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Biomedical subjects

Martine Extermann

Publications and source records attributed to Martine Extermann.

At least 19 recordsLinked to original sources
PubMed2006

Impact of breast cancer survivorship on quality of life in older women.

Quality of life (QOL) is an important outcome for cancer survivors; but although age is a major risk factor, most breast cancer survivorship studies are conducted with younger women. The objective of our study was to compare QOL in a sample of older breast cancer survivors to a sample of older women who were never diagnosed with breast cancer. A sample of 127 older breast cancer survivors as identified by a cancer registry was compared to a demographically equated sample of 87 older women participating in an epidemiological study. Both groups completed a questionnaire and participated in an interview to measure QOL. The older breast cancer survivors scored worse in the Medical Outcomes Study-Short Form, a measure of health-related QOL. Survivors reported no more depressive symptoms or anxious mood than the comparison group, but scored lower in measures of positive psychosocial well-being, including life satisfaction, mastery, and spiritual well-being, and reported more depressed mood and days affected by fatigue. Older breast cancer survivors show multiple indications of decrements in their health-related quality of life, and lower psychosocial well-being than the comparison group. These decrements may represent deficits in reserve capacity that predispose older cancer survivors to functional disability but may not be readily detected in typical clinical evaluations given the multiple impairments common in geriatric populations. Results suggest a need for greater attention to promoting functioning and psychological well-being among older cancer survivors, even when they may not have obvious cancer-related medical complications.

Aged↗
PubMed2006

The abbreviated comprehensive geriatric assessment (aCGA) for use in the older cancer patient as a prescreen: scoring and interpretation.

UNLABELLED: The abbreviated CGA (aCGA) can be used as a prescreening assessment to identify patients who would most benefit from the complete CGA. OBJECTIVE: To develop cutpoints for scoring the aCGA that are consistent with existing limitations as revealed by the full CGA. DESIGN/SETTING: A retrospective chart review of patients at the H. Lee Moffitt Cancer Center. PARTICIPANTS: Over 500 charts between 1995 and 2001 were reviewed on cancer patients 70 and over. MEASUREMENTS: Each of the four domains: functional status (activities of daily living (ADL), instrumental activities of daily living (IADL), depression, using the geriatric depression scale (GDS), and cognition using the mini-mental state examination (MMSE)) are scored separately. RESULTS: For the depression domain, a score of 2 or more toward depression indicates that the entire GDS be administered. For the MMSE, a score of 6 or lower indicates necessity of the entire MMSE. For the ADL/IADL, any deficit on either scale (needs assistance or complete assistance) requires further clinical evaluation using the entire instruments. CONCLUSIONS: These guidelines provide the clinician with parameters to target patients most likely to benefit from more intensive geriatric evaluation.

Activities of Daily Living↗
PubMed2006

Performance status and comorbidity predict transplant-related mortality after allogeneic hematopoietic cell transplantation.

Comorbidity measurements have recently been used to improve estimation of tolerance to allogeneic hematopoietic cell transplantation (HCT). We sought to determine the independent effect of comorbidity and performance status on HCT outcome and to devise a simple risk classification system for transplant-related mortality. We analyzed 105 consecutively enrolled patients who underwent HCT and received reduced intensity conditioning with fludarabine, melphalan, and alemtuzumab. Comorbid conditions were tabulated using 2 scales, the Charlson Comorbidity Index (CCI) and the Kaplan-Feinstein Scale (KFS). Comorbid conditions were found in 47% of patients by the KFS and in 27% by the CCI (P < .001). Using the Eastern Cooperative Oncology Group Performance Status (PS) scale, 34% had a PS score >0 (range, 0-2). A simple scale combining the KFS and PS enabled separation of high- from low-risk patients, with 6-month cumulative incidences 50% and 15%, respectively for transplant-related mortality (P = .001) and enhanced prognostic power over the CCI alone (P = .018). Prospective studies evaluating more comprehensive functional and comorbidity measurements are warranted.

Adult↗
PubMed2006

Treating advanced breast cancer in the older woman.

As half of all breast cancers occur in patients beyond the age of 65 and a quarter beyond the age of 75, a significant number of patients with metastatic breast cancer are elderly. New hormonal therapies, such as aromatase inhibitors, appear to have favorably improved the survival of these patients. Side effects such as osteoporosis or cognitive issues appear manageable. Information specific to elderly patients has recently emerged in the field of chemotherapy for metastatic breast cancer. This article reviews data on anthracyclines, taxanes, capecitabine (Xeloda), gemcitabine (Gemzar), trastuzumab (Herceptin), and bevacizumab (Avastin). For most patients in this setting, sequential single-agent chemotherapy appears at this time to be the preferred course of treatment.

Antibodies, Monoclonal↗
PubMed2005

Pilot testing of the computerized cognitive test Microcog in chemotherapy-treated older cancer patients.

BACKGROUND: Chemotherapy has a potential for inducing cognitive side effects. However, no study has focused on elderly cancer patients, a group that might be at risk for this complication. Computerized cognitive tests are available and could simplify cooperative group studies on the matter, but have not been applied to older cancer patients. METHODS: We tested the performance of Microcog (short form) in a sample of 10 consecutive cancer patients, aged 70 and older, having received chemotherapy. Patients were also asked by questionnaire to express their comments on the test. RESULTS: Six patients had never used a computer. All reported at least minor visual impairment. All did complete the test without pause. Nine out of 10 thought that most patients like them would have no problems completing the test. As a group, our patient sample generally performed within normal limits for age and education. There were a wide range of scores for the majority of the subscales, with the greatest variability of scores in Spatial Processing and Information Processing Accuracy and the least variability in reaction time. The results were robust when assessed by level of computer literacy, minor auditory and visual problems, and fluent English as a second language. CONCLUSIONS: A computer test such as Microcog appears well feasible in older cancer patients. It appears robust to comorbidity. This bodes well for a potential use of such tests in trials conducted in this patient population.

Aged↗
PubMed2005

The abbreviated comprehensive geriatric assessment (aCGA): a retrospective analysis.

BACKGROUND: A comprehensive geriatric assessment (CGA) is a multidimensional assessment that is designed to detect health problems. A barrier to conducting the CGA is the length of time required to complete the entire assessment. OBJECTIVE: To understand what items contained in the instruments that make up the CGA could be compiled to construct an abbreviated CGA (aCGA). DESIGN/SETTING: A retrospective chart review of patients at the H. Lee Moffitt Cancer Center. PARTICIPANTS: Over 500 charts between 1995 and 2001 were reviewed on patients 70 and over. MEASUREMENTS: Item-to-total correlations and Cronbach's alpha coefficient were calculated. Construct validity was assessed using a Pearson's product moment correlation coefficient. RESULTS: Fifteen items were compiled to form the aCGA. Cronbach's alpha was 0.65-0.92 on each instrument of the entire CGA compared to 0.70-0.94 on the aCGA. Correlations ranged from 0.84 to 0.96 for the entire CGA and the aCGA. CONCLUSION: An aCGA can be helpful in screening for those seniors who would benefit from the entire CGA.

Activities of Daily Living↗
PubMed2005

Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG).

BACKGROUND: As more and more cancers occur in elderly people, oncologists are increasingly confronted with the necessity of integrating geriatric parameters in the treatment of their patients. METHODS: The International Society of Geriatric Oncology (SIOG) created a task force to review the evidence on the use of a comprehensive geriatric assessment (CGA) in cancer patients. A systematic review of the evidence was conducted. RESULTS: Several biological and clinical correlates of aging have been identified. Their relative weight and clinical usefulness is still poorly defined. There is strong evidence that a CGA detects many problems missed by a regular assessment in general geriatric and in cancer patients. There is also strong evidence that a CGA improves function and reduces hospitalization in the elderly. There is heterogeneous evidence that it improves survival and that it is cost-effective. There is corroborative evidence from a few studies conducted in cancer patients. Screening tools exist and were successfully used in settings such as the emergency room, but globally were poorly tested. The article contains recommendations for the use of CGA in research and clinical care for older cancer patients. CONCLUSIONS: A CGA, with or without screening, and with follow-up, should be used in older cancer patients, in order to detect unaddressed problems, improve their functional status, and possibly their survival. The task force cannot recommend any specific tool or approach above others at this point and general geriatric experience should be used.

Advisory Committees↗
PubMed2005

Cancer in the older person.

Cancer in the older person is an increasingly common problem, due to the progressive prolongation of the life-expectancy of the Western population. This article reviews the mechanisms associating aging and cancer, age-related changes in cancer biology, assessment of the older person to estimate life-expectancy, treatment tolerance, and medical and social conditions that may interfere with cancer treatment, effectiveness of cancer prevention and cancer treatment in older individuals. A comprehensive geriatric assessment (CGA) is commonly used to predict life-expectancy and functional reserve and to unearth conditions that may jeopardize cancer prevention and treatment. In the interest of cost and time, shortened forms of CGA are being explored. Chemoprevention of cancer is a promising form of prevention that at present has no conclusive clinical indications. Early diagnosis of breast and colon cancer through screening of asymptomatic patients at risk may be beneficial for individuals with a life-expectancy of 5 years or longer. Early detection of lung cancer in ex-smokers is undergoing clinical trials, as this disease is becoming more and more common. Age should not prevent appropriate treatment of cancer in older individuals, especially in those with adequate life-expectancy and functional reserve. The National Cancer Center Network (NCCN) has issued a series of guidelines to minimize the toxicity and promote the effectiveness of cancer in older patients. Important interventions include prevention of neutropaenic infections with filgrastim and peg-filgrastim, prevention of anaemia with epoietin or darbepoietin, and prevention and early management of mucositis.

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PubMed2005

Toward optimal screening strategies for older women. Costs, benefits, and harms of breast cancer screening by age, biology, and health status.

CONTEXT: Optimal ages of breast cancer screening cessation remain uncertain. OBJECTIVE: To evaluate screening policies based on age and quartiles of life expectancy (LE). DESIGN AND POPULATION: We used a stochastic model with proxies of age-dependent biology to evaluate the incremental U.S. societal costs and benefits of biennial screening from age 50 until age 70, 79, or lifetime. MAIN OUTCOME MEASURES: Discounted incremental costs per life years saved (LYS). RESULTS: Lifetime screening is expensive (151,434 dollars per LYS) if women have treatment and survival comparable to clinical trials (idealized); stopping at age 79 costs 82,063 dollars per LYS. This latter result corresponds to costs associated with an LE of 9.5 years at age 79, a value expected for 75% of 79-year-olds, about 50% of 80-year-olds, and 25% of 85-year-olds. Using actual treatment and survival patterns, screening benefits are greater, and lifetime screening of all women might be considered (114,905 dollars per LYS), especially for women in the top 25% of LE for their age (50,643 dollars per LYS, life expectancy of approximately 7 years at age 90). CONCLUSIONS: If all women receive idealized treatment, the benefits of mammography beyond age 79 are too low relative to their costs to justify continued screening. However, if treatment is not ideal, extending screening beyond age 79 could be considered, especially for women in the top 25% of life expectancy for their age.

Age Factors↗
PubMed2005

Never too old? Age should not be a barrier to enrollment in cancer clinical trials.

Throughout Europe and the U.S., over 60% of the total incidence of cancer occurs in the elderly (> or =65 years) population, a patient group that requires particular consideration when making treatment decisions due to a number of factors. Despite this, elderly patients are generally under-represented in clinical trials such that study data should be interpreted with caution because results in younger cancer patients may not always extrapolate to the typical elderly cancer patient. Reports suggest that elderly cancer patients represent around 22% of patients enrolled in phase II clinical studies. Barriers to the accrual of elderly patients to clinical trials include lack of appropriate trials, high burden of comorbidity, study-imposed restrictions, and attitudes of physicians. There is a belief that elderly patients may be unable to tolerate various cancer therapies, which may result in this patient population being excluded from prospective trials. However, clinical data demonstrate that age alone is not a sufficient reason to withhold treatment. Lack of clinical trial data and the associated lack of evidence-based guidelines for elderly patients mean physicians have little to guide them, with the result that patients may not receive the optimal therapy. As clinical trials are the primary method of evaluating the efficacy and safety of adjuvant and palliative cancer therapies, trials that specifically target the elderly cancer patient are required to adequately assess the risks and benefits of treatment in this vulnerable population. This review aims to assess the clinical reality and clinical trial age mismatch to evaluate implications for elderly cancer patients and to identify how this situation may be addressed. Possible reasons for the disparity, and the resulting clinical consequences, are also considered.

Age Factors↗
PubMed2005

Older patients, cognitive impairment, and cancer: an increasingly frequent triad.

The incidence of both cancer and cognitive impairments from various origins increases with age. Oncologists are increasingly being confronted with cancers occurring in patients with cognitive impairment, yet very few studies have addressed the problem. Cognitive impairment affects a patients' survival to an extent similar to an average cancer, and this can be an important thing to consider, especially in the adjuvant setting. Cognitive impairment also predisposes patients to delirium in the surgery setting or during hospitalization. Because effective preventive measures exist, careful attention should be paid to identifying patients at risk. Cognitive impairment does not automatically mean inability to consent, but particular precautions should be taken. For outpatient treatments such as chemotherapy, a comprehensive multidisciplinary approach is key for a good outcome. Proper caregiver support should be ensured up-front, and aggressive supportive care should be used. In the setting of an experienced geriatric oncology team, patients with cognitive impairment appear more likely to receive standard oncologic therapies. Cancer patients with cognitive impairment are at high risk of concomitant depression.

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PubMed2004

Management issues for elderly patients with breast cancer.

Fifty percent of breast cancers occur after the age of 65 years and 25% occur after the age of 75 years. Encountering a breast cancer in an older woman is frequent. After years of dearth of data specific to the elderly, some evidence is beginning to accumulate concerning breast cancer in the older woman. Recent data from mammography studies confirm its effective in women with 10 years or more of life expectancy (perhaps even 5 years). Epidemiologic and randomized studies demonstrate that a proper surgery and adjuvant treatment can decrease relapse and improve survival in patients older than 80 years. Radiation therapy studies show a decrease in local relapse even in patients older than 70 years. Adjuvant hormonal therapy has essentially the same effectiveness as in younger women. Chemotherapy has a role in patients older than 70 years. Consensus statements, such as the St. Gallen consensus, have dropped the age limit of 70 years from their recommendations. Comorbidity and life expectancy should be taken into account for proper selection of adjuvant treatment. The treatment of metastatic breast cancer has evolved significantly with the introduction of aromatase inhibitors, new chemotherapeutic agents, and targeted biologic agents. New chemotherapeutic agents are as effective as single agents compared to older and more toxic drug combinations. The cumulative result of the introduction of these new agents, at a population level, is a 7.5-month increase in the median survival time of patients with metastatic breast cancer over the past decade.

Aged↗
PubMed2004

A comprehensive geriatric intervention detects multiple problems in older breast cancer patients.

UNLABELLED: Studies of comprehensive geriatric assessment (CGA) have shown the importance of follow-up for effectiveness, but this has not been tested in an oncology clinic. In this pilot study, we enrolled 15 early breast cancer patients, aged 70 and older. They received a multidisciplinary CGA every 3 months and structured follow-up from the SAOP nurse practitioner, dietitian, social worker, and pharmacist according to risk. Total follow-up was 6 months. Median age of evaluable patients was 79 years (range 72-87). Median number of comorbidities by Cumulative Index Rating Scale-Geriatric (CIRS-G) was 5 (3-9) at baseline. Ten patients were at pharmacological risk, five at psychosocial risk, and eight at nutritional risk. Patients presented on average six problems initially, and three new problems during follow-up. The intervention directly influenced oncological treatment in four cases. It ensured continuity/coordination of care in seven cases. Success rate in addressing problems was 87%. Mean Functional Assessment of Cancer Treatment-Breast (FACT-B) scores improved from 110.5 (S.D. 16.7) to 116.3 (S.D. 16.5) (t=0.025). Function and independence were maintained. CONCLUSIONS: Older patients with early breast cancer have a high prevalence of comorbidity. A CGA with follow-up has potential for improving the treatment and prognosis of these patients and is feasible in an academic oncology setting.

Aged↗
PubMed2003

Are older French patients as willing as older American patients to undertake chemotherapy?

PURPOSE: A view often held in Europe is that older Europeans are less willing than older Americans to undertake chemotherapy. This study assesses whether this view is valid. PATIENTS AND METHODS: Three-hundred twenty outpatients aged 70 years and older were interviewed via anonymous questionnaires: French patients with and without cancer and American patients with and without cancer. The response rate was 61% (195 of 320 questionnaires). Ages ranged from 70 to 95 years (29% aged 80 years and older). Two scenarios were presented: a strong chemotherapy (platinum/taxane combination-like) and a milder chemotherapy (weekly vinorelbine-like). The options were to refuse chemotherapy or to accept for a threshold chance of cure, of life prolongation, or of symptom relief. Functional status, education, self-rated health, and depression were controlled for. RESULTS: French noncancer patients (34%) were less willing to accept the strong chemotherapy than French cancer patients (77.8%), American noncancer patients (73.8%), and American cancer patients (70.5%) (P <.001 for each pair). This was also true for the moderate chemotherapy (67.9% v 100%, 95.2%, and 88.5%, respectively; P <.001). Age and sex did not correlate with response, but self-rated health, cancer status, and nationality did. Thresholds varied from patient to patient. CONCLUSION: Whereas older French people without cancer are more reluctant than older Americans to envision chemotherapy, older cancer patients in both countries have the same amenability to treatment. Chemotherapy options should be fully discussed with older cancer patients, given that most are willing to consider them.

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