Systemic Therapy for Elderly Patients with Gastrointestinal Cancer

Hubbard, Joleen M.; Grothey, Axel; Sargent, Daniel J.

doi:10.4137/cmo.s6983

Cited by 3 publications

(3 citation statements)

References 87 publications

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“…However, Vickers and colleagues analyzed the impact of comorbidities on patients receiving gemcitabine and erlotinib and found that OS was not affected by the presence of comorbidities [Vickers et al 2012]. Although elderly patients seem to benefit from systemic therapy in pancreatic cancer [Hubbard et al 2011], a fear of increased toxicity and decreased benefits may lead to less aggressive treatment [Lewis et al 2003; Hubbard et al 2011], which could explain lower utilization of systemic therapy with advancing age.…”

Section: Discussionmentioning

confidence: 99%

Systemic therapy in stage IV pancreatic cancer: a population-based analysis using the National Cancer Data Base

et al. 2015

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Background: Pancreatic cancer accounts for approximately 7% of all cancer deaths. More than half of all pancreatic cancers are stage IV at diagnosis, where systemic chemotherapy is used with the goal of life prolongation as well as palliation. The patient characteristics and health system factors that drive the use of systemic therapy are unknown. Method: This is a retrospective study of stage IV pancreatic cancer patients (n = 140,210) diagnosed between 2000 and 2011 in the NCDB. NCDB contains approximately 70% of new cancer diagnosis from more than 1500 accredited cancer programs in the United States and Puerto Rico. Chi-squared test was used to determine any differences in characteristics of patients who did or did not receive systemic therapy. Results: Our study demonstrated that only 49.1% of stage IV pancreatic cancer patients received systemic therapy. The use of systemic therapy is significantly lower in female, African American/Hispanic, patients older than 40 years, those without insurance or with Medicare and Medicaid, higher Charlson Comorbidity Score, poor economic and educational status and in nonacademic centers. Conclusions: This is the largest study to evaluate the determinants of systemic therapy use in stage IV pancreatic cancer. The use of systemic therapy was significantly lower in patients older than 40 years, lower educational status, nonprivate insurance and with higher Charlson Comorbidity Scores. In addition, the use of systemic therapy was lower with female sex, African Americans/Hispanic, and lower socio-economic status. Understanding the barriers in the use of systemic therapy as well as appropriate utilization of systemic therapy can both optimize cancer care.

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Section: Discussionmentioning

confidence: 99%

Systemic therapy in stage IV pancreatic cancer: a population-based analysis using the National Cancer Data Base

et al. 2015

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“…Oteracil potassium, a competitive inhibitor of orotate phosphoribosyltransferase, inhibits the phosphorylation of 5-FU in the gastrointestinal tract, thereby reducing the serious gastrointestinal toxicity associated with 5-FU. S-1 shows broad activity against a variety of tumors and is currently approved in Japan for use in patients with non-smallcell lung cancer, gastric cancer, colorectal cancer, breast cancer, head and neck cancer, biliary tract cancer and pancreatic cancer (8)(9)(10)(11)(12)(13)(14).…”

Section: Introduction Introductionmentioning

confidence: 99%

A Phase II Study of S-1 in Elderly Patients with Unresectable Pancreatic Cancer

Kuriyama¹,

Inamori²,

Iida³

et al. 2018

SGO

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Background/Aims: The aim of this study was to investigate the efficacy and safetyof the oral fluoropyrimidine derivativeS-1 in elderly patients with unresectable pancreatic cancer. Methods: Patients were eligible if they were at least 70 years old and had unresectable pancreatic carcinoma. S-1 was administered orally twice daily after meals at doses of 80, 100, and 120 mg/day forbody surface areasfor 28 consecutive days, followed by a 14-day rest period. Administration was repeated until the appearance of disease progression or unacceptable toxicity. Results: Twenty-one patients were enrolledin this study. Five patients (23.8%) achieved a partial response (95% CI, 8.2-47.2%),stable disease was observed in 9 patients (42.9%), and progressive disease was observed in 5 patients (23.8%).The disease control rate was 66.7%. The median time to progression and overall survivaltime were 3.7 months (95% CI, 2.3-6.5 months) and 7.3 months (95% confidence interval, 4.9-12.1 months), respectively. Toxicity was generally mild, and the most common grade 3/4 toxicities were neutro-penia (14.3%), anemia (14.3%), leucopenia (9.5%), thrombocytopenia (9.5%), anorexia (9.5%), and diarrhea (9.5%). There were no treatment-related deaths. Conclusions: Monotherapy with S-1 is an effective and well-tolerated regimen for elderly patients with unresectable pancreatic cancer.

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“…Research by Jonathan et al ., published in the “New England Journal of Medicine”, analysed surgical risk and mortality amongst patients aged between 65 and 99 years over a 10-year period from 1999 to 2008. Their findings indicate a considerable decrease in mortality in high-risk surgeries (extended oncological surgeries, cardiac surgeries) amongst the analysed group [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

A clinical psychologist’s perspective of mental disorders in patients of 70 years of age or more, who underwent digestive tract cancer surgeries

Zielińska¹,

Durlik²

2014

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IntroductionBehavioural and psychological disorders in surgical patients treated for malignant diseases are not always adequately appreciated and often neglected. However, they are very important in the therapeutic process because they may severely disturb physical and psychological rehabilitation, the patient’s effective struggle with malignancy, environmental relationships and quality of life. Professional preoperative psychological assessment is necessary to facilitate therapy for malignant diseases in those patients who are specifically exposed to a severely stressful situation.AimTo investigate the incidence of depression, hallucinations and anxiety in patients undergoing surgery for malignancy of the digestive tract. The influence of those disorders on the period of hospitalisation, cooperation with medical staff and postoperative quality of life was analysed.Material and methodsA routine program of psychological and psychiatric care for patients with malignancy, who undergo extensive surgical procedures, was implemented in our department several years ago. The program allows for identification of patients with a high risk of psychiatric disorders to provide them with special psychological support. Sixty-nine patients with advanced malignancy were followed after the surgery between 2009 and 2010. All were examined by a professional psychologist. A QLQ C-30 (EORTC) questionnaire was used to assess the quality of life.ResultsPsychotic disorders were present in 53.6% of examined patients. Depression was dominating (57%), followed by anxiety (28%) and hallucinations (15%). The mean hospital stay was different between those, respectively, with and without psychotic disorders (17 days vs. 15 days). Quality of life index for patients at risk was 3.8 vs. 5.1 for more psychologically stable patients.ConclusionsApproximately 50% of patients undergoing surgery for malignant diseases develop severe psychotic disorders in the postoperative period. Preoperative psychological assessment seems to be extremely useful in providing adequate postoperative psychological support for individual patients.

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Systemic Therapy for Elderly Patients with Gastrointestinal Cancer

Cited by 3 publications

References 87 publications

Systemic therapy in stage IV pancreatic cancer: a population-based analysis using the National Cancer Data Base

Systemic therapy in stage IV pancreatic cancer: a population-based analysis using the National Cancer Data Base

A Phase II Study of S-1 in Elderly Patients with Unresectable Pancreatic Cancer

A clinical psychologist’s perspective of mental disorders in patients of 70 years of age or more, who underwent digestive tract cancer surgeries

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