculated using abbreviated Modification of Diet in Renal Disease (MDRD) formulae and then staged in accordance with the clinical practice guidelines published by the Working Group of the National Kidney Foundation. Results A total of 666 patients were included and 60% were male. The median age was 74.2 years (range: 65 to 99 years). The most prevalent diagnosis in the study population were colorectal (24%), prostate (20%), breast (16%) and lung cancer (16%). The prevalence of elevated serum creatinine (>1.0mg/dL) was 30%. However, when patients were assessed using abbreviated MDRD formulae, 66% had abnormal renal function, stratified as follows: 45% with stage 2, 18% with stage 3, 3% with stage 4 and 0.3% with stage 5. Conclusion To the best of our knowledge, this was the first study to estimate the frequency of renal insufficiency in elderly cancer patients in Brazil. The prevalence of abnormal renal function among our cohort was high. As suspected, the absolute creatinine level does underestimate renal function impairment and should not be used as predictor of chemotherapy metabolism, excretion and consequent toxicity.