Are Older French Patients As Willing As Older American Patients to Undertake Chemotherapy?

Extermann, Martine; Albrand, G.; Chen, Hongbin; Zanetta, Sylvie; Schonwetter, Ronald S.; Zulian, Gilbert; Cantor, Alan; Droz, Jean‐Pierre

doi:10.1200/jco.2003.08.091

Cited by 168 publications

(70 citation statements)

References 14 publications

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“…These studies support previous research that indicates that the majority of older adults prefer treatments that facilitate comfort over those that prolong life [82]. Symptom relief is clearly a highly valued treatment outcome for elderly patients [83]. Unfortunately, research continues to report that very old hospitalized patients, who subsequently died while hospitalized, often received life-sustaining treatments regardless of their desire for comfort care [79], despite the widely accepted tenet that "the provision of care at the end of life should honor patients' preferences" [78].…”

Section: Life Prolongation and Symptom Reliefsupporting

confidence: 87%

Too Old to Care?

2004

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Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH (http://www.theschwarzcenter.org/rounds.asp). The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient and support to caregivers, and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members.Ageism is a pervasive problem throughout society. It is rooted in language, attitudes, beliefs, behaviors, and policies. Aging profoundly influences physiology, challenging the medical community to accommodate but not discriminate. The elderly are at an increased risk of disease and disability. Sixty percent of cancer occurs in people aged 65 and older, and the population is aging. The treatment of cancer in the elderly is complicated by comorbidities and other physiological factors, particularly renal, bone marrow, and metabolic reserve. Caregivers have to treat patients in a manner that optimizes treatment and avoids anticipated harm. However, the caregiver is often faced with situations where they must balance their personal beliefs, professional values, and knowledge of medicine with their patients' preferences and needs. Discussion in the Rounds focused on age bias, drug toxicity, life prolongation, and symptom relief, with the role of the caregiver, and the relationship to the patient, being pivotal. The Oncologist 2004;9:343-352 LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Discuss the competing issues in the use of cytotoxic chemotherapy in older patients.2. Identify the intrinsic biases in evaluating the elderly.3. Explain how to inform patients in the face of uncertainty.Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com CME CME CASE PRESENTATIONMrs. L, an 84-year-old woman, was undergoing rehabilitation after hip and wrist surgery when a mass in her lung was detected on a hospital admission chest x-ray. Evaluation of the mass revealed that it was small cell lung carcinoma. She had a cough, occasional hemoptysis, chest This material is protected by U.S.

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Section: Life Prolongation and Symptom Reliefsupporting

confidence: 87%

Too Old to Care?

2004

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“…[5][6][7][8][9][10][11][12][13][14][15] Studies show that older adults are willing to receive treatment for cancer just as readily as younger patients. [16][17][18][19][20][21] However, the challenge of managing older patients with cancer is the ability to accurately assess whether the expected benefits of treatment outweigh risks. Because aging is a heterogeneous process, older patients with cancer need individualized management.…”

Section: Introductionmentioning

confidence: 99%

Older Breast Cancer Survivors: Geriatric Assessment Domains Are Associated With Poor Tolerance of Treatment Adverse Effects and Predict Mortality Over 7 Years of Follow-Up

Clough‐Gorr

Stuck

Thwin

et al. 2010

JCO

164

108

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A B S T R A C T PurposeTo evaluate geriatric assessment (GA) domains in relation to clinically important outcomes in older breast cancer survivors. MethodsSix hundred sixty women diagnosed with primary breast cancer in four US geographic regions (Los Angeles, CA; Minnesota; North Carolina; and Rhode Island) were selected with disease stage I to IIIA, age Ն 65 years at date of diagnosis, and permission from attending physician to contact. Data were collected over 7 years of follow-up from consenting patients' medical records, telephone interviews, physician questionnaires, and the National Death Index. Outcomes included self-reported treatment tolerance and all-cause mortality. Four GA domains were described by six individual measures, as follows: sociodemographic by adequate finances; clinical by Charlson comorbidity index (CCI) and body mass index; function by number of physical function limitations; and psychosocial by the five-item Mental Health Index (MHI5) and Medical Outcomes Study Social Support Survey (MOS-SSS). Associations were evaluated using t tests, 2 tests, and regression analyses. ResultsIn multivariable regression including age and stage, three measures from two domains (clinical and psychosocial) were associated with poor treatment tolerance; these were CCI Ն 1 (odds ratio [OR] ϭ 2.49; 95% CI, 1.18 to 5.25), MHI5 score less than 80 (OR ϭ 2.36; 95% CI, 1.15 to 4.86), and MOS-SSS score less than 80 (OR ϭ 3.32; 95% CI, 1.44 to 7.66). Four measures representing all four GA domains predicted mortality; these were inadequate finances (hazard ratio [HR] ϭ 1.89; 95% CI, 1.24 to 2.88; CCI Ն 1 (HR ϭ 1.38; 95% CI, 1.01 to 1.88), functional limitation (HR ϭ 1.40; 95% CI, 1.01 to 1.93), and MHI5 score less than 80 (HR ϭ 1.34; 95% CI, 1.01 to 1.85). In addition, the proportion of women with these outcomes incrementally increased as the number of GA deficits increased. ConclusionThis study provides longitudinal evidence that GA domains are associated with poor treatment tolerance and predict mortality at 7 years of follow-up, independent of age and stage of disease.

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“…4 Two important observations are that elderly patients have been critically undertreated in the past, 5 but that their willingness to receive treatment is evident. 6 The recent demographic trend has led to the emergence of a new medical discipline called oncogeriatry and to the worldwide development of oncogeriatric programmes dedicated to the management of elderly cancer patients. 7 This article focuses on the principal areas of development of oncogeriatry through a discussion of the French experience, since it is impossible to collect homogeneous data on the organisation of oncogeriatry in the different European countries.…”

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confidence: 99%

Development of Oncogeriatry – A European Perspective from the French Experience

Terret¹,

Droz²

2009

European Oncology &Amp; Haematology

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Oncogeriatry is the clinical discipline concerned with the management of elderly cancer patients. It is based on a global oncological and geriatric approach to the health status of patients. Oncogeriatry has been widely adopted throughout the world, but the approaches used and the organisational solutions provided are complex and varied. Based on the French experience of a centralised health system, the different aspects are discussed: clinical management, organisation, clinical research and information. At a European level, the best approach seems to be a partnership between the International Society of Geriatric Oncology and the Elderly Task Force of the European Organisation on Research and Treatment of Cancer. This co-operation ensures comprehensive information on oncogeriatric programmes, clinical research and teaching programmes, thus enhancing the effectiveness of the oncogeriatric approach.

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Are Older French Patients As Willing As Older American Patients to Undertake Chemotherapy?

Cited by 168 publications

References 14 publications

Too Old to Care?

Too Old to Care?

Older Breast Cancer Survivors: Geriatric Assessment Domains Are Associated With Poor Tolerance of Treatment Adverse Effects and Predict Mortality Over 7 Years of Follow-Up

Development of Oncogeriatry – A European Perspective from the French Experience

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