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Advances in Geriatric Oncology: Exploring Practical Ways to Optimize Treatment in Older Patients with Cancer

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A topical collection in Cancers (ISSN 2072-6694). This collection belongs to the section "Cancer Therapy".

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Prof. Dr. Pierre Soubeyran

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Collection Editor

Institut Bergonié, INSERM U1218, Université de Bordeaux, 33000 Bordeaux, France
Interests: geriatric oncology; lymphoma
Special Issues, Collections and Topics in MDPI journals

Dr. Marije E. Hamaker

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Collection Editor

Department of Geriatric Medicine, Diakonessenhuis, 3582 KB Utrecht, The Netherlands
Interests: geriatric oncology; oncologic decision making
Special Issues, Collections and Topics in MDPI journals

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Dear Colleagues,

Cancer is a disease of aging, with patients over 70 accounting for 50% of newly diagnosed malignancies and 70% of all cancer deaths. However, despite this epidemiologic context, older patients with cancer are underrepresented in clinical trials, which are necessary to establish new standards of cancer care. This is particularly striking for those with functional decline and/or with comorbid conditions who are usually excluded from clinical trials. As a result, robust data on the benefit/risk balance for many treatment strategies in these older patients are lacking, putting them at increased risk for treatment toxicity. Measures of frailty syndrome by geriatric assessment and biological markers are critical to elucidate risks of morbidity, loss of quality of life, functional impairment, and mortality in older patients with cancer. Treating frailty syndrome via geriatric interventions will likely reduce risk for poor cancer outcomes, but this should first be demonstrated and quantified. Further research is needed in this area.

This Topical Collection will highlight the role of frailty syndrome in geriatric oncology in all its diversity on both clinical and biological aspects that advance our understanding in order to optimize and personalize cancer treatment. Original Articles are preferred. Reviews/Systematic Reviews are also welcome.

Prof. Dr. Pierre Soubeyran
Dr. Marije E. Hamaker
Collection Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the collection website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

cancer
older
frailty
geriatric assessment
chemo-toxicities
overall survival
cachexia
biomarker
comorbidities
quality of life
functional status

Related Special Issue

Advances in Geriatric Oncology: Exploring Practical Ways to Optimize Treatment in Older Patients with Cancer in Cancers (26 articles)

Published Papers (8 papers)

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2023

Jump to: 2022

12 pages, 572 KiB

Open AccessArticle

Treatment Outcomes after Dose-Escalated Moderately Hypofractionated Radiotherapy for Frail Patients with High-Grade Glioma

by Nalee Kim, Hyunju Shin, Do Hoon Lim, Do-Hyun Nam, Jung-Il Lee, Ho Jun Seol, Doo-Sik Kong, Jung Won Choi, Kyuha Chong and Won Jae Lee

Cancers 2024, 16(1), 64; https://doi.org/10.3390/cancers16010064 - 21 Dec 2023

Viewed by 683

Abstract

For high-grade glioma (HGG) patients with old age or poor performance status, hypofractionated radiotherapy (hypoRT) in 10–15 fractions is recommended. Also, limited data exist on the impact of salvage treatment after progression in frail patients. We retrospectively analyzed the outcomes of dose-escalated hypoRT in 40 frail HGG patients who were treated with hypoRT between 2013 and 2021. With a median biologically effective dose of 71.7 Gy, a total dose of 56 Gy in 20 fractions was the most frequently used regimen (53.7%). The median age and Karnofsky Performance Status of patients were 74 years and 70, respectively. Most patients (n = 31, 77.5%) were diagnosed with glioblastoma, IDH-wildtype, CNS WHO grade 4. Only 10 (25.0%) patients underwent surgical resection, and 28 (70.0%) patients received concurrent temozolomide during hypoRT. With a median follow-up of 9.7 months, the median overall survival (OS) was 12.2 months. Of the 30 (75.0%) patients with disease progression, only 12 patients received salvage treatment. The OS after progression differed significantly depending on salvage treatment (median OS, 9.6 vs. 4.6 months, p = 0.032). Dose-escalated hypoRT in 20 fractions produced survival outcomes outperforming historical data for frail patients. Full article

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22 pages, 1298 KiB

Open AccessSystematic Review

Exercise Training in Elderly Cancer Patients: A Systematic Review

by Francesco Giallauria, Crescenzo Testa, Gianluigi Cuomo, Anna Di Lorenzo, Elio Venturini, Fulvio Lauretani, Marcello Giuseppe Maggio, Gabriella Iannuzzo and Carlo Vigorito

Cancers 2023, 15(6), 1671; https://doi.org/10.3390/cancers15061671 - 08 Mar 2023

Cited by 4 | Viewed by 3628

Abstract

Due to the aging of the population, in 70% of cases, a new cancer diagnosis equals a cancer diagnosis in a geriatric patient. In this population, beyond the concept of mortality and morbidity, functional capacity, disability, and quality of life remain crucial. In fact, when the functional status is preserved, the pathogenetic curve towards disability will stop or even regress. The present systematic review investigated the effectiveness of physical exercise, as part of a holistic assessment of the patient, for preventing disability and improving the patient’s quality of life, and partially reducing all-cause mortality. This evidence must point towards decentralization of care by implementing the development of rehabilitation programs for elderly cancer patients either before or after anti-cancer therapy. Full article

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11 pages, 2522 KiB

Open AccessArticle

Multidimensional Oncological Frailty Scale (MOFS): A New Quick-To-Use Tool for Detecting Frailty and Stratifying Risk in Older Patients with Cancer—Development and Validation Pilot Study

by Riccardo Franchi, Chukwuma Okoye, Rachele Antognoli, Igino Maria Pompilii, Irene Taverni, Tommaso Landi, Matteo Ghilli, Manuela Roncella, Valeria Calsolaro and Fabio Monzani

Cancers 2023, 15(5), 1553; https://doi.org/10.3390/cancers15051553 - 01 Mar 2023

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Abstract

Background: Frailty detection with comprehensive geriatric assessment (CGA) is of pivotal importance in older patients with cancer to avoid over- or under-treatment and to detect those at increased risk for poor outcomes. Several tools have been developed to capture the complexity of frailty, but only a few were explicitly conceived for older adults with cancer. The study aimed at developing and validating a multidimensional, easy-to-use diagnostic tool for early-risk stratification in patients with cancer, called the Multidimensional Oncological Frailty Scale (MOFS). Methods: In this single-center prospective study, we consecutively enrolled 163 older women (age ≥ 75 years) with breast cancer, screened with a G8 score ≤ 14 during the outpatient preoperative evaluation at our breast centre, as the development cohort. Seventy patients with different types of cancer admitted to our OncoGeriatric Clinic served as the validation cohort. Using stepwise linear regression analysis, we evaluated the relationship between Multidimensional Prognostic Index (MPI) and CGA items, and, finally, realized a screening tool based on the combination of the significant variables. Results: The mean age of the study population was 80.4 ± 5.8 years, while the mean age of the validation cohort was 78.6 ± 6.6 years [42 women (60%)]. A composite model of the Clinical Frailty Scale, G8, and hand grip strength test showed a strong correlation with MPI (R= −0.712, p < 0.001). The MOFS accuracy in the prediction of mortality was optimal in both the development and the validation cohorts (AUC 0.82 and 0.87; p < 0.001 and 0.003, respectively). Conclusion: MOFS represents a new, accurate, quick-to-use frailty screening tool for stratifying the risk of mortality in geriatric cancer patients. Full article

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12 pages, 2442 KiB

Open AccessArticle

Association between Iron Deficiency and Survival in Older Patients with Cancer

by Julie Tisserand, Violaine Randrian, Marc Paccalin, Pierre-Jean Saulnier, Marine Arviset, Arthur Fourmy, Victor Arriudarré, Amélie Jamet, Yvan Moreno, Simon Valéro and Evelyne Liuu

Cancers 2023, 15(5), 1533; https://doi.org/10.3390/cancers15051533 - 28 Feb 2023

Viewed by 1957

Abstract

Background: iron deficiency (ID) is frequent in older patients. Purpose: to evaluate the association between ID and survival in patients ≥ 75 years old with confirmed solid tumors. Methods: a retrospective monocentric study including patients between 2009 and 2018. ID, absolute ID (AID) and functional ID (FID) were defined according to the European Society for Medical Oncology (ESMO) criteria. Severe ID was defined by a ferritin level < 30 µg/L. Results: in total, 556 patients were included, the mean age was 82 (±4.6) years, 56% were male, the most frequent cancer was colon cancer (19%, n = 104), and metastatic cancers were found in 38% (n = 211). Median follow-up time: 484 [190–1377] days. In anemic patients, ID and FID were independently associated with an increased risk of mortality (respectively, HR 1.51; p = 0.0065 and HR 1.73; p = 0.0007). In non-anemic patients, FID was independently associated with better survival (HR 0.65; p = 0.0495). Conclusion: in our study, ID was significantly associated with survival, and with better survival for patients without anemia. These results suggest that attention should be paid to the iron status in older patients with tumors and raise questions about the prognostic value of iron supplementation for iron-deficient patients without anemia. Full article

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13 pages, 954 KiB

Open AccessArticle

Management and Outcomes of Older Patients (Age ≥ 70 Years) with Advanced Soft Tissue Sarcoma and Role of Geriatric Assessment and Oncological Multidimensional Prognostic Index (Onco-MPI) in a Real-World Setting

by Benedetta Chiusole, Ilaria Tortorelli, Antonella Galiano, Fabio Murtas, Selma Ahcene-Djaballah, Giuseppina Tierno, Eleonora Bergo, Alberto Banzato, Maura Gatti, Antonio Di Maggio, Giuseppe Sergi, Marco Rastrelli, Marta Sbaraglia, Vittorina Zagonel and Antonella Brunello

Cancers 2023, 15(4), 1043; https://doi.org/10.3390/cancers15041043 - 07 Feb 2023

Cited by 1 | Viewed by 2048

Abstract

Background: Incidences of soft tissue sarcomas (STS) steadily increase with age. Yet, despite the high prevalence in advanced age, older patients (pts) are underrepresented in sarcoma clinical trials and evidence-based guidelines for chemotherapy are lacking. International oncological societies suggest using geriatric tools to evaluate older patients with cancer to optimise treatment indication. Comprehensive geriatric assessment (CGA) is a multidimensional assessment of older subjects, based on which pts can be classified as fit, vulnerable or frail. Onco-MPI (multidimensional prognostic index) is a CGA-based score which also considers tumour characteristics, classifying pts into three risk groups of death at one year: high-risk, intermediate-risk and low-risk. Methods: This is a single-centre retrospective study which aims at describing real-word management and outcomes of older pts with advanced stage STS and at assessing the ability of CGA and onco-MPI to predict survival in these pts. Consecutive pts with advanced stage STS aged 70 years or older and treated at the Istituto Oncologico Veneto from January 2009 to June 2020 were retrieved from a prospectively maintained database. Pts’ demographics, CGA assessments and tumour characteristics were analysed. Statistical analysis was performed with R version 3.4.3 Results: Out of 101 pts, with a median age of 77 years, 76 received chemotherapy (75.3%), which was anthracycline-based for 46 pts (60.5%). Anthracyclines were used in a higher proportion in fit pts (58.9% fit vs. 45.1% vulnerable vs. 12.5% frail pts). Frail pts and pts in the onco-MPI high-risk group experienced a higher rate of chemotherapy-related toxicities. Median OS was 13.8 months (95% CI 11.3–17.7 months). According to CGA, the median OS was 19.53 months (95% CI 15.23–36.8) for fit pts, 12.83 months (95% CI 9.7–17.5) for vulnerable and 7.75 months (95% CI 2.73–30) for frail pts (p = 0.005). Onco-MPI confirmed a predictive value for 1-year survival with intermediate risk pts not reaching a median OS at 1 year, and high-risk pts having a median one-year OS of 11.5 months (95%CI 9.7–NA), p = 0.02. In multivariate analysis, onco-MPI and CGA were associated with survival (high risk onco-MPI: HR 5.5, 95%CI 1.25–24.7 p = 0.02; fitness at CGA HR 0.552 95% 0.314–0.973; p = 0.040) as well as chemotherapy use (HR 0.24, 95% CI 0.11–0.51, p < 0.005). Conclusions: Both CGA and onco-MPI retain prognostic value for survival in pts with metastatic STS. Pts frail/vulnerable at CGA and pts within the onco-MPI high risk category should be offered an oncogeriatric management approach in order to optimise treatment-related survival and reduce toxicity. Full article

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2022

Jump to: 2023

9 pages, 915 KiB

Open AccessArticle

Time Trends in Treatment Strategies and Survival of Older versus Younger Patients with Synchronous Metastasised Melanoma—A Population-Based Study in the Netherlands Cancer Registry

by Daisy van der Ziel, Marloes G. M. Derks, Ellen Kapiteijn, Esther Bastiaannet, Marieke Louwman, Frederiek van den Bos, Simon P. Mooijaart, Johanneke E. A. Portielje and Nienke A. de Glas

Cancers 2022, 14(19), 4904; https://doi.org/10.3390/cancers14194904 - 07 Oct 2022

Viewed by 1082

Abstract

Around 45% of patients with melanoma are older than 65 years. In recent years, immunotherapy has proven very effective for metastasised melanoma. The aim of this study was to investigate the time trends in treatment strategies and survival in older versus younger patients with synchronous metastasised melanoma. We included all patients diagnosed between 2000 and 2019 from the Netherlands cancer registry. We analysed changes in first-line systemic treatment using multivariable logistic regression models, stratified by age (<65, 65–75, and ≥75). Changes in overall survival were studied using multivariable Cox regression analysis. A total of 2967 patients were included. Immunotherapy prescription increased significantly over time for all age groups (<65 years: 11.8% to 64.9%, p < 0.001; 65–75 years: 0% to 68.6%, p < 0.001; >75 years: 0% to 39.5%, p < 0.001). In multivariable analyses, overall survival improved for patients aged <65 and 65–75 (HR 0.96, 95% CI 0.92–1.00 and HR 0.95, 95% CI 0.89–1.00, respectively), but not in patients over 75 (HR 0.98, 95% CI 0.91–1.05). In conclusion, overall survival has improved in patients with synchronous metastasised melanoma aged <75 years, but not in patients aged 75 years or older. This might be explained by lower prescription rates of immunotherapy in this age group. Full article

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13 pages, 1725 KiB

Open AccessArticle

Differences in Treatment Modalities and Prognosis of Elderly Patients with Ovarian Cancer: A Two-Center Propensity Score-Matched Study

by Yuxi Zhao, Jing Zuo, Ning Li, Rongshou Zheng, Guangwen Yuan, Guihua Shen and Lingying Wu

Cancers 2022, 14(15), 3655; https://doi.org/10.3390/cancers14153655 - 27 Jul 2022

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Abstract

Background: The prognosis of older patients with ovarian cancer is poor. We evaluated the effect of chronological age and different treatment characteristics on the prognosis of older patients with ovarian cancer; Methods: The study retrospectively analyzed patients aged over 60 years who underwent cytoreduction followed by platinum-based adjuvant chemotherapy between January 2011 and December 2019 in two national centers in China. Propensity score matching (PSM, 1:1) was performed to stratify the comorbidity- and treatment-related factors. The Kaplan–Meier method was employed to estimate progression-free survival (PFS) in the original cohort and the cohort after PSM; Results: A total of 324 patients were evaluated. The Age ≥ 70 group often received more neoadjuvant chemotherapy (62.3% vs. 31.2%, p < 0.001), more discontinuation of adjuvant chemotherapy (31.2% vs. 10.8%, p < 0.001), and had more severe chemotherapy-related toxicity (45.6% vs. 34.2%, p = 0.040) than the Age < 70 group. After matching, the PFS of the Age < 70 group was not significantly different from the Age ≥ 70 group (median PFS = 12.4 and 11.9 months, respectively, p = 0.850). Furthermore, the advanced FIGO stage, non-R0 cytoreduction, and discontinuation of adjuvant chemotherapy were all found to be poor prognostic factors. Serum albumin level <40 g/L (HR = 2.441, p = 0.018) and age ≥ 70 years (HR = 2.639, p = 0.008) led to more severe chemotherapy-related toxicity. Additionally, poor renal function (HR = 5.128, p = 0.002) was in association with discontinuation of adjuvant chemotherapy; Conclusions: The chronological age of older patients cannot be seen as a poor prognostic factor. Older patients may benefit most from R0 cytoreduction followed by the completion of chemotherapy. Postoperative poor renal function and serum albumin level <40 g/L may help predict the discontinuation of adjuvant chemotherapy. Full article

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15 pages, 7120 KiB

Open AccessArticle

Effectiveness of Geriatric Assessment-Driven Interventions on Survival and Functional and Nutritional Status in Older Patients with Head and Neck Cancer: A Randomized Controlled Trial (EGeSOR)

by Elena Paillaud, Lydia Brugel, Chloe Bertolus, Melany Baron, Emilie Bequignon, Philippe Caillet, Thomas Schouman, Jean Lacau Saint Guily, Sophie Périé, Eric Bouvard, Marie Laurent, Didier Salvan, Laurence Chaumette, Laure de Decker, Benoit Piot, Beatrix Barry, Agathe Raynaud-Simon, Elisabeth Sauvaget, Christine Bach, Antoine Bizard, Abderrahmane Bounar, Aurelien Minard, Bechara Aziz, Eric Chevalier, Dominique Chevalier, Cedric Gaxatte, Olivier Malard, Evelyne Liuu, Sandrine Lacour, Laetitia Gregoire, Charlotte Lafont and Florence Canouï-Poitrine Show full author list Hide full author list

Cancers 2022, 14(13), 3290; https://doi.org/10.3390/cancers14133290 - 05 Jul 2022

Cited by 10 | Viewed by 2259

Abstract

This study assesses the efficacy of Geriatric Assessment (GA)-driven interventions and follow-up on six-month mortality, functional, and nutritional status in older patients with head and neck cancer (HNC). HNC patients aged 65 years or over were included between November 2013 and September 2018 by 15 Ear, Nose, and Throat (ENT) and maxillofacial surgery departments at 13 centers in France. The study was of an open-label, multicenter, randomized, controlled, and parallel-group design, with independent outcome assessments. The patients were randomized 1:1 to benefit from GA-driven interventions and follow-up versus standard of care. The interventions consisted in a pre-therapeutic GA, a standardized geriatric intervention, and follow-up, tailored to the cancer-treatment plan for 24 months. The primary outcome was a composite criterion including six-month mortality, functional impairment (fall in the Activities of Daily Living (ADL) score ≥2), and weight loss ≥10%. Among the patients included (n = 499), 475 were randomized to the experimental (n = 238) or control arm (n = 237). The median age was 75.3 years [70.4–81.9]; 69.5% were men, and the principal tumor site was oral cavity (43.9%). There were no statistically significant differences regarding the primary endpoint (n = 98 events; 41.0% in the experimental arm versus 90 (38.0%); p = 0.53), or for each criterion (i.e., death (31 (13%) versus 27 (11.4%); p = 0.48), weight loss of ≥10% (69 (29%) versus 65 (27.4%); p = 0.73) and fall in ADL score ≥2 (9 (3.8%) versus 13 (5.5%); p = 0.35)). In older patients with HNC, GA-driven interventions and follow-up failed to improve six-month overall survival, functional, and nutritional status. Full article

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Advances in Geriatric Oncology: Exploring Practical Ways to Optimize Treatment in Older Patients with Cancer

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Published Papers (8 papers)

2023

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2022

Jump to: 2023

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