Abstract Background Body composition plays an important role in predicting treatment outcomes in adults with cancer. Using existing computed tomographic (CT) cross-sectional imaging and readily ...available software, the assessment of skeletal muscle mass to evaluate sarcopenia has become simplified. We performed a systematic review and meta-analysis to quantify the prognostic value of skeletal muscle index (SMI) obtained from cross-sectional CT imaging on clinical outcomes in non-haematologic solid tumours. Methods We searched PubMed and the American Society Clinical Oncology online database of meeting abstracts up to October 2015 for relevant studies. We included studies assessing the prognostic impact of pre-treatment SMI on clinical outcomes in patients with non-haematologic solid tumours. The primary outcome was overall survival (OS) and the secondary outcomes included cancer-specific survival (CSS), disease-free survival (DFS), and progression-free survival (PFS). The summary hazard ratio (HR) and 95% confidence interval (CI) were calculated. Results A total of 7843 patients from 38 studies were included. SMI lower than the cut-off was associated with poor OS (HR = 1.44, 95% CI = 1.32–1.56, p < 0.001). The effect of SMI on OS was observed among various tumour types and across disease stages. Worse CSS was also associated with low SMI (HR = 1.93, 95% CI = 1.38–2.70, p < 0.001) as well as DFS (HR = 1.16, 95% CI = 1.00–1.30, p = 0.014), but not PFS (HR = 1.54, 95% CI = 0.90–2.64, p = 0.117). Conclusions This meta-analysis demonstrates that low SMI at cancer diagnosis is associated with worse survival in patients with solid tumours. Further research into understanding and mitigating the negative effects of sarcopenia in adults with cancer is needed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Highlights • This meta-analysis compared the efficacy of ICIs between younger and older patients. • ICIs significantly improved OS in both younger (HR, 0.75) and older (HR, 0.73) groups. • An ...improvement in PFS was observed in younger (HR, 0.58) and older (HR, 0.77) patients. • In the PD-1 inhibitor subgroup, a significant benefit was not seen in the patients aged 7 75 years.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Introduction
Cisplatin, a platinum‐based antineoplastic agent, is the cornerstone for the treatment of many malignancies. Nephrotoxicity is the primary dose‐limiting toxicity, and various hydration ...regimens and supplementation strategies are used to prevent cisplatin‐induced kidney injury. However, evidence‐based recommendations on specific hydration regimens are limited. A systematic review was performed to evaluate clinical studies that have examined hydration and supplementation strategies to prevent cisplatin‐induced nephrotoxicity.
Materials and Methods
PubMed and Excerpta Medica databases were searched from 1966 through October 2015 for clinical trials and other studies focused on hydration regimens to prevent nephrotoxicity in cancer patients treated with cisplatin. The University of Oxford Centre for Evidence‐Based Medicine criteria were used to grade level of evidence.
Results
Among the 1,407 identified studies, 24 were included in this systematic review. All studies differed on type, volume, and duration of hydration. Among the 24 studies, 5 evaluated short‐duration hydration, 4 evaluated low‐volume hydration, 4 investigated magnesium supplementation, and 7 reviewed forced diuresis with hydration. Short‐duration and lower‐volume hydration regimens are effective in preventing cisplatin‐induced nephrotoxicity. Magnesium supplementation may have a role as a nephroprotectant, and forced diuresis may be appropriate in some patients receiving cisplatin.
Conclusion
Hydration is essential for all patients to prevent cisplatin‐induced nephrotoxicity. Specifically, short‐duration, low‐volume, outpatient hydration with magnesium supplementation and mannitol forced diuresis (in select patients) represent best practice principles for the safe use of cisplatin.
Implications for Practice
The findings contained within this systematic review show that (a) hydration is essential for all patients to prevent cisplatin‐induced nephrotoxicity, (b) short‐duration, low‐volume, outpatient hydration regimens appear to be safe and feasible, even in patients receiving intermediate‐ to high‐dose cisplatin, (c) magnesium supplementation (8–16 milliequivalents) may limit cisplatin‐induced nephrotoxicity, and (d) mannitol may be considered for high‐dose cisplatin and/or patients with preexisting hypertension. These findings have broad implications for clinical practice and represent best practice principles for the prevention of cisplatin‐induced nephrotoxicity.
Various hydration regimens and supplementation strategies are used to prevent cisplatin‐induced kidney injury; however, evidence‐based recommendations on specific hydration regimens are limited. This systematic review of the literature evaluates clinical studies that have examined hydration and supplementation strategies to prevent cisplatin‐induced nephrotoxicity.
Background
Compared with chemotherapy, significant improvement in survival outcomes with the programmed death receptor‐1 (PD‐1) inhibitors nivolumab and pembrolizumab and the programmed death‐ligand ...1 (PD‐L1) inhibitor atezolizumab has been shown in several types of advanced solid tumors. We conducted a systematic review and meta‐analysis to compare safety and tolerability between PD‐1/PD‐L1 inhibitors and chemotherapy.
Methods
PubMed and American Society of Clinical Oncology (ASCO) databases were searched 1966 to September 2016. Eligible studies included randomized controlled trials (RCTs) comparing single‐agent U.S. Food and Drug Administration–approved PD‐1/PD‐L1 inhibitors (nivolumab, pembrolizumab, or atezolizumab) with chemotherapy in cancer patients reporting any all‐grade (1–4) or high‐grade (3–4) adverse events (AEs), all‐ or high‐grade treatment‐related symptoms, hematologic toxicities and immune‐related AEs, treatment discontinuation due to toxicities, or treatment‐related deaths. The summary incidence, relative risk, and 95% confidence intervals were calculated.
Results
A total of 3,450 patients from 7 RCTs were included in the meta‐analysis: 4 nivolumab, 2 pembrolizumab, and 1 atezolizumab trials. The underlying malignancies included were non‐small cell lung cancer (4 trials) and melanoma (3 trials). Compared with chemotherapy, the PD‐1/PD‐L1 inhibitors had a significantly lower risk of all‐ and high‐grade fatigue, sensory neuropathy, diarrhea and hematologic toxicities, all‐grade anorexia, nausea, and constipation, any all‐ and high‐grade AEs, and treatment discontinuation. There was an increased risk of all‐grade rash, pruritus, colitis, aminotransferase elevations, hypothyroidism, and hyperthyroidism, and all‐ and high‐grade pneumonitis with PD1/PD‐L1 inhibitors.
Conclusion
PD‐1/PD‐L1 inhibitors are overall better tolerated than chemotherapy. Our results provide further evidence supporting the favorable risk/benefit ratio for PD‐1/PD‐L1 inhibitors.
Implications for Practice
We conducted a systematic review and meta‐analysis to compare summary toxicity endpoints and clinically relevant adverse events between programmed death receptor‐1 (PD‐1)/programmed death‐ligand 1 (PD‐L1) inhibitors and chemotherapy. PD1/PD‐L1 inhibitors were associated with a lower risk of treatment‐related symptoms (fatigue, anorexia, nausea, diarrhea, constipation, and sensory neuropathy) but a higher risk of immune‐related adverse events (AEs). Summary toxicity endpoints favor PD1/PD‐L1 inhibitors (any all‐ and high‐grade AEs and treatment discontinuation). PD1/PD‐L1 inhibitors are overall better tolerated than chemotherapy. In addition to efficacy data from trials, our findings provide useful information for clinicians for well‐balanced discussions with their patients on the risks and benefits of treatment options for advanced cancer.
The development of immune checkpoint inhibitors represents a major breakthrough in cancer therapy. This systematic review and meta‐analysis of randomized controlled trials was conducted to compare summary toxicity endpoints and clinically relevant adverse events between PD‐1/PD‐L1 inhibitors and chemotherapy.
Highlights • This meta-analysis quantified the prognostic value of LMR in solid tumors. • LMR lower than the cut-off was associated with poor OS (HR, 1.73; 95% CI, 1.55–1.93). • The effect of LMR on ...OS was observed in among various tumors and disease stages. • A low LMR was an unfavorable prognostic factor for CSS (HR, 1.56) and DFS (HR, 1.56).
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Objective Geriatric screening followed by a more detailed assessment and intervention is recommended for older adults with cancer. However, little is known regarding how the geriatric screening ...covered by Japanese health insurance is used for hospitalized older cancer patients. We surveyed all hospitals in Japanese Association of Clinical Cancer Centers (JACCC) to explore the current use of this approach. Methods The JACCC member hospitals specialize in cancer care from prevention, through diagnosis and treatment, to palliative care. We mailed paper questionnaires to the presidents of the hospitals in December 2019 and collected them by February 2020. The survey requested general hospital information and asked whether (and how) such geriatric screening for hospitalized older adults with cancer was conducted. Results Twenty-six of 32 hospitals completed the survey (81%). Fourteen hospitals are cancer centers, while the remaining 12 hospitals are general hospitals which care of both cancer and non-cancer patients. Eleven hospitals (42%) performed geriatric screening and the most common use of the results was for "early discharge planning" and for "applying for long-term care insurance." Most clinicians rated the screening "somewhat" or "a little" helpful and found it most helpful for "meeting patient-post discharge needs". The most frequently reported barrier to implementation was a "lack of leadership to improve the care of older adults." Conclusion Geriatric screening was used at less than half of the major cancer centers and hospitals in Japan. One feasible solution to this problem is to establish an interprofessional workgroup at each hospital with the shared goal of providing high-quality care for this population.
Background
Current guidelines recommend a comprehensive geriatric assessment (CGA) for the management of older adults with cancer. We evaluated the effect of CGA conducted by a geriatric oncology ...service (GOS) on the management of older adults with cancer. We also queried patients about their perceptions of the value of this process.
Methods
This was a prospective quality assessment study of 498 consecutive older adults with cancer who were referred to the GOS from May 2020 through December 2021. Treating physicians requested a consultation and the GOS conducted a CGA and assessed patient preferences. The GOS provided recommendations on cancer treatment and geriatric interventions. Patient perspectives on the consultation were evaluated using collaboRATE and modified Patient Assessment of Care for Chronic Conditions (PACIC) subscales.
Results
A 10‐item frailty index based on a CGA (FI‐CGA‐10) Oncologist, 26, e1751 (2021) in the 498 patients showed that 19% of patients were fit, 40% pre‐frail, and 41% frail. Prior to CGA the intent of the proposed cancer treatment was curative in 56% (n = 280), life‐extending in 40% (n = 201), and palliative in 3.4% (n = 17). After a CGA consultation, a cancer treatment decision was changed in 45% of patients. The intent of treatment after the CGA consultation was curative in 45%, life‐extending in 34%, and palliative in 21%. At least one referral to relevant disciplines was recommended for 88% of patients and was implemented in 43%. As part of the GOS consultation educational support was provided to 97% of patients. Based on the collaboRATE and PACIC tools, patients perceived the GOS consultation positively and helpful for facilitating shared decision‐making and patient‐centered care.
Conclusion
Our institutional experience demonstrated the valuable effect of the CGA consultation on oncologic decision‐making and geriatric interventions in a patient‐centered manner.
See related Editorial by Fernandes Dos Santos Hughes et al. in this issue.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
We aimed to evaluate the potential utility of the Robinson Frailty Score (RFS), the Edmonton Frail Scale (EFS), and the G8 tool for predicting postoperative adverse events (AEs) in older adults with ...cancer.
We included consecutive older adults evaluated at geriatric oncology service before undergoing oncologic surgery between September 2018 and December 2019. The RFS measures cognition, function, falls, comorbidity, albumin, and hematocrit. The EFS evaluates cognition, function, incontinence, self-perceived health, mood, nutrition, polypharmacy, and social support. These scales classify patients into three frailty categories (fit, pre-frail, or frail). The G8 score was dichotomized at a cut-off value of 14. The primary outcome was composite AEs including 30-day postoperative complications (≥Clavien-Dindo grade II) and discharge to an institutional care facility. The severity of surgery was assessed using the Operative Stress Score (OSS).
Among 114 patients (median age 80 years, range 72–96 years), the main surgery types were gastrointestinal (62%), and head and neck (20%). Using the OSS, surgical procedures were classified as very low to low-stress (9%), moderate-stress (31%), high-stress (46%), and very high-stress (15%). Forty-five patients (40%) experienced postoperative AEs. After adjusting for the OSS, preoperative RFS was significantly associated with AEs (fit: 25%, pre-frail: 49%, frail: 77%; p < 0.01). However, the EFS (fit: 30%, pre-frail: 37%, frail: 60%; p = 0.14) and the G8 tool (score >14: 17%, score ≤14: 41%; p = 0.07) were not significantly associated with the risk of AEs.
The RFS is predictive of postoperative AEs in older adults undergoing elective surgery for cancer.
•Robinson Frailty Score (RFS) categorizes older adults into fit, pre-frail and frail status.•RFS is associated with postoperative adverse events (AEs) in a dose-response manner.•After controlling for operative stress, AE-risk was fit: 25%, pre-frail: 49%, frail: 77%.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background
A frailty index (FI) based on domain‐level deficits identified through a comprehensive geriatric assessment (CGA) has been previously developed and validated in general geriatric patients. ...Our objectives were to construct an FI‐CGA and to assess its construct validity in the geriatric oncology setting.
Methods
Five hundred forty consecutive Japanese patients with cancer who underwent a CGA on a geriatric oncology service were included (median age 80 years, range 66–96 years). We developed a 10‐item frailty index based on deficits in 10 domains (FI‐CGA‐10): cognition, mood, communication, mobility, balance, nutrition, basic and instrumental activities of daily living, social support, and comorbidity. Deficits in each domain were scored as 0 (no problem), 0.5 (minor problem), and 1.0 (major problem). Scores were calculated by dividing the sum of the scores for each domain by 10 and then categorized as fit (<0.2), pre‐frail (0.2–0.35), and frail (>0.35). Construct validity was tested by correlating the FI‐CGA‐10 with other established frailty measures.
Results
FI‐CGA‐10 was well approximated by the gamma distribution. Overall, 20% of patients were fit, 41% were pre‐frail, and 39% were frail. FI‐CGA‐10 was correlated with Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (r = 0.83), CSHA rules‐based frailty definition (r = 0.67), and CSHA Function Score (r = 0.77). Increasing levels of frailty were significantly associated with functional and cognitive impairments, high comorbidity burden, poor self‐rated health, and low estimated survival probabilities.
Conclusion
The FI‐CGA‐10 is a user‐friendly and construct‐validated measure for quantifying frailty from a CGA.
Implications for Practice
This article describes the construction of a user‐friendly 10‐item frailty index based on a comprehensive geriatric assessment (FI‐CGA‐10) for older adults with cancer: cognition, mood, communication, mobility, balance, nutrition, basic and instrumental activities of daily living, social support, and comorbidity. The FI‐CGA‐10 simplifies the original FI‐CGA used in the general geriatric setting while maintaining its content validity. The index's construct validity was demonstrated in a cohort of older adults with various cancer types. The advantage of the FI‐CGA‐10 is that a frailty score can be calculated more readily and interpreted in a more clinically sensible manner than the original FI‐CGA.
Frailty is associated with chemotherapy intolerance, postoperative complications, and death. This study aimed to construct an easy‐to‐use frailty index based on a comprehensive geriatric assessment that would be applicable in the geriatric oncology setting.
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