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Hurria A.,Cancer and Aging Research Program | Cohen H.J.,Duke University | Extermann M.,Moffitt Cancer Center
Journal of Geriatric Oncology | Year: 2010

Purpose: The purpose of this meeting was to bring together geriatric oncology researchers in the cooperative groups to discuss the design of clinical trials to improve our knowledge of the efficacy and toxicity of cancer therapeutics in older adults with cancer. Design: Meeting of cooperative group leaders in geriatric oncology research. Results: Several strategies were suggested to improve our knowledge of the efficacy and toxicity of cancer therapeutics in older adults. These include: (1) developing therapeutic studies for older adults who are not eligible for standard clinical trials (because of comorbidity or functional status), or for patients who are deemed to be at high risk for toxicity from standard therapy (frail or vulnerable); (2) identifying the age group of older adults who are underrepresented on clinical trials and developing trials specifically for these patients; (3) designing trials to include a certain proportion of older adults for subset analyses; and (4) including a geriatric assessment in therapeutic clinical trials in order to identify factors other than chronologic age that identify those older adults who are "vulnerable" (at risk for toxicity) and "fit" (able to tolerate cancer therapy without significant toxicity). Conclusions: To address knowledge gaps in geriatric oncology, national and international cooperative group leaders discussed strategies in clinical trial design to improve the evidence-based research and accrual of older adults. Linking the efforts among cooperative groups will expedite this progress, and this conference was a major first step toward this goal. © 2010 Elsevier Ltd.

Yood M.U.,EpiSource | Yood M.U.,Ford Motor Company | Yood M.U.,Boston University | Wells K.E.,Ford Motor Company | And 6 more authors.
Pharmacoepidemiology and Drug Safety | Year: 2012

Purpose: To quantify incidence of cardiovascular outcomes in patients with advanced breast cancer receiving cardiotoxic and non-cardiotoxic chemotherapy. Methods: This study identified all women at a Midwestern health system with initial diagnosis of American Joint Commission on Cancer Stage III/IV breast cancer (1995-2003) and random sample of 50 women initially diagnosed with Stage I/II who progressed to Stage III/IV. The rate of new cardiovascular outcomes (heart failure, dysrhythmia, and ischemia events) for cardiotoxic (anthracycline or trastuzumab) and non-cardiotoxic agents was calculated. Results: Of 315 patients, 90.5% (n=285) received systemic cancer therapy; 67.7% (n=193) received cardiotoxic drugs. Older patients were less likely to receive cardiotoxic agents (86.4%, ≤59years vs. 31.9%, 70+ years). Adjusting for age, race, stage, surgery/radiation, estrogen receptor/progesterone receptor status, and diagnosis year, rate of new cardiac events was higher in patients exposed to cardiotoxic drugs compared with those exposed to non-cardiotoxic drugs (adjusted hazard ratio=2.5, 95%CI = 0.9-7.2). Patients with cardiac event history (relative risk=3.2, 95%CI = 2.0-5.1) and those with heart failure history (relative risk=5.9, 95%CI = 2.4-14.6) were more likely to receive non-cardiotoxic treatment. Heart failure events occurred steadily over time; after 3years of follow-up, 16% exposed to cardiotoxic drugs experienced an event, and 8% of those exposed to non-cardiotoxic drugs experienced an event. Conclusions: Patients with cardiac comorbidity are less likely to receive cardiotoxic agents. Use of cardiotoxic agents is common; treatment is related to patient and tumor characteristics and is associated with substantial risk of cardiotoxicity that persists during patients' remaining lifespan. © 2012 John Wiley & Sons, Ltd.

Economou D.,City of Hope | Hurria A.,Cancer and Aging Research Program | Grant M.,City of Hope
Clinical Journal of Oncology Nursing | Year: 2012

Older adults constitute the greatest percentage of cancer survivors in the country, with 61 % being aged 65 years and older. Assessing older adult cancer survivors beyond chronological age to include changes in functional status is an essential process to help nurses anticipate cancer treatment impact and aid in planning individualized survivorship care. The objective of this article is to identify a method to assess older adult cancer survivors to be used in tailoring survivorship care. A review of geriatric literature was conducted through MEDLINE® and PubMed from 1997-2011 and focused on the pathophysiology of aging, cancer impact, and comorbidities in this population. Results were combined with previous research to provide an evidence-based approach to assessing older cancer survivors. The resulting assessment provides valuable information on the functional status of older adult patients with cancer. This assessment can be used by nurses to develop treatment plans and tailor management strategies to improve quality of life.

Hurria A.,Cancer and Aging Research Program
JNCCN Journal of the National Comprehensive Cancer Network | Year: 2013

Whether a patient is a candidate for cancer therapy goes far beyond the person's age. To evaluate an older adult for cancer treatment, oncologists must understand the benefits and quantify the risks of the proposed treatment, determine the patient's decision-making capacity, and make the decision in collaboration with the patient's preferences and values. In her presentation at the NCCN 18th Annual Conference, Dr. Arti Hurria discussed the major components in the comprehensive geriatric assessment in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Senior Adult Oncology, focusing on functional (rather than chronologic) age, comorbidities, nutritional status, cognitive impairment, and psychosocial support. By uncovering problems possibly left undetected on a routine history and physical examination, this assessment may lead to interventions that improve health and well-being in older people with cancer. © JNCCN-Journal of the National Comprehensive Cancer Network.

Pal S.K.,City of Hope Comprehensive Cancer Center | Katheria V.,City of Hope Comprehensive Cancer Center | Hurria A.,Cancer Control and Population science Program | Hurria A.,Cancer and Aging Research Program
CA Cancer Journal for Clinicians | Year: 2010

The majority of cancer incidence and mortality occurs in individuals aged older than 65 years, and the number of older adults with cancer is projected to significantly increase secondary to the aging of the US population. As such, understanding the changes accompanying age in the context of the cancer patient is of critical importance. Agerelated changes can impact tolerance of anticancer therapy and can shift the overall risk-benefit ratio of such treatment. A challenge in implementing evidence-based approaches in older adults is the under-representation of this group in oncology clinical trials. In addition, although older adults are particularly vulnerable to the side effects of cancer therapy, few oncology studies to date have incorporated a measure of health status other than the Eastern Cooperative Oncology Group or Karnofsky performance scales. Novel metrics such as frailty indices or the geriatric assessment recognize heterogeneity among older adults, and may allow for risk-adapted approaches to therapy. It is increasingly recognized that several laboratory markers may predict morbidity and mortality in older adults; these biologic variables may further aid in stratifying this group of patients based on risk. This review describes key studies from the geriatric literature that provide principles for assessing health status in the older patient, and ways that these principles can be applied to oncology care in an older population are proposed. ©2010 American Cancer Society, Inc.

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