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Severe Comorbidity Doubles Death Risk in Multiple Myeloma
PARIS – Elderly patients with multiple myeloma and severe comorbid disease are more than twice as likely to die as were those with no comorbidities, data from a single-center, retrospective study show.
Mild or moderate comorbidities did not appear to influence overall survival significantly in the 179-patient study. The hazard ratio (HR) for death in patients with severe comorbidity vs. none was 2.36 (P = .01), which was associated with a median overall survival of 15.1 months.
Median overall survival was 43.1 months for those with no comorbidities and 31.5 and 35 months, respectively, in those with mild (HR, 1.38; P = .26) or moderate (HR, 1.5; P = .19) comorbidities.
"The severity of comorbidities is associated with poorer survival in older adults with multiple myeloma," said lead author Dr. Tanya M. Wildes of Washington University in St. Louis.
Nevertheless, comorbidities are not currently incorporated into any staging systems for the disease, Dr. Wildes observed in an interview at the annual meeting of the International Society of Geriatric Oncology.
The research is part of a wider project that is looking at the value of performing a geriatric assessment to help predict which elderly patients with hematological malignancies may be able to undergo standard cancer treatment, or require additional monitoring for adverse events, or more supportive care.
"The severity of comorbidities is associated with poorer survival in older adults with multiple myeloma."
In the current study, Dr. Wildes and her colleagues identified all patients who were diagnosed and treated for multiple myeloma at Barnes-Jewish Hospital, St. Louis, between January 2000 and March 2010. Demographic, clinical, and survival data were obtained, with concomitant conditions graded using the Adult Comorbidity Evaluation (ACE) 27 index as none, mild, moderate, or severe.
The primary end point of the study was overall survival, the duration of which was calculated from the date of diagnosis until the time of last follow-up.
The median age of patients at baseline was 69 years (range, 65-91 years). There was a similar percentage of men (48.4%) and women (51.4%), and 75% of the population was white. Most of the remainder were black (23.5%).
According to the ACE-27 index, 41.3% of patients had mild, 24.6% had moderate, and 15.6% had severe comorbidities. The remaining 18.5% had no comorbidities.
"The challenge with multiple myeloma is that some of the comorbidities may be disease related as opposed to patient’s underlying comorbidities," Dr. Wildes noted. That would require reviewing the patients’ medical records, which was not done in the current evaluation of this data set but is something that the researchers plan on looking at next.
"These are hypothesis-generating data at the moment," Dr. Wildes said. Further study, to evaluate the impact of comorbidities on survival in multiple myeloma and their influence on patients’ tolerance of therapy and treatment decisions, is needed.
"On average, three comorbidities can be expected in a patient [aged] 65 years and older," said Dr. Lazzaro Repetto of the Istituto Nazionale di Riposo e Cura per Anziani at the Istituto di Ricovero e Cura a Carattere Scientifico in Rome.
Speaking at separate session during the meeting, Dr. Repetto said common comorbidities in elderly cancer patients included cardiovascular disease, renal insufficiency, diabetes, dementia, depression, anemia, osteoporosis, arthritis and arthrosis, and chronic obstructive pulmonary disease. All of these may have an impact on survival.
Indeed, other research presented by a Danish team showed that colorectal and lung cancers in particular were associated with a high number of comorbidities when compared with the general elderly population. A high comorbidity burden was also linked to reduced overall survival, but only in those with lung cancer, reported Dr. Trine Lembrecht Jørgensen of Odense (Denmark) University Hospital and associates.
The presence of comorbidities can alter treatment decisions, influencing the type of treatment offered, said Dr. Repetto. However, although assessing comorbid disease is important, it should always be part of a wider geriatric assessment, he advised. This should include measures of cognition, emotional and physical functioning, medication use, socioeconomic and social support factors, and the patient’s wishes.
"Using the geriatric assessment we can personalize treatment, and optimize the balance between benefit and risk of our decisions," Dr. Repetto suggested.
Dr. Wildes’ research was supported by a grant from the U.S. National Cancer Institute. Dr. Wildes and Dr. Repetto had no conflicts of interest.
PARIS – Elderly patients with multiple myeloma and severe comorbid disease are more than twice as likely to die as were those with no comorbidities, data from a single-center, retrospective study show.
Mild or moderate comorbidities did not appear to influence overall survival significantly in the 179-patient study. The hazard ratio (HR) for death in patients with severe comorbidity vs. none was 2.36 (P = .01), which was associated with a median overall survival of 15.1 months.
Median overall survival was 43.1 months for those with no comorbidities and 31.5 and 35 months, respectively, in those with mild (HR, 1.38; P = .26) or moderate (HR, 1.5; P = .19) comorbidities.
"The severity of comorbidities is associated with poorer survival in older adults with multiple myeloma," said lead author Dr. Tanya M. Wildes of Washington University in St. Louis.
Nevertheless, comorbidities are not currently incorporated into any staging systems for the disease, Dr. Wildes observed in an interview at the annual meeting of the International Society of Geriatric Oncology.
The research is part of a wider project that is looking at the value of performing a geriatric assessment to help predict which elderly patients with hematological malignancies may be able to undergo standard cancer treatment, or require additional monitoring for adverse events, or more supportive care.
"The severity of comorbidities is associated with poorer survival in older adults with multiple myeloma."
In the current study, Dr. Wildes and her colleagues identified all patients who were diagnosed and treated for multiple myeloma at Barnes-Jewish Hospital, St. Louis, between January 2000 and March 2010. Demographic, clinical, and survival data were obtained, with concomitant conditions graded using the Adult Comorbidity Evaluation (ACE) 27 index as none, mild, moderate, or severe.
The primary end point of the study was overall survival, the duration of which was calculated from the date of diagnosis until the time of last follow-up.
The median age of patients at baseline was 69 years (range, 65-91 years). There was a similar percentage of men (48.4%) and women (51.4%), and 75% of the population was white. Most of the remainder were black (23.5%).
According to the ACE-27 index, 41.3% of patients had mild, 24.6% had moderate, and 15.6% had severe comorbidities. The remaining 18.5% had no comorbidities.
"The challenge with multiple myeloma is that some of the comorbidities may be disease related as opposed to patient’s underlying comorbidities," Dr. Wildes noted. That would require reviewing the patients’ medical records, which was not done in the current evaluation of this data set but is something that the researchers plan on looking at next.
"These are hypothesis-generating data at the moment," Dr. Wildes said. Further study, to evaluate the impact of comorbidities on survival in multiple myeloma and their influence on patients’ tolerance of therapy and treatment decisions, is needed.
"On average, three comorbidities can be expected in a patient [aged] 65 years and older," said Dr. Lazzaro Repetto of the Istituto Nazionale di Riposo e Cura per Anziani at the Istituto di Ricovero e Cura a Carattere Scientifico in Rome.
Speaking at separate session during the meeting, Dr. Repetto said common comorbidities in elderly cancer patients included cardiovascular disease, renal insufficiency, diabetes, dementia, depression, anemia, osteoporosis, arthritis and arthrosis, and chronic obstructive pulmonary disease. All of these may have an impact on survival.
Indeed, other research presented by a Danish team showed that colorectal and lung cancers in particular were associated with a high number of comorbidities when compared with the general elderly population. A high comorbidity burden was also linked to reduced overall survival, but only in those with lung cancer, reported Dr. Trine Lembrecht Jørgensen of Odense (Denmark) University Hospital and associates.
The presence of comorbidities can alter treatment decisions, influencing the type of treatment offered, said Dr. Repetto. However, although assessing comorbid disease is important, it should always be part of a wider geriatric assessment, he advised. This should include measures of cognition, emotional and physical functioning, medication use, socioeconomic and social support factors, and the patient’s wishes.
"Using the geriatric assessment we can personalize treatment, and optimize the balance between benefit and risk of our decisions," Dr. Repetto suggested.
Dr. Wildes’ research was supported by a grant from the U.S. National Cancer Institute. Dr. Wildes and Dr. Repetto had no conflicts of interest.
PARIS – Elderly patients with multiple myeloma and severe comorbid disease are more than twice as likely to die as were those with no comorbidities, data from a single-center, retrospective study show.
Mild or moderate comorbidities did not appear to influence overall survival significantly in the 179-patient study. The hazard ratio (HR) for death in patients with severe comorbidity vs. none was 2.36 (P = .01), which was associated with a median overall survival of 15.1 months.
Median overall survival was 43.1 months for those with no comorbidities and 31.5 and 35 months, respectively, in those with mild (HR, 1.38; P = .26) or moderate (HR, 1.5; P = .19) comorbidities.
"The severity of comorbidities is associated with poorer survival in older adults with multiple myeloma," said lead author Dr. Tanya M. Wildes of Washington University in St. Louis.
Nevertheless, comorbidities are not currently incorporated into any staging systems for the disease, Dr. Wildes observed in an interview at the annual meeting of the International Society of Geriatric Oncology.
The research is part of a wider project that is looking at the value of performing a geriatric assessment to help predict which elderly patients with hematological malignancies may be able to undergo standard cancer treatment, or require additional monitoring for adverse events, or more supportive care.
"The severity of comorbidities is associated with poorer survival in older adults with multiple myeloma."
In the current study, Dr. Wildes and her colleagues identified all patients who were diagnosed and treated for multiple myeloma at Barnes-Jewish Hospital, St. Louis, between January 2000 and March 2010. Demographic, clinical, and survival data were obtained, with concomitant conditions graded using the Adult Comorbidity Evaluation (ACE) 27 index as none, mild, moderate, or severe.
The primary end point of the study was overall survival, the duration of which was calculated from the date of diagnosis until the time of last follow-up.
The median age of patients at baseline was 69 years (range, 65-91 years). There was a similar percentage of men (48.4%) and women (51.4%), and 75% of the population was white. Most of the remainder were black (23.5%).
According to the ACE-27 index, 41.3% of patients had mild, 24.6% had moderate, and 15.6% had severe comorbidities. The remaining 18.5% had no comorbidities.
"The challenge with multiple myeloma is that some of the comorbidities may be disease related as opposed to patient’s underlying comorbidities," Dr. Wildes noted. That would require reviewing the patients’ medical records, which was not done in the current evaluation of this data set but is something that the researchers plan on looking at next.
"These are hypothesis-generating data at the moment," Dr. Wildes said. Further study, to evaluate the impact of comorbidities on survival in multiple myeloma and their influence on patients’ tolerance of therapy and treatment decisions, is needed.
"On average, three comorbidities can be expected in a patient [aged] 65 years and older," said Dr. Lazzaro Repetto of the Istituto Nazionale di Riposo e Cura per Anziani at the Istituto di Ricovero e Cura a Carattere Scientifico in Rome.
Speaking at separate session during the meeting, Dr. Repetto said common comorbidities in elderly cancer patients included cardiovascular disease, renal insufficiency, diabetes, dementia, depression, anemia, osteoporosis, arthritis and arthrosis, and chronic obstructive pulmonary disease. All of these may have an impact on survival.
Indeed, other research presented by a Danish team showed that colorectal and lung cancers in particular were associated with a high number of comorbidities when compared with the general elderly population. A high comorbidity burden was also linked to reduced overall survival, but only in those with lung cancer, reported Dr. Trine Lembrecht Jørgensen of Odense (Denmark) University Hospital and associates.
The presence of comorbidities can alter treatment decisions, influencing the type of treatment offered, said Dr. Repetto. However, although assessing comorbid disease is important, it should always be part of a wider geriatric assessment, he advised. This should include measures of cognition, emotional and physical functioning, medication use, socioeconomic and social support factors, and the patient’s wishes.
"Using the geriatric assessment we can personalize treatment, and optimize the balance between benefit and risk of our decisions," Dr. Repetto suggested.
Dr. Wildes’ research was supported by a grant from the U.S. National Cancer Institute. Dr. Wildes and Dr. Repetto had no conflicts of interest.
FROM THE ANNUAL MEETING OF THE INTERNATIONAL SOCIETY OF GERIATRIC ONCOLOGY
Major Finding: Median overall survival in patients with severe comorbidity was 15.1 months vs. 43.1 months in patients with no comorbidity (hazard ratio for death, 2.36; P less than .01).
Data Source: Retrospective, single center study of 179 patients with multiple myeloma aged 65 years or older.
Disclosures: Dr. Wildes’ research was supported by a grant from the US National Cancer Institute. Neither Dr. Wildes nor Dr. Repetto reported any conflicts of interest.
Walking Ability Aids Assessment of Elderly Breast Cancer Patients
PARIS – Women older than 65 years of age with early-stage breast cancer have worse long-term survival if they report poor overall health and have significant limitations in how far they can walk, according to the results of a prospective trial.
At 10 years, 80% of women with a low self-rated health status and a walking limitation had died, compared with 50% of those with a high self-rated health status and no walking limitation (P less than .0001). The probability of survival in women with low self-rated health but no walking limitation was 47%, and in those with high self-rated health and a walking limitation it was 44%.
"Approximately 192,000 new cases of invasive breast cancer were diagnosed in the United States in 2009," and more than half of those cases were in women older than age 60, said study investigator Dr. Jessica A. Eng of Boston University.
"There are many challenges in managing cancer in older adults," and one of the major ones is determining what the optimal treatment benefits are, compared with the risks, Dr. Eng added. Having a simple tool that could, early on, help identify those patients who are likely to do worse could be of great practical benefit, she suggested at the annual meeting of the International Society of Geriatric Oncology.
Dr. Eng and colleagues have previously shown that three or more deficits on a cancer-specific geriatric assessment are predictive of 5- and 10-year mortality in older women with breast cancer (Eur. J. Cancer 2011 July 7 [doi:10.1016/j.ejca.2011.06.016]).
In the current study, the researchers looked at whether self-rated health status and mobility could also be linked to mortality in the same population of 660 women who were aged 65 years or older and had stage I-IIIA breast cancer.
All women in the study were asked two questions at baseline: first, to rate their overall health as excellent, very good, good, or poor; and second, whether they could walk a couple of street blocks with no, a little, or a lot of limitation.
The women were followed for 10 years via annual telephone interviews, and the U.S. National Death Index was used to determine mortality rates.
At baseline, the majority of women were aged 65-79 years, with 18% aged 80 years or older. Most (94%) of the women were white, and 84% had 12 years or more of education. At least one comorbidity was present in 59% of participants, 51% had stage I breast cancer, and 76% were estrogen receptor positive.
Dr. Eng reported that 39% of women rated their health status as low, and 28% said that their ability to walk several street blocks was limited a little or a lot.
There was an absolute difference of 27% in the survival of women with a walking limitation plus high vs. low self-rated health, and a 24% absolute difference in the survival of women with low self-rated health plus no vs. some walking limitation.
Adjusted analysis showed that the risk of dying from any cause was doubled by being older than 80 years, with a hazard ratio of 2.11. The presence of at least one comorbidity also increased the risk of death significantly (HR, 1.37), compared with no comorbidity.
The hazard ratio for low self-rated health plus a walking limitation was 1.58. Separately, low self-rated health and a walking limitation did not increase the mortality risk.
"The combination of low self-rated health and limitation in walking several blocks at diagnosis is an important predictor of all-cause mortality at 10 years," concluded Dr. Eng, adding that the effect was independent of age, comorbidity, tumor characteristics, and treatment.
"Using these two easily assessed questions in clinical practice may represent an effective strategy to improve treatment decision making in older adults with cancer," Dr. Eng said.
The study was supported by the U.S. National Cancer Institute. Dr. Eng had no conflicts of interest.
"How many oncologists watch the patient walk?" asked Dr. Stuart M. Lichtman. He noted in an interview that patients are often sitting when the oncologist walks into the examining room, and the oncologist often leaves before the patient gets up.
"Sometimes watching the patient walk can be very revealing." Dr. Lichtman added. The take-home message from this study is that "you can learn a lot with simple things. All they did was ask patients ‘How’s your health?’ and ‘How fast do you walk?’ " he said; this shows that a general geriatric assessment in cancer patients does not need to be complicated.
Dr. Lichtman, an associate editor of The Oncology Report, is a professor of medicine at Cornell University and an attending physician with the 65+ Clinical Geriatrics Program at Memorial Sloan-Kettering Cancer Center, both in New York. He was not involved in the study and reported no conflicts.
"How many oncologists watch the patient walk?" asked Dr. Stuart M. Lichtman. He noted in an interview that patients are often sitting when the oncologist walks into the examining room, and the oncologist often leaves before the patient gets up.
"Sometimes watching the patient walk can be very revealing." Dr. Lichtman added. The take-home message from this study is that "you can learn a lot with simple things. All they did was ask patients ‘How’s your health?’ and ‘How fast do you walk?’ " he said; this shows that a general geriatric assessment in cancer patients does not need to be complicated.
Dr. Lichtman, an associate editor of The Oncology Report, is a professor of medicine at Cornell University and an attending physician with the 65+ Clinical Geriatrics Program at Memorial Sloan-Kettering Cancer Center, both in New York. He was not involved in the study and reported no conflicts.
"How many oncologists watch the patient walk?" asked Dr. Stuart M. Lichtman. He noted in an interview that patients are often sitting when the oncologist walks into the examining room, and the oncologist often leaves before the patient gets up.
"Sometimes watching the patient walk can be very revealing." Dr. Lichtman added. The take-home message from this study is that "you can learn a lot with simple things. All they did was ask patients ‘How’s your health?’ and ‘How fast do you walk?’ " he said; this shows that a general geriatric assessment in cancer patients does not need to be complicated.
Dr. Lichtman, an associate editor of The Oncology Report, is a professor of medicine at Cornell University and an attending physician with the 65+ Clinical Geriatrics Program at Memorial Sloan-Kettering Cancer Center, both in New York. He was not involved in the study and reported no conflicts.
PARIS – Women older than 65 years of age with early-stage breast cancer have worse long-term survival if they report poor overall health and have significant limitations in how far they can walk, according to the results of a prospective trial.
At 10 years, 80% of women with a low self-rated health status and a walking limitation had died, compared with 50% of those with a high self-rated health status and no walking limitation (P less than .0001). The probability of survival in women with low self-rated health but no walking limitation was 47%, and in those with high self-rated health and a walking limitation it was 44%.
"Approximately 192,000 new cases of invasive breast cancer were diagnosed in the United States in 2009," and more than half of those cases were in women older than age 60, said study investigator Dr. Jessica A. Eng of Boston University.
"There are many challenges in managing cancer in older adults," and one of the major ones is determining what the optimal treatment benefits are, compared with the risks, Dr. Eng added. Having a simple tool that could, early on, help identify those patients who are likely to do worse could be of great practical benefit, she suggested at the annual meeting of the International Society of Geriatric Oncology.
Dr. Eng and colleagues have previously shown that three or more deficits on a cancer-specific geriatric assessment are predictive of 5- and 10-year mortality in older women with breast cancer (Eur. J. Cancer 2011 July 7 [doi:10.1016/j.ejca.2011.06.016]).
In the current study, the researchers looked at whether self-rated health status and mobility could also be linked to mortality in the same population of 660 women who were aged 65 years or older and had stage I-IIIA breast cancer.
All women in the study were asked two questions at baseline: first, to rate their overall health as excellent, very good, good, or poor; and second, whether they could walk a couple of street blocks with no, a little, or a lot of limitation.
The women were followed for 10 years via annual telephone interviews, and the U.S. National Death Index was used to determine mortality rates.
At baseline, the majority of women were aged 65-79 years, with 18% aged 80 years or older. Most (94%) of the women were white, and 84% had 12 years or more of education. At least one comorbidity was present in 59% of participants, 51% had stage I breast cancer, and 76% were estrogen receptor positive.
Dr. Eng reported that 39% of women rated their health status as low, and 28% said that their ability to walk several street blocks was limited a little or a lot.
There was an absolute difference of 27% in the survival of women with a walking limitation plus high vs. low self-rated health, and a 24% absolute difference in the survival of women with low self-rated health plus no vs. some walking limitation.
Adjusted analysis showed that the risk of dying from any cause was doubled by being older than 80 years, with a hazard ratio of 2.11. The presence of at least one comorbidity also increased the risk of death significantly (HR, 1.37), compared with no comorbidity.
The hazard ratio for low self-rated health plus a walking limitation was 1.58. Separately, low self-rated health and a walking limitation did not increase the mortality risk.
"The combination of low self-rated health and limitation in walking several blocks at diagnosis is an important predictor of all-cause mortality at 10 years," concluded Dr. Eng, adding that the effect was independent of age, comorbidity, tumor characteristics, and treatment.
"Using these two easily assessed questions in clinical practice may represent an effective strategy to improve treatment decision making in older adults with cancer," Dr. Eng said.
The study was supported by the U.S. National Cancer Institute. Dr. Eng had no conflicts of interest.
PARIS – Women older than 65 years of age with early-stage breast cancer have worse long-term survival if they report poor overall health and have significant limitations in how far they can walk, according to the results of a prospective trial.
At 10 years, 80% of women with a low self-rated health status and a walking limitation had died, compared with 50% of those with a high self-rated health status and no walking limitation (P less than .0001). The probability of survival in women with low self-rated health but no walking limitation was 47%, and in those with high self-rated health and a walking limitation it was 44%.
"Approximately 192,000 new cases of invasive breast cancer were diagnosed in the United States in 2009," and more than half of those cases were in women older than age 60, said study investigator Dr. Jessica A. Eng of Boston University.
"There are many challenges in managing cancer in older adults," and one of the major ones is determining what the optimal treatment benefits are, compared with the risks, Dr. Eng added. Having a simple tool that could, early on, help identify those patients who are likely to do worse could be of great practical benefit, she suggested at the annual meeting of the International Society of Geriatric Oncology.
Dr. Eng and colleagues have previously shown that three or more deficits on a cancer-specific geriatric assessment are predictive of 5- and 10-year mortality in older women with breast cancer (Eur. J. Cancer 2011 July 7 [doi:10.1016/j.ejca.2011.06.016]).
In the current study, the researchers looked at whether self-rated health status and mobility could also be linked to mortality in the same population of 660 women who were aged 65 years or older and had stage I-IIIA breast cancer.
All women in the study were asked two questions at baseline: first, to rate their overall health as excellent, very good, good, or poor; and second, whether they could walk a couple of street blocks with no, a little, or a lot of limitation.
The women were followed for 10 years via annual telephone interviews, and the U.S. National Death Index was used to determine mortality rates.
At baseline, the majority of women were aged 65-79 years, with 18% aged 80 years or older. Most (94%) of the women were white, and 84% had 12 years or more of education. At least one comorbidity was present in 59% of participants, 51% had stage I breast cancer, and 76% were estrogen receptor positive.
Dr. Eng reported that 39% of women rated their health status as low, and 28% said that their ability to walk several street blocks was limited a little or a lot.
There was an absolute difference of 27% in the survival of women with a walking limitation plus high vs. low self-rated health, and a 24% absolute difference in the survival of women with low self-rated health plus no vs. some walking limitation.
Adjusted analysis showed that the risk of dying from any cause was doubled by being older than 80 years, with a hazard ratio of 2.11. The presence of at least one comorbidity also increased the risk of death significantly (HR, 1.37), compared with no comorbidity.
The hazard ratio for low self-rated health plus a walking limitation was 1.58. Separately, low self-rated health and a walking limitation did not increase the mortality risk.
"The combination of low self-rated health and limitation in walking several blocks at diagnosis is an important predictor of all-cause mortality at 10 years," concluded Dr. Eng, adding that the effect was independent of age, comorbidity, tumor characteristics, and treatment.
"Using these two easily assessed questions in clinical practice may represent an effective strategy to improve treatment decision making in older adults with cancer," Dr. Eng said.
The study was supported by the U.S. National Cancer Institute. Dr. Eng had no conflicts of interest.
FROM THE ANNUAL MEETING OF THE INTERNATIONAL SOCIETY OF GERIATRIC ONCOLOGY
Major Finding: At 10 years, 80% of women with low self-rated health status and a walking limitation had died, compared with 50% of those with high self-rated health status and no walking limitation (P less than .0001).
Data Source: A prospective, multicenter study of 660 women aged 65 years or older with stage I–IIIA primary breast cancer.
Disclosures: The study was supported by the U.S. National Cancer Institute. Dr. Eng had no conflicts of interest.
Radionuclide Therapy Alleviates Bone Pain in Prostate Cancer Patients
PARIS – Radionuclide therapy can alleviate painful bone metastases in 63%-75% of men with prostate cancer, reducing the need for narcotic analgesics, according to the results of an 841-patient, retrospective, single-center study.
Investigators concluded that based on their experience at Hôpital René Huguenin in Saint-Cloud, France, treatment with strontium-89 chloride can be suggested as a "valuable supplement" to other treatments currently used. The hospital is part of the Curie Institute Hospital Group.
"Bone metastases are present in more than 90% of patients who die from prostate carcinomas," Dr. Alain Pecking told attendees at the annual meeting of the International Society of Geriatric Oncology. In addition to pain, metastases in the bone can lead to fractures and neurologic symptoms, and can compress the spinal cord, he said, all of which can have a significant impact on the patient’s ability to function normally and can increase their reliance on others to perform daily tasks.
For the past 18 years, Dr. Pecking of the department of nuclear medicine at Hôpital René Huguenin has been using radionuclide therapy with strontium-89 chloride to treat patients with painful bone metastases.
A bone-targeting, beta-emitting radionuclide, strontium-89 chloride (Metastron) is deposited in metabolically active regions of bone. It has a long half-life (more than 50 days); after a single infused dose of 148 MBq – the equivalent of about 9 Gy of radiation – about 80% is retained in the tumor at 100 days.
The rationale for using strontium-89 is that many patients suffer from painful bone metastases despite using current therapies, which includes narcotic analgesics, hormonal treatments, chemotherapy, bisphosphonates, and external beam radiotherapy.
To look at the effects of radionuclide therapy on pain caused by multiple bone metastases secondary to prostate cancer, Dr. Pecking and colleagues retrospectively looked at the medical records of men who were treated with strontium-89 at their institution. All participants were using narcotic analgesics, and the aim was to see whether strontium-89 therapy could reduce the need for their use.
The researchers studied the records of 841 patients with a median age of 73 years. Dr. Pecking reported that if there was a partial response or if the patient relapsed after a complete response to strontium-89, a second infusion was given to 268 men (median age, 71 years) and a third to 86 men (median age, 70 years). Patients who received one or two infusions had 12-16 metastatic sites, of which about 4 were painful, whereas those who needed three doses had about 7 painful sites.
A complete or global response was defined as the disappearance of more than 80% of all painful metastatic bone sites and a significant decrease in the use of narcotic analgesics. A partial response was defined as a reduction in pain of more than 40% without any significant reduction in the daily use of narcotic analgesics. A slight change, no change, or increase in the use of narcotic analgesics was regarded as treatment failure.
"From one infusion [of strontium-89] you have 63% good responses, and after two courses you have 75%," Dr. Pecking said. A "good" response equated to the number of complete plus partial responses, which for one infusion was 12.6% and 50.4%, and for two infusions was 21.4% and 53.7%. The number of complete and partial responses after three doses of strontium-89 was 15.1% and 43%, respectively.
The time to response was 11 days following one infusion, 14 days after two infusions, and just over 15 days after three infusions. The duration of the pain-easing effect was longest (158 days) after one infusion, decreasing to 138 days after two and 101 days after three infusions.
Pain was a common side effect of treatment, occurring in just fewer than quarter of patients during the first 15 days after an infusion.
Prostate-specific antigen levels also spiked after the first infusion in 681 patients (81%), but this is not a problem according to Dr. Pecking. "It is necessary to explain this phenomenon to the patient and to his medical doctor, but it is not a contraindication to the treatment."
Spine neurologic syndrome was observed in three patients within 4 months after the infusion, and external radiation therapy was necessary in one case. Colitis was seen in 4.8% of patients, and grade 2-4 platelet toxicity was seen in 5.1%, 11.9%, and 13.2% of patients after the first, second, and third infusions, respectively.
"Radionuclide therapy of painful bone metastases may improve the patient’s quality of life in more than 60% of all treated cases, and can be suggested as a valuable supplement to other modalities currently used," Dr. Pecking said.
Although not without side effects, strontium-89 was generally well tolerated, he added, noting that it’s important to remember that other treatments used currently also have side effects such as fatigue, nausea, constipation, and anorexia.
"Radionuclide therapy of painful bone metastases may improve the patient’s quality of life in more than 60% of all treated cases."
As for the cost, Dr. Pecking said in an interview that the treatment was not as expensive as people might think. For a single infusion at his institution, the cost is 1,225 euros, but consider that the therapeutic benefit of a single dose can last for up to 150 days, he added.
Comparing the cost with that of other therapies is "really difficult," Dr. Pecking said, noting that patients are usually treated with two or even three analgesics, and that bisphosphonate therapy would probably be in the region of 1,157 euros.
"Today, radionuclide therapy is a palliative option," added Dr. Pecking, used "to reduce analgesic dosages and thus decrease their side effects, particularly when radiation therapy is not a good option, such as in patients with multiple metastatic sites."
In the future, however, it could be used to treat patients with metastatic bone disease, but an alpha-emitter such as radium-223 would need to be used and it would probably be given as an adjuvant therapy and over six courses. Fewer side effects may be expected by switching from a beta-emitter to an alpha-emitter, Dr. Pecking suggested.
The Curie Institute financed the study. Dr. Pecking had no conflicts of interest.
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Dr. Martine Extermann noted that the study involved a "fairly large series of older patients, allowing a quantification of effect and safety assessment."
She added that "the good hematologic tolerance and reasonable effect duration of repeated injections in the elderly is a welcome finding."
Dr. Extermann is a senior member of the senior adult oncology program of the H. Lee Moffitt Cancer Center and Research Institute and a professor at the University of South Florida, both in Tampa. She has received research support, honoraria, or both from Amgen, Sanofi-Aventis, and GTX. She was not involved in the study.
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Dr. Martine Extermann noted that the study involved a "fairly large series of older patients, allowing a quantification of effect and safety assessment."
She added that "the good hematologic tolerance and reasonable effect duration of repeated injections in the elderly is a welcome finding."
Dr. Extermann is a senior member of the senior adult oncology program of the H. Lee Moffitt Cancer Center and Research Institute and a professor at the University of South Florida, both in Tampa. She has received research support, honoraria, or both from Amgen, Sanofi-Aventis, and GTX. She was not involved in the study.
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Dr. Martine Extermann noted that the study involved a "fairly large series of older patients, allowing a quantification of effect and safety assessment."
She added that "the good hematologic tolerance and reasonable effect duration of repeated injections in the elderly is a welcome finding."
Dr. Extermann is a senior member of the senior adult oncology program of the H. Lee Moffitt Cancer Center and Research Institute and a professor at the University of South Florida, both in Tampa. She has received research support, honoraria, or both from Amgen, Sanofi-Aventis, and GTX. She was not involved in the study.
PARIS – Radionuclide therapy can alleviate painful bone metastases in 63%-75% of men with prostate cancer, reducing the need for narcotic analgesics, according to the results of an 841-patient, retrospective, single-center study.
Investigators concluded that based on their experience at Hôpital René Huguenin in Saint-Cloud, France, treatment with strontium-89 chloride can be suggested as a "valuable supplement" to other treatments currently used. The hospital is part of the Curie Institute Hospital Group.
"Bone metastases are present in more than 90% of patients who die from prostate carcinomas," Dr. Alain Pecking told attendees at the annual meeting of the International Society of Geriatric Oncology. In addition to pain, metastases in the bone can lead to fractures and neurologic symptoms, and can compress the spinal cord, he said, all of which can have a significant impact on the patient’s ability to function normally and can increase their reliance on others to perform daily tasks.
For the past 18 years, Dr. Pecking of the department of nuclear medicine at Hôpital René Huguenin has been using radionuclide therapy with strontium-89 chloride to treat patients with painful bone metastases.
A bone-targeting, beta-emitting radionuclide, strontium-89 chloride (Metastron) is deposited in metabolically active regions of bone. It has a long half-life (more than 50 days); after a single infused dose of 148 MBq – the equivalent of about 9 Gy of radiation – about 80% is retained in the tumor at 100 days.
The rationale for using strontium-89 is that many patients suffer from painful bone metastases despite using current therapies, which includes narcotic analgesics, hormonal treatments, chemotherapy, bisphosphonates, and external beam radiotherapy.
To look at the effects of radionuclide therapy on pain caused by multiple bone metastases secondary to prostate cancer, Dr. Pecking and colleagues retrospectively looked at the medical records of men who were treated with strontium-89 at their institution. All participants were using narcotic analgesics, and the aim was to see whether strontium-89 therapy could reduce the need for their use.
The researchers studied the records of 841 patients with a median age of 73 years. Dr. Pecking reported that if there was a partial response or if the patient relapsed after a complete response to strontium-89, a second infusion was given to 268 men (median age, 71 years) and a third to 86 men (median age, 70 years). Patients who received one or two infusions had 12-16 metastatic sites, of which about 4 were painful, whereas those who needed three doses had about 7 painful sites.
A complete or global response was defined as the disappearance of more than 80% of all painful metastatic bone sites and a significant decrease in the use of narcotic analgesics. A partial response was defined as a reduction in pain of more than 40% without any significant reduction in the daily use of narcotic analgesics. A slight change, no change, or increase in the use of narcotic analgesics was regarded as treatment failure.
"From one infusion [of strontium-89] you have 63% good responses, and after two courses you have 75%," Dr. Pecking said. A "good" response equated to the number of complete plus partial responses, which for one infusion was 12.6% and 50.4%, and for two infusions was 21.4% and 53.7%. The number of complete and partial responses after three doses of strontium-89 was 15.1% and 43%, respectively.
The time to response was 11 days following one infusion, 14 days after two infusions, and just over 15 days after three infusions. The duration of the pain-easing effect was longest (158 days) after one infusion, decreasing to 138 days after two and 101 days after three infusions.
Pain was a common side effect of treatment, occurring in just fewer than quarter of patients during the first 15 days after an infusion.
Prostate-specific antigen levels also spiked after the first infusion in 681 patients (81%), but this is not a problem according to Dr. Pecking. "It is necessary to explain this phenomenon to the patient and to his medical doctor, but it is not a contraindication to the treatment."
Spine neurologic syndrome was observed in three patients within 4 months after the infusion, and external radiation therapy was necessary in one case. Colitis was seen in 4.8% of patients, and grade 2-4 platelet toxicity was seen in 5.1%, 11.9%, and 13.2% of patients after the first, second, and third infusions, respectively.
"Radionuclide therapy of painful bone metastases may improve the patient’s quality of life in more than 60% of all treated cases, and can be suggested as a valuable supplement to other modalities currently used," Dr. Pecking said.
Although not without side effects, strontium-89 was generally well tolerated, he added, noting that it’s important to remember that other treatments used currently also have side effects such as fatigue, nausea, constipation, and anorexia.
"Radionuclide therapy of painful bone metastases may improve the patient’s quality of life in more than 60% of all treated cases."
As for the cost, Dr. Pecking said in an interview that the treatment was not as expensive as people might think. For a single infusion at his institution, the cost is 1,225 euros, but consider that the therapeutic benefit of a single dose can last for up to 150 days, he added.
Comparing the cost with that of other therapies is "really difficult," Dr. Pecking said, noting that patients are usually treated with two or even three analgesics, and that bisphosphonate therapy would probably be in the region of 1,157 euros.
"Today, radionuclide therapy is a palliative option," added Dr. Pecking, used "to reduce analgesic dosages and thus decrease their side effects, particularly when radiation therapy is not a good option, such as in patients with multiple metastatic sites."
In the future, however, it could be used to treat patients with metastatic bone disease, but an alpha-emitter such as radium-223 would need to be used and it would probably be given as an adjuvant therapy and over six courses. Fewer side effects may be expected by switching from a beta-emitter to an alpha-emitter, Dr. Pecking suggested.
The Curie Institute financed the study. Dr. Pecking had no conflicts of interest.
PARIS – Radionuclide therapy can alleviate painful bone metastases in 63%-75% of men with prostate cancer, reducing the need for narcotic analgesics, according to the results of an 841-patient, retrospective, single-center study.
Investigators concluded that based on their experience at Hôpital René Huguenin in Saint-Cloud, France, treatment with strontium-89 chloride can be suggested as a "valuable supplement" to other treatments currently used. The hospital is part of the Curie Institute Hospital Group.
"Bone metastases are present in more than 90% of patients who die from prostate carcinomas," Dr. Alain Pecking told attendees at the annual meeting of the International Society of Geriatric Oncology. In addition to pain, metastases in the bone can lead to fractures and neurologic symptoms, and can compress the spinal cord, he said, all of which can have a significant impact on the patient’s ability to function normally and can increase their reliance on others to perform daily tasks.
For the past 18 years, Dr. Pecking of the department of nuclear medicine at Hôpital René Huguenin has been using radionuclide therapy with strontium-89 chloride to treat patients with painful bone metastases.
A bone-targeting, beta-emitting radionuclide, strontium-89 chloride (Metastron) is deposited in metabolically active regions of bone. It has a long half-life (more than 50 days); after a single infused dose of 148 MBq – the equivalent of about 9 Gy of radiation – about 80% is retained in the tumor at 100 days.
The rationale for using strontium-89 is that many patients suffer from painful bone metastases despite using current therapies, which includes narcotic analgesics, hormonal treatments, chemotherapy, bisphosphonates, and external beam radiotherapy.
To look at the effects of radionuclide therapy on pain caused by multiple bone metastases secondary to prostate cancer, Dr. Pecking and colleagues retrospectively looked at the medical records of men who were treated with strontium-89 at their institution. All participants were using narcotic analgesics, and the aim was to see whether strontium-89 therapy could reduce the need for their use.
The researchers studied the records of 841 patients with a median age of 73 years. Dr. Pecking reported that if there was a partial response or if the patient relapsed after a complete response to strontium-89, a second infusion was given to 268 men (median age, 71 years) and a third to 86 men (median age, 70 years). Patients who received one or two infusions had 12-16 metastatic sites, of which about 4 were painful, whereas those who needed three doses had about 7 painful sites.
A complete or global response was defined as the disappearance of more than 80% of all painful metastatic bone sites and a significant decrease in the use of narcotic analgesics. A partial response was defined as a reduction in pain of more than 40% without any significant reduction in the daily use of narcotic analgesics. A slight change, no change, or increase in the use of narcotic analgesics was regarded as treatment failure.
"From one infusion [of strontium-89] you have 63% good responses, and after two courses you have 75%," Dr. Pecking said. A "good" response equated to the number of complete plus partial responses, which for one infusion was 12.6% and 50.4%, and for two infusions was 21.4% and 53.7%. The number of complete and partial responses after three doses of strontium-89 was 15.1% and 43%, respectively.
The time to response was 11 days following one infusion, 14 days after two infusions, and just over 15 days after three infusions. The duration of the pain-easing effect was longest (158 days) after one infusion, decreasing to 138 days after two and 101 days after three infusions.
Pain was a common side effect of treatment, occurring in just fewer than quarter of patients during the first 15 days after an infusion.
Prostate-specific antigen levels also spiked after the first infusion in 681 patients (81%), but this is not a problem according to Dr. Pecking. "It is necessary to explain this phenomenon to the patient and to his medical doctor, but it is not a contraindication to the treatment."
Spine neurologic syndrome was observed in three patients within 4 months after the infusion, and external radiation therapy was necessary in one case. Colitis was seen in 4.8% of patients, and grade 2-4 platelet toxicity was seen in 5.1%, 11.9%, and 13.2% of patients after the first, second, and third infusions, respectively.
"Radionuclide therapy of painful bone metastases may improve the patient’s quality of life in more than 60% of all treated cases, and can be suggested as a valuable supplement to other modalities currently used," Dr. Pecking said.
Although not without side effects, strontium-89 was generally well tolerated, he added, noting that it’s important to remember that other treatments used currently also have side effects such as fatigue, nausea, constipation, and anorexia.
"Radionuclide therapy of painful bone metastases may improve the patient’s quality of life in more than 60% of all treated cases."
As for the cost, Dr. Pecking said in an interview that the treatment was not as expensive as people might think. For a single infusion at his institution, the cost is 1,225 euros, but consider that the therapeutic benefit of a single dose can last for up to 150 days, he added.
Comparing the cost with that of other therapies is "really difficult," Dr. Pecking said, noting that patients are usually treated with two or even three analgesics, and that bisphosphonate therapy would probably be in the region of 1,157 euros.
"Today, radionuclide therapy is a palliative option," added Dr. Pecking, used "to reduce analgesic dosages and thus decrease their side effects, particularly when radiation therapy is not a good option, such as in patients with multiple metastatic sites."
In the future, however, it could be used to treat patients with metastatic bone disease, but an alpha-emitter such as radium-223 would need to be used and it would probably be given as an adjuvant therapy and over six courses. Fewer side effects may be expected by switching from a beta-emitter to an alpha-emitter, Dr. Pecking suggested.
The Curie Institute financed the study. Dr. Pecking had no conflicts of interest.
FROM THE ANNUAL MEETING OF THE INTERNATIONAL SOCIETY OF GERIATRIC ONCOLOGY
Major Finding: After one infusion, pain was alleviated and narcotic analgesic use reduced or stopped in 63% of elderly patients, with 12.6% achieving a complete response and 50.4% a partial response.
Data Source: Retrospective, single center study of 841 patients with prostate cancer, aged 65-92 years, who were treated with one, two or three infusions of the radionuclide strontium-89 chloride.
Disclosures: The Curie Institute financed the study. Dr. Pecking had no conflicts of interest. Dr. Extermann has received research support, honoraria, or both from Amgen, Sanofi-Aventis, and GTX. She was not involved in the study.
Cancer Often Goes Untreated in Nursing Home Residents
PARIS – For elderly nursing home residents, a cancer diagnosis often comes at an advanced stage and fails to trigger appropriate therapy or overall general care, according to data from a study of more than 145,000 nursing home residents in the United States.
Even early-stage cancers are likely to go untreated, and more than 20% of patients in pain receive no medication, regardless of the cancer site or the degree of pain, investigators reported at the annual meeting of the International Society for Geriatric Oncology.
"We saw that late and unstaged cancer was more prevalent in nursing home patients than in other elderly patients," Dr. Giuseppe Colloca, a geriatrician at the Università Cattolica del Sacro Cuore in Rome, told attendees.
"Older age was associated with late-stage diagnosis and death within a few months of diagnosis," Dr. Colloca said, adding that there was "low hospice use and very little cancer-directed treatment – even among patients with early-stage cancer."
The aim of the study was to look at patterns of cancer diagnosis, survival, treatment, and quality of care among elderly individuals recently admitted to nursing homes. In the United States, an estimated 5% of elderly individuals live in nursing homes categorized as offering a high-level of care, with a further 1.5% in residential care that provides lower levels of nursing support, according to Dr. Colloca.
The investigators obtained data on individuals aged 65 years or older whose records were contained with the SAGE (Systematic Assessment of Geriatric Drug Use via Epidemiology) database. This is a multilinked database of clinical care information based on a census of all nursing home residents in the United States.
The study evaluated data on 145,757 elderly individuals who were recently admitted to a nursing home in five U.S. states; of these, 21,064 (14%) had a cancer diagnosis that was made in most cases after admission. Among these residents with cancer, the most common diagnoses were prostate (10.8%) and lung (9%) tumors, with other known cancer types including colon (6.7%), breast (4.5%), bladder (3.1%), anal (2.9%), skin (2.2%), brain (1.6%), pancreas (1.5%), and renal (1.5%).
Analysis of sociodemographic characteristics showed that across all tumor types, the average age was between 75 and 84 years of age but did vary according to the type of tumor. More than 40% of patients with prostate or colon cancer were 85 years or older, while just 13% of lung cancer patients were this old.
Most of the elderly cancer patients were white (83.2%-91.2%), with moderate (49.7%-54.4%) or severe (34.9%-44.1%) limitations in physical function. More than half were moderately (36.4%-44.1%) or severely (7.8%-11.3%) cognitively impaired.
Around a quarter of patients experienced daily symptoms of pain, with other common symptoms including shortness of breath, constipation, unstable cognitive status, edema, and recent falls. "Control of pain symptoms has been shown to be inadequate among nursing home cancer patients," Dr. Colloca said.
"Chemotherapy and radiation treatment were really quite infrequent," he added, noting that while 17.1% of breast cancer patients received chemotherapy, only 2.9% of those with colon cancer received such treatment. Chemotherapy rates also were low among those with lung (3%), prostate (6.3%), and "other" (5.4%) tumors.
Lung cancer patients were more likely to receive radiation with a radiotherapy rate of 10.9%. In the other cancer patients radiotherapy rates ranged from 0.9% for colon cancer to 4.2% for "other." Only 3.8% of breast tumors and 2.9% of prostate cancers were treated with radiation.
A terminal diagnosis of cancer was reported in 8.4% of breast, 8.9% of prostate, 10.5% of colon, 12.4% of "other," and 21.5% of lung tumors. Lung cancer patients also had the highest 1-year mortality rate: 91.9% (lung). But 1-year mortality was high across the board at 80% in breast cancer patients, 78.6% (prostate), 80.9% (colon), and 83.2% ("other’).
Survival time was usually short, at just 54 days for those with lung cancer and 110 days for patients with "other" cancers. The longest survival times were in breast (172 days), prostate (149 days), and colon (142) cancers.
"Cancer appears to be ignored in the nursing home," Dr. Colloca observed in an interview. "Often there is a misdiagnosis of cancer," with patients not being diagnosed with terminal cancer and cancer considered more of a comorbidity." This needs to be addressed, he said.
Dr. Colloca reported no conflicts of interest. The society is also known as the Société Internationale d’Oncologie Gériatrique (SIOG).
Dr. Stuart M. Lichtman, scientific committee chair of the meeting, noted that although a high percentage of patients in this study reported pain, not all pain may be caused by cancer. "The worst pain I see in practice is not due to cancer. The worst pain is usually due to vertebral pain, body collapse, and a lot of people are reluctant to give these old people narcotics, but sometimes that is the best way to go," he said in an interview.
Dr. Lichtman is a professor of medicine at Cornell University and an attending physician with the 65+ Clinical Geriatrics Program at Memorial Sloan-Kettering Cancer Center, both in New York. He was not involved in the study and reported no disclosures.
Dr. Stuart M. Lichtman, scientific committee chair of the meeting, noted that although a high percentage of patients in this study reported pain, not all pain may be caused by cancer. "The worst pain I see in practice is not due to cancer. The worst pain is usually due to vertebral pain, body collapse, and a lot of people are reluctant to give these old people narcotics, but sometimes that is the best way to go," he said in an interview.
Dr. Lichtman is a professor of medicine at Cornell University and an attending physician with the 65+ Clinical Geriatrics Program at Memorial Sloan-Kettering Cancer Center, both in New York. He was not involved in the study and reported no disclosures.
Dr. Stuart M. Lichtman, scientific committee chair of the meeting, noted that although a high percentage of patients in this study reported pain, not all pain may be caused by cancer. "The worst pain I see in practice is not due to cancer. The worst pain is usually due to vertebral pain, body collapse, and a lot of people are reluctant to give these old people narcotics, but sometimes that is the best way to go," he said in an interview.
Dr. Lichtman is a professor of medicine at Cornell University and an attending physician with the 65+ Clinical Geriatrics Program at Memorial Sloan-Kettering Cancer Center, both in New York. He was not involved in the study and reported no disclosures.
PARIS – For elderly nursing home residents, a cancer diagnosis often comes at an advanced stage and fails to trigger appropriate therapy or overall general care, according to data from a study of more than 145,000 nursing home residents in the United States.
Even early-stage cancers are likely to go untreated, and more than 20% of patients in pain receive no medication, regardless of the cancer site or the degree of pain, investigators reported at the annual meeting of the International Society for Geriatric Oncology.
"We saw that late and unstaged cancer was more prevalent in nursing home patients than in other elderly patients," Dr. Giuseppe Colloca, a geriatrician at the Università Cattolica del Sacro Cuore in Rome, told attendees.
"Older age was associated with late-stage diagnosis and death within a few months of diagnosis," Dr. Colloca said, adding that there was "low hospice use and very little cancer-directed treatment – even among patients with early-stage cancer."
The aim of the study was to look at patterns of cancer diagnosis, survival, treatment, and quality of care among elderly individuals recently admitted to nursing homes. In the United States, an estimated 5% of elderly individuals live in nursing homes categorized as offering a high-level of care, with a further 1.5% in residential care that provides lower levels of nursing support, according to Dr. Colloca.
The investigators obtained data on individuals aged 65 years or older whose records were contained with the SAGE (Systematic Assessment of Geriatric Drug Use via Epidemiology) database. This is a multilinked database of clinical care information based on a census of all nursing home residents in the United States.
The study evaluated data on 145,757 elderly individuals who were recently admitted to a nursing home in five U.S. states; of these, 21,064 (14%) had a cancer diagnosis that was made in most cases after admission. Among these residents with cancer, the most common diagnoses were prostate (10.8%) and lung (9%) tumors, with other known cancer types including colon (6.7%), breast (4.5%), bladder (3.1%), anal (2.9%), skin (2.2%), brain (1.6%), pancreas (1.5%), and renal (1.5%).
Analysis of sociodemographic characteristics showed that across all tumor types, the average age was between 75 and 84 years of age but did vary according to the type of tumor. More than 40% of patients with prostate or colon cancer were 85 years or older, while just 13% of lung cancer patients were this old.
Most of the elderly cancer patients were white (83.2%-91.2%), with moderate (49.7%-54.4%) or severe (34.9%-44.1%) limitations in physical function. More than half were moderately (36.4%-44.1%) or severely (7.8%-11.3%) cognitively impaired.
Around a quarter of patients experienced daily symptoms of pain, with other common symptoms including shortness of breath, constipation, unstable cognitive status, edema, and recent falls. "Control of pain symptoms has been shown to be inadequate among nursing home cancer patients," Dr. Colloca said.
"Chemotherapy and radiation treatment were really quite infrequent," he added, noting that while 17.1% of breast cancer patients received chemotherapy, only 2.9% of those with colon cancer received such treatment. Chemotherapy rates also were low among those with lung (3%), prostate (6.3%), and "other" (5.4%) tumors.
Lung cancer patients were more likely to receive radiation with a radiotherapy rate of 10.9%. In the other cancer patients radiotherapy rates ranged from 0.9% for colon cancer to 4.2% for "other." Only 3.8% of breast tumors and 2.9% of prostate cancers were treated with radiation.
A terminal diagnosis of cancer was reported in 8.4% of breast, 8.9% of prostate, 10.5% of colon, 12.4% of "other," and 21.5% of lung tumors. Lung cancer patients also had the highest 1-year mortality rate: 91.9% (lung). But 1-year mortality was high across the board at 80% in breast cancer patients, 78.6% (prostate), 80.9% (colon), and 83.2% ("other’).
Survival time was usually short, at just 54 days for those with lung cancer and 110 days for patients with "other" cancers. The longest survival times were in breast (172 days), prostate (149 days), and colon (142) cancers.
"Cancer appears to be ignored in the nursing home," Dr. Colloca observed in an interview. "Often there is a misdiagnosis of cancer," with patients not being diagnosed with terminal cancer and cancer considered more of a comorbidity." This needs to be addressed, he said.
Dr. Colloca reported no conflicts of interest. The society is also known as the Société Internationale d’Oncologie Gériatrique (SIOG).
PARIS – For elderly nursing home residents, a cancer diagnosis often comes at an advanced stage and fails to trigger appropriate therapy or overall general care, according to data from a study of more than 145,000 nursing home residents in the United States.
Even early-stage cancers are likely to go untreated, and more than 20% of patients in pain receive no medication, regardless of the cancer site or the degree of pain, investigators reported at the annual meeting of the International Society for Geriatric Oncology.
"We saw that late and unstaged cancer was more prevalent in nursing home patients than in other elderly patients," Dr. Giuseppe Colloca, a geriatrician at the Università Cattolica del Sacro Cuore in Rome, told attendees.
"Older age was associated with late-stage diagnosis and death within a few months of diagnosis," Dr. Colloca said, adding that there was "low hospice use and very little cancer-directed treatment – even among patients with early-stage cancer."
The aim of the study was to look at patterns of cancer diagnosis, survival, treatment, and quality of care among elderly individuals recently admitted to nursing homes. In the United States, an estimated 5% of elderly individuals live in nursing homes categorized as offering a high-level of care, with a further 1.5% in residential care that provides lower levels of nursing support, according to Dr. Colloca.
The investigators obtained data on individuals aged 65 years or older whose records were contained with the SAGE (Systematic Assessment of Geriatric Drug Use via Epidemiology) database. This is a multilinked database of clinical care information based on a census of all nursing home residents in the United States.
The study evaluated data on 145,757 elderly individuals who were recently admitted to a nursing home in five U.S. states; of these, 21,064 (14%) had a cancer diagnosis that was made in most cases after admission. Among these residents with cancer, the most common diagnoses were prostate (10.8%) and lung (9%) tumors, with other known cancer types including colon (6.7%), breast (4.5%), bladder (3.1%), anal (2.9%), skin (2.2%), brain (1.6%), pancreas (1.5%), and renal (1.5%).
Analysis of sociodemographic characteristics showed that across all tumor types, the average age was between 75 and 84 years of age but did vary according to the type of tumor. More than 40% of patients with prostate or colon cancer were 85 years or older, while just 13% of lung cancer patients were this old.
Most of the elderly cancer patients were white (83.2%-91.2%), with moderate (49.7%-54.4%) or severe (34.9%-44.1%) limitations in physical function. More than half were moderately (36.4%-44.1%) or severely (7.8%-11.3%) cognitively impaired.
Around a quarter of patients experienced daily symptoms of pain, with other common symptoms including shortness of breath, constipation, unstable cognitive status, edema, and recent falls. "Control of pain symptoms has been shown to be inadequate among nursing home cancer patients," Dr. Colloca said.
"Chemotherapy and radiation treatment were really quite infrequent," he added, noting that while 17.1% of breast cancer patients received chemotherapy, only 2.9% of those with colon cancer received such treatment. Chemotherapy rates also were low among those with lung (3%), prostate (6.3%), and "other" (5.4%) tumors.
Lung cancer patients were more likely to receive radiation with a radiotherapy rate of 10.9%. In the other cancer patients radiotherapy rates ranged from 0.9% for colon cancer to 4.2% for "other." Only 3.8% of breast tumors and 2.9% of prostate cancers were treated with radiation.
A terminal diagnosis of cancer was reported in 8.4% of breast, 8.9% of prostate, 10.5% of colon, 12.4% of "other," and 21.5% of lung tumors. Lung cancer patients also had the highest 1-year mortality rate: 91.9% (lung). But 1-year mortality was high across the board at 80% in breast cancer patients, 78.6% (prostate), 80.9% (colon), and 83.2% ("other’).
Survival time was usually short, at just 54 days for those with lung cancer and 110 days for patients with "other" cancers. The longest survival times were in breast (172 days), prostate (149 days), and colon (142) cancers.
"Cancer appears to be ignored in the nursing home," Dr. Colloca observed in an interview. "Often there is a misdiagnosis of cancer," with patients not being diagnosed with terminal cancer and cancer considered more of a comorbidity." This needs to be addressed, he said.
Dr. Colloca reported no conflicts of interest. The society is also known as the Société Internationale d’Oncologie Gériatrique (SIOG).
FROM A MEETING OF THE INTERNATIONAL SOCIETY OF GERIATRIC ONCOLOGY
Major Finding: Chemotherapy treatment rates ranged from 2.9% of residents with colon cancer to 17.1 % of those diagnosed with breast cancer.
Data Source: Records of than 145,000 elderly individuals newly admitted to nursing homes in the SAGE (Systematic Assessment of Geriatric Drug Use via Epidemiology) database.
Disclosures: Dr. Colloca reported no conflicts of interest.
Geriatric Assessment Predicts Overall Survival in AML
PARIS – Impaired physical and cognitive abilities are predictive of worse overall survival in elderly patients with acute myeloid leukemia, according to prospective study findings.
In a 74-patient trial, scores of less than 9 out of 12 on the Short Physical Performance Battery (SPPB) and less than 77 out of 100 on a Modified Mini-Mental State (3MS) exam were associated with a threefold increase in risk of death, compared with scores in patients who had no physical or cognitive difficulties.
The study’s findings could ultimately help determine which elderly patients with acute myeloid leukemia (AML) are fit enough to receive standard chemotherapy regimens for the disease, and which may require a different therapeutic approach. The results should currently be viewed as a "signal" of a possible worse prognosis, however, until further validation.
"Acute leukemia is probably one of the most dramatic examples of age-related outcome disparity in oncology," said study author Dr. Heidi D. Klepin, of Wake Forest University, Winston-Salem, N.C.
"Older patients consistently do much worse when diagnosed with disease than [do] young patients," Dr. Klepin said on Nov. 4 in an interview at the annual meeting of the International Society for Geriatric Oncology (also known as Société Internationale d’Oncologie Gériatrique).
While much research has focused on examining tumor biology in older and younger patients with AML, few studies have looked at differences in the capabilities of the patients themselves, such as increasing vulnerability or frailty in the geriatric population.
"There has been so little done in geriatric assessment in the leukemia population," Dr. Stuart M. Lichtman said in a separate interview.
Dr. Lichtman of Memorial-Sloan–Kettering Cancer Center, N.Y., who was not involved in the study and served as scientific committee chair of the meeting, said the findings were important because they suggest that general and relatively simple-to-measure parameters could provide valuable information to help clinical decision-making. The SPPB includes asking patients to perform a 4-meter timed walk, stand after being in a seated position, and show how well they balance while standing.
The objective of the study was to assess whether performing a geriatric assessment at the patient’s bedside could predict patient’s likely overall survival. All of the patients included in the trial were about to start induction chemotherapy for AML.
The geriatric assessment consisted of multiple tests to examine cognition (3MS), emotion (Center for Epidemiological Studies Depression Scale, Distress Thermometer), self-reported disability (Pepper Assessment Tool for Disability) and objective (SPPB) physical function, grip strength, and the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI).
The mean age of patients included in the study was 70 years, 56% was male and 78% had an Eastern Cooperative Group Oncology Performance Status (ECOG PS) score of 0-1. The majority (95%) had an intermediate or poor cytogenic profile. The median follow-up was 7.4 months.
At baseline, 30% of patients were identified as having some form of cognitive impairment, 39% had depressive symptoms, 42% were distressed, 41% had reduced instrumental activities of daily living (IADL), 50% had reduced objective physical function, and 42% had comorbidities.
After researchers adjusted for a host of potentially confounding factors, including age, gender, ECOG PS, and cytogenic risk group, among others, hazard ratios for overall survival were 3.4 for SPPB score less than 9 (P =.03) and 3.0 for a 3MS score less than 77 (P = .008).
"There has been so little done in geriatric assessment in the leukemia population."
Reduced self-reported IADL was also associated with worse overall survival (HR, 2.6), but only after adjusting for confounding factors. SPPB and 3MS were also predictive on univariate analysis.
These data suggest that a better assessment of physical function could provide valuable information about a patient’s likely outcome, "even in clinical practice right now," Dr. Klepin said.
"I think we can use this to improve how patients do with standard treatments, by just paying attention [to baseline parameters] and changing how we manage people," she said. "If we are aware of a problem, can we do things that would prevent that problem from putting a patient in the ICU?"
Dr. Klepin also noted that the information provided by the geriatric assessment could be used to inform and to help patents decide whether they want to be treated with standard chemotherapy or perhaps enter into an appropriate clinical trial of novel agents.
Preliminary data from the trial have been published in the Journal of the American Geriatrics Society (2011;59:1837-46).
The study was supported by the American Society of Hematology, Atlantic Philanthropies, the John A. Hartford Association, the Association of Specialty Professors, and the Pepper Center at Wake Forest University. Dr. Klepin and Dr. Lichtman did not report any conflicts of interest.
PARIS – Impaired physical and cognitive abilities are predictive of worse overall survival in elderly patients with acute myeloid leukemia, according to prospective study findings.
In a 74-patient trial, scores of less than 9 out of 12 on the Short Physical Performance Battery (SPPB) and less than 77 out of 100 on a Modified Mini-Mental State (3MS) exam were associated with a threefold increase in risk of death, compared with scores in patients who had no physical or cognitive difficulties.
The study’s findings could ultimately help determine which elderly patients with acute myeloid leukemia (AML) are fit enough to receive standard chemotherapy regimens for the disease, and which may require a different therapeutic approach. The results should currently be viewed as a "signal" of a possible worse prognosis, however, until further validation.
"Acute leukemia is probably one of the most dramatic examples of age-related outcome disparity in oncology," said study author Dr. Heidi D. Klepin, of Wake Forest University, Winston-Salem, N.C.
"Older patients consistently do much worse when diagnosed with disease than [do] young patients," Dr. Klepin said on Nov. 4 in an interview at the annual meeting of the International Society for Geriatric Oncology (also known as Société Internationale d’Oncologie Gériatrique).
While much research has focused on examining tumor biology in older and younger patients with AML, few studies have looked at differences in the capabilities of the patients themselves, such as increasing vulnerability or frailty in the geriatric population.
"There has been so little done in geriatric assessment in the leukemia population," Dr. Stuart M. Lichtman said in a separate interview.
Dr. Lichtman of Memorial-Sloan–Kettering Cancer Center, N.Y., who was not involved in the study and served as scientific committee chair of the meeting, said the findings were important because they suggest that general and relatively simple-to-measure parameters could provide valuable information to help clinical decision-making. The SPPB includes asking patients to perform a 4-meter timed walk, stand after being in a seated position, and show how well they balance while standing.
The objective of the study was to assess whether performing a geriatric assessment at the patient’s bedside could predict patient’s likely overall survival. All of the patients included in the trial were about to start induction chemotherapy for AML.
The geriatric assessment consisted of multiple tests to examine cognition (3MS), emotion (Center for Epidemiological Studies Depression Scale, Distress Thermometer), self-reported disability (Pepper Assessment Tool for Disability) and objective (SPPB) physical function, grip strength, and the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI).
The mean age of patients included in the study was 70 years, 56% was male and 78% had an Eastern Cooperative Group Oncology Performance Status (ECOG PS) score of 0-1. The majority (95%) had an intermediate or poor cytogenic profile. The median follow-up was 7.4 months.
At baseline, 30% of patients were identified as having some form of cognitive impairment, 39% had depressive symptoms, 42% were distressed, 41% had reduced instrumental activities of daily living (IADL), 50% had reduced objective physical function, and 42% had comorbidities.
After researchers adjusted for a host of potentially confounding factors, including age, gender, ECOG PS, and cytogenic risk group, among others, hazard ratios for overall survival were 3.4 for SPPB score less than 9 (P =.03) and 3.0 for a 3MS score less than 77 (P = .008).
"There has been so little done in geriatric assessment in the leukemia population."
Reduced self-reported IADL was also associated with worse overall survival (HR, 2.6), but only after adjusting for confounding factors. SPPB and 3MS were also predictive on univariate analysis.
These data suggest that a better assessment of physical function could provide valuable information about a patient’s likely outcome, "even in clinical practice right now," Dr. Klepin said.
"I think we can use this to improve how patients do with standard treatments, by just paying attention [to baseline parameters] and changing how we manage people," she said. "If we are aware of a problem, can we do things that would prevent that problem from putting a patient in the ICU?"
Dr. Klepin also noted that the information provided by the geriatric assessment could be used to inform and to help patents decide whether they want to be treated with standard chemotherapy or perhaps enter into an appropriate clinical trial of novel agents.
Preliminary data from the trial have been published in the Journal of the American Geriatrics Society (2011;59:1837-46).
The study was supported by the American Society of Hematology, Atlantic Philanthropies, the John A. Hartford Association, the Association of Specialty Professors, and the Pepper Center at Wake Forest University. Dr. Klepin and Dr. Lichtman did not report any conflicts of interest.
PARIS – Impaired physical and cognitive abilities are predictive of worse overall survival in elderly patients with acute myeloid leukemia, according to prospective study findings.
In a 74-patient trial, scores of less than 9 out of 12 on the Short Physical Performance Battery (SPPB) and less than 77 out of 100 on a Modified Mini-Mental State (3MS) exam were associated with a threefold increase in risk of death, compared with scores in patients who had no physical or cognitive difficulties.
The study’s findings could ultimately help determine which elderly patients with acute myeloid leukemia (AML) are fit enough to receive standard chemotherapy regimens for the disease, and which may require a different therapeutic approach. The results should currently be viewed as a "signal" of a possible worse prognosis, however, until further validation.
"Acute leukemia is probably one of the most dramatic examples of age-related outcome disparity in oncology," said study author Dr. Heidi D. Klepin, of Wake Forest University, Winston-Salem, N.C.
"Older patients consistently do much worse when diagnosed with disease than [do] young patients," Dr. Klepin said on Nov. 4 in an interview at the annual meeting of the International Society for Geriatric Oncology (also known as Société Internationale d’Oncologie Gériatrique).
While much research has focused on examining tumor biology in older and younger patients with AML, few studies have looked at differences in the capabilities of the patients themselves, such as increasing vulnerability or frailty in the geriatric population.
"There has been so little done in geriatric assessment in the leukemia population," Dr. Stuart M. Lichtman said in a separate interview.
Dr. Lichtman of Memorial-Sloan–Kettering Cancer Center, N.Y., who was not involved in the study and served as scientific committee chair of the meeting, said the findings were important because they suggest that general and relatively simple-to-measure parameters could provide valuable information to help clinical decision-making. The SPPB includes asking patients to perform a 4-meter timed walk, stand after being in a seated position, and show how well they balance while standing.
The objective of the study was to assess whether performing a geriatric assessment at the patient’s bedside could predict patient’s likely overall survival. All of the patients included in the trial were about to start induction chemotherapy for AML.
The geriatric assessment consisted of multiple tests to examine cognition (3MS), emotion (Center for Epidemiological Studies Depression Scale, Distress Thermometer), self-reported disability (Pepper Assessment Tool for Disability) and objective (SPPB) physical function, grip strength, and the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI).
The mean age of patients included in the study was 70 years, 56% was male and 78% had an Eastern Cooperative Group Oncology Performance Status (ECOG PS) score of 0-1. The majority (95%) had an intermediate or poor cytogenic profile. The median follow-up was 7.4 months.
At baseline, 30% of patients were identified as having some form of cognitive impairment, 39% had depressive symptoms, 42% were distressed, 41% had reduced instrumental activities of daily living (IADL), 50% had reduced objective physical function, and 42% had comorbidities.
After researchers adjusted for a host of potentially confounding factors, including age, gender, ECOG PS, and cytogenic risk group, among others, hazard ratios for overall survival were 3.4 for SPPB score less than 9 (P =.03) and 3.0 for a 3MS score less than 77 (P = .008).
"There has been so little done in geriatric assessment in the leukemia population."
Reduced self-reported IADL was also associated with worse overall survival (HR, 2.6), but only after adjusting for confounding factors. SPPB and 3MS were also predictive on univariate analysis.
These data suggest that a better assessment of physical function could provide valuable information about a patient’s likely outcome, "even in clinical practice right now," Dr. Klepin said.
"I think we can use this to improve how patients do with standard treatments, by just paying attention [to baseline parameters] and changing how we manage people," she said. "If we are aware of a problem, can we do things that would prevent that problem from putting a patient in the ICU?"
Dr. Klepin also noted that the information provided by the geriatric assessment could be used to inform and to help patents decide whether they want to be treated with standard chemotherapy or perhaps enter into an appropriate clinical trial of novel agents.
Preliminary data from the trial have been published in the Journal of the American Geriatrics Society (2011;59:1837-46).
The study was supported by the American Society of Hematology, Atlantic Philanthropies, the John A. Hartford Association, the Association of Specialty Professors, and the Pepper Center at Wake Forest University. Dr. Klepin and Dr. Lichtman did not report any conflicts of interest.
FROM THE ANNUAL MEETING OF THE INTERNATIONAL SOCIETY FOR GERIATRIC ONCOLOGY
Major Finding: Scores of less than 9 out of 12 on the Short Physical Performance Battery (SPPB) and less than 77 out of 100 on a Modified Mini-Mental State exam (3MS) were associated with a threefold increase in risk of death.
Data Source: Prospective trial of 74 elderly hospitalized patients undergoing induction chemotherapy for acute myeloid leukemia.
Disclosures: The study was supported by the American Society of Hematology, Atlantic Philanthropies, the John A. Hartford Association, the Association of Specialty Professors, and the Pepper Center at Wake Forest University. Dr. Klepin and Dr. Lichtman had no conflicts of interest.