Search Results (192)

Background: Comprehensive Geriatric Assessment (CGA) is essential for evaluating older cancer patients, but significant gaps persist in both research and clinical practice. This study aimed (I) to identify the CGA elements that most influence anti-cancer treatment decisions in older patients and (II) to explore the predictive value of CGA components for mortality. Methods: This observational study included older patients with newly diagnosed, histologically confirmed solid or hematological cancers, recruited consecutively from 2003 to 2023. Participants were followed for four years. The data collected included CGA measures of functional (Activities of Daily Living-ADL), cognitive (Mini-Mental State Examination-MMSE), and emotional (Geriatric Depression Scale-GDS) domains. Patients were categorized into frail, vulnerable, or fit groups based on Balducci’s criteria. Statistical analyses included decision tree modeling and Cox regression to identify predictors of mortality. Results: A total of 7022 patients (3222 females) were included, with a mean age of 78.3 ± 12.9 years. The key CGA factors influencing treatment decisions were ADL (first step), cohabitation status (second step), and age (last step). After four years, 21.9% patients had died. Higher GDS scores (OR 1.04, 95% CI 1.01–1.07, p = 0.04) were independently associated with survival in men and living with family members (OR 1.67, 95% CI 1.35–2.07, p < 0.001) in women. Younger patients (<77 years) showed both MMSE and GDS as significant risk factors for mortality. Conclusions: Functional capacity, cohabitation status, and GDS scores are crucial for guiding treatment decisions and predicting mortality in older cancer patients, emphasizing the need for a multidimensional geriatric assessment. Full article

Introduction: Urinary tract infections (UTIs) remain a significant public health issue worldwide, particularly affecting the geriatric population with increased morbidity and mortality. Aging-related immune changes, comorbidities, and urogenital abnormalities contribute to the higher incidence and complexity of UTIs in elderly patients. Antimicrobial resistance, especially extended-spectrum beta-lactamase (ESBL) production and carbapenem resistance, poses a major challenge in managing UTIs in this group. Methods: This retrospective, multicenter study included 776 patients aged 65 and older, hospitalized with a diagnosis of urinary tract infection between January 2019 and August 2024. Clinical, laboratory, and microbiological data were collected and analyzed. Urine samples were obtained under sterile conditions and pathogens identified using conventional and automated systems. Antibiotic susceptibility testing was performed according to CLSI standards. Logistic regression analyses were conducted to identify factors associated with ESBL production, carbapenem resistance, and mortality. Results: Among the patients, the median age was 78.9 years, with 45.5% female. ESBL production was detected in 56.8% of E. coli isolates and carbapenem resistance in 1.2%. Klebsiella species exhibited higher carbapenem resistance (37.8%). Independent predictors of ESBL production included the presence of urogenital cancer and antibiotic use within the past three months. Carbapenem resistance was associated with recent hospitalization, absence of kidney stones, and infection with non-E. coli pathogens. Mortality was independently associated with intensive care admission at presentation, altered mental status, Gram-positive infections, and comorbidities such as chronic obstructive pulmonary disease and urinary incontinence. Discussion: Our findings suggest that urinary pathogens and resistance patterns in elderly patients are similar to those in younger adults reported in the literature, highlighting the need for age-specific awareness in empiric therapy. The identification of risk factors for multidrug-resistant organisms emphasizes the importance of targeted antibiotic stewardship, especially in high-risk geriatric populations. Multicenter data contribute to regional understanding of resistance trends, aiding clinicians in optimizing management strategies for elderly patients with UTIs. Conclusions: This study highlights that E. coli and Klebsiella species are the primary causes of UTIs in the elderly, with resistance patterns similar to those seen in younger adults. The findings also contribute important data on risk factors for ESBL production and carbapenem resistance, supported by a robust patient sample. Full article

Cardiotoxicity is a leading cause of mortality in the growing populations of elderly breast cancer (BC) patients. Breast cancer treatment in the elderly is highly challenging due to its heterogeneous nature and the lack of specific evidence, as this population is usually underrepresented in randomized clinical trials. Decision making requires a comprehensive approach, considering the type and stage of BC, the patient’s overall health status, life expectancy, geriatric and frailty assessment, the risk of cancer recurrence, comorbidities, cardiotoxicity risk, and the patient’s preferences. The cardiotoxic effects of BC treatments cover the whole spectrum of cardiovascular diseases: heart failure, hypertension, arrhythmias, and myocardial ischemia. Cardiotoxicity risk in these patients is defined by several factors: anticancer therapies, polypharmacy, established cardiovascular disease, comorbidities, frailty, cellular senescence, hormonal changes, and genetic predisposition. Preventive oncological and cardio-oncological strategies, as well as patients’ education, are critical for improved outcomes. Prospective clinical trials in this population are urgently needed. Full article

Background and Objectives: Despite advances in immunotherapy, predicting survival outcomes in patients with non-small-cell lung cancer (NSCLC) remains challenging. Inflammatory and nutritional indices such as the Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Inflammatory Burden Index (IBI) have emerged as promising prognostic markers associated with overall survival (OS) in NSCLC patients. Materials and Methods: We retrospectively analyzed a total of 196 NSCLC patients treated with second-line nivolumab across multiple centers in Turkey. Of these, 101 patients aged ≥ 65 years were included in the elderly subgroup analysis. PNI, GNRI (in patients aged ≥ 65), and inflammation-based indices were calculated using pre-treatment laboratory values. ROC analysis determined optimal cut-off values. The Kaplan–Meier method and Cox proportional hazards models were used for survival analysis. Results: Median overall survival (OS) was 12.9 months in the full cohort and 12.1 months in patients aged ≥ 65. In univariate analysis, ECOG performance status (0–1), lower NLR (<3.3), lower PLR (<196.8), higher PNI (≥45.2), and higher GNRI (≥98.0) were significantly associated with longer OS. However, in the multivariate analysis adjusted for ECOG PS, NLR, PLR, and GNRI, only PNI remained an independent prognostic factor for OS in both the overall cohort [HR: 0.49, 95% CI: 0.26–0.92; p = 0.02] and elderly patients [HR: 0.45, 95% CI: 0.24–0.84; p = 0.01]. PNI is an independent prognostic biomarker for OS in NSCLC patients treated with immune checkpoint inhibitors. Conclusions: These findings support incorporating simple, cost-effective nutritional indices into clinical decision-making, particularly in elderly patients with NSCLC. Full article

Background: The geriatric nutritional risk index (GNRI), a composite metric of serum albumin and body weight, has emerged as a prognostic tool in various cancers. However, its relevance in nasopharyngeal carcinoma (NPC) patients treated with volumetric modulated arc therapy (VMAT) remains unexplored. The aim of this study was to assess the effect of the GNRI in the prediction of the prognosis of nasopharyngeal carcinoma in the era of VMAT. Methods: This retrospective study analyzed 498 newly diagnosed, non-metastatic NPC patients treated with VMAT between 2010 and 2011. The GNRI was calculated using serum albumin and body weight ratios, with receiver operating characteristic (ROC) curve analysis determining its optimal prognostic cutoff. Patients were stratified into training (70%) and validation (30%) cohorts. Cox regression identified independent prognostic factors, which were integrated into a nomogram predicting 3- and 5-year overall survival (OS). Model performance was assessed via the concordance index (C-index), calibration curves, and decision curve analysis (DCA). Results: In the study, 348 patients were included in the training cohort and 150 patients were included in the validation cohort according to a ratio of 7:3. The median follow-up was 68 months, with 5-year OS rates of 79.3%. A GNRI > 102 independently predicted improved survival (HR = 0.64; p = 0.044), alongside tumor volume, age, and N-stage. The nomogram demonstrated strong discrimination (C-index: 0.757–0.762 for training; 0.737–0.744 for validation) and calibration, aligning closely with observed survival. DCA confirmed superior clinical utility over default strategies. NPC patients treated with VMAT with a high GNRI, female sex, and a lower N-stage exhibited significantly better OS (p < 0.05). Conclusions: The GNRI is a robust prognostic marker for NPC patients receiving VMAT, reflecting the interplay of nutrition, inflammation, and treatment response. The validated nomogram provides a practical tool for individualized risk stratification, enhancing clinical decision-making in the era of precision radiotherapy. Full article

Background: Locomotive syndrome (LS), a condition characterized by impaired mobility due to locomotive organ dysfunction, is highly prevalent among patients with cancer. The phase angle (PhA), measured via bioelectrical impedance analysis (BIA), reflects cellular health and nutritional status. This study aimed to investigate the association between LS and the PhA in patients with cancer. Methods: This cross-sectional study included hospitalized patients who underwent cancer treatment. The assessed variables included age, sex, body mass index (BMI), gait speed, grip strength, PhA, and the outcomes of LS risk assessment using the stand-up test, two-step test, and the 25-Geriatric Locomotive Function Scale (GLFS25). Results: A total of 190 patients (57 females, 133 males; mean age, 62.6 ± 17.2 years) were analyzed. The PhA was significantly negatively correlated with the LS stage (rs = −0.507, p < 0.001). Similarly, a significant negative correlation was observed between the PhA and each LS risk test, namely, the stand-up test, two-step test, and GLFS25. Furthermore, the PhA was identified as an independent and significant factor associated with LS progression (odds ratio, 0.361; 95% confidence interval, 0.221–0.588; p < 0.001). More effective and rapid than completing the full range of LS risk tests, measuring the PhA represents a convenient and practical tool for the early screening of mobility decline. Conclusions: The PhA is a simple and effective parameter for assessing mobility decline in patients with cancer. It is a potential clinical indicator for initiating rehabilitation interventions aimed at preventing the onset and progression of LS. Full article

Backgrounds and Objectives: In this study, we aimed to assess preoperative frailty among hospitalized patients over 60 undergoing colorectal cancer surgery. We investigated the impacts of frailty and sarcopenia on postoperative recovery, complications, and discharge time, while also identifying a cost-effective, bedside-accessible USG parameter for diagnosing sarcopenia among patients assessed using the “Sonographic Thigh Adjustment Ratio” method. Materials and Methods: In this prospective study, we investigated the impacts of frailty and sarcopenia on the postoperative outcomes of 42 geriatric patients (with American Society of Anesthesiologists (ASA) scores of I–III) undergoing colorectal cancer surgery under general anesthesia. Frailty was assessed using the FRAIL scale, and sarcopenia was evaluated using the STAR (sonographic thigh adjustment ratio). Ultrasonographic measurements of rectus femoris and vastus intermedius muscle thicknesses were taken, and thigh lengths (TLs) were recorded. Ratios, including rectus femoris thickness/TL (RFT/TL), vastus intermedius thickness/TL (VIT/TL), and total muscle thickness/TL (TMT/TL), were calculated. Postoperative anesthesia recovery was monitored using the Modified Aldrete Score, indicating the time until discharge from the recovery unit. Complications were classified using the Clavien–Dindo system, and hospital discharge times were noted. Results: We observed significant differences between frailty status and ASA scores, as well as between age and frailty status. Muscle thickness significantly differed between the frail and pre-frail patients. Among the sarcopenic patients, age differences were significant. In men, VIT/TL was significantly correlated with sarcopenia diagnosis, whereas, in women, RFT/TL, VIT/TL, and TMT/TL were all correlated with sarcopenia. Conclusions: Based on our results, we conclude that VIT/TL measurement can serve as a predictive marker for preoperative sarcopenia, optimizing patient health before surgery. Full article

The Hippocratic principle primum non nocere, or “first, do no harm”, serves as a vital lens through which to re-evaluate modern oncology practices. While recent advances such as immunotherapy, targeted agents, and precision medicine have transformed cancer care, these treatments are not without risk. Even with improved tolerability, they may still lead to substantial toxicities, particularly in frail patients with advanced cancer. The pursuit of survival often overshadows the patient’s quality of life, with aggressive interventions frequently continuing beyond the point of meaningful benefit. This perspective article argues for a more individualized and ethically grounded approach to cancer treatment, emphasizing the careful assessment of each patient’s clinical status, values, and goals. By integrating geriatric and palliative assessments, improving shared decision making, and moving away from a default treatment-at-all-costs mindset, clinicians can better align care with what truly matters to patients. Honoring primum non nocere in oncology means not only extending life when appropriate but ensuring that life remains worth living. Full article

Background: Patients with pancreatic cancer are at increased risk of malnutrition and functional decline. This study aimed to identify preoperative nutritional and functional risk factors associated with postoperative complications. Methods: Adult patients with pancreatic cancer admitted to two university surgical departments in Athens, Greece, were included. Preoperative laboratory values, nutritional status, and functional status were assessed. Results: Among 96 patients included in this study, postoperative complications occurred in 69 (71.9%). Complication rates were significantly higher in patients with severe malnutrition (87.9% vs. 62.7%, p = 0.015), low Geriatric Nutritional Risk Index (GNRI) (90.5% vs. 66.2%, p = 0.023), low handgrip strength (91.7% vs. 61.5%, p = 0.037), and low gait speed (90.5% vs. 63.6%, p = 0.027). Major complications were linked to lower hemoglobin (Hb) (11.5 ± 1.9 vs. 12.8 ± 1.7 g/dL, p = 0.001), lower hematocrit (HCT) (34.7 ± 5.4% vs. 38.4 ± 4.7%, p = 0.001), and severe malnutrition (42.4% vs. 23.7%, p = 0.05). Lower Hb, lower HCT, malnutrition, and greater waist circumference were associated with postoperative mortality. Longer hospital stays were correlated with weaker handgrip strength and slower gait speed. Conclusion: Preoperative malnutrition and impaired functional status are significant predictors of adverse postoperative outcomes in pancreatic cancer surgery. Full article

Health beliefs, disease acceptance, and self-efficacy significantly influence patients’ behavior. This study examined factors associated with self-efficacy and illness acceptance in patients with heart failure (HF). The study, conducted from June 2022 to June 2024, included 231 patients aged ≥ 65 years hospitalized for HF. Self-efficacy and illness acceptance were assessed using the Generalized Self-Efficacy Scale (GSES) and Acceptance of Illness Scale (AIS). The median age of participants was 80 years (72–86); a total of 63.6% were women. The AIS score median was 25, indicating moderate disease acceptance, while the GSES score median was 30, reflecting relatively high self-efficacy. Lower GSES scores were associated with a history of cancer (p = 0.002) and geriatric depression (p = 0.000). Poor illness acceptance was linked to prior myocardial infarction (p = 0.020), atrial fibrillation (p = 0.008), stroke (p = 0.040), depression (p = 0.000), and frailty (p = 0.000). Frailty (OR 0.81) and cancer history (OR 3.08) independently predicted self-efficacy, while lower illness acceptance was linked to older age (OR 0.95), stressful events (OR 0.53), stroke (OR 0.26), and improved by physical activity (OR 1.22). Our results indicated that older HF patients exhibit high self-efficacy but moderate illness acceptance. Self-efficacy is influenced by frailty and cancer history, while illness acceptance by age, stress, stroke, and physical activity. Full article

Background and Clinical Significance: Pancreatic cancer was the third leading cause of cancer-related mortality in the United States in 2020 after lung and colorectal cancers. The prevalence of pancreatic cancer has been increasing and is projected to continue rising through 2040, with an estimated 355,317 additional cases expected. We present the case of an 81-year-old patient with metastatic pancreatic ductal adenocarcinoma (PDAC) who tolerated NALIRIFOX for a year with grade 1 adverse events. Case presentation: An 81-year-old Asian male presented with abdominal pain associated with weight loss and fatigue. An abdominal computed tomography (CT) scan showed a mass in the body of the pancreas measuring 3.5 cm with an infiltrative appearance invading the retroperitoneum and encasing the splenic artery. A biopsy confirmed poorly differentiated PDAC. The patient received 13 cycles of NALIRIFOX in a palliative setting over the course of one year, demonstrating excellent tolerance aside from minor toxicities, including worsening of pre-existing macrocytic anemia, treatment-related grade 1 neuropathy, diarrhea, and thrombocytopenia. A subsequent CT scan revealed disease progression, and the patient was switched to second-line therapy. However, per his preference, the patient was referred to hospice care and passed away a few days later. Conclusions: This case highlights the excellent tolerability of NALIRIFOX in an elderly patient, with minimal adverse events observed, which is uncommon among similar patient populations. Full article

Background and Objectives: Along with the ageing of the population, cancer and cardiovascular (CV) diseases more frequently coexist, complicating patients’ management. Here, we focus on elderly oncologic patients, describing clinical features and comorbidities, discussing therapeutic management CV risk factors and CV complications risen during our CV follow-up, and exploring the different items of the comprehensive geriatric assessment (CGA) and the correlation between cardiac function by means of standard 2D echocardiography and each of the CGA items. Methods: A total of 108 consecutive patients (mean age 73.55 ± 5.43 years old; 40.7% females) referred to our cardio-oncology unit were enrolled, and three different groups were identified: Group 1, patients naïve for oncologic treatments (mean age 73.32 ± 5.40; 33% females); Group 2, patients already on antineoplastic protocols (mean age 73.46 ± 5.09; 44.1% females); and Group 3, patients who had already completed cancer treatments (mean age 74.34 ± 6.23; 55% female). The correlation between CGA, performed in a subgroup of 62 patients (57.4%), and echocardiographic parameters was assessed. Results: Group 2 patients had the highest incidence of CV events (CVEs) (61.8% vs. 14.8% in Group 1, 15% in Group 3; p ≤ 0.001) and withdrawals from oncologic treatments (8.8% vs. none in Group 1; p = 0.035). Group 2 had worse 48-month survival (47.1% vs. 22.2% in Group 1, 20% in Group 3; p = 0.05), which was even more evident when focusing on patients who died during follow-up. When assessing echocardiographic parameters, physical activity showed an inverse correlation with the left ventricular mass index (p = 0.034), while the Frailty index showed a direct correlation with the E/e’ ratio (p = 0.005). Conclusions: A thorough baseline CV assessment is important in elderly oncologic patients eligible for anticancer treatment. In this population, CGA can be a simple, feasible screening tool that might help identify patients at a greater risk of developing CVEs correlating to several pivotal cardiovascular parameters. Full article

Background: The incidence of cancer in older patients is high, reaching 2.3 million world-wide in 2018 for patients aged over 80. Because the characteristics of this population make therapeutic choices difficult, co-management between geriatricians and other cancer specialists has gradually become essential. Methods: This narrative review aims to synthesize current data on the contribution of geriatric assessment in the management of elderly patients with non-colorectal digestive cancers. Oncogeriatric assessment is multi-domain, including the evaluation of co-morbidities, autonomy, nutrition, cognition, mood, and functional assessment. Results: Oncogeriatric parameters are predictive of mortality and adverse events. In the peri-operative phase of non-colorectal digestive cancer surgical management, geriatric management can assist in the decision-making process, identify frailties, and arrange a specific and personalized trimodal preoperative rehabilitation program, including nutritional management, adapted physical activity, and psychological care. Its aim is to limit the risks of confusion and of decompensation of comorbidities, mainly cardio-respiratory, which is associated with the highest morbidity in biliary-pancreatic surgery for older adults, facilitate recovery of previous autonomy when possible, and shorten hospital stay. For metastatic cancers, or during multimodal management, such as peri-operative chemotherapy for localized gastric cancers or pre-operative radio-chemotherapy for oesophageal or rectal cancers, specific assessment of the tolerance of chemotherapy is necessary. Neuropathic toxicity and chemobrain have a greater impact on elderly patients, with an increased loss of autonomy. Joint geriatric management can reduce the rate of grade 3–5 adverse effects of chemotherapy in particular and improve quality of life. Conclusions: Co-management between geriatricians and other specialties should be encouraged wherever possible. Full article

Introduction: Canada’s aging population is leading to an increased number of older adults being diagnosed with cancer. This population faces unique challenges, including frailty, comorbidities, polypharmacy, and malnutrition, which can negatively affect treatment outcomes. The role of registered dietitians (RDs) in managing nutrition-related issues in this population is well-documented, but there is limited research on their integration into geriatric oncology clinics. We evaluated the impact of integrating a registered dietitian (RD) into the Older Adult with Cancer Clinic (OACC) at the Princess Margaret Cancer Centre, Toronto, Canada. Materials and Methods: A retrospective chart review was conducted of older adult cancer patients seen at the OACC, comparing outcomes before and after the RD’s integration. The focus was on weight characteristics and change, malnutrition screening/identification, and management. The two-item Canadian Nutrition Screening Tool (CNST) was introduced during the RD’s integration and was also examined to see its usefulness in identifying malnutrition risk. Chi-squared tests and t-tests were used for data analysis. Results: The pre-cohort (n = 140) had a mean age of 80.2 years, 48.6% female, and 77.9% vulnerable (Vulnerable Elders Survey (VES-13) ≥ 3). The post-cohort (n = 117) had a mean age of 81.4 years, 59.8% female, and 80.3% vulnerable (VES-13 ≥ 3). Weight change within 3 ± 1 months after the initial OACC consult was similar between pre and post groups with −1.4 kg and −1.2 kg, respectively (p = 0.77). Patients at nutritional risk, as determined by the OACC team, generated significantly more referrals to the RD in the post group (100% vs. 36.4%, p < 0.001). Among patients who had CNST screening and saw the RD, there was a higher rate of high nutrition risk among CNST-positive compared to CNST-negative patients (67.2% versus 44.4%, respectively). After the integration of the RD, a greater number of patients at nutritional risk received nutritional education and referrals to other healthcare professionals (43 versus 1). Conclusions: The integration of an RD into the OACC led to improved referral rates, nutritional education, and referrals to other healthcare professionals. Moreover, patients who were CNST positive were more likely to have high nutritional risk. Full article

Background/Objectives: Reports on oral frailty as a risk factor for chronic constipation are scarce. In this study, we examined the relationship between Oral Frailty Index-8 (OFI-8) and constipation severity. Methods: This cross-sectional analysis involved patients aged ≥65 years (outpatients between November 2020 and November 2021). Patient background (age, sex, body mass index, medical history, lifestyle history, and oral medications), a constipation severity questionnaire (Constipation Scoring System [CSS]), grip strength, walking speed, skeletal muscle mass index (dual-energy X-ray absorptiometry), a frailty questionnaire, an oral frailty questionnaire (OFI-8), an abdominal symptoms quality of life (QOL) questionnaire (Izumo scale), a swallowing evaluation questionnaire (10-item Eating Assessment Tool [EAT-10]), a chronic obstructive pulmonary disease (COPD) evaluation questionnaire (COPD assessment test [CAT]), a simplified QOL evaluation (EuroQol-five dimensions [EQ-5D]), the Dietary Variety Score, a nutritional evaluation (CONtrolling NUTritional Status [CONUT] score), and the 15-item Geriatric Depression Scale (GDS-15) were analyzed. Risk factors for constipation severity (CSS) were examined using multivariate analysis. Patients with advanced gastrointestinal cancer, inflammatory bowel disease, and active gastroduodenal ulcer were excluded. Results: In total, 1029 patients (male/female: 450/579; mean age: 78.3 ± 6.1 years; mean body mass index: 22.9 ± 3) were included. Multivariate analysis demonstrated a significant association between CSS and OFI-8 (β = 0.065), EAT-10 (β = 0.061), sarcopenia (β = 0.050), laxative (β = 0.126), constipation-related QOL score (β = 0.625), diarrhea-related QOL score (β = −0.064), and CAT (β = 0.061). Conclusions: Comprehensive risk factors associated with CSS included a high oral frailty score, impaired swallowing (EAT-10), sarcopenia, laxative use, a high constipation QOL score, a low diarrhea QOL score, and COPD assessment through CAT. Full article