Improving the quality of survivorship for older adults with cancer

Mohile, Supriya G.; Hurria, Arti; Cohen, Harvey Jay; Rowland, Julia H.; Leach, Corinne R.; Arora, Neeraj; Canin, Beverly; Muss, Hyman B.; Magnuson, Allison; Flannery, Marie; Lowenstein, Lisa M.; Allore, Heather G.; Mustian, Karen M.; Demark‐Wahnefried, Wendy; Extermann, Martine; Ferrell, Betty; Inouye, Sharon K.; Studenski, Stephanie A.; Dale, William

doi:10.1002/cncr.30053

Cited by 104 publications

(83 citation statements)

References 49 publications

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“…Although the American Society of Clinical Oncology and other guidelines have recommended GA for older patients with cancer receiving chemotherapy, limited data are available on how GA can help guide interventions to improve QOL and emotional health in caregivers of older adults with cancer. Given the aging of both patients with cancers and their caregivers, a GA‐guided dyadic approach to interventions should be studied . Engaging both older patients and their caregivers in the research process from design to dissemination of interventions may improve the successful implementation and integration of interventions for vulnerable caregivers at high risk for poor emotional health and QOL.…”

Section: Discussionmentioning

confidence: 99%

Quality of Life of Caregivers of Older Patients with Advanced Cancer

Kehoe

Duberstein

et al. 2019

J American Geriatrics Society

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OBJECTIVES To evaluate the relationships between aging‐related domains captured by geriatric assessment (GA) for older patients with advanced cancer and caregivers’ emotional health and quality of life (QOL). DESIGN In this cross sectional study of baseline data from a nationwide investigation of older patients and their caregivers, patients completed a GA that included validated tests to evaluate eight domains of health (eg, function, cognition). SETTING Thirty‐one community oncology practices throughout the United States. PARTICIPANTS Enrolled patients were aged 70 and older, had one or more GA domain impaired, and had an incurable solid tumor malignancy or lymphoma. Each could choose one caregiver to enroll. MEASUREMENTS Caregivers completed the Generalized Anxiety Disorder‐7, Distress Thermometer, Patient Health Questionnaire‐2 (depression), and Short Form Health Survey‐12 (SF‐12 for QOL). Separate multivariate linear or logistic regression models were used to examine the association of the number and type of patient GA impairments with caregiver outcomes, controlling for patient and caregiver covariates. RESULTS A total of 541 patients were enrolled, 414 with a caregiver. Almost half (43.5%) of the caregivers screened positive for distress, 24.4% for anxiety, and 18.9% for depression. Higher numbers of patient GA domain impairments were associated with caregiver depression (adjusted odds ratio [aOR] = 1.29; P < .001], caregiver physical health on SF‐12 (regression coefficient [β] = −1.24; P < .001), and overall caregiver QOL (β = −1.14; P < .01). Impaired patient function was associated with lower caregiver QOL (β = −4.11; P < .001). Impaired patient nutrition was associated with caregiver depression (aOR = 2.08; P < .01). Lower caregiver age, caregiver comorbidity, and patient distress were also associated with worse caregiver outcomes. CONCLUSION Patient GA impairments were associated with poorer emotional health and lower QOL of caregivers. J Am Geriatr Soc 67:969–977, 2019.

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Section: Discussionmentioning

confidence: 99%

Quality of Life of Caregivers of Older Patients with Advanced Cancer

Kehoe

Duberstein

et al. 2019

J American Geriatrics Society

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“…The results are intended to inform development of online or electronic medical record based systems to assist in frailty assessment, and facilitate treatment decision-making and care planning with older patients. 7,23 The ease of administration and predictive validity of deficits accumulation indices could provide a novel approach to expand the reach of frailty measurement in routine oncology practice settings.…”

Section: Introductionmentioning

confidence: 99%

Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance)

Mandelblatt

Cai

Luta

et al. 2017

Breast Cancer Res Treat

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Purpose Breast cancer patients aged 65+ (“older”) vary in frailty status. We tested whether a deficits accumulation frailty index predicted long-term mortality. Methods Older patients (n=1280) with non-metastatic, invasive breast cancer were recruited from 78 Alliance sites from 2004-2011, with follow-up to 2015. Frailty categories (robust, pre-frail, and frail) were based on 35 baseline illness and function items. Cox proportional hazards and competing risk models were used to calculate all-cause and breast cancer-specific mortality for up to 7-years, respectively. Potential covariates included demographic, psychosocial, and clinical factors, diagnosis year, and care setting. Results Patients were 65-91 years old. Most (76.6%) were robust; 18.3% were pre-frail, and 5.1% frail. Robust patients tended to receive more chemotherapy +/- hormonal therapy (vs. hormonal) than pre-frail or frail patients (45% vs. 37% and 36%, p=.06), and had the highest adherence to hormonal therapy. The adjusted hazard ratios for all-cause mortality (n=209 deaths) were 1.7 (95% CI 1.2-2.4) and 2.4 (95% CI 1.5-4.0) for pre-frail and frail vs. robust women, respectively, with an absolute mortality difference of 23.5%. The adjusted hazard of breast cancer death (n-99) was 3.1 (95% CI 1.6-5.8) times higher for frail vs. robust patients (absolute difference of 14%). Treatment differences didn't account for the relationships between frailty and mortality. Conclusions Most older breast cancer patients are robust and could consider chemotherapy where otherwise indicated. Patients who are frail or pre-frail have elevated long-term all-cause and breast-cancer mortality. Frailty indices could be useful for treatment decision-making and care planning with older patients.

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“…We led a U13 grant (U13 AG038151), in close collaboration with the National Institute of Aging (NIA), the National Cancer Institute (NCI), and other major organizations (AGS, Gerontological Society of America, and the Alliance), which coordinated three research conferences composed of top leaders at the interface of aging and cancer research. The resulting series of 16 articles, including 4 major white papers, summarized the essential research priorities in geriatric oncology and identified that a coordinated research infrastructure and expertise to develop and prioritize these studies was desperately needed (Table ) . We also collaborated as principal investigators and coinvestigators on several other grants from the Patient‐Centered Outcomes Research Institute (PCORI), NCI, and NIA; hosted several conferences, bringing national leaders together; and coauthored dozens of other articles together.…”

Section: Carg: the Cancer And Aging Research Groupmentioning

confidence: 99%

Lessons Learned from Arti—Collaborating to Improve Care: the Past, Present, and Future of the Cancer and Aging Research Group

Dale

Mohile

2019

J American Geriatrics Society

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Dr Arti Hurria, who died tragically in November 2018, was a driving force in the growing field of geriatric oncology. She led the field through her commitment to her goals, collaboration with her colleagues, and the creation of the Cancer and Aging Research Group (CARG). As two of her closest colleagues, we are carrying her work forward with our colleagues through an infrastructure grant we led with Arti from the National Institute on Aging (R21/33; CARinG). This grant will provide a national structure for continuing to build the field through research, mentorship, and dissemination. We miss our friend dearly but are committed to carrying her legacy forward through CARG. J Am Geriatr Soc 67:879–883, 2019.

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Improving the quality of survivorship for older adults with cancer

Cited by 104 publications

References 49 publications

Quality of Life of Caregivers of Older Patients with Advanced Cancer

Quality of Life of Caregivers of Older Patients with Advanced Cancer

Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance)

Lessons Learned from Arti—Collaborating to Improve Care: the Past, Present, and Future of the Cancer and Aging Research Group

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