Severe functional limitation due to pain &amp; emotional distress and subsequent receipt of prescription medications among older adults with cancer

Presley, Carolyn J.; Canavan, Maureen; Wang, Shiyi; Feder, Shelli; Kapo, Jennifer; Saphire, Maureen; Sheinfeld, Ella; Kent, Erin E.; Davidoff, Amy J.

doi:10.1016/j.jgo.2020.02.006

Cited by 19 publications

(10 citation statements)

References 37 publications

(36 reference statements)

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“…26 Comprehensive geriatric assessment can be resource-and time-consuming; however, there are brief assessment tools that can be implemented in a short amount of time. 27 Using these screening tools, such as the G8 28 and the EQ-5D-5L, or simply asking about activities of daily living and instrumental activities of daily living can uncover functional disability, 29 pain, 30 and psychological 31 impairments that would otherwise go unrecognized and are independently associated with poor patient outcomes. More recently, the ELDERS study demonstrated that older adults with advanced lung cancer or melanoma receiving immunotherapy with a positive G8 screening test ( 14 points) had a higher risk of hospital admissions (p = .03) and death (p = .01), but not a higher incidence of treatment-related toxicity.…”

Section: Assessmentmentioning

confidence: 99%

Care Disparities Across the Health Care Continuum for Older Adults: Lessons From Multidisciplinary Perspectives

Dharmarajan

Presley

Wyld

2021

American Society of Clinical Oncology Educational Book

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Older adults comprise a considerable proportion of patients with cancer in the world. Across multiple cancer types, cancer treatment outcomes among older age groups are often inferior to those among younger adults. Cancer care for older individuals is complicated by the need to adapt treatment to baseline health, fitness, and frailty, all of which vary widely within this age group. Rates of social deprivation and socioeconomic disparities are also higher in older adults, with many living on reduced incomes, further compounding health inequality. It is important to recognize and avoid undertreatment and overtreatment of cancer in this age group; however, simply addressing this problem by mandating standard treatment of all would lead to harms resulting from treatment toxicity and futility. However, there is little high-quality evidence on which to base these decisions, because older adults are poorly represented in clinical trials. Clinicians must recognize that simple extrapolation of outcomes from younger age cohorts may not be appropriate because of variance in disease stage and biology, variation in fitness and treatment tolerance, and reduced life expectancy. Older patients may also have different life goals and priorities, with a greater focus on quality of life and less on length of life at any cost. Health care professionals struggle with treatment of older adults with cancer, with high rates of variability in practice between and within countries. This suggests that better national and international recommendations that more fully address the needs of this special patient population are required and that primary research focused on the older age group is urgently required to inform these guidelines.

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Section: Assessmentmentioning

confidence: 99%

Care Disparities Across the Health Care Continuum for Older Adults: Lessons From Multidisciplinary Perspectives

Dharmarajan

Presley

Wyld

2021

American Society of Clinical Oncology Educational Book

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“…41,59 In addition, the perception of pain is strongly affected by age, and the majority (;70%) of older adult patients with cancer included in a recent study reported severe functional limitations associated with pain. 23,47 A study in patients with cancer with pain resulting from bone metastasis failed to find sex differences in pain characteristics or analgesic prescriptions in patients whose median age was .55 years. Women with metastatic cancer have reported inadequate pain management more frequently than men, although patient age being $70 years was a stronger predictor than sex.…”

Section: Discussionmentioning

confidence: 99%

“… 41 , 59 In addition, the perception of pain is strongly affected by age, and the majority (∼70%) of older adult patients with cancer included in a recent study reported severe functional limitations associated with pain. 23 , 47 …”

Section: Discussionmentioning

confidence: 99%

Fadu head and neck squamous cell carcinoma induces hyperexcitability of primary sensory neurons in an in vitro coculture model

Uhelski

Görür

Corrales

et al. 2022

PR9

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Introduction: Currently, cancer pain is viewed as a process orchestrated by the release of pronociceptive molecules and the invasion of neural structures, referred to as perineural invasion (PNI). Cancer pain resulting from PNI is well-documented, but the mechanisms leading to peripheral sensitization because of tumor growth are not fully known. Methods: A retrospective study was used to examine how the use of anti-inflammatory medications affected preoperative pain in patients with oral squamous cell carcinoma cancer. We then used an in vitro coculture model in which dorsal root ganglion (DRG) neurons were incubated together with Fadu human head and neck squamous cell carcinoma cancer cells to explore how cancer cells affect the electrical membrane properties of sensory neurons. Results: We found that inflammation contributes to preoperative pain in patients with oral squamous cell carcinoma. After coculture with Fadu human head and neck squamous cell carcinoma cancer cells, we identified markers of inflammation in coculture media and found evidence of neuronal sensitization, including spontaneous activity, reduced current thresholds, depolarized resting membrane potential, and enhanced responses to current stimulation in human and rat DRG neurons. In rats, these effects were influenced by sex and age: neurons from young adult female rats were resistant to changes in neuronal activity, in contrast to neurons from older adult female rats or male rats of either age group. Conclusions: Pro-inflammatory substances released in cancer cell-DRG coculture promoted neuronal hyperexcitability and may contribute to cancer pain after PNI, and these effects may differ across age groups and sexes.

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“…Functional impairments are highly prevalent among older cancer survivors. A recent epidemiological study showed that 68.6% of the cancer survivors had moderate to severe functional limitation due to pain, 48.3% moderate to severe functional limitation due to emotional distress, and approximately 10% reported severe functional limitation due to co-occurring symptoms of pain and emotional distress 10 . Severe functional limitation was more common among octogenarians, stage IV disease at diagnosis, and for those with lung cancer 10 .…”

Section: Introductionmentioning

confidence: 99%

“…A recent epidemiological study showed that 68.6% of the cancer survivors had moderate to severe functional limitation due to pain, 48.3% moderate to severe functional limitation due to emotional distress, and approximately 10% reported severe functional limitation due to co-occurring symptoms of pain and emotional distress 10 . Severe functional limitation was more common among octogenarians, stage IV disease at diagnosis, and for those with lung cancer 10 . After cancer diagnosis, 45.0% of the older adults showed limitations on their instrumental activities of daily life and 12.8% on basic activities of daily life 11 .…”

Section: Introductionmentioning

confidence: 99%

Functional outcomes and oncological fatigue among older cancer patients: a cross-sectional study

Lorca

Sacomori

Vidal-Labra

et al. 2021

Motriz: rev. educ. fis.

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To characterize functional outcomes and oncological fatigue in older cancer patients, and verify the relation of these outcomes with age, number of hospitalizations, and falls within 12-months. Methods: Cross-sectional study involving 116 older adults with cancer undergoing treatment in a hospital in Santiago de Chile. Participants were assessed for independence on the activity of daily living (Barthel index), functional mobility with "timed up and go" (TUG) test, handgrip strength with a Baseline® Hydraulic Hand Dynamometer, and fatigue with Brief Fatigue Inventory. Information about the number of falls and hospitalizations from the previous 12-months was also collected.Results: 21.6% had experienced at least one fall during the previous 12-months, and 52% had been hospitalized over the same period. Handgrip strength was below the cut-off thresholds for older adults and 78.4% were classified with the risk of falls according to the TUG test. Forty-nine percent of participants experienced moderate fatigue, and 58% were dependent to perform activities of daily living. There was a correlation of TUG results with age (r = 0.204; p = 0.028). Conclusions:Older adults with cancer in our study experienced moderate fatigue, a high dependence to perform activities of daily living, especially those associated with mobility, dressing, and bladder or bowel function. Older adults with cancer are more likely to develop functional decline which leads to increased dependency or death. The data suggests they present functional impairment. Physical activity interventions would benefit this population.

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Severe functional limitation due to pain & emotional distress and subsequent receipt of prescription medications among older adults with cancer

Cited by 19 publications

References 37 publications

Care Disparities Across the Health Care Continuum for Older Adults: Lessons From Multidisciplinary Perspectives

Care Disparities Across the Health Care Continuum for Older Adults: Lessons From Multidisciplinary Perspectives

Fadu head and neck squamous cell carcinoma induces hyperexcitability of primary sensory neurons in an in vitro coculture model

Functional outcomes and oncological fatigue among older cancer patients: a cross-sectional study

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