Advancing Care, Advancing Years: Improving Cancer Treatment and Care for an Ageing Population 

Cancer Research UK | June 2018 | Advancing Care, Advancing Years: Improving Cancer Treatment and Care for an Ageing Population 

A new report presents the findings of  research commissioned by Cancer Research UK (CRUK) and conducted by the University of Birmingham’s Health Services Management Centre and ICF International, which sought to understand the specific needs of older patients, and to explore the process of clinical decision-making for older people with cancer across the UK.

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This research involved a literature review, clinical observations at eight case study sites, interviews with 15 national decision-makers and 80 health professionals, and three UK-wide surveys (of primary care professionals, secondary care professionals and older people affected by cancer). The direction of the research was also informed by engagement with a group of older people affected by cancer, and by extensive engagement and interviews with national policymakers.

This research involved a literature review, clinical observations at eight case study sites, interviews with 15 national decision-makers and 80 health professionals, and three UK-wide surveys (of primary care professionals, secondary care professionals and older people affected by cancer). The direction of the research was also informed by engagement with a group of older people affected by cancer, and by extensive engagement and interviews with national policymakers.

The report is available from CRUK 

What factors affect quality of life in older patients with cancer?

A new study provides insights on the factors that affect health-related quality of life in older adults with cancer. The findings support the importance of addressing persistent symptoms, managing comorbidities, promoting leisure-time physical activity, and addressing financial challenges. | Cancer  | Story via ScienceDaily

Abstract

As the population of older adults with cancer continues to grow, the most important factors contributing to their health-related quality of life (HRQOL) remain unclear.

Methods

A total of 1457 older adults (aged ≥65 years) with cancer participated in a telephone survey. Outcomes were measured using the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the 12-Item Short Form Survey from the Medical Outcomes Study. Statistical techniques used to identify factors in 4 domains (physical, psychological, social, and spiritual) most strongly associated with HRQOL included linear models, recursive partitioning, and random forests. Models were developed in a training data set (920 respondents) and performance was assessed in a validation data set (537 respondents).

Results

Respondents were a median of 19 months from diagnosis, and 28.1% were receiving active treatment. The most relevant factors found to be associated with PCS were symptom severity, comorbidity scores, leisure-time physical activity, and having physical support needs. The most relevant factors for MCS were having emotional support needs, symptom severity score, and the number of financial hardship events. Results were consistent across modeling techniques. Symptoms found to be strongly associated with PCS included fatigue, pain, disturbed sleep, and drowsiness.

Symptoms found to be strongly associated with MCS included fatigue, problems remembering things, disturbed sleep, and lack of appetite.

Conclusions

The findings of the current study support the importance of addressing persistent symptoms, managing comorbidities, promoting leisure-time physical activity, and addressing financial challenges. A long-term comprehensive approach is needed to ensure the well-being of older adults with cancer.

 

Full reference: Maria Pisu et al. | Most impactful factors on the health-related quality of life of a geriatric population with cancer |Cancer |  First publishd 18 December 2017

Association between self-perception of aging, view of cancer and health of older patients in oncology

The authors hypothesize that more negative self-perception of aging (SPA) and view of cancer could be linked to worse physical and mental health outcomes in cancer patients | BMC Cancer

https://www.flickr.com/photos/vydd/3812230235/
Image source: Danilo Vidovic – Flickr // CC BY 2.0

Identifying older people affected by cancer who are more at risk of negative health outcomes is a major issue in health initiatives focusing on medical effectiveness. In this regard, psychological risk factors such as patients’ perception of their own aging and cancer could be used as indicators to improve customization of cancer care.

Negative SPA and/or view of cancer at baseline are associated with negative evolution of patients’ physical and mental health. Moreover, when the evolution of SPA and cancer view were taken into account, these two stigmas are still linked with the evolution of mental health. In comparison, only a negative evolution of SPA was linked to worse physical health outcomes.

Full reference: Schroyen, S. et al. (2017) Association between self-perception of aging, view of cancer and health of older patients in oncology: a one-year longitudinal study. BMC Cancer. 17:614

Risk factors for falls in older patients with cancer

A rising number of patients with cancer are older adults (65 years of age and older), and this proportion will increase to 70% by the year 2020. Falls are a common condition in older adults. We sought to assess the prevalence and risk factors for falls in older patients with cancer | BMJ Supportive & Palliative Care

This is a single-site, retrospective cohort study. Patients who were receiving cancer care underwent a comprehensive geriatric assessments, including cognitive, functional, nutritional, physical, falls in the prior 6 months and comorbidity assessment. Vitamin D and bone densitometry were performed.

Falls are common in older patients with cancer and lead to adverse clinical outcomes. Major depression, functional impairment, frailty, dementia and low social support were risk factors for falls. Heightened awareness and targeted interventions can prevent falls in older patients with cancer.

Full reference: Zhang, X. et al. (2017) Risk factors for falls in older patients with cancer. BMJ Supportive & Palliative Care. Published Online: 31 August 2017.

Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women

Concurrent chemoradiotherapy (CCRT) is the standard treatment for local advanced cervical cancer. However, for elderly patients, studies are limited and the outcomes are controversial | BMC Cancer

Methods: We retrospectively analyzed the elderly cervical cancer patients treated with radical RT or CCRT between January 2006 and December 2014. For external beam radiotherapy, 50Gy in 25 fractions or 50.4Gy in 28 fractions were delivered via 3-dimensional conformal radiation therapy or intensity modulated radiation therapy. High-dose-rate intracavitary brachytherapy was performed with a dose of 30-36Gy in 5–7 fractions to point A. Concurrent chemotherapy regimens included weekly cisplatin and paclitaxel.

Conclusion: Elderly cervical cancer patients could tolerate radical RT and CCRT very well and get a favored survival. Compared with RT, CCRT could improve the survival of elder cervical cancer patients with similar nonhematological toxicity. CCRT should be considered in elderly cervical cancer patients.

Full reference: Wang, W. et al. (2017) Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women. BMC Cancer 17:510

Patterns of care and predictors of adjuvant therapies in elderly patients with glioblastoma

Amsbaugh, M.J. et al. Cancer | Published online: 27 April 2017

Background: The objectives of this study were to characterize patterns of care and to identify predictors for adjuvant therapy in elderly patients with glioblastoma in the modern era.

Conclusions: In this analysis of elderly patients who had glioblastoma diagnosed from 2004 through 2012, a significant increase in the receipt of combined-modality therapy was observed. Combined-modality treatment produces improved survival outcomes and should be considered as adjuvant treatment for carefully selected elderly patients.

Read the abstract here

One Hospital System’s Journey to Reduce Clostridium Difficile

Delaney, M.B. Journal of Emergency Nursing | Published online: 4 April 2017

a&e department

Problem: Albert Einstein defines insanity as doing the same thing over again but expecting different results. Although the United States claims to reduce antibiotic abuse, practice strict isolation, and clean meticulously, the burden of Clostridium difficile outpaces goals. Unless innovative approaches are tried, we risk culling elderly, immunosuppressed, and otherwise debilitated populations. Emergency departments are a primary access point for patients who are unable to wait for primary care. As a result, many patients with diarrhea are seen in emergency departments.

Methods: This article describes one hospital system’s quality improvement trial of disposable commode pails (DCPs) for high-acuity patients in 3 of 5 institutions. The rationale was to prevent staff from touching surfaces heavily contaminated with C difficile. Staff members were not to wash or reuse commode buckets between patients. Instead, DCPs were substituted, and only the commode chairs were wiped. For quantitative date, C difficile infections (CDIs) were compared across hospitals. Staff members were surveyed for qualitative data.

Read the full abstract here