Mostafa R Mohamed1, Kaitlin Kyi2, Supriya G Mohile3, Huiwen Xu4, Eva Culakova4, Kah Poh Loh3, Marie Flannery5, Spencer Obrecht3, Erika Ramsdale3, Amita Patil3, Richard F Dunne3, Grace DiGiovanni3, Aram Hezel3, Brian Burnette6, Nisarg Desai7, Jeffrey Giguere8, Allison Magnuson9. 1. James P Wilmot Cancer Institute, University of Rochester, New York, USA; Department of Public Health Sciences, University of Rochester, New York, USA. 2. Department of Medicine, University of Rochester, Rochester, New York, USA. 3. James P Wilmot Cancer Institute, University of Rochester, New York, USA. 4. Department of Surgery, Cancer Control, University of Rochester, New York, USA. 5. School of Nursing, University of Rochester, New York, USA. 6. Cancer Research of Wisconsin and Northern Michigan, NCORP, USA. 7. Beebe Healthcare, Lewes, Delaware, NCORP, USA. 8. NCORP of the Carolinas, Prisma Health System, USA. 9. James P Wilmot Cancer Institute, University of Rochester, New York, USA. Electronic address: allison_magnuson@urmc.rochester.edu.
Abstract
INTRODUCTION: Treatment toxicities are common in older adults with cancer and consequently, treatment modifications are sometimes considered. We evaluated the prevalence and factors associated with treatment modifications at the first cycle in older patients receiving palliative systemic treatment. METHODS: Patients (n = 369) from the GAP 70+ Trial (NCT02054741; PI: Mohile) usual care arm were included. Enrolled patients were aged 70+ with advanced cancer and ≥ 1 Geriatric Assessment (GA) domain impairment. Treatment modification was defined as any change from National Comprehensive Cancer Network guidelines or published clinical trials. Baseline variables included: 1) sociodemographic factors; 2) clinical variables; 3) GA domains; and 4) physician beliefs about life expectancy. Bivariate analyses and multivariable cluster-weighted generalized estimating equation model were conducted to assess the association of baseline variables with cycle 1 treatment modifications. RESULTS: Mean age was 77.2 years (range: 70-94); 62% had lung or gastrointestinal cancers, and 35% had treatment modifications at cycle 1. Increasing age by one year (odds ratio (OR) 1.1, 95% confidence interval [CI] 1.0-1.2), receipt of ≥second line of chemotherapy (OR 1.8, CI 1.1-3.0), functional impairment (OR 1.6, CI 1.1-2.3) and income ≤$50,000 (OR 1.7, CI 1.1-2.4) were independently associated with a higher likelihood of cycle 1 treatment modification. CONCLUSION: Treatment modifications occurred in 35% of older adults with advanced cancer at cycle 1. Increasing age, receipt of ≥second line of chemotherapy, functional impairment, and lower income were independently associated with treatment modifications. These findings emphasize the need for evidence-based regimens in older adults with cancer and GA impairments.
INTRODUCTION: Treatment toxicities are common in older adults with cancer and consequently, treatment modifications are sometimes considered. We evaluated the prevalence and factors associated with treatment modifications at the first cycle in older patients receiving palliative systemic treatment. METHODS: Patients (n = 369) from the GAP 70+ Trial (NCT02054741; PI: Mohile) usual care arm were included. Enrolled patients were aged 70+ with advanced cancer and ≥ 1 Geriatric Assessment (GA) domain impairment. Treatment modification was defined as any change from National Comprehensive Cancer Network guidelines or published clinical trials. Baseline variables included: 1) sociodemographic factors; 2) clinical variables; 3) GA domains; and 4) physician beliefs about life expectancy. Bivariate analyses and multivariable cluster-weighted generalized estimating equation model were conducted to assess the association of baseline variables with cycle 1 treatment modifications. RESULTS: Mean age was 77.2 years (range: 70-94); 62% had lung or gastrointestinal cancers, and 35% had treatment modifications at cycle 1. Increasing age by one year (odds ratio (OR) 1.1, 95% confidence interval [CI] 1.0-1.2), receipt of ≥second line of chemotherapy (OR 1.8, CI 1.1-3.0), functional impairment (OR 1.6, CI 1.1-2.3) and income ≤$50,000 (OR 1.7, CI 1.1-2.4) were independently associated with a higher likelihood of cycle 1 treatment modification. CONCLUSION: Treatment modifications occurred in 35% of older adults with advanced cancer at cycle 1. Increasing age, receipt of ≥second line of chemotherapy, functional impairment, and lower income were independently associated with treatment modifications. These findings emphasize the need for evidence-based regimens in older adults with cancer and GA impairments.
Authors: Allison Magnuson; Heather Allore; Harvey Jay Cohen; Supriya G Mohile; Grant R Williams; Andrew Chapman; Martine Extermann; Rebecca L Olin; Valerie Targia; Amy Mackenzie; Holly M Holmes; Arti Hurria Journal: J Geriatr Oncol Date: 2016-07-05 Impact factor: 3.599
Authors: Matthew T Seymour; Lindsay C Thompson; Harpreet S Wasan; Gary Middleton; Alison E Brewster; Stephen F Shepherd; M Sinead O'Mahony; Timothy S Maughan; Mahesh Parmar; Ruth E Langley Journal: Lancet Date: 2011-05-11 Impact factor: 79.321
Authors: Ronald M Epstein; Paul R Duberstein; Joshua J Fenton; Kevin Fiscella; Michael Hoerger; Daniel J Tancredi; Guibo Xing; Robert Gramling; Supriya Mohile; Peter Franks; Paul Kaesberg; Sandy Plumb; Camille S Cipri; Richard L Street; Cleveland G Shields; Anthony L Back; Phyllis Butow; Adam Walczak; Martin Tattersall; Alison Venuti; Peter Sullivan; Mark Robinson; Beth Hoh; Linda Lewis; Richard L Kravitz Journal: JAMA Oncol Date: 2017-01-01 Impact factor: 31.777
Authors: Carolyn J Presley; Mostafa R Mohamed; Eva Culakova; Marie Flannery; Pooja H Vibhakar; Rebecca Hoyd; Arya Amini; Noam VanderWalde; Melisa L Wong; Yukari Tsubata; Daniel J Spakowicz; Supriya G Mohile Journal: Front Oncol Date: 2022-03-31 Impact factor: 5.738