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Arti Hurria - One of the best experts on this subject based on the ideXlab platform.
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Identifying Geriatric Oncology Competencies for Medical Oncology Trainees: A Modified Delphi Consensus Study.
The oncologist, 2020Co-Authors: Tina Hsu, Holly M. Holmes, Allison Magnuson, William Dale, Ronald J. Maggiore, Ajeet Gajra, Elizabeth R. Kessler, Ira R. Parker, June M. Mckoy, Arti HurriaAbstract:Background Most Oncology trainees are not taught about the needs of older patients, who make up the majority of patients with cancer. Training of health care providers is critical to improve the care of older adults with cancer. There is no consensus about which Geriatric Oncology (GO) competencies are important for medical Oncology trainees. Our objective was to identify GO competencies medical Oncology trainees should acquire during training. Materials and methods A modified Delphi consensus of experts in Oncology medical education and GO was conducted. Experts categorized at what training stage proposed competencies should be attained: internal medicine, Oncology, or GO training. Consensus was obtained if two thirds of experts agreed on the training stage at which the competency should be attained. Results A total of 78 potential competencies were identified, of which 35 (44.9%) proposed competencies were felt to be appropriate to be acquired during Oncology training. The majority of the identified competencies pertained to prescribing of systemic therapy (n = 12) and psychosocial and supportive care (n = 13). No competencies related to Geriatric assessment were identified for acquisition during Oncology training. Conclusion Experts in Oncology education and Geriatric Oncology agreed upon a set of GO competencies appropriate for Oncology trainees. These results provide the foundation for developing a GO curriculum for medical Oncology trainees and will hopefully lead to better care of older adults with cancer. Implications for practice The aging population will drive the projected rise in cancer incidence. Although aging patients make up the majority of patients diagnosed with cancer, oncologists rarely receive training on how to care for them. Training of health care providers is critical to improving the care of older adults with cancer. The results of this study will help form the foundation of developing a Geriatric Oncology curriculum for medical Oncology trainees.
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Hematology-Oncology Fellows' Training in Geriatrics and Geriatric Oncology: Findings From an American Society of Clinical Oncology-Sponsored National Survey.
Journal of Oncology Practice, 2017Co-Authors: Ronald J. Maggiore, Supriya G. Mohile, Arti Hurria, William Dale, Heidi D. Klepin, Andrew E. Chapman, Efrat Dotan, Arash Naeim, Ajeet Gajra, Mary K. BussAbstract:Purpose:Older adults compose the majority of patients with cancer in the United States; however, it is unclear how well Geriatrics or Geriatric Oncology training is being incorporated into hematology-Oncology (hem-onc) fellowships.Methods:A convenience sample of hem-onc fellows completed a (written or electronic) survey assessing their education, clinical experiences, and perceived proficiency in Geriatric Oncology during training; knowledge base in Geriatric Oncology; confidence in managing older adults with cancer; and general attitudes toward Geriatric Oncology principles.Results:Forty-five percent of respondents (N = 138) were female, 67% were based in the United States, and most (60%) were past their first year of training. Most fellows rated Geriatric Oncology as important or very important (84%); however, only 25% reported having access to a Geriatric Oncology clinic and more than one half (53%) reported no lectures in Geriatric Oncology. Fellows reported fewer educational experiences in Geriatric ...
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Hematology-Oncology Fellows' Training in Geriatrics and Geriatric Oncology: Findings From an American Society of Clinical Oncology-Sponsored National Survey.
Journal of oncology practice, 2017Co-Authors: Ronald J. Maggiore, Supriya G. Mohile, Arti Hurria, William Dale, Heidi D. Klepin, Efrat Dotan, Arash Naeim, Ajeet Gajra, Andrew Chapman, Mary K. BussAbstract:Older adults compose the majority of patients with cancer in the United States; however, it is unclear how well Geriatrics or Geriatric Oncology training is being incorporated into hematology-Oncology (hem-onc) fellowships. A convenience sample of hem-onc fellows completed a (written or electronic) survey assessing their education, clinical experiences, and perceived proficiency in Geriatric Oncology during training; knowledge base in Geriatric Oncology; confidence in managing older adults with cancer; and general attitudes toward Geriatric Oncology principles. Forty-five percent of respondents (N = 138) were female, 67% were based in the United States, and most (60%) were past their first year of training. Most fellows rated Geriatric Oncology as important or very important (84%); however, only 25% reported having access to a Geriatric Oncology clinic and more than one half (53%) reported no lectures in Geriatric Oncology. Fellows reported fewer educational experiences in Geriatric Oncology than in nonGeriatric Oncology. For example, among procedure-based activities, 12% learned how to perform a Geriatric assessment but 78% learned how to perform a bone marrow biopsy ( P < .05). Of those completing the knowledge-based items, 41% were able to identify correctly the predictors of chemotherapy toxicity in older adults with cancer. Despite the prevalence of cancer in older adults, hem-onc fellows report limited education in or exposure to Geriatric Oncology. The high value fellows place on Geriatric Oncology suggests that they would be receptive to additional training in this area.
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Geriatric Assessment-Guided Care Processes for Older Adults: A Delphi Consensus of Geriatric Oncology Experts.
Journal of the National Comprehensive Cancer Network : JNCCN, 2015Co-Authors: Supriya G. Mohile, Arti Hurria, Anita O'donovan, Chintan Pandya, Allison Magnuson, Carla Velarde, Lisa M. Lowenstein, Rita Gorawara-bhat, William DaleAbstract:Background Structured care processes that provide a framework for how oncologists can incorporate Geriatric assessment (GA) into clinical practice could improve outcomes for vulnerable older adults with cancer, a growing population at high risk of toxicity from cancer treatment. We sought to obtain consensus from an expert panel on the use of GA in clinical practice and to develop algorithms of GA-guided care processes. Methods The Delphi technique, a well-recognized structured and reiterative process to reach consensus, was used. Participants were Geriatric Oncology experts who attended NIH-funded U13 or Cancer and Aging Research Group conferences. Consensus was defined as an interquartile range of 2 or more units, or 66.7% or greater, selecting a utility/helpfulness rating of 7 or greater on a 10-point Likert scale. For nominal data, consensus was defined as agreement among 66.7% or more of the group. Results From 33 invited, 30 participants completed all 3 rounds. Most experts (75%) used GA in clinical care, and the remainder were involved in Geriatric Oncology research. The panel met consensus that "all patients aged 75 years or older and those who are younger with age-related health concerns" should undergo GA and that all domains (function, physical performance, comorbidity/polypharmacy, cognition, nutrition, psychological status, and social support) should be included. Consensus was met for how GA could guide nononcologic interventions and cancer treatment decisions. Algorithms for GA-guided care processes were developed. Conclusions This Delphi investigation of Geriatric Oncology experts demonstrated that GA should be performed for older patients with cancer to guide care processes.
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Geriatric Oncology: An Overview
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014Co-Authors: Stuart M. Lichtman, Arti Hurria, Paul B. JacobsenAbstract:It is a great privilege for us to introduce the second special issue of Journal of Clinical Oncology (JCO) to be devoted to Geriatric Oncology. The first special issue, which was published in 2007, focused on the treatment of cancers in older adults, with a specific call for additional research given the impending rise in the number of older adults with cancer. The demographic shift and the resultant increase in the number of elderly patients with cancer, which was predicted by the founders of Geriatric Oncology (Kennedy, Yancik, and others), has now arrived. It has long been recognized that the most significant risk factor for the development of cancer is aging. Cancer and its treatment can affect the overall life expectancy as well as the active life expectancy and functioning of older individuals. The traditional study of cancer, with its focus on younger, healthier patients, has resulted in a lack of high-quality data to adequately guide care for older patients. In 1983, Yancik organized a symposium sponsored by the National Cancer Institute and the National Institute on Aging and published a monograph, “Perspectives on Prevention and Treatment of Cancer in the Elderly,” which highlighted the importance of research in cancer and aging. In the 1988 American Society of Clinical Oncology (ASCO) Presidential Address, Kennedy encouraged the study of aging and cancer. He stated, “Our society need not ration how we will treat our disadvantaged members, but should continue to seek those preventive and positive measures that can shorten our later period of morbidity. A very major cancer load will persist well into the 21st century, even if the attempts at prevention are eventually a total success... There is a developing knowledge on aging. Care of the older person needs to be part of medical education and Oncology education. Research will help attain a desirable quality of life with aging and a reduced morbidity.” The goals set forth by Yancik and Kennedy are yet to be fully achieved; however, many strides have been made toward those ends. There has been increased recognition of the importance of the relationship between aging and cancer, as well as an increase in evidencebased research to guide the care of older adults with cancer. In addition, this research is being performed by a growing number of investigators at institutions across the nation, as well as internationally. The International Society of Geriatric Oncology, founded in the year 2000, fosters the mission of developing health professionals in the field of Geriatric Oncology to optimize treatment of older adults with cancer through education, clinical practice, and research. The Society’s publication, Journal of Geriatric Oncology, is the first journal devoted solely to the field. The Cancer and Leukemia Group B (now the Alliance for Clinical Trials in Oncology) Cancer in the Elderly Committee has supported furthering research in Geriatric Oncology through clinical trials and secondary data analyses. The Cancer and Aging Research Group has developed an instrument to predict chemotherapy toxicity, initiated and supported trials to validate this methodology in different clinical settings, and, most importantly, mentored junior investigators in Geriatric Oncology. The Elderly Taskforce of the Gynecologic Oncology Group is supporting the first prospective trial in older women with ovarian cancer and planning additional studies in other diseases and modalities. ASCO has also fostered a number of initiatives in Geriatric Oncology. These include a Geriatric Oncology Issue Exploration Team; educational materials, including some offered through ASCO University; sessions at the Annual Meeting, including a Geriatric Oncology track; the B.J. Kennedy Award for Excellence in Geriatric Oncology; and a Geriatric Oncology component of the Cancer Education Committee. This special issue of JCO highlights the achievements of researchers in the field, brings clinical oncologists up to date on evidence-based treatment recommendations for older patients with cancer, and highlights gaps in knowledge to stimulate ideas for future research. The issue can be subdivided into a number of broad topics, including disease-specific reviews in Geriatric Oncology, the approach to clinical trial design in older adults, assessment of the older patient with cancer, and survivorship issues that face older adults. The diseases highlighted are those that contribute significantly to the cancer burden of older patients, including breast, lung, colon, and prostate cancer, as well additional areas where important clinical advances have been made, such as acute leukemia, ovary cancer, and multiple myeloma. Advances in clinical trial design and patient evaluation are critical to efforts to improve the quality of care for the older patient. There is a need for both elderly specific trials and for increases in the overall participation of older patients in clinical trials. Investigators in Geriatric Oncology have been evaluating various clinical trial design components to enroll a population of patients who are more representative of the older patients seen in practice (eg, patients with multiple comorbidities and impairments in function). A new approach is imperative to obtain meaningful data that can be easily applied to daily treatment decisions for older adults with cancer. This issue includes a general overview of clinical trial design and the role of biomarkers in cancer and aging research. Components of patient selection for clinical trials and patient evaluation in standard practice are discussed, including a comprehensive Geriatric assessment. JOURNAL OF CLINICAL Oncology S P E C I A L S E R I E S O V E R V I E W VOLUME 32 NUMBER 24 AUGUST 2
Supriya G. Mohile - One of the best experts on this subject based on the ideXlab platform.
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The Globalization of Geriatric Oncology: From Data to Practice
American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting, 2020Co-Authors: Ravindran Kanesvaran, Supriya G. Mohile, Enrique Soto-perez-de-celis, Harpreet SinghAbstract:Older adults with cancer are a unique group of patients who require specialized care and treatment. The field of Geriatric Oncology (GO) was born more than 3 decades ago to address the needs of this growing group of patients. Some challenges in the GO field include establishing a GO clinical service, educating and training personnel, and conducting research in GO. These issues are addressed to varying extents with global initiatives in GO, which are largely dependent on the socioeconomic status of the countries involved. To overcome disparities seen globally, scientific journals that reach an international cancer audience should publish content related to improving care of older adults with cancer around the world, develop an organizational structure that encourages global dissemination of GO knowledge, and advance reporting policies that encourage higher-quality reporting of data relevant to older adults with cancer worldwide. A number of international scientific journals have risen to the occasion to address these disparities. A key battle in enabling access of this vulnerable group of patients to clinical trials is now being fought and won on the global front with numerous regulatory initiatives. The U.S. Food and Drug Administration (FDA) Oncology Center of Excellence (OCE) recently issued draft guidance on the inclusion of older adults in cancer clinical trials. This and other global initiatives led by the FDA have the potential to further improve the evidence base for older adults with cancer.
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Behavioral, psychological, and supportive care interventions in Geriatric Oncology: The Cancer and Aging Research Group infrastructure core.
Journal of geriatric oncology, 2019Co-Authors: Rawad Elias, Kah Poh Loh, Valerie Targia, Mary I. Whitehead, Beverly Canin, Aminah Jatoi, Matthew Loscalzo, Supriya G. MohileAbstract:Abstract Current research efforts focusing on improving outcomes of older adults with cancer lack the appropriate infrastructure to support this growing need. The Cancer and Aging Group R21/33 National Institute of Health (NIH)/National Institute of Aging (NIA) grant aims to support development of Geriatric Oncology research through dedicated cores. The mission of the Core on Behavioral, Psychological, and Supportive Care Interventions will be to provide guidance in the field of non-pharmacological interventions. The Core will provide investigators with expertise, advocacy, and support in study design, development, and execution.
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Hematology-Oncology Fellows' Training in Geriatrics and Geriatric Oncology: Findings From an American Society of Clinical Oncology-Sponsored National Survey.
Journal of Oncology Practice, 2017Co-Authors: Ronald J. Maggiore, Supriya G. Mohile, Arti Hurria, William Dale, Heidi D. Klepin, Andrew E. Chapman, Efrat Dotan, Arash Naeim, Ajeet Gajra, Mary K. BussAbstract:Purpose:Older adults compose the majority of patients with cancer in the United States; however, it is unclear how well Geriatrics or Geriatric Oncology training is being incorporated into hematology-Oncology (hem-onc) fellowships.Methods:A convenience sample of hem-onc fellows completed a (written or electronic) survey assessing their education, clinical experiences, and perceived proficiency in Geriatric Oncology during training; knowledge base in Geriatric Oncology; confidence in managing older adults with cancer; and general attitudes toward Geriatric Oncology principles.Results:Forty-five percent of respondents (N = 138) were female, 67% were based in the United States, and most (60%) were past their first year of training. Most fellows rated Geriatric Oncology as important or very important (84%); however, only 25% reported having access to a Geriatric Oncology clinic and more than one half (53%) reported no lectures in Geriatric Oncology. Fellows reported fewer educational experiences in Geriatric ...
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Hematology-Oncology Fellows' Training in Geriatrics and Geriatric Oncology: Findings From an American Society of Clinical Oncology-Sponsored National Survey.
Journal of oncology practice, 2017Co-Authors: Ronald J. Maggiore, Supriya G. Mohile, Arti Hurria, William Dale, Heidi D. Klepin, Efrat Dotan, Arash Naeim, Ajeet Gajra, Andrew Chapman, Mary K. BussAbstract:Older adults compose the majority of patients with cancer in the United States; however, it is unclear how well Geriatrics or Geriatric Oncology training is being incorporated into hematology-Oncology (hem-onc) fellowships. A convenience sample of hem-onc fellows completed a (written or electronic) survey assessing their education, clinical experiences, and perceived proficiency in Geriatric Oncology during training; knowledge base in Geriatric Oncology; confidence in managing older adults with cancer; and general attitudes toward Geriatric Oncology principles. Forty-five percent of respondents (N = 138) were female, 67% were based in the United States, and most (60%) were past their first year of training. Most fellows rated Geriatric Oncology as important or very important (84%); however, only 25% reported having access to a Geriatric Oncology clinic and more than one half (53%) reported no lectures in Geriatric Oncology. Fellows reported fewer educational experiences in Geriatric Oncology than in nonGeriatric Oncology. For example, among procedure-based activities, 12% learned how to perform a Geriatric assessment but 78% learned how to perform a bone marrow biopsy ( P < .05). Of those completing the knowledge-based items, 41% were able to identify correctly the predictors of chemotherapy toxicity in older adults with cancer. Despite the prevalence of cancer in older adults, hem-onc fellows report limited education in or exposure to Geriatric Oncology. The high value fellows place on Geriatric Oncology suggests that they would be receptive to additional training in this area.
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polypharmacy and potentially inappropriate medication use in Geriatric Oncology
Journal of Geriatric Oncology, 2016Co-Authors: Manvi Sharma, Ginah Nightingale, Supriya G. Mohile, Holly M. HolmesAbstract:Abstract Polypharmacy is a highly prevalent problem in older persons, and is challenging to assess and improve due to variations in definitions of the problem and the heterogeneous methods of medication review and reduction. The purpose of this review is to summarize evidence regarding the prevalence and impact of polypharmacy in Geriatric Oncology patients and to provide recommendations for assessment and management. Polypharmacy has somewhat variably been incorporated into Geriatric assessment studies in Geriatric Oncology, and polypharmacy has not been consistently evaluated as a predictor of negative outcomes in patients with cancer. Once screened, interventions for polypharmacy are even more uncertain. There is a great need to create standardized interventions to improve polypharmacy in Geriatrics, and particularly in Geriatric Oncology. The process of deprescribing is aimed at reducing medications for which real or potential harm outweighs benefit, and there are numerous methods to determine which medications are candidates for deprescribing. However, deprescribing approaches have not been evaluated in older patients with cancer. Ultimately, methods to identify polypharmacy will need to be clearly defined and validated, and interventions to improve medication use will need to be based on clearly defined and standardized methods.
William Dale - One of the best experts on this subject based on the ideXlab platform.
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Identifying Geriatric Oncology Competencies for Medical Oncology Trainees: A Modified Delphi Consensus Study.
The oncologist, 2020Co-Authors: Tina Hsu, Holly M. Holmes, Allison Magnuson, William Dale, Ronald J. Maggiore, Ajeet Gajra, Elizabeth R. Kessler, Ira R. Parker, June M. Mckoy, Arti HurriaAbstract:Background Most Oncology trainees are not taught about the needs of older patients, who make up the majority of patients with cancer. Training of health care providers is critical to improve the care of older adults with cancer. There is no consensus about which Geriatric Oncology (GO) competencies are important for medical Oncology trainees. Our objective was to identify GO competencies medical Oncology trainees should acquire during training. Materials and methods A modified Delphi consensus of experts in Oncology medical education and GO was conducted. Experts categorized at what training stage proposed competencies should be attained: internal medicine, Oncology, or GO training. Consensus was obtained if two thirds of experts agreed on the training stage at which the competency should be attained. Results A total of 78 potential competencies were identified, of which 35 (44.9%) proposed competencies were felt to be appropriate to be acquired during Oncology training. The majority of the identified competencies pertained to prescribing of systemic therapy (n = 12) and psychosocial and supportive care (n = 13). No competencies related to Geriatric assessment were identified for acquisition during Oncology training. Conclusion Experts in Oncology education and Geriatric Oncology agreed upon a set of GO competencies appropriate for Oncology trainees. These results provide the foundation for developing a GO curriculum for medical Oncology trainees and will hopefully lead to better care of older adults with cancer. Implications for practice The aging population will drive the projected rise in cancer incidence. Although aging patients make up the majority of patients diagnosed with cancer, oncologists rarely receive training on how to care for them. Training of health care providers is critical to improving the care of older adults with cancer. The results of this study will help form the foundation of developing a Geriatric Oncology curriculum for medical Oncology trainees.
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Hematology-Oncology Fellows' Training in Geriatrics and Geriatric Oncology: Findings From an American Society of Clinical Oncology-Sponsored National Survey.
Journal of Oncology Practice, 2017Co-Authors: Ronald J. Maggiore, Supriya G. Mohile, Arti Hurria, William Dale, Heidi D. Klepin, Andrew E. Chapman, Efrat Dotan, Arash Naeim, Ajeet Gajra, Mary K. BussAbstract:Purpose:Older adults compose the majority of patients with cancer in the United States; however, it is unclear how well Geriatrics or Geriatric Oncology training is being incorporated into hematology-Oncology (hem-onc) fellowships.Methods:A convenience sample of hem-onc fellows completed a (written or electronic) survey assessing their education, clinical experiences, and perceived proficiency in Geriatric Oncology during training; knowledge base in Geriatric Oncology; confidence in managing older adults with cancer; and general attitudes toward Geriatric Oncology principles.Results:Forty-five percent of respondents (N = 138) were female, 67% were based in the United States, and most (60%) were past their first year of training. Most fellows rated Geriatric Oncology as important or very important (84%); however, only 25% reported having access to a Geriatric Oncology clinic and more than one half (53%) reported no lectures in Geriatric Oncology. Fellows reported fewer educational experiences in Geriatric ...
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Hematology-Oncology Fellows' Training in Geriatrics and Geriatric Oncology: Findings From an American Society of Clinical Oncology-Sponsored National Survey.
Journal of oncology practice, 2017Co-Authors: Ronald J. Maggiore, Supriya G. Mohile, Arti Hurria, William Dale, Heidi D. Klepin, Efrat Dotan, Arash Naeim, Ajeet Gajra, Andrew Chapman, Mary K. BussAbstract:Older adults compose the majority of patients with cancer in the United States; however, it is unclear how well Geriatrics or Geriatric Oncology training is being incorporated into hematology-Oncology (hem-onc) fellowships. A convenience sample of hem-onc fellows completed a (written or electronic) survey assessing their education, clinical experiences, and perceived proficiency in Geriatric Oncology during training; knowledge base in Geriatric Oncology; confidence in managing older adults with cancer; and general attitudes toward Geriatric Oncology principles. Forty-five percent of respondents (N = 138) were female, 67% were based in the United States, and most (60%) were past their first year of training. Most fellows rated Geriatric Oncology as important or very important (84%); however, only 25% reported having access to a Geriatric Oncology clinic and more than one half (53%) reported no lectures in Geriatric Oncology. Fellows reported fewer educational experiences in Geriatric Oncology than in nonGeriatric Oncology. For example, among procedure-based activities, 12% learned how to perform a Geriatric assessment but 78% learned how to perform a bone marrow biopsy ( P < .05). Of those completing the knowledge-based items, 41% were able to identify correctly the predictors of chemotherapy toxicity in older adults with cancer. Despite the prevalence of cancer in older adults, hem-onc fellows report limited education in or exposure to Geriatric Oncology. The high value fellows place on Geriatric Oncology suggests that they would be receptive to additional training in this area.
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Geriatric Assessment-Guided Care Processes for Older Adults: A Delphi Consensus of Geriatric Oncology Experts.
Journal of the National Comprehensive Cancer Network : JNCCN, 2015Co-Authors: Supriya G. Mohile, Arti Hurria, Anita O'donovan, Chintan Pandya, Allison Magnuson, Carla Velarde, Lisa M. Lowenstein, Rita Gorawara-bhat, William DaleAbstract:Background Structured care processes that provide a framework for how oncologists can incorporate Geriatric assessment (GA) into clinical practice could improve outcomes for vulnerable older adults with cancer, a growing population at high risk of toxicity from cancer treatment. We sought to obtain consensus from an expert panel on the use of GA in clinical practice and to develop algorithms of GA-guided care processes. Methods The Delphi technique, a well-recognized structured and reiterative process to reach consensus, was used. Participants were Geriatric Oncology experts who attended NIH-funded U13 or Cancer and Aging Research Group conferences. Consensus was defined as an interquartile range of 2 or more units, or 66.7% or greater, selecting a utility/helpfulness rating of 7 or greater on a 10-point Likert scale. For nominal data, consensus was defined as agreement among 66.7% or more of the group. Results From 33 invited, 30 participants completed all 3 rounds. Most experts (75%) used GA in clinical care, and the remainder were involved in Geriatric Oncology research. The panel met consensus that "all patients aged 75 years or older and those who are younger with age-related health concerns" should undergo GA and that all domains (function, physical performance, comorbidity/polypharmacy, cognition, nutrition, psychological status, and social support) should be included. Consensus was met for how GA could guide nononcologic interventions and cancer treatment decisions. Algorithms for GA-guided care processes were developed. Conclusions This Delphi investigation of Geriatric Oncology experts demonstrated that GA should be performed for older patients with cancer to guide care processes.
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Palliative care needs: Symptom reporting during Geriatric Oncology evaluation.
Journal of Clinical Oncology, 2014Co-Authors: Marie Flannery, Chintan Pandya, Mohamedtaki Abdulaziz Tejani, Charles Kamen, Allison Magnuson, William Dale, Gary R. Morrow, Supriya G. MohileAbstract:184 Background: Although extensive descriptive work has been conducted on the symptom experience in cancer, relatively little is known about the specific palliative care needs for Geriatric Oncology populations. When all age groups are studied older individuals report less symptoms and the symptom experience of older cancer patients is minimized. Utilizing data collected from two Geriatric Oncology referral clinics the primary aim of this study was to identify Geriatric Oncology patients’ symptom reports, the number of symptoms experienced, and interference reported from symptoms. Methods: Patients referred to a Geriatric Oncology consult clinic were asked to complete the MD Anderson Symptom Inventory (MDASI) total of 13 items. In addition all patients underwent comprehensive Geriatric assessment with a battery of tests. Results: 192 patients completed the symptom inventory with a median age of 81 years (range 65-95). 94% of patients reported at least one symptom, >45% reported experiencing 10 of the 13 s...
Etienne Brain - One of the best experts on this subject based on the ideXlab platform.
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Management of older cancer patients: updated recommendations of the International Society of Geriatric Oncology (SIOG)
Annals of Oncology, 2019Co-Authors: Etienne BrainAbstract:Abstract More than 60% of cancers will be soon diagnosed after 70 years, sparing no country, no culture, but even more importantly no single physician involved in the management of cancer in adults. Ironically, clinical trials setting our standard of cares include very few older selected patients, who usually are not representative of most, making conclusions poorly evidence-based for this largest segment of our patients population. Improving clinical practice in Geriatric Oncology is a key mission of the International Society of Geriatric Oncology (SIOG) in order to reverse this situation and prejudice. It can be achieved through education, as the SIOG International Course in Geriatric Oncology in Treviso now in preparation for its 7th edition in 2020. The development of specific guidelines is another vital line of action. Indeed nothing is better than framing practice conditions with repeated guidance to support such practical field showing so many unmet clinical needs, biased representations and management. SIOG has a long standing history of developing such literature, from guidelines to consensus papers, reviews of the literature, or expert position papers, covering both disease-oriented topics or more transversal ones. We shall review SIOG publications from the last 3 years, including nutritional management, quality of life, metastatic renal cell carcinoma, rectal cancer, prostate cancer, and HER2-positive breast cancer. Of note, many of these landmark publications by SOG require regular updates to maintain appropriate knowledge and skills, keeping our community up to speed. They rely on a large dissemination by high-quality journals including the journal of the society, the Journal of Geriatric Oncology. This JSMO-JCOG-SIOG joint symposium highlights the strength of these recommendations which require international cross-fertilization and collaboration to step up to the challenge of our moving society, catering for all, not leaving the frailer ones behind.
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Addressing heterogeneity in the design of phase II clinical trials in Geriatric Oncology.
European journal of cancer (Oxford England : 1990), 2018Co-Authors: Bastien Cabarrou, Etienne Brain, Patrick Sfumato, Loic Mourey, Eve Leconte, Laurent Balardy, Alejandra Martinez, Jean-pierre Delord, Jean-marie Boher, Thomas FilleronAbstract:Abstract Introduction Cancer in the elderly is a major public issue. However, older patients have long been debarred from clinical trials. There is a high unmet medical need for specific trials addressing Oncology strategies adapted to older patients' conditions. While randomised phase III trials remain the gold standard, they usually require large numbers of patients. In this perspective, late single-arm phase II trials assessing treatment feasibility might prove a good alternative. However, it is essential to take into account the heterogeneity in an ageing population characterised by frailty. Standard parallel phase II studies in defined frail and non-frail populations also require a high number of patients. Used in molecular subtyping and treatment effect heterogeneity, stratified adaptive designs can improve statistical performance, but they have never been used in Geriatric Oncology. This report describes their potential benefits and useful applications as compared with standard designs. Methods In a heterogeneous population, stratified adaptive designs allowed us to select subgroups of interest in two stages. Operational characteristics were evaluated through simulations of clinical trials under different scenarios. Results Simulations showed that the use of stratified adaptive designs can efficiently minimise both the number of patients to be included and accrual duration with competitive statistical power and high heterogeneity detection rate at interim analysis. Conclusion Compared with classical phase II designs, stratified adaptive phase II trial methodology offers a promising approach to improve clinical research in Geriatric Oncology. These designs may also be efficient in other populations such as children or adolescents and young adults.
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Addressing heterogeneity in the design of phase II clinical trials in Geriatric Oncology
European Journal of Cancer, 2018Co-Authors: Bastien Cabarrou, Etienne Brain, Patrick Sfumato, Loic Mourey, Eve Leconte, Laurent Balardy, Alejandra Martinez, Jean-pierre Delord, Jean-marie Boher, Thomas FilleronAbstract:Introduction: Cancer in the elderly is a major public issue. However, older patients have long been debarred from clinical trials. There is a high unmet medical need for specific trials addressing Oncology strategies adapted to older patients' conditions. While randomised phase III trials remain the gold standard, they usually require large numbers of patients. In this perspective, late single-arm phase II trials assessing treatment feasibility might prove a good alternative. However, it is essential to take into account the heterogeneity in an ageing population characterised by frailty. Standard parallel phase II studies in defined frail and non-frail populations also require a high number of patients. Used in molecular subtyping and treatment effect heterogeneity, stratified adaptive designs can improve statistical performance, but they have never been used in Geriatric Oncology. This report describes their potential benefits and useful applications as compared with standard designs. Methods: In a heterogeneous population, stratified adaptive designs allowed us to select subgroups of interest in two stages. Operational characteristics were evaluated through simulations of clinical trials under different scenarios. Results: Simulations showed that the use of stratified adaptive designs can efficiently minimise both the number of patients to be included and accrual duration with competitive statistical power and high heterogeneity detection rate at interim analysis. Conclusion: Compared with classical phase II designs, stratified adaptive phase II trial methodology offers a promising approach to improve clinical research in Geriatric Oncology. These designs may also be efficient in other populations such as children or adolescents and young adults. (C) 2018 Elsevier Ltd. All rights reserved.
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International Society of Geriatric Oncology Consensus on Geriatric Assessment in Older Patients With Cancer
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014Co-Authors: Hans Wildiers, Etienne Brain, Martine Extermann, Martine Puts, Pieter Heeren, Eva Topinkova, Maryska L.g. Janssen-heijnen, Claire Falandry, Andrew S. Artz, Giuseppe CollocaAbstract:Purpose To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on Geriatric assessment (GA) in older patients with cancer. Methods SIOG composed a panel with expertise in Geriatric Oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in Geriatric Oncology patients; ability of GA to predict Oncology treatment–related complications; association between GA findings and overall survival (OS); impact of GA findings on Oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. Results GA can be valuable in Oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensit...
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The International Society of Geriatric Oncology conference: Paris 2011
Aging Health, 2012Co-Authors: Stuart M. Lichtman, Etienne BrainAbstract:The 11th meeting of the International Society of Geriatric Oncology (SIOG) was held in Paris on 4–5 November 2011. Founded in the year 2000, SIOG is dedicated to the education of physicians about the care of the older cancer patient. The International Society of Geriatric Oncology has a number of activities, including task forces that have published important position statements about various aspects of Geriatric Oncology care: chemotherapy, renal dysfunction, surgery, Geriatric assessment and others. There is also a national representatives group whose role is to stimulate interest in Geriatric Oncology in their respective countries. Age is one of the most important risk factors for cancer: given the aging of the world population, we are facing a major epidemiologic challenge. The goal of SIOG is to foster the development of health professionals in the field of Geriatric Oncology, in order to optimize treatment of older adults with cancer. It promotes efforts in training, research, policy and care to sup...
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Polypharmacy in the Geriatric Oncology Population.
Current oncology reports, 2017Co-Authors: Lauren Hersh, Kathryn Beldowski, Emily R. HajjarAbstract:Purpose of Review This review explores the multiple definitions, epidemiology, and impact of polypharmacy in Geriatric Oncology patients. Risk factors and clinical implications of polypharmacy are delineated and potential clinical approaches to reduce polypharmacy are reviewed.