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The standard evaluation of older lung cancer or mesothelioma patients for systemic anti-cancer treatment, based on performance status, is inaccurate. We used the G8 questionnaire to assess a patient's fitness for chemotherapy and explored the correlations between G8 scores, treatment decisions and clinical outcomes. In total, 201 older patients (≥70 years) with advanced lung cancer or mesothelioma were prospectively assessed by standard clinical methods and a G8 questionnaire. Treatment decisions before and after reviewing the G8 score were documented. Patients were divided into low (<11), intermediate (11–14) and high (>14) G8 score groups. Patients' characteristics, treatment plans and clinical outcomes among each G8 score group were compared. Similar analyses were compared between good (<2) and poor (≥2) performance status. 10.1% of patients' treatment plans changed after oncologists reviewed G8 scores. The G8 score correlated inversely with performance status. More patients with low G8 scores (22.5%) were offered the best supportive care compared with 4.5% in intermediate and 1.9% in high G8 score groups. More patients (30.1%) with low G8 scores had treatment changed from chemotherapy to best supportive care on the planned day of their treatment, compared with intermediate (7.5%) and high (6.1%) G8 score groups. High G8 score patients received higher chemotherapy intensity and survived longer than patients with intermediate or low G8 scores. The G8 score with two cut-off values can predict functional status, chemotherapy tolerability and prognosis in older patients with lung cancer or mesothelioma, thus supporting oncologists on treatment decisions for this population. • The G8 scores correlate inversely with performance status. • Low G8 scores can predict a rapid functional decline of older patients with lung cancer or mesothelioma. • The G8 score with two cut-off values can predict chemotherapy tolerability and prognosis. • Our findings reinforce the clinical utility of the G8 scores to support oncologists on treatment decisions and chemotherapy intensity. [ABSTRACT FROM AUTHOR]

Introduction older patients represent the majority of cancer patients but are under-represented in trials, particularly early phase clinical trials (EPCTs). Material and Methods observational retrospective study of patients referred for EPCTs (January–December 2018) at a specialist cancer centre in the UK. The primary aim was to analyse the successful enrolment into EPCTs according to age (<65/65+). The secondary aims were to identify enrolment obstacles and the outcomes of enrolled patients. Patient data were analysed at: referral; in-clinic assessment and after successful enrolment. Among patients assessed in clinic, a sample was defined by randomly matching the older cohort with the younger cohort (1:1) by tumour type. Results 555 patients were referred for EPCTs with a median age of 60 years, of whom 471 were assessed in new patient clinics (38% were 65+). From those assessed, a randomly tumour-matched sample of 318 patients (159 per age cohort) was selected. Older patients had a significantly higher comorbidity score measured by ACE-27 (P  < 0.0001), lived closer to the hospital (P  = 0.045) and were referred at a later point in their cancer management (P  = 0.002). There was no difference in suitability for EPCTs according to age with overall 84% deemed suitable. For patients successfully enrolled into EPCTs, there was no difference between age cohorts (20.1 vs. 22.6% for younger and older, respectively; P =  0.675) and no significant differences in their safety and efficacy outcomes. Discussion older age did not affect the enrolment into EPCTs. However, the selected minority referred for EPCTs suggests a pre-selection upstream by primary oncologists. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) in quality improvement of oncological care pathways for older patients are rare. Objectives: Improve the care pathway experience of older cancer patients and explore lessons learned regarding how to engage this vulnerable group. Design: Experience‐Based Co‐Design. Setting and participants: Older cancer patients, their caregivers and healthcare professionals within colorectal and breast cancer care pathways. Interventions: Co‐design quality improvement teams. Main outcome measures: Colorectal cancer care pathway touchpoints were (a) availability of a contact person during diagnostic, treatment and aftercare phases; (b) collaboration between physicians and different hospital departments; (c) continuous relationship with same physician; (d) respectful treatment; (e) and information transfer with primary care. Breast cancer care pathway touchpoints were (a) comprehensive information package and information provision, (b) care planning based on patient preferences, (c) continuity of patient–professional relationship and (d) specialized care in case of vulnerability. Challenges related to PPI included (a) ability of older cancer patients to be reflective, critical and think at a collective level; (b) gaining support and commitment of professionals; (d) overcoming cultural differences and power inequalities; and (e) involving researchers and facilitators with appropriate expertise and position. Conclusion: This multidisciplinary quality improvement project revealed several challenges of PPI with older cancer patients and their caregivers. Research teams themselves need to assume the role of facilitator to enable meaningful PPI of older cancer patients. Patient or Public Contribution: Patient and caregiver representatives and advocates were involved in the design, conduct, analysis, interpretation of the data and preparation of this manuscript. [ABSTRACT FROM AUTHOR]

Background: Independent decision-making is one of the basic rights of patients. However, in clinical practice, most older cancer patients' treatment decisions are made by family members. Objective: This study attempted to analyze the treatment decision-making process and formation mechanism for older cancer patients within the special cultural context of Chinese medical practice. Method: A qualitative study was conducted. With the sample saturation principle, data collected by in-depth interviews with 17 family members and 12 patients were subjected to thematic analysis. Ethical considerations: The study was approved by the ethics committees of Sun Yat-sen University. All participants provided verbal informed consent after being told their rights of confidentiality, anonymity, and voluntary participation. They had the right to refuse to answer questions and could withdraw at any time. Results: Three themes emerged: (1) complex process; (2) transformation of family decision-making power; and (3) individual compromise. Family members inevitably had different opinions during the long process of treatment decision-making for older cancer patients. The direction of this process could be regarded as an extension of the family power relationship. The patient usually compromised the decision to survive, which was made by family members. Conclusion: This study describes the treatment decision-making process of older cancer patients in the context of Chinese culture. The reasons underlying this process are related to the views on life and death and family values. An individual is a part of the family, which is often seen as the minimal interpersonal unit in Chinese society. It is significant that while emphasizing patient autonomy in the decision-making process, health professionals should also pay attention to the important roles of culture and family. [ABSTRACT FROM AUTHOR]

Various frailty screening tools have been developed. However, there is currently no single ideal model; some scores are better for population-level, whereas others are best suited for clinical screening and preoperative assessment. Therefore, the choice of the score might relay on specific clinical condition, the aim of the tool and department resources. The G8 and the aCGA seem to be the the most suitable in the case of preoperative frailty assessments of older patients with solid abdominal cancer who are undergoing high-risk surgery. They also may be used to identify patients at risk for adverse postoperative outcomes. They may support the decision process particularly in situations of lack of experience in full Geriatric Assessment (easy to master and implement), in acute admitted patients (time pressure or some of the domains cannot be assessed) and in case of low-/moderate-risk surgery (where extensive frailty evaluation may not influence the postoperative outcome). [ABSTRACT FROM AUTHOR]

Background: An increasingly older population, improved diagnostics and treatment increase the number of older cancer survivors, thus more than 60% of those affected by cancer are over the age of 65. Symptom relief and the prevention of functional impairment are important tasks for home care nursing, considering that patients can live a long time with their cancer disease and related side effects. The aim of this study was to investigate the extent to which cancer patients over the age of 65 reported access to information and counselling from home care nursing services, including those offered by the cancer coordinator. Methods: A cross-sectional survey was used. The survey consisted of 174 cancer patients from two regions in Norway living at home (101 women; 66-92 years). The questionnaire contained questions of various sequences including information and advices given and data on access to and use of home health care services. The questions focused on the extent to which home health care services provided the following: 1) information about the disease and treatment, 2) information about consequences and complications of the cancer disease, 3) nutritional advice and 4) advice on physical activity. Demographic, clinical and organizational variables were used. SPSS program version 22 was employed to perform descriptive and inferential statistics including correlation and logistic regression analysis. For ethical reasons, patients who were dying, delirious or with presence of cognitive impairment (any kind of dementia) were excluded. Results: The results showed that a majority (67-77%) of the respondents reported low levels of information and counselling offered. Low levels represents in this study medium, small and very small degree (Likert scale). Women, those above 85 years of age and patients with a gynecological or hematological cancer diagnosis experienced less access to information and counselling. Respondents facing availability of a cancer coordinator reported significantly higher access to information about the disease and treatment (p = 0.03), nutritional advice (p = 0.04) and advice on physical activity (p = 0.04) compared to those who only had contact with a home health care nurse or home health care assistant. Conclusions: The results indicated that the availability of a cancer coordinator facilitated personalized information and counselling for older cancer patients. [ABSTRACT FROM AUTHOR]

Background: Screening tools are proposed to identify those older cancer patients in need of geriatric assessment (GA) and multidisciplinary approach. We aimed to update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on the use of screening tools. Materials and methods: SIOG composed a task group to review, interpret and discuss evidence on the use of screening tools in older cancer patients. A systematic review was carried out and discussed by an expert panel, leading to a consensus statement on their use. Results: Forty-four studies reporting on the use of 17 different screening tools in older cancer patients were identified. The tools most studied in older cancer patients are G8, Flemish version of the Triage Risk Screening Tool (fTRST) and Vulnerable Elders Survey-13 (VES-13). Across all studies, the highest sensitivity was observed for: G8, fTRST, Oncogeriatric screen, Study of Osteoporotic Fractures, Eastern Cooperative Oncology Group-Performance Status, Senior Adult Oncology Program (SAOP) 2 screening and Gerhematolim. In 11 direct comparisons for detecting problems on a full GA, the G8 was more or equally sensitive than other instruments in all six comparisons, whereas results were mixed for the VES-13 in seven comparisons. In addition, different tools have demonstrated associations with outcome measures, including G8 and VES-13. Conclusions: Screening tools do not replace GA but are recommended in a busy practice in order to identify those patients in need of full GA. If abnormal, screening should be followed by GA and guided multidisciplinary interventions. Several tools are available with different performance for various parameters (including sensitivity for addressing the need for further GA). Further research should focus on the ability of screening tools to build clinical pathways and to predict different outcome parameters. [ABSTRACT FROM AUTHOR]

Background Previous studies have reported that older cancer patients experience lower psychological distress than younger patients, but most prior studies do not differentiate between age groups within the 'older' category. Aim The aim of this study was to assess the intensity of the symptoms of depression, anxiety, and somatic symptoms among different age groups of older cancer patients. Methods Participants were composed of 321 cancer patients 60 years and older, who were divided into three age groups: 60-69, 70-79, and 80+ years. The participants answered the Brief Symptom Inventory-18, which included subscales for depression, anxiety, and somatic symptoms and the cancer-related problem list, in addition to providing personal and cancer-related details. Results Depressive, anxiety, and somatic symptoms and cancer-related problems were lowest in the 70-79 years age group and highest in the 80+ years age group. Comparisons between pairs of groups showed significant differences between each of the groups in Brief Symptom Inventory total scores and between the 80+ years age group and the other two groups in regard to depressive symptoms and cancer-related problems. Differences, related to anxiety and somatic symptoms, were significant for the 70-79 year olds, in comparison with the youngest and oldest groups. Intensity of symptoms was explained by older age, higher number of cancer-related problems, female gender, and lower income. Conclusion Nonlinear relations exist between age and psychological symptoms, which is in line with the postponement of age-related health and functional decline in the modern era. These results suggest that the study of psychological reactions to cancer should examine differences between age groups among older cancer patients. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Recommendations from international task forces on geriatric assessment emphasize the need for research including validation of cancer-specific geriatric assessment (C-SGA) tools in oncological settings. This study was to evaluate the feasibility of the SAKK Cancer-Specific Geriatric Assessment (C-SGA) in clinical practice. Methods: A cross sectional study of cancer patients ⩾65 years old (N = 51) with pathologically confirmed cancer presenting for initiation of chemotherapy treatment (07/01/2009-03/31/2011) at two oncology departments in Swiss canton hospitals: Kantonsspital Graubünden (KSGR N = 25), Kantonsspital St. Gallen (KSSG N = 26). Data was collected using three instruments, the SAKK C-SGA plus physician and patient evaluation forms. The SAKK C-SGA includes six measures covering five geriatric assessment domains (comorbidity, function, psychosocial, nutrition, cognition) using a mix of medical record abstraction (MRA) and patient interview. Five individual domains and one overall SAKK C-SGA score were calculated and dichotomized as below/above literature-based cut-offs. The SAKK C-SGA was evaluated by: patient and physician estimated time to complete, ease of completing, and difficult or unanswered questions. Results: Time to complete the patient questionnaire was considered acceptable by almost all (⩾96%) patients and physicians. Patients reported slightly shorter times to complete the questionnaire than physicians (17.33 ± 7.34 vs. 20.59 ± 6.53 minutes, p = 0.02). Both groups rated the patient questionnaire as easy/fairly easy to complete (91% vs. 84% respectively, p = 0.14) with few difficult or unanswered questions. The MRA took on average 8.32 ± 4.72 minutes to complete. Physicians (100%) considered time to complete MRA acceptable, 96% rated it as easy/fairly easy to complete. Individual study site populations differed on health-related characteristics (excellent/good physician-rated general health KSGR 71% vs. KSSG 32%, p = 0.007). The overall mean C-SGA score was 2.4 ± 1.12. Patients at KSGR had lower C-SGA scores (2.00 ± 1.19 vs. 2.81 ± 0.90, p = 0.009) and a smaller proportion (28% vs.65%, p = 0.008) was above the C-SGA cut-off score compared to KSSG. Conclusions: These results suggest the SAKK C-SGA is a feasible practical tool for use in clinical practice. It demonstrated discriminative ability based on objective geriatric assessment measures, but additional investigations on use for clinical decision-making are warranted. The SAKK C-SGA also provides important usable domain information for intervention to optimize outcomes in older cancer patients. [ABSTRACT FROM AUTHOR]

Abstract: Life expectancy has greatly increased in the last century. In the last decades, cancer in the older people has become an increasingly common problem owing to the prolonged life-expectancy of the general population and to the improved management of common cancers. The aim of this study was to demonstrate the age-specific incidence ratios in patients with CRC. Data were collected from hospital-based registries from 1988 to 2007. A total of 4209 patients were assessed. The median age at diagnosis was 58 years. When compared to Surveillance Epidemiology and End Results (SEER) data, these values were found to be 13 years younger than American patients. Trends consist of the median ages of patients were increased during years (p <0.001). Along the years, especially in the last years, the ratios of cancer patients of older than 70 years were significantly increased among the cancer patient populations. CRC in older person has become an increasingly common problem in the last years. [Copyright &y& Elsevier]

Abstract: A randomized pre- and post-test control group design was conducted in 12 oncology wards to investigate the effectiveness of an intervention, existing of a communication skills training with web-enabled video feedback and a Question Prompt Sheet (QPS), which aimed to improve patient education to older cancer patients (≥65 years). The effects were studied by analyzing questionnaires and video recordings of patient education sessions preceding chemotherapy with 210 different patients. Patients’ recall of information was the primary outcome of the study. Recall was checked against the actual communication in the video-recordings. Moreover, communication skills were assessed by observing the extent to which nurses implemented 67 communication aspects, categorized in seven dimensions, using the QUOTEchemo. Experimental nurses demonstrated a significant intervention effect on communicating realistic expectations. Within-group improvements were measured in the experimental group for tailored communication, affective communication and interpersonal communication. Although the use of a QPS significantly increased question asking, only limited results were found on older patients’ recall scores. The overall proportion recall of recommendations showed a marginally significant pre-/post-change in proportion recall in favour of the experimental group and there was a significant pre-/post-change in two out of six sub-categories. The results indicate that nurses’ communication skills can be improved by communication skills training. More research is needed to understand the difficult relationship between patient–provider communication and recall of information. [Copyright &y& Elsevier]

Abstract: Introduction: The Comprehensive Geriatric Assessment (CGA) is a key component of the treatment approach for older cancer patients. The goals of the current study were to develop a brief but non-self-administered cancer-specific geriatric assessment and to determine its feasibility, as measured by (1) the length of time to completion and (2) patient satisfaction. Methods: The literature was reviewed to select validated scales for geriatric assessment across the following domains: functional status, co-morbidity, cognition, social support and risk of malnutrition. Oncologic patients older than 70 years were included in the study. Results: The instrument was completed by 99 patients (mean age, 78.65 yrs). The mean time to completion of that was 12.9min (range, 9.5–20.5min). Most patients were satisfied with its length (63.6%), and most considered it fairly easy to complete (69.7%). Conclusions: The designed CGA was accepted by most patients and was not perceived to be overly time-consuming. [ABSTRACT FROM AUTHOR]

Purpose: Side effects of chemotherapy on cognitive functions in older patients have rarely been investigated. Addressing this lack of research, the present study evaluated cognitive functions in older cancer patients. Methods: A total of 130 younger ( n=59; age<60) and older ( n=71; age≥60) cancer patients with hematological disease or cancer of the intestinal tract took part in the study. To explore short-term effects of chemotherapy, a group of patients assessed before the start of chemotherapy was compared with patients who already received their first course of chemotherapy. Results: Cognitive impairments of verbal learning, word fluency, and memory were observed following the first few days after treatment onset. Older patients showed stronger memory impairments after start of chemotherapy than younger cancer patients. Additionally, depression was neither associated with short-term effect of chemotherapy nor with age. Conclusions: The results suggest that chemotherapy has negative short-term effects on some cognitive functions. But age-dependent effects were only found for memory. [ABSTRACT FROM AUTHOR]

Sarcopenia is a geriatric syndrome characterized by losses of quantity and quality of skeletal muscle, which is associated with negative outcomes in older adults and in cancer patients. Different definitions of sarcopenia have been used, with quantitative data more frequently used in oncology, while functional measures have been advocated in the geriatric literature. Little is known about the correlation between frailty status as assessed by comprehensive geriatric assessment (CGA) and sarcopenia in cancer patients. We retrospectively analyzed data from 96 older women with early breast cancer who underwent CGAs and Dual X-ray Absorptiometry (DXA) scans for muscle mass assessment before cancer treatment at a single cancer center from 2016 to 2019 to explore the correlation between frailty status as assessed by CGA and sarcopenia using different definitions. Based on the results of the CGA, 35 patients (36.5%) were defined as frail. Using DXA Appendicular Skeletal Mass (ASM) or the Skeletal Muscle Index (SMI=ASM/height^2), 41 patients were found to be sarcopenic (42.7%), with no significant difference in prevalence between frail and nonfrail subjects. Using the European Working Group on Sarcopenia in Older People (EWGSOP2) definition of sarcopenia (where both muscle function and mass are required), 58 patients were classified as "probably" sarcopenic; among these, 25 were sarcopenic and 17 "severely" sarcopenic. Only 13 patients satisfied both the requirements for being defined as sarcopenic and frail. Grade 3-4 treatment-related toxicities (according to Common Terminology Criteria for Adverse Events) were more common in sarcopenic and frail sarcopenic patients. Our data support the use of a definition of sarcopenia that includes both quantitative and functional data in order to identify frail patients who need tailored treatment. [ABSTRACT FROM AUTHOR]

The purpose of this article is to describe areas in need of psychosocial research for older adults who are currently receiving cancer treatment. Areas in which there are gaps in knowledge related to psychosocial research are outlined. Topics discussed for future research include comorbidity, physical function, cognitive status, frailty, and geriatric syndromes. In addition, the need for intervention to support patients and family caregivers is outlined. There are numerous areas of concern to older patients with cancer receiving treatment that warrant further study. Research is needed to identify ways to support patients and families at the time of cancer treatment so that they can make informed decisions and actively participate in cancer treatment. [ABSTRACT FROM AUTHOR]