Functional and cognitive impairment, social functioning, frailty and adverse health outcomes in older patients with esophageal cancer, a systematic review

Deudekom, Floor J. van; Klop, Henk G.; Hartgrink, Henk H.; Boonstra, Jurjen J.; Lips, Irene M.; Slingerland, Marije; Mooijaart, Simon P.

doi:10.1016/j.jgo.2018.03.019

Cited by 29 publications

(15 citation statements)

References 59 publications

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“…Huang et al suggested EC patients aged ≥80 benefit from RT only if the cancer is in localized/regional stage (24). Functional and cognitive impairment, depression and social isolation are prevalent in older patients with esophageal cancer, and associate with adverse health outcomes (25). Thus, basically, advanced age itself is not enough reason to be excluded for RT.…”

Section: Discussionmentioning

confidence: 99%

Definitive Radiotherapy for Older Patients Aged ≥75 Years With Localized Esophageal Cancer

Suzuki¹,

Yamazaki²,

Aibe³

et al. 2019

In Vivo

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Background/Aim: To evaluate the predictive factors in older patients with localized esophageal cancer treated with definitive radiotherapy. Patients and Methods: We retrospectively analyzed patients aged ≥75 years who were treated with three-dimensional conformal radiotherapy between 2008 and 2017. The patients were classified into the oldest-old group (≥80 years) and the old group (75-79 years). Results: Fifty patients were identified, 28 in the oldest-old group and 22 in the old group. Forty-six patients (92%) completed the planned radiotherapy. The median follow-up time was 21 months. Two-year overall survival (OS), disease-free survival, and locoregional control rates were 53%, 42%, and 51%, respectively. Univariate analyses for OS showed that neither the radiotherapy field nor total radiotherapy dose was a significant factor. Clinical T stage, clinical N stage, and age were independent predictors of OS. Conclusion: Age ≥80 years is an independent prognostic factor for OS. Elective nodal irradiation and total radiotherapy dose above 50.4 Gy did not improve survival. Our findings may help in the treatment decisions for localized esophageal cancer in older patients. The number of older individuals has rapidly increased in Japan. At present, people aged 65 years or older comprise 28.1% of the Japanese population, including 14.2% of the population in late-stage old age (aged 75 years or older) (1). Cancer is the leading cause of death in the older population. Aging in the Japanese population and increased life expectancy means that cancer in older adults is becoming an increasingly common social issue. Esophageal cancer remains one of the most fatal cancers worldwide (2, 3). It occurs mainly in middle-aged and older people. In Japan, esophageal cancer was responsible for 11,483 deaths in 2016, accounting for 3.1% of all cancer deaths in the country. In 2013, of the 22,812 patients with esophageal cancer in Japan, about half were older than 75 years (4). Although older patients with localized esophageal cancer are less subjected to aggressive treatment, any treatment, including palliative care, may be associated with an improved survival rate (5). Despite progress in surgical techniques, esophagectomy is associated with significant morbidity and mortality, and 75 years is often considered the age limit for this type of surgery (6). For patients who are either deemed medically inoperable or have tumors that are unresectable, the efficacy of definitive chemoradiation (CRT) has been established in numerous randomized, controlled trials (7, 8). The 2018 National Comprehensive Cancer Network guidelines recommend definitive CRT with fluorouracil and cisplatin, using a radiotherapy (RT) dose of 50.4 Gy as the standard care for patients with esophageal cancer who are not suitable for surgery (9). However, older patients are under-represented in these trials (7, 8), and little is known about data on the efficacy and safety of definitive RT for patients older than 75 years with localized esophageal cancer. RT is a less inva...

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Section: Discussionmentioning

confidence: 99%

Definitive Radiotherapy for Older Patients Aged ≥75 Years With Localized Esophageal Cancer

Suzuki¹,

Yamazaki²,

Aibe³

et al. 2019

In Vivo

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“…Survivors report numerous unmet physical, functional, psychosocial, and financial needs and problems with subsequent cancers, fatigue, pain, lymphedema, neuropathies, balance problems, mobility issues, bladder and bowel problems, dysphonia and other communication difficulties, dysphagia, cardiopulmonary and other end‐organ function declines, sexual dysfunction, depression and anxiety, and cognitive problems, among others . These problems can lead to reduced work productivity, quality of life, and survival . A confluence of several factors is limiting the resources of both health care systems and patients to offer and participate in needed follow‐up care services.…”

Section: The Need For Personalized Pathways For Cancer Follow‐up Carementioning

confidence: 99%

“…[8][9][10][11][12][13][14] These problems can lead to reduced work productivity, 15 quality of life, 16,17 and survival. [18][19][20][21][22] A conf luence of several factors is limiting the resources of both health care systems and patients to offer and participate in needed follow-up care services. These factors include: the growing number of survivors, especially those older than 65 years, who require the management of multiple comorbid conditions in addition to their cancer-specific concerns 2 ; health care provider shortages in oncology, primary care, and nursing [23][24][25][26] ; scarce provider education or training in how to provide cancer follow-up care, especially for the primary care workforce 27 ; and the increasing costs of cancer care 28 and posttreatment survivorship care.…”

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confidence: 99%

Implementing personalized pathways for cancer follow‐up care in the United States: Proceedings from an American Cancer Society–American Society of Clinical Oncology summit

Alfano

Mayer

Bhatia

et al. 2019

CA A Cancer J Clinicians

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A new approach to cancer follow‐up care is necessary to meet the needs of cancer survivors while dealing with increasing volume and provider shortages, knowledge gaps, and costs to both health care systems and patients. An approach that triages patients to personalized follow‐up care pathways, depending on the type(s) and level(s) of resources needed for patients’ long‐term care, is in use in the United Kingdom and other countries and has been shown to meet patients’ needs, more efficiently use the health care system, and reduce costs. Recognizing that testing and implementing a similar personalized approach to cancer follow‐up care in the United States will require a multipronged strategy, the American Cancer Society and the American Society of Clinical Oncology convened a summit in January 2018 to identify the needed steps to move this work from concept to implementation. The summit identified 4 key strategies going forward: 1) developing a candidate model (or models) of care delivery; 2) building the case for implementation by conducting studies modeling the effects of personalized pathways of follow‐up care on patient outcomes, workforce and health care resources, and utilization and costs; 3) creating consensus‐based guidelines to guide the delivery of personalized care pathways; and 4) identifying and filling research gaps to develop and implement needed care changes. While these national strategies are pursued, oncology and primary care providers can lay the groundwork for implementation by assessing their patients’ risk of recurrence and the chronic and late effects of cancer as well as other health care needs and resources available for care and by considering triaging patients accordingly, referring patients to appropriate specialized survivorship clinics as these are developed, helping to support patients who are capable of self‐managing their health, setting expectations with patients from diagnosis onward for the need for follow‐up in primary care and/or a survivorship clinic, and improving coordination of care between oncology and primary care.

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“…The most prevalent of these needs were fatigue, changes in sexual function, and changes in memory and concentration (physical); worry about cancer recurrence, changes in sexual intimacy, and depression (emotional); and challenges presented when returning to work/school, challenges getting to/from appointments, and paying for health care (practical). These ongoing issues can negatively impact survivors’ functional ability, survival, quality of life and their economic, emotional, and social wellbeing [ 3 , 4 , 5 , 6 , 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Stakeholder-Identified Interventions to Address Cancer Survivors’ Psychosocial Needs after Completing Treatment

et al. 2021

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The interventions used in cancer-survivorship care do not always address outcomes important to survivors. This study sought to understand stakeholders’ views on the key concerns of cancer survivors after treatment and the interventions needed to meet survivors’ and families’ psychosocial needs after completing cancer treatment. We conducted a descriptive qualitative study using semi-structured interviews with stakeholders (survivors, family/friend caregivers, oncology providers, primary care providers, and cancer system decision-/policy-makers) from across Canada. For the data analysis, we used techniques commonly employed in descriptive qualitative research, such as coding, grouping, detailing, and comparing the data. There were 44 study participants: 11 survivors, seven family/friend caregivers, 18 health care providers, and eight decision-/policy-makers. Stakeholder-relevant interventions to address survivors’ psychosocial needs were categorized into five groups, as follows: information provision, peer support, navigation, knowledge translation interventions, and caregiver-specific supports. These findings, particularly interventions that deliver timely and relevant information about the post-treatment period and knowledge translation interventions that strive to integrate effective tools and programs into survivorship care, have implications for future research and practice.

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Functional and cognitive impairment, social functioning, frailty and adverse health outcomes in older patients with esophageal cancer, a systematic review

Cited by 29 publications

References 59 publications

Definitive Radiotherapy for Older Patients Aged ≥75 Years With Localized Esophageal Cancer

Definitive Radiotherapy for Older Patients Aged ≥75 Years With Localized Esophageal Cancer

Implementing personalized pathways for cancer follow‐up care in the United States: Proceedings from an American Cancer Society–American Society of Clinical Oncology summit

Stakeholder-Identified Interventions to Address Cancer Survivors’ Psychosocial Needs after Completing Treatment

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