Development of a comprehensive multidisciplinary geriatric oncology center, the Thomas Jefferson University experience

Chapman, Andrew E.; Swartz, Kristine; Schoppe, Joshua; Arenson, Christine

doi:10.1016/j.jgo.2013.09.167

Cited by 9 publications

(14 citation statements)

References 3 publications

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“…As improved breast cancer treatment guideline concordance and surgical outcomes at an NCICC were reported previously (37)(38)(39), our findings imply that for older breast cancer patients, which represent the vast majority of the patient population (80%), receiving care at an NCICC and ensuring that guideline-appropriate treatment is provided will decrease breast cancer mortality in this older age group. Although we could not completely characterize these effects nor do our data allow us to definitively attribute treatment to specific facilities, the better survival outcome for older patients may be due to improved multidisciplinary care coordination, in addition to access to tumor boards, patient-centered care programs, and clinical trials for special geriatric cancer care that may be more achievable in NCICC than in other types of facilities (40,41). With limited evidence from clinical trials and research studies on older patients due to their comorbid conditions or belief from providers that older patients are incapable of tolerating treatment or have limited long-term benefit, it is difficult to formulate evidencebased treatment and guideline-compliance recommendations.…”

Section: Discussionmentioning

confidence: 99%

Breast Cancer Mortality in Older and Younger Patients in California

Schwab

Miguel

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Breast cancer in younger patients is reported to be more aggressive and associated with lower survival; however, factors associated with age-specific mortality differences have not been adequately assessed.Methods: We used data from the population-based California Cancer Registry for 38,509 younger (18-49 years) and 121,573 older (50 years and older) women diagnosed with stage I to III breast cancer, 2005-2014. Multivariable Cox regression models were used to estimate breast cancer-specific mortality rate ratios (MRR) and 95% confidence intervals (CI), stratified by tumor subtype, guideline treatment, and care at an NCI-designated cancer center (NCICC).Results: Older breast cancer patients at diagnosis experienced 17% higher disease-specific mortality than younger patients, after multivariable adjustment (MRR ¼ 1.17; 95% CI, 1.11-1.23). Higher MRRs (95% CI) were observed for older versus younger patients with hormone receptor (HR) þ /HER2 -(1.24; 1.14-1.35) and HR þ /HER2 þ (1.38; 1.17-1.62), but not for HR -/HER2 þ (HR ¼ 0.94; 0.79-1.12) nor triple-negative breast cancers (1.01; 0.92-1.11). The higher mortality in older versus younger patients was diminished among patients who received guideline-concordant treatment (MRR ¼ 1.06; 95% CI, 0.99-1.14) and reversed among those seen at an NCICC (MRR ¼ 0.86; 95% CI, 0.73-1.01).Conclusions: Although younger women tend to be diagnosed with more aggressive breast cancers, adjusting for these aggressive features results in older patients having higher mortality than younger patients, with variations by age, tumor subtype, receipt of guideline treatment, and being cared for at an NCICC.Impact: Higher breast cancer mortality in older compared with younger women could partly be addressed by ensuring optimal treatment and comprehensive patient-centered care.

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Section: Discussionmentioning

confidence: 99%

Breast Cancer Mortality in Older and Younger Patients in California

Schwab

Miguel

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…8,18 Approximately 20% are identified with cognitive disorders who would benefit from further workup and management. 19 Older individuals with cancer have been found to have a higher prevalence of functional impairment, geriatric syndromes, and frailty compared with older patients without cancer in population-based analyses. 20 Oncologists need a greater understanding of how to manage agerelated health issues.…”

Section: Methodsmentioning

confidence: 99%

Improving the quality of survivorship for older adults with cancer

Mohile

Hurria

Cohen

et al. 2016

Cancer

104

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In May 2015, the Cancer and Aging Research Group (CARG), in collaboration with the National Cancer Institute and the National Institute on Aging through a U13 grant, convened a conference to identify research priorities to help design and implement intervention studies to improve the quality of life and survivorship of older, frailer adults with cancer. Conference attendees included researchers with multidisciplinary expertise and advocates. It was concluded that future intervention trials for older adults with cancer should: 1) rigorously test interventions to prevent decline or improve health status, especially interventions focused on optimizing physical performance, nutritional status, and cognition while undergoing cancer treatment; 2) utilize standardized care plans based on geriatric assessment findings to guide targeted interventions; and 3) incorporate the principles of geriatrics into survivorship care plans. Also highlighted was the need to integrate the expertise of interdisciplinary team members into geriatric oncology research, improve funding mechanisms to support geriatric oncology research, and disseminate high-impact results to the research and clinical community. In conjunction with the prior two U13 meetings, this conference provides the framework for future research to improve the evidence base for the clinical care of older adults with cancer.

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“…The CGA, which is considered the 'gold standard' approach for predicting patient survival, treatment morbidity and mortality, is strongly recommended for patients >70 years of age with cancer 20,21 . Some studies have reported that as many as 50% of initial patient treatment decisions may be modified following a geriatrician review.…”

Section: Discussionmentioning

confidence: 99%