Assessment of the external validity of the National Comprehensive Cancer Network (NCCN) guidelines for pancreatic ductal adenocarcinoma in a population of older patients aged 70 years and older.

Introduction: Pancreatic ductal adenocarcinoma (PDAC) mainly occurs in older adults. Since randomized clinical trials (RCTs) provide the highest-quality evidence incorporated in NCCN recommendations, the underrepresentation of older patients in RCTs challenges guidelines' external validity and limits the solidity of evidence in this specific population.

Materials And Methods: The study aimed to investigate external validity of NCCN guidelines for PDCA and the impact of reference studies eligibility on overall survival (OS) in a real-world older population.

Development of a health data derived frailty index as a predictor of adverse outcomes in older patients with pancreatic cancer.

Pancreatic cancer is a prevalent disease among older adults. Well-selected patients, based on a geriatric assessment for risk stratification, could be good candidates for chemotherapy and/or curative resection. Deficits accumulation frailty indices (FI) utilize readily available clinical data and easily obtained patient-reported information to predict hospitalization and mortality of older individuals.

A simple test-based frailty index to predict survival among cancer patients with an unplanned hospitalization: An observational cohort study.

Background: Frailty is a state of increased vulnerability to stressors, and predicts risk of adverse outcomes, such as mortality. Frailty can be defined by a frailty index (FI) using an accumulation of deficits approach. An FI comprised of 20 items derived from our previously studied test-based frailty index (TBFI) and an additional 33 survey-based elements sourced from the standard CGA was developed to evaluate if predictive validity of survival was improved.

Impact of age, comorbidity, and treatment characteristics on survival in older women with advanced high grade epithelial ovarian cancer.

Objectives: Older women have a worse prognosis with advanced epithelial ovarian cancer (EOC) and comorbidities likely contribute to poor outcomes. We sought to identify comorbid conditions and treatment-related factors in older women.

Methods: A retrospective chart review identified 351 patients who underwent cytoreductive surgery (CRS).

Benchmarking treatment effects for patients over 70 with acute myeloid leukemia: A systematic review and meta-analysis.

Objectives: The majority of patients with acute myeloid leukemia (AML) are aged 70 and over. However, there is uncertainty about how and whether older patients with AML should receive cytotoxic treatment.

Materials And Methods: Medline and Cochrane library search was performed for studies in newly diagnosed AML which enrolled at least 20 patients per arm (for randomized controlled trials), or 50 patients (for non-randomized studies) over the age of 70.

Biologic Mechanisms Linked to Prognosis in Ovarian Cancer that May Be Affected by Aging.

The increase of both life expectancy of the Western industrialized population and cancer incidence with aging is expected to result in a rapid expansion of the elderly cancer population, including patients with epithelial ovarian cancer (EOC). Although the survival of patients with EOC has generally improved over the past three decades, this progress has yet to provide benefits for elderly patients. Compared with young age, advanced age has been reported as an adverse prognostic factor influencing EOC.

Comparisons of commonly used front-line regimens on survival outcomes in patients aged 70 years and older with acute myeloid leukemia.

In older patients with acute myeloid leukemia, the more frequent presence of biologically inherent therapy-resistant disease and increased comorbidities translate to poor overall survival and therapeutic challenges. Optimal front-line therapies for older patients with acute myeloid leukemia remain controversial. We retrospectively evaluated survival outcomes in 980 elderly (≥70 years) acute myeloid leukemia patients from a single institution between 1995 and 2016.

Using Big Data in oncology to prospectively impact clinical patient care: A proof of concept study.

Objective: Big Data is widely seen as a major opportunity for progress in the practice of personalized medicine, attracting the attention from medical societies and presidential teams alike as it offers a unique opportunity to enlarge the base of evidence, especially for older patients underrepresented in clinical trials. This study prospectively assessed the real-time availability of clinical cases in the Health & Research Informatics Total Cancer Care™ (TCC) database matching community patients with cancer, and the impact of such a consultation on treatment.

Materials And Methods: Patients aged 70 and older seen at the Lynn Cancer Institute (LCI) with a documented malignancy were eligible.

Using heat maps to assess the multidimensional association of comorbidities with survival in older cancer patients treated with chemotherapy.

Objective: To date, most comorbidity studies have analyzed either a subgroup of frequent diseases, or used summary instruments such as the Charlson score or the Cumulative Illness Rating Scale-Geriatric (CIRS-G). Yet, comorbidity is a multidimensional construct and impacts function, treatment tolerance, and survival. We assessed how heat maps can unveil specific patterns of comorbidities associated with overall survival (OS) in older cancer patients treated with chemotherapy.

Assessment of the External Validity of the National Comprehensive Cancer Network and European Society for Medical Oncology Guidelines for Non-Small-Cell Lung Cancer in a Population of Patients Aged 80 Years and Older.

Non-small-cell lung cancer (NSCLC) is a disease of the elderly, who are under-represented in clinical trials. This challenges the external validity of the evidence base for its management and of current guidelines, that we evaluated in a population of older patients. We retrieved randomized clinical trials (RCTs) supporting the guidelines and identified 18 relevant topics.

Impact of chemotherapy on medium-term physical function and activity of older breast cancer survivors, and associated biomarkers.

Objective: Chemotherapy is less often prescribed in older individuals due to concerns about post-treatment morbidity and quality of life. We evaluated the physical performance of breast cancer survivors treated with and without adjuvant chemotherapy.

Materials And Methods: We conducted a case-control study in 56 estrogen receptor positive breast cancer survivors (BCS) on adjuvant aromatase inhibitors 1-2years after definitive surgery.

Chemotoxicity recurrence in older patients: Risk factors and effectiveness of preventive strategies-a prospective study.

Background: The National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) and adjustment rules after severe toxicity are derived by consensus, but to the authors' knowledge little is known regarding the determinants of toxicity recurrence, especially in the elderly.

Methods: The authors prospectively accrued 200 patients (aged ≥65 years) before chemotherapy. For those with CTCAE grade 3 to 4 nonhematologic or CTCAE grade 4 hematologic toxicities (severe toxicity), the duration and functional impact, treatment modifications, and severe toxicity recurrence were recorded.

Psychosocial assistance to students with posttraumatic stress disorder in primary and secondary schools in post-war Bosnia Herzegovina.

Background: The 1992-1995 war in Bosnia and Herzegovina (BH) has had a tremendous impact on civilians; thousands of inhabitants were left with numerous traumatic experiences. Many children suffered or witnessed horrifying acts of violence and aggression. Although young trauma victims are often resilient, many experience mental health difficulties, including PTSD.