scholarly journals Prospective comparison of the value of CRASH and CARG toxicity scores in predicting chemotherapy toxicity in geriatric oncology

2019 ◽  
Author(s):  
Jun Zhang ◽  
Xin Liao ◽  
Jin Feng ◽  
Tiejun Yin ◽  
Yajun Liang
Keyword(s):  
Geriatric Oncology ◽  
Chemotherapy Toxicity ◽  
Prospective Comparison ◽  
Toxicity Scores

A tailored predication model to improve outcomes and mortality in geriatric indigenous women with breast cancer of western Australia.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14000-e14000
Author(s):  
Azim Khan ◽  
Hilary Laura Martin ◽  
Lisa Spalding ◽  
Andrew D. Redfern
Keyword(s):  
Breast Cancer ◽  
Cancer Biology ◽  
Indigenous Women ◽  
Morbidity And Mortality ◽  
Lymph Node Status ◽  
Model Of Care ◽  
Chemotherapy Toxicity ◽  
Morbidity Burden ◽  
Co Morbidity ◽  
Toxicity Scores

e14000 Background: Indigenous women with breast cancer (BrCa) have higher mortality than Non-Indigenous women. Remoteness, aggressive tumour biology, treatment acceptance and compliance are all contributory factors. A retrospective study of geriatric indigenous women (aged 55 years more) with BrCa has shown high co-morbidity and treatment-related toxicity scores translating to high mortality comparing to the non-indigenous geriatric population (aged 65 years or more). An algorithm allowing prediction of risk of morbidity and mortality to enable optimisation of care for this patient group, catering to needs, values, beliefs and resources of geriatric Indigenous patients is warranted. Methods: To create a predictive algorithm and model of care based on the demographics, social environment, biology, co-morbidity burden and predicted chemotherapy toxicity scores of Indigenous women with BrCa to then be applied to a validatory prospective study.A cohort of 132 indigenous geriatric patients was identified from the Western Australian Cancer Registry from 2001 to 2010 along with remoteness matched geriatric non-Indigenous women in a 1:1 ratio. Data was collated on cancer biology, chemotherapy toxicity, mortality, co-morbidity burden (by the Charlson Co-Morbidity Index -CCI) and predicted chemotherapy toxicity (by CARG toxicity score). An algorithm was created based on these factors to identify patients at greatest risk of morbidity and mortality. Results: Elements identified as predicting morbidity and mortality were; remoteness based on distance from Perth (scored 0-3), lymph node status (scored 0-1), social isolation (scored 0-1), the Carg score (scored 0-3), and the CCI (scored 0-4). The KR Geri-Indigenous Rx Model was created using these components and scored out of 12. Conclusions: The score has been used to create three risk categories, low (1-3) intermediate (4-8) and high risk (9-12). A model of care was designed with staged increases in service elements and intensity for increasing risk category. These include the addition of Indigenous health worker review initially in clinic as well as at home during chemotherapy, initial geriatric assessment and potential geriatrician review, optimization of co-morbidities and medications, consideration of dose adjustments, social worker visits to increase services, increased surveillance, with telehealth contact and GP update with treatment planning as well as on treatment completion. A prospective study based on this model is planned.

Does screening for frailty with the vulnerable elders survey (VES-13) identify older adults with GU malignancy who benefit most from a consultation in a geriatric oncology clinic?

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 209-209
Author(s):  
Naser M. KH. M. S AlQurini ◽  
Narhari Timilshina ◽  
Rana Jin ◽  
Allison Loucks ◽  
Arielle Berger ◽  
...  
Keyword(s):  
Older Adults ◽  
Treatment Plan ◽  
Strong Association ◽  
Univariate Analysis ◽  
Geriatric Oncology ◽  
Adverse Outcomes ◽  
Treatment Optimization ◽  
Chemotherapy Toxicity ◽  
Falls Risk ◽  
Final Treatment

209 Background: The VES-13 is a well-studied brief frailty screening tool for ≥ 65 older adults (OAs) in the oncology setting. Vulnerable patients (scoring ≥ 3) are at higher risk for adverse outcomes and will benefit from a Comprehensive Geriatric assessment (CGA) and cancer treatment decision optimization. Whether the VES-13 is effective specifically in patients with Genitourinary (GU) malignancies remains to be established. Primary objective: to determine if the VES-13 can predict which OAs with GU cancer (Bladder, Prostate, Kidney) had subsequent treatment modification after CGA. Secondary objective: to investigate if there is any association between VES-13 score with comorbidity and chemotherapy toxicity prediction tool (CARG). Methods: The VES-13 was administered to consecutive patients referred to the geriatric oncology (GO) clinic from GU site at the Princess Margaret Cancer Centre, Canada. All patients underwent CGA. CGA assess 8 domains including cognition, comorbidities, function, falls risk. Among patients referred for pre-treatment assessment, we examined whether the VES-13 predicted changes in the final treatment plan after CGA. Descriptive statistics were used to describe the VES-13 scores and final treatment impact. Results: From July 2015-October 2019, 77 were included in this analysis. The VES-13 ≥ 3 group were 52/77 (67.5%), and significantly associated with higher comorbidities (P = 0.003) and worse CARG scores (P = 0.005). The final treatment plan was modified in 36/77 (47%). In univariate analysis, the odds ratio (OR) for VES-13 ≥3 was 1.92 (95% CI 0.72-5.12) for change in final treatment, which was not statistically significant likely due to modest sample size. Interestingly in the same univariate analysis, there was a strong association between final treatment plan with falls risk (OR 2.63, 95% CI 1.03-6.72), physical performance (OR 2.51, 95% CI 0.98-6.45) and cognition (OR 3.95, 95% CI 1.19-13.19). Conclusions: The VES-13 identified vulnerable GU patients who will benefit from CGA and may predict treatment optimization by identifying patients at higher risk of chemotherapy toxicity and higher comorbidity.

Measures of polypharmacy and chemotherapy toxicity in older adults with cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9545-9545 ◽  
Author(s):  
Ronald John Maggiore ◽  
Tao Feng ◽  
William Dale ◽  
Cary Philip Gross ◽  
William P. Tew ◽  
...  
Keyword(s):  
Older Adults ◽  
Adverse Drug Events ◽  
Inappropriate Medication ◽  
Geriatric Oncology ◽  
Stage Iv ◽  
The Elderly ◽  
Chi Square ◽  
Chemotherapy Toxicity ◽  
Chi Square Test ◽  
Grade 3

9545 Background: Polypharmacy is common and associated with adverse clinical outcomes in older adults. Potentially inappropriate medication (PIM) use serves as an adjunctive assessment of polypharmacy. The goals of this study in an outpatient population of older adults with cancer (CA) were: 1) to estimate the prevalence of polypharmacy using multiple measures; and 2) to determine the relationship between polypharmacy and chemotherapy (chemo) toxicity. Methods: Medication use was evaluated in 500 patients (pts) age ≥65 years with invasive CA who were starting a new chemo regimen. Polypharmacy was defined by number of daily medications (meds), including non-prescription meds. PIM use was defined by 4 indices: Beers (2003 and 2012 update), Zhan, and HEDIS Drugs to Avoid in the Elderly (DAE) criteria. Prevalence of polypharmacy, PIM, and their association with grade 3-5 chemo toxicity [NCI Common Toxicity Criteria (v. 3.0)] were analyzed using chi square test and unconditional logistic regression. Results: All 500 pts were evaluable [mean age, 73 years (range 65-91); 56% female; 61% stage IV]. The mean number of daily meds was 5 (range 0-23); 38% used ≤3 daily meds, 51% used 4-9 meds, and 11% using ≥10 meds. Using 0-3 daily meds as the referent group, no association was found between daily meds and chemo tox: 4-9 meds, OR 1.34 (95% CI: 0.92-1.97); ≥10, OR 0.82 (95% CI: 0.45-1.49). PIM use was identified in 87 (17%), 147 (29%), 54 (11%), and 69 (13%) patients utilizing the 2003 Beers, 2012 Beers, Zhan, and HEDIS DAE criteria, respectively. There was no association between each PIM use index and chemo toxicity (p>0.10 for all). Conclusions: Polypharmacy and PIM use were common in the geriatric oncology population. Although polypharmacy did not increase the risk of chemotherapy toxicity in this sample, further studies of polypharmacy’s impact on additional outcomes, including non-chemotherapy adverse drug events, in older persons with cancer are warranted.

Implementing the cancer and aging research group (CARG) tool in the ambulatory oncology setting to drive informed treatment selection.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 209-209
Author(s):  
Alexander Mbewe ◽  
Paula Pike ◽  
Russell Lewis ◽  
Jeremy S. Kortmansky ◽  
Anne C. Chiang ◽  
...  
Keyword(s):  
Older Patients ◽  
Geriatric Patients ◽  
Geriatric Oncology ◽  
Treatment Selection ◽  
Physician Education ◽  
Cancer Center ◽  
Chemotherapy Toxicity ◽  
Ambulatory Oncology ◽  
Toxicity Risk ◽  
Informed Treatment

209 Background: Smilow Cancer Hospital is a NCI designated cancer center in Connecticut that has built a network of 15 community-based oncology (CBO) clinics. Older patients present with unique clinical challenges including multiple comorbidities, decreased functional status, and cognitive impairment. ASCO Geriatric Oncology guidelines recommend completing both a comprehensive geriatric assessment and a chemotherapy toxicity risk assessment on all oncology patients ≥65 years old for informed treatment selection. The CARG calculator is a simple, validated tool to assess chemotherapy toxicity risk in older patients with solid tumors. Despite ASCO guidelines, the existence of validated tools, and literature confirming improved patient outcomes, oncologists’ utilization of risk calculators is limited; therefore, we conducted a pilot CARG quality improvement initiative throughout our CBO network. Methods: 36 CBO physicians agreed to complete five CARG tools, document toxicity scores in the EMR, and complete a post-survey between March and June 2021. PDSA cycles included interventions of a hyperlink to the CARG tool incorporated in the EMR and creating a dot phrase built to simplify documentation. Education was provided on both the CARG and the survey. The survey captured perceived clinical value, time commitment, and barriers to implementation. Baseline data was collected during February 2021 and included geriatric patients receiving a new chemotherapy regimen for a solid tumor. Results: 180 consecutive new chemotherapy starts in geriatric patients were monitored. The CARG score utilization in new chemotherapy starts increased from 6.5% of new cases during the first month, to 26.4% in the third month. 82% of providers found the CARG score helpful in discussing chemotherapy risks with patients. In 32% of cases, the CARG score led to a decision to dose attenuate, and in 15% of cases, the CARG score led to a different treatment regimen. Most oncologists (65%) reported spending ≤5 minutes calculating toxicity, and 88% spent ≤10 minutes. 89% of oncologists reported the CARG score was worth the added time. Conclusions: This QI initiative demonstrates feasibility and increased use of the CARG geriatric chemotherapy toxicity tool in accordance with ASCO geriatric guideline-based care. Physician education and EMR workflow modification were utilized. In the CBO setting, oncologists found the CARG tool to be quick and helpful in discussing treatment risks with patients. Use of the CARG tool led to meaningful changes in treatment, including chemotherapy dose attenuation. Further study metrics such as palliative and supportive care referrals, ED visits, and hospitalizations will fuel sustainability.

554: Prospective Comparison of Short-Term Recovery between Open and Robotic Radical Prostatectomy

2007 ◽  
Vol 177 (4S) ◽  
pp. 184-185
Author(s):  
Ryan T. Schulte ◽  
Rodney L. Dunn ◽  
Brent K. Hollenbeck ◽  
J. Stuart Wolf ◽  
James E. Montie ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Short Term ◽  
Robotic Radical Prostatectomy ◽  
Prospective Comparison

Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison

The Lancet ◽  
2005 ◽  
Vol 365 (9456) ◽  
pp. 305-311 ◽  
Author(s):  
D ROCKEY ◽  
E PAULSON ◽  
D NIEDZWIECKI ◽  
W DAVIS ◽  
H BOSWORTH ◽  
...  
Keyword(s):  
Barium Enema ◽  
Computed Tomographic Colonography ◽  
Computed Tomographic ◽  
Prospective Comparison
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