scholarly journals Ovarian Cancer in the Elderly: Time to Move towards a More Logical Approach to Improve Prognosis—A Study from the FRANCOGYN Group

2020 ◽  
Vol 9 (5) ◽  
pp. 1339
Author(s):  
Ludivine Dion ◽  
Camille Mimoun ◽  
Krystel Nyangoh Timoh ◽  
Sofiane Bendifallah ◽  
Alexandre Bricou ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Postoperative Complications ◽  
Elderly Women ◽  
The Elderly ◽  
Optimal Treatment ◽  
Surgical Approaches ◽  
University Hospitals ◽  
Younger Women ◽  
Primary Surgery ◽  
Comorbidity Index

Background and objective: Elderly and/or frail women with ovarian cancer are often undertreated. The aim of the study is to compare the effects of age and frailty on surgical approaches, postoperative complications, and prognosis in elderly women with ovarian cancer. Methods: A retrospective multicenter study of women ≥70 years were treated for ovarian cancer at seven French university hospitals between 2007 and 2015. Results: Of the 1119 women treated for ovarian cancer during the study period, 147 were ≥70 years and had complete data. Of these women, 65 were aged 70–74 years, and 82 were aged ≥75 years. Overall, 77% of the younger women (49/65) received optimal treatment compared with 51% (40/82) of the older women (p = 0.018). Women ≥75 years underwent fewer bowel resections (32% vs. 67%, p < 0.001) and experienced fewer postoperative complications (22.6% vs. 38.9%, p < 0.001); 53.2% of the women in this age group were treated by primary surgery or surgery only. These women also received more chemotherapy with platinum only (15% [9/56] vs. 2% [1/57], p = 0.007) and less bevacizumab (9% [5/56] vs. 32% [18/57], p = 0.003). Patients with greater frailty (a modified Charlson Comorbidity Index [mCCI] score >3) had a five-year survival rate of 30% versus 62% for those with a score ≤3 (p < 0.001). Conclusions: Surgeons modify their approach to treating ovarian cancer in women ≥75 years probably to reduce immediate postoperative complications. The prognosis is significantly worse in patients with greater frailty. Improvements to the sequence of treatments administered, with priority given to neoadjuvant chemotherapy in patients with greater frailty, could help increase the number of women who receive optimal treatment and improve their prognosis.

Treatment Practices and Outcomes of Elderly Women with Breast Cancer in a Community Hospital

2014 ◽  
Vol 80 (7) ◽  
pp. 714-719
Author(s):  
Rosewellv Mackey ◽  
Gopal Chandru Kowdley
Keyword(s):  
Breast Cancer ◽  
Survival Data ◽  
Community Hospital ◽  
Elderly Women ◽  
Specific Treatment ◽  
The Elderly ◽  
Study Groups ◽  
Younger Women ◽  
Treatment Practices ◽  
The Impact

There is a paucity of clinical data available on specific treatment in the oncogeriatric population with breast cancer. The purpose of this study was to evaluate treatment patterns and survival outcomes in the elderly to address any disparities at our community hospital. We retrospectively identified a total of 1749 patients diagnosed and treated for breast cancer at our institution between 2001 and 2011. Patient demographics, surgical treatment, stage of disease, tumor characteristics, adjuvant therapy, and 5-year survival data were obtained from tumor registry records. Comparisons between study groups were made using the Pearson χ2 test and Student's t test. We found more favorable prognostic makers among women older than 70 years of age. Of the women with lymph node-positive disease, 84 per cent of those younger than 70 years and 33 per cent in the older than 70 years of age study group received chemotherapy. Adjuvant chemotherapy and radiation therapy were more frequently performed in the younger group. Overall 5-year survival was 90 per cent and 71 per cent for younger than 70 years and older than 70 years groups, respectively. Women older than 70 years of age have more favorable breast cancer characteristics compared with younger women and received less aggressive treatment and experienced a higher mortality rate. Prospective trials are needed to assess the impact of aggressive multimodality therapy in this oncogeriatric population.

scholarly journals Risk Factors and Indications for 30-Day Readmission After Primary Surgery for Epithelial Ovarian Cancer

2015 ◽  
Vol 25 (2) ◽  
pp. 193-202 ◽  
Author(s):  
Mariam AlHilli ◽  
Carrie Langstraat ◽  
Christine Tran ◽  
Janice Martin ◽  
Amy Weaver ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ovarian Cancer ◽  
Postoperative Complications ◽  
Epithelial Ovarian Cancer ◽  
Odds Ratio ◽  
Residual Disease ◽  
Factors Associated ◽  
Primary Surgery ◽  
American Society ◽  
American Society Of Anesthesiologists

BackgroundTo identify patients at risk for postoperative morbidities, we evaluated indications and factors associated with 30-day readmission after epithelial ovarian cancer surgery.MethodsPatients undergoing primary surgery for epithelial ovarian cancer between January 2, 2003, and December 29, 2008, were evaluated. Univariable and multivariable logistic regression models were fit to identify factors associated with 30-day readmission. A parsimonious multivariable model was identified using backward and stepwise variable selection.ResultsIn total, 324 (60.2%) patients were stage III and 91 (16.9%) were stage IV. Of all 538 eligible patients, 104 (19.3%) were readmitted within 30 days. Cytoreduction to no residual disease was achieved in 300 (55.8%) patients, and 167 (31.0%) had measurable disease (≤1 cm residual disease). The most common indications for readmission were surgical site infection (SSI; 21.2%), pleural effusion/ascites management (14.4%), and thromboembolic events (12.5%). Multivariate analysis identified American Society of Anesthesiologists score of 3 or higher (odds ratio, 1.85; 95% confidence interval, 1.18–2.89;P= 0.007), ascites [1.76 (1.11–2.81);P= 0.02], and postoperative complications during initial admission [grade 3–5 vs none, 2.47 (1.19–5.16); grade 1 vs none, 2.19 (0.98–4.85); grade 2 vs none, 1.28 (0.74–2.21);P= 0.048] to be independently associated with 30-day readmission (c-index = 0.625). Chronic obstructive pulmonary disease was the sole predictor of readmission for SSI (odds ratio, 3.92; 95% confidence interval, 1.07–4.33;P= 0.04).ConclusionsClinically significant risk factors for 30-day readmission include American Society of Anesthesiologists score of 3 or higher, ascites and postoperative complications at initial admission. The SSI and pleural effusions/ascites are common indications for readmission. Systems can be developed to predict patients needing outpatient management, improve care, and reduce costs.

scholarly journals Management and Survival of Elderly and Very Elderly Patients with Ovarian Cancer: An Age-Stratified Study of 1123 Women from the FRANCOGYN Group

2020 ◽  
Vol 9 (5) ◽  
pp. 1451
Author(s):  
Yolaine Joueidi ◽  
Ludivine Dion ◽  
Sofiane Bendifallah ◽  
Camille Mimoun ◽  
Alexandre Bricou ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Elderly Patients ◽  
Elderly Women ◽  
Residual Disease ◽  
Univariate Analysis ◽  
Advanced Ovarian Cancer ◽  
The Elderly ◽  
Figo Stage ◽  
Very Elderly ◽  
Cancer Management

Elderly women with ovarian cancer are often undertreated due to a perception of frailty. We aimed to evaluate the management of young, elderly and very elderly patients and its impact on survival in a retrospective multicenter study of women with ovarian cancer between 2007 to 2015. We included 979 women: 615 women (62.8%) <65 years, 225 (22.6%) 65–74 years, and 139 (14.2%) ≥75 years. Women in the 65–74 years age group were more likely to have serous ovarian cancer (p = 0.048). Patients >65 years had more >IIa FIGO stage: 76% for <65 years, 84% for 65–74 years and 80% for ≥75 years (p = 0.033). Women ≥75 years had less standard procedures (40% (34/84) vs. 59% (104/177) for 65–74 years and 72% (384/530) for <65 years (p < 0.001). Only 9% (13/139) of women ≥75 years had an Aletti score >8 compared with 16% and 22% for the other groups (p < 0.001). More residual disease was found in the two older groups (30%, respectively) than the younger group (20%) (p < 0.05). Women ≥75 years had fewer neoadjuvant/adjuvant cycles than the young and elderly women: 23% ≥75 years received <6 cycles vs. 10% (p = 0.003). Univariate analysis for 3-year Overall Survival showed that age >65 years, FIGO III (HR = 3.702, 95%CI: 2.30–5.95) and IV (HR = 6.318, 95%CI: 3.70–10.77) (p < 0.001), residual disease (HR = 3.226, 95%CI: 2.51–4.15; p < 0.001) and lymph node metastasis (HR = 2.81, 95%CI: 1.91–4.12; p < 0.001) were associated with lower OS. Women >65 years are more likely to have incomplete surgery and more residual disease despite more advanced ovarian cancer. These elements are prognostic factors for women’s survival regardless of age. Specific trials in the elderly would produce evidence-based medicine and guidelines for ovarian cancer management in this population.

scholarly journals Age and education influence the performance of elderly women on the dual-task Timed Up and Go test

2015 ◽  
Vol 73 (3) ◽  
pp. 187-193 ◽  
Author(s):  
Gisele de Cássia Gomes ◽  
Luci Fuscaldi Teixeira-Salmela ◽  
Bruna Espeschit Fonseca ◽  
Flávia Alexandra Silveira de Freitas ◽  
Maria Luísa Morais Fonseca ◽  
...  
Keyword(s):  
Physical Activity ◽  
Dual Task ◽  
Elderly Women ◽  
Functional Decline ◽  
The Elderly ◽  
Timed Up And Go ◽  
Younger Women ◽  
Education Levels ◽  
Activity Method ◽  
Different Levels

Gait variability is related to functional decline in the elderly. The dual-task Timed Up and Go Test (TUG-DT) reflects the performance in daily activities. Objective To evaluate the differences in time to perform the TUG with and without DT in elderly women with different ages and levels of education and physical activity. Method Ninety-two elderly women perfomed the TUG at usual and fast speeds, with and without motor and cognitive DT. Results Increases in the time to perform the TUG-DT were observed at older ages and lower educational levels, but not at different levels of physical activity. More educated women performed the test faster with and without DT at both speeds. When age was considered, significant differences were found only for the TUG-DT at both speeds. Conclusion Younger women with higher education levels demonstrated better performances on the TUG-DT.

scholarly journals Evaluation of Postural Stability in Young and Elderly Women

2018 ◽  
Vol 10 (1) ◽  
pp. 134-140
Author(s):  
Tomasz Marciniak ◽  
Ida Wiszomirska ◽  
Lidia Ilnicka
Keyword(s):  
Effect Size ◽  
Postural Stability ◽  
Elderly Women ◽  
The Elderly ◽  
Relative Difference ◽  
Younger Women ◽  
Balance System ◽  
Eyes Open ◽  
Comparison Of The Results ◽  
The Impact

AbstractStudy aim: Assessment of postural stability performed on an unstable stabilometry platform. Comparison of the results ob­tained by two groups consisting of elderly (OW) (60+ years old) and younger women (YW).Material and methods: Seventy-three female volunteers were divided into two groups: 40 young women (20.2 ± 1.75), and 32 elderly women (68.3 ± 7.43). Participants performed five stability tests on Biodex Balance System SD: three 20-second tries, the Postural Stability Test (PST) and the Fall Risk Test (FRT). Three stability indexes - overall (OSI), anterior-posterior (APSI), and medial-lateral (MLSI) - both with eyes open (EO) and closed (EC) were analyzed. The impact of vision on balance was calculated as EC-EO. Also effect size was calculated and evaluated.Results: All of the parameters differed significantly between groups in favour of YW. The largest difference in significance as well as effect size was noted for FRT, p < 0.001 and 1.86 respectively. Tries measure the impact of vision on balance (EC-EO). The results concerning tries with EC-EO showed the strongest discrimination between groups - OSI p = 0.0088 (relative differ­ence 0.23 ± 0.26) and APSI p = 0.0268 (relative difference 0.17 ± 0.2). YW had a significantly better outcome.Conclusions: YW had better results in all of the parameters taken into consideration, with most of them being significant. This confirms that all of the regressive changes appearing with age influence balance. Lack of visual input (EC) in OW caused sig­nificantly worse results in most of the measured parameters, showing that vision is a very important factor for balance mainte­nance in the elderly.

Treatment and Trials: Ovarian Cancer in Older Women

2013 ◽  
pp. 227-235
Author(s):  
G. Freyer ◽  
W. P. Tew ◽  
K. N. Moore
Keyword(s):  
Ovarian Cancer ◽  
Older Women ◽  
Geriatric Assessment ◽  
Elderly Women ◽  
The Elderly ◽  
Medical Problems ◽  
Risk Of Death ◽  
Increased Risk ◽  
Treatment Tolerance ◽  
Functional Capacities

Ovarian cancer (OC) is a disease of elderly women. The disease spreads insidiously and presents at an advanced stage at initial diagnosis for most patients. Several groups reported at least a two-fold increased risk of death in women older than 65. Various theories have been proposed to explain this survival disparity in older women, including: (1) more aggressive cancer with advanced age, (2) inherent resistance to chemotherapy, (3) individual patient factors such as multiple concurrent medical problems, and (4) physician and health-care biases toward the elderly that lead to inadequate surgery, less than optimal chemotherapy, and poor enrollment in clinical trials. As a result of this high clinical variability, oncologists need to be more familiar with the comprehensive geriatric assessment to better identify vulnerable patients at higher risk of complications. Several geriatric tools are available to assess the physiologic and functional capacities of older patients and to better individualize treatment. This paper gives an overview of the management of elderly patients with OC, in particular the integration of chemotherapy, surgery, and geriatric assessment to improve treatment tolerance and survival outcomes.

scholarly journals The Effect of Ageing on Nasal Mucociliary Clearance in Women: A Pilot Study

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Preetha Paul ◽  
Priscilla Johnson ◽  
Padmavathi Ramaswamy ◽  
Sitalakshmi Ramadoss ◽  
Bagavad Geetha ◽  
...  
Keyword(s):  
Mucociliary Clearance ◽  
Elderly Women ◽  
Respiratory Health ◽  
The Elderly ◽  
Sweet Taste ◽  
Respiratory Epithelium ◽  
Mirror Image ◽  
Older Individuals ◽  
Younger Women ◽  
Nasal Mucociliary Clearance

Introduction. Pneumonia is the leading infectious cause of death in the elderly. Impaired respiratory defences are one of the causes for increased susceptibility of the elderly to such infections. Nasal mucociliary clearance, the mirror image of bronchial clearance, is crucial in respiratory defence and is affected by various factors. Little is known about the effect of ageing on nasal respiratory epithelium. Aim. To evaluate the effect of ageing on nasal mucociliary clearance (NMC) in women. Materials and Methods. NMC was measured in 91 apparently healthy women of ages ranging from 20 to 80 years. The time taken to experience sweet taste at nasopharynx following the placement of saccharin pellet in the nostril was recorded as NMC time. Results and Discussion. NMC time was 10 min 36 secs in elderly women and it was significantly prolonged when compared to younger women (8 min 39 secs). The prolonged clearance may be due to altered cilia, slowed ciliary beating, or changes in the properties of mucus. Conclusion. NMC time clearly shows an increase with age signifying decreasing respiratory epithelium function. This study highlights an important cause of impaired respiratory health in older individuals and emphasises the need for preventive measures to be put in place.

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