scholarly journals Infused Chemotherapy Use in the Elderly After Patent Expiration

2012 ◽  
Vol 8 (3S) ◽  
pp. e18s-e23s ◽  
Author(s):  
Rena M. Conti ◽  
Meredith B. Rosenthal ◽  
Blase N. Polite ◽  
Peter B. Bach ◽  
Ya-Chen Tina Shih
Keyword(s):  
Decision Making ◽  
Cost Efficiency ◽  
Empirical Work ◽  
Treatment Decision ◽  
The Elderly ◽  
Patent Expiration ◽  
Treatment Decision Making

As calls for improving the quality and cost efficiency of oncology increase, future empirical work is needed to examine the responsiveness of oncologists' treatment decision making to incentives among patients of all ages and insurance types.

scholarly journals Tumor Treating Fields for Glioblastoma Therapy During the COVID-19 Pandemic

2021 ◽  
Vol 11 ◽  
Author(s):  
Na Tosha N. Gatson ◽  
Jill Barnholtz-Sloan ◽  
Jan Drappatz ◽  
Roger Henriksson ◽  
Andreas F. Hottinger ◽  
...  
Keyword(s):  
Decision Making ◽  
Elderly Patients ◽  
Health Care Systems ◽  
Panel Discussion ◽  
Treatment Decision ◽  
The Elderly ◽  
Tumor Patients ◽  
Treatment Decision Making ◽  
Tumor Treating Fields ◽  
Care Systems

BackgroundThe COVID-19 pandemic has placed excessive strain on health care systems and is especially evident in treatment decision-making for cancer patients. Glioblastoma (GBM) patients are among the most vulnerable due to increased incidence in the elderly and the short survival time. A virtual meeting was convened on May 9, 2020 with a panel of neuro-oncology experts with experience using Tumor Treating Fields (TTFields). The objective was to assess the risk-to-benefit ratio and provide guidance for using TTFields in GBM during the COVID-19 pandemic.Panel DiscussionTopics discussed included support and delivery of TTFields during the COVID-19 pandemic, concomitant use of TTFields with chemotherapy, and any potential impact of TTFields on the immune system in an intrinsically immunosuppressed GBM population. Special consideration was given to TTFields' use in elderly patients and in combination with radiotherapy regimens. Finally, the panel discussed the need to better capture data on COVID-19–positive brain tumor patients to analyze longitudinal outcomes and changes in treatment decision-making during the pandemic.Expert OpinionTTFields is a portable home-use device which can be managed via telemedicine and safely used in GBM patients during the COVID-19 pandemic. TTFields has no known immunosuppressive effects which is important during a crisis where other treatment methods might be limited, especially for elderly patients with multiple co-morbidities. It is too early to estimate the full impact of COVID-19 on the global healthcare system and on patient outcomes and the panel strongly recommended collaboration with existing cancer COVID-19 registries to follow CNS tumor patients.

Screening and Treating Prostate Cancer in the Older Patient: Decision Making Across the Clinical Spectrum

2017 ◽  
pp. 370-381
Author(s):  
Alicia K. Morgans ◽  
William Dale ◽  
Alberto Briganti
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Elderly Population ◽  
Prostate Cancer Screening ◽  
Treatment Decision ◽  
The Elderly ◽  
Developed Countries ◽  
Elderly Men ◽  
Geriatric Population ◽  
Treatment Decision Making

Treatment of the growing geriatric patient population is increasingly being recognized as a necessary priority of the oncology community. As the most common cancer among men in developed countries, prostate cancer afflicts a sizable portion of elderly men. Caring for this population requires knowledge of aspects of disease presentation, screening strategies, treatment approaches, and survivorship care considerations unique to the geriatric population. In this article, we review characteristics of prostate cancer screening and treatment decision making for localized disease in elderly men, including a discussion of the biology of disease in the elderly population. We also review best practices for providing treatment for localized and recurrent disease in an elderly population, including engaging in a basic geriatric assessment to determine fitness for treatment, eliciting information about patient preferences and support systems, and balancing treatment decisions in the context of these factors using the resources of a multidisciplinary care team. We then consider complications of prostate cancer survivorship related to systemic treatment in the elderly population of men with this disease. Finally, we emphasize the importance of engaging patients in treatment decision making across the spectrum of disease to personalize treatment plans and provide optimal care.

scholarly journals Ethical issues in geriatric cranial neurosurgery

2020 ◽  
Vol 49 (4) ◽  
pp. E3
Author(s):  
Laureen D. Hachem ◽  
Mark Bernstein
Keyword(s):  
Decision Making ◽  
Ethical Issues ◽  
Surgical Care ◽  
Treatment Decision ◽  
The Elderly ◽  
Demographic Shift ◽  
Older Population ◽  
Treatment Decision Making ◽  
Disease States ◽  
Guide Treatment Decision

The global demographic shift to an older population has led to the emergence of the new field of geriatric neurosurgery. Beyond the complexities of disease states and multimorbidity, advanced age brings with it intricate ethical issues pertaining to both the practice and provision of medical and surgical care. In this paper, the authors describe the central ethical themes seen across the spectrum of common neurosurgical conditions in the elderly and highlight the use of foundational ethical principles to help guide treatment decision-making.

scholarly journals Physician decision-making pattern and family presence: A randomized cross-sectional online vignette study in Japan (Preprint)

2018 ◽  
Author(s):  
Kenji Tsuda ◽  
Asaka Higuchi ◽  
Emi Yokoyama ◽  
Kazuhiro Kosugi ◽  
Tsunehiko Komatsu ◽  
...  
Keyword(s):  
Decision Making ◽  
Elderly People ◽  
Online Survey ◽  
Artificial Ventilation ◽  
Family Members ◽  
Treatment Decision ◽  
The Elderly ◽  
Cross Sectional ◽  
Treatment Decision Making ◽  
Consciousness Disturbance

BACKGROUND Japan faces increase of elderly people without children living in single households with the progress of low birthrate and aging population. The elderly without spouse and/or children result in lack of caregivers because most care for the elderly are not provided by private agencies but by family members in Japan. However, family caregivers are not only helpers of daily living but are key participants in the treatment decision-making. Effect of family absence on treatment decision-making has not been elucidated although more and more elderly people will not have family members who make surrogate decisions on behalf of incapacitated themselves. OBJECTIVE To understand the influence of family absence on treatment decision-making, we conducted a randomized, cross-sectional online survey with three hypothetical vignettes of patients. METHODS We conducted a randomised cross-sectional online survey among Japanese physicians using three hypothetical vignettes. The first vignette was about a 65-year-old man with alcoholic liver cirrhosis and the second about a 78-year-old woman with dementia, both of whom developed pneumonia with consciousness disturbance. The third vignette was about a 70-year-old woman with necrosis of her lower limb. Participants were randomly assigned either of the two versions of questionnaires—with family or without family—but otherwise identical. Participants chose yes or no responses to questions about whether they would perform the presented medical procedures. RESULTS Among 1112 physicians, 454 (40.8%) completed the survey and there were no significant differences in the baseline characteristics between groups. Significantly fewer physicians had a willingness to perform dialysis (odds ratio [OR], 0.55; P=0.002) and artificial ventilation (OR, 0.51; P<0.001) for a patient from vignette one, without family. Similarly, artificial ventilation was less intended in vignette two (OR, 0.59; P=0.02). In vignette three, significantly fewer physicians showed willingness to perform wound treatment (OR, 0.51; P=0.007), surgery (OR, 0.35; P<0.001), blood transfusion (OR, 0.45; P<0.001), vasopressor (OR, 0.49; P<0.001), dialysis (OR, 0.38; P<0.001), artificial ventilation (OR, 0.25; P<0.001) and chest compression (OR, 0.29; P<0.001) for a patient without family. CONCLUSIONS Elderly patients may sometimes be submitted to treatments withheld due to the absence of family, highlighting the potential importance of the advance care planning in the era of aging society with declining birthrate. CLINICALTRIAL None

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