Cancer and Aging Research Program

Duarte, CA, United States

Cancer and Aging Research Program

Duarte, CA, United States

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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.


McCleary N.J.,Dana-Farber Cancer Institute | Wigler D.,Dana-Farber Cancer Institute | Berry D.,Dana-Farber Cancer Institute | Sato K.,Dana-Farber Cancer Institute | And 9 more authors.
Oncologist | Year: 2013

Background. The Cancer-Specific Geriatric Assessment (CSGA) is a primarily self-administered paper survey of validated measures. Methods. We developed and tested the feasibility of a computer- based CSGA in patients ≥70 years of age who were receiving treatment for gastrointestinal malignancies at the Dana-Farber Cancer Institute. From December 2009 to June 2011, patientswereinvited tocompletetheCSGAat baseline (start of new treatment) and follow-up (at the first of 4 months later or within 4 weeks of completing treatment). Feasibility endpoints were proportion of eligible patients consented, proportion completing CSGA at baseline and follow- up,timetocompleteCSGA,andproportion of physicians reporting CSGA results that led to a change in clinical decision- making. Results. Of the 49 eligible patients, 38 consented (76% were treatment naive). Median age was 77 years (range: 70-89 years), and 48% were diagnosed with colorectal cancer. Mean physician-rated Karnofsky Performance Status was 87.5 at baseline (SD 8.4)and83.5 at follow-up (SD 8). At baseline, 92% used a touchscreen computer; 97% completed the CSGA (51% independently). At follow-up, all patients used a touchscreen computer; 71% completed the CSGA (41% independently). Mean time to completion was 23 minutes at baseline (SD 8.4) and 20 minutes at follow-up (SD 5.1). The CSGA added information to clinical assessment for 75% at baseline (n=27) and65%at follow-up (n=17), but it did not alter immediate clinical decision-making. Conclusion. The computer-based CSGA feasibility endpoints were met, although approximately half of patients required assistance. The CSGA added information to clinical assessmentbutdidnotaffect clinical decision-making, possiblydue to limited alternate treatment options in this subset of patients. © AlphaMed Press.


Pal S.K.,Cancer and Aging Research Program | Hurria A.,Cancer and Aging Research Program
Journal of Clinical Oncology | Year: 2010

A theme of personalized medicine was highlighted at the 2009 Annual Meeting of the American Society of Clinical Oncology. To this end, the current review focuses on the impact of host characteristics (such as age, sex, and comorbidity) as they pertain to cancer biology, treatment efficacy, and tolerance. Increasing age is associated with complex changes in physiology, including alterations in renal and hepatic function, and decreased bone marrow reserve. These may in turn result in alterations in pharmacokinetics and toxicity related to many commonly used anticancer agents. Using tools, such as the geriatric assessment, may help to elucidate the physiologic age of the patient as opposed to the chronologic age. Increasing age is paralleled by an increase in comorbidity, and comorbidity may have independent prognostic implications and substantially impact medical decision making in the patient with cancer. Numerous biologic ties between cancer and comorbidity exist, one example being an association of diabetes with an increased risk of disease recurrence and mortality in the setting of colon cancer. Biologic features can also vary by sex; several biomarkers with either prognostic or predictive value (ie, excision-repair cross-complementation group 1 expression, epidermal growth factor receptor mutation, or dihydropyrimidine dehydrogenase polymorphism) may differentiate efficacy or toxicity in males and females. Taken together, age, sex, and comorbidity each encompass a complex array of physiologic and molecular variations that may each aid in personalizing care for the patient with cancer. © 2010 by American Society of Clinical Oncology.


Dotan E.,Chase Medical | Browner I.,Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins | Hurria A.,Cancer and Aging Research Program | Denlinger C.,Chase Medical
JNCCN Journal of the National Comprehensive Cancer Network | Year: 2012

Most patients with colon cancer are older than 65 years. Their treatment poses multiple challenges, because they may have age-related comorbidities, polypharmacy, and physical or physiologic changes associated with older age. These challenges include limited data on the ability to predict tolerance to anticancer therapy and the appropriate use of treatment modalities in the setting of comorbidity and concurrent frailty. The low number of older patients enrolled in large clinical trials results in a paucity of evidence to guide oncologists in the appropriate management of this population. In early-stage disease, clinical dilemmas arise regarding the ability of older patients to undergo successful curative surgical procedures and the risk/benefit ratio of adjuvant chemotherapy. The management of metastatic disease raises questions regarding the clinical benefit of various anticancer therapies and the role of combination therapy with possible increased toxicity in the noncurative setting. Overall, the available evidence shows that fit older patients are able to tolerate treatment and derive similar clinical benefits to younger patients. Limited data are available to guide treatment for less-fit, more-vulnerable older patients. This lack of data leads to variations in treatment patterns in older adults, making them less likely to receive standard therapies. This review provides an overview of the available data regarding the management of older adults with colon cancer in the adjuvant and metastatic settings. © JNCCN-Journal of the National Comprehensive Cancer Network.


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.


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.


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.


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.


Runowicz C.D.,Florida International University | Leach C.R.,Cancer and Aging Research | Henry N.L.,University of Michigan | Henry K.S.,University of Miami | And 12 more authors.
CA Cancer Journal for Clinicians | Year: 2016

Answer questions and earn CME/CNE The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made. CA Cancer J Clin 2016;43-73. © 2015 American Cancer Society.


PubMed | University of Michigan, Cancer and Aging Research, Fred Hutchinson Cancer Research Center, University of Miami and 12 more.
Type: Journal Article | Journal: CA: a cancer journal for clinicians | Year: 2016

Answer questions and earn CME/CNE The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.

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