Background
Nutritional counseling is frequently overlooked in cancer patients with normal nutritional status. This study aimed to evaluate the impact of nutritional counseling in head and neck cancer ...(HNC) patients with normal nutritional status prior to concurrent chemoradiotherapy (CCRT).
Methods
A total of 243 patients with pretreatment normal nutritional status and locally advanced HNC receiving concurrent chemoradiotherapy (CCRT) at three medical centers were enrolled. All patients were retrospectively allocated into the early (≤ 2 weeks,
n
= 105, 43.2%), late (> 2 weeks,
n
= 102, 42.0%), and no nutritional counseling groups (
n
= 36, 14.8%) according to the time interval between the date of CCRT initiation and the first date of nutritional counseling for comparison.
Results
The 1-year overall survival rates were 95.0%, 87.5%, and 81.3% in the early, late, and no nutritional counseling groups (
p
= 0.035), respectively. The median body weight changes at end of CCRT were − 4.8% (range, − 13.3 to 8.7%), − 5.6% (range, − 21.9 to 5.6%), and − 8.6% (range, − 20.3 to 2.4%) in patients in the early, late, and no nutritional counseling groups, respectively. The early termination of chemotherapy rates and the incompletion rates of planned radiotherapy were 1.9% and 1.9%, 2.9%, and 2.0%, 13.9%, and 19.4% in patients in the early, late, and no nutritional counseling groups, respectively.
Conclusions
Our findings strongly suggest that while some HNC patients may have pretreatment normal nutritional status, early nutritional counseling is nevertheless essential for the improvement of treatment tolerance and survival outcome.
Background and Aim
Given that a wide variation in tumor response rates and survival times suggests heterogeneity among the patients with advanced pancreatic cancer (APC) who underwent second‐line ...(L2) chemotherapy, it is a challenge in clinical practice to identify patients who will receive the most benefit from L2 treatment.
Methods
We selected 183 APC patients who received L2 palliative chemotherapy between 2010 and 2016 from a medical center as the development cohort. A Cox proportional hazard model was used to identify the prognostic factors and construct the nomogram. An independent cohort of 166 patients from three other hospitals was selected for external validation.
Results
The nomogram was based on eight independent prognostic factors from the multivariate Cox model: sex, Eastern Cooperative Oncology Group performance status, reason for first‐line treatment discontinuation, duration of first‐line treatment, neutrophil‐to‐lymphocyte ratio, tumor stage, body mass index, and serum carbohydrate antigen 19‐9 levels at the beginning of L2 treatment. The model exhibited good discrimination ability, with a C‐index of 0.733 (95% confidence interval, 0.681–0.785) and 0.724 (95% confidence interval, 0.661–0.787) in the development and validation cohorts, respectively. The calibration plots of the development and validation cohorts showed optimal agreement between model prediction and actual observation in predicting survival probability at 6 months, 1 year, and 2 years.
Conclusions
This study developed and externally validated a prognostic model that accurately predicts the survival outcome of APC patients before L2 palliative chemotherapy, which could assist in clinical decision‐making, counseling for treatment, and most importantly, prognostic stratification of patients.
Background
Whether the prevalence of frailty and its clinical significance are relevant to treatment outcomes in younger (aged < 65 years) cancer patients remains uncertain. This study aimed to ...evaluate the impact of frailty on treatment outcomes in younger cancer patients with head and neck and esophageal malignancy.
Material and methods
This multicenter prospective study recruited 502 patients with locally advanced head and neck and esophageal cancer during 2016–2017 in Taiwan, aged 20–64 years who received curative-intent concurrent chemoradiotherapy (CCRT) as first-line antitumor treatment. Baseline frailty assessment using geriatric assessment (GA) was performed for each patient within 7 days before CCRT initiation.
Results
Frailty was observed in 169 (33.7%) of 502 middle-aged patients. Frail patients had significantly higher incidences of chemotherapy incompletion (16.6% versus 3.3%, P < .001) and radiotherapy incompletion (16.6% versus 3.6%, P < .001) than fit patients. During CCRT, frail patients had a significantly higher percentage of hospitalizations (42.0% versus 24.6%, P < .001) and a trend toward a higher percentage of emergency room visits (37.9% versus 30.0%, P = .08) than fit patients. Frail patients more likely had a significantly higher incidence of grade ≥ 3 adverse events than fit patients during CCRT. The 1-year survival rate was 68.7% and 85.2% (hazard ratio 2.56, 95% confidence interval 1.80–3.63, P < .001) for frail and fit patients, respectively.
Conclusions
This study demonstrated the significance of pretreatment frailty on treatment tolerance, treatment-related toxicity, and survival outcome in younger patients with head and neck and esophageal cancer undergoing CCRT. While GA is commonly targeted toward the older population, frailty assessment by GA may also be utilized in younger patients for decision-making guidance and prognosis prediction.
Objectives
Early mortality, defined as death within 120 days after initiated antitumor therapy, is an important issue especially for elder patients with B‐cell lymphoma. This study aimed to evaluate ...the clinical value of comprehensive geriatric assessment (CGA) in early mortality prediction in elderly patients with B‐cell lymphoma receiving immunochemotherapy.
Methods
Seventy‐six consecutive patients with newly diagnosed B‐cell lymphoma receiving immunochemotherapy from a medical center in Taiwan were prospectively enrolled. Patients were divided into fit (n = 49) and frail (n = 27) groups per pretreatment CGA for early mortality comparison.
Results
The early mortality rate in our patient cohort was 16% (n = 12): from 6% in patients with no CGA domain impairment to 43% in patients with ≥4 CGA domain impairment. The early mortality rate was 6% and 33% in fit and frail patients (odds ratio, 7.67; 95% CI, 1.86‐31.6; P = .005), respectively. Frailty was the significant predictor for early mortality in univariate and multivariate analysis.
Conclusion
In this study, the number of geriatric domain impairment is positively associated with the early mortality risk in elderly patients with B‐cell lymphoma. Therefore, CGA can help clinicians to identify the risk of early mortality in elderly patients and provide alternative treatment.
Background
Recent studies have suggested the suboptimal efficacy of liposomal irinotecan plus 5‐fluorouracil/leucovorin (nal‐IRI+5‐FU/LV) in metastatic pancreatic ductal adenocarcinoma (mPDAC) ...patients previously treated with conventional irinotecan. This study investigated the effect of conventional irinotecan treatment in mPDAC patients receiving nal‐IRI+5‐FU/LV by analyzing a population‐based dataset.
Methods
We reviewed 667 consecutive mPDAC patients treated with nal‐IRI+5‐FU/LV between August 2018 and November 2020 at Taiwanese medical centers. Eighty‐six patients previously treated with conventional irinotecan were matched to 86 patients not treated with conventional irinotecan, following propensity matching for age, sex, performance status, metastatic organ site, pre‐treatment carbohydrate antigen 19‐9 level, lines of prior chemotherapy treatment, and time from first‐line treatment to nal‐IRI+5‐FU/LV therapy.
Results
The median overall survival and time‐to‐treatment failure were 4.8 and 2.6 vs 4.1 and 2.1 months, respectively, for patients who were and were not previously treated with conventional irinotecan. The tumor response and disease control rates were 5.8% and 32.6% vs 5.8% and 37.2%, respectively, for patients previously treated and not treated with conventional irinotecan. No significant differences were observed in survival times and tumor response rates between the two groups.
Conclusions
Previous conventional irinotecan treatment does not compromise the efficacy of subsequent nal‐IRI+5‐FU/LV treatment in mPDAC patients.
HighlightChiu and colleagues conducted a retrospective analysis of a population‐based dataset in Taiwan to investigate the survival outcomes and safety profiles of conventional irinotecan treatment in patients with metastatic pancreatic cancer receiving liposomal irinotecan plus 5‐fluorouracil and leucovorin. Propensity score matching was used to adjust potential confounding variables.
Postoperative delirium (POD) is a common surgical complication in elderly patients. As frailty is a relatively novel concept, its clinical significance for POD has seldom been examined. This study ...aimed to investigate the association between frailty and POD in aged cancer patients undergoing elective abdominal surgery in Taiwan.
We prospectively enrolled 345 consecutive patients aged ≥65 years with newly diagnosed cancer who underwent elective abdominal surgery between 2016 and 2018. Frailty assessment was performed using the Comprehensive Geriatric Assessment (CGA). POD was assessed daily using the Confusion Assessment Method from postoperative day 1 until discharge. Patients were allocated into fit and frail groups.
POD occurred in 19 (5.5%) of 345 patients. POD incidence was 1.6%, 3.1%, 4.8%, 11.5%, and 10.0% in patients with 0, 1, 2, 3, and 4+ frail conditions, respectively, which presented a positive linear correlation among patients with an increased number of frail conditions and POD incidence. Based on CGA, 159 (46.1%) and 186 (53.9%) patients were allocated to fit and frail groups, respectively. POD incidence was 2.5% and 8.1% for the fit and frail groups, respectively. Frailty status was an independent risk factor for POD occurrence in multivariate analysis.
Our study identified frailty as an independent risk factor for POD in aged Taiwanese cancer patients undergoing elective abdominal surgery. Given the high prevalence of frailty among older cancer patients, preoperative assessment is important to identify high risk of POD and to improve the quality of postoperative care.
Background/purpose
Frailty is a common clinical syndrome among the elderly; however, it is frequently neglected in patients with hematological malignancies, especially among the Asian population. ...This study is aimed to evaluate the prevalence and effect of frailty on survival outcomes in elderly Asian patients with B‐cell lymphoma.
Methods
We prospectively enrolled 76 consecutive patients with age ≥ 65 years and newly diagnosed B‐cell lymphoma and were receiving immunochemotherapy in a medical center in Taiwan between August 2016 and December 2017. The frailty of all patients was assessed using a comprehensive geriatric assessment (CGA) within 7 days before immunochemotherapy.
Results
Twenty‐seven patients (36%) were allocated to the frail group based on CGA. With a median follow‐up duration of 26.5 (range, 1.7–39.8) months, the 1‐ and 2‐year survival rates were 68% and 58%, respectively, for all group of patients. In patients in the non‐frail group, the 1‐year and 2‐year survival rates were 81% and 71%, respectively, compared to 44% and 33%, respectively, in the frail group (hazard ratio HR, 3.57, 95% confidence interval CI, 1.74–7.30; p = 0.001). Age ≥ 75years (adjusted HR 2.57, 95% CI 1.02–6.47, p = 0.045), presence of B‐symptoms (adjusted HR 2.43, 95% CI 1.05–5.60, p = 0.038), and frailty (adjusted HR 3.03, 95% CI 1.29–7.11, p = 0.011) were independent prognostic factors in the multivariate analysis.
Conclusion
Frailty significantly influenced the survival outcome as an independent prognostic factor in elderly patients with B‐cell lymphoma undergoing immunochemotherapy. Pretreatment frailty assessment is critical to assist clinicians and patients with B‐cell lymphoma with prognosis prediction and counseling on an appropriate treatment goal.
Frailty is a common clinical syndrome among the elderly; however, it is frequently neglected in patients with hematological malignancies, especially among the Asian population. This is the first study to evaluate the prevalence rate and effect of frailty on survival outcome in elderly patients undergoing immunochemotherapy for the treatment of B‐cell lymphoma in Taiwan. This study found a negative association between the numbers of geriatric dimensional impairment and survival outcome. Pretreatment frailty assessment is essential to assist clinicians and patients with B‐cell lymphoma with prognosis prediction and counseling on an appropriate treatment goal.
Purpose
Health-related quality of life (HRQoL) is associated with treatment-related complications and poor survival in patients with head and neck cancer (HNC). We investigated the effects of frailty ...on HRQoL in patients with HNC receiving definitive concurrent chemoradiotherapy (CCRT).
Methods
A total of 461 consecutive patients with locally advanced HNC who received CCRT between 2017 and 2018 at three medical centers in Taiwan were included. Frailty and HRQoL were assessed using the Comprehensive Geriatric Assessment and QLQ-H&N35 before CCRT. The sum score was calculated based on the first 30 questions of QLQ-H&N35. Multivariate analysis was performed to evaluate the impact of frailty on HRQoL.
Results
The overall sum score was 39 (34–49). The sum scores of patients with impairments in 0, 1, 2, 3, and ≥ 4 frailty domains were 34 (32–38), 40 (34–47), 46 (36–55), 48 (41–64), and 56 (50–60), respectively. Patients with impairments in more frailty domains had a higher symptom burden (p for trend < 0.001). Frail patients tended to experience symptoms across all QLQ-H&N35 subscales. Sex, body mass index, tumor type, tumor stage, Eastern Cooperative Oncology Group performance status, and frailty were determinants of HRQoL in the univariate analysis. Frailty was an independent determinant of HRQoL in the multivariate analysis.
Conclusion
Routine frailty assessment may serve as a surrogate for the selection of patients with HNC with poor HRQoL before CCRT. Further studies are needed to determine whether appropriate interventions in frail patients would improve their HRQoL during CCRT.
Background
No gold standard of nutritional assessment is established among patients with head and neck cancer (HNC) receiving concurrent chemoradiotherapy (CCRT). This study aimed to evaluate the ...clinical significance of pre-treatment nutritional status using the Mini Nutritional Assessment-short form (MNA-SF) among HNC patients receiving CCRT.
Methods
A total of 461 consecutive patients with newly diagnosed HNC treated with definitive CCRT at three medical institutes were prospectively enrolled. Nutritional status was assessed using MNA-SF within 7 days before CCRT initiation. Patients were classified as having normal nutrition, at risk of malnutrition, and malnourished groups according to MNA-SF for comparison.
Results
The 1-year overall survival rates were 89.8%, 76.8%, and 67.7% in the normal nutrition, at risk of malnutrition, and malnourished groups, respectively. Patients with normal nutrition had significantly lower rates of uncompleted radiotherapy and chemotherapy (4.5% and 4.1%, respectively) compared with patients at risk for malnutrition (14.1% and 11.5%, respectively) and those malnourished (11.1% and 11.1%, respectively). Patients with normal nutrition had significantly lower treatment-related complication rates regarding emergency room visits, hospital admission, and need for tubal feeding than those with at risk of malnutrition and malnourished. Patients with normal nutrition had significantly fewer severe hematologic toxicities (
p
= 0.044) and severe non-hematologic toxicities (
p
= 0.012) of CCRT than those malnourished.
Conclusion
Pre-CCRT nutritional status identifies HNC patients vulnerable to treatment interruption and treatment complications. We suggest that nutritional assessment with MNA-SF should be incorporated in pre-CCRT evaluation for all HNC patients.
Postoperative delirium (POD) is a common complication in older adults, with unknown epidemiology and effects on surgical outcomes in Asian geriatric cancer patients. This study evaluated incidence, ...risk factors, and association between adverse surgical outcomes and POD after intra-abdominal cancer surgery in Taiwan.
Overall, 345 patients aged ≥65 years who underwent elective abdominal cancer surgery at a medical center in Taiwan were prospectively enrolled. Delirium was assessed daily using the Confusion Assessment Method. Univariate and multivariate logistic regression analyses investigated risk factors for POD occurrence and estimated the association with adverse surgical outcomes.
POD occurred in 19 (5.5%) of the 345 patients. Age ≥73 years, Charlson comorbidity index ≥3, and operative time >428 min were independent predictors for POD occurrence. Patients presenting with one, two, and three risk factors had 4.1-fold (95% confidence interval CI, 0.4–35.8, p = 0.20), 17.4-fold (95% CI, 2.2–138, p = 0.007), and 30.8-fold likelihood (95% CI, 2.9–321, p = 0.004) for POD occurrence, respectively. Patients with POD had a higher probability of prolonged hospital stay (adjusted odds ratio OR 2.8; 95% CI, 1.0–8.1; p = 0.037), intensive care stay (adjusted OR: 3.9; 95% CI, 1.5–10.5; p = 0.008), 30-day readmission (adjusted OR 3.1; 95% CI, 1.1–9.7; p = 0.039), and 90-day postoperative death (adjusted OR: 4.2; 95% CI, 1.0–17.7; p = 0.041).
POD occurrence was significantly associated with adverse surgical outcomes in geriatric patients undergoing elective abdominal cancer surgery, highlighting the importance of early POD identification in geriatric patients to improve postoperative care quality.
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