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Cohen, Harvey Jay

Overview:

Dr. Cohen's research program includes clinical research relating to aspects of the pathways to functional decline with aging, geriatric assessment, and cancer in the elderly.

Pathways to functional decline are being explored through the NIA funded Claude Pepper Older Americans Independence Center, and includes studies of the contributions of age related physiologic change, in particular changes in inflammatory parameters, comorbid diseases and conditions, environment, genetics, and the interactionas among them. Data are derived from several current studies as well as previously collected data sets from the Established Populations for Epidemiologic Studies of the Elderly (EPESE), National Long Term Care Survey, and the Chinese Longevity Study (with Dr. Zeng Yi). Previous work has demonstrated the important contributions of age related inflammation and coagulation activation to functional status.

Geriatric assessment approaches have been studied in a number of randomized and controlled studies and work is now concentrating on the application of Comprehensive Geriatric Assessment tools to the evaluation and treatment of elderly patients with cancer. This is an extension and continuation of a long standing interest in geriatric oncology. Previous studies have elucidated age-related patterns of disease presentation, treatment approaches, clinical trials, survivorship, quality of life, impact of comrobidities and functional outcomes. Dr. Cohen is co-chair of the Cancer in the Elderly Committee of Cancer and Acute Luekemia Group B (CALGB). A number of active studies and ongoing data bases aree being utilized to address these questions.

Positions:

Professor of Medicine

Medicine, Geriatrics
School of Medicine

Walter Kempner Professor of Medicine, in the School of Medicine

Medicine, Geriatrics
School of Medicine

Director, Center for the Study of Aging & Human Development

Center for the Study of Aging and Human Development
School of Medicine

Faculty Research Scholar of DuPRI's Center for Population Health & Aging

Center for Population Health & Aging
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1965

M.D. — State University of New York at Brooklyn

News:

Grants:

Neuro-inflammation in Postoperative Cognitive Dysfunction: CSF and fMRI Studies

Administered By
Anesthesiology, Neuroanesthesia
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
July 15, 2017
End Date
March 31, 2022

Behavioral and Physiology in Aging

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
September 01, 2015
End Date
August 31, 2020

Mentoring Intervention Development in Fall and Fracture Prevention

Administered By
Medicine, Geriatrics
AwardedBy
National Institutes of Health
Role
Advisor
Start Date
August 01, 2015
End Date
April 30, 2020

Alliance NCORP Research Base

Administered By
Center for the Study of Aging and Human Development
AwardedBy
Mayo Clinic
Role
Principal Investigator
Start Date
August 01, 2014
End Date
July 31, 2019

Physical Resiliencies: Indicators and Mechanisms in the Elderly Collaborative

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Collaborating Investigator
Start Date
September 30, 2017
End Date
May 31, 2019

PACTTE-Partnership for Anemia: Clinical and Translational Trials in the Elderly

Administered By
Duke Clinical Research Institute
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
September 30, 2009
End Date
November 30, 2018

The Significance of Perioperative Changes in CSF tau levels in the Elderly

Administered By
Anesthesiology, Neuroanesthesia
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
August 15, 2015
End Date
May 31, 2018

Cognitive Changes and Brain Connectivity in Age-Related Macular Degeneration

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
August 01, 2013
End Date
May 31, 2018

Duke-UNC Clinical Hematology and Transfusion Research Career Development Program

Administered By
Medicine, Hematology
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
September 28, 2006
End Date
April 30, 2018

Gene regulatory analysis of social integration and resilience during aging

Administered By
Duke Population Research Institute
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
August 15, 2016
End Date
September 15, 2017

Generating new knowledge to support reversibility interventions

Administered By
Psychology and Neuroscience
AwardedBy
National Institutes of Health
Role
Consultant
Start Date
September 30, 2014
End Date
April 30, 2017

John A. Hartford Foundation's Centers of Excellence (CoE)

Administered By
Center for the Study of Aging and Human Development
AwardedBy
John A. Hartford Foundation, Inc.
Role
Principal Investigator
Start Date
July 01, 2015
End Date
December 31, 2016

Adherence to Venous Thromboembolism Prophylaxis Guidelines in Hospitalized Elders

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Co-Mentor
Start Date
September 01, 2014
End Date
August 31, 2016

Translational meta-analysis for elderly lung cancer patients

Administered By
Biostatistics & Bioinformatics
AwardedBy
National Institutes of Health
Role
Collaborator
Start Date
August 01, 2013
End Date
May 31, 2016

Clinico-Genomic Assessment of Performance Status in Elderly AML Patients

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
September 01, 2012
End Date
August 31, 2015

Integrating Population and Basic Science in Cancer Research

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Advisor
Start Date
September 01, 2009
End Date
August 31, 2015

Behavior And Physiology In Aging

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 1999
End Date
August 31, 2015

T32 Bridge Funding

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 1984
End Date
August 31, 2015

Clinical Oncology Research Career Development Program

Administered By
Surgery, Surgical Sciences
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
September 29, 2009
End Date
July 31, 2015

Developing Interventions to Improve Function in Seniors with Comorbid Conditions

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
September 01, 2008
End Date
July 31, 2013

Claude D. Pepper OAIC

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 2006
End Date
June 30, 2013

Candidate Genes and Longitudinal Disability Phenotypes

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Co-Mentor
Start Date
May 15, 2006
End Date
April 30, 2012

IPA - Gerda Fillenbaum

Administered By
Center for the Study of Aging and Human Development
AwardedBy
Veterans Administration Medical Center
Role
Principal Investigator
Start Date
December 01, 2010
End Date
June 30, 2011

IPA - Gerda Fillenbaum

Administered By
Center for the Study of Aging and Human Development
AwardedBy
Veterans Administration Medical Center
Role
Principal Investigator
Start Date
December 01, 2009
End Date
November 30, 2010

IPA Agreement - Koenig

Administered By
Center for the Study of Aging and Human Development
AwardedBy
Veterans Administration Medical Center
Role
Principal Investigator
Start Date
April 01, 2010
End Date
September 30, 2010

Aging and Immune Response in Sepsis

Administered By
Surgery
AwardedBy
National Institutes of Health
Role
Consultant
Start Date
August 15, 2007
End Date
July 31, 2010

Molecular Basis of Postoperative Delirium in the Elderly

Administered By
Anesthesiology
AwardedBy
National Institutes of Health
Role
Collaborator
Start Date
January 15, 2003
End Date
June 30, 2010

RENEW: Reach-Out to Enhance Wellness in Older Survivors

Administered By
School of Nursing
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
July 15, 2004
End Date
May 31, 2010

IPA Agreement - Koenig

Administered By
Center for the Study of Aging and Human Development
AwardedBy
Veterans Administration Medical Center
Role
Principal Investigator
Start Date
April 01, 2009
End Date
March 31, 2010

IPA - Gerda Fillenbaum

Administered By
Center for the Study of Aging and Human Development
AwardedBy
Veterans Administration Medical Center
Role
Principal Investigator
Start Date
December 01, 2008
End Date
November 30, 2009

From a Patient's Perspective: The Quigless Clinic-its role in the lives of Blacks living in Tarbor NC

Administered By
Medicine
AwardedBy
Josiah Charles Trent Memorial Foundation
Role
Principal Investigator
Start Date
July 01, 2006
End Date
September 30, 2008

Integrated Program for Persons with Hemostatic Disorders

Administered By
Medicine, Medical Oncology
AwardedBy
Centers for Disease Control
Role
Collaborator
Start Date
September 30, 2001
End Date
June 30, 2007

Herpes Zoster and Medications in the Elderly

Administered By
Medicine
AwardedBy
National Institutes of Health
Role
Program Director
Start Date
September 01, 2001
End Date
May 31, 2007

IPA Agreement - Koenig

Administered By
Center for the Study of Aging and Human Development
AwardedBy
Veterans Administration Medical Center
Role
Principal Investigator
Start Date
April 01, 2006
End Date
March 31, 2007

PPARy: Biomarker for Breast Cancer in Older Women

Administered By
Medicine, Geriatrics
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
August 01, 2005
End Date
March 31, 2007

Mentored Clinical Research Scholar Program

Administered By
Medicine, Infectious Diseases
AwardedBy
National Institutes of Health
Role
Advisor
Start Date
September 30, 2002
End Date
September 29, 2006

Geriatric Academic Career Award

Administered By
Medicine
AwardedBy
Health Resources and Service Administration
Role
Mentor
Start Date
September 30, 1999
End Date
September 29, 2006

Claude D. Pepper Older American Independence Centers

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
September 30, 1992
End Date
June 30, 2006

Claude D. Pepper Older Americans Independence Centers

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
September 30, 1999
End Date
June 30, 2004

Impact of geriatric care on drug related problems

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 30, 1996
End Date
July 31, 2001

Phase Ten Year Followup

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Clinical Coordinator
Start Date
September 01, 1997
End Date
August 31, 2000

Phse Ten Year Follow-Up

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Co-Principal Investigator
Start Date
September 25, 1995
End Date
August 31, 1999

Phse Ten-Year Follow Up

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Co-Principal Investigator
Start Date
September 25, 1995
End Date
August 31, 1999

Faculty Training Projects In Geriatric Med & Dentistry

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 1995
End Date
June 30, 1999

Faculty Training Projects In Geriatric Med & Dentistry

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 1994
End Date
June 30, 1999

Claude D Pepper Older Americans Independence Center

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
September 30, 1992
End Date
June 30, 1999

Faculty Training Projects In Geriatric Medicine & Dentistr

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
October 01, 1988
End Date
June 30, 1999

Faculty Training Projects In Geratric Medicine And Denistr

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 1988
End Date
June 30, 1999

Behavior And Physiology In Aging

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
May 01, 1998
End Date
April 30, 1999

Cognitive Impairment And Medication Appropriateness

Administered By
Medicine, General Internal Medicine
AwardedBy
National Institutes of Health
Role
Co-Principal Investigator
Start Date
February 01, 1993
End Date
January 31, 1998

Claude D. Pepper Older Americans Independence Center

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 05, 1993
End Date
June 30, 1997

Claude D. Pepper Older American Independence Centers

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Co-Principal Investigator
Start Date
September 30, 1992
End Date
June 30, 1997

Claude D. Pepper Older American Independence Center

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
September 30, 1992
End Date
June 30, 1997

Claude D. Pepper Older American Independence Centers

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
September 30, 1992
End Date
June 30, 1997

Research Support Services For Gerontology Center

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
April 01, 1993
End Date
March 31, 1995

Behavior And Physiology In Aging

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 1993
End Date
June 30, 1994

Faculty Training Projects In Geriatric Med/Dentistry

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 1991
End Date
June 30, 1994

Research Support Services For Gerontology Center

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
April 01, 1992
End Date
March 31, 1994

Faculty Training Projects In Geriatric Medicine And Dentis

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 1992
End Date
June 30, 1993

Geriatric Research And Training Centers

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
March 01, 1992
End Date
February 28, 1993

Ags Summer Workshop: Geriatrics Clinical Research Method

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 1991
End Date
June 30, 1992

Grants For Geriatric Education Centers

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
October 01, 1990
End Date
September 30, 1991

Faculty Training Projects In Geriatric Medicine/Dentistry

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
October 01, 1989
End Date
June 01, 1991

Faculty Training Projects In Geriatric Medicine & Dentistr

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
October 01, 1988
End Date
June 01, 1991

Ags Summer Workshop: Geriatrics Clinical Research Methods

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 1989
End Date
June 01, 1990

Cooperative Studies In Cancer Therapy (Secsg)

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
August 01, 1985
End Date
July 01, 1987

Characterization Of Cancer Management In The Elderly

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
December 01, 1985
End Date
November 01, 1986

Cooperative Studies In Cancer Therapy

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 1985
End Date
July 01, 1986

Southeastern Cancer Study Group

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 1984
End Date
July 01, 1985
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Awards:

Donald P. Kent Award. Gerontological Society of America, The.

Type
National
Awarded By
Gerontological Society of America, The
Date
January 01, 2004

Joseph T. Freeman Award. Gerontological Society of America, The.

Type
National
Awarded By
Gerontological Society of America, The
Date
January 01, 1998

Publications:

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Pooled Analysis of Individual Patient Data on Concurrent Chemoradiotherapy for Stage III Non-Small-Cell Lung Cancer in Elderly Patients Compared With Younger Patients Who Participated in US National Cancer Institute Cooperative Group Studies.

Purpose Concurrent chemoradiotherapy is standard treatment for patients with stage III non-small-cell lung cancer. Elderly patients may experience increased rates of adverse events (AEs) or less benefit from concurrent chemoradiotherapy. Patients and Methods Individual patient data were collected from 16 phase II or III trials conducted by US National Cancer Institute-supported cooperative groups of concurrent chemoradiotherapy alone or with consolidation or induction chemotherapy for stage III non-small-cell lung cancer from 1990 to 2012. Overall survival (OS), progression-free survival, and AEs were compared between patients age ≥ 70 (elderly) and those younger than 70 years (younger). Unadjusted and adjusted hazard ratios (HRs) for survival time and CIs were estimated by single-predictor and multivariable frailty Cox models. Unadjusted and adjusted odds ratio (ORs) for AEs and CIs were obtained from single-predictor and multivariable generalized linear mixed-effect models. Results A total of 2,768 patients were classified as younger and 832 as elderly. In unadjusted and multivariable models, elderly patients had worse OS (HR, 1.20; 95% CI, 1.09 to 1.31 and HR, 1.17; 95% CI, 1.07 to 1.29, respectively). In unadjusted and multivariable models, elderly and younger patients had similar progression-free survival (HR, 1.01; 95% CI, 0.93 to 1.10 and HR, 1.00; 95% CI, 0.91 to 1.09, respectively). Elderly patients had a higher rate of grade ≥ 3 AEs in unadjusted and multivariable models (OR, 1.35; 95% CI, 1.07 to 1.70 and OR, 1.38; 95% CI, 1.10 to 1.74, respectively). Grade 5 AEs were significantly higher in elderly compared with younger patients (9% v 4%; P < .01). Fewer elderly compared with younger patients completed treatment (47% v 57%; P < .01), and more discontinued treatment because of AEs (20% v 13%; P < .01), died during treatment (7.8% v 2.9%; P < .01), and refused further treatment (5.8% v 3.9%; P = .02). Conclusion Elderly patients in concurrent chemoradiotherapy trials experienced worse OS, more toxicity, and had a higher rate of death during treatment than younger patients.

Authors
Stinchcombe, TE; Zhang, Y; Vokes, EE; Schiller, JH; Bradley, JD; Kelly, K; Curran, WJ; Schild, SE; Movsas, B; Clamon, G; Govindan, R; Blumenschein, GR; Socinski, MA; Ready, NE; Akerley, WL; Cohen, HJ; Pang, HH; Wang, X
MLA Citation
Stinchcombe, TE, Zhang, Y, Vokes, EE, Schiller, JH, Bradley, JD, Kelly, K, Curran, WJ, Schild, SE, Movsas, B, Clamon, G, Govindan, R, Blumenschein, GR, Socinski, MA, Ready, NE, Akerley, WL, Cohen, HJ, Pang, HH, and Wang, X. "Pooled Analysis of Individual Patient Data on Concurrent Chemoradiotherapy for Stage III Non-Small-Cell Lung Cancer in Elderly Patients Compared With Younger Patients Who Participated in US National Cancer Institute Cooperative Group Studies." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 35.25 (September 2017): 2885-2892.
PMID
28493811
Source
epmc
Published In
Journal of Clinical Oncology
Volume
35
Issue
25
Publish Date
2017
Start Page
2885
End Page
2892
DOI
10.1200/jco.2016.71.4758

A Cumulative Deficit Laboratory Test-based Frailty Index: Personal and Neighborhood Associations.

To explore the association between a newly developed cumulative laboratory-based frailty index (FI) and intrinsic (personal) and extrinsic (social, environmental) characteristics.Cross-sectional longitudinal study.The third and fourth waves of the community-representative, five-county, 10-year Duke Established Populations for Epidemiologic Studies of the Elderly study, carried out in a health service-rich area.Cognitively intact survivors of the third wave (N = 1,740), who provided blood samples for standard laboratory work.Biomarkers (n = 28) were measured to develop a cumulative deficit laboratory test-based FI (Duke FI) derived from standard laboratory tests: SMAC-24 chemistry panel, high-density lipoprotein cholesterol panel, and complete blood count. Information was gathered on scales assessing intrinsic characteristics (personal locus of control, life satisfaction, self-esteem, depressive symptomatology) and extrinsic characteristics (support received from and provided to family and friends, stressful life events, neighborhood disadvantage).The newly developed Duke FI had content, construct, concurrent, and predictive validity. In addition to sex, race, and income, the Duke FI was associated at the intrinsic level with locus of control, self-esteem, life satisfaction, and depressive symptomatology (each P < .01) and at the extrinsic level with provision (P < .01) and with receipt of instrumental help (P < .10), social stressors (P < .03), and neighborhood disadvantage (P < .01) in unadjusted analysis; race fully explained neighborhood disadvantage.Intrinsic (personality) characteristics and personally close extrinsic characteristics (contacts with family and friends, personal stressors) are associated with laboratory test-based frailty, as is neighborhood disadvantage, although in this accessible, health service-rich environment, race fully explained association with neighborhood disadvantage, suggesting that interventions to reduce frailty in residents in such an environment should pay particular attention to characteristics that immediately affect the individual.

Authors
King, KE; Fillenbaum, GG; Cohen, HJ
MLA Citation
King, KE, Fillenbaum, GG, and Cohen, HJ. "A Cumulative Deficit Laboratory Test-based Frailty Index: Personal and Neighborhood Associations." Journal of the American Geriatrics Society 65.9 (September 2017): 1981-1987.
PMID
28665517
Source
epmc
Published In
Journal of American Geriatrics Society
Volume
65
Issue
9
Publish Date
2017
Start Page
1981
End Page
1987
DOI
10.1111/jgs.14983

Redefining Unexplained Anemia in Elderly-Reply.

Authors
Cohen, HJ; Roy, CN; Snyder, PJ
MLA Citation
Cohen, HJ, Roy, CN, and Snyder, PJ. "Redefining Unexplained Anemia in Elderly-Reply." JAMA internal medicine 177.9 (September 2017): 1395-.
PMID
28873192
Source
epmc
Published In
JAMA Internal Medicine
Volume
177
Issue
9
Publish Date
2017
Start Page
1395
DOI
10.1001/jamainternmed.2017.2970

Impact of early personal-history characteristics on the Pace of Aging: implications for clinical trials of therapies to slow aging and extend healthspan.

Therapies to extend healthspan are poised to move from laboratory animal models to human clinical trials. Translation from mouse to human will entail challenges, among them the multifactorial heterogeneity of human aging. To inform clinical trials about this heterogeneity, we report how humans' pace of biological aging relates to personal-history characteristics. Because geroprotective therapies must be delivered by midlife to prevent age-related disease onset, we studied young-adult members of the Dunedin Study 1972-73 birth cohort (n = 954). Cohort members' Pace of Aging was measured as coordinated decline in the integrity of multiple organ systems, by quantifying rate of decline across repeated measurements of 18 biomarkers assayed when cohort members were ages 26, 32, and 38 years. The childhood personal-history characteristics studied were known predictors of age-related disease and mortality, and were measured prospectively during childhood. Personal-history characteristics of familial longevity, childhood social class, adverse childhood experiences, and childhood health, intelligence, and self-control all predicted differences in cohort members' adulthood Pace of Aging. Accumulation of more personal-history risks predicted faster Pace of Aging. Because trials of anti-aging therapies will need to ascertain personal histories retrospectively, we replicated results using cohort members' retrospective personal-history reports made in adulthood. Because many trials recruit participants from clinical settings, we replicated results in the cohort subset who had recent health system contact according to electronic medical records. Quick, inexpensive measures of trial participants' early personal histories can enable clinical trials to study who volunteers for trials, who adheres to treatment, and who responds to anti-aging therapies.

Authors
Belsky, DW; Caspi, A; Cohen, HJ; Kraus, WE; Ramrakha, S; Poulton, R; Moffitt, TE
MLA Citation
Belsky, DW, Caspi, A, Cohen, HJ, Kraus, WE, Ramrakha, S, Poulton, R, and Moffitt, TE. "Impact of early personal-history characteristics on the Pace of Aging: implications for clinical trials of therapies to slow aging and extend healthspan." Aging cell 16.4 (August 2017): 644-651.
PMID
28401731
Source
epmc
Published In
Aging Cell
Volume
16
Issue
4
Publish Date
2017
Start Page
644
End Page
651
DOI
10.1111/acel.12591

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer (July 12, 2017).
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort.

A nocebo is an inert substance associated with adverse events. Although previous studies have examined the positive (placebo) effects of such inert substances, few have examined negative (nocebo) adverse event profiles, particularly in older patients who have higher morbidity and can experience frequent and severe adverse events from cancer therapy.This study focused on placebo/nocebo-exposed patients who participated in 2 double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Therapy Group trial NCCTG 97-24-51 and American College of Surgeons Oncology Group trial Z9001, with the goal of reporting the comparative, age-based adverse event rates, as reported during the conduct of these trials.Among the 446 patients who received only placebo/nocebo and who were the focus of the current report, 161 were aged ≥65 years at the time of respective trial entry, and 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients aged ≥65 years and younger patients (rate ratio, 1.01; 99% confidence interval, 0.47-2.02), and the findings were similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and individual trial resulted in no significant age-based differences in adverse event rates. Similar findings were observed with an age threshold of 70 years.Adverse events are equally common in older and younger cancer patients who are exposed to nocebo and thus require the same degree of clinical consideration regardless of age. Cancer 2017;123:4193-4198. © 2017 American Cancer Society.

Authors
Foster, JC; Le-Rademacher, JG; Feliciano, JL; Gajra, A; Seisler, DK; DeMatteo, R; Lafky, JM; Hurria, A; Muss, HB; Cohen, HJ; Jatoi, A
MLA Citation
Foster, JC, Le-Rademacher, JG, Feliciano, JL, Gajra, A, Seisler, DK, DeMatteo, R, Lafky, JM, Hurria, A, Muss, HB, Cohen, HJ, and Jatoi, A. "Comparative "nocebo effects" in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort." Cancer 123.21 (November 2017): 4193-4198.
PMID
28700816
Source
epmc
Published In
Cancer
Volume
123
Issue
21
Publish Date
2017
Start Page
4193
End Page
4198
DOI
10.1002/cncr.30867

Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance).

Breast cancer patients aged 65+ ("older") vary in frailty status. We tested whether a deficits accumulation frailty index predicted long-term mortality.Older patients (n = 1280) with non-metastatic, invasive breast cancer were recruited from 78 Alliance sites from 2004 to 2011, with follow-up to 2015. Frailty categories (robust, pre-frail, and frail) were based on 35 baseline illness and function items. Cox proportional hazards and competing risk models were used to calculate all-cause and breast cancer-specific mortality for up to 7 years, respectively. Potential covariates included demographic, psychosocial, and clinical factors, diagnosis year, and care setting.Patients were 65-91 years old. Most (76.6%) were robust; 18.3% were pre-frail, and 5.1% frail. Robust patients tended to receive more chemotherapy ± hormonal therapy (vs. hormonal) than pre-frail or frail patients (45% vs. 37 and 36%, p = 0.06), and had the highest adherence to hormonal therapy. The adjusted hazard ratios for all-cause mortality (n = 209 deaths) were 1.7 (95% CI 1.2-2.4) and 2.4 (95% CI 1.5-4.0) for pre-frail and frail versus robust women, respectively, with an absolute mortality difference of 23.5%. The adjusted hazard of breast cancer death (n-99) was 3.1 (95% CI 1.6-5.8) times higher for frail versus robust patients (absolute difference of 14%). Treatment differences did not account for the relationships between frailty and mortality.Most older breast cancer patients are robust and could consider chemotherapy where otherwise indicated. Patients who are frail or pre-frail have elevated long-term all-cause and breast cancer mortality. Frailty indices could be useful for treatment decision-making and care planning with older patients.

Authors
Mandelblatt, JS; Cai, L; Luta, G; Kimmick, G; Clapp, J; Isaacs, C; Pitcher, B; Barry, W; Winer, E; Sugarman, S; Hudis, C; Muss, H; Cohen, HJ; Hurria, A
MLA Citation
Mandelblatt, JS, Cai, L, Luta, G, Kimmick, G, Clapp, J, Isaacs, C, Pitcher, B, Barry, W, Winer, E, Sugarman, S, Hudis, C, Muss, H, Cohen, HJ, and Hurria, A. "Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance)." Breast cancer research and treatment 164.1 (July 2017): 107-117.
PMID
28364214
Source
epmc
Published In
Breast Cancer Research and Treatment
Volume
164
Issue
1
Publish Date
2017
Start Page
107
End Page
117
DOI
10.1007/s10549-017-4222-8

Cognitive function and discontinuation of adjuvant hormonal therapy in older breast cancer survivors: CALGB 369901 (Alliance).

To investigate the effects of cognitive function on discontinuation of hormonal therapy in breast cancer survivors ages 65+ ("older").Older breast cancer survivors with invasive, non-metastatic disease, and no reported cognitive difficulties were recruited from 78 Alliance sites between 2004 and 2011. Eligible survivors (n = 1280) completed baseline interviews; follow-up was conducted annually for up to 7 years. Survivors with estrogen-receptor-positive (ER+) cancers who initiated hormonal therapy (n = 990) were included. Self-reported cognitive function was measured using the EORTC-QLQ30 scale; a difference of eight points on the 0-100 scale was considered clinically significant. Based on varying rates of discontinuation over time, discontinuation was evaluated separately for three time periods: early (<1 year); midpoint (1-3 years); and late discontinuation (>3-5 years). Cox models for each time period were used to evaluate the effects of cognition immediately preceding discontinuation, controlling for age, chemotherapy, and other covariates.Survivors were 65-91 years old (mean 72.6 years), and 79% had stages 1 or 2A disease. Overall, 43% discontinued hormonal therapy before 5 years. Survivors who reported lower cognitive function in the period before discontinuation had greater hazards of discontinuing therapy at the treatment midpoint (HR 1.22 per 8-point difference, CI 1.09-1.40, p < 0.001), considering covariates, but cognition was not related to discontinuation in the other periods.Self-reported cognitive problems were a significant risk factor for discontinuation of hormonal therapy 1-3 years post-initiation. Additional research is needed on the temporality of cognitive effects and hormonal therapy to support survivorship care needs of older survivors.

Authors
Bluethmann, SM; Alfano, CM; Clapp, JD; Luta, G; Small, BJ; Hurria, A; Cohen, HJ; Sugarman, S; B Muss, H; Isaacs, C; Mandelblatt, JS
MLA Citation
Bluethmann, SM, Alfano, CM, Clapp, JD, Luta, G, Small, BJ, Hurria, A, Cohen, HJ, Sugarman, S, B Muss, H, Isaacs, C, and Mandelblatt, JS. "Cognitive function and discontinuation of adjuvant hormonal therapy in older breast cancer survivors: CALGB 369901 (Alliance)." Breast cancer research and treatment (June 26, 2017).
PMID
28653250
Source
epmc
Published In
Breast Cancer Research and Treatment
Publish Date
2017
DOI
10.1007/s10549-017-4353-y

Using ePrognosis to estimate 2-year all-cause mortality in older women with breast cancer: Cancer and Leukemia Group B (CALGB) 49907 and 369901 (Alliance A151503).

Tools to estimate survival, such as ePrognosis ( http://eprognosis.ucsf.edu/carey2.php ), were developed for general, not cancer, populations. In older patients with breast cancer, accurate overall survival estimates would facilitate discussions about adjuvant therapies.Secondary analyses were performed of data from two parallel breast cancer studies (CALGB/Alliance 49907/NCT000224102 and CALGB/Alliance 369901/NCT00068328). We included patients (n = 971) who were age 70 years and older with complete baseline quality of life data (194 from 49907; 777 from 369901). Estimated versus observed all-cause two-year mortality rates were compared. ePrognosis score was calculated based on age, sex, and daily function (derived from EORTC QLQ-C30). ePrognosis scores range from 0 to 10, with higher scores indicating worse prognosis based on mortality of community-dwelling elders and were categorized into three groups (0-2, 3-6, 7-10). Observed mortality rates were estimated using Kaplan-Meier methods.Patient mean age was 75.8 years (range 70-91) and 73% had stage I-IIA disease. Most patients were classified by ePrognosis as good prognosis (n = 562, 58% 0-2) and few (n = 18, 2% 7-10) poor prognosis. Two-year observed mortality rates were significantly lower than ePrognosis estimates for patients scoring 0-2 (2% vs 5%, p = 0.001) and 3-6 (8% vs 12%, p = 0.01). The same trend was seen with scores of 7-10 (23% vs 36%, p = 0.25).ePrognosis tool only modestly overestimates mortality rate in older breast cancer patients enrolled in two cooperative group studies. This tool, which estimates non-cancer mortality risk based on readily available clinical information may inform adjuvant therapy decisions but should be validated in non-clinical trial populations.

Authors
Kimmick, GG; Major, B; Clapp, J; Sloan, J; Pitcher, B; Ballman, K; Barginear, M; Freedman, RA; Artz, A; Klepin, HD; Lafky, JM; Hopkins, J; Winer, E; Hudis, C; Muss, H; Cohen, H; Jatoi, A; Hurria, A; Mandelblatt, J
MLA Citation
Kimmick, GG, Major, B, Clapp, J, Sloan, J, Pitcher, B, Ballman, K, Barginear, M, Freedman, RA, Artz, A, Klepin, HD, Lafky, JM, Hopkins, J, Winer, E, Hudis, C, Muss, H, Cohen, H, Jatoi, A, Hurria, A, and Mandelblatt, J. "Using ePrognosis to estimate 2-year all-cause mortality in older women with breast cancer: Cancer and Leukemia Group B (CALGB) 49907 and 369901 (Alliance A151503)." Breast cancer research and treatment 163.2 (June 2017): 391-398.
PMID
28283904
Source
epmc
Published In
Breast Cancer Research and Treatment
Volume
163
Issue
2
Publish Date
2017
Start Page
391
End Page
398
DOI
10.1007/s10549-017-4188-6

Physical Performance Across the Adult Life Span: Correlates With Age and Physical Activity.

A number of large-scale population studies have provided valuable information about physical performance in aged individuals; however, there is little information about trajectories of function and associations with age across the adult life span. We developed a mobility-focused physical performance screener designed to be appropriate for the adult life span.The physical performance battery includes measures of mobility, strength, endurance, and balance. Physical activity (PA) was assessed with accelerometry. We examined age-related trends in physical performance and PA, and the relationship between physical performance and PA across the age range (30-90+), by decade, in 775 participants enrolled in the study 2012-2014.Physical performance was worse with increasing age decade. Although men performed better than women across all ages, the decrement by age group was similar between genders. Worsening physical performance was observed as early as the fifth decade for chair stands and balance and in the sixth decade for gait speed and aerobic endurance. The number and strength of significant associations between physical performance and PA increased with greater age: the greatest number of significant associations was seen in the 60-79 age groups, with fewer reported in the 30-59 and 80-90+ age groups. More PA was associated with better physical function.These results emphasize the importance of a life span approach to studies of function and aging. This work points to the need for a physical performance screener that spans across adulthood as a clinical tool for identifying functional decline.

Authors
Hall, KS; Cohen, HJ; Pieper, CF; Fillenbaum, GG; Kraus, WE; Huffman, KM; Cornish, MA; Shiloh, A; Flynn, C; Sloane, R; Newby, LK; Morey, MC
MLA Citation
Hall, KS, Cohen, HJ, Pieper, CF, Fillenbaum, GG, Kraus, WE, Huffman, KM, Cornish, MA, Shiloh, A, Flynn, C, Sloane, R, Newby, LK, and Morey, MC. "Physical Performance Across the Adult Life Span: Correlates With Age and Physical Activity." The journals of gerontology. Series A, Biological sciences and medical sciences 72.4 (April 2017): 572-578.
PMID
27356977
Source
epmc
Published In
Journals of Gerontology: Series A
Volume
72
Issue
4
Publish Date
2017
Start Page
572
End Page
578
DOI
10.1093/gerona/glw120

Association of Testosterone Levels With Anemia in Older Men: A Controlled Clinical Trial.

In one-third of older men with anemia, no recognized cause can be found.To determine if testosterone treatment of men 65 years or older with unequivocally low testosterone levels and unexplained anemia would increase their hemoglobin concentration.A double-blinded, placebo-controlled trial with treatment allocation by minimization using 788 men 65 years or older who have average testosterone levels of less than 275 ng/dL. Of 788 participants, 126 were anemic (hemoglobin ≤12.7 g/dL), 62 of whom had no known cause. The trial was conducted in 12 academic medical centers in the United States from June 2010 to June 2014.Testosterone gel, the dose adjusted to maintain the testosterone levels normal for young men, or placebo gel for 12 months.The percent of men with unexplained anemia whose hemoglobin levels increased by 1.0 g/dL or more in response to testosterone compared with placebo. The statistical analysis was intent-to-treat by a logistic mixed effects model adjusted for balancing factors.The men had a mean age of 74.8 years and body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of 30.7; 84.9% were white. Testosterone treatment resulted in a greater percentage of men with unexplained anemia whose month 12 hemoglobin levels had increased by 1.0 g/dL or more over baseline (54%) than did placebo (15%) (adjusted OR, 31.5; 95% CI, 3.7-277.8; P = .002) and a greater percentage of men who at month 12 were no longer anemic (58.3%) compared with placebo (22.2%) (adjusted OR, 17.0; 95% CI, 2.8-104.0; P = .002). Testosterone treatment also resulted in a greater percentage of men with anemia of known cause whose month 12 hemoglobin levels had increased by 1.0 g/dL or more (52%) than did placebo (19%) (adjusted OR, 8.2; 95% CI, 2.1-31.9; P = .003). Testosterone treatment resulted in a hemoglobin concentration of more than 17.5 g/dL in 6 men who had not been anemic at baseline.Among older men with low testosterone levels, testosterone treatment significantly increased the hemoglobin levels of those with unexplained anemia as well as those with anemia from known causes. These increases may be of clinical value, as suggested by the magnitude of the changes and the correction of anemia in most men, but the overall health benefits remain to be established. Measurement of testosterone levels might be considered in men 65 years or older who have unexplained anemia and symptoms of low testosterone levels.clinicaltrials.gov Identifier: NCT00799617.

Authors
Roy, CN; Snyder, PJ; Stephens-Shields, AJ; Artz, AS; Bhasin, S; Cohen, HJ; Farrar, JT; Gill, TM; Zeldow, B; Cella, D; Barrett-Connor, E; Cauley, JA; Crandall, JP; Cunningham, GR; Ensrud, KE; Lewis, CE; Matsumoto, AM; Molitch, ME; Pahor, M; Swerdloff, RS; Cifelli, D; Hou, X; Resnick, SM; Walston, JD; Anton, S; Basaria, S; Diem, SJ; Wang, C; Schrier, SL; Ellenberg, SS
MLA Citation
Roy, CN, Snyder, PJ, Stephens-Shields, AJ, Artz, AS, Bhasin, S, Cohen, HJ, Farrar, JT, Gill, TM, Zeldow, B, Cella, D, Barrett-Connor, E, Cauley, JA, Crandall, JP, Cunningham, GR, Ensrud, KE, Lewis, CE, Matsumoto, AM, Molitch, ME, Pahor, M, Swerdloff, RS, Cifelli, D, Hou, X, Resnick, SM, Walston, JD, Anton, S, Basaria, S, Diem, SJ, Wang, C, Schrier, SL, and Ellenberg, SS. "Association of Testosterone Levels With Anemia in Older Men: A Controlled Clinical Trial." JAMA internal medicine 177.4 (April 2017): 480-490.
PMID
28241237
Source
epmc
Published In
JAMA Internal Medicine
Volume
177
Issue
4
Publish Date
2017
Start Page
480
End Page
490
DOI
10.1001/jamainternmed.2016.9540

Personality, coping, and social support as predictors of long-term quality-of-life trajectories in older breast cancer survivors: CALGB protocol 369901 (Alliance).

To determine long-term quality-of-life (QOL) trajectories among breast cancer survivors aged 65+ (older) evaluating the effects of personality and social support.Older women (N = 1280) newly examined with invasive, nonmetastatic breast cancer completed baseline assessments. Follow-up data were collected 6 and 12 months later and then annually for up to 7 years (median 4.5 years). Quality of life was assessed using EORTC-QLQ-C30 emotional, physical, and cognitive scales. Optimism (Life Orientation Test), Coping (Brief COPE), and social support (Medical Outcomes Study) were assessed at baseline. Group-based trajectory modeling identified QOL trajectories; multinomial regression evaluated effects of predictors on trajectory groups. Age, education, systemic therapy, comorbidity, and reported precancer function (SF-12) were considered as controlling variables.Three trajectories were identified for each QOL domain: "maintained high," "phase shift" (lower but parallel scores to "maintained high" group), and "accelerated decline" (lowest baseline scores and steepest decline). Accelerated decline in emotional, physical, and cognitive function was seen in 6.9%, 31.8%, and 7.6% of older survivors, respectively. Maladaptive coping and lower social support increased adjusted odds of being in the accelerated decline group for all QOL domains; lower optimism was only related to decline in emotional function. Chemotherapy was related to physical and cognitive but not emotional function trajectories.Personality and social resources affect the course of long-term emotional well-being of older breast cancer survivors; treatment is more important for physical and cognitive than emotional function. Early identification of those vulnerable to deterioration could facilitate clinical and psychological support.

Authors
Durá-Ferrandis, E; Mandelblatt, JS; Clapp, J; Luta, G; Luta, G; Faul, L; Kimmick, G; Cohen, HJ; Yung, RL; Hurria, A
MLA Citation
Durá-Ferrandis, E, Mandelblatt, JS, Clapp, J, Luta, G, Luta, G, Faul, L, Kimmick, G, Cohen, HJ, Yung, RL, and Hurria, A. "Personality, coping, and social support as predictors of long-term quality-of-life trajectories in older breast cancer survivors: CALGB protocol 369901 (Alliance)." Psycho-oncology (February 20, 2017).
PMID
28219113
Source
epmc
Published In
Psycho-Oncology
Publish Date
2017
DOI
10.1002/pon.4404

Accrual of Older Patients With Breast Cancer to Alliance Systemic Therapy Trials Over Time: Protocol A151527.

Purpose Despite increasing awareness of accrual challenges, it is unknown if accrual of older patients to breast cancer treatment trials is improving. Methods We examined accrual of older patients to Alliance for Clinical Trials in Oncology systemic therapy breast cancer trials during 1985-2012 and compared disease characteristics and reasons for therapy cessation for older (age ≥ 65 years and ≥ 70 years) versus younger (age < 65 years and < 70 years) participants. To examine accrual trends, we modeled age as a function of time, using logistic regression. Results Overall, 17% of study participants were ≥ 65 years of age. Approximately 15%, 24%, and 24% of participants in adjuvant, neoadjuvant, and metastatic trials were age ≥ 65 years, and 7%, 15%, and 13% were age ≥ 70 years, respectively. The odds of a patient age ≥ 65 years enrolling significantly increased over time for adjuvant trials (odds ratio [OR] per year, 1.04; 95% CI, 1.04 to 1.05) but decreased significantly for neoadjuvant and metastatic trials (OR, 0.62; 95% CI, 0.58 to 0.67 and OR, 0.98, 95% CI, 0.97 to 1.00). Similar trends were seen for those age ≥ 70 years but these were statistically significant for adjuvant and neoadjuvant trials only (OR, 1.05, 95% CI, 1.04 to 1.07; and OR, 0.57, 95% CI, 0.52 to 0.62). In general, those age ≥ 65 years ( v those < 65 years) in adjuvant studies had a higher mean number of lymph nodes involved and more hormone receptor-negative tumors, although tumor sizes were similar. Early protocol treatment cessation was also more frequent in those age ≥ 65 years (50%) versus < 65 years (35.9%) across trials. Conclusion Older patients with breast cancer remain largely underrepresented in cooperative group therapeutic trials. We observed some improvement in accrual to adjuvant trials but worsening of accrual for neoadjuvant/metastatic trials. Novel strategies to increase accrual of older patients are critical to meaningfully change the evidence base for this growing patient population.

Authors
Freedman, RA; Foster, JC; Seisler, DK; Lafky, JM; Muss, HB; Cohen, HJ; Mandelblatt, J; Winer, EP; Hudis, CA; Partridge, AH; Carey, LA; Cirrincione, C; Moreno-Aspitia, A; Kimmick, G; Jatoi, A; Hurria, A
MLA Citation
Freedman, RA, Foster, JC, Seisler, DK, Lafky, JM, Muss, HB, Cohen, HJ, Mandelblatt, J, Winer, EP, Hudis, CA, Partridge, AH, Carey, LA, Cirrincione, C, Moreno-Aspitia, A, Kimmick, G, Jatoi, A, and Hurria, A. "Accrual of Older Patients With Breast Cancer to Alliance Systemic Therapy Trials Over Time: Protocol A151527." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 35.4 (February 2017): 421-431.
PMID
27992272
Source
epmc
Published In
Journal of Clinical Oncology
Volume
35
Issue
4
Publish Date
2017
Start Page
421
End Page
431
DOI
10.1200/jco.2016.69.4182

Response to Letter From De Alfieri et al.: Biological Resilience of Elderly Hospitalized Patients.

Authors
Whitson, HE; Duan-Porter, W; Schmader, K; Morey, M; Cohen, HJ; Colón-Emeric, C
MLA Citation
Whitson, HE, Duan-Porter, W, Schmader, K, Morey, M, Cohen, HJ, and Colón-Emeric, C. "Response to Letter From De Alfieri et al.: Biological Resilience of Elderly Hospitalized Patients." The journals of gerontology. Series A, Biological sciences and medical sciences 72.1 (January 2017): 142-. (Letter)
PMID
27811154
Source
epmc
Published In
Journals of Gerontology: Series A
Volume
72
Issue
1
Publish Date
2017
Start Page
142
DOI
10.1093/gerona/glw161

Risk of acute myeloid leukemia and myelodysplastic syndrome among older women receiving anthracycline-based adjuvant chemotherapy for breast cancer on Modern Cooperative Group Trials (Alliance A151511).

We examined acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) events among 9679 women treated for breast cancer on four adjuvant Alliance for Clinical Trials in Oncology trials with >90 months of follow-up in order to better characterize the risk for AML/MDS in older patients receiving anthracyclines.We used multivariable Cox regression to examine factors associated with AML/MDS, adjusting for age (≥65 vs. <65 years; separately for ≥70 vs. <70 years), race/ethnicity, insurance, performance status, and anthracycline receipt. We also examined the effect of cyclophosphamide, the interaction of anthracycline and age, and outcomes for those developing AML/MDS.On Cancer and Leukemia Group B (CALGB) 40101, 49907, 9344, and 9741, 7290 received anthracyclines; 15% were in the age ≥65 and 7% were ≥70. Overall, 47 patients developed AML/MDS (30 AML [0.3%], 17 MDS [0.2%]); 83% of events occurred within 5 years of study registration. Among those age ≥65 and ≥70, 0.8 and 1.0% developed AML/MDS (vs. 0.4% for age <65), respectively. In adjusted analyses, older age and anthracycline receipt were significantly associated with AML/MDS (adjusted hazard ratio [HR] for age ≥65 [vs. <65] = 3.13, 95% confidence interval [CI] 1.18-8.33; HR for anthracycline receipt [vs. no anthracycline] = 5.16, 95% CI 1.47-18.19). There was no interaction between age and anthracycline use. Deaths occurred in 70% of those developing AML/MDS.We observed an increased risk for AML/MDS for older patients and those receiving anthracyclines, though these events were rare. Our results help inform discussions surrounding anticipated toxicities of adjuvant chemotherapy in older patients.

Authors
Freedman, RA; Seisler, DK; Foster, JC; Sloan, JA; Lafky, JM; Kimmick, GG; Hurria, A; Cohen, HJ; Winer, EP; Hudis, CA; Partridge, AH; Carey, LA; Jatoi, A; Klepin, HD; Citron, M; Berry, DA; Shulman, LN; Buzdar, AU; Suman, VJ; Muss, HB
MLA Citation
Freedman, RA, Seisler, DK, Foster, JC, Sloan, JA, Lafky, JM, Kimmick, GG, Hurria, A, Cohen, HJ, Winer, EP, Hudis, CA, Partridge, AH, Carey, LA, Jatoi, A, Klepin, HD, Citron, M, Berry, DA, Shulman, LN, Buzdar, AU, Suman, VJ, and Muss, HB. "Risk of acute myeloid leukemia and myelodysplastic syndrome among older women receiving anthracycline-based adjuvant chemotherapy for breast cancer on Modern Cooperative Group Trials (Alliance A151511)." Breast cancer research and treatment 161.2 (January 2017): 363-373.
PMID
27866278
Source
epmc
Published In
Breast Cancer Research and Treatment
Volume
161
Issue
2
Publish Date
2017
Start Page
363
End Page
373
DOI
10.1007/s10549-016-4051-1

Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy.

Frailty has been suggested as a construct for oncologists to consider in treating older cancer patients. Therefore, the authors assessed the potential of creating a deficit-accumulation frailty index (DAFI) from a largely self-administered comprehensive geriatric assessment (CGA).Five hundred patients aged ≥65 years underwent a CGA before receiving chemotherapy. A DAFI was constructed, resulting in a 51-item scale, and cutoff values were examined for patients in the robust/nonfrail (cutoff value, 0.0 < 0.2), prefrail (cutoff value, 0.2 < 0.35), and frail (cutoff value, ≥ 0.35) groups.Two hundred and fifty patients (50%) were nonfrail, 197 (39%) were prefrail, and 52 (11%) were frail. Older patients (aged ≥ 80 years) and those who had lower education, were living alone, and had higher stage disease were associated with prefrail/frail status. Prefrail/frail patients were more likely to have grade ≥3 toxicity but not to have a dose delay or reduction, and they were more likely to discontinue drug and be hospitalized. The association with grade ≥3 toxicity was attenuated by controlling for a toxicity risk calculator, but the other outcomes were not.A deficit-accumulation frailty index can be constructed from a CGA in older patients with cancer and can indicate the frailty status of the population. The frailty status so determined is associated both with outcomes likely because of chemotherapy toxicity and with those likely because of age-related physiologic and functional deficits and thus can be useful in the overall assessment of the patient. Cancer 2016;122:3865-3872. © 2016 American Cancer Society.

Authors
Cohen, HJ; Smith, D; Sun, C-L; Tew, W; Mohile, SG; Owusu, C; Klepin, HD; Gross, CP; Lichtman, SM; Gajra, A; Filo, J; Katheria, V; Hurria, A; Cancer and Aging Research Group,
MLA Citation
Cohen, HJ, Smith, D, Sun, C-L, Tew, W, Mohile, SG, Owusu, C, Klepin, HD, Gross, CP, Lichtman, SM, Gajra, A, Filo, J, Katheria, V, Hurria, A, and Cancer and Aging Research Group, . "Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy." Cancer 122.24 (December 2016): 3865-3872.
PMID
27529755
Source
epmc
Published In
Cancer
Volume
122
Issue
24
Publish Date
2016
Start Page
3865
End Page
3872
DOI
10.1002/cncr.30269

Disease drivers of aging.

It has long been known that aging, at both the cellular and organismal levels, contributes to the development and progression of the pathology of many chronic diseases. However, much less research has examined the inverse relationship-the contribution of chronic diseases and their treatments to the progression of aging-related phenotypes. Here, we discuss the impact of three chronic diseases (cancer, HIV/AIDS, and diabetes) and their treatments on aging, putative mechanisms by which these effects are mediated, and the open questions and future research directions required to understand the relationships between these diseases and aging.

Authors
Hodes, RJ; Sierra, F; Austad, SN; Epel, E; Neigh, GN; Erlandson, KM; Schafer, MJ; LeBrasseur, NK; Wiley, C; Campisi, J; Sehl, ME; Scalia, R; Eguchi, S; Kasinath, BS; Halter, JB; Cohen, HJ; Demark-Wahnefried, W; Ahles, TA; Barzilai, N; Hurria, A; Hunt, PW
MLA Citation
Hodes, RJ, Sierra, F, Austad, SN, Epel, E, Neigh, GN, Erlandson, KM, Schafer, MJ, LeBrasseur, NK, Wiley, C, Campisi, J, Sehl, ME, Scalia, R, Eguchi, S, Kasinath, BS, Halter, JB, Cohen, HJ, Demark-Wahnefried, W, Ahles, TA, Barzilai, N, Hurria, A, and Hunt, PW. "Disease drivers of aging." Annals of the New York Academy of Sciences 1386.1 (December 2016): 45-68. (Review)
PMID
27943360
Source
epmc
Published In
Annals of the New York Academy of Sciences
Volume
1386
Issue
1
Publish Date
2016
Start Page
45
End Page
68
DOI
10.1111/nyas.13299

Reliability, Validity, and Feasibility of a Computer-Based Geriatric Assessment for Older Adults With Cancer.

The goal of this study was to evaluate the feasibility, reliability, and validity of a computer-based geriatric assessment via two methods of electronic data capture ( SupportScreen and REDCap) compared with paper-and-pencil data capture among older adults with cancer.Eligible patients were ≥ 65 years old, had a cancer diagnosis, and were fluent in English. Patients were randomly assigned to one of four arms, in which they completed the geriatric assessment twice: (1) REDCap and paper and pencil in sessions 1 and 2; (2) REDCap in both sessions; (3) SupportScreen and paper and pencil in sessions 1 and 2; and (4) SupportScreen in both sessions. The feasibility, reliability, and validity of the computer-based geriatric assessment compared with paper and pencil were evaluated.The median age of participants (N = 100) was 71 years (range, 65 to 91 years) and the diagnosis was solid tumor (82%) or hematologic malignancy (18%). For session 1, REDCap took significantly longer to complete than paper and pencil (median, 21 minutes [range, 11 to 44 minutes] v median, 15 minutes [range, 9 to 29 minutes], P < .01) or SupportScreen (median, 16 minutes [range, 6 to 38 minutes], P < .01). There were no significant differences in completion times between SupportScreen and paper and pencil ( P = .50). The computer-based geriatric assessment was feasible. Few participants (8%) needed help with completing the geriatric assessment (REDCap, n = 7 and SupportScreen, n = 1), 89% reported that the length was "just right," and 67% preferred the computer-based geriatric assessment to paper and pencil. Test-retest reliability was high (Spearman correlation coefficient ≥ 0.79) for all scales except for social activity. Validity among similar scales was demonstrated.Delivering a computer-based geriatric assessment is feasible, reliable, and valid. SupportScreen methodology is preferred to REDCap.

Authors
Hurria, A; Akiba, C; Kim, J; Mitani, D; Loscalzo, M; Katheria, V; Koczywas, M; Pal, S; Chung, V; Forman, S; Nathwani, N; Fakih, M; Karanes, C; Lim, D; Popplewell, L; Cohen, H; Canin, B; Cella, D; Ferrell, B; Goldstein, L
MLA Citation
Hurria, A, Akiba, C, Kim, J, Mitani, D, Loscalzo, M, Katheria, V, Koczywas, M, Pal, S, Chung, V, Forman, S, Nathwani, N, Fakih, M, Karanes, C, Lim, D, Popplewell, L, Cohen, H, Canin, B, Cella, D, Ferrell, B, and Goldstein, L. "Reliability, Validity, and Feasibility of a Computer-Based Geriatric Assessment for Older Adults With Cancer." Journal of oncology practice 12.12 (December 2016): e1025-e1034.
PMID
27624950
Source
epmc
Published In
Journal of Oncology Practice
Volume
12
Issue
12
Publish Date
2016
Start Page
e1025
End Page
e1034
DOI
10.1200/jop.2016.013136

Older adult oncology, version 2.2016: Featured updates to the NCCN guidelines

Cancer is the leading cause of death in older adults aged 60 to 79 years. Older patients with good performance status are able to tolerate commonly used treatment modalities as well as younger patients, particularly when adequate supportive care is provided. For older patients who are able to tolerate curative treatment, options include surgery, radiation therapy (RT), chemotherapy, and targeted therapies. RT can be highly effective and well tolerated in carefully selected patients, and advanced age alone should not preclude the use of RT in older patients with cancer. Judicious application of advanced RT techniques that facilitate normal tissue sparing and reduce RT doses to organs at risk are important for all patients, and may help to assuage concerns about the risks of RT in older adults. These NCCN Guidelines Insights focus on the recent updates to the 2016 NCCN Guidelines for Older Adult Oncology specific to the use of RT in the management of older adults with cancer.

Authors
Van Der Walde, N; Jagsi, R; Dotan, E; Baumgartner, J; Browner, IS; Burhenn, P; Cohen, HJ; Edil, BH; Edwards, B; Extermann, M; Ganti, AKP; Gross, C; Hubbard, J; Keating, NL; Korc-Grodzicki, B; McKoy, JM; Medeiros, BC; Mrozek, E; O'Connor, T; Rugo, HS; Rupper, RW; Shepard, D; Silliman, RA; Stirewalt, DL; Tew, WP; Walter, LC; Wildes, T; Bergman, MA; Sundar, H; Hurria, A
MLA Citation
Van Der Walde, N, Jagsi, R, Dotan, E, Baumgartner, J, Browner, IS, Burhenn, P, Cohen, HJ, Edil, BH, Edwards, B, Extermann, M, Ganti, AKP, Gross, C, Hubbard, J, Keating, NL, Korc-Grodzicki, B, McKoy, JM, Medeiros, BC, Mrozek, E, O'Connor, T, Rugo, HS, Rupper, RW, Shepard, D, Silliman, RA, Stirewalt, DL, Tew, WP, Walter, LC, Wildes, T, Bergman, MA, Sundar, H, and Hurria, A. "Older adult oncology, version 2.2016: Featured updates to the NCCN guidelines." JNCCN Journal of the National Comprehensive Cancer Network 14.11 (November 1, 2016): 1357-1370. (Review)
Source
scopus
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
14
Issue
11
Publish Date
2016
Start Page
1357
End Page
1370

Association of Plasma Small-Molecule Intermediate Metabolites With Age and Body Mass Index Across Six Diverse Study Populations.

Older age and obesity are associated with metabolic dysregulation; the mechanism by which these factors impact metabolism across the lifespan is important, but relatively unknown. We evaluated a panel of amino acids (AAs) and acylcarnitines (ACs) to identify effects of age and adiposity (body mass index) on circulating small-molecule metabolites in a meta-analysis of six diverse study populations.Targeted metabolic profiling was performed in six independent studies, representing 739 subjects with a broad range of age, body mass index, health states, and ethnic origin. Principal components analysis was performed on log-normalized values for AAs and ACs separately, generating one AC factor and two AA factors for each study. A common AC factor consisted primarily of acetylcarnitine, medium-chain AC, and several long-chain AC. AA Factor 1 consisted primarily of large neutral AAs. Glycine was its own factor.Metabolic profiling and factor analysis identified clusters of related metabolites of lipid and AA metabolism that were consistently associated with age and body mass in a series of studies with a broad range of age, body mass index, and health status. An inverse association of glycine with body mass index and male gender supports its role as a marker of favorable metabolic health.An important focus of future investigations should be to determine whether these clusters of metabolic intermediates are possible early predictors of health outcomes associated with body mass; are involved with accelerated aging; are involved in the causative pathway of aging; and how modification of these metabolic pathways impact the biology of aging.

Authors
Kraus, WE; Pieper, CF; Huffman, KM; Thompson, DK; Kraus, VB; Morey, MC; Cohen, HJ; Ravussin, E; Redman, LM; Bain, JR; Stevens, RD; Newgard, CB
MLA Citation
Kraus, WE, Pieper, CF, Huffman, KM, Thompson, DK, Kraus, VB, Morey, MC, Cohen, HJ, Ravussin, E, Redman, LM, Bain, JR, Stevens, RD, and Newgard, CB. "Association of Plasma Small-Molecule Intermediate Metabolites With Age and Body Mass Index Across Six Diverse Study Populations." The journals of gerontology. Series A, Biological sciences and medical sciences 71.11 (November 2016): 1507-1513.
PMID
26984390
Source
epmc
Published In
Journals of Gerontology: Series A
Volume
71
Issue
11
Publish Date
2016
Start Page
1507
End Page
1513
DOI
10.1093/gerona/glw031

Physical resilience of older cancer survivors: An emerging concept.

To characterize factors contributing to physical resilience in older cancer survivors, as demonstrated by resistance to decline or recovery (resilience).We conducted a secondary analysis of data from a randomized controlled trial of cancer survivors ≥65years old and ≥5years from cancer diagnoses. Physical function was assessed quarterly over 2years, with Short-Form 36 physical function subscale. Participants with ≥2 follow-up assessments (n=594) were evaluated for physical resilience: 1) Resistance was defined as lack of any decline, where decline was a drop of ≥13 points, and 2) resilience (i.e., recovery) was defined as regaining ≥50% of lost function, subsequent to decline.Mean age was 73.1years and 89.1% were Caucasian. Forty-nine percent (n=289) were resistant to decline in function; these individuals were younger, had higher education and income, were more likely to be Caucasian, and had higher baseline physical function (mean difference [MD] 7.8 points, 95% CI 5.0-10.8) and general health (MD 7.5 points, 95% CI 4.9-10.1). Fifty-seven percent (n=137 of 239) demonstrated resilience, with 91.2% (n=125) recovering within 6months of declines; these participants had higher baseline physical function (MD 6.6 points, 95% CI 1.8-11.4), but similar pre-decline function. More participants who were resistant, and more who showed resilience, reported high self-efficacy and social support.The majority of older cancer survivors exhibited physical resilience; this was associated with high baseline health, physical function, self-efficacy, and social support. Assessing and targeting psychosocial factors may be important for interventions seeking to promote physical resilience.

Authors
Duan-Porter, W; Cohen, HJ; Demark-Wahnefried, W; Sloane, R; Pendergast, JF; Snyder, DC; Morey, MC
MLA Citation
Duan-Porter, W, Cohen, HJ, Demark-Wahnefried, W, Sloane, R, Pendergast, JF, Snyder, DC, and Morey, MC. "Physical resilience of older cancer survivors: An emerging concept." Journal of geriatric oncology 7.6 (November 2016): 471-478.
PMID
27478133
Source
epmc
Published In
Journal of Geriatric Oncology
Volume
7
Issue
6
Publish Date
2016
Start Page
471
End Page
478
DOI
10.1016/j.jgo.2016.07.009

Enrollment Trends and Disparity Among Patients With Lung Cancer in National Clinical Trials, 1990 to 2012.

Under-representation of elderly, women, and racial/ethnic minority patients with cancer in clinical trials is of national concern. The goal of this study was to characterize enrollment trends and disparities by age, sex, and race/ethnicity in lung cancer trials.We analyzed data for 23,006 National Cancer Institute cooperative group lung cancer trial participants and 578,476 patients with lung cancer from the SEER registry from 1990 to 2012. The enrollment disparity difference (EDD) and enrollment disparity ratio (EDR) were calculated on the basis of the proportion of each subgroup in the trial population and the US lung cancer population. Annual percentage changes (APCs) in the subgroup proportions in each population were compared over time.Enrollment disparity for patients ≥ 70 years of age with non-small-cell lung cancer improved from 1990 to 2012 (test of parallelism, P = .020), with a remaining EDD of 0.22 (95% CI, 0.19 to 0.25) and EDR of 1.65 (95% CI, 1.51 to 1.82) in 2010 to 2012. No improvement was seen for elderly patients with small-cell lung cancer (SCLC), with an APC of 0.20 (P = .714) among trial participants, despite a rising proportion of elderly patients with SCLC in the US population (APC, 0.32; P = .020). Enrollment disparity for women with lung cancer improved overall, with the gap closing by 2012 (EDD, 0.03 [95% CI, 0.00 to 0.06]; EDR, 1.07 [95% CI, 1.00 to 1.16]). Enrollment disparities persisted without significant improvement for elderly women, blacks, Asians/Pacific Islanders, and Hispanics.Under-representation in lung cancer trials improved significantly from 1990 to 2012 for elderly patients with non-small-cell lung cancer and for women, but ongoing efforts to improve the enrollment of elderly patients with SCLC and minorities are needed. Our study highlights the importance of addressing enrollment disparities by demographic and disease subgroups to better target under-represented groups of patients with lung cancer.

Authors
Pang, HH; Wang, X; Stinchcombe, TE; Wong, ML; Cheng, P; Ganti, AK; Sargent, DJ; Zhang, Y; Hu, C; Mandrekar, SJ; Redman, MW; Manola, JB; Schilsky, RL; Cohen, HJ; Bradley, JD; Adjei, AA; Gandara, D; Ramalingam, SS; Vokes, EE
MLA Citation
Pang, HH, Wang, X, Stinchcombe, TE, Wong, ML, Cheng, P, Ganti, AK, Sargent, DJ, Zhang, Y, Hu, C, Mandrekar, SJ, Redman, MW, Manola, JB, Schilsky, RL, Cohen, HJ, Bradley, JD, Adjei, AA, Gandara, D, Ramalingam, SS, and Vokes, EE. "Enrollment Trends and Disparity Among Patients With Lung Cancer in National Clinical Trials, 1990 to 2012." Journal of clinical oncology : official journal of the American Society of Clinical Oncology (September 19, 2016).
PMID
27646951
Source
epmc
Published In
Journal of Clinical Oncology
Publish Date
2016

Detailed methods of two home-based vegetable gardening intervention trials to improve diet, physical activity, and quality of life in two different populations of cancer survivors.

Cancer survivors suffer from long-term adverse effects that reduce health-related quality of life (QOL) and physical functioning, creating an urgent need to develop effective, durable, and disseminable interventions. Harvest for Health, a home-based vegetable gardening intervention, holds promise for these domains.This report describes the methods and recruitment experiences from two randomized controlled feasibility trials that employ a waitlist-controlled design. Delivered in partnership with Cooperative Extension Master Gardeners, this intervention provides one-on-one mentorship of cancer survivors in planning and maintaining three seasonal vegetable gardens over 12months. The primary aim is to determine intervention feasibility and acceptability; secondary aims are to explore effects on objective and subjective measures of diet, physical activity and function, and QOL and examine participant factors associated with potential effects. One trial is conducted exclusively among 82 female breast cancer survivors residing in the Birmingham, AL metropolitan area (BBCS); another broadly throughout Alabama among 46 older cancer survivors aged >60 (ASCS).Response rates were 32.6% (BBCS) and 52.3% (ASCS). Both trials exceeded 80% of their accrual target. Leading reasons for ineligibility were removal of >10 lymph nodes (lymphedema risk factor), lack of physician approval, and unwillingness to be randomized to the waitlist.To date, recruitment and implementation of Harvest for Health appears feasible.Although both studies encountered recruitment challenges, lessons learned can inform future larger-scale studies. Vegetable gardening interventions are of interest to cancer survivors and may provide opportunities to gain life skills leading to improvements in overall health and QOL.

Authors
Cases, MG; Frugé, AD; De Los Santos, JF; Locher, JL; Cantor, AB; Smith, KP; Glover, TA; Cohen, HJ; Daniel, M; Morrow, CD; Moellering, DR; Demark-Wahnefried, W
MLA Citation
Cases, MG, Frugé, AD, De Los Santos, JF, Locher, JL, Cantor, AB, Smith, KP, Glover, TA, Cohen, HJ, Daniel, M, Morrow, CD, Moellering, DR, and Demark-Wahnefried, W. "Detailed methods of two home-based vegetable gardening intervention trials to improve diet, physical activity, and quality of life in two different populations of cancer survivors." Contemporary clinical trials 50 (September 2016): 201-212.
PMID
27565830
Source
epmc
Published In
Contemporary Clinical Trials
Volume
50
Publish Date
2016
Start Page
201
End Page
212
DOI
10.1016/j.cct.2016.08.014

Improving the quality of survivorship for older adults with cancer.

In May 2015, the Cancer and Aging Research Group, in collaboration with the National Cancer Institute and the National Institute on Aging through a U13 grant, convened a conference to identify research priorities to help design and implement intervention studies to improve the quality of life and survivorship of older, frailer adults with cancer. Conference attendees included researchers with multidisciplinary expertise and advocates. It was concluded that future intervention trials for older adults with cancer should: 1) rigorously test interventions to prevent the decline of or improve health status, especially interventions focused on optimizing physical performance, nutritional status, and cognition while undergoing cancer treatment; 2) use standardized care plans based on geriatric assessment findings to guide targeted interventions; and 3) incorporate the principles of geriatrics into survivorship care plans. Also highlighted was the need to integrate the expertise of interdisciplinary team members into geriatric oncology research, improve funding mechanisms to support geriatric oncology research, and disseminate high-impact results to the research and clinical community. In conjunction with the 2 prior U13 meetings, this conference provided the framework for future research to improve the evidence base for the clinical care of older adults with cancer. Cancer 2016;122:2459-68. © 2016 American Cancer Society.

Authors
Mohile, SG; Hurria, A; Cohen, HJ; Rowland, JH; Leach, CR; Arora, NK; Canin, B; Muss, HB; Magnuson, A; Flannery, M; Lowenstein, L; Allore, HG; Mustian, KM; Demark-Wahnefried, W; Extermann, M; Ferrell, B; Inouye, SK; Studenski, SA; Dale, W
MLA Citation
Mohile, SG, Hurria, A, Cohen, HJ, Rowland, JH, Leach, CR, Arora, NK, Canin, B, Muss, HB, Magnuson, A, Flannery, M, Lowenstein, L, Allore, HG, Mustian, KM, Demark-Wahnefried, W, Extermann, M, Ferrell, B, Inouye, SK, Studenski, SA, and Dale, W. "Improving the quality of survivorship for older adults with cancer." Cancer 122.16 (August 2016): 2459-2568. (Review)
PMID
27172129
Source
epmc
Published In
Cancer
Volume
122
Issue
16
Publish Date
2016
Start Page
2459
End Page
2568
DOI
10.1002/cncr.30053

Long-term trajectories of self-reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance).

The number of survivors of breast cancer aged ≥65 years ("older") is growing, but to the authors' knowledge, little is known regarding the cognitive outcomes of these individuals.A cohort of cognitively intact older survivors with nonmetastatic, invasive breast cancer was recruited from 78 sites from 2004 through 2011; approximately 83.7% of the survivors (1280 survivors) completed baseline assessments. Follow-up data were collected at 6 months and annually for up to 7 years (median, 4.1 years). Cognitive function was self-reported using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30); scores ranged from 0 to 100, with a higher score indicating better function. Group-based trajectory modeling determined trajectories; women were assigned to a trajectory group based on the highest predicted probability of membership. Multinomial logistic regression evaluated the association between receipt of chemotherapy (with or without hormonal treatment) and trajectory group.Survivors were aged 65 to 91 years; approximately 41% received chemotherapy. There were 3 cognitive trajectories: "maintained high" (42.3% of survivors); "phase shift" (50.1% of survivors), with scores slightly below but parallel to maintained high; and "accelerated decline" (7.6% of survivors), with the lowest baseline scores and greatest decline (from 71.7 [standard deviation, 19.8] to 58.3 [standard deviation, 21.9]). The adjusted odds of being in the accelerated decline group (vs the maintained high group) were 2.1 times higher (95% confidence interval, 1.3-3.5) for survivors who received chemotherapy (with or without hormonal therapy) versus those treated with hormonal therapy alone. Greater comorbidity and frailty also were found to be associated with accelerated decline.Trajectory group analysis demonstrated that the majority of older survivors maintained good long-term self-reported cognitive function, and that only a small subset who were exposed to chemotherapy manifested accelerated cognitive decline. Future research is needed to determine factors that place some older survivors at risk of experiencing cognitive decline. Cancer 2016. 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Authors
Mandelblatt, JS; Clapp, JD; Luta, G; Faul, LA; Tallarico, MD; McClendon, TD; Whitley, JA; Cai, L; Ahles, TA; Stern, RA; Jacobsen, PB; Small, BJ; Pitcher, BN; Dura-Fernandis, E; Muss, HB; Hurria, A; Cohen, HJ; Isaacs, C
MLA Citation
Mandelblatt, JS, Clapp, JD, Luta, G, Faul, LA, Tallarico, MD, McClendon, TD, Whitley, JA, Cai, L, Ahles, TA, Stern, RA, Jacobsen, PB, Small, BJ, Pitcher, BN, Dura-Fernandis, E, Muss, HB, Hurria, A, Cohen, HJ, and Isaacs, C. "Long-term trajectories of self-reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance)." Cancer (July 22, 2016).
PMID
27447359
Source
epmc
Published In
Cancer
Publish Date
2016
DOI
10.1002/cncr.30208

Comorbidity in older adults with cancer.

Comorbidity is an issue of growing importance due to changing demographics and the increasing number of adults over the age of 65 with cancer. The best approach to the clinical management and decision-making in older adults with comorbid conditions remains unclear. In May 2015, the Cancer and Aging Research Group, in collaboration with the National Cancer Institute and the National Institute on Aging, met to discuss the design and implementation of intervention studies in older adults with cancer. A presentation and discussion on comorbidity measurement, interventions, and future research was included. In this article, we discuss the relevance of comorbidities in cancer, examine the commonly used tools to measure comorbidity, and discuss the future direction of comorbidity research. Incorporating standardized comorbidity measurement, relaxing clinical trial eligibility criteria, and utilizing novel trial designs are critical to developing a larger and more generalizable evidence base to guide the management of these patients. Creating or adapting comorbidity management strategies for use in older adults with cancer is necessary to define optimal care for this growing population.

Authors
Williams, GR; Mackenzie, A; Magnuson, A; Olin, R; Chapman, A; Mohile, S; Allore, H; Somerfield, MR; Targia, V; Extermann, M; Cohen, HJ; Hurria, A; Holmes, H
MLA Citation
Williams, GR, Mackenzie, A, Magnuson, A, Olin, R, Chapman, A, Mohile, S, Allore, H, Somerfield, MR, Targia, V, Extermann, M, Cohen, HJ, Hurria, A, and Holmes, H. "Comorbidity in older adults with cancer." Journal of geriatric oncology 7.4 (July 2016): 249-257. (Review)
PMID
26725537
Source
epmc
Published In
Journal of Geriatric Oncology
Volume
7
Issue
4
Publish Date
2016
Start Page
249
End Page
257
DOI
10.1016/j.jgo.2015.12.002

Geriatric assessment with management in cancer care: Current evidence and potential mechanisms for future research.

Older adults with cancer represent a complex patient population. Geriatric assessment (GA) is recommended to evaluate the medical and supportive care needs of this group. "GA with management" is a term encompassing the resultant medical decisions and interventions implemented in response to vulnerabilities identified on GA. In older, non-cancer patients, GA with management has been shown to improve a variety of outcomes, such as reducing functional decline and health care utilization. However, the role of GA with management in the older adult with cancer is less well established. Rigorous clinical trials of GA with management are necessary to develop an evidence base and support its use in the routine oncology care of older adults. At the recent U-13 conference, "Design and Implementation of Intervention Studies to Improve or Maintain Quality of Survivorship in Older and/or Frail Adults with Cancer," a session was dedicated to developing research priorities in GA with management. Here we summarize identified knowledge gaps in GA with management studies for older patients with cancer and propose areas for future research.

Authors
Magnuson, A; Allore, H; Cohen, HJ; Mohile, SG; Williams, GR; Chapman, A; Extermann, M; Olin, RL; Targia, V; Mackenzie, A; Holmes, HM; Hurria, A
MLA Citation
Magnuson, A, Allore, H, Cohen, HJ, Mohile, SG, Williams, GR, Chapman, A, Extermann, M, Olin, RL, Targia, V, Mackenzie, A, Holmes, HM, and Hurria, A. "Geriatric assessment with management in cancer care: Current evidence and potential mechanisms for future research." Journal of geriatric oncology 7.4 (July 2016): 242-248. (Review)
PMID
27197915
Source
epmc
Published In
Journal of Geriatric Oncology
Volume
7
Issue
4
Publish Date
2016
Start Page
242
End Page
248
DOI
10.1016/j.jgo.2016.02.007

Interventions to improve the quality of life and survivorship of older adults with cancer: The funding landscape at NIH, ACS and PCORI.

Identifying knowledge gaps and research opportunities in cancer and aging research was the focus of a three-part conference series led by the Cancer and Aging Research Group from 2010 to 2015. The third meeting, featured representatives from the NIA, NCI, ACS and PCORI each of whom discussed research priorities and funding opportunities in cancer and aging at their respective agencies. This manuscript reports on the proceedings of that conference with a specific focus on funding priorities for interventions to improve the quality of life and survivorship of older adults with cancer. Helpful tips from each funder regarding writing a scientifically strong research proposal are presented.

Authors
Flannery, M; Mohile, SG; Dale, W; Arora, NK; Azar, L; Breslau, ES; Cohen, HJ; Dotan, E; Eldadah, BA; Leach, CR; Mitchell, SA; Rowland, JH; Hurria, A
MLA Citation
Flannery, M, Mohile, SG, Dale, W, Arora, NK, Azar, L, Breslau, ES, Cohen, HJ, Dotan, E, Eldadah, BA, Leach, CR, Mitchell, SA, Rowland, JH, and Hurria, A. "Interventions to improve the quality of life and survivorship of older adults with cancer: The funding landscape at NIH, ACS and PCORI." Journal of geriatric oncology 7.4 (July 2016): 225-233. (Review)
PMID
27197917
Source
epmc
Published In
Journal of Geriatric Oncology
Volume
7
Issue
4
Publish Date
2016
Start Page
225
End Page
233
DOI
10.1016/j.jgo.2016.02.001

Validation of a Prediction Tool for Chemotherapy Toxicity in Older Adults With Cancer.

Older adults are at increased risk for chemotherapy toxicity, and standard oncology assessment measures cannot identify those at risk. A predictive model for chemotherapy toxicity was developed (N = 500) that consisted of geriatric assessment questions and other clinical variables. This study aims to externally validate this model in an independent cohort (N = 250).Patients age ≥ 65 years with a solid tumor, fluent in English, and who were scheduled to receive a new chemotherapy regimen were recruited from eight institutions. Risk of chemotherapy toxicity was calculated (low, medium, or high risk) on the basis of the prediction model before the start of chemotherapy. Chemotherapy-related toxicity was captured (grade 3 [hospitalization indicated], grade 4 [life threatening], and grade 5 [treatment-related death]). Validation of the prediction model was performed by calculating the area under the receiver-operating characteristic curve.The study sample (N = 250) had a mean age of 73 years (range, 65 to 94 [standard deviation, 5.8]). More than one half of patients (58%) experienced grade ≥ 3 toxicity. Risk of toxicity increased with increasing risk score (36.7% low, 62.4% medium, 70.2% high risk; P < .001). The area under the curve of the receiver-operating characteristic curve was 0.65 (95% CI, 0.58 to 0.71), which was not statistically different from the development cohort (0.72; 95% CI, 0.68 to 0.77; P = .09). There was no association between Karnofsky Performance Status and chemotherapy toxicity (P = .25).This study externally validated a chemotherapy toxicity predictive model for older adults with cancer. This predictive model should be considered when discussing the risks and benefits of chemotherapy with older adults.

Authors
Hurria, A; Mohile, S; Gajra, A; Klepin, H; Muss, H; Chapman, A; Feng, T; Smith, D; Sun, C-L; De Glas, N; Cohen, HJ; Katheria, V; Doan, C; Zavala, L; Levi, A; Akiba, C; Tew, WP
MLA Citation
Hurria, A, Mohile, S, Gajra, A, Klepin, H, Muss, H, Chapman, A, Feng, T, Smith, D, Sun, C-L, De Glas, N, Cohen, HJ, Katheria, V, Doan, C, Zavala, L, Levi, A, Akiba, C, and Tew, WP. "Validation of a Prediction Tool for Chemotherapy Toxicity in Older Adults With Cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34.20 (July 2016): 2366-2371.
PMID
27185838
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
20
Publish Date
2016
Start Page
2366
End Page
2371
DOI
10.1200/jco.2015.65.4327

Reply to N. Lowy et al and to J. Dhanda et al.

Authors
Hurria, A; Levit, LA; Dale, W; Mohile, SG; Muss, HB; Fehrenbacher, L; Magnuson, A; Lichtman, SM; Bruinooge, SS; Soto-Perez-de-Celis, E; Tew, WP; Postow, MA; Cohen, HJ
MLA Citation
Hurria, A, Levit, LA, Dale, W, Mohile, SG, Muss, HB, Fehrenbacher, L, Magnuson, A, Lichtman, SM, Bruinooge, SS, Soto-Perez-de-Celis, E, Tew, WP, Postow, MA, and Cohen, HJ. "Reply to N. Lowy et al and to J. Dhanda et al." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34.14 (May 2016): 1708-1709.
PMID
27001583
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
14
Publish Date
2016
Start Page
1708
End Page
1709
DOI
10.1200/jco.2015.66.3740

Effects of Religious Versus Conventional Cognitive-Behavioral Therapy on Gratitude in Major Depression and Chronic Medical Illness: A Randomized Clinical Trial

Authors
Pearce, MJ; Koenig, HG; Robins, CJ; Daher, N; Shaw, SF; Nelson, B; Berk, LS; Belinger, D; Cohen, HJ; King, MB
MLA Citation
Pearce, MJ, Koenig, HG, Robins, CJ, Daher, N, Shaw, SF, Nelson, B, Berk, LS, Belinger, D, Cohen, HJ, and King, MB. "Effects of Religious Versus Conventional Cognitive-Behavioral Therapy on Gratitude in Major Depression and Chronic Medical Illness: A Randomized Clinical Trial." Journal of Spirituality in Mental Health 18.2 (April 2, 2016): 124-144.
Source
crossref
Published In
Journal of Spirituality in Mental Health
Volume
18
Issue
2
Publish Date
2016
Start Page
124
End Page
144
DOI
10.1080/19349637.2015.1100971

Social support and its implications in older, early-stage breast cancer patients in CALGB 49907 (Alliance A171301).

Studies point to a direct association between social support and better cancer outcomes. This study examined whether baseline social support is associated with better survival and fewer chemotherapy-related adverse events in older, early-stage breast cancer patients.This study is a pre-planned secondary analysis of CALGB 49907/Alliance A171301, a randomized trial that compared standard adjuvant chemotherapy versus capecitabine in breast cancer patients 65 years of age or older. A subset reported on the extent of their social support with questionnaires that were completed 6 times over 2 years.The median age of this 331-patient cohort was 72 years (range: 65, 90); 179 (55%) were married, and 210 (65%) lived with someone. One hundred forty-five patients (46%) described a social network of 0-10 people; 110 (35%) of 11-25; and 58 (19%) of 26 or more. The Medical Outcomes Study (MOS) social support survey revealed that the median scores (range) for emotional/informational, tangible, positive social interaction, and affectionate social support were 94 (3, 100), 94 (0, 100), 96 (0, 100), and 100 (8, 100), respectively. Social support scores appeared stable over 2 years and higher (more support) than in other cancer settings. No statistically significant associations were observed between social support and survival and adverse events in multivariate analyses. However, married patients had smaller tumors, and those with arthritis reported less social support.Although social support did not predict survival and adverse events, the exploratory but plausible inverse associations with larger tumors and arthritis suggest that social support merits further study.

Authors
Jatoi, A; Muss, H; Allred, JB; Cohen, HJ; Ballman, K; Hopkins, JO; Gajra, A; Lafky, J; Wolff, A; Kottschade, L; Gralow, J; Hurria, A
MLA Citation
Jatoi, A, Muss, H, Allred, JB, Cohen, HJ, Ballman, K, Hopkins, JO, Gajra, A, Lafky, J, Wolff, A, Kottschade, L, Gralow, J, and Hurria, A. "Social support and its implications in older, early-stage breast cancer patients in CALGB 49907 (Alliance A171301)." Psycho-oncology 25.4 (April 2016): 441-446.
PMID
25994447
Source
epmc
Published In
Psycho-Oncology
Volume
25
Issue
4
Publish Date
2016
Start Page
441
End Page
446
DOI
10.1002/pon.3850

Physical Resilience in Older Adults: Systematic Review and Development of an Emerging Construct.

Resilience has been described in the psychosocial literature as the capacity to maintain or regain well-being during or after adversity. Physical resilience is a newer concept that is highly relevant to successful aging. Our objective was to characterize the emerging construct of resilience as it pertains to physical health in older adults, and to identify gaps and opportunities to advance research in this area.We conducted a systematic review to identify English language papers published through January 2015 that apply the term "resilience" in relation to physical health in older adults. We applied a modified framework analysis to characterize themes in implicit or explicit definitions of physical resilience.Of 1,078 abstracts identified, 49 articles met criteria for inclusion. Sixteen were letters or concept papers, and only one was an intervention study. Definitions of physical resilience spanned cellular to whole-person levels, incorporated many outcome measures, and represented three conceptual themes: resilience as a trait, trajectory, or characteristic/capacity.Current biomedical literature lacks consensus on how to define and measure physical resilience. We propose a working definition of physical resilience at the whole person level: a characteristic which determines one's ability to resist or recover from functional decline following health stressor(s). We present a conceptual framework that encompasses the related construct of physiologic reserve. We discuss gaps and opportunities in measurement, interactions across contributors to physical resilience, and points of intervention.

Authors
Whitson, HE; Duan-Porter, W; Schmader, KE; Morey, MC; Cohen, HJ; Colón-Emeric, CS
MLA Citation
Whitson, HE, Duan-Porter, W, Schmader, KE, Morey, MC, Cohen, HJ, and Colón-Emeric, CS. "Physical Resilience in Older Adults: Systematic Review and Development of an Emerging Construct." The journals of gerontology. Series A, Biological sciences and medical sciences 71.4 (April 2016): 489-495. (Review)
PMID
26718984
Source
epmc
Published In
Journals of Gerontology: Series A
Volume
71
Issue
4
Publish Date
2016
Start Page
489
End Page
495
DOI
10.1093/gerona/glv202

Renal Toxicity Associated with Salsalate in Elderly Adults with Anemia.

Authors
Cohen, HJ; Walston, JD; Rao, SV; Schrier, SL; Artz, A; Partnership for Anemia: Clinical and Translational Trials in the Elderly Consortium,
MLA Citation
Cohen, HJ, Walston, JD, Rao, SV, Schrier, SL, Artz, A, and Partnership for Anemia: Clinical and Translational Trials in the Elderly Consortium, . "Renal Toxicity Associated with Salsalate in Elderly Adults with Anemia." Journal of the American Geriatrics Society 64.4 (April 2016): 898-899. (Letter)
PMID
27100595
Source
epmc
Published In
Journal of American Geriatrics Society
Volume
64
Issue
4
Publish Date
2016
Start Page
898
End Page
899
DOI
10.1111/jgs.14065

Effect of Pretreatment Renal Function on Treatment and Clinical Outcomes in the Adjuvant Treatment of Older Women With Breast Cancer: Alliance A171201, an Ancillary Study of CALGB/CTSU 49907.

CALGB 49907 showed the superiority of standard therapy, which included either cyclophosphamide/doxorubicin (AC) or cyclophosphamide/methotrexate/fluorouracil over single-agent capecitabine in the treatment of patients age ≥ 65 with early-stage breast cancer. The treatment allowed dosing adjustments of methotrexate and capecitabine for pretreatment renal function. The purpose of the current analysis was to assess the relationship between pretreatment renal function and five end points: toxicity, dose modification, therapy completion, relapse-free survival, and overall survival.Pretreatment renal function was defined as creatinine clearance (CrCl) using the Cockcroft-Gault equation. Multivariable logistic and proportional hazards regression were used to model separately for each regimen the relationship between CrCl and the first three binary end points and the last two time-to-event end points, respectively, after adjusting for variables of prognostic importance.Six hundred nineteen assessable patients were analyzed. The incidence of stage III (moderate) or stage IV (severe) renal dysfunction was 72%, 64%, and 75% for treatment with cyclophosphamide/methotrexate/fluorouracil, AC, and capecitabine, respectively. There was no relationship for any regimen between pretreatment renal function and the five end points. For AC, as CrCl increased, the odds of nonhematologic toxicity decreased (P = .008), whereas for capecitabine, as CrCl increased, the odds of experiencing toxicity of any type also increased (P = .035). Patients with renal insufficiency who received dose modifications were not at increased risk for complications compared with those who did not have renal insufficiency and received a full dose.Excluding from clinical trials patients with renal insufficiency but good performance status on the basis of concern of excessive hematologic toxicity or poor outcomes may not be justified with appropriate dosing modifications. Results should be considered in the design of clinical trials for older patients.

Authors
Lichtman, SM; Cirrincione, CT; Hurria, A; Jatoi, A; Theodoulou, M; Wolff, AC; Gralow, J; Morganstern, DE; Magrinat, G; Cohen, HJ; Muss, HB
MLA Citation
Lichtman, SM, Cirrincione, CT, Hurria, A, Jatoi, A, Theodoulou, M, Wolff, AC, Gralow, J, Morganstern, DE, Magrinat, G, Cohen, HJ, and Muss, HB. "Effect of Pretreatment Renal Function on Treatment and Clinical Outcomes in the Adjuvant Treatment of Older Women With Breast Cancer: Alliance A171201, an Ancillary Study of CALGB/CTSU 49907." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34.7 (March 2016): 699-705.
PMID
26755510
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
7
Publish Date
2016
Start Page
699
End Page
705
DOI
10.1200/jco.2015.62.6341

A Novel Analytic Technique to Measure Associations Between Circulating Biomarkers and Physical Performance Across the Adult Life Span.

Understanding associations between circulating biomarkers and physical performance across the adult life span could aid in better describing mechanistic pathways leading to disability. We hypothesized that high concentrations of circulating biomarkers would be associated with lower functioning across study populations representing the adult life span. The data were from four intervention and two observational studies with ages ranging 22-89 years. Biomarkers assayed included inflammatory, coagulation, and endothelial function markers. Physical performance was measured either by VO2peak (studies of young and middle-aged adults) or usual gait speed (studies of older adults). Partialled (by age, body mass index, race, and sex) and weighted common correlations were calculated between biomarkers and physical performance. Homogeneity of the associations was also assessed. Interleukin-6 (weighted r = -.22), tumor necrosis factor receptor 2 (weighted r = -.19), D-dimer (weighted r = -.16), tumor necrosis factor receptor 1 (weighted r = -.15), granulocyte colony-stimulating factor (weighted r = -.14), and tumor necrosis factor alpha (weighted r = -.10) were all significantly inversely correlated with physical performance (p < .05). All significant correlations were homogeneous across studies. In summary, we observed consistent inverse associations between six circulating biomarkers and objective measures of physical performance. These results suggest that these serum biomarkers may be broadly applicable for detection, trajectory, and treatment monitoring of physical function across the life span or possibly for midlife predictors of functionally deleterious conditions.

Authors
Peterson, MJ; Thompson, DK; Pieper, CF; Morey, MC; Kraus, VB; Kraus, WE; Sullivan, P; Fillenbaum, G; Cohen, HJ
MLA Citation
Peterson, MJ, Thompson, DK, Pieper, CF, Morey, MC, Kraus, VB, Kraus, WE, Sullivan, P, Fillenbaum, G, and Cohen, HJ. "A Novel Analytic Technique to Measure Associations Between Circulating Biomarkers and Physical Performance Across the Adult Life Span." The journals of gerontology. Series A, Biological sciences and medical sciences 71.2 (February 2016): 196-202.
PMID
25745025
Source
epmc
Published In
Journals of Gerontology: Series A
Volume
71
Issue
2
Publish Date
2016
Start Page
196
End Page
202
DOI
10.1093/gerona/glv007

Preface.

Authors
Rao, AV; Cohen, HJ
MLA Citation
Rao, AV, and Cohen, HJ. "Preface." Clinics in geriatric medicine 32.1 (February 2016): xiii-xiv.
PMID
26614869
Source
epmc
Published In
Clinics in Geriatric Medicine
Volume
32
Issue
1
Publish Date
2016
Start Page
xiii
End Page
xiv
DOI
10.1016/j.cger.2015.09.001

Effects of religious vs. standard cognitive behavioral therapy on therapeutic alliance: A randomized clinical trial.

Treatments that integrate religious clients' beliefs into therapy may enhance the therapeutic alliance (TA) in religious clients.Compare the effects of religiously integrated cognitive behavioral therapy (RCBT) and standard CBT (SCBT) on TA in adults with major depression and chronic medical illness.Multi-site randomized controlled trial in 132 participants, of whom 108 (SCBT = 53, RCBT = 55) completed the Revised Helping Alliance Questionnaire (HAQ-II) at 4, 8, and 12 weeks. Trajectory of change in scores over time was compared between groups.HAQ-II score at 4 weeks predicted a decline in depressive symptoms over time independent of treatment group (B = -0.06, SE = 0.02, p = 0.002, n = 108). There was a marginally significant difference in HAQ-II scores at 4 weeks that favored RCBT (p = 0.076); however, the mixed effects model indicated a significant group by time interaction that favored the SCBT group (B = 1.84, SE = 0.90, degrees of freedom = 181, t = 2.04, p = 0.043, d = 0.30).While RCBT produces a marginally greater improvement in TA initially compared with SCBT, SCBT soon catches up.

Authors
Koenig, HG; Pearce, M; Nelson, B; Shaw, S; Robins, C; Daher, N; Cohen, HJ; King, MB
MLA Citation
Koenig, HG, Pearce, M, Nelson, B, Shaw, S, Robins, C, Daher, N, Cohen, HJ, and King, MB. "Effects of religious vs. standard cognitive behavioral therapy on therapeutic alliance: A randomized clinical trial." Psychotherapy research : journal of the Society for Psychotherapy Research 26.3 (January 2016): 365-376.
PMID
25669236
Source
epmc
Published In
Psychotherapy Research
Volume
26
Issue
3
Publish Date
2016
Start Page
365
End Page
376
DOI
10.1080/10503307.2015.1006156

Group trajectory analysis helps to identify older cancer survivors who benefit from distance-based lifestyle interventions.

The number of older cancer survivors is increasing as more adults survive to older ages. The objectives of this study were to examine trajectories of physical activity (PA) and physical function (PF) over a 2-year lifestyle counseling study and to identify characteristics of the trajectory groups.This was a secondary analysis of Reach Out to Enhance Wellness, a randomized controlled trial of home-based lifestyle counseling. The 641 participants were older (≥65 years), overweight (body mass index [BMI], 25 to <40 kg/m(2)), long-term community-dwelling survivors (>5 years) of breast, prostate, and colorectal cancer from Canada, the United Kingdom, and the United States (21 states) who had been randomly assigned to an immediate intervention or a 12-month-wait-listed control arm. The main outcome measures were PA and PF trajectory group membership.Three PA groups and 5 PF trajectory groups were observed. The baseline BMI (P < .001) and self-efficacy for performing strength (P < .0001) and endurance exercises (P < .0002) were the strongest predictors of achieving the highest amount of PA and the most favorable functional trajectory over 2 years. Individuals with low baseline self-efficacy, no PA, and a Short Form 36 PF subscale score < 65 did not benefit from the intervention.This study identified characteristics of survivors who benefited from home-based interventions and suggested alternative approaches for survivors requiring more structured and intensive interventions to promote behavioral changes.

Authors
Morey, MC; Blair, CK; Sloane, R; Cohen, HJ; Snyder, DC; Demark-Wahnefried, W
MLA Citation
Morey, MC, Blair, CK, Sloane, R, Cohen, HJ, Snyder, DC, and Demark-Wahnefried, W. "Group trajectory analysis helps to identify older cancer survivors who benefit from distance-based lifestyle interventions." Cancer 121.24 (December 2015): 4433-4440.
PMID
26512712
Source
epmc
Published In
Cancer
Volume
121
Issue
24
Publish Date
2015
Start Page
4433
End Page
4440
DOI
10.1002/cncr.29684

Advancing Geriatrics Education Through a Faculty Development Program for Geriatrics-Oriented Clinician Educators.

Geriatrician and nongeriatrician faculty need instruction as teachers to provide quality training for a broader community of physicians who can care for the expanding population of older adults. Educators at Duke University designed a program to equip geriatrician and nongeriatrician faculty to develop quality educational programs and teach medical learners about geriatrics. Eighty-three faculty representing 52 institutions from across the United States participated in mini-fellowship programs (2005-09) consisting of workshops and 1-year follow-up mentoring by Duke faculty. Participants attended 1-week on-campus sessions on curriculum development and teaching skills and designed and implemented a curriculum in their home institution. Participant specialties included general medicine (nearly 50%), family medicine, surgery, psychiatry, rehabilitation medicine, and emergency medicine. Pre- and postprogram self-efficacy surveys, program evaluation surveys, and 6- and 12-month progress reports on scholars' educational projects were used to assess the effect of the Duke mini-fellowship programs on participants' educational practices. Forty-four scholars (56%) completed the end-of-year self-efficacy survey and end-of-program evaluation. Self-efficacy results indicated significant gains (P < .001) in 12 items assessed at 1 week and 1 year. Scholars reported the largest average gains at 1 year in applying adult learning principles in the design of educational programs (1.72), writing measurable learning objectives (1.51), and identifying optimal instructional methods to deliver learning objectives (1.50). Participants described improved knowledge and skills in designing curricula, implemented new and revised geriatrics curricula, and demonstrated commitment to faculty development and improving learning experiences for medical learners. This faculty development program improved participants' self-efficacy in curriculum design and teaching and enhanced geriatrics education in their home institutions.

Authors
Pinheiro, SO; White, HK; Buhr, GT; Elbert-Avila, K; Cohen, HJ; Heflin, MT
MLA Citation
Pinheiro, SO, White, HK, Buhr, GT, Elbert-Avila, K, Cohen, HJ, and Heflin, MT. "Advancing Geriatrics Education Through a Faculty Development Program for Geriatrics-Oriented Clinician Educators." Journal of the American Geriatrics Society (November 13, 2015).
Website
http://hdl.handle.net/10161/13054
PMID
26563754
Source
epmc
Published In
Journal of American Geriatrics Society
Publish Date
2015

Baseline Prostate Atrophy is Associated with Reduced Risk of Prostate Cancer in Men Undergoing Repeat Prostate Biopsy.

We evaluated whether the presence and severity of baseline prostate atrophy in men with initial biopsy negative for prostate cancer was associated the risk of subsequent prostate cancer detection in a clinical trial with scheduled study mandated biopsies.We retrospectively analyzed the records of 3,084 men 50 to 75 years old with prostate specific antigen between 2.5 and 10 ng/ml, and a prior negative biopsy in the placebo arm of the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) study who completed at least 1 per-protocol biopsy. Prostate cancer (defined as present or absent) and prostate atrophy (graded as absent, mild or moderate/marked) was assessed by central pathology review. The association of baseline atrophy with positive 2 and 4-year repeat biopsies was evaluated with logistic regression, controlling for baseline covariates.Baseline prostate atrophy was detected in 2,143 men (70%) and graded as mild and moderate/marked in 1,843 (60%) and 300 (10%) baseline biopsies, respectively. Patients with atrophy were older and had a larger prostate, and more acute and chronic prostate inflammation. At 2-year biopsy the prostate cancer incidence was 17% (508 cases). Baseline atrophy was significantly associated with lower prostate cancer risk (univariable and multivariable OR 0.60, 95% CI 0.50-0.74 and OR 0.67, 95% CI 0.54-0.83, p <0.001, respectively) at the 2-year biopsy. These results were similar at the 4-year biopsy (univariable and multivariable OR 0.70, 95% CI 0.53-0.93 and OR 0.72, 95% CI 0.53-0.97, p = 0.03, respectively). Relative to no atrophy the prostate cancer risk at the 2-year repeat biopsy was lower for mild atrophy (OR 0.69, 95% CI 0.55-0.86) and moderate/marked atrophy (OR 0.51, 95% CI 0.34-0.76, each p <0.001).Baseline prostate atrophy in men with a prostate biopsy negative for prostate cancer was independently associated with subsequent lower prostate cancer detection.

Authors
Moreira, DM; Bostwick, DG; Andriole, GL; Peterson, BL; Cohen, HJ; Castro-Santamaria, R; Freedland, SJ
MLA Citation
Moreira, DM, Bostwick, DG, Andriole, GL, Peterson, BL, Cohen, HJ, Castro-Santamaria, R, and Freedland, SJ. "Baseline Prostate Atrophy is Associated with Reduced Risk of Prostate Cancer in Men Undergoing Repeat Prostate Biopsy." The Journal of urology 194.5 (November 2015): 1241-1246.
PMID
26165588
Source
epmc
Published In
The Journal of Urology
Volume
194
Issue
5
Publish Date
2015
Start Page
1241
End Page
1246
DOI
10.1016/j.juro.2015.05.103

Improving the Evidence Base for Treating Older Adults With Cancer: American Society of Clinical Oncology Statement.

The American Society of Clinical Oncology (ASCO) convened a subcommittee to develop recommendations on improving the evidence base for treating older adults with cancer in response to a critical need identified by the Institute of Medicine. Older adults experience the majority of cancer diagnoses and deaths and make up the majority of cancer survivors. Older adults are also the fastest growing segment of the US population. However, the evidence base for treating this population is sparse, because older adults are underrepresented in clinical trials, and trials designed specifically for older adults are rare. The result is that clinicians have less evidence on how to treat older adults, who represent the majority of patients with cancer. Clinicians and patients are forced to extrapolate from trials conducted in younger, healthier populations when developing treatment plans. This has created a dearth of knowledge regarding the risk of toxicity in the average older patient and about key end points of importance to older adults. ASCO makes five recommendations to improve evidence generation in this population: (1) Use clinical trials to improve the evidence base for treating older adults with cancer, (2) leverage research designs and infrastructure for generating evidence on older adults with cancer, (3) increase US Food and Drug Administration authority to incentivize and require research involving older adults with cancer, (4) increase clinicians' recruitment of older adults with cancer to clinical trials, and (5) use journal policies to improve researchers' reporting on the age distribution and health risk profiles of research participants.

Authors
Hurria, A; Levit, LA; Dale, W; Mohile, SG; Muss, HB; Fehrenbacher, L; Magnuson, A; Lichtman, SM; Bruinooge, SS; Soto-Perez-de-Celis, E; Tew, WP; Postow, MA; Cohen, HJ; American Society of Clinical Oncology,
MLA Citation
Hurria, A, Levit, LA, Dale, W, Mohile, SG, Muss, HB, Fehrenbacher, L, Magnuson, A, Lichtman, SM, Bruinooge, SS, Soto-Perez-de-Celis, E, Tew, WP, Postow, MA, Cohen, HJ, and American Society of Clinical Oncology, . "Improving the Evidence Base for Treating Older Adults With Cancer: American Society of Clinical Oncology Statement." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 33.32 (November 2015): 3826-3833.
PMID
26195697
Source
epmc
Published In
Journal of Clinical Oncology
Volume
33
Issue
32
Publish Date
2015
Start Page
3826
End Page
3833
DOI
10.1200/jco.2015.63.0319

Validation of survival prognostic models for non-small-cell lung cancer in stage- and age-specific groups.

Prognostic models have been proposed to predict survival for non-small-cell lung cancer (NSCLC). It is important to evaluate whether these models perform better than performance status (PS) alone in stage- and age-specific subgroups.The validation cohort included 2060 stage I and 1611 stage IV NSCLC patients from 23CALGB studies. For stage I, Blanchon (B), Chansky (C) and Gail (G) models were evaluated along with the PS only model. For stage IV, Blanchon (B) and Mandrekar (M) models were compared with the PS only model. The c-index was used to assess the concordance between survival and risk scores. The c-index difference (c-difference) and the integrated discrimination improvement (IDI) were used to determine the improvement of these models over the PS only model.For stage I, B and PS have better survival separation. The c-index for B, PS, C and G are 0.61, 0.58, 0.57 and 0.52, respectively, and B performs significantly better than PS with c-difference=0.034. For stage IV, B, M and PS have c-index 0.61, 0.64 and 0.60, respectively; B and M perform significantly better than PS with c-difference=0.015 and 0.033, respectively.Although some prognostic models have better concordance with survival than the PS only model, the absolute improvement is small. More accurate prognostic models should be developed; the inclusion of tumor genetic variants may improve prognostic models.

Authors
Wang, X; Gu, L; Zhang, Y; Sargent, DJ; Richards, W; Ganti, AK; Crawford, J; Cohen, HJ; Stinchcombe, T; Vokes, E; Pang, H
MLA Citation
Wang, X, Gu, L, Zhang, Y, Sargent, DJ, Richards, W, Ganti, AK, Crawford, J, Cohen, HJ, Stinchcombe, T, Vokes, E, and Pang, H. "Validation of survival prognostic models for non-small-cell lung cancer in stage- and age-specific groups." Lung cancer (Amsterdam, Netherlands) 90.2 (November 2015): 281-287.
PMID
26319317
Source
epmc
Published In
Lung Cancer
Volume
90
Issue
2
Publish Date
2015
Start Page
281
End Page
287
DOI
10.1016/j.lungcan.2015.08.007

Symptoms, weight loss, and physical function in a lifestyle intervention study of older cancer survivors.

Many older cancer survivors are overweight or obese, with additional illness burden increasing functional decline, which may affect their ability to engage in lifestyle interventions. This study examined how overweight long-term survivors' symptom severity associated with comorbidity prior to a diet and exercise intervention was associated with post-intervention function and examined symptoms' effects on function through change in physical activity, diet quality, and weight status.This is a secondary data analysis of 514 breast, prostate, and colorectal cancer survivors who participated in the one-year home-based diet and exercise intervention Reach-Out to Enhance Wellness trial. Measures included symptoms, weight, physical activity, diet quality, overall physical function (PF), and basic and advanced lower extremity function (BLEF and ALEF). Simple and serial mediation analyses were conducted to examine direct effects of symptom severity on PF, BLEF, and ALEF and indirect effects of symptom severity through changes in diet quality, physical activity, and weight.Symptom severity was directly associated with lower functioning scores for PF (b=-0.63 p<0.001), BLEF (b=-0.33, p<0.001), and ALEF (b=-0.22, p<0.001). Indirect effects of symptom severity through weight loss, physical activity, and diet were not significant. Weight loss and physical activity were associated with higher PF and ALEF and diet quality was associated with higher BLEF.Symptom severity of older, overweight cancer survivors negatively affects physical function. However, greater weight loss and more physical activity were associated with higher functioning scores, regardless of symptom severity.

Authors
Kenzik, KM; Morey, MC; Cohen, HJ; Sloane, R; Demark-Wahnefried, W
MLA Citation
Kenzik, KM, Morey, MC, Cohen, HJ, Sloane, R, and Demark-Wahnefried, W. "Symptoms, weight loss, and physical function in a lifestyle intervention study of older cancer survivors." Journal of geriatric oncology 6.6 (November 2015): 424-432.
PMID
26362355
Source
epmc
Published In
Journal of Geriatric Oncology
Volume
6
Issue
6
Publish Date
2015
Start Page
424
End Page
432
DOI
10.1016/j.jgo.2015.08.004

Anemia and Functional Disability in Older Adults With Cancer.

Anemia is associated with functional disability among older adults in general. However, the relationship between anemia and functional disability has not been well characterized among older adults with cancer. Therefore, we examined the association between anemia and functional disability in patients with cancer aged 65 years or older.We conducted cross-sectional analysis of data derived from a multicenter prospective study of 500 patients with cancer aged 65 years or older. The primary outcome was functional disability at chemotherapy initiation, defined as the need for assistance with at least one instrumental activity of daily living. Anemia (using WHO criteria) was defined as a hemoglobin (Hb) level of less than 12 g/dL in women and less than 13 g/dL in men. Multivariable logistic regression was used to examine the association between anemia and functional disability.Among 491 evaluable patients (median age, 73.1 years [range, 65-91 years]), the prevalence of functional disability and anemia was 43% and 51%, respectively. Compared with patients without anemia, patients with anemia were more likely to report functional disability. On multivariable analysis, adjusting for sex, stage, and unintentional weight loss, patients with anemia were more likely to have functional disability (odds ratio, 2.40; 95% CI, 1.61-3.59).Anemia was highly prevalent and independently associated with functional disability in this cohort of older adults with cancer. Given the importance of functional status in cancer treatment decision-making, longitudinal studies evaluating the causal relation between anemia and functional status among older patients with cancer are warranted to evaluate causality.

Authors
Owusu, C; Cohen, HJ; Feng, T; Tew, W; Mohile, SG; Klepin, HD; Gross, CP; Gajra, A; Lichtman, SM; Hurria, A; Cancer and Aging Research Group (CARG),
MLA Citation
Owusu, C, Cohen, HJ, Feng, T, Tew, W, Mohile, SG, Klepin, HD, Gross, CP, Gajra, A, Lichtman, SM, Hurria, A, and Cancer and Aging Research Group (CARG), . "Anemia and Functional Disability in Older Adults With Cancer." Journal of the National Comprehensive Cancer Network : JNCCN 13.10 (October 2015): 1233-1239.
PMID
26483063
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
13
Issue
10
Publish Date
2015
Start Page
1233
End Page
1239
DOI
10.6004/jnccn.2015.0152

An Accidental Career in Geriatrics.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "An Accidental Career in Geriatrics." Journal of the American Geriatrics Society 63.9 (September 2015): 1945-1948.
PMID
26277439
Source
epmc
Published In
Journal of American Geriatrics Society
Volume
63
Issue
9
Publish Date
2015
Start Page
1945
End Page
1948
DOI
10.1111/jgs.13603

Postoperative Cognitive Dysfunction: Minding the Gaps in Our Knowledge of a Common Postoperative Complication in the Elderly.

Postoperative cognitive dysfunction (POCD) is a common complication associated with significant morbidity and mortality in elderly patients. There is much interest in and controversy about POCD, reflected partly in the increasing number of articles published on POCD recently. Recent work suggests surgery may also be associated with cognitive improvement in some patients, termed postoperative cognitive improvement (POCI). As the number of surgeries performed worldwide approaches 250 million per year, optimizing postoperative cognitive function and preventing/treating POCD are major public health issues. In this article, we review the literature on POCD and POCI, and discuss current research challenges in this area.

Authors
Berger, M; Nadler, JW; Browndyke, J; Terrando, N; Ponnusamy, V; Cohen, HJ; Whitson, HE; Mathew, JP
MLA Citation
Berger, M, Nadler, JW, Browndyke, J, Terrando, N, Ponnusamy, V, Cohen, HJ, Whitson, HE, and Mathew, JP. "Postoperative Cognitive Dysfunction: Minding the Gaps in Our Knowledge of a Common Postoperative Complication in the Elderly." Anesthesiology clinics 33.3 (September 2015): 517-550. (Review)
PMID
26315636
Source
epmc
Published In
Anesthesiology Clinics
Volume
33
Issue
3
Publish Date
2015
Start Page
517
End Page
550
DOI
10.1016/j.anclin.2015.05.008

Quantification of biological aging in young adults.

Antiaging therapies show promise in model organism research. Translation to humans is needed to address the challenges of an aging global population. Interventions to slow human aging will need to be applied to still-young individuals. However, most human aging research examines older adults, many with chronic disease. As a result, little is known about aging in young humans. We studied aging in 954 young humans, the Dunedin Study birth cohort, tracking multiple biomarkers across three time points spanning their third and fourth decades of life. We developed and validated two methods by which aging can be measured in young adults, one cross-sectional and one longitudinal. Our longitudinal measure allows quantification of the pace of coordinated physiological deterioration across multiple organ systems (e.g., pulmonary, periodontal, cardiovascular, renal, hepatic, and immune function). We applied these methods to assess biological aging in young humans who had not yet developed age-related diseases. Young individuals of the same chronological age varied in their "biological aging" (declining integrity of multiple organ systems). Already, before midlife, individuals who were aging more rapidly were less physically able, showed cognitive decline and brain aging, self-reported worse health, and looked older. Measured biological aging in young adults can be used to identify causes of aging and evaluate rejuvenation therapies.

Authors
Belsky, DW; Caspi, A; Houts, R; Cohen, HJ; Corcoran, DL; Danese, A; Harrington, H; Israel, S; Levine, ME; Schaefer, JD; Sugden, K; Williams, B; Yashin, AI; Poulton, R; Moffitt, TE
MLA Citation
Belsky, DW, Caspi, A, Houts, R, Cohen, HJ, Corcoran, DL, Danese, A, Harrington, H, Israel, S, Levine, ME, Schaefer, JD, Sugden, K, Williams, B, Yashin, AI, Poulton, R, and Moffitt, TE. "Quantification of biological aging in young adults." Proceedings of the National Academy of Sciences of the United States of America 112.30 (July 6, 2015): E4104-E4110.
Website
http://hdl.handle.net/10161/10319
PMID
26150497
Source
epmc
Published In
Proceedings of the National Academy of Sciences of USA
Volume
112
Issue
30
Publish Date
2015
Start Page
E4104
End Page
E4110
DOI
10.1073/pnas.1506264112

Religious vs. conventional cognitive behavioral therapy for major depression in persons with chronic medical illness: a pilot randomized trial.

We examine the efficacy of conventional cognitive behavioral therapy (CCBT) versus religiously integrated CBT (RCBT) in persons with major depression and chronic medical illness. Participants were randomized to either CCBT (n = 67) or RCBT (n = 65). The intervention in both groups consisted of ten 50-minute sessions delivered remotely during 12 weeks (94% by telephone). Adherence to treatment was similar, except in more religious participants in whom adherence to RCBT was slightly greater (85.7% vs. 65.9%, p = 0.10). The intention-to-treat analysis at 12 weeks indicated no significant difference in outcome between the two groups (B = 0.33; SE, 1.80; p = 0.86). Response rates and remission rates were also similar. Overall religiosity interacted with treatment group (B = -0.10; SE, 0.05; p = 0.048), suggesting that RCBT was slightly more efficacious in the more religious participants. These preliminary findings suggest that CCBT and RCBT are equivalent treatments of major depression in persons with chronic medical illness. Efficacy, as well as adherence, may be affected by client religiosity.

Authors
Koenig, HG; Pearce, MJ; Nelson, B; Shaw, SF; Robins, CJ; Daher, NS; Cohen, HJ; Berk, LS; Bellinger, DL; Pargament, KI; Rosmarin, DH; Vasegh, S; Kristeller, J; Juthani, N; Nies, D; King, MB
MLA Citation
Koenig, HG, Pearce, MJ, Nelson, B, Shaw, SF, Robins, CJ, Daher, NS, Cohen, HJ, Berk, LS, Bellinger, DL, Pargament, KI, Rosmarin, DH, Vasegh, S, Kristeller, J, Juthani, N, Nies, D, and King, MB. "Religious vs. conventional cognitive behavioral therapy for major depression in persons with chronic medical illness: a pilot randomized trial." The Journal of nervous and mental disease 203.4 (April 2015): 243-251.
PMID
25816046
Source
epmc
Published In
Journal of Nervous and Mental Disease
Volume
203
Issue
4
Publish Date
2015
Start Page
243
End Page
251
DOI
10.1097/nmd.0000000000000273

Religiously integrated cognitive behavioral therapy: a new method of treatment for major depression in patients with chronic medical illness.

Intervention studies have found that psychotherapeutic interventions that explicitly integrate clients' spiritual and religious beliefs in therapy are as effective, if not more so, in reducing depression than those that do not for religious clients. However, few empirical studies have examined the effectiveness of religiously (vs. spiritually) integrated psychotherapy, and no manualized mental health intervention had been developed for the medically ill with religious beliefs. To address this gap, we developed and implemented a novel religiously integrated adaptation of cognitive-behavioral therapy (CBT) for the treatment of depression in individuals with chronic medical illness. This article describes the development and implementation of the intervention. First, we provide a brief overview of CBT. Next, we describe how religious beliefs and behaviors can be integrated into a CBT framework. Finally, we describe Religiously Integrated Cognitive Behavioral Therapy (RCBT), a manualized therapeutic approach designed to assist depressed individuals to develop depression-reducing thoughts and behaviors informed by their own religious beliefs, practices, and resources. This treatment approach has been developed for 5 major world religions (Christianity, Judaism, Islam, Buddhism, and Hinduism), increasing its potential to aid the depressed medically ill from a variety of religious backgrounds.

Authors
Pearce, MJ; Koenig, HG; Robins, CJ; Nelson, B; Shaw, SF; Cohen, HJ; King, MB
MLA Citation
Pearce, MJ, Koenig, HG, Robins, CJ, Nelson, B, Shaw, SF, Cohen, HJ, and King, MB. "Religiously integrated cognitive behavioral therapy: a new method of treatment for major depression in patients with chronic medical illness." Psychotherapy (Chicago, Ill.) 52.1 (March 2015): 56-66.
PMID
25365155
Source
epmc
Published In
Psychotherapy: Theory, Research, Practice, Training
Volume
52
Issue
1
Publish Date
2015
Start Page
56
End Page
66
DOI
10.1037/a0036448

Generalizability of trial results to elderly Medicare patients with advanced solid tumors (Alliance 70802).

In the United States, patients who enroll in chemotherapy trials seldom reflect the attributes of the general population with cancer, as they are often younger, more functional, and have less comorbidity. We compared survival following three chemotherapy regimens according to the setting in which care was delivered (ie, clinical trial vs usual care) to determine the generalizability of clinical trial results to unselected elderly Medicare patients.Using SEER-Medicare data, we estimated survival for elderly patients (ie, age 65 years or older, n = 14097) with advanced pancreatic or lung cancer following receipt of one of three guideline-recommended first-line chemotherapy regimens. We compared their survival to that of similarly treated clinical trial enrollees, without age restrictions, with the same diagnosis and stage (n = 937). All statistical tests were two-sided.Trial patients were 9.5 years younger than elderly Medicare patients. Medicare patients were more often white and tended to live in areas of greater educational attainment than trial enrollees. For each tumor type, Medicare patients who were 75 years or older had median survivals that were six to eight weeks shorter than those of trial patients (4.3 vs 5.8 months following treatment with single agent gemcitabine for advanced pancreatic cancer, P = .03; 7.3 vs 8.9 months following treatment with carboplatin and paclitaxel for stage IV non-small cell lung cancer, P = .91; 8.2 vs 10.2 months following treatment with CDDP/ VP16 for extensive stage small cell lung cancer, P ≤ .01), whereas younger Medicare patients had survival times that were similar to those of trial patients.Results of clinical trials for advanced pancreatic cancer and lung cancers tended to correctly estimate survival for Medicare patients aged 65 to 74 years, but to overestimate survival for older Medicare patients by six to eight weeks. These estimates of Medicare patients' survival may aid subsequent patients and their oncologists in treatment decision-making.

Authors
Lamont, EB; Schilsky, RL; He, Y; Muss, H; Cohen, HJ; Hurria, A; Meilleur, A; Kindler, HL; Venook, A; Lilenbaum, R; Niell, H; Goldberg, RM; Joffe, S; Alliance for Clinical Trials in Oncology,
MLA Citation
Lamont, EB, Schilsky, RL, He, Y, Muss, H, Cohen, HJ, Hurria, A, Meilleur, A, Kindler, HL, Venook, A, Lilenbaum, R, Niell, H, Goldberg, RM, Joffe, S, and Alliance for Clinical Trials in Oncology, . "Generalizability of trial results to elderly Medicare patients with advanced solid tumors (Alliance 70802)." Journal of the National Cancer Institute 107.1 (January 2015): 336-.
PMID
25432408
Source
epmc
Published In
Journal of the National Cancer Institute
Volume
107
Issue
1
Publish Date
2015
Start Page
336
DOI
10.1093/jnci/dju336

Effects of religious versus conventional cognitive-behavioral therapy on generosity in major depression and chronic medical illness: A randomized clinical trial.

Authors
Pearce, MJ; Koenig, HG; Robins, CJ; Daher, N; Shaw, SF; Nelson, B; Berk, LS; Bellinger, D; Cohen, HJ; King, MB
MLA Citation
Pearce, MJ, Koenig, HG, Robins, CJ, Daher, N, Shaw, SF, Nelson, B, Berk, LS, Bellinger, D, Cohen, HJ, and King, MB. "Effects of religious versus conventional cognitive-behavioral therapy on generosity in major depression and chronic medical illness: A randomized clinical trial." Spirituality in Clinical Practice 2.3 (2015): 202-215.
Source
crossref
Published In
Spirituality in Clinical Practice
Volume
2
Issue
3
Publish Date
2015
Start Page
202
End Page
215
DOI
10.1037/scp0000076

A prospective randomized wait list control trial of intravenous iron sucrose in older adults with unexplained anemia and serum ferritin 20-200ng/mL

© 2014. Anemia is common in older persons and is associated with substantial morbidity and mortality. One third of anemic older adults have unexplained anemia of the elderly (UAE). We carried out a randomized, wait list control trial in outpatients with UAE and serum ferritin levels between 20 and 200. ng/mL. Intravenous iron sucrose was given as a 200-mg weekly dose for 5. weeks either immediately after enrollment (immediate intervention group) or following a 12-week wait list period (wait list control group). The primary outcome measure was changed in 6-minute walk test (6MWT) distances from baseline to 12. weeks between the two groups. Hematologic, physical, cognitive, and quality of life parameters were also assessed. The study was terminated early after 19 subjects enrolled. The distance walked in the 6MWT increased a mean 8.05 ± 55.48 m in the immediate intervention group and decreased a mean 11.45 ± 49.46 m in the wait list control group (p = 0.443). The hemoglobin increased a mean 0.39 ± 0.46 g/dL in the immediate intervention group and declined a mean 0.39 ± 0.85 g/dL in the wait list control group (p = 0.026). Thus, a subgroup of adults with UAE may respond to intravenous iron. Enrollment of subjects into this type of study remains challenging.

Authors
Price, E; Artz, AS; Barnhart, H; Sapp, S; Chelune, G; Ershler, WB; Walston, JD; Gordeuk, VR; Berger, NA; Reuben, D; Prchal, J; Rao, SV; Roy, CN; Supiano, MA; Schrier, SL; Cohen, HJ
MLA Citation
Price, E, Artz, AS, Barnhart, H, Sapp, S, Chelune, G, Ershler, WB, Walston, JD, Gordeuk, VR, Berger, NA, Reuben, D, Prchal, J, Rao, SV, Roy, CN, Supiano, MA, Schrier, SL, and Cohen, HJ. "A prospective randomized wait list control trial of intravenous iron sucrose in older adults with unexplained anemia and serum ferritin 20-200ng/mL." Blood Cells, Molecules, and Diseases 53.4 (December 1, 2014): 221-230.
Source
scopus
Published In
Blood Cells, Molecules and Diseases
Volume
53
Issue
4
Publish Date
2014
Start Page
221
End Page
230
DOI
10.1016/j.bcmd.2014.06.003

Associations among survivorship care plans, experiences of survivorship care, and functioning in older breast cancer survivors: CALGB/Alliance 369901.

Survivorship care plans (SCP) are recommended for all cancer patients and could be especially useful to survivors 65 years and over ("older"). This study examined receipt of SCPs among older breast cancer survivors and whether SCPs were associated with improved patient-reported outcomes.Three hundred and twenty-eight older women diagnosed with invasive, nonmetastatic breast cancer between 2007-2011 were recruited from 78 cooperative-group sites. Participants completed telephone interviews at baseline and 1-year posttreatment. Regression analyses examined SCP receipt (yes/no) and functioning (EORTC-QLQ-C30), cancer worry, and experiences of survivorship care (care coordination, knowledge).Only 35% of women received SCPs. For each 1-year increase in age, there was a 5% lower odds of receiving an SCP (odds ratio (OR) = 0.94, 95% confidence interval (CI) 0.91-0.98, p = 0.007). Besides age, no other factor predicted SCPs. SCP receipt was associated with greater knowledge and understanding of requisite follow-up care (p < 0.05); however, functioning was not significantly different among those with vs. without SCPs.Receipt of care plans was limited. SCPs improved understanding of breast cancer follow-up care among older survivors, but did not impact functioning one year post-treatment.To impact functioning and salient needs of the growing cohort of older survivors, survivorship care plans likely should be tailored to geriatric-specific issues. To improve functioning, SCP content should expand to include exercise, nutrition, polypharmacy, social support and management of symptom burden from cancer, and other comorbid conditions. To improve follow-up care for cancer survivors, SCPs should delineate shared care roles between oncology and primary care in managing recurrence surveillance, screening, and cancer sequelae.

Authors
Faul, LA; Luta, G; Luta, G; Sheppard, V; Isaacs, C; Cohen, HJ; Muss, HB; Yung, R; Clapp, JD; Winer, E; Hudis, C; Tallarico, M; Wang, J; Barry, WT; Mandelblatt, JS
MLA Citation
Faul, LA, Luta, G, Luta, G, Sheppard, V, Isaacs, C, Cohen, HJ, Muss, HB, Yung, R, Clapp, JD, Winer, E, Hudis, C, Tallarico, M, Wang, J, Barry, WT, and Mandelblatt, JS. "Associations among survivorship care plans, experiences of survivorship care, and functioning in older breast cancer survivors: CALGB/Alliance 369901." Journal of cancer survivorship : research and practice 8.4 (December 2014): 627-637.
PMID
24917307
Source
epmc
Published In
Journal of Cancer Survivorship
Volume
8
Issue
4
Publish Date
2014
Start Page
627
End Page
637
DOI
10.1007/s11764-014-0371-5

A prospective randomized wait list control trial of intravenous iron sucrose in older adults with unexplained anemia and serum ferritin 20-200 ng/mL.

Anemia is common in older persons and is associated with substantial morbidity and mortality. One third of anemic older adults have unexplained anemia of the elderly (UAE). We carried out a randomized, wait list control trial in outpatients with UAE and serum ferritin levels between 20 and 200 ng/mL. Intravenous iron sucrose was given as a 200-mg weekly dose for 5 weeks either immediately after enrollment (immediate intervention group) or following a 12-week wait list period (wait list control group). The primary outcome measure was changed in 6-minute walk test (6MWT) distances from baseline to 12 weeks between the two groups. Hematologic, physical, cognitive, and quality of life parameters were also assessed. The study was terminated early after 19 subjects enrolled. The distance walked in the 6MWT increased a mean 8.05±55.48 m in the immediate intervention group and decreased a mean 11.45±49.46 m in the wait list control group (p=0.443). The hemoglobin increased a mean 0.39±0.46 g/dL in the immediate intervention group and declined a mean 0.39±0.85 g/dL in the wait list control group (p=0.026). Thus, a subgroup of adults with UAE may respond to intravenous iron. Enrollment of subjects into this type of study remains challenging.

Authors
Price, E; Artz, AS; Barnhart, H; Sapp, S; Chelune, G; Ershler, WB; Walston, JD; Gordeuk, VR; Berger, NA; Reuben, D; Prchal, J; Rao, SV; Roy, CN; Supiano, MA; Schrier, SL; Cohen, HJ
MLA Citation
Price, E, Artz, AS, Barnhart, H, Sapp, S, Chelune, G, Ershler, WB, Walston, JD, Gordeuk, VR, Berger, NA, Reuben, D, Prchal, J, Rao, SV, Roy, CN, Supiano, MA, Schrier, SL, and Cohen, HJ. "A prospective randomized wait list control trial of intravenous iron sucrose in older adults with unexplained anemia and serum ferritin 20-200 ng/mL." Blood cells, molecules & diseases 53.4 (December 2014): 221-230.
PMID
25065855
Source
epmc
Published In
Blood Cells, Molecules and Diseases
Volume
53
Issue
4
Publish Date
2014
Start Page
221
End Page
230
DOI
10.1016/j.bcmd.2014.06.003

Perinatal complications and aging indicators by midlife.

Perinatal complications predict increased risk for morbidity and early mortality. Evidence of perinatal programming of adult mortality raises the question of what mechanisms embed this long-term effect. We tested a hypothesis related to the theory of developmental origins of health and disease: that perinatal complications assessed at birth predict indicators of accelerated aging by midlife.Perinatal complications, including both maternal and neonatal complications, were assessed in the Dunedin Multidisciplinary Health and Development Study cohort (N = 1037), a 38-year, prospective longitudinal study of a representative birth cohort. Two aging indicators were assessed at age 38 years, objectively by leukocyte telomere length (TL) and subjectively by perceived facial age.Perinatal complications predicted both leukocyte TL (β = -0.101; 95% confidence interval, -0.169 to -0.033; P = .004) and perceived age (β = 0.097; 95% confidence interval, 0.029 to 0.165; P = .005) by midlife. We repeated analyses with controls for measures of family history and social risk that could predispose to perinatal complications and accelerated aging, and for measures of poor health taken in between birth and the age-38 follow-up. These covariates attenuated, but did not fully explain the associations observed between perinatal complications and aging indicators.Our findings provide support for early-life developmental programming by linking newborns' perinatal complications to accelerated aging at midlife. We observed indications of accelerated aging "inside," as measured by leukocyte TL, an indicator of cellular aging, and "outside," as measured by perceived age, an indicator of declining tissue integrity. A better understanding of mechanisms underlying perinatal programming of adult aging is needed.

Authors
Shalev, I; Caspi, A; Ambler, A; Belsky, DW; Chapple, S; Cohen, HJ; Israel, S; Poulton, R; Ramrakha, S; Rivera, CD; Sugden, K; Williams, B; Wolke, D; Moffitt, TE
MLA Citation
Shalev, I, Caspi, A, Ambler, A, Belsky, DW, Chapple, S, Cohen, HJ, Israel, S, Poulton, R, Ramrakha, S, Rivera, CD, Sugden, K, Williams, B, Wolke, D, and Moffitt, TE. "Perinatal complications and aging indicators by midlife." Pediatrics 134.5 (November 2014): e1315-e1323.
PMID
25349321
Source
epmc
Published In
Pediatrics
Volume
134
Issue
5
Publish Date
2014
Start Page
e1315
End Page
e1323
DOI
10.1542/peds.2014-1669

Introduction

Authors
Jazwinski, SM; Yashin, AI
MLA Citation
Jazwinski, SM, and Yashin, AI. "Introduction." October 9, 2014. vii-xii.
Source
scopus
Volume
40
Publish Date
2014
Start Page
vii
End Page
xii

Comorbidity, chemotherapy toxicity, and outcomes among older women receiving adjuvant chemotherapy for breast cancer on a clinical trial: CALGB 49907 and CALGB 361004 (alliance).

We evaluated associations among comorbidity, toxicity, time to relapse (TTR), and overall survival (OS) in older women with early-stage breast cancer receiving adjuvant chemotherapy.Cancer and Leukemia Group B 49907 (Alliance) randomly assigned women ≥ 65 years old with stages I-III breast cancer to standard adjuvant chemotherapy or capecitabine. We reviewed data from 329 women who participated in the quality of life companion study CALGB 70103 and completed the Physical Health Subscale of the Older American Resources and Services Questionnaire. This questionnaire captures data on 14 comorbid conditions and the degree to which each interferes with daily activities. A comorbidity burden score was computed by multiplying the total number of conditions by each condition's level of interference with function. Outcomes were grade 3 to 5 toxicity, TTR, and OS. Logistic regression was used to evaluate associations between comorbidity and toxicity, and Cox proportional hazards models for TTR and survival.Number of comorbidities ranged from 0 to 10 (median 2); the comorbidity burden score ranged from 0 to 25 (median 3). The most common conditions were arthritis (58%) and hypertension (55%). Comorbidity was associated with shorter OS, but not with toxicity or TTR. The hazard of death increased by 18% for each comorbidity (hazard ratio [HR] = 1.18, 95% CI = 1.06 to 1.33) after adjusting for age, tumor size, treatment, node and receptor status. Comorbidity burden score was similarly associated with OS (HR = 1.08; 95% CI, 1.03 to 1.14).Among older women enrolled onto a clinical trial, comorbidity was associated with shorter OS, but not toxicity or relapse.

Authors
Klepin, HD; Pitcher, BN; Ballman, KV; Kornblith, AB; Hurria, A; Winer, EP; Hudis, C; Cohen, HJ; Muss, HB; Kimmick, GG
MLA Citation
Klepin, HD, Pitcher, BN, Ballman, KV, Kornblith, AB, Hurria, A, Winer, EP, Hudis, C, Cohen, HJ, Muss, HB, and Kimmick, GG. "Comorbidity, chemotherapy toxicity, and outcomes among older women receiving adjuvant chemotherapy for breast cancer on a clinical trial: CALGB 49907 and CALGB 361004 (alliance)." Journal of oncology practice 10.5 (September 2014): e285-e292.
PMID
25074878
Source
epmc
Published In
Journal of Oncology Practice
Volume
10
Issue
5
Publish Date
2014
Start Page
e285
End Page
e292
DOI
10.1200/jop.2014.001388

Religious involvement is associated with greater purpose, optimism, generosity and gratitude in persons with major depression and chronic medical illness.

OBJECTIVE: Religious involvement may help individuals with chronic medical illness cope better with physical disability and other life changes. We examine the relationships between religiosity, depressive symptoms, and positive emotions in persons with major depression and chronic illness. METHODS: 129 persons who were at least somewhat religious/spiritual were recruited into a clinical trial to evaluate the effectiveness of religious vs. secular cognitive behavioral therapy. Reported here are the relationships at baseline between religious involvement and depressive symptoms, purpose in life, optimism, generosity, and gratefulness using standard measures. RESULTS: Although religiosity was unrelated to depressive symptoms (F=0.96, p=0.43) and did not buffer the disability-depression relationship (B=-1.56, SE 2.90, p=0.59), strong relationships were found between religious indicators and greater purpose, optimism, generosity, and gratefulness (F=7.08, p<0.0001). CONCLUSIONS: Although unrelated to depressive symptoms in the setting of major depression and chronic medical illness, higher religious involvement is associated with positive emotions, a finding which may influence the course of depression over time.

Authors
Koenig, HG; Berk, LS; Daher, NS; Pearce, MJ; Bellinger, DL; Robins, CJ; Nelson, B; Shaw, SF; Cohen, HJ; King, MB
MLA Citation
Koenig, HG, Berk, LS, Daher, NS, Pearce, MJ, Bellinger, DL, Robins, CJ, Nelson, B, Shaw, SF, Cohen, HJ, and King, MB. "Religious involvement is associated with greater purpose, optimism, generosity and gratitude in persons with major depression and chronic medical illness." Journal of psychosomatic research 77.2 (August 2014): 135-143.
PMID
25077855
Source
epmc
Published In
Journal of Psychosomatic Research
Volume
77
Issue
2
Publish Date
2014
Start Page
135
End Page
143
DOI
10.1016/j.jpsychores.2014.05.002

Frailty and adherence to adjuvant hormonal therapy in older women with breast cancer: CALGB protocol 369901.

Most patients with breast cancer age ≥ 65 years (ie, older patients) are eligible for adjuvant hormonal therapy, but use is not universal. We examined the influence of frailty on hormonal therapy noninitiation and discontinuation.A prospective cohort of 1,288 older women diagnosed with invasive, nonmetastatic breast cancer recruited from 78 sites from 2004 to 2011 were included (1,062 had estrogen receptor-positive tumors). Interviews were conducted at baseline, 6 months, and annually for up to 7 years to collect sociodemographic, health care, and psychosocial data. Hormonal initiation was defined from records and discontinuation from self-report. Baseline frailty was measured using a previously validated 35-item scale and grouped as prefrail or frail versus robust. Logistic regression and proportional hazards models were used to assess factors associated with noninitiation and discontinuation, respectively.Most women (76.4%) were robust. Noninitiation of hormonal therapy was low (14%), but in prefrail or frail (v robust) women the odds of noninitiation were 1.63 times as high (95% CI, 1.11 to 2.40; P = .013) after covariate adjustment. Nonwhites (v whites) had higher odds of noninitiation (odds ratio, 1.71; 95% CI, 1.04 to 2.80; P = .033) after covariate adjustment. Among initiators, the 5-year continuation probability was 48.5%. After adjustment, the risk of discontinuation was higher with increasing age (P = .005) and lower for stage ≥ IIB (v stage I) disease (P = .003).Frailty is associated with noninitiation of hormonal therapy, but it does not seem to be a major predictor of early discontinuation in older patients.

Authors
Sheppard, VB; Faul, LA; Luta, G; Luta, G; Clapp, JD; Yung, RL; Wang, JH-Y; Kimmick, G; Isaacs, C; Tallarico, M; Barry, WT; Pitcher, BN; Hudis, C; Winer, EP; Cohen, HJ; Muss, HB; Hurria, A; Mandelblatt, JS
MLA Citation
Sheppard, VB, Faul, LA, Luta, G, Luta, G, Clapp, JD, Yung, RL, Wang, JH-Y, Kimmick, G, Isaacs, C, Tallarico, M, Barry, WT, Pitcher, BN, Hudis, C, Winer, EP, Cohen, HJ, Muss, HB, Hurria, A, and Mandelblatt, JS. "Frailty and adherence to adjuvant hormonal therapy in older women with breast cancer: CALGB protocol 369901." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.22 (August 2014): 2318-2327.
PMID
24934786
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
22
Publish Date
2014
Start Page
2318
End Page
2327
DOI
10.1200/jco.2013.51.7367

Designing therapeutic clinical trials for older and frail adults with cancer: U13 conference recommendations.

A majority of cancer diagnoses and deaths occur in patients age ≥ 65 years. With the aging of the US population, the number of older adults with cancer will grow. Although the coming wave of older patients with cancer was anticipated in the early 1980s, when the need for more research on the cancer-aging interface was recognized, many knowledge gaps remain when it comes to treating older and/or frailer patients with cancer. Relatively little is known about the best way to balance the risks and benefits of existing cancer therapies in older patients; however, these patients continue to be underrepresented in clinical trials. Furthermore, the available clinical trials often do not include end points pertinent to the older adult population, such as preservation of function, cognition, and independence. As part of its ongoing effort to advance research in the field of geriatric oncology, the Cancer and Aging Research Group held a conference in November 2012 in collaboration with the National Cancer Institute, the National Institute on Aging, and the Alliance for Clinical Trials in Oncology. The goal was to develop recommendations and establish research guidelines for the design and implementation of therapeutic clinical trials for older and/or frail adults. The conference sought to identify knowledge gaps in cancer clinical trials for older adults and propose clinical trial designs to fill these gaps. The ultimate goal of this conference series is to develop research that will lead to evidence-based care for older and/or frail adults with cancer.

Authors
Hurria, A; Dale, W; Mooney, M; Rowland, JH; Ballman, KV; Cohen, HJ; Muss, HB; Schilsky, RL; Ferrell, B; Extermann, M; Schmader, KE; Mohile, SG; Cancer and Aging Research Group,
MLA Citation
Hurria, A, Dale, W, Mooney, M, Rowland, JH, Ballman, KV, Cohen, HJ, Muss, HB, Schilsky, RL, Ferrell, B, Extermann, M, Schmader, KE, Mohile, SG, and Cancer and Aging Research Group, . "Designing therapeutic clinical trials for older and frail adults with cancer: U13 conference recommendations." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.24 (August 2014): 2587-2594. (Review)
PMID
25071116
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
24
Publish Date
2014
Start Page
2587
End Page
2594
DOI
10.1200/jco.2013.55.0418

Incorporating biomarkers into cancer and aging research.

The challenge in treating the older adult with cancer is accurately accounting for and adapting management to the heterogeneity in health status of the individual patient. Many oncologists recognize that chronological age alone should not be the determinant when deciding on a treatment regimen. Easily measurable markers that provide an assessment of functional age would be ideal to assess frailty, which may predispose the patient to complications from cancer treatment, including increased toxicity, functional decline, decreased quality of life, and poorer survival. Several categories of potential markers, including chronic inflammatory markers, markers of cellular senescence, and imaging to assess muscle mass to detect sarcopenia, may provide insight into the likelihood of treatment-related complications. This article discusses candidate markers and strategies to evaluate these markers in cancer treatment trials, with the aim of developing a method to assess risk of oncologic outcomes and guide management decisions for both the physician and patient.

Authors
Hubbard, JM; Cohen, HJ; Muss, HB
MLA Citation
Hubbard, JM, Cohen, HJ, and Muss, HB. "Incorporating biomarkers into cancer and aging research." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.24 (August 2014): 2611-2616. (Review)
PMID
25071114
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
24
Publish Date
2014
Start Page
2611
End Page
2616
DOI
10.1200/jco.2014.55.4261

Inflammation and Coagulation as Mediators in the Relationships Between Religious Attendance and Functional Limitations in Older Adults.

The aim of this study was to examine inflammation and coagulation, which are positively linked to disability and inversely linked to increased religious attendance, as mediators in the cross-sectional relationships between religious attendance and functional status.Frequency of attendance and limitations in basic activities of daily living (ADLs), instrumental activities (IADLs), and mobility were assessed in 1,423 elders.More frequent attendance was associated with fewer ADL, IADL, and mobility limitations, and with lower levels of inflammation and coagulation including interleukin-6, soluble vascular cell adhesion molecule, and D-dimer. Inflammation and coagulation partially mediated the associations between attendance and function. Eight percent of the effect of attendance on ADL (p = .014), 5% of the effect on IADL (p = .003), and 8% of the effect on mobility (p = .001) limitations were due to inflammation and coagulation.Relationships between attendance and function may be due in part to lower levels of inflammation and coagulation among elders who attend services.

Authors
Hybels, CF; George, LK; Blazer, DG; Pieper, CF; Cohen, HJ; Koenig, HG
MLA Citation
Hybels, CF, George, LK, Blazer, DG, Pieper, CF, Cohen, HJ, and Koenig, HG. "Inflammation and Coagulation as Mediators in the Relationships Between Religious Attendance and Functional Limitations in Older Adults." Journal of aging and health 26.4 (June 2014): 679-697.
PMID
24728938
Source
epmc
Published In
Journal of Aging and Health
Volume
26
Issue
4
Publish Date
2014
Start Page
679
End Page
697
DOI
10.1177/0898264314527479

Multiple myeloma in the very old: an IASIA conference report.

Multiple myeloma (MM) in patients aged greater than 80 years poses an increasingly common challenge for oncology providers. A multidisciplinary workshop was held in which MM-focused hematologists/oncologists, geriatricians, and associated health-care team members discussed the state of research for MM therapy, as well as themes from geriatric medicine that pertain directly to this patient population. A summary statement of our discussions is presented here, in which we highlight several topics. MM disproportionately affects senior adults, and demographic trends indicate that this trend will accelerate. Complex issues impact cancer in seniors, and although factors such as social environment, comorbidities, and frailty have been well characterized in nononcological geriatric medicine, these themes have been inadequately explored in cancers such as MM, despite their clear relevance to this field. Therapeutically, novel agents have improved survival for MM patients of all ages, but less so for seniors than younger patients for a variety of reasons. Lastly, both MM- and treatment-related symptoms and toxicities require special attention in senior adults. Existing research provides limited insight into how best to manage these often complex patients, who are often not reflected in typical clinical trial populations. We hence offer suggestions for clinical trials that address knowledge gaps in how to manage very old and/or frail patients with MM, given the complicated issues that often surround this patient population.

Authors
Tuchman, SA; Shapiro, GR; Ershler, WB; Badros, A; Cohen, HJ; Dispenzieri, A; Flores, IQ; Kanapuru, B; Jurivich, D; Longo, DL; Nourbakhsh, A; Palumbo, A; Walston, J; Yates, JW
MLA Citation
Tuchman, SA, Shapiro, GR, Ershler, WB, Badros, A, Cohen, HJ, Dispenzieri, A, Flores, IQ, Kanapuru, B, Jurivich, D, Longo, DL, Nourbakhsh, A, Palumbo, A, Walston, J, and Yates, JW. "Multiple myeloma in the very old: an IASIA conference report." Journal of the National Cancer Institute 106.5 (April 3, 2014).
PMID
24700806
Source
epmc
Published In
Journal of the National Cancer Institute
Volume
106
Issue
5
Publish Date
2014
DOI
10.1093/jnci/dju067

Characteristics and treatment options of elderly Chinese patients with cancer as determined by Comprehensive Geriatric Assessment (CGA).

China is experiencing a rapid increase in cancer incidence in elderly patients. In order to better understand this group, a large study of patients from multiple tertiary centers in the Beijing area was designed. This study was designed to provide insight into their unique treatment preferences, including the use of traditional Chinese medicine (TCM).803 patients from nine hospitals in the Beijing area were enrolled into this study. The inclusion criteria were patients who were 65 years or older and had a diagnosis of cancer at any stage. The CGA questionnaire used with these patients included the Chinese translation of the Gero-Oncology Health and Quality of Life Assessment tool. The questionnaire was provided to patients by a research nurse and was administered in Mandarin.The mean age of the patients was 72 years (range 65-94). The patients were mainly male (59.8%) and of Han ethnicity (95.4%). About 45% of these patients also had concurrent TCM in addition to their other cancer treatments. About 70% were able to manage their activities of daily living without assistance. Patients on TCM were more likely to have higher number of co-morbidities compared to their counterparts.This is the largest prospective study of CGA assessments done on elderly patients with cancer in Asia. The study demonstrates that CGA provides insights into understanding the needs of elderly Chinese patients with cancer. TCM is used frequently in China, and its impact on quality of life needs further investigation.

Authors
Kanesvaran, R; Wang, W; Yang, Y; Wei, Z; Jia, L; Li, F; Wu, S; Bai, C; Xie, H; Zhang, H; Yang, G; Sloane, R; Li, P; Cohen, HJ
MLA Citation
Kanesvaran, R, Wang, W, Yang, Y, Wei, Z, Jia, L, Li, F, Wu, S, Bai, C, Xie, H, Zhang, H, Yang, G, Sloane, R, Li, P, and Cohen, HJ. "Characteristics and treatment options of elderly Chinese patients with cancer as determined by Comprehensive Geriatric Assessment (CGA)." Journal of geriatric oncology 5.2 (April 2014): 171-178.
PMID
24486112
Source
epmc
Published In
Journal of Geriatric Oncology
Volume
5
Issue
2
Publish Date
2014
Start Page
171
End Page
178
DOI
10.1016/j.jgo.2014.01.004

Reply to L.K. Mell et al.

Authors
Ballman, KV; Mauer, M; Wedding, U; Mohile, SG; Muss, H; Extermann, M; Luciani, A; Cohen, HJ; Hurria, A; Lichtman, SM; Curigliano, G; Wildiers, H
MLA Citation
Ballman, KV, Mauer, M, Wedding, U, Mohile, SG, Muss, H, Extermann, M, Luciani, A, Cohen, HJ, Hurria, A, Lichtman, SM, Curigliano, G, and Wildiers, H. "Reply to L.K. Mell et al." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.10 (April 2014): 1090-1091. (Letter)
PMID
24550420
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
10
Publish Date
2014
Start Page
1090
End Page
1091
DOI
10.1200/jco.2013.54.5236

Underrepresentation of older adults in cancer trials--reply.

Authors
Cohen, HJ; Naylor, M; Hurria, A
MLA Citation
Cohen, HJ, Naylor, M, and Hurria, A. "Underrepresentation of older adults in cancer trials--reply." JAMA 311.9 (March 2014): 966-967. (Letter)
PMID
24595790
Source
epmc
Published In
JAMA : the journal of the American Medical Association
Volume
311
Issue
9
Publish Date
2014
Start Page
966
End Page
967
DOI
10.1001/jama.2013.286457

The Duke Center for the Study of Aging: one of our earliest roots.

The Duke University Center for the Study of Aging and Human Development (Duke CFA) was established by a multidisciplinary group of visionary scientists in 1955. It is the oldest continually operating center or institute dedicated to aging in the United States. This article outlines the origins of the Duke CFA and summarizes the major research initiatives conducted in its early years. The primary focus is on these landmark studies and their legacies. Those studies made important initial contributions to the knowledge base, introduced measurement tools and research designs that became standards in the field, and served as the impetus for later and current research. The hallmarks of these studies are their multidisciplinary foundations and their focus on the health and well-being of older adults. The Duke CFA's current research clearly builds upon the goals, insights, and empirical results of previous research initiatives. Although aging research is and has been the bedrock of the Duke CFA, developing services responsive to the needs of older adults and multidisciplinary training have also been hallmarks of the Duke CFA. Duke's Geriatric Evaluation and Treatment Clinic was established in 1974 and remains a national model for geriatric assessment. Our postdoctoral research training program has graduated more than 200 scholars and our Geriatric Fellowship program has graduated 113 geriatricians. Many of our graduates have exemplary careers in aging, contributing to important research advances, providing care to thousands of older adults, serving as leaders in the field, and training new generations of gerontologists and geriatricians.

Authors
George, LK; Palmore, E; Cohen, HJ
MLA Citation
George, LK, Palmore, E, and Cohen, HJ. "The Duke Center for the Study of Aging: one of our earliest roots." Gerontologist 54.1 (February 2014): 59-66.
PMID
23733867
Source
pubmed
Published In
The Gerontologist
Volume
54
Issue
1
Publish Date
2014
Start Page
59
End Page
66
DOI
10.1093/geront/gnt049

Senior adult oncology, version 2.2014: Clinical practice guidelines in oncology

Cancer is the leading cause of death in older adults aged 60 to 79 years. The biology of certain cancers and responsiveness to therapy changes with the patient's age. Advanced age alone should not preclude the use of effective treatment that could improve quality of life or extend meaningful survival. The challenge of managing older patients with cancer is to assess whether the expected benefits of treatment are superior to the risk in a population with decreased life expectancy and decreased tolerance to stress. These guidelines provide an approach to decision-making in older cancer patients based on comprehensive geriatric assessment and also include diseasespecific issues related to age in the management of some cancer types in older adults. Copyright © 2014 by the National Comprehensive Cancer Network.

Authors
Hurria, A; Wildes, T; Blair, SL; Browner, IS; Cohen, HJ; De Shazo, M; Dotan, E; Edil, BH; Extermann, M; Ganti, AKP; Holmes, HM; Jagsi, R; Karlekar, MB; Keating, NL; Korc-Grodzicki, B; McKoy, JM; Medeiros, BC; Mrozek, E; O'Connor, T; Rugo, HS; Rupper, RW; Silliman, RA; Stirewalt, DL; Tew, WP; Walter, LC; Weir, AB; Bergman, MA; Sundar, H
MLA Citation
Hurria, A, Wildes, T, Blair, SL, Browner, IS, Cohen, HJ, De Shazo, M, Dotan, E, Edil, BH, Extermann, M, Ganti, AKP, Holmes, HM, Jagsi, R, Karlekar, MB, Keating, NL, Korc-Grodzicki, B, McKoy, JM, Medeiros, BC, Mrozek, E, O'Connor, T, Rugo, HS, Rupper, RW, Silliman, RA, Stirewalt, DL, Tew, WP, Walter, LC, Weir, AB, Bergman, MA, and Sundar, H. "Senior adult oncology, version 2.2014: Clinical practice guidelines in oncology." JNCCN Journal of the National Comprehensive Cancer Network 12.1 (January 1, 2014): 82-126.
Source
scopus
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
12
Issue
1
Publish Date
2014
Start Page
82
End Page
126

Light-intensity activity attenuates functional decline in older cancer survivors

While moderate-to vigorous-intensity physical activities (MVPA) confer the greatest health benefits, evidence suggests that light-intensity activities are also beneficial, particularly for older adults and individuals with moderate to severe comorbidities. Purpose: To examine cross-sectional and longitudinal associations between light-intensity activity and physical function in older cancer survivors at increased risk for age-And treatment-related comorbidities, including accelerated functional decline. Methods: The analysis included data from 641 breast, prostate, and colorectal cancer survivors (54% female) age 65 yr and older who participated in a 1-yr home-based diet and exercise intervention designed to reduce the rate of physical function decline. ANCOVA was used to compare means of physical function across levels of PA intensity (low-light [LLPA]: 1.5-2.0 METs; high-light [HLPA] : 2.1-2.9 METs; MVPA: ‰13.0 METs). Results: In cross-sectional analyses, increasing tertiles of light-intensity activity were associated with higher scores for all three measures of physical function (all P values < 0.005), after adjusting for age, sex, body mass index, comorbidity, symptoms, and MVPA. Associations were stronger for HLPA than for LLPA. Compared with survivors who had decreased MVPA or maintained stable MVPA and HLPA at the postintervention follow-up, those who had increased HLPA, but had decreased MVPA or maintained stable MVPA, reported higher physical function scores (LS means [95% confidence interval]: SF-36 Physical Function Subscale:-5.58 [-7.96 to-3.20] vs-2.54 [-5.83 to 0.75], P = 0.14; Basic Lower Extremity Function:-2.00 [-3.45 to-0.55] vs 0.28 [-1.72 to 2.28], P = 0.07; Advanced Lower Extremity Function:-2.58 [-4.00 to-1.15] vs 0.44 [-1.52 to 2.40], P = 0.01). Conclusions: Our findings suggest that increasing light-intensity activities, especially HLPA, may be a viable approach to reducing the rate of physical function decline in individuals who are unable or reluctant to initiate or maintain adequate levels of moderate-intensity activities. © 2014 by the American College of Sports Medicine.

Authors
Blair, CK; Morey, MC; Desmond, RA; Cohen, HJ; Sloane, R; Snyder, DC; Demark-Wahnefried, W
MLA Citation
Blair, CK, Morey, MC, Desmond, RA, Cohen, HJ, Sloane, R, Snyder, DC, and Demark-Wahnefried, W. "Light-intensity activity attenuates functional decline in older cancer survivors." Medicine and Science in Sports and Exercise 46.7 (January 1, 2014): 1375-1383.
Source
scopus
Published In
Medicine and Science in Sports and Exercise
Volume
46
Issue
7
Publish Date
2014
Start Page
1375
End Page
1383
DOI
10.1249/MSS.0000000000000241

Religious involvement is associated with greater purpose, optimism, generosity and gratitude in persons with major depression and chronic medical illness

Objective: Religious involvement may help individuals with chronic medical illness cope better with physical disability and other life changes. We examine the relationships between religiosity, depressive symptoms, and positive emotions in persons with major depression and chronic illness. Methods: 129 persons who were at least somewhat religious/spiritual were recruited into a clinical trial to evaluate the effectiveness of religious vs. secular cognitive behavioral therapy. Reported here are the relationships at baseline between religious involvement and depressive symptoms, purpose in life, optimism, generosity, and gratefulness using standard measures. Results: Although religiosity was unrelated to depressive symptoms (F. = 0.96, p. = 0.43) and did not buffer the disability-depression relationship (B. = - 1.56, SE 2.90, p. = 0.59), strong relationships were found between religious indicators and greater purpose, optimism, generosity, and gratefulness (F. = 7.08, p. < . 0.0001). Conclusions: Although unrelated to depressive symptoms in the setting of major depression and chronic medical illness, higher religious involvement is associated with positive emotions, a finding which may influence the course of depression over time. © 2014 Elsevier Inc.

Authors
Koenig, HG; Berk, LS; Daher, NS; Pearce, MJ; Bellinger, DL; Robins, CJ; Nelson, B; Shaw, SF; Cohen, HJ; King, MB
MLA Citation
Koenig, HG, Berk, LS, Daher, NS, Pearce, MJ, Bellinger, DL, Robins, CJ, Nelson, B, Shaw, SF, Cohen, HJ, and King, MB. "Religious involvement is associated with greater purpose, optimism, generosity and gratitude in persons with major depression and chronic medical illness." Journal of Psychosomatic Research 77.2 (January 1, 2014): 135-143.
Source
scopus
Published In
Journal of Psychosomatic Research
Volume
77
Issue
2
Publish Date
2014
Start Page
135
End Page
143
DOI
10.1016/j.jpsychores.2014.05.002

Senior adult oncology, version 2.2014: clinical practice guidelines in oncology .

Cancer is the leading cause of death in older adults aged 60 to 79 years. The biology of certain cancers and responsiveness to therapy changes with the patient's age. Advanced age alone should not preclude the use of effective treatment that could improve quality of life or extend meaningful survival. The challenge of managing older patients with cancer is to assess whether the expected benefits of treatment are superior to the risk in a population with decreased life expectancy and decreased tolerance to stress. These guidelines provide an approach to decision-making in older cancer patients based on comprehensive geriatric assessment and also include disease specific issues related to age in the management of some cancer types in older adults.

Authors
Hurria, A; Wildes, T; Blair, SL; Browner, IS; Cohen, HJ; Deshazo, M; Dotan, E; Edil, BH; Extermann, M; Ganti, AKP; Holmes, HM; Jagsi, R; Karlekar, MB; Keating, NL; Korc-Grodzicki, B; McKoy, JM; Medeiros, BC; Mrozek, E; O'Connor, T; Rugo, HS; Rupper, RW; Silliman, RA; Stirewalt, DL; Tew, WP; Walter, LC; Weir, AB; Bergman, MA; Sundar, H
MLA Citation
Hurria, A, Wildes, T, Blair, SL, Browner, IS, Cohen, HJ, Deshazo, M, Dotan, E, Edil, BH, Extermann, M, Ganti, AKP, Holmes, HM, Jagsi, R, Karlekar, MB, Keating, NL, Korc-Grodzicki, B, McKoy, JM, Medeiros, BC, Mrozek, E, O'Connor, T, Rugo, HS, Rupper, RW, Silliman, RA, Stirewalt, DL, Tew, WP, Walter, LC, Weir, AB, Bergman, MA, and Sundar, H. "Senior adult oncology, version 2.2014: clinical practice guidelines in oncology ." Journal of the National Comprehensive Cancer Network : JNCCN 12.1 (January 2014): 82-126.
PMID
24453295
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
12
Issue
1
Publish Date
2014
Start Page
82
End Page
126
DOI
10.6004/jnccn.2014.0009

Accelerated aging among cancer survivors: from pediatrics to geriatrics.

There are almost 14-million cancer survivors in the United States and the population is growing. Almost two-thirds of these survivors are age 65 or older. Given this, it is imperative to understand the impact of cancer and its therapies on the aging process. Childhood cancer survivors, diagnosed with cancer at age 21 or younger, particularly females, have rates of frailty similar to rates in older adults. This phenomenon appears to start early, suggesting an aging phenotype. Frailty among childhood cancer survivors increases risk for chronic disease and mortality. Adults diagnosed with cancer are faced with the effects of cancer and its therapies compounded by the issues of multiple morbidities that occur with the typical aging process. Intervention studies to date have focused on smoking cessation, diet, and exercise, as well as improving rates of late effects surveillance in childhood cancer survivors. No intervention studies have specifically addressed the issue of frailty or multiple morbidities in cancer survivors. Concerted efforts must continue to create and disseminate survivorship care plans to all cancer survivors.

Authors
Henderson, TO; Ness, KK; Cohen, HJ
MLA Citation
Henderson, TO, Ness, KK, and Cohen, HJ. "Accelerated aging among cancer survivors: from pediatrics to geriatrics." American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Meeting (January 2014): e423-e430. (Review)
PMID
24857133
Source
epmc
Published In
American Society of Clinical Oncology educational book / ASCO. American Society of Clinical Oncology. Meeting
Publish Date
2014
Start Page
e423
End Page
e430
DOI
10.14694/edbook_am.2014.34.e423

Light-intensity activity attenuates functional decline in older cancer survivors

Authors
Blair, CK; Morey, MC; Desmond, RA; Cohen, HJ; Sloane, R; Snyder, DC; Demark-Wahnefried, W
MLA Citation
Blair, CK, Morey, MC, Desmond, RA, Cohen, HJ, Sloane, R, Snyder, DC, and Demark-Wahnefried, W. "Light-intensity activity attenuates functional decline in older cancer survivors." Medicine and Science in Sports and Exercise (2014).
PMID
24389524
Source
scopus
Published In
Medicine and Science in Sports and Exercise
Publish Date
2014

Characteristics and treatment options of elderly Chinese patients with cancer as determined by comprehensive geriatric assessment (CGA)

Objective: China is experiencing a rapid increase in cancer incidence in elderly patients. In order to better understand this group, a large study of patients from multiple tertiary centers in the Beijing area was designed. This study was designed to provide insight into their unique treatment preferences, including the use of traditional Chinese medicine (TCM). Materials and Methods: 803 patients from nine hospitals in the Beijing area were enrolled into this study. The inclusion criteria were patients who were 65. years or older and had a diagnosis of cancer at any stage. The CGA questionnaire used with these patients included the Chinese translation of the Gero-Oncology Health and Quality of Life Assessment tool. The questionnaire was provided to patients by a research nurse and was administered in Mandarin. Results: The mean age of the patients was 72. years (range 65-94). The patients were mainly male (59.8%) and of Han ethnicity (95.4%). About 45% of these patients also had concurrent TCM in addition to their other cancer treatments. About 70% were able to manage their activities of daily living without assistance. Patients on TCM were more likely to have higher number of co-morbidities compared to their counterparts. Conclusion: This is the largest prospective study of CGA assessments done on elderly patients with cancer in Asia. The study demonstrates that CGA provides insights into understanding the needs of elderly Chinese patients with cancer. TCM is used frequently in China, and its impact on quality of life needs further investigation. © 2014 Elsevier Inc.

Authors
Kanesvaran, R; Wang, W; Yang, Y; Wei, Z; Jia, L; Li, F; Wu, S; Bai, C; Xie, H; Zhang, H; Yang, G; Sloane, R; Li, P; Cohen, HJ
MLA Citation
Kanesvaran, R, Wang, W, Yang, Y, Wei, Z, Jia, L, Li, F, Wu, S, Bai, C, Xie, H, Zhang, H, Yang, G, Sloane, R, Li, P, and Cohen, HJ. "Characteristics and treatment options of elderly Chinese patients with cancer as determined by comprehensive geriatric assessment (CGA)." Journal of Geriatric Oncology 5.2 (2014): 171-178.
Source
scival
Published In
Journal of Geriatric Oncology
Volume
5
Issue
2
Publish Date
2014
Start Page
171
End Page
178
DOI
10.1016/j.jgo.2014.01.004

Associations among survivorship care plans, experiences of survivorship care, and functioning in older breast cancer survivors: CALGB/Alliance 369901

© 2014, Springer Science+Business Media New York.Implications for Cancer Survivors: To impact functioning and salient needs of the growing cohort of older survivors, survivorship care plans likely should be tailored to geriatric-specific issues. To improve functioning, SCP content should expand to include exercise, nutrition, polypharmacy, social support and management of symptom burden from cancer, and other comorbid conditions. To improve follow-up care for cancer survivors, SCPs should delineate shared care roles between oncology and primary care in managing recurrence surveillance, screening, and cancer sequelae.Purpose: Survivorship care plans (SCP) are recommended for all cancer patients and could be especially useful to survivors 65 years and over (“older”). This study examined receipt of SCPs among older breast cancer survivors and whether SCPs were associated with improved patient-reported outcomes.Methods: Three hundred and twenty-eight older women diagnosed with invasive, nonmetastatic breast cancer between 2007–2011 were recruited from 78 cooperative-group sites. Participants completed telephone interviews at baseline and 1-year posttreatment. Regression analyses examined SCP receipt (yes/no) and functioning (EORTC-QLQ-C30), cancer worry, and experiences of survivorship care (care coordination, knowledge).Results: Only 35 % of women received SCPs. For each 1-year increase in age, there was a 5 % lower odds of receiving an SCP (odds ratio (OR) = 0.94, 95 % confidence interval (CI) 0.91–0.98, p = 0.007). Besides age, no other factor predicted SCPs. SCP receipt was associated with greater knowledge and understanding of requisite follow-up care (p < 0.05); however, functioning was not significantly different among those with vs. without SCPs.Conclusions: Receipt of care plans was limited. SCPs improved understanding of breast cancer follow-up care among older survivors, but did not impact functioning one year post-treatment.

Authors
Faul, LA; Luta, G; Sheppard, V; Isaacs, C; Cohen, HJ; Muss, HB; Yung, R; Clapp, JD; Winer, E; Hudis, C; Tallarico, M; Wang, J; Barry, WT; Mandelblatt, JS
MLA Citation
Faul, LA, Luta, G, Sheppard, V, Isaacs, C, Cohen, HJ, Muss, HB, Yung, R, Clapp, JD, Winer, E, Hudis, C, Tallarico, M, Wang, J, Barry, WT, and Mandelblatt, JS. "Associations among survivorship care plans, experiences of survivorship care, and functioning in older breast cancer survivors: CALGB/Alliance 369901." Journal of Cancer Survivorship 8.4 (2014): 627-637.
Source
scival
Published In
Journal of Cancer Survivorship
Volume
8
Issue
4
Publish Date
2014
Start Page
627
End Page
637
DOI
10.1007/s11764-014-0371-5

Lower levels of circulating progenitor cells are associated with low physical function and performance in elderly men with impaired glucose tolerance: a pilot substudy from the VA Enhanced Fitness trial.

BACKGROUND: Aging is marked by a decline in physical function. Although the biological underpinnings for this remain unclear, loss of regenerative capacity has been proposed as one cause of the loss of physical function that occurs over time. The quantity of circulating progenitor cells (CPCs) may be one reflection of regenerative capability. We sought to determine whether certain specific CPC subpopulations were associated with physical function. METHODS: Baseline CPCs were measured in 129 randomized participants in the Enhanced Fitness clinical trial based on the cell surface markers CD34, CD133, CD146, and CD14 and aldehyde dehydrogenase (ALDH) activity. Physical function was assessed using usual and rapid gait speed, 6-minute walk distance, chair stand time, and balance time. RESULTS: Low counts of early angiogenic CPCs identified as CD34(+), CD34(+)CD133(+), and ALDH-bright (ALDH(br)) cells were associated with low usual gait speed (p < .005, p < .001, and p < .007), rapid gait speed (p < .001, p < .003, and p < .001), and 6-minute walking distance (all comparisons p < .001), and longer time required to complete five chair stands (p < .006, p < .002, and p < .004). CPC counts of mature endothelial or monocytic markers were not associated with physical function. CONCLUSIONS: The numbers of CD34(+) and ALDH(br) CPCs are significantly lower in patients with impaired physical function. Further studies are needed to determine the underlying causes for this association.

Authors
Povsic, TJ; Sloane, R; Zhou, J; Pieper, CF; Pearson, MP; Peterson, ED; Green, JB; Cohen, HJ; Morey, MC
MLA Citation
Povsic, TJ, Sloane, R, Zhou, J, Pieper, CF, Pearson, MP, Peterson, ED, Green, JB, Cohen, HJ, and Morey, MC. "Lower levels of circulating progenitor cells are associated with low physical function and performance in elderly men with impaired glucose tolerance: a pilot substudy from the VA Enhanced Fitness trial." J Gerontol A Biol Sci Med Sci 68.12 (December 2013): 1559-1566.
PMID
23682163
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
68
Issue
12
Publish Date
2013
Start Page
1559
End Page
1566
DOI
10.1093/gerona/glt067

Improving the Quality of Cancer Care in an Aging Population Recommendations From an IOM Report

Authors
Hurria, A; Naylor, M; Cohen, HJ
MLA Citation
Hurria, A, Naylor, M, and Cohen, HJ. "Improving the Quality of Cancer Care in an Aging Population Recommendations From an IOM Report." JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 310.17 (November 6, 2013): 1795-1796.
PMID
24193075
Source
wos-lite
Published In
JAMA : the journal of the American Medical Association
Volume
310
Issue
17
Publish Date
2013
Start Page
1795
End Page
1796
DOI
10.1001/jama.2013.280416

Depletion of circulating progenitor cells precedes overt diabetes: A substudy from the VA enhanced fitness trial

Background One theory of aging and disease development is that chronic injury (pathology) results in activation of regenerative processes and initial repair, with overt disease arising only after exhaustion of reparative capability leads to inadequate repair. While depletion of circulating progenitor cells (CPCs) has been noted in diabetes, the degree to which CPC depletion predates and is associated with propensity to develop overt disease is unclear. Methods The Enhanced Fitness trial enrolled overweight/obese (body mass index > 25) sedentary patients with glucose intolerance but without overt diabetes. Baseline CPCs were measured in 129 patients based on the cell surface markers CD34, CD133, and aldehyde dehydrogenase (ALDH) activity. HgbA 1C , fasting insulin and glucose levels, and HOMA calculations were ascertained. Results Lower counts of early angiogenic CPCs identified as CD34 + , CD34 + CD133 + , and ALDH-bright (ALDH br ) cells were associated with impairments in glucose homeostasis as reflected by HgbA 1C , but not fasting insulin, glucose, or HOMA-IR. These associations remained when corrected for age and cardiovascular risk factors. Conclusions/Interpretation The numbers of CD34 + and ALDH br CPCs were significantly lower in patients with impaired glucose tolerance. Depletion of reparative capacity as reflected by loss of CPCs may presage overt disease as exemplified in this pre-diabetes model. © 2013 Elsevier Inc.

Authors
Povsic, TJ; Sloane, R; Green, JB; Zhou, J; Pieper, CF; Pearson, MP; Peterson, ED; Cohen, HJ; Morey, MC
MLA Citation
Povsic, TJ, Sloane, R, Green, JB, Zhou, J, Pieper, CF, Pearson, MP, Peterson, ED, Cohen, HJ, and Morey, MC. "Depletion of circulating progenitor cells precedes overt diabetes: A substudy from the VA enhanced fitness trial." Journal of Diabetes and its Complications 27.6 (November 1, 2013): 633-636.
Source
scopus
Published In
Journal of Diabetes and its Complications
Volume
27
Issue
6
Publish Date
2013
Start Page
633
End Page
636
DOI
10.1016/j.jdiacomp.2013.08.004

Depletion of circulating progenitor cells precedes overt diabetes: a substudy from the VA enhanced fitness trial.

BACKGROUND: One theory of aging and disease development is that chronic injury (pathology) results in activation of regenerative processes and initial repair, with overt disease arising only after exhaustion of reparative capability leads to inadequate repair. While depletion of circulating progenitor cells (CPCs) has been noted in diabetes, the degree to which CPC depletion predates and is associated with propensity to develop overt disease is unclear. METHODS: The Enhanced Fitness trial enrolled overweight/obese (body mass index >25) sedentary patients with glucose intolerance but without overt diabetes. Baseline CPCs were measured in 129 patients based on the cell surface markers CD34, CD133, and aldehyde dehydrogenase (ALDH) activity. HgbA1C, fasting insulin and glucose levels, and HOMA calculations were ascertained. RESULTS: Lower counts of early angiogenic CPCs identified as CD34(+), CD34(+)CD133(+), and ALDH-bright (ALDH(br)) cells were associated with impairments in glucose homeostasis as reflected by HgbA1C, but not fasting insulin, glucose, or HOMA-IR. These associations remained when corrected for age and cardiovascular risk factors. CONCLUSIONS/INTERPRETATION: The numbers of CD34(+) and ALDH(br) CPCs were significantly lower in patients with impaired glucose tolerance. Depletion of reparative capacity as reflected by loss of CPCs may presage overt disease as exemplified in this pre-diabetes model.

Authors
Povsic, TJ; Sloane, R; Green, JB; Zhou, J; Pieper, CF; Pearson, MP; Peterson, ED; Cohen, HJ; Morey, MC
MLA Citation
Povsic, TJ, Sloane, R, Green, JB, Zhou, J, Pieper, CF, Pearson, MP, Peterson, ED, Cohen, HJ, and Morey, MC. "Depletion of circulating progenitor cells precedes overt diabetes: a substudy from the VA enhanced fitness trial." J Diabetes Complications 27.6 (November 2013): 633-636.
PMID
24055327
Source
pubmed
Published In
Journal of Diabetes and Its Complications
Volume
27
Issue
6
Publish Date
2013
Start Page
633
End Page
636
DOI
10.1016/j.jdiacomp.2013.08.004

End points and trial design in geriatric oncology research: a joint European organisation for research and treatment of cancer--Alliance for Clinical Trials in Oncology--International Society Of Geriatric Oncology position article.

Selecting the most appropriate end points for clinical trials is important to assess the value of new treatment strategies. Well-established end points for clinical research exist in oncology but may not be as relevant to the older cancer population because of competing risks of death and potentially increased impact of therapy on global functioning and quality of life. This article discusses specific clinical end points and their advantages and disadvantages for older individuals. Randomized or single-arm phase II trials can provide insight into the range of efficacy and toxicity in older populations but ideally need to be confirmed in phase III trials, which are unfortunately often hindered by the severe heterogeneity of the older cancer population, difficulties with selection bias depending on inclusion criteria, physician perception, and barriers in willingness to participate. All clinical trials in oncology should be without an upper age limit to allow entry of eligible older adults. In settings where so-called standard therapy is not feasible, specific trials for older patients with cancer might be required, integrating meaningful measures of outcome. Not all questions can be answered in randomized clinical trials, and large observational cohort studies or registries within the community setting should be established (preferably in parallel to randomized trials) so that treatment patterns across different settings can be compared with impact on outcome. Obligatory integration of a comparable form of geriatric assessment is recommended in future studies, and regulatory organizations such as the European Medicines Agency and US Food and Drug Administration should require adequate collection of data on efficacy and toxicity of new drugs in fit and frail elderly subpopulations.

Authors
Wildiers, H; Mauer, M; Pallis, A; Hurria, A; Mohile, SG; Luciani, A; Curigliano, G; Extermann, M; Lichtman, SM; Ballman, K; Cohen, HJ; Muss, H; Wedding, U
MLA Citation
Wildiers, H, Mauer, M, Pallis, A, Hurria, A, Mohile, SG, Luciani, A, Curigliano, G, Extermann, M, Lichtman, SM, Ballman, K, Cohen, HJ, Muss, H, and Wedding, U. "End points and trial design in geriatric oncology research: a joint European organisation for research and treatment of cancer--Alliance for Clinical Trials in Oncology--International Society Of Geriatric Oncology position article." J Clin Oncol 31.29 (October 10, 2013): 3711-3718.
PMID
24019549
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
31
Issue
29
Publish Date
2013
Start Page
3711
End Page
3718
DOI
10.1200/JCO.2013.49.6125

A low-vision rehabilitation program for patients with mild cognitive deficits.

IMPORTANCE: We are unaware of any standardized protocols within low-vision rehabilitation (LVR) to address cognitive impairment. OBJECTIVE: To design and pilot-test an LVR program for patients with macular disease and cognitive deficits. DESIGN: The Memory or Reasoning Enhanced Low Vision Rehabilitation (MORE-LVR) program was created by a team representing optometry, occupational therapy, ophthalmology, neuropsychology, and geriatrics. This pilot study compares outcomes before and after participation in the MORE-LVR program. SETTING: Eligible patients were recruited from an LVR clinic from October 1, 2010, through March 31, 2011. PARTICIPANTS: Twelve patients completed the intervention, and 11 companions attended at least 1 training session. INTERVENTION: Key components of the MORE-LVR intervention are as follows: (1) repetitive training with a therapist twice weekly during a 6-week period, (2) simplified training experience addressing no more than 3 individualized goals in a minimally distracting environment, and (3) involvement of an informal companion (friend or family member). MAIN OUTCOME MEASURES: Version 2000 National Eye Institute Vision Function Questionnaire-25; timed performance measures, Telephone Interview for Cognitive Status-modified(TICS-m), Logical Memory tests, satisfaction with activities of daily living, and goal attainment scales. RESULTS: Twelve patients without dementia (mean age, 84.5 years; 75% female) who screened positive for cognitive deficits completed the MORE-LVR program. Participants demonstrated improved mean (SD) scores on the National Eye Institute's Visual Function Questionnaire-25 composite score (47.2 [16.3] to 54.8 [13.8], P = .01) and near-activities score (21.5 [14.0] to 41.0 [23.1], P = .02), timed performance measures (writing a grocery list [P = .03], filling in a crossword puzzle answer [P = .003]), a score indicating satisfaction with independence (P = .05), and logical memory (P = .02). All patients and companions reported progress toward at least 1 individualized goal; more than 70% reported progress toward all 3 goals. CONCLUSIONS AND RELEVANCE: This pilot study demonstrates feasibility of an LVR program for patients with macular disease and mild cognitive deficits. Participants demonstrated improvements in vision-related function and cognitive measures and expressed high satisfaction. Future work is needed to determine whether MORE-LVR is superior to usual outpatient LVR for persons with coexisting visual and cognitive impairments.

Authors
Whitson, HE; Whitaker, D; Potter, G; McConnell, E; Tripp, F; Sanders, LL; Muir, KW; Cohen, HJ; Cousins, SW
MLA Citation
Whitson, HE, Whitaker, D, Potter, G, McConnell, E, Tripp, F, Sanders, LL, Muir, KW, Cohen, HJ, and Cousins, SW. "A low-vision rehabilitation program for patients with mild cognitive deficits." JAMA Ophthalmol 131.7 (July 2013): 912-919.
PMID
23619914
Source
pubmed
Published In
JAMA Ophthalmology
Volume
131
Issue
7
Publish Date
2013
Start Page
912
End Page
919
DOI
10.1001/jamaophthalmol.2013.1700

Trajectory classes of body mass index in a representative elderly community sample.

BACKGROUND: It is unclear whether distinct weight-related trajectory classes, differing in course, demographics, and health characteristics, exist in the elderly population. METHODS: Data came from the 10-year (1986-1996) Duke Established Populations for Epidemiologic Studies of the Elderly study of 3,861 black (54%) and white (46%) participants aged 65-105 years. Latent-class trajectories of body mass index (BMI: kg/m(2)) based on self-reported weight and height at baseline, 3, 6, and 10 years later were determined using generalized mixture models. Polytomous logistic regression was used to identify baseline demographic and health characteristics that distinguished the trajectories, and 10-year postbaseline data to confirm the findings. RESULTS: We identified three trajectories: normal weight (BMI ~24, 27.6% of the sample), overweight (BMI ~26, 65.1%), and obese (BMI ~31, 7.3%). Demographic characteristics distinguished the three trajectories: highest odds of blacks, women, and less education in the obese trajectory, lowest in the normal-weight trajectory. Obese and overweight differed adversely from normal-weight trajectories, but not significantly from each other on cognitive impairment, hypertension, and diabetes. Depressive symptomatology was more prevalent in the obese; they were also younger. There was no association with cancer or heart disease. CONCLUSION: Distinct trajectories and course of BMI were present in this older population. Weight loss increased with increase in BMI class. Although demographic characteristics distinguished all trajectory classes, adverse health characteristics distinguished the overweight and obese classes from the normal-weight class, but not from each other. Problems associated with education and health are present at study entry and should be addressed earlier in life.

Authors
Kuchibhatla, MN; Fillenbaum, GG; Kraus, WE; Cohen, HJ; Blazer, DG
MLA Citation
Kuchibhatla, MN, Fillenbaum, GG, Kraus, WE, Cohen, HJ, and Blazer, DG. "Trajectory classes of body mass index in a representative elderly community sample." J Gerontol A Biol Sci Med Sci 68.6 (June 2013): 699-704.
PMID
23089335
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
68
Issue
6
Publish Date
2013
Start Page
699
End Page
704
DOI
10.1093/gerona/gls215

Cognitive function in older women with breast cancer treated with standard chemotherapy and capecitabine on Cancer and Leukemia Group B 49907.

Cognitive changes in older women receiving chemotherapy are poorly understood. We examined self-reported cognitive function for older women who received adjuvant chemotherapy on Cancer and Leukemia Group B (CALGB) 49907. CALGB 49907 randomized 633 women aged ≥65 with stage I-III breast cancer to standard adjuvant chemotherapy (cyclophosphamide-methotrexate-5-fluorouracil or doxorubicin-cyclophosphamide) versus capecitabine. We examined self-reported cognitive function in 297 women (CALGB 361002) who enrolled on the quality of life substudy and had no gross impairment on cognitive screening. Women were evaluated using an 18-item instrument at six time points (baseline through 24 months). At each time point for each patient, we calculated a cognitive function score (CFS) defined as the mean response of items 1-18 and defined impairment as a score >1.5 standard deviations above the overall average baseline score. Differences in scores by patient characteristics were evaluated using a Kruskal-Wallis test. A linear mixed-effects model was used to assess CFSs by treatment over time. Among 297 women, the median age was 71.5 (range 65-85) and 73 % had performance status of 0. Baseline depression and fatigue were reported in 6 and 14 % of patients, respectively. The average CFS at baseline was 2.08 (corresponding to "normal ability"), and baseline cognitive function did not differ by treatment regimen (p = 0.350). Over 24 months, women reported minimal changes at each time point and insignificant differences by treatment arm were observed. In a healthy group of older women, chemotherapy was not associated with longitudinal changes in self-reported cognitive function.

Authors
Freedman, RA; Pitcher, B; Keating, NL; Ballman, KV; Mandelblatt, J; Kornblith, AB; Kimmick, GG; Hurria, A; Winer, EP; Hudis, CA; Cohen, HJ; Muss, HB; Alliance for Clinical Trials in Oncology,
MLA Citation
Freedman, RA, Pitcher, B, Keating, NL, Ballman, KV, Mandelblatt, J, Kornblith, AB, Kimmick, GG, Hurria, A, Winer, EP, Hudis, CA, Cohen, HJ, Muss, HB, and Alliance for Clinical Trials in Oncology, . "Cognitive function in older women with breast cancer treated with standard chemotherapy and capecitabine on Cancer and Leukemia Group B 49907." Breast Cancer Res Treat 139.2 (June 2013): 607-616.
PMID
23681403
Source
pubmed
Published In
Breast Cancer Research and Treatment
Volume
139
Issue
2
Publish Date
2013
Start Page
607
End Page
616
DOI
10.1007/s10549-013-2562-6

Multidisciplinary Models of Care

Authors
Unroe, KT; Cohen, HJ
MLA Citation
Unroe, KT, and Cohen, HJ. "Multidisciplinary Models of Care." (January 2, 2013): 487-497. (Chapter)
Source
scopus
Publish Date
2013
Start Page
487
End Page
497
DOI
10.1002/9781118312513.ch31

Cognitive function in older women with breast cancer treated with standard chemotherapy and capecitabine on Cancer and Leukemia Group B 49907

Cognitive changes in older women receiving chemotherapy are poorly understood. We examined self-reported cognitive function for older women who received adjuvant chemotherapy on Cancer and Leukemia Group B (CALGB) 49907. CALGB 49907 randomized 633 women aged ≥65 with stage I-III breast cancer to standard adjuvant chemotherapy (cyclophosphamide-methotrexate-5-fluorouracil or doxorubicin-cyclophosphamide) versus capecitabine. We examined self-reported cognitive function in 297 women (CALGB 361002) who enrolled on the quality of life substudy and had no gross impairment on cognitive screening. Women were evaluated using an 18-item instrument at six time points (baseline through 24 months). At each time point for each patient, we calculated a cognitive function score (CFS) defined as the mean response of items 1-18 and defined impairment as a score >1.5 standard deviations above the overall average baseline score. Differences in scores by patient characteristics were evaluated using a Kruskal-Wallis test. A linear mixed-effects model was used to assess CFSs by treatment over time. Among 297 women, the median age was 71.5 (range 65-85) and 73 % had performance status of 0. Baseline depression and fatigue were reported in 6 and 14 % of patients, respectively. The average CFS at baseline was 2.08 (corresponding to "normal ability"), and baseline cognitive function did not differ by treatment regimen (p = 0.350). Over 24 months, women reported minimal changes at each time point and insignificant differences by treatment arm were observed. In a healthy group of older women, chemotherapy was not associated with longitudinal changes in self-reported cognitive function. © 2013 Springer Science+Business Media New York.

Authors
Freedman, RA; Pitcher, B; Keating, NL; Ballman, KV; Mandelblatt, J; Kornblith, AB; Kimmick, GG; Hurria, A; Winer, EP; Hudis, CA; Cohen, HJ; Muss, HB
MLA Citation
Freedman, RA, Pitcher, B, Keating, NL, Ballman, KV, Mandelblatt, J, Kornblith, AB, Kimmick, GG, Hurria, A, Winer, EP, Hudis, CA, Cohen, HJ, and Muss, HB. "Cognitive function in older women with breast cancer treated with standard chemotherapy and capecitabine on Cancer and Leukemia Group B 49907." Breast Cancer Research and Treatment 139.2 (2013): 607-616.
Source
scival
Published In
Breast Cancer Research and Treatment
Volume
139
Issue
2
Publish Date
2013
Start Page
607
End Page
616
DOI
10.1007/s10549-013-2562-6

A planned, prospective comparison of short-term quality of life outcomes among older breast cancer patients treated with standard chemotherapy in a randomized clinical trial vs. an observational study: CALGB #49907 and #369901

Objectives: Patients ≥ 65 years old ("older") are often not included in randomized clinical trials (RCT), but when they are, care in an RCT might improve quality of life (QoL). We conducted a prospective comparison of QoL among older women receiving standard chemotherapy from the same cooperative group physicians in an RCT vs. an observational study ("off-trial"). Methods: Older women with invasive, non-metastatic breast cancer (n = 150 RCT; 530 off-trial) were included. Linear mixed-effects models tested associations between chemotherapy on- vs. off-trial and changes in EORTC (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire) QoL scores over 24 months, controlling for pre-treatment QoL, age, education, tumor factors, comorbidity, and other covariates. Results: Anthracycline regimens were used by 58% of women treated on-trial vs. 54% of those treated off-trial. Women in the RCT reported an adjusted mean increase of 13.7 points (95% CI 10.2, 17.1) in global QoL at 24 months (vs. mid-treatment), while women treated off-trial had only an adjusted improvement of 7.0 points (95% CI 3.5, 10.4; p = .007 for difference in mean changes). Women in the RCT had significantly greater improvement in emotional function than those treated off-trial, controlling for baseline; they also had greater reductions in therapy side effects and fatigue at 24 months than women off-trial, controlling for covariates. Conclusion: There may be different QoL trajectories for older women undergoing breast cancer chemotherapy on- vs. off-trial. If confirmed, the results suggest that the extra monitoring and communication within an RCT could provide the infrastructure for interventions to address symptoms and improve QoL for the growing older cancer population. © 2013 Elsevier Inc. All rights reserved.

Authors
Mandelblatt, JS; Makgoeng, SB; Luta, G; Hurria, A; Kimmick, G; Isaacs, C; Tallarico, M; Barry, WT; Pitcher, B; Winer, EP; al, E
MLA Citation
Mandelblatt, JS, Makgoeng, SB, Luta, G, Hurria, A, Kimmick, G, Isaacs, C, Tallarico, M, Barry, WT, Pitcher, B, Winer, EP, and al, E. "A planned, prospective comparison of short-term quality of life outcomes among older breast cancer patients treated with standard chemotherapy in a randomized clinical trial vs. an observational study: CALGB #49907 and #369901." Journal of Geriatric Oncology (2013).
PMID
24472479
Source
scival
Published In
Journal of Geriatric Oncology
Publish Date
2013
DOI
10.1016/j.jgo.2013.05.004

A planned, prospective comparison of short-term quality of life outcomes among older patients with breast cancer treated with standard chemotherapy in a randomized clinical trial vs. an observational study: CALGB #49907 and #369901

Objectives: Patients ≥. 65. years old ("older") are often not included in randomized clinical trials (RCT), but when they are, care in an RCT might improve quality of life (QoL). We conducted a prospective comparison of QoL among older women receiving standard chemotherapy from the same cooperative group physicians in an RCT vs. an observational study ("off-trial"). Methods: Older women with invasive, non-metastatic breast cancer (n. =. 150 RCT; 530 off-trial) were included. Linear mixed-effects models tested associations between chemotherapy on- vs. off-trial and changes in EORTC (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire) QoL scores over 24. months, controlling for pre-treatment QoL, age, education, tumor factors, comorbidity, and other covariates. Results: Anthracycline regimens were used by 58% of women treated on-trial vs. 54% of those treated off-trial. Women in the RCT reported an adjusted mean increase of 13.7 points (95% CI 10.2, 17.1) in global QoL at 24. months (vs. mid-treatment), while women treated off-trial had only an adjusted improvement of 7.0 points (95% CI 3.5, 10.4; p. =. .007 for difference in mean changes). Women in the RCT had significantly greater improvement in emotional function than those treated off-trial, controlling for baseline; they also had greater reductions in therapy side effects and fatigue at 24. months than women off-trial, controlling for covariates. Conclusion: There may be different QoL trajectories for older women undergoing breast cancer chemotherapy on- vs. off-trial. If confirmed, the results suggest that the extra monitoring and communication within an RCT could provide the infrastructure for interventions to address symptoms and improve QoL for the growing older cancer population. © 2013 Elsevier Inc.

Authors
Mandelblatt, JS; Makgoeng, SB; Luta, G; Hurria, A; Kimmick, G; Isaacs, C; Tallarico, M; Barry, WT; Pitcher, B; Winer, EP; Hudis, C; Cohen, HJ; Muss, HB
MLA Citation
Mandelblatt, JS, Makgoeng, SB, Luta, G, Hurria, A, Kimmick, G, Isaacs, C, Tallarico, M, Barry, WT, Pitcher, B, Winer, EP, Hudis, C, Cohen, HJ, and Muss, HB. "A planned, prospective comparison of short-term quality of life outcomes among older patients with breast cancer treated with standard chemotherapy in a randomized clinical trial vs. an observational study: CALGB #49907 and #369901." Journal of Geriatric Oncology 4.4 (2013): 353-361.
Source
scival
Published In
Journal of Geriatric Oncology
Volume
4
Issue
4
Publish Date
2013
Start Page
353
End Page
361
DOI
10.1016/j.jgo.2013.05.004

Memory deficit associated with worse functional trajectories in older adults in low-vision rehabilitation for macular disease.

OBJECTIVES: To examine whether performance on a brief memory test is related to functional outcomes in older individuals undergoing low-vision rehabilitation (LVR) for macular disease. DESIGN: Observational cohort study of individuals receiving outpatient LVR. SETTING: Academic center. PARTICIPANTS: Ninety-one individuals (average age 80.1) with macular disease. MEASUREMENTS: Memory was assessed at baseline using a 10-word list; memory deficit was defined as immediate recall of two or fewer words. Vision-related function was measured using the 25-item Visual Function Questionnaire (VFQ-25) administered at baseline and during subsequent interviews (mean follow-up, 115 days). Linear mixed models were constructed to compare average trajectories of four VFQ-25 subscales: near activities, distance activities, dependency, and role difficulty. RESULTS: The 29.7% of participants with memory deficits tended to decline in ability to accomplish activities that involved near vision. Controlling for age, sex, and education, the functional trajectory of participants with memory deficit differed significantly from that of those with better memory (P = .002), who tended to report improvements in ability to accomplish near activities. CONCLUSION: Of older adults receiving LVR for macular disease, those with memory deficits experienced worse functional trajectories in their ability to perform specific visually mediated tasks. A brief memory screen may help explain variability in rehabilitation outcomes and identify individuals who might require special accommodations.

Authors
Whitson, HE; Whitaker, D; Sanders, LL; Potter, GG; Cousins, SW; Ansah, D; McConnell, E; Pieper, CF; Landerman, L; Steffens, DC; Cohen, HJ
MLA Citation
Whitson, HE, Whitaker, D, Sanders, LL, Potter, GG, Cousins, SW, Ansah, D, McConnell, E, Pieper, CF, Landerman, L, Steffens, DC, and Cohen, HJ. "Memory deficit associated with worse functional trajectories in older adults in low-vision rehabilitation for macular disease." J Am Geriatr Soc 60.11 (November 2012): 2087-2092.
PMID
23126548
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
60
Issue
11
Publish Date
2012
Start Page
2087
End Page
2092
DOI
10.1111/j.1532-5415.2012.04194.x

Role of pain medications, consultants, and other services in improved pain control of elderly adults with cancer in geriatric evaluation and management units.

OBJECTIVES: To determine whether pain medication use and inpatient consultations and services were associated with significantly better pain control. DESIGN: Secondary data analysis from a randomized two-by-two factorial trial. Hospitalized, frail individuals aged 65 and older were randomized to receive care in a geriatric inpatient unit, a geriatric outpatient clinic, both, or neither. SETTING: Eleven Veterans Affairs Medical Centers. PARTICIPANTS: Ninety-nine individuals with a diagnosis of cancer, excluding nonmelanoma skin cancer; 44 received geriatric evaluation and management unit (GEMU) care and 55 usual care. MEASUREMENTS: Pain medications were measured at baseline and discharge; consultations and other services were quantified for the entire admission. RESULTS: Participants receiving GEMU care had a significantly higher number of consultations than those in usual care. Participants in GEMU care received psychiatry, endocrinology, and psychology consultations 12.7% (P = .004), 9.1% (P = .04), and 21.8% (P = .05) times more, respectively, and occupational and physical therapy 27.3% (P = .004) and 18.2% (P = .04) more, respectively. There were no significant differences in pain medication use between intervention and usual care. CONCLUSION: Significantly greater use of psychology, psychiatry, physical and occupational therapy in the GEMU participants may have improved the effectiveness of pain management in individuals in inpatient GEMUs. Although analgesic use was not significantly different between the GEMU and usual care groups, small sample size may have limited the ability to detect these differences.

Authors
Nipp, R; Sloane, R; Rao, AV; Schmader, KE; Cohen, HJ
MLA Citation
Nipp, R, Sloane, R, Rao, AV, Schmader, KE, and Cohen, HJ. "Role of pain medications, consultants, and other services in improved pain control of elderly adults with cancer in geriatric evaluation and management units." J Am Geriatr Soc 60.10 (October 2012): 1912-1917.
PMID
23036028
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
60
Issue
10
Publish Date
2012
Start Page
1912
End Page
1917
DOI
10.1111/j.1532-5415.2012.04143.x

Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors.

PURPOSE: Diet and exercise interventions have been tested in cancer survivors as a means to reduce late effects and comorbidity, but few have assessed adherence and health outcomes long term. METHODS: Between July 2005 and May 2007, the Reach Out to Enhance Wellness (RENEW) trial accrued 641 locoregionally staged, long-term (≥ 5 years from diagnosis) colorectal, breast, and prostate cancer survivors in the United States (21 states), Canada, and the United Kingdom. All participants were sedentary (< 150 minutes of physical activity [PA] a week), overweight or obese (body mass index, 25 to 40 kg/m(2)), and over age 65 years. The trial tested a diet-exercise intervention delivered via mailed print materials and telephone counseling. RENEW used a wait-list control, cross-over design (ie, participants received the year-long intervention immediately or after a 1-year delay), which allowed the opportunity to assess program efficacy (previously reported primary outcome), durability, and reproducibility (reported herein). Measures included diet quality (DQ), PA, BMI, and physical function (PF). RESULTS: No significant relapse was observed in the immediate-intervention arm for DQ, PA, and BMI; however, rates of functional decline increased when the intervention ceased. From year 1 to year 2, significant improvements were observed in the delayed-intervention arm; mean change scores in behaviors and BMI and PF slopes were as follows: DQ score, 5.2 (95% CI, 3.4 to 7.0); PA, 45.8 min/wk (95% CI, 26.9 to 64.6 min/wk); BMI, -0.56 (95% CI, -0.75 to -0.36); and Short Form-36 PF, -1.02 versus -5.52 (P < .001 for all measures). Overall, both arms experienced significant improvements in DQ, PA, and BMI from baseline to 2-year follow-up (P < .001). CONCLUSION: Older cancer survivors respond favorably to lifestyle interventions and make durable changes in DQ and PA that contribute to sustained weight loss. These changes positively reorient functional decline trajectories during intervention delivery.

Authors
Demark-Wahnefried, W; Morey, MC; Sloane, R; Snyder, DC; Miller, PE; Hartman, TJ; Cohen, HJ
MLA Citation
Demark-Wahnefried, W, Morey, MC, Sloane, R, Snyder, DC, Miller, PE, Hartman, TJ, and Cohen, HJ. "Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors." J Clin Oncol 30.19 (July 1, 2012): 2354-2361.
PMID
22614994
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
30
Issue
19
Publish Date
2012
Start Page
2354
End Page
2361
DOI
10.1200/JCO.2011.40.0895

Dietary patterns differ between urban and rural older, long-term survivors of breast, prostate, and colorectal cancer and are associated with body mass index.

BACKGROUND: Older adult cancer survivors are at greater risk of cancer recurrence and other comorbidities that can be prevented through improved diet and weight management. The tertiary prevention needs of rural-dwelling survivors can be even greater, yet little is known about rural and urban differences in lifestyle factors among this high-risk population. OBJECTIVES: To compare dietary patterns of urban and rural cancer survivors and to examine associations of dietary patterns with body mass index (BMI). DESIGN: A secondary analysis was performed of baseline data from the Reach Out to Enhance Wellness (RENEW) trial, a diet and exercise intervention among overweight, long-term (≥5 years), older survivors of colorectal, breast, and prostate cancer. Survivors in the present analysis (n=729) underwent two 45- to 60-minute telephone surveys, which included two 24-hour dietary recalls. Principal components analysis and multivariable general linear models were used to derive dietary patterns and to evaluate associations between dietary patterns and BMI, respectively. RESULTS: Principal components analysis identified three primary dietary patterns among rural dwellers (high sweets and starches, high reduced-fat dairy, cereal, nuts, and fruits, and mixed) and three among urban dwellers (high fruits and vegetables, high meat and refined grains, and high sugar-sweetened beverages). Among rural survivors, greater adherence to the high reduced-fat dairy, cereal, nuts, and fruits pattern was positively associated with lower BMI (P trend <0.05), whereas higher scores on the mixed pattern was associated with greater BMI (P trend <0.05). Greater adherence to the high fruits and vegetables pattern among urban survivors was inversely associated with BMI (P trend <0.05). CONCLUSIONS: Urban and rural differences in dietary intake behavior should be considered in designing public health interventions among the increasing population of older cancer survivors. In addition, targeting overall dietary patterns might be one approach to help reduce the burden of obesity among this population.

Authors
Miller, PE; Morey, MC; Hartman, TJ; Snyder, DC; Sloane, R; Cohen, HJ; Demark-Wahnefried, W
MLA Citation
Miller, PE, Morey, MC, Hartman, TJ, Snyder, DC, Sloane, R, Cohen, HJ, and Demark-Wahnefried, W. "Dietary patterns differ between urban and rural older, long-term survivors of breast, prostate, and colorectal cancer and are associated with body mass index." J Acad Nutr Diet 112.6 (June 2012): 824-831.e1.
PMID
22709810
Source
pubmed
Published In
Journal of the Academy of Nutrition and Dietetics
Volume
112
Issue
6
Publish Date
2012
Start Page
824
End Page
831.e1
DOI
10.1016/j.jand.2012.02.021

The Donald W. Reynolds Consortium for Faculty Development to Advance Geriatrics Education (FD~AGE): a model for dissemination of subspecialty educational expertise.

PURPOSE: Most U.S. medical schools and training programs lack sufficient faculty expertise in geriatrics to train future physicians to care for the growing population of older adults. Thus, to reach clinician-educators at institutions and programs that have limited resources for enhancing geriatrics curricula, the Donald W. Reynolds Foundation launched the Faculty Development to Advance Geriatrics Education (FD~AGE) program. This consortium of four medical schools disseminates expertise in geriatrics education through support and training of clinician-educators. The authors conducted this study to measure the effects of FD~AGE. METHOD: Program leaders developed a three-pronged strategy to meet program goals: FD~AGE offers (1) advanced fellowships in clinical education for geriatricians who have completed clinical training, (2) mini-fellowships and intensive courses for faculty in geriatrics, teaching skills, and curriculum development, and (3) on-site consultations to assist institutions with reviewing and redesigning geriatrics education programs. FD~AGE evaluators tracked the number and type of participants and conducted interviews and follow-up surveys to gauge effects on learners and institutions. RESULTS: Over six years (2004-2010), FD~AGE trained 82 fellows as clinician-educators, hosted 899 faculty scholars in mini-fellowships and intensive courses, and conducted 65 site visits. Participants taught thousands of students, developed innovative curricula, and assumed leadership roles. Participants cited as especially important to program success expanded knowledge, improved teaching skills, mentoring, and advocacy. CONCLUSIONS: The FD~AGE program represents a unique model for extending concentrated expertise in geriatrics education to a broad group of faculty and institutions to accelerate progress in training future physicians.

Authors
Heflin, MT; Bragg, EJ; Fernandez, H; Christmas, C; Osterweil, D; Sauvigné, K; Warshaw, G; Cohen, HJ; Leipzig, R; Reuben, DB; Durso, SC
MLA Citation
Heflin, MT, Bragg, EJ, Fernandez, H, Christmas, C, Osterweil, D, Sauvigné, K, Warshaw, G, Cohen, HJ, Leipzig, R, Reuben, DB, and Durso, SC. "The Donald W. Reynolds Consortium for Faculty Development to Advance Geriatrics Education (FD~AGE): a model for dissemination of subspecialty educational expertise." Acad Med 87.5 (May 2012): 618-626.
PMID
22450185
Source
pubmed
Published In
Academic Medicine
Volume
87
Issue
5
Publish Date
2012
Start Page
618
End Page
626
DOI
10.1097/ACM.0b013e31824d5251

Biological, clinical, and psychosocial correlates at the interface of cancer and aging research.

In September 2010, the Cancer and Aging Research Group, in collaboration with the National Cancer Institute and the National Institute on Aging, conducted the first of three planned conferences to discuss research methodology to generate the highest quality research in older adults with cancer and then disseminate these findings among those working in the fields of cancer and aging. Conference speakers discussed the current level of research evidence in geriatric oncology, outlined the current knowledge gaps, and put forth principles for research designs and strategies that would address these gaps within the next 10 years. It was agreed that future oncology research trials that enroll older adults should include: (1) improved standardized geriatric assessment of older oncology patients, (2) substantially enhanced biological assessment of older oncology patients, (3) specific trials for the most vulnerable and/or those older than 75 years, and (4) research infrastructure that specifically targets older adults and substantially strengthened geriatrics and oncology research collaborations. This initial conference laid the foundation for the next two meetings, which will address the research designs and collaborations needed to enhance therapeutic and intervention trials in older adults with cancer.

Authors
Dale, W; Mohile, SG; Eldadah, BA; Trimble, EL; Schilsky, RL; Cohen, HJ; Muss, HB; Schmader, KE; Ferrell, B; Extermann, M; Nayfield, SG; Hurria, A; Cancer and Aging Research Group,
MLA Citation
Dale, W, Mohile, SG, Eldadah, BA, Trimble, EL, Schilsky, RL, Cohen, HJ, Muss, HB, Schmader, KE, Ferrell, B, Extermann, M, Nayfield, SG, Hurria, A, and Cancer and Aging Research Group, . "Biological, clinical, and psychosocial correlates at the interface of cancer and aging research." J Natl Cancer Inst 104.8 (April 18, 2012): 581-589.
PMID
22457474
Source
pubmed
Published In
Journal of the National Cancer Institute
Volume
104
Issue
8
Publish Date
2012
Start Page
581
End Page
589
DOI
10.1093/jnci/djs145

Impact of age, comorbidity and symptoms on physical function in long-term breast cancer survivors (CALGB 70803).

PURPOSE: The purpose of this study was to assess the impact of aging, comorbidities and symptoms on physical function in patients surviving 20 years since adjuvant treatment for breast cancer. PATIENTS #ENTITYSTARTX00026; METHODS: Patients were originally treated on CALGB 7581 (from 1975-1980), a randomized trial of three adjuvant therapies and reassessed (153 of 193 eligible survivors) 20 years from the onset of therapy for physical function and symptoms by the EORTC QLQ-C30 and comorbidities by the OARS questionnaire. RESULTS: The average age at reassessment was 64.5 years. 66% of patients had at least two comorbidities and 22% had four or more, but relatively little interference with activities. Older patients had greater multimorbidity. Physical function was generally high and comparable to matched population norms. Older patients had greater difficulty with strenuous activities. For every increase in number of comorbidities, physical function score decreased by 5.1 (p<.001). Symptoms were also frequent (80%) and correlated strongly with decreases in function (0-100u scale) (p <.001), to an even greater degree than comorbidities. CONCLUSION: Very long-term cancer survivors have changes in physical function and symptoms largely consistent with their aging suggesting that the impact of cancer and its treatment is attenuated over time and largely replaced by the impact of age-related comorbidities and functional decline.

Authors
Cohen, HJ; Lan, L; Archer, L; Kornblith, AB
MLA Citation
Cohen, HJ, Lan, L, Archer, L, and Kornblith, AB. "Impact of age, comorbidity and symptoms on physical function in long-term breast cancer survivors (CALGB 70803)." J Geriatr Oncol 3.2 (April 1, 2012): 82-89.
PMID
22707996
Source
pubmed
Published In
Journal of Geriatric Oncology
Volume
3
Issue
2
Publish Date
2012
Start Page
82
End Page
89
DOI
10.1016/j.jgo.2012.01.005

Higher medical morbidity burden is associated with external locus of control.

OBJECTIVES: To describe the association between an increasing number of coexisting conditions and locus of control (LOC), a psychological construct reflecting the degree to which one perceives circumstances to be controlled by personal actions (internal LOC) versus outside factors (external LOC) in older adults. DESIGN: Cross-sectional study using survey data from the North Carolina Established Population for Epidemiologic Studies of the Elderly (NC EPESE) data set. SETTING: Community. PARTICIPANTS: Three thousand two hundred twelve community-dwelling adults aged 68 and older. MEASUREMENTS: Nine common medical conditions were assessed according to self-report. LOC was measured using a standard questionnaire. Analyses were adjusted for demographics, functional status (self-reported activities of daily living), cognition (Short Portable Mental Status Questionnaire), and depression score (Center for Epidemiologic Studies Depression Scale). RESULTS: A higher number of chronic conditions was associated with external LOC (β = 0.37, P < .001). This relationship persisted after adjustment for age, race, sex, functional status, cognition, and depression (β = 0.17, P < .001). Most individual conditions were not associated with LOC, although vision impairment (P < .001) and arthritis (P = .02) were associated with more-internal LOC. CONCLUSION: These results suggest that medically complex patients tend to exhibit a more-external LOC, meaning that they perceive little personal control over circumstances and environment. Clinicians should be aware of this tendency, because external LOC may impede an older adult's willingness to engage in the considerable task of managing multiple chronic conditions.

Authors
Henninger, DE; Whitson, HE; Cohen, HJ; Ariely, D
MLA Citation
Henninger, DE, Whitson, HE, Cohen, HJ, and Ariely, D. "Higher medical morbidity burden is associated with external locus of control." J Am Geriatr Soc 60.4 (April 2012): 751-755.
PMID
22458257
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
60
Issue
4
Publish Date
2012
Start Page
751
End Page
755
DOI
10.1111/j.1532-5415.2012.03904.x

Persistence, adherence, and toxicity with oral CMF in older women with early-stage breast cancer (Adherence companion study 60104 for CALGB 49907)

Background: Cyclophosphamide-methotrexate-5-fluorouracil (CMF) is often selected as adjuvant chemotherapy for older patients with early-stage breast cancer due to perceived superior tolerability. We sought to measure persistence with CMF, adherence to oral cyclophosphamide, and the association of these with toxic effects. Patients and methods: CALGB 49907 was a randomized trial comparing standard chemotherapy (CMF or AC, provider/patient choice) with capecitabine in patients aged ≥65 with stage I-IIIB breast cancer. Those randomized to standard therapy and choosing CMF were prescribed oral cyclophosphamide 100 mg/m. 2 for 14 consecutive days in six 28-day cycles. Persistence was defined as being prescribed six cycles of at least one of the three CMF drugs. Adherence was the number of cyclophosphamide doses that women reported they had taken divided by the number prescribed. Persistence and adherence were based on case report forms and medication calendars. Results: Of 317 randomized to standard chemotherapy, 133 received CMF. Median age was 73 (range 65-88). Seventy-one percent submitted at least one medication calendar; 65% persisted with CMF. Non-persistence was associated with node negativity (P = 0.019), febrile neutropenia (P = 0.002), and fatigue (P = 0.044). Average adherence was 97% during prescribed cycles. Conclusions: Self-reported adherence to cyclophosphamide was high, but persistence was lower, which may be attributable to toxic effects. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Authors
Ruddy, KJ; Pitcher, BN; Archer, LE; Cohen, HJ; Winer, EP; Hudis, CA; Muss, HB; Partridge, AH
MLA Citation
Ruddy, KJ, Pitcher, BN, Archer, LE, Cohen, HJ, Winer, EP, Hudis, CA, Muss, HB, and Partridge, AH. "Persistence, adherence, and toxicity with oral CMF in older women with early-stage breast cancer (Adherence companion study 60104 for CALGB 49907)." Annals of Oncology 23.12 (2012): 3075-3081.
PMID
22767584
Source
scival
Published In
Annals of Oncology
Volume
23
Issue
12
Publish Date
2012
Start Page
3075
End Page
3081
DOI
10.1093/annonc/mds133

Patient and physician decision styles and breast cancer chemotherapy use in older women: Cancer and leukemia group B protocol 369901

Purpose: Physician and patient decision styles may influence breast cancer care for patients ≥ 65 years ("older") because there is uncertainty about chemotherapy benefits in this group. We evaluate associations between decision-making styles and actual treatment. Methods: Data were collected from women treated outside of clinical trials for newly diagnosed stage I to III breast cancer (83% response) from January 2004 through April 2011 in 75 cooperative group sites. Physicians completed a one-time mailed survey (91% response), and clinical data were abstracted from charts. Patient decision style was measured on a five-point scale. Oncologists'preference for prescribing chemotherapy was based on standardized vignettes. Regression and multiple imputation were used to assess associations between chemotherapy and other variables. Results: There were 1,174 women seen by 212 oncologists; 43% of women received chemotherapy. One-third of women preferred to make their own treatment decision. Patient and physician decision styles were independently associated with chemotherapy. Women who preferred less physician input had lower odds of chemotherapy than women who preferred more input (odds ratio [OR] = 0.79 per 1-point change; 95% CI, 0.65 to 0.97; P = .02) after considering covariates. Patients whose oncologists had a high chemotherapy preference had higher odds of receiving chemotherapy (OR = 2.65; 95% CI, 1.80 to 3.89; P < .001) than those who saw oncologists with a low preference. Conclusion: Physicians' and older patients' decision styles are each associated with breast cancer chemotherapy use. It will be important to re-evaluate the impact of decision styles when there is greater empirical evidence about the benefits and risks of chemotherapy in older patients. © 2012 by American Society of Clinical Oncology.

Authors
Mandelblatt, JS; Faul, LA; Luta, G; Makgoeng, SB; Isaacs, C; Taylor, K; Sheppard, VB; Tallarico, M; Barry, WT; Cohen, HJ
MLA Citation
Mandelblatt, JS, Faul, LA, Luta, G, Makgoeng, SB, Isaacs, C, Taylor, K, Sheppard, VB, Tallarico, M, Barry, WT, and Cohen, HJ. "Patient and physician decision styles and breast cancer chemotherapy use in older women: Cancer and leukemia group B protocol 369901." Journal of Clinical Oncology 30.21 (2012): 2609-2614.
PMID
22614985
Source
scival
Published In
Journal of Clinical Oncology
Volume
30
Issue
21
Publish Date
2012
Start Page
2609
End Page
2614
DOI
10.1200/JCO.2011.40.2909

Geriatric inpatient units in the care of hospitalized frail adults with a history of heart failure

Background: Frail hospitalized older adults are at risk for adverse outcomes. Previous studies have suggested benefits for inpatient geriatric management (GEM). We sought to determine whether hospitalized patients with a history of heart failure (HF) benefitted from inpatient GEM or not. Methods: We studied 309 inpatients previously diagnosed with HF who were participants in a randomized trial of geriatric evaluation and management (GEM) versus usual care (UC). The intervention involved multidisciplinary teams that provided comprehensive geriatric assessment. We evaluated health-related quality of life (HRQOL), basic activities of daily living (ADLs), health service utilization, and survival at discharge, 6 months, and 1 year post randomization. Results: GEM patients had higher mean change scores for physical function (unadjusted means: 0.17 vs. -4.67, p = 0.046) and basic ADLs (1.25 vs. 0.67, p = 0.003) at hospital discharge, which remained significant after adjusting for baseline HRQOL scores and in-hospital days. Outcomes were not significantly different at 1 year. Length of stay for GEM was greater than UC (24 days vs. 17 days, p = 0.03), but total costs at 1 year were not different (p = 0.9). Mortality rates at 1 year were high and similar (GEM 29.0%, UC 27.3%, p = 0.73) in both the groups. Conclusion: Inpatient GEM was associated with better maintenance of physical function and basic ADLs at hospital discharge; however, no differences in HRQOL or survival were observed between GEM and UC at 1 year post randomization. Restructuring inpatient care models to incorporate inpatient GEM principles may be one method to optimize health-care delivery. © 2012, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.

Authors
Gharacholou, SM; Sloane, R; Cohen, HJ; Schmader, KE
MLA Citation
Gharacholou, SM, Sloane, R, Cohen, HJ, and Schmader, KE. "Geriatric inpatient units in the care of hospitalized frail adults with a history of heart failure." International Journal of Gerontology 6.2 (2012): 112-116.
Source
scival
Published In
International Journal of Gerontology
Volume
6
Issue
2
Publish Date
2012
Start Page
112
End Page
116
DOI
10.1016/j.ijge.2012.01.012

Senior adult oncology: Clinical practice guidelines in oncology

Cancer is the leading cause of death in women and men aged 60 to 79 years. The biologic characteristics of certain cancers are different in older patients compared with their younger counterparts, and older patients also have decreased tolerance to chemotherapy. Nevertheless, advanced age alone should not be the only criteria to preclude effective cancer treatment that could improve quality of life or lead to a survival benefit in older patients. Treatment should be individualized based the nature of the disease, the physiologic status of the patient, and patient preferences. Chronologic age is not reliable in estimating life expectancy, functional reserve, or the risk of treatment complications. Whether cancer treatment is appropriate may be best determined through careftil assessment of the older patient. CGA can be used to assess life expectancy and risk of morbidity from cancer in elderly patients, in turn enabling physicians to develop a coordinated plan for cancer treatment and guide interventions tailored to the patient's problems. © JNCCN-Journal of the National Comprehensive Cancer Network.

Authors
Hurria, A; Browner, IS; Cohen, HJ; Denlinger, CS; DeShazo, M; Extermann, M; Ganti, AKP; Holland, JC; Holmes, HM; Karlekar, MB; Keating, NL; McKoy, J; Medeiros, BC; Mrozek, E; O'Connor, T; Petersdorf, SH; Rugo, HS; Silliman, RA; Tew, WP; Walter, LC; III, ABW; Wildes, T
MLA Citation
Hurria, A, Browner, IS, Cohen, HJ, Denlinger, CS, DeShazo, M, Extermann, M, Ganti, AKP, Holland, JC, Holmes, HM, Karlekar, MB, Keating, NL, McKoy, J, Medeiros, BC, Mrozek, E, O'Connor, T, Petersdorf, SH, Rugo, HS, Silliman, RA, Tew, WP, Walter, LC, III, ABW, and Wildes, T. "Senior adult oncology: Clinical practice guidelines in oncology." JNCCN Journal of the National Comprehensive Cancer Network 10.2 (2012): 162-209.
PMID
22308515
Source
scival
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
10
Issue
2
Publish Date
2012
Start Page
162
End Page
209

Paclitaxel efficacy and toxicity in older women with metastatic breast cancer: Combined analysis of calgb 9342 and 9840

Background: Two Cancer and Leukemia Group B (CALGB) studies were utilized to determine the efficacy and tolerability of paclitaxel (Taxol) in older patients with metastatic breast cancer. Patients and methods: CALGB 9840 evaluated weekly paclitaxel (80 mg/m. 2) versus paclitaxel every 3 weeks (175 mg/m. 2); CALGB 9342 evaluated three doses of paclitaxel as follows: 175, 210 and 250 mg/m. 2 each over 3 h every 3 weeks. Of the 1048 patients, paclitaxel was used first line in 57%. The groups: (i) <55 years (45%), (ii) 55-64 years (29%), and (iii) ≥65 years (26%). Results: Tumor response was also similar among age groups. First-line therapy (P = 0.0001) and better performance status (PS) (P = 0.018) were significantly related to higher response. Age did not significantly relate to overall survival (OS) or progression-free survival (PFS). First-line therapy, better PS, estrogen receptor positive status and a fewer number of metastatic sites were significantly related to improved OS and PFS. The grade ≥3 toxic effects that increased linearly with age were leucopenia (P = 0.0099), granulocytopenia (P = 0.022), anorexia (P = 0.028), bilirubin elevation (P = 0.0035) and neurotoxicity (P < 0.0001). Patients over 65 years receiving second-line therapy had the shortest time to neurotoxicity. Conclusions: Older women with breast cancer derive similar efficacy from treatment with paclitaxel as younger women. Older women are at increased risk for specific toxic effects. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Authors
Lichtman, SM; Hurria, A; Cirrincione, CT; Seidman, AD; Winer, E; Hudis, C; Cohen, HJ; Muss, HB
MLA Citation
Lichtman, SM, Hurria, A, Cirrincione, CT, Seidman, AD, Winer, E, Hudis, C, Cohen, HJ, and Muss, HB. "Paclitaxel efficacy and toxicity in older women with metastatic breast cancer: Combined analysis of calgb 9342 and 9840." Annals of Oncology 23.3 (2012): 632-638.
PMID
21693770
Source
scival
Published In
Annals of Oncology
Volume
23
Issue
3
Publish Date
2012
Start Page
632
End Page
638
DOI
10.1093/annonc/mdr297

Relations of a marker of endothelial activation (s-VCAM) to function and mortality in community-dwelling older adults.

BACKGROUND: We wished to determine if a marker of endothelial dysfunction/activation soluble vascular cell adhesion molecule (s-VCAM)-was related to functional status and mortality in community-dwelling older adults independent of the known effects of markers of inflammation and coagulation. METHODS: Data came from the third and fourth in-person waves of the Duke Established Populations for Epidemiologic Studies of the Elderly. Participants (aged ≥ 71 years) had participated in a blood draw (N = 1,551) from which concentrations of s-VCAM, interleukin-6, and D-dimer were determined. Information was gathered in-person on demographics, health behaviors, chronic health conditions, and functional status (Katz, Rosow-Breslau, Nagi). Death was determined through the National Death Index. Multivariable regression analysis was used to examine the adjusted association of s-VCAM with functional status; Cox proportional hazards models ascertained hazard of mortality. RESULTS: Controlled analyses indicated that cross-sectionally, but not longitudinally (4 years later), greater s-VCAM concentrations were associated with poorer function as measured by the Katz and Rosow-Breslau scales (p < .05 for both), independent of interleukin-6 and D-dimer. In controlled analyses, s-VCAM (p = .002), D-dimer (p = .008), and interleukin-6 (p = .01) were independently related to 4-year mortality; 1 SD increase in log concentration conferred 1.2-, 1.1-, and 1.2-fold increases in mortality, respectively. The greatest hazard of mortality was observed within the first year after measurement. s-VCAM concentrations were not predictive of 15-year mortality. CONCLUSIONS: Independent of inflammation and coagulation markers, endothelial dysfunction serves as a marker of, and potentially contributes causally to, poor function and death in community-dwelling older adults.

Authors
Huffman, KM; Pieper, CF; Kraus, VB; Kraus, WE; Fillenbaum, GG; Cohen, HJ
MLA Citation
Huffman, KM, Pieper, CF, Kraus, VB, Kraus, WE, Fillenbaum, GG, and Cohen, HJ. "Relations of a marker of endothelial activation (s-VCAM) to function and mortality in community-dwelling older adults." J Gerontol A Biol Sci Med Sci 66.12 (December 2011): 1369-1375.
PMID
21798862
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
66
Issue
12
Publish Date
2011
Start Page
1369
End Page
1375
DOI
10.1093/gerona/glr121

Comorbid cognitive impairment and functional trajectories in low vision rehabilitation for macular disease.

BACKGROUND AND AIMS: Comorbid cognitive impairment is common among visually impaired older adults. This study investigated whether baseline cognitive status predicts functional trajectories among older adults in low vision rehabilitation (LVR) for macular disease. METHODS: The Telephone Interview for Cognitive Status - modified (TICS-m) was administered to macular disease patients aged ≥ 65 years receiving outpatient LVR. Mixed models assessed the rate of change in instrumental activities of daily living and visual function measures over a mean follow-up of 115 days. RESULTS: Of 91 participants, 17 (18.7%) had cognitive impairment (TICS-m score ≤ 27) and 23 (25.3%) had marginal impairment (TICS-m scores 28 to 30). Controlling for age and gender, baseline cognitive status did not predict most functional outcomes. However, participants with marginal cognitive impairment experienced worse functional trajectories in ability to prepare meals (p=0.03) and activities that require distance vision (p=0.05). CONCLUSION: Patients with mild to moderate cognitive impairment should not be excluded from LVR, but programs should be prepared to detect and accommodate a range of cognitive ability.

Authors
Whitson, HE; Ansah, D; Sanders, LL; Whitaker, D; Potter, GG; Cousins, SW; Steffens, DC; Landerman, LR; Pieper, CF; Cohen, HJ
MLA Citation
Whitson, HE, Ansah, D, Sanders, LL, Whitaker, D, Potter, GG, Cousins, SW, Steffens, DC, Landerman, LR, Pieper, CF, and Cohen, HJ. "Comorbid cognitive impairment and functional trajectories in low vision rehabilitation for macular disease." Aging Clin Exp Res 23.5-6 (October 2011): 343-350.
PMID
22526069
Source
pubmed
Published In
Aging clinical and experimental research
Volume
23
Issue
5-6
Publish Date
2011
Start Page
343
End Page
350

Categorizing the effect of comorbidity: a qualitative study of individuals' experiences in a low-vision rehabilitation program.

OBJECTIVES: To identify generalizable ways that comorbidity affects older adults' experiences in a health service program directed toward an index condition and to develop a framework to assist clinicians in approaching comorbidity in the design, delivery, and evaluation of such interventions. DESIGN: A qualitative data content analysis of interview transcripts to identify themes related to comorbidity. SETTING: An outpatient low-vision rehabilitation program for macular disease. PARTICIPANTS: In 2007/08, 98 individuals undergoing low-vision rehabilitation and their companions provided 624 semistructured interviews that elicited perceptions about barriers and facilitators of successful program participation. RESULTS: The interviews revealed five broad themes about comorbidity: (i) "good days, bad days," reflecting participants' fluctuating health status during the program because of concurrent medical problems; (ii) "communication barriers." which were sometimes due to participant impairments and sometimes situational; (iii) "overwhelmed," which encompassed pragmatic and emotional concerns of participants and caregivers; (iv) "delays," which referred to the tendency of comorbidities to delay progress in the program and to confer added inconvenience during lengthy appointments; and (v) value of companion involvement in overcoming some barriers imposed by comorbid conditions. CONCLUSION: This study provides a taxonomy and conceptual framework for understanding consequences of comorbidity in the experience of individuals receiving a health service. If confirmed in individuals receiving interventions for other index diseases, the framework suggests actionable items to improve care and facilitate research involving older adults.

Authors
Whitson, HE; Steinhauser, K; Ammarell, N; Whitaker, D; Cousins, SW; Ansah, D; Sanders, LL; Cohen, HJ
MLA Citation
Whitson, HE, Steinhauser, K, Ammarell, N, Whitaker, D, Cousins, SW, Ansah, D, Sanders, LL, and Cohen, HJ. "Categorizing the effect of comorbidity: a qualitative study of individuals' experiences in a low-vision rehabilitation program." J Am Geriatr Soc 59.10 (October 2011): 1802-1809.
PMID
22091493
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
59
Issue
10
Publish Date
2011
Start Page
1802
End Page
1809
DOI
10.1111/j.1532-5415.2011.03602.x

Black-white disparity in disability: the role of medical conditions.

OBJECTIVES: To describe the independent contributions of selected medical conditions to the disparity between black and white people in disability rates, controlling for demographic and socioeconomic factors. DESIGN: Cross-sectional analysis of a community-based cohort. SETTING: Urban and rural counties of central North Carolina. PARTICIPANTS: Two thousand nine hundred sixty-six adults aged 68 and older participating in the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE). MEASUREMENTS: Self-reported data on sociodemographic characteristics and medical conditions, Short Portable Mental Status Questionnaire, activities of daily living (ADLs). RESULTS: Fifty-five percent of the cohort was black. Blacks were more likely than whites to report disability (odds ratio=1.39, 95% confidence interval= 1.15-1.68). Controlling for age, sex, marital status, and socioeconomic status, blacks were more likely to be obese and have diabetes mellitus, and less likely to report vision problems, fractures, and heart attacks. The higher prevalence of obesity and diabetes mellitus in blacks, after adjustment for sociodemographic factors, accounted for more than 30% of the black-white difference in disability. Conversely, the black-white disability gap would be approximately 45% wider if whites had a lower prevalence of fractures and vision impairment, similar to their black peers. CONCLUSION: Higher rates of obesity and diabetes mellitus in older black Americans account for a large amount of the racial disparity in disability, even after controlling for socioeconomic differences. Culturally appropriate interventions that lower the prevalence or the functional consequences of obesity and diabetes mellitus in blacks could substantially decrease this racial health disparity.

Authors
Whitson, HE; Hastings, SN; Landerman, LR; Fillenbaum, GG; Cohen, HJ; Johnson, KS
MLA Citation
Whitson, HE, Hastings, SN, Landerman, LR, Fillenbaum, GG, Cohen, HJ, and Johnson, KS. "Black-white disparity in disability: the role of medical conditions." J Am Geriatr Soc 59.5 (May 2011): 844-850.
PMID
21568956
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
59
Issue
5
Publish Date
2011
Start Page
844
End Page
850
DOI
10.1111/j.1532-5415.2011.03401.x

Plasma acylcarnitines are associated with physical performance in elderly men.

BACKGROUND: Metabolic profiling might provide insight into the biologic underpinnings of disability in older adults. METHODS: A targeted mass spectrometry-based platform was used to identify and quantify 45 plasma acylcarnitines in 77 older men with a mean age of 79 years and average body mass index of 28.4 kg/m(2). To control for type I error inherent in a test of multiple analytes, principal components analysis was employed to reduce the acylcarnitines from 45 separate metabolites, into a single "acylcarnitine factor." We then tested for an association between this acylcarnitine factor and multiple indices of physical performance and self-reported function. RESULTS: The acylcarnitine factor accounted for 40% of the total variance in 45 acylcarnitines. Of the metabolites analyzed, those that contributed most to our one-factor solution were even-numbered medium and long-chain species with side chains containing 10-18 carbons (factor loadings ≥0.70). Odd-numbered chain species, in contrast, had factor loadings 0.50 or less. Acylcarnitine factor scores were inversely related to physical performance as measured by the Short Physical Performance Battery total score, two of its three component scores (gait and chair stands Short Physical Performance Battery), and usual and maximal gait speeds (ρ = -0.324, -0.348, -0.309, -0.241, and -0.254, respectively; p < .05). CONCLUSIONS: Higher acylcarnitine factor scores were associated with lower levels of objectively measured physical performance in this group of older, largely overweight men. Metabolic profiles of rodents exhibiting lipid-induced mitochondrial dysfunction show a similar phenotypic predominance of medium- and long-chain acylcarnitines.

Authors
Lum, H; Sloane, R; Huffman, KM; Kraus, VB; Thompson, DK; Kraus, WE; Bain, JR; Stevens, R; Pieper, CF; Taylor, GA; Newgard, CB; Cohen, HJ; Morey, MC
MLA Citation
Lum, H, Sloane, R, Huffman, KM, Kraus, VB, Thompson, DK, Kraus, WE, Bain, JR, Stevens, R, Pieper, CF, Taylor, GA, Newgard, CB, Cohen, HJ, and Morey, MC. "Plasma acylcarnitines are associated with physical performance in elderly men." J Gerontol A Biol Sci Med Sci 66.5 (May 2011): 548-553.
PMID
21367961
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
66
Issue
5
Publish Date
2011
Start Page
548
End Page
553
DOI
10.1093/gerona/glr006

Why John wasn't healed by prayer: perspectives across disciplines.

Patients and family members often turn to prayer in response to serious, life-threatening illness. Prayer for a miraculous cure is often the request. While prayer can keep hope alive, it may also promote unrealistic expectations that fuel demands for life-preserving technology in medically futile situations. Furthermore, if prayer does not achieve the desired results, then disappointment and disillusionment may follow and make the coping process even more difficult. We present here a case of a seriously ill man whose family and faith community prayed for his healing. John, however, was not healed. A medical internist, two psychiatrists, a sociologist, and a theologian discuss their perspectives on the apparent failure of prayer to heal John. This cross-disciplinary discussion reveals insights that we believe physicians can use when confronting such issues with patients.

Authors
Blazer, DG; Cohen, HJ; George, LK; Koenig, HG; Verhey, A
MLA Citation
Blazer, DG, Cohen, HJ, George, LK, Koenig, HG, and Verhey, A. "Why John wasn't healed by prayer: perspectives across disciplines." Int J Psychiatry Med 42.4 (2011): 377-391.
PMID
22530400
Source
pubmed
Published In
International journal of psychiatry in medicine
Volume
42
Issue
4
Publish Date
2011
Start Page
377
End Page
391
DOI
10.2190/PM.42.4.d

Implementing a geriatric assessment in cooperative group clinical cancer trials: CALGB 360401

Purpose: Factors captured in a geriatric assessment can predict morbidity and mortality in older adults, but are not routinely measured in cancer clinical trials. This study evaluated the implementation of a geriatric assessment tool in the cooperative group setting. Patients and Methods: Patients age ≥ 65 with cancer, who enrolled on cooperative group cancer trials, were eligible to enroll on Cancer and Leukemia Group B (CALGB) 360401. They completed a geriatric assessment tool before initiation of protocol therapy, consisting of valid and reliable geriatric assessment measures which are primarily self-administered and require minimal resources and time by healthcare providers. The assessment measures functional status, comorbidity, cognitive function, psychological state, social support, and nutritional status. The protocol specified criteria for incorporation of the tool in future cooperative group trials was based on the time to completion and percent of patients who could complete their portion without assistance. Patient satisfaction with the tool was captured. Results: Of the 93 patients who enrolled in this study, five (5%) met criteria for cognitive impairment and three did not complete the cognitive screen, leaving 85 assessable patients (median age, 72 years). The median time to complete the geriatric assessment tool was 22 minutes, 87% of patients (n = 74) completed their portion without assistance, 92% (n = 78) were satisfied with the questionnaire length, 95% (n = 81) reported no difficult questions, and 96% (n = 82) reported no upsetting questions. One hundred percent of health care professionals completed their portion. Conclusion: This brief, primarily self-administered geriatric assessment tool met the protocol specified criteria for inclusion in future cooperative group clinical trials. © 2011 by American Society of Clinical Oncology.

Authors
Hurria, A; Cirrincione, CT; Muss, HB; Kornblith, AB; Barry, W; Artz, AS; Schmieder, L; Ansari, R; Tew, WP; Weckstein, D; Kirshner, J; Togawa, K; Hansen, K; Katheria, V; Stone, R; Galinsky, I; Postiglione, J; Cohen, HJ
MLA Citation
Hurria, A, Cirrincione, CT, Muss, HB, Kornblith, AB, Barry, W, Artz, AS, Schmieder, L, Ansari, R, Tew, WP, Weckstein, D, Kirshner, J, Togawa, K, Hansen, K, Katheria, V, Stone, R, Galinsky, I, Postiglione, J, and Cohen, HJ. "Implementing a geriatric assessment in cooperative group clinical cancer trials: CALGB 360401." Journal of Clinical Oncology 29.10 (2011): 1290-1296.
PMID
21357782
Source
scival
Published In
Journal of Clinical Oncology
Volume
29
Issue
10
Publish Date
2011
Start Page
1290
End Page
1296
DOI
10.1200/JCO.2010.30.6985

Quality of life of older patients with early-stage breast cancer receiving adjuvant chemotherapy: A companion study to cancer and leukemia group B 49907

Purpose: A phase III trial (Cancer and Leukemia Group B CALGB-49907) was conducted to test whether older patients with early-stage breast cancer would have equivalent relapse-free and overall survival with capecitabine compared with standard chemotherapy. The quality of life (QoL) substudy tested whether capecitabine treatment would be associated with a better QoL than standard chemotherapy. Patients and Methods: QoL was assessed in 350 patients randomly assigned to either standard chemotherapy (cyclophosphamide, methotrexate, and fluorouracil [CMF] or doxorubicin and cyclophosphamide [AC]; n = 182) or capecitabine (n = 168). Patients were interviewed by telephone before treatment (baseline), midtreatment, within 1 month post-treatment, and at 12, 18, and 24 months postbaseline by using questionnaires from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30), a breast systemic adverse effects scale (EORTC BR23), and the Hospital Anxiety and Depression Scale (HADS). Results: Compared with patients who were treated with standard chemotherapy, patients who were treated with capecitabine had significantly better QoL, role function, and social function, fewer systemic adverse effects, less psychological distress, and less fatigue during and at the completion of treatment (P ≤ .005). Capecitabine treatment was associated with less nausea, vomiting, and constipation and with better appetite than standard treatment (P ≤ .004), but worse hand-foot syndrome and diarrhea (P < .005). These differences all resolved by 12 months. Conclusion: Standard chemotherapy was superior to capecitabine in improving relapse-free and overall survival for older women with early-stage breast cancer. Although capecitabine was associated with better QoL during treatment, QoL was similar for both groups at 1 year. The brief period of poorer QoL with standard treatment is a modest price to pay for a chance at improved survival. © 2011 by American Society of Clinical Oncology.

Authors
Kornblith, AB; Lan, L; Archer, L; Partridge, A; Kimmick, G; Hudis, C; Winer, E; Casey, R; Bennett, S; Cohen, HJ; Muss, HB
MLA Citation
Kornblith, AB, Lan, L, Archer, L, Partridge, A, Kimmick, G, Hudis, C, Winer, E, Casey, R, Bennett, S, Cohen, HJ, and Muss, HB. "Quality of life of older patients with early-stage breast cancer receiving adjuvant chemotherapy: A companion study to cancer and leukemia group B 49907." Journal of Clinical Oncology 29.8 (2011): 1022-1028.
PMID
21300923
Source
scival
Published In
Journal of Clinical Oncology
Volume
29
Issue
8
Publish Date
2011
Start Page
1022
End Page
1028
DOI
10.1200/JCO.2010.29.9859

Chronic medical conditions and the sex-based disparity in disability: the Cardiovascular Health Study.

BACKGROUND: Older women experience disability more commonly than their male peers. This disparity may be due, in part, to sex-based differences in the prevalence or the disabling effects of common medical conditions. The objectives of this analysis were to (a) quantify the extent to which excess disability in women is explained by higher prevalence of selected medical conditions and (b) evaluate whether the same conditions have differing effects on disability in men and women. METHODS: We analyzed cross-sectional data from 5,888 community-dwelling older men and women. Disability was defined as difficulty with greater than or equal to one activity of daily living. Thirteen medical conditions were assessed by self-report, testing, or record review. RESULTS: Controlling for age, race, education, and marital status, women were more likely to experience disability (odds ratio = 1.70, 95% confidence interval = 1.36-2.11). Higher prevalence of arthritis and obesity in women explained 30.2% and 12.9%, respectively, of the sex-based difference in disability rates, whereas male prevalent diseases like vascular conditions and emphysema narrowed the disability gap. Women with arthritis, hearing problems, coronary artery disease, congestive heart failure, stroke, and claudication were more likely to exhibit disability compared with men with the same conditions (p < .001). CONCLUSIONS: Efforts to lessen sex-based inequality in disability should focus on reducing the prevalence of arthritis and obesity. Future generations may see greater functional disparity if rates of vascular disease and emphysema rise among women. Several conditions were more often associated with disability in women, suggesting additional sex-based differences in the disablement process.

Authors
Whitson, HE; Landerman, LR; Newman, AB; Fried, LP; Pieper, CF; Cohen, HJ
MLA Citation
Whitson, HE, Landerman, LR, Newman, AB, Fried, LP, Pieper, CF, and Cohen, HJ. "Chronic medical conditions and the sex-based disparity in disability: the Cardiovascular Health Study." J Gerontol A Biol Sci Med Sci 65.12 (December 2010): 1325-1331.
PMID
20675619
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
65
Issue
12
Publish Date
2010
Start Page
1325
End Page
1331
DOI
10.1093/gerona/glq139

Accuracy of self-reported height and weight in a community-based sample of older African Americans and whites.

BACKGROUND: To ascertain accuracy of self-reported height, weight (and hence body mass index) in African American and white women and men older than 70 years of age. METHOD: The sample consisted of cognitively intact participants at the third in-person wave (1992-1993) of the Duke Established Populations for Epidemiologic Studies of the Elderly (age 71 and older, N = 1761; residents of five adjacent counties, one urban, four rural). During in-person, in-home interviews using trained interviewers, height and weight were self-reported (and measured later in the same visit using a standardized protocol), and information were obtained on race, sex, and age. RESULTS: Accuracy of self-reported height and weight was high (intraclass correlation coefficient 0.85 and 0.97, respectively) but differed as a function of race and age. On average, all groups overestimated their height; whereas (non-Hispanic) white men and women underestimated their weight, African Americans overestimated their weight. Overestimation of height and weight was more marked in persons 85 years and older. Specificity for overweight (body mass index [kg/m(2)] ≥ 25) and obesity (body mass index ≥ 30) ranged from 0.90 to 0.99 for African Americans and whites, but sensitivity was better for African Americans (overweight: 0.81, obesity: 0.89), than for whites (0.66 and 0.57, respectively). CONCLUSIONS: Height and weight self-reported by African Americans and whites over the age of 70 can be used in epidemiological studies, with greater caution needed for self-reports of whites, and of persons 85 years of age or older.

Authors
Fillenbaum, GG; Kuchibhatla, MN; Whitson, HE; Batch, BC; Svetkey, LP; Pieper, CF; Kraus, WE; Cohen, HJ; Blazer, DG
MLA Citation
Fillenbaum, GG, Kuchibhatla, MN, Whitson, HE, Batch, BC, Svetkey, LP, Pieper, CF, Kraus, WE, Cohen, HJ, and Blazer, DG. "Accuracy of self-reported height and weight in a community-based sample of older African Americans and whites." J Gerontol A Biol Sci Med Sci 65.10 (October 2010): 1123-1129.
PMID
20530243
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
65
Issue
10
Publish Date
2010
Start Page
1123
End Page
1129
DOI
10.1093/gerona/glq096

The Link Between Religion and Health: Psychoneuroimmunology and the Faith Factor

© 2002 by Oxford University Press, Inc. All rights reserved. This book presents new medical research establishing a connection between religion and health and examines the implications for Eastern and Western religious traditions and for society and culture. It examines a series of psychoneuroimmunology (PNI) topics that relate to religious faith and behavior. PNI studies the relationships between mental states and the nervous, endocrine, and immune systems. Among the issues explored are how mental states in general and belief states in particular affect physical health. The book argues that religious involvement and belief can affect certain neuroendocrine and immune mechanisms, and that these mechanisms, in turn, positively affect a wide variety of health outcomes such as susceptibility to cancer and recovery following surgery.

Authors
Koenig, HG; Cohen, HJ
MLA Citation
Koenig, HG, and Cohen, HJ. The Link Between Religion and Health: Psychoneuroimmunology and the Faith Factor. April 1, 2010.
Source
scopus
Publish Date
2010
Start Page
1
End Page
316
DOI
10.1093/acprof:oso/9780195143607.001.0001

Avenues for Future Research

© 2002 by Oxford University Press, Inc. All rights reserved. This chapter explores avenues for future research in the area of religion, spirituality and psychoneuroimmunology. Recommendations are made based in part on a recent conference at Duke University Medical Center that brought together the world's leading experts in psychoneuroimmunology to discuss the future of research on religion and immune function. This chapter describes what went on during that conference and then discusses areas of research that conference participants and chapter authors felt should have the highest priority. Because the immune response is part of the "stress response", one recurring theme was the need to study spirituality or religion as a potential moderator of the stress response in situations of high stress. This could include populations at risk for negative outcome from stress, such as Scandinavians at high risk for suicide or Irish Catholics at high risk for alcoholism. Other specific health effects mightbe studied as well, such as wound healing, responses to viral illness, or immune responses following administration of vaccines.

Authors
Cohen, HJ; Harold, GK
MLA Citation
Cohen, HJ, and Harold, GK. "Avenues for Future Research." The Link Between Religion and Health: Psychoneuroimmunology and the Faith Factor. April 1, 2010.
Source
scopus
Publish Date
2010
DOI
10.1093/acprof:oso/9780195143607.003.0016

Psychological Stress and Autoimmune Disease

© 2002 by Oxford University Press, Inc. All rights reserved. This chapter looks at diseases which result not from a hypoactive immune system but rather from an immune system functioning in an exaggerated or uncontrolled fashion. This is seen in autoimmune diseases such as psoriasis, rheumatoid arthritis, Graves's disease, multiple sclerosis, insulin-dependent diabetes mellitus, lupus erythematosus, inflammatory bowel disease, chronic fatigue syndrome, and a host of other disorders which arise when an overactive immune system attacks normal healthy tissue. Religious beliefs and practices (from Buddhist to Judeo-Christian traditions) may help reduce stress by improving coping and thereby favorably affect the course of these diseases. Religious beliefs may facilitate coping by providing patients with a greater "sense of coherence" which makes sense of or gives meaning to the pain and suffering which these people experience.

Authors
Koenig, HG; Cohen, HJ
MLA Citation
Koenig, HG, and Cohen, HJ. "Psychological Stress and Autoimmune Disease." The Link Between Religion and Health: Psychoneuroimmunology and the Faith Factor. April 1, 2010.
Source
scopus
Publish Date
2010
DOI
10.1093/acprof:oso/9780195143607.003.0011

Psychosocial Factors, Immunity, and Wound Healing

© 2002 by Oxford University Press, Inc. All rights reserved. This chapter reviews the work of Janice Kiecolt-Glaser, Ron Glaser and others who have investigated the effects of psychological stress and social support on immune functioning and wound healing. This area of research is of particular importance because of its potentially wide clinical application. If either individual or group support has an impact on immune function, the public health implications would be enormous. Likewise if psychological stress affects wound healing in a clinically significant way, then stressreducing interventions before and after surgical operations might significantly affect the speed of post-surgical recovery. This chapter also explores how such research advances may help inform future studies of the relationship between religion and health and proposes a number of research avenues to pursue. If religious involvement enhances social support and reduces stress, then investigations which explore the relationship between religion and immunity, wound healing and post-surgical recovery, may be worth pursuing.

Authors
Koenig, HG; Cohen, HJ
MLA Citation
Koenig, HG, and Cohen, HJ. "Psychosocial Factors, Immunity, and Wound Healing." The Link Between Religion and Health: Psychoneuroimmunology and the Faith Factor. April 1, 2010.
Source
scopus
Publish Date
2010
DOI
10.1093/acprof:oso/9780195143607.003.0008

Prevalence and patterns of comorbid cognitive impairment in low vision rehabilitation for macular disease.

The prevalence of comorbid cognitive impairment among older adults referred to low vision rehabilitation (LVR) for macular disease is unknown. We performed cognitive testing on 101 adults aged 65 years or older with macular disease who were referred to The Duke LVR Clinic between September 2007 and March 2008. Scores on the telephone interview for cognitive status-modified (TICS-m) ranged from 7 to 44, with 18.8% of scores below an established cutoff for cognitive impairment (< or = 27) and an additional 27.7% of scores considered marginal (28-30). On letter fluency, 46% of participants scored at least 1 x standard deviation (SD) below the mean for their age, gender, race, and education level, and 18% of participants scored at least 2 x below their demographic mean. On logical memory, 26% of participants scored at least 1x below the mean for their age group and race and 6% scored at least 2 x below their demographic mean. High prevalence of cognitive impairment, with particular difficulty in verbal fluency and verbal memory, may compromise the success of LVR interventions among macular disease patients. Additional work is needed to develop strategies to maximize function in older adults with this common comorbidity.

Authors
Whitson, HE; Ansah, D; Whitaker, D; Potter, G; Cousins, SW; MacDonald, H; Pieper, CF; Landerman, L; Steffens, DC; Cohen, HJ
MLA Citation
Whitson, HE, Ansah, D, Whitaker, D, Potter, G, Cousins, SW, MacDonald, H, Pieper, CF, Landerman, L, Steffens, DC, and Cohen, HJ. "Prevalence and patterns of comorbid cognitive impairment in low vision rehabilitation for macular disease." Arch Gerontol Geriatr 50.2 (March 2010): 209-212.
PMID
19427045
Source
pubmed
Published In
Archives of Gerontology and Geriatrics
Volume
50
Issue
2
Publish Date
2010
Start Page
209
End Page
212
DOI
10.1016/j.archger.2009.03.010

Geriatric assessment for the older adult with cancer

© Cambridge University Press 2010. The aging population in the United States and worldwide Cancer is a disease associated with aging. Approximately 60 percent of cancer incidence and 70 percent of cancer mortality occur in adults over 65 years of age.1 Thus the principles of geriatrics are particularly relevant in today’s field of oncology and will become even more relevant as the United States and world populations age. Over the past century, the population of individuals aged 65 years and older grew 10-fold, increasing from 3.1 million in the year 1900 to 35 million in the year 2000.2 This number is expected to double from 2000 to 2030 as baby boomers (born 1946–1964) start to reach age 65 in 2011 (Figure 1.1). By 2030, the population aged 65 years and older is projected to account for almost 20 percent (about one in five) of the population.2 Along with the increase in the absolute number of older adults, life expectancy is also increasing. From 1900 to 2000, average life expectancy in theUnited States increased from 47.3 to 76.9 years.2 After 2030, the population considered to be the oldest old (aged 85 years and older) is projected to increase rapidly as baby boomers reach and surpass age 85. Similar growth in the older population is projected to take place across the world. In the year 2000, 420 million people worldwide were aged 65 years and older, representing 7 percent of the world's population.

Authors
Hurria, A; Cohen, HJ
MLA Citation
Hurria, A, and Cohen, HJ. "Geriatric assessment for the older adult with cancer." Practical Geriatric Oncology. January 1, 2010. 3-17.
Source
scopus
Publish Date
2010
Start Page
3
End Page
17
DOI
10.1017/CBO9780511763182.001

Practical geriatric oncology

© Cambridge University Press 2010. The risk of cancer increases with age, and the number of older adults seeking treatment is increasing dramatically in line with the aging population. The care of older patients differs from that of younger adults because of differences in the biology of the tumor, age-related differences in host physiology, comorbidity burden and psychosocial issues, which might im pact the efficacy and side effects of cancer therapy. Practical Geriatric Oncology is a comprehensive, evidence-based text that synthesizes the growing literature in this field and provides practical guidelines to the care of older adults with cancer. Coverage includes patient assessment, management of solid tumors and hematologic malignancies, the impact of age on the pharmacology of cancer therapy, surgical oncology and radiation oncology in the older adult, symptom management, and supportive care. In addition to serving as core reading for oncologists and hematologists, the book will also be a useful work for other healthcare professionals who provide oncology care, including surgeons, radiation oncologists, palliative care doctors, primary care providers, geriatricians, and nurses.

Authors
Hurria, A; Cohen, HJ
MLA Citation
Hurria, A, and Cohen, HJ. Practical geriatric oncology. January 1, 2010.
Source
scopus
Publish Date
2010
Start Page
1
End Page
435
DOI
10.1017/CBO9780511763182

Functional assessment and the cancer survivor: Something old, something new

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Functional assessment and the cancer survivor: Something old, something new." Journal of the National Cancer Institute 102.19 (2010): 1450-1451.
PMID
20861455
Source
scival
Published In
Journal of the National Cancer Institute
Volume
102
Issue
19
Publish Date
2010
Start Page
1450
End Page
1451
DOI
10.1093/jnci/djq365

Low birth weight is associated with components of the metabolic syndrome

The purpose of the study was to investigate the association between birth weight and number of metabolic syndrome (MetS) components in an urban Chinese cohort. Individuals (N = 2019) who were born between 1921 and 1954 at the Peking Union Medical College Hospital and who had detailed obstetric records volunteered to take part and were examined by medical personnel in a clinical setting between May 2003 and April 2005. Data of birth outcome and results on clinic examination in adulthood were analyzed using analysis of variance and multivariate ordinal regression to estimate the association between birth weight and MetS. Metabolic syndrome was defined as per the National Cholesterol Education Program Adult Treatment Panel III. The prevalence of MetS was 26.74%, whereas 55.43% of the subjects had at least 2 components of MetS. Subjects who presented with all 5 components of MetS exhibited a significantly lower birth weight and higher age, body mass index, and waist circumference at follow-up. Multivariate ordinal regression analysis revealed that, as compared with those with birth weights of 3000 to 3500 g, subjects who had birth weights of less than 2500 g were 66% more likely to develop a greater number of MetS components in adulthood (95% confidence interval, 1.18-2.34; P = .004), whereas those with birth weights between 2500 and 3000 g were 33% more likely to develop a greater number of MetS components as adults (95% confidence interval, 1.09-1.63; P = .005). The present study demonstrated the relationship between low birth weight and increased presentation of MetS components in Chinese adults. © 2010 Elsevier Inc. All rights reserved.

Authors
Xiao, X; Zhang, Z-X; Li, W-H; Feng, K; Sun, Q; Cohen, HJ; Xu, T; Wang, H; Liu, A-M; Gong, X-M; Shen, Y; Yi, Z
MLA Citation
Xiao, X, Zhang, Z-X, Li, W-H, Feng, K, Sun, Q, Cohen, HJ, Xu, T, Wang, H, Liu, A-M, Gong, X-M, Shen, Y, and Yi, Z. "Low birth weight is associated with components of the metabolic syndrome." Metabolism: Clinical and Experimental 59.9 (2010): 1282-1286.
PMID
20045533
Source
scival
Published In
Metabolism
Volume
59
Issue
9
Publish Date
2010
Start Page
1282
End Page
1286
DOI
10.1016/j.metabol.2009.12.001

The need for an aging and cancer curriculum for hematology/oncology trainees

Purpose: There has long been recognition for the need of education and training in aging and cancer. As the proportion of older individuals in the United States increases, with 20% being over 65 by 2030, it will become increasingly important for hematology-oncology trainees to have directed curriculum in geriatric-oncology. Methods: In order to better define the best way to meet the need for educational material specific to the special population of older patients for Oncology Training Programs, a survey was developed and administered to Hematology-Oncology Program Directors, in order to perform an educational needs assessment. The survey was administered during the 2008 Annual Meeting to 54 attendees at the Program Director's Breakfast. The survey asked questions regarding general program characteristics, as well as the importance of geriatric-oncology curriculum, a description of such current curriculum, the most important topics to cover in the curriculum, and recommendations for the format of the curriculum. Results: The survey showed that 32% of training programs had a formal curriculum that covered topics in geriatric-oncology, 56% had an informal curriculum, and 2% had no curriculum. Most used a multimodality approach including clinical experience, journal clubs and lectures. Most hematology-oncology fellowship directors believe curriculum in geriatric-oncology is important; have faculty with either training or interest in geriatric-oncology that could facilitate curriculum delivery; and would use a curriculum if it were readily available. Conclusion: Investment in developing content and curriculum in geriatric-oncology would be very valuable and well-received. © 2010 Elsevier Inc.

Authors
Naeim, A; Hurria, A; Rao, A; Cohen, H; Heflin, M; Seo, P
MLA Citation
Naeim, A, Hurria, A, Rao, A, Cohen, H, Heflin, M, and Seo, P. "The need for an aging and cancer curriculum for hematology/oncology trainees." Journal of Geriatric Oncology 1.2 (2010): 109-113.
Source
scival
Published In
Journal of Geriatric Oncology
Volume
1
Issue
2
Publish Date
2010
Start Page
109
End Page
113
DOI
10.1016/j.jgo.2010.08.004

Geriatric oncology research in the cooperative groups: A report of a SIOG special meeting

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.

Authors
Hurria, A; Cohen, HJ; Extermann, M
MLA Citation
Hurria, A, Cohen, HJ, and Extermann, M. "Geriatric oncology research in the cooperative groups: A report of a SIOG special meeting." Journal of Geriatric Oncology 1.1 (2010): 40-44.
Source
scival
Published In
Journal of Geriatric Oncology
Volume
1
Issue
1
Publish Date
2010
Start Page
40
End Page
44
DOI
10.1016/j.jgo.2010.03.005

Breast cancer adjuvant chemotherapy decisions in older women: The role of patient preference and interactions with physicians

Purpose: Breast cancer chemotherapy decisions in patients ≥ 65 years old (older) are complex because of comorbidity, toxicity, and limited data on patient preference. We examined relationships between preferences and chemotherapy use. Methods: Older women (n = 934) diagnosed with invasive (≥ 1 cm), nonmetastatic breast cancer from 2004 to 2008 were recruited from 53 cooperative group sites. Data were collected from patient interviews (87% complete), physician survey (93% complete), and charts. Logistic regression and multiple imputation methods were used to assess associations between chemotherapy and independent variables. Chemotherapy use was also evaluated according to the following two groups: indicated (estrogen receptor [ER] negative and/or node positive) and possibly indicated (ER positive and node negative). Results: Mean patient age was 73 years (range, 65 to 100 years). Unadjusted chemotherapy rates were 69% in the indicated group and 16% in the possibly indicated group. Women who would choose chemotherapy for an increase in survival of ≤ 12 months had 3.9 times (95% CI, 2.4 to 6.3 times; P < .001) higher odds of receiving chemotherapy than women with lower preferences, controlling for covariates. Stronger preferences were seen when chemotherapy could be indicated (odds ratio [OR] = 7.7; 95% CI, 3.8 to 16; P < .001) than when treatment might be possibly indicated (OR = 1.9; 95% CI, 1.0 to 3.8; P = .06). Higher patient rating of provider communication was also related to chemotherapy use in the possibly indicated group (OR = 1.9 per 5-point increase in communication score; 95% CI, 1.4 to 2.8; P < .001) but not in the indicated group (P = .15). Conclusion: Older women's preferences and communication with providers are important correlates of chemotherapy use, especially when benefits are more equivocal. © 2010 by American Society of Clinical Oncology.

Authors
Mandelblatt, JS; Sheppard, VB; Hurria, A; Kimmick, G; Isaacs, C; Taylor, KL; Kornblith, AB; Noone, A-M; Luta, G; Tallarico, M; Barry, WT; Hunegs, L; Zon, R; Naughton, M; Winer, E; Hudis, C; Edge, SB; Cohen, HJ; Muss, H
MLA Citation
Mandelblatt, JS, Sheppard, VB, Hurria, A, Kimmick, G, Isaacs, C, Taylor, KL, Kornblith, AB, Noone, A-M, Luta, G, Tallarico, M, Barry, WT, Hunegs, L, Zon, R, Naughton, M, Winer, E, Hudis, C, Edge, SB, Cohen, HJ, and Muss, H. "Breast cancer adjuvant chemotherapy decisions in older women: The role of patient preference and interactions with physicians." Journal of Clinical Oncology 28.19 (2010): 3146-3153.
PMID
20516438
Source
scival
Published In
Journal of Clinical Oncology
Volume
28
Issue
19
Publish Date
2010
Start Page
3146
End Page
3153
DOI
10.1200/JCO.2009.24.3295

Promoting healthy lifestyles in older cancer survivors to improve health and preserve function.

Currently, there are about 7 million cancer survivors in this country aged 65 and older, and this number is expected to increase rapidly, given trends toward aging and improvements in early detection and treatment. Unfortunately, cancer survivors are at risk for several comorbid conditions and accelerated functional decline. A previous cross-sectional study of 688 older breast and prostate cancer survivors found significant associations between lifestyle practices and levels of physical functioning, with positive associations noted for physical activity and fruit and vegetable consumption and negative associations observed for dietary fat. In a more-recent cross-sectional study of 753 older survivors of breast, prostate, and colorectal cancer, significant associations were also observed between physical function, and physical activity (rho=0.22, P<.001) and diet quality (rho=0.07, P=.046), and a significant negative association was also found between physical function and body mass index (rho=-0.29, P<.001). Therefore, lifestyle interventions may be helpful in positively reorienting the trajectory of functional decline in this vulnerable population, although there are substantial barriers, such as travel, that must be overcome in delivering behavioral interventions to older cancer survivors. Previously reported results from the Pepper Center-funded Leading the Way in Exercise and Diet Project intervention development study suggested that an exercise and diet intervention delivered using telephone counseling and mailed materials was readily accepted and appeared to be of benefit. Larger trials, such as Reach-out to ENhancE Wellness in Older Survivors, have recently produced compelling data.

Authors
Demark-Wahnefried, W; Morey, MC; Sloane, R; Snyder, DC; Cohen, HJ
MLA Citation
Demark-Wahnefried, W, Morey, MC, Sloane, R, Snyder, DC, and Cohen, HJ. "Promoting healthy lifestyles in older cancer survivors to improve health and preserve function." J Am Geriatr Soc 57 Suppl 2 (November 2009): S262-S264. (Review)
PMID
20122025
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
57 Suppl 2
Publish Date
2009
Start Page
S262
End Page
S264
DOI
10.1111/j.1532-5415.2009.02507.x

A model for the shared care of elderly patients with cancer.

A model of care for elderly patients with cancer is suggested that incorporates the concept of shared care by various disciplines but in particular the oncologist and primary care provider or geriatrician. Degrees of participation will vary over time, depending upon the needs of the patient and family.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "A model for the shared care of elderly patients with cancer." J Am Geriatr Soc 57 Suppl 2 (November 2009): S300-S302.
PMID
20122034
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
57 Suppl 2
Publish Date
2009
Start Page
S300
End Page
S302
DOI
10.1111/j.1532-5415.2009.02518.x

Associations between lifestyle factors and quality of life among older long-term breast, prostate, and colorectal cancer survivors.

BACKGROUND: Older cancer survivors are at increased risk for secondary cancers, cardiovascular disease, obesity, and functional decline and, thus, may benefit from health-related interventions. However, to the authors' knowledge, little is known regarding the health behaviors of older cancer survivors and the associations of those behaviors with quality-of-life outcomes, especially during the long-term post-treatment period. METHODS: In total, 753 older (aged > or =65 years) long-term survivors (> or =5 years postdiagnosis) of breast, prostate, and colorectal cancer completed 2 baseline telephone interviews to assess their eligibility for a diet and exercise intervention trial. The interviews assessed exercise, diet, weight status, and quality of life. RESULTS: Older cancer survivors reported a median of 10 minutes of moderate-to-vigorous exercise per week, and only 7% had Healthy Eating Index scores >80 (indicative of healthful eating habits relative to national guidelines). Despite their suboptimal health behaviors, survivors reported mental and physical quality of life that exceeded age-related norms. Greater exercise and better diet quality were associated with better physical quality-of-life outcomes (eg, better vitality and physical functioning; P < .05), whereas greater body mass index was associated with reduced physical quality of life (P < .001). CONCLUSIONS: The current results indicated a high prevalence of suboptimal health behaviors among older, long-term survivors of breast, prostate, and colorectal cancer who were interested in lifestyle modification. In addition, the findings pointed to the potential negative impact of obesity and the positive impact of physical activity and a healthy diet on physical quality of life in this population.

Authors
Mosher, CE; Sloane, R; Morey, MC; Snyder, DC; Cohen, HJ; Miller, PE; Demark-Wahnefried, W
MLA Citation
Mosher, CE, Sloane, R, Morey, MC, Snyder, DC, Cohen, HJ, Miller, PE, and Demark-Wahnefried, W. "Associations between lifestyle factors and quality of life among older long-term breast, prostate, and colorectal cancer survivors." Cancer 115.17 (September 1, 2009): 4001-4009.
PMID
19637244
Source
pubmed
Published In
Cancer
Volume
115
Issue
17
Publish Date
2009
Start Page
4001
End Page
4009
DOI
10.1002/cncr.24436

Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial.

CONTEXT: Five-year survival rates for early stage colorectal, breast, and prostate cancer currently exceed 90% and are increasing. Cancer survivors are at greater risk for second malignancies, other comorbidities, and accelerated functional decline. Lifestyle interventions may provide benefit, but it is unknown whether long-term cancer survivors can modify their lifestyle behaviors sufficiently to improve functional status. OBJECTIVE: To determine whether a telephone counseling and mailed print material-based diet and exercise intervention is effective in reorienting functional decline in older, overweight cancer survivors. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of 641 overweight (body mass index > or = 25 and < 40), long-term (> or = 5 years) survivors (aged 65-91 years) of colorectal, breast, and prostate cancer, who were randomly assigned to an intervention group (n = 319) or delayed intervention (control) group (n = 322) in Canada, the United Kingdom, and 21 US states. Individuals were recruited for the Reach out to Enhance Wellness (RENEW) trial from July 1, 2005, through May 17, 2007. INTERVENTION: A 12-month, home-based tailored program of telephone counseling and mailed materials promoting exercise, improved diet quality, and modest weight loss. The control group was wait-listed for 12 months. MAIN OUTCOME MEASURES: Change in self-reported physical function on the Short-Form 36 physical function subscale (score range, 0-100; a high score indicates better functioning) from baseline to 12 months was the primary end point. Secondary outcomes included changes in function on the basic and advanced lower extremity function subscales of the Late Life Function and Disability Index (score range, 0-100), physical activity, body mass index, and overall health-related quality of life. RESULTS: The mean baseline Short-Form 36 physical function score was 75.7. At the 12-month follow-up, the mean function scores declined less rapidly in the intervention group (-2.15; 95% confidence interval [CI], -0.36 to -3.93) compared with the control group (-4.84; 95% CI, -3.04 to -6.63) (P = .03). The mean baseline basic lower extremity function score was 78.2. The mean changes in basic lower extremity function were 0.34 (95% CI, -0.84 to 1.52) in the intervention group compared with -1.89 (95% CI, -0.70 to -3.09) in the control group (P = .005). Physical activity, dietary behaviors, and overall quality of life increased significantly in the intervention group compared with the control group, and weight loss also was greater (2.06 kg [95% CI, 1.69 to 2.43 kg] vs 0.92 kg [95% CI, 0.51 to 1.33 kg], respectively; P < .001). CONCLUSION: Among older, long-term survivors of colorectal, breast, and prostate cancer, a diet and exercise intervention reduced the rate of self-reported functional decline compared with no intervention. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00303875.

Authors
Morey, MC; Snyder, DC; Sloane, R; Cohen, HJ; Peterson, B; Hartman, TJ; Miller, P; Mitchell, DC; Demark-Wahnefried, W
MLA Citation
Morey, MC, Snyder, DC, Sloane, R, Cohen, HJ, Peterson, B, Hartman, TJ, Miller, P, Mitchell, DC, and Demark-Wahnefried, W. "Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial." JAMA 301.18 (May 13, 2009): 1883-1891.
PMID
19436015
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
301
Issue
18
Publish Date
2009
Start Page
1883
End Page
1891
DOI
10.1001/jama.2009.643

Reach out to ENhancE Wellness in Older Cancer Survivors (RENEW): design, methods and recruitment challenges of a home-based exercise and diet intervention to improve physical function among long-term survivors of breast, prostate, and colorectal cancer.

OBJECTIVE: Cure rates for cancer are increasing, especially for breast, prostate, and colorectal cancer. Despite positive trends in survivorship, a cancer diagnosis can trigger accelerated functional decline that can threaten independence, reduce quality-of-life and increase healthcare costs, especially among the elderly who comprise the majority of survivors. Lifestyle interventions may hold promise in reorienting functional decline in older cancer survivors, but few studies have been conducted. METHODS: We describe the design and methods of a randomized controlled trial, RENEW (Reach out to ENhancE Wellness), that tests whether a home-based multi-behavior intervention focused on exercise, and including a low saturated fat, plant-based diet, would improve physical functioning among 641 older, long-term (>or=5 years post-diagnosis) survivors of breast, prostate, or colorectal cancer. Challenges to recruitment are examined. RESULTS: Twenty thousand and fifteen cases were approached, and screened using a two-step screening process to assure eligibility. This population of long-term, elderly cancer survivors had lower rates of response (approximately 11%) and higher rates of ineligibility (approximately 70%) than our previous intervention studies conducted on adults with newly diagnosed cancer. Significantly higher response rates were noted among survivors who were White, younger, and more proximal to diagnosis and breast cancer survivors (p-values<0.001). CONCLUSION: Older cancer survivors represent a vulnerable population for whom lifestyle interventions may hold promise. RENEW may provide guidance in allocating limited resources in order to maximize recruitment efforts aimed at this needy, but hard-to-reach population.

Authors
Snyder, DC; Morey, MC; Sloane, R; Stull, V; Cohen, HJ; Peterson, B; Pieper, C; Hartman, TJ; Miller, PE; Mitchell, DC; Demark-Wahnefried, W
MLA Citation
Snyder, DC, Morey, MC, Sloane, R, Stull, V, Cohen, HJ, Peterson, B, Pieper, C, Hartman, TJ, Miller, PE, Mitchell, DC, and Demark-Wahnefried, W. "Reach out to ENhancE Wellness in Older Cancer Survivors (RENEW): design, methods and recruitment challenges of a home-based exercise and diet intervention to improve physical function among long-term survivors of breast, prostate, and colorectal cancer." Psychooncology 18.4 (April 2009): 429-439.
PMID
19117329
Source
pubmed
Published In
Psycho-Oncology
Volume
18
Issue
4
Publish Date
2009
Start Page
429
End Page
439
DOI
10.1002/pon.1491

Correlation between symptoms and function in older adults with comorbidity.

OBJECTIVES: To describe the relationship between symptom scores and mobility function measures, assess whether symptom scores and disease scores are similarly associated with mobility function, and identify clusters of symptoms that are most strongly associated with functional status in older adults. DESIGN: Secondary analysis of cross-sectional data from three cohorts. SETTING: Academic medical center. PARTICIPANTS: One hundred ninety-five community-dwelling subjects with poor flexibility or cardiorespiratory fitness (fitness cohort), 211 female retirement community residents with vertebral fractures (VF cohort), and 61 subjects with Parkinson's disease (PD cohort). MEASUREMENTS: Twenty-item self-reported symptom scale, 17-item self-reported disease scale, Medical Outcomes Study 36-item Short Form Survey (SF-36) Physical Functioning Scale, 5-item Nagi Disability scale, 10-m walk time, supine to stand time. RESULTS: Symptom scores correlated with mobility function measures (Spearman correlation coefficients ranged from 0.222 to 0.509) at least as strongly as, if not more strongly than, did disease scores. Symptom scores remained associated with functional outcomes after controlling for disease score and demographic variables. Adding symptom scores to models that contained disease scores significantly increased the association with functional outcomes. In the fitness cohort, muscle weakness was the most explanatory single symptom, associated with an average decrease of 17.8 points on the Physical Functioning Scale. A model that included only muscle weakness, pain, and shortness of breath accounted for 21.2% of the variability in the Physical Functioning Score. CONCLUSION: Symptoms represent useful indicators of disability burden in older adults and are promising targets for interventions to improve function in medically complex patients.

Authors
Whitson, HE; Sanders, LL; Pieper, CF; Morey, MC; Oddone, EZ; Gold, DT; Cohen, HJ
MLA Citation
Whitson, HE, Sanders, LL, Pieper, CF, Morey, MC, Oddone, EZ, Gold, DT, and Cohen, HJ. "Correlation between symptoms and function in older adults with comorbidity." J Am Geriatr Soc 57.4 (April 2009): 676-682.
PMID
19392960
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
57
Issue
4
Publish Date
2009
Start Page
676
End Page
682
DOI
10.1111/j.1532-5415.2009.02178.x

Differential gene expression of interleukin-1 receptor associated kinase-1 and interleukin-1 receptor associated kinase-M in peripheral blood mononuclear cells of young and aged rats following preconditioning with endotoxin.

The IL-1 receptor-associated kinase 1 (IRAK-1) and IRAK-M are key signaling molecules in cellular responses to endotoxin initiated through the Toll-like receptors (TLRs). The aim of this study was to evaluate the effect of age on the modulation of TLRs and IRAK-1 and IRAK-M in peripheral blood mononuclear cells (PBMCs) exposed in vitro to endotoxin under conditions that could induce endotoxin tolerance. Peripheral blood mononuclear cells obtained from young (4- to 6-month-old) and aged (24- to 26-month-old) Brown Norway rats were treated with high-dose LPS, with or without priming with low-dose LPS. In comparison with younger rats, the intensity of TLR-4 expression was persistently high in monocytes from aged rats after stimulation with LPS and was not decreased by priming with low-dose LPS (P < 0.05). Messenger RNA (mRNA) for TLR-4 in PBMCs from aged rats did not show any decrease after priming with low-dose LPS as seen in PBMCs from young rats at 24 h (P = 0.01) after restimulation. In PBMCs from young rats, but not aged rats, preconditioning with low-dose LPS and subsequent stimulation with high-dose LPS resulted in markedly decreased IRAK-1 protein (P = 0.02) and decreased mRNA for IRAK-1 (P < 0.05). In contrast, PBMCs from aged rats treated in this manner continued to express measurable levels of IRAK-1 protein. Preconditioning with low-dose LPS caused an increase in both IRAK-M protein and mRNA (P = 0.05) after stimulation with high-dose LPS only in cells from young rats. These phenotypic characteristics of PBMCs from aged rats can interfere with their ability to develop tolerance to endotoxin.

Authors
Li, Y; Howell, EA; Lagoo, AS; Kuchibhatla, M; Pan, H; Cohen, HJ; Lagoo, SA
MLA Citation
Li, Y, Howell, EA, Lagoo, AS, Kuchibhatla, M, Pan, H, Cohen, HJ, and Lagoo, SA. "Differential gene expression of interleukin-1 receptor associated kinase-1 and interleukin-1 receptor associated kinase-M in peripheral blood mononuclear cells of young and aged rats following preconditioning with endotoxin." Shock 31.1 (January 2009): 55-63.
PMID
18497707
Source
pubmed
Published In
Shock
Volume
31
Issue
1
Publish Date
2009
Start Page
55
End Page
63
DOI
10.1097/SHK.0b013e3181778ab2

Physical activity as a preventative factor for frailty: the health, aging, and body composition study.

BACKGROUND: It is unclear if physical activity (PA) can prevent or reverse frailty. We examined different doses and types of PA and their association with the onset and severity of frailty. METHODS: Health, Aging and Body Composition (Health ABC) study participants (N = 2,964) were followed for 5 years, with frailty defined as a gait speed of less than 0.60 m/s and/or inability to rise from a chair without using one's arms. Individuals with one impairment were considered moderately frail and those with both severely frail. We examined PA doses of volume and intensity, activity types (eg, lifestyle vs exercise activities), and their associations with incident frailty and transition to severe frailty in those who became frail. RESULTS: Adjusted models indicated that sedentary individuals had significantly increased odds of developing frailty compared with the exercise active group (adjusted odds ratio [OR] = 1.45; 95% confidence interval [CI]: 1.04-2.01), whereas the lifestyle active did not. Number of diagnoses was the strongest predictor of incident frailty. In those who became frail during follow-up (n = 410), there was evidence that the sedentary (adjusted OR = 2.80; 95% CI: 0.98-8.02) and lifestyle active (adjusted OR = 2.81; 95% CI: 1.22-6.43) groups were more likely to have worsening frailty over time. CONCLUSIONS: Despite the strong relationship seen between comorbid conditions and onset of frailty, this observational study suggests that participation in self-selected exercise activities is independently associated with delaying the onset and the progression of frailty. Regular exercise should be further examined as a potential factor in frailty prevention for older adults.

Authors
Peterson, MJ; Giuliani, C; Morey, MC; Pieper, CF; Evenson, KR; Mercer, V; Cohen, HJ; Visser, M; Brach, JS; Kritchevsky, SB; Goodpaster, BH; Rubin, S; Satterfield, S; Newman, AB; Simonsick, EM; Health, Aging and Body Composition Study Research Group,
MLA Citation
Peterson, MJ, Giuliani, C, Morey, MC, Pieper, CF, Evenson, KR, Mercer, V, Cohen, HJ, Visser, M, Brach, JS, Kritchevsky, SB, Goodpaster, BH, Rubin, S, Satterfield, S, Newman, AB, Simonsick, EM, Health, and Aging and Body Composition Study Research Group, . "Physical activity as a preventative factor for frailty: the health, aging, and body composition study." J Gerontol A Biol Sci Med Sci 64.1 (January 2009): 61-68.
PMID
19164276
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
64
Issue
1
Publish Date
2009
Start Page
61
End Page
68
DOI
10.1093/gerona/gln001

Adjuvant chemotherapy in older women with early-stage breast cancer

BACKGROUND: Older women with breast cancer are underrepresented in clinical trials, and data on the effects of adjuvant chemotherapy in such patients are scant. We tested for the noninferiority of capecitabine as compared with standard chemotherapy in women with breast cancer who were 65 years of age or older. METHODS: We randomly assigned patients with stage I, II, IIIA, or IIIB breast cancer to standard chemotherapy (either cyclophosphamide, methotrexate, and fluorouracil or cyclophosphamide plus doxorubicin) or capecitabine. Endocrine therapy was recommended after chemotherapy in patients with hormone-receptor-positive tumors. A Bayesian statistical design was used with a range in sample size from 600 to 1800 patients. The primary end point was relapse-free survival. RESULTS: When the 600th patient was enrolled, the probability that, with longer follow-up, capecitabine therapy was highly likely to be inferior to standard chemotherapy met a prescribed level, and enrollment was discontinued. After an additional year of follow-up, the hazard ratio for disease recurrence or death in the capecitabine group was 2.09 (95% confidence interval, 1.38 to 3.17; P<0.001). Patients who were randomly assigned to capecitabine were twice as likely to have a relapse and almost twice as likely to die as patients who were randomly assigned to standard chemotherapy (P=0.02). At 3 years, the rate of relapse-free survival was 68% in the capecitabine group versus 85% in the standard-chemotherapy group, and the overall survival rate was 86% versus 91%. Two patients in the capecitabine group died of treatment-related complications; as compared with patients receiving capecitabine, twice as many patients receiving standard chemotherapy had moderate-to-severe toxic effects (64% vs. 33%). CONCLUSIONS: Standard adjuvant chemotherapy is superior to capecitabine in patients with earlystage breast cancer who are 65 years of age or older. (ClinicalTrials.gov number, NCT00024102.) Copyright © 2009 Massachusetts Medical Society.

Authors
Muss, HB; Berry, DA; Cirrincione, CT; Theodoulou, M; Mauer, AM; Kornblith, AB; Partridge, AH; Dressler, LG; Cohen, HJ; Becker, HP; Kartcheske, PA; Wheeler, JD; Perez, EA; Wolff, AC; Gralow, JR; Burstein, HJ; Mahmood, AA; Magrinat, G; Parker, BA; Hart, RD; Grenier, D; Norton, L; Hudis, CA; Winer, EP
MLA Citation
Muss, HB, Berry, DA, Cirrincione, CT, Theodoulou, M, Mauer, AM, Kornblith, AB, Partridge, AH, Dressler, LG, Cohen, HJ, Becker, HP, Kartcheske, PA, Wheeler, JD, Perez, EA, Wolff, AC, Gralow, JR, Burstein, HJ, Mahmood, AA, Magrinat, G, Parker, BA, Hart, RD, Grenier, D, Norton, L, Hudis, CA, and Winer, EP. "Adjuvant chemotherapy in older women with early-stage breast cancer." New England Journal of Medicine 360.20 (2009): 2055-2065.
PMID
19439741
Source
scival
Published In
The New England journal of medicine
Volume
360
Issue
20
Publish Date
2009
Start Page
2055
End Page
2065
DOI
10.1056/NEJMoa0810266

Fatigue in older cancer patients: etiology, assessment, and treatment.

Cancer-related fatigue (CRF) is one of the most common and debilitating symptoms experienced by elderly cancer patients and by cancer survivors. However, this has not translated into an increase in clinical trials for assessment and therapy of CRF in this population. The early recognition and formal assessment of this symptom is important in order to be able to treat it, before it negatively impacts the patient's quality of life. All reversible causes like anemia, depression, anxiety, and hypothyroidism should be ruled out and treated appropriately. CRF can be treated with pharmacologic and nonpharmacologic measures and possibly a combination of both measures. Pharmacologic measures that have been studied in cancer patients with fatigue include hematopoeitics, antidepressants, donepezil, modafinil, methylphenidate, and other agents. Exercise programs continue to be the most popular and widely studied nonpharmacologic intervention for CRF. Psychosocial interventions, energy conservation measures, and improvement of sleep also can lead to less fatigue in cancer patients. However, there continues to be a need for randomized controlled trials (RCTs) evaluating CRF specifically in elderly patients with cancer. This review provides a brief overview of CRF in elderly cancer patients and highlights the areas of required research in this patient population.

Authors
Rao, AV; Cohen, HJ
MLA Citation
Rao, AV, and Cohen, HJ. "Fatigue in older cancer patients: etiology, assessment, and treatment." Semin Oncol 35.6 (December 2008): 633-642. (Review)
PMID
19027467
Source
pubmed
Published In
Seminars in Oncology
Volume
35
Issue
6
Publish Date
2008
Start Page
633
End Page
642
DOI
10.1053/j.seminoncol.2008.08.005

New light on an age-old issue.

In this issue, Varadhan and colleagues propose a methodologic framework that seeks to quantify impaired resiliency in dynamic systems underlying the frailty syndrome. We view this work, which is based on modeling stimulus-response data, as an exciting expansion of longstanding theories of age-related decline in physiologic reserve across systems. We outline ways in which this methodology might make substantial contributions in frailty research and clinical practice, and we discuss potential obstacles in its operationalization.

Authors
Whitson, HE; Pieper, CF; Cohen, HJ
MLA Citation
Whitson, HE, Pieper, CF, and Cohen, HJ. "New light on an age-old issue." Mech Ageing Dev 129.11 (November 2008): 673-674.
PMID
18926846
Source
pubmed
Published In
Mechanisms of Ageing and Development
Volume
129
Issue
11
Publish Date
2008
Start Page
673
End Page
674
DOI
10.1016/j.mad.2008.09.006

Effect of physical activity guidelines on physical function in older adults.

OBJECTIVES: To determine whether elderly people who meet national guidelines have higher physical function (PF) scores than those who do not and the effect on functional trajectory when physical activity (PA) levels change from above to below this threshold, or vice versa. DESIGN: Pooled data. SETTING: Two 6-month randomized controlled trials aimed at increasing PA in adults. PARTICIPANTS: Adults aged 65 to 94 (N=357). INTERVENTION: PA counseling over the telephone and through mailed materials. MEASUREMENTS: Self-reported PA dichotomized at 150 minutes/week and PF using the Medical Outcomes Study 36-item Short Form Questionnaire PF subscale. RESULTS: At baseline, individuals reporting 150 minutes or more of moderate PA/week had mean PF scores that were 20.3 points higher than those who did not (P<.001). Change in PA minutes from above threshold to below threshold or from below threshold to above threshold from baseline to 6 months resulted in an average change in PF of -11.18 (P<.001) and +5.10 (P=.05), respectively. CONCLUSION: These findings suggest that PA is an important predictor of functional status. Older sedentary adults can improve PF by meeting recommended PA levels. Conversely, dropping below recommended PA levels has a deleterious effect on PF. Given the importance of PF in maintenance of independence and quality of life in older adults, adherence to recommended PA guidelines should be endorsed.

Authors
Morey, MC; Sloane, R; Pieper, CF; Peterson, MJ; Pearson, MP; Ekelund, CC; Crowley, GM; Demark-Wahnefried, W; Snyder, DC; Clipp, EC; Cohen, HJ
MLA Citation
Morey, MC, Sloane, R, Pieper, CF, Peterson, MJ, Pearson, MP, Ekelund, CC, Crowley, GM, Demark-Wahnefried, W, Snyder, DC, Clipp, EC, and Cohen, HJ. "Effect of physical activity guidelines on physical function in older adults." J Am Geriatr Soc 56.10 (October 2008): 1873-1878.
PMID
18800990
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
56
Issue
10
Publish Date
2008
Start Page
1873
End Page
1878
DOI
10.1111/j.1532-5415.2008.01937.x

Dietary supplement use among elderly, long-term cancer survivors.

INTRODUCTION: The purpose of the present study was to assess dietary supplement use and its association with micronutrient intakes and diet quality among older (>or=65 years), long-term survivors (>or=5 years post-diagnosis) of female breast, prostate, and colorectal cancer. METHODS: The sample included 753 survivors who participated in telephone screening interviews to determine eligibility for a randomized diet and physical activity intervention trial entitled RENEW: Reach-out to ENhancE Wellness in Older Cancer Survivors. Telephone surveys included two 24-hour dietary recalls and items regarding supplement use (type, dose, and duration). Nutrient intakes were compared to Dietary Reference Intakes (DRIs). Diet quality was assessed using the revised Healthy Eating Index (HEI). Descriptive statistics and multivariate logistic regression were used in this cross-sectional study. RESULTS: A majority of survivors (74%) reported taking supplements, with multivitamins (60%), calcium/vitamin D (37%), and antioxidants (30%) as the most prevalent. Overall proportions of the total sample with dietary intakes below Estimated Average Requirements (EARs) were substantial, although supplement users had more favorable mean HEI scores (P < 0.01) and nutrient intakes for 12 of the 13 vitamins and minerals investigated (P values < 0.05). Supplement use was positively associated with older age (>or=70 years) (odds ratio (OR)=1.70; 95% confidence interval (95% CI)=1.17, 2.46) and female gender (OR=1.49; 95% CI=1.04, 2.13), and negatively associated with current smoking (OR=0.40, 95% CI=0.21, 0.76). Individuals scoring higher on the Total Fruit (OR=1.12, 95% CI=1.01, 1.23), Whole Grain (OR=1.14, 95% CI=1.04, 1.25), and Oil (OR=1.10, 95% CI=1.01, 1.11) components of the HEI were significantly more likely to take supplements, while those scoring higher on the Meat and Beans category (OR=0.81, 95% CI=0.71, 0.93) were significantly less likely to take supplements. Compared to those with less than a high school education, survivors with a professional or graduate degree were significantly more likely to use supplements (OR=2.18, 95% CI=1.13, 4.23). DISCUSSIONS/CONCLUSIONS: Demographic, disease, and health-related correlates of supplement use follow similar trends observed in the general population as well as previous reports from other cancer survivor populations. Supplement use may reduce the prevalence of nutrient inadequacies in this population, though survivors who use supplements are the least likely to need them. IMPLICATIONS FOR CANCER SURVIVORS: Supplement use may be an effective means for many survivors to achieve adequate nutrient intakes; however, open communication between healthcare providers and survivors is needed to ensure potential concerns are addressed as supplement use may not always be beneficial.

Authors
Miller, P; Demark-Wahnefried, W; Snyder, DC; Sloane, R; Morey, MC; Cohen, H; Kranz, S; Mitchell, DC; Hartman, TJ
MLA Citation
Miller, P, Demark-Wahnefried, W, Snyder, DC, Sloane, R, Morey, MC, Cohen, H, Kranz, S, Mitchell, DC, and Hartman, TJ. "Dietary supplement use among elderly, long-term cancer survivors." J Cancer Surviv 2.3 (September 2008): 138-148.
PMID
18792788
Source
pubmed
Published In
Journal of Cancer Survivorship
Volume
2
Issue
3
Publish Date
2008
Start Page
138
End Page
148
DOI
10.1007/s11764-008-0060-3

The older cancer patient.

Providing effective and tolerable cancer treatment for the growing number of older adult patients who have cancer requires an understanding of the role of aging, comorbidity, functional status, and frailty on treatment outcomes. The incorporation of comprehensive geriatric assessment (CGA) into the care of older patients who have cancer ensures that the cognitive, physical, and psychosocial strengths and limitations of individual patients are considered in the development of treatment plans. CGA also may improve outcomes by identifying and optimally treating comorbid conditions and functional impairments. Optimal treatment of the older adult patient who has cancer starts with careful delineation of goals through conversation. The treatment plan should be comprehensive and address cancer-specific treatment, symptom-specific treatment, supportive treatment modalities, and end-of-life care.

Authors
White, HK; Cohen, HJ
MLA Citation
White, HK, and Cohen, HJ. "The older cancer patient." Nurs Clin North Am 43.2 (June 2008): 307-322.
PMID
18514690
Source
pubmed
Published In
Nursing Clinics of North America
Volume
43
Issue
2
Publish Date
2008
Start Page
307
End Page
322
DOI
10.1016/j.cnur.2008.03.003

Geographical segregation and IL-6: a marker of chronic inflammation in older adults.

AIM: To examine environmental sociodemographic risks of high IL-6, a marker of chronic inflammation in older adults. METHODS: We spatially linked 1990 USA Census tract demographic and economic measures to a prospective cohort study of representative community residents aged 71 years and older, from over 1700 of whom a cytokine protein and biological marker of chronic inflammation. IL-6, was collected. Using generalized interactive mixed models, we modeled 1989-1990 individual and census level risk factors for the dependent variable high IL-6 between 1992-1993 (high IL-6 = upper quartile: >2.96 pg/ml). RESULTS: After individual health risk adjustment, IL-6 remained elevated in communities with greater densities of poor older adults (odd ratio [OR]: 1.25 per 10% increase in exposure. 95% confidence interval [CI]: 1.05, 1.48) and in racially segregated communities (OR: 1.14 per 10% increase in exposure. 95% CI: 1.04, 1.25). CONCLUSIONS: Socially disadvantaged environments may influence IL-6, a biomarker of age-associated inflammation.

Authors
Purser, JL; Kuchibhatla, MN; Miranda, ML; Blazer, DG; Cohen, HJ; Fillenbaum, GG
MLA Citation
Purser, JL, Kuchibhatla, MN, Miranda, ML, Blazer, DG, Cohen, HJ, and Fillenbaum, GG. "Geographical segregation and IL-6: a marker of chronic inflammation in older adults." Biomark Med 2.4 (2008): 335-348.
PMID
19655043
Source
pubmed
Published In
Biomarkers in medicine
Volume
2
Issue
4
Publish Date
2008
Start Page
335
End Page
348
DOI
10.2217/17520363.2.4.335

Overturning barriers will take heavy lifting

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Overturning barriers will take heavy lifting." Journal of Oncology Practice 4.4 (2008): 169-170.
Source
scival
Published In
Journal of Oncology Practice
Volume
4
Issue
4
Publish Date
2008
Start Page
169
End Page
170
DOI
10.1200/JOP.0841502

Evidence of a relationship between infant birth weight and later diabetes and impaired glucose regulation in a Chinese population

OBJECTIVE - The aim of this study was to determine the influence of birth weight, a marker of fetal growth, on the development of later impaired glucose metabolism throughout the life span of people living in China. RESEARCH DESIGN AND METHODS - We recorded detailed anthropometric data including height, weight, and health status and measured blood glucose levels and insulin concentrations after fasting and at 120 min of a standard oral glucose tolerance test from 2,019 eligible subjects born between 1921 and 1954 to investigate the risk of developing type 2 diabetes and impaired glucose regulation (IGR). RESULTS - The diabetes and IGR groups were characterized by significantly lower birth weight (P < 0.001), smaller head circumference (P < 0.001), smaller ponderal index (P = 0.007), and shorter length (P = 0.004) compared with those in the normal glucose tolerance group. Using multiple logistic regression analysis, we observed that birth weight remained significantly associated with diabetes and IGR after adjustments for possible confounding variables at birth and in adult life such as sex, age, central obesity, smoking status, alcohol consumption, dyslipidemia, family history of diabetes, and occupational status (P = 0.027). There was a significantly increased risk of getting diabetes and IGR for those with low birth weight (odds ratio 1.748 [95% CI 1.018-3.001], P = 0.043). CONCLUSIONS -The results confirm that lower birth weight is an independent risk factor for later diabetes or IGR and show for the first time that this risk factor also applies for a Chinese population. © 2008 by the American Diabetes Association.

Authors
Xiao, X; Zhang, Z-X; Cohen, HJ; Wang, H; Li, W; Wang, T; Xu, T; Liu, A; Gai, M-Y; Ying, S; Schmitz, O; Yi, Z
MLA Citation
Xiao, X, Zhang, Z-X, Cohen, HJ, Wang, H, Li, W, Wang, T, Xu, T, Liu, A, Gai, M-Y, Ying, S, Schmitz, O, and Yi, Z. "Evidence of a relationship between infant birth weight and later diabetes and impaired glucose regulation in a Chinese population." Diabetes Care 31.3 (2008): 483-487.
PMID
18070988
Source
scival
Published In
Diabetes Care
Volume
31
Issue
3
Publish Date
2008
Start Page
483
End Page
487
DOI
10.2337/dc07-1130

Effect of telephone exercise counseling on frailty in older veterans: project LIFE.

This study sought to determine if telephone exercise counseling attenuates frailty in older, male veterans through increased levels of physical activity. Eighty-one elderly, male veterans (age = 78.4 +/- 4.9 years) randomized to intervention (n = 39) or combined control groups (n = 42) completed baseline and 6-month follow-up measures of gait velocity, 6-min walk, chair stands, body mass index, and physical activity. Adapting the Fried frailty model, deficits in one or more of these outcomes indicated frailty. The intervention group had a 6-month decrease of 18% in the proportion of frail to not frail participants, whereas the control groups had no change in proportions (Fisher's p = .08). Frail participants had a mean 6-month decrease in physical activity levels of 124 kilocalories/week, whereas the not frail group increased by 619 kilocalories/week (p = .07). There was a clinically meaningful change in frailty status with intensive, telephone exercise counseling. Improvement in frailty status was likely due to improvement in functional limitations.

Authors
Peterson, MJ; Sloane, R; Cohen, HJ; Crowley, GM; Pieper, CF; Morey, MC
MLA Citation
Peterson, MJ, Sloane, R, Cohen, HJ, Crowley, GM, Pieper, CF, and Morey, MC. "Effect of telephone exercise counseling on frailty in older veterans: project LIFE." Am J Mens Health 1.4 (December 2007): 326-334.
PMID
19482814
Source
pubmed
Published In
American Journal of Men's Health
Volume
1
Issue
4
Publish Date
2007
Start Page
326
End Page
334
DOI
10.1177/1557988307306153

Application of assessing care of vulnerable elders-3 quality indicators to patients with advanced dementia and poor prognosis.

OBJECTIVES: To use a formal decision-making strategy to reach clinically appropriate, internally consistent decisions on the application of quality indicators (QIs) to vulnerable elders (VEs) with advanced dementia (AD) or poor prognosis (PP). DESIGN: Using a conceptual model that classifies QIs principally by aim and burden of the care process, 12 clinical experts rated whether each Assessing Care of Vulnerable Elders-3 (ACOVE-3) QI should be applied in evaluating quality of care for older persons with AD or PP. QI exclusions were assessed for each of the 26 conditions and by whether these conditions were mainly medical (e.g., diabetes mellitus), geriatric (e.g., falls), or crosscutting processes of care (e.g., pain management). QI exclusions were also identified for older persons who decided against hospitalization or surgery. RESULTS: Of 392 ACOVE-3 QIs, 140 (36%) were excluded for patients with AD and 135 (34%) for patients with PP; 57% of QIs focusing on medical conditions were excluded from patients with AD and 53% from patients with PP, whereas only 20% of QIs for geriatric conditions were excluded from AD and 15% from PP. All QIs with care processes judged to carry a heavy burden were excluded; 86% of moderate-burden QIs were excluded from AD and 92% from PP. All QIs aimed at long-term goals were excluded; 83% of intermediate-term goal QIs were excluded from AD and 98% from PP. Individuals holding a preference to forgo hospitalization or surgery would be excluded from 7% of potentially applicable QIs. CONCLUSION: Measurement of quality of care for VEs with AD, PP, and less-aggressive care preferences should include only a subset of the ACOVE-3 QIs, largely those whose burden is light and whose goal is continuity or short-term improvement or prevention.

Authors
Wenger, NS; Solomon, DH; Amin, A; Besdine, RK; Blazer, DG; Cohen, H; Fulmer, T; Ganz, PA; Grunwald, M; Hall, WJ; Katz, PR; Kitzman, DW; Leipzig, RM; Rosenthal, RA; ACOVE-3 Clinical Committee,
MLA Citation
Wenger, NS, Solomon, DH, Amin, A, Besdine, RK, Blazer, DG, Cohen, H, Fulmer, T, Ganz, PA, Grunwald, M, Hall, WJ, Katz, PR, Kitzman, DW, Leipzig, RM, Rosenthal, RA, and ACOVE-3 Clinical Committee, . "Application of assessing care of vulnerable elders-3 quality indicators to patients with advanced dementia and poor prognosis." J Am Geriatr Soc 55 Suppl 2 (October 2007): S457-S463.
PMID
17910571
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
55 Suppl 2
Publish Date
2007
Start Page
S457
End Page
S463
DOI
10.1111/j.1532-5415.2007.01375.x

Combination of flavor enhancement and chemosensory education improves nutritional status in older cancer patients.

BACKGROUND: Abnormalities in taste and smell functioning occur with elevated frequency in both older adults and patients with cancer. With the predicted increase in both of these populations in the coming decades, it is imperative to evaluate potential interventions that are designed to help older cancer patients compensate for the additive burden of this disease and its treatment on age-related taste and smell losses. OBJECTIVE: The purpose of the current study was to determine if providing instruction and products for flavor enhancement of foods to elderly cancer patients in addition to nutritional information would improve their nutritional status, and, by extension, functional and immune status as well as quality of life. DESIGN: One hundred and seven subjects enrolled in the study. Fifty-four subjects were in the experimental group that received flavor enhancement plus nutritional information; fifty-three control subjects received only nutritional information. Subjects were evaluated 1 month, 3 months, and 8 months after beginning chemotherapy. At every session, subjects completed taste and smell assessments as well as questionnaires related to nutritional status, activities of daily living, and quality of life. Blood samples were also obtained to determine immune parameters. RESULTS: At the eight-month time point, experimental subjects had better scores on the mini nutritional assessment (MNA) and the physical function assessment of the quality of life questionnaire. Also at eight months, self-reported taste and smell perception for experimental subjects was better than that of controls as well as better than at earlier time points. Tests that assessed quantity and quality of food intake, as well as a number of immune parameters declined over time and did not differ significantly between groups. CONCLUSION: The combination of flavor enhancement, chemosensory education, and nutritional information for elderly cancer patients improved their nutritional assessment on the MNA and physical function over time. On the whole, experimental subjects perceived themselves to be better functioning at eight months than did their control counterparts.

Authors
Schiffman, SS; Sattely-Miller, EA; Taylor, EL; Graham, BG; Landerman, LR; Zervakis, J; Campagna, LK; Cohen, HJ; Blackwell, S; Garst, JL
MLA Citation
Schiffman, SS, Sattely-Miller, EA, Taylor, EL, Graham, BG, Landerman, LR, Zervakis, J, Campagna, LK, Cohen, HJ, Blackwell, S, and Garst, JL. "Combination of flavor enhancement and chemosensory education improves nutritional status in older cancer patients." J Nutr Health Aging 11.5 (September 2007): 439-454.
PMID
17657366
Source
pubmed
Published In
The Journal of Nutrition Health and Aging
Volume
11
Issue
5
Publish Date
2007
Start Page
439
End Page
454

The Diet Quality Index-Revised: a tool to promote and evaluate dietary change among older cancer survivors enrolled in a home-based intervention trial.

OBJECTIVE: To utilize the Diet Quality Index-Revised (DQI-R) as a framework for delivering and evaluating an intervention to improve overall diet quality among older cancer survivors. DESIGN: As part of a randomized controlled trial to improve lifestyle behaviors among older cancer survivors, we sought a dietary measure that could serve as both an intervention framework and a means to evaluate global dietary quality. The DQI-R measures overall diet quality by summing 10 subscales that relate to national guidelines. At baseline, DQI-R scores were generated from three multi-pass 24-hour dietary recalls. The 6-month intervention delivered tailored feedback on individual DQI-R subscales. Dietary recalls were repeated at 6 and 12 months. SUBJECTS: Elderly (aged >or=65 years) individuals within 18 months of diagnosis of breast or prostate cancer (n=182) were randomized postbaseline measures to intervention vs attention control arms. RESULTS: Significant differences in overall diet quality were observed between arms at 6 months, with the intervention arm improving (67.6+/-12.2 to 69.8+/-13.9), and controls declining (67.5+/-12.5 to 64.6+/-14.7) (P=0.003). Significant differences were observed between arms over time in dietary diversity subscale scores: baseline and 6-month follow-up means among intervention and control arms were 4.8+/-1.3 to 4.8+/-1.4, and 4.7+/-1.2 to 4.1+/-1.1, respectively (P=0.001). CONCLUSIONS: The DQI-R served as an effective guide and evaluation tool for this diet-related randomized controlled trial. Like many interventions, our effect diminished after the intervention was complete. Future research should consider testing interventions that use the DQI-R, or other global diet-related indexes, as guides and evaluation tools over longer study periods, as well as in other populations.

Authors
Clutter Snyder, D; Sloane, R; Haines, PS; Miller, P; Clipp, EC; Morey, MC; Pieper, C; Cohen, H; Demark-Wahnefried, W
MLA Citation
Clutter Snyder, D, Sloane, R, Haines, PS, Miller, P, Clipp, EC, Morey, MC, Pieper, C, Cohen, H, and Demark-Wahnefried, W. "The Diet Quality Index-Revised: a tool to promote and evaluate dietary change among older cancer survivors enrolled in a home-based intervention trial." J Am Diet Assoc 107.9 (September 2007): 1519-1529.
PMID
17761229
Source
pubmed
Published In
Journal of the American Dietetic Association
Volume
107
Issue
9
Publish Date
2007
Start Page
1519
End Page
1529
DOI
10.1016/j.jada.2007.06.014

Frailty thy name is ... Phrailty?

Authors
Whitson, HE; Purser, JL; Cohen, HJ
MLA Citation
Whitson, HE, Purser, JL, and Cohen, HJ. "Frailty thy name is .. Phrailty?." J Gerontol A Biol Sci Med Sci 62.7 (July 2007): 728-730.
PMID
17634319
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
62
Issue
7
Publish Date
2007
Start Page
728
End Page
730

Evaluation of agreement between physicians' notation of 'no evidence of disease' (NED) and patients' report of cancer status.

This study examines extent of agreement between oncologists' and cancer patients' reports of current cancer status. Participants with history of cancer were given a comprehensive geriatric assessment in which they were asked whether they had cancer at the present time. This was compared to cancer status concurrently recorded by their physicians in the chart. 75.5% of patients whose physicians reported 'no evidence of disease' (NED) reported that they currently had cancer. 30% of them were anxious and 27% were depressed. Among patients for whom both the patient and physician reported no cancer, only 12.5% were anxious and 7% depressed. Compared to patients with concordant responses, those who discrepantly reported they had cancer had significantly more comorbid illnesses, medications, and pain, and lower levels of social, emotional, and physical functioning. Moreover, equal levels of distress and dysfunction were found between those who reported cancer but had NED and those who reported cancer and did have active disease by physician notation. Although conclusions about cause and effect are limited due to study design, findings suggest that some patients might suffer unnecessarily from lack of understanding about current disease status. These findings also suggest the need for improved physician-patient communication and symptom recognition/management.

Authors
Oates, CT; Sloane, R; Ingram, SS; Seo, PH; Cohen, HJ; Clipp, EC
MLA Citation
Oates, CT, Sloane, R, Ingram, SS, Seo, PH, Cohen, HJ, and Clipp, EC. "Evaluation of agreement between physicians' notation of 'no evidence of disease' (NED) and patients' report of cancer status." Psychooncology 16.7 (July 2007): 668-675.
PMID
17091532
Source
pubmed
Published In
Psycho-Oncology
Volume
16
Issue
7
Publish Date
2007
Start Page
668
End Page
675
DOI
10.1002/pon.1127

The combined effect of visual impairment and cognitive impairment on disability in older people.

OBJECTIVES: To determine the risk of disability in individuals with coexisting visual and cognitive impairment and to compare the magnitude of risk associated with visual impairment, cognitive impairment, or the multimorbidity. DESIGN: Prospective cohort. SETTING: North Carolina. PARTICIPANTS: Three thousand eight hundred seventy-eight participants in the North Carolina Established Populations for the Epidemiologic Studies of the Elderly with nonmissing visual status, cognitive status, and disability status data at baseline MEASUREMENTS: Short Portable Mental Status Questionnaire (cognitive impairment defined as > or =4 errors), self reported visual acuity (visual impairment defined as inability to see well enough to recognize a friend across the street or to read newspaper print), demographic and health-related variables, disability status (activities of daily living (ADLs), instrumental activities of daily living (IADLs), mobility), death, and time to nursing home placement. RESULTS: Participants with coexisting visual and cognitive impairment were at greater risk of IADL disability (odds ratio (OR)=6.50, 95% confidence interval (CI)=4.34-9.75), mobility disability (OR=4.04, 95% CI=2.49-6.54), ADL disability (OR=2.84, 95% CI=1.87-4.32), and incident ADL disability (OR=3.66, 95%, CI=2.36-5.65). In each case, the estimated OR associated with the multimorbidity was greater than the estimated OR associated with visual or cognitive impairment alone, a pattern that was not observed for other adverse outcomes assessed. No significant interactions were observed between cognitive impairment and visual impairment as predictors of disability status. CONCLUSION: Individuals with coexisting visual impairment and cognitive impairment are at high risk of disability, with each condition contributing additively to disability risk. Further study is needed to improve functional trajectories in patients with this prevalent multimorbidity. When visual or cognitive impairment is present, efforts to maximize the other function may be beneficial.

Authors
Whitson, HE; Cousins, SW; Burchett, BM; Hybels, CF; Pieper, CF; Cohen, HJ
MLA Citation
Whitson, HE, Cousins, SW, Burchett, BM, Hybels, CF, Pieper, CF, and Cohen, HJ. "The combined effect of visual impairment and cognitive impairment on disability in older people." J Am Geriatr Soc 55.6 (June 2007): 885-891.
PMID
17537089
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
55
Issue
6
Publish Date
2007
Start Page
885
End Page
891
DOI
10.1111/j.1532-5415.2007.01093.x

Meeting report: Translational Research at the Aging and Cancer Interface.

Authors
Benz, CC; Campisi, J; Cohen, HJ; Ershler, WB; Irminger-Finger, I
MLA Citation
Benz, CC, Campisi, J, Cohen, HJ, Ershler, WB, and Irminger-Finger, I. "Meeting report: Translational Research at the Aging and Cancer Interface." Cancer Res 67.10 (May 15, 2007): 4560-4563.
PMID
17510382
Source
pubmed
Published In
Cancer Research
Volume
67
Issue
10
Publish Date
2007
Start Page
4560
End Page
4563
DOI
10.1158/0008-5472.CAN-07-1236

The cancer aging interface: a research agenda.

There are substantial knowledge gaps in our understanding of the relationships between cancer and aging. These include areas of basic biology, societal aspects, and clinical aspects. Recommendations for research agendas in each of these areas are offered. In addition, the need for training investigators to work at this interface is addressed.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "The cancer aging interface: a research agenda." J Clin Oncol 25.14 (May 10, 2007): 1945-1948. (Review)
PMID
17488995
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
25
Issue
14
Publish Date
2007
Start Page
1945
End Page
1948
DOI
10.1200/JCO.2007.10.6807

Report of the national institute on aging task force on comorbidity.

Authors
Yancik, R; Ershler, W; Satariano, W; Hazzard, W; Cohen, HJ; Ferrucci, L
MLA Citation
Yancik, R, Ershler, W, Satariano, W, Hazzard, W, Cohen, HJ, and Ferrucci, L. "Report of the national institute on aging task force on comorbidity." J Gerontol A Biol Sci Med Sci 62.3 (March 2007): 275-280.
PMID
17389724
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
62
Issue
3
Publish Date
2007
Start Page
275
End Page
280

Anemia and cancer in older persons.

Although the overall prevalence for many cancers is declining, cancer still remains a diagnosis more common in the elderly than in younger individuals. As the population ages, the proportion of patients with cancer who are elderly is expected to increase dramatically. Anemia occurs more often in older individuals for a variety of reasons, and its prevalence in elderly patients with cancer is significantly increasing. Although information on anemia in the elderly is limited, data on cancer patients of all ages have shown that the presence of anemia is associated with poorer prognosis and functional status. The impact of anemia on performance status in patients with cancer is matched by results from a large number of studies indicating negative effects of anemia on a wide variety of performance measures. Despite an apparent reluctance to undertake aggressive therapy in elderly patients with cancer, physicians are using a wider range of treatments with increasing frequency in this older population. Optimizing treatment outcomes in elderly patients with cancer depends on careful determination of performance status as well as the potential of therapies to treat anemia in these patients.

Authors
Penninx, BW; Cohen, HJ; Woodman, RC
MLA Citation
Penninx, BW, Cohen, HJ, and Woodman, RC. "Anemia and cancer in older persons." J Support Oncol 5.3 (March 2007): 107-113. (Review)
PMID
17410807
Source
pubmed
Published In
The Journal of Supportive Oncology
Volume
5
Issue
3
Publish Date
2007
Start Page
107
End Page
113

Effect of motorized scooters on physical performance and mobility: a randomized clinical trial.

OBJECTIVE: To investigate the effects of providing a motorized scooter on physical performance and mobility. DESIGN: Randomized clinical trial comparing scooter users with usual care. SETTING: One academic and 1 Veterans Affairs medical center. PARTICIPANTS: Ambulatory, community-dwelling outpatients with rheumatoid arthritis or osteoarthritis of the knee. INTERVENTION: Provision of a motorized scooter for 3 months. MAIN OUTCOME MEASURES: Six-minute walk distance (6MWD) and mobility methods in diverse locations at baseline, 1 month, and 3 months, and accidents while using the scooter. RESULTS: The majority of scooter subjects (n=16/22 [72.7%]) used the scooter 4 or more days per week. The difference+/-standard deviation between the 2 groups in change in 6MWD over the study period was not statistically significant (scooter users, 16.9+/-73.0 m [55.5+/-239.6 ft]; usual care, 17.2+/-72.5 m [56.5+/-238.0 ft], P=.55). Four (18.1%) scooter users reported 9 accidents. Over the study period, the proportion of persons reporting use of a scooter (provided by the study or otherwise available) increased in the scooter-users group (eg, food stores, 16.7% to 52.6%; doctor's office, 0% to 35.7%) but not the usual-care group (food stores, 9.1% to 9.5%; doctor's office, 0% to 0%). CONCLUSIONS: Motorized scooters provided to ambulatory persons with arthritis were used intermittently. The greatest short-term risk from scooter usage appeared to be minor collisions.

Authors
Hoenig, H; Pieper, C; Branch, LG; Cohen, HJ
MLA Citation
Hoenig, H, Pieper, C, Branch, LG, and Cohen, HJ. "Effect of motorized scooters on physical performance and mobility: a randomized clinical trial." Arch Phys Med Rehabil 88.3 (March 2007): 279-286.
PMID
17321817
Source
pubmed
Published In
Archives of Physical Medicine and Rehabilitation
Volume
88
Issue
3
Publish Date
2007
Start Page
279
End Page
286
DOI
10.1016/j.apmr.2006.11.022

Biological and clinical significance of monoclonal gammopathy

© Cambridge University Press 2008. Introduction: Monoclonal gammopathy of unknown significance (MGUS) affects up to 2% of persons aged 50 years or over, and about 3% of those older than 70 years. The aim of this chapter is to highlight some of the features of this disease process and its relationship to aging. It will focus on (1) epidemiology, (2) biology of MGUS and the role of various cytokines in the pathophysiology, (3) correlation of the biology of MGUS with aging, (4) diagnosis and follow-up of patients with MGUS, and (5) natural history and predictors of progression in patients with MGUS. Epidemiology: The monoclonal gammopathies are a group of disorders associated with proliferation of a single clone (monoclonal) of plasma cells. They are characterized by the secretion of an immunologically homogenous monoclonal protein (M-protein, M-component, M-spike, or paraprotein). Each M-protein consists of two heavy (H) polypeptide chains of the same class and subclass, and two light (L) chains of the same type. The heavy chains are IgG, IgM, IgA, IgD, and IgE, while the light-chain types are kappa (κ), and lambda (λ). In contrast, a polyclonal gammopathy is characterized by an increase in one or more heavy chains, and in both types of light chains, and is usually associated with an inflammatory or reactive process.

Authors
Rao, AV; Cohen, HJ
MLA Citation
Rao, AV, and Cohen, HJ. "Biological and clinical significance of monoclonal gammopathy." Blood Disorders in the Elderly. January 1, 2007. 138-154.
Source
scopus
Publish Date
2007
Start Page
138
End Page
154
DOI
10.1017/CBO9780511545238.012

Effect of cancer screening and desirable health behaviors on functional status, self-rated health, health service use and mortality.

OBJECTIVES: To determine whether some health behaviors of older people (e.g., obtaining cancer screens) have a limited and others (e.g., exercise) have a broad association with population-level health status 4 to 6 years later. DESIGN: Longitudinal cohort. SETTING: North Carolina five-county urban and rural area. PARTICIPANTS: Representative community residents aged 71 and older (Duke Established Populations for Epidemiologic Studies of the Elderly; African American, n=1,256; white, n=974) who provided information on cancer screening and health behaviors. MEASUREMENTS: Demographics, health conditions, functional status, health service use, health insurance. Dependent measures were functional status and self-rated health 4 years later, hospitalization within 4 years, and death within 6 years. Data were analyzed using descriptive statistics, multivariable logistic regression, and Cox proportional hazards. RESULTS: In fully adjusted analyses, cancer screening had no significant protective association with functional status, self-rated health, hospitalization, or death. Smoking was a risk factor for hospitalization (odds ratio (OR)=1.48, 95% confidence interval (CI)=1.07-2.05), and death (hazard rate (HR)=1.81, 95% CI=1.47-2.23). Sufficient food reduced hospitalization (OR=0.38, 95% CI=0.15-0.94) and mortality (HR=0.70, 95% CI=0.49-1.02). Regular exercise protected against poor mobility (OR=0.56, 95% CI=0.41-0.77), and poor self-rated health (OR=0.61, 95% CI=0.45-0.82). Lower activity level increased the hazard of death (HR=1.18, 95% CI=1.03-1.36). CONCLUSION: Disease-specific screens are important at an individual level but, because of low incidence of condition and comorbidity, may not be associated with population-level health 4 to 6 years later. Practice of health behaviors with a broader focus is associated, at a population level, with better functional status and self-rated health and lower rates of hospitalization and death 4 to 6 years later.

Authors
Fillenbaum, GG; Burchett, BM; Kuchibhatla, MN; Cohen, HJ; Blazer, DG
MLA Citation
Fillenbaum, GG, Burchett, BM, Kuchibhatla, MN, Cohen, HJ, and Blazer, DG. "Effect of cancer screening and desirable health behaviors on functional status, self-rated health, health service use and mortality." J Am Geriatr Soc 55.1 (January 2007): 66-74.
PMID
17233687
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
55
Issue
1
Publish Date
2007
Start Page
66
End Page
74
DOI
10.1111/j.1532-5415.2006.01009.x

Monitoring the randomized trials of the Women's Health Initiative: the experience of the Data and Safety Monitoring Board.

Data Safety Monitoring Committees (DSMB) for large, long-term randomized trials of agents in common use face challenging problems especially when the emerging data indicate unanticipated effects. The DSMB for the Women's Health Initiative Clinical Trials, on observing early indication of a surprising adverse cardiovascular effect of post-menopausal hormones, spent several years deliberating what recommendations it should make. This paper describes the dilemmas faced by the DSMB and the considerations it made over the course of its existence. The paper concludes with some recommendations for other DSMBs.

Authors
Wittes, J; Barrett-Connor, E; Braunwald, E; Chesney, M; Cohen, HJ; Demets, D; Dunn, L; Dwyer, J; Heaney, RP; Vogel, V; Walters, L; Yusuf, S
MLA Citation
Wittes, J, Barrett-Connor, E, Braunwald, E, Chesney, M, Cohen, HJ, Demets, D, Dunn, L, Dwyer, J, Heaney, RP, Vogel, V, Walters, L, and Yusuf, S. "Monitoring the randomized trials of the Women's Health Initiative: the experience of the Data and Safety Monitoring Board." Clin Trials 4.3 (2007): 218-234.
PMID
17715247
Source
pubmed
Published In
Clinical Trials
Volume
4
Issue
3
Publish Date
2007
Start Page
218
End Page
234
DOI
10.1177/1740774507079439

Telephone monitoring of distress in patients aged 65 years or older with advanced stage cancer: a cancer and leukemia group B study.

BACKGROUND: Significant barriers to cancer patients receiving mental health treatment for distress have been reported in the literature. The objective of the current study was to determine whether distress in older patients (aged 65 years and older) would be reduced with educational materials (EM) supplemented by monthly telephone monitoring (TM) (TM + EM) compared with the use of EM alone because of more timely referrals to appropriate health professionals. METHODS: One hundred ninety-two older patients with breast, prostate, and colorectal cancers who had advanced disease and currently were receiving treatment were randomized to receive either TM + EM or EM alone. One hundred thirty-one patients were evaluated by telephone interview for psychologic and physical distress and for social support at baseline and at 6 months using the Hospital Anxiety and Depression Scale (HADS), the European Organization for Research and Treatment of Cancer (EORTC)-QLQ-C30 quality-of-life questionnaire, and the Medical Outcomes Study (MOS) Social Support Survey. Patients who in the TM + EM group were called monthly for 6 months to monitor their distress using the HADS and EORTC physical symptom items and the MOS Social Support Survey items, with cutoff levels were established to indicate which patients were in greater distress. Those patients who scored above the cutoff levels were referred to their oncology nurse for referral to the appropriate professional. Patients in the EM group received written materials regarding cancer-related psychosocial issues and available resources. RESULTS: At 6 months, patients in the TM + EM group reported significantly less anxiety (HADS; P < .0001), depression (HADS; P = .0004), and overall distress (HADS; P < .0001) compared with patients in the EM group. CONCLUSIONS: Monthly monitoring of older patients' distress with TM and EM along with referral for appropriate help was found to be an efficient means of reducing patients' anxiety and depression compared with patients who received only EM.

Authors
Kornblith, AB; Dowell, JM; Herndon, JE; Engelman, BJ; Bauer-Wu, S; Small, EJ; Morrison, VA; Atkins, J; Cohen, HJ; Holland, JC
MLA Citation
Kornblith, AB, Dowell, JM, Herndon, JE, Engelman, BJ, Bauer-Wu, S, Small, EJ, Morrison, VA, Atkins, J, Cohen, HJ, and Holland, JC. "Telephone monitoring of distress in patients aged 65 years or older with advanced stage cancer: a cancer and leukemia group B study." Cancer 107.11 (December 1, 2006): 2706-2714.
PMID
17078057
Source
pubmed
Published In
Cancer
Volume
107
Issue
11
Publish Date
2006
Start Page
2706
End Page
2714
DOI
10.1002/cncr.22296

Keynote comment: cancer survivorship and ageing--a double whammy.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Keynote comment: cancer survivorship and ageing--a double whammy." Lancet Oncol 7.11 (November 2006): 882-883. (Letter)
PMID
17081910
Source
pubmed
Published In
The Lancet Oncology
Volume
7
Issue
11
Publish Date
2006
Start Page
882
End Page
883
DOI
10.1016/S1470-2045(06)70913-5

Spirituality across the lifespan.

Authors
Koenig, HG; Cohen, HJ
MLA Citation
Koenig, HG, and Cohen, HJ. "Spirituality across the lifespan." South Med J 99.10 (October 2006): 1157-1158.
PMID
17100052
Source
pubmed
Published In
Southern Medical Journal
Volume
99
Issue
10
Publish Date
2006
Start Page
1157
End Page
1158
DOI
10.1097/01.smj.0000242796.62483.de

Geriatric assessment for oncologists: rationale and future directions.

Sixty percent of all cancer occurrences and seventy percent of cancer mortalities occur in people over the age of 65. As the population ages, there is an emerging need to develop a means for oncologists to characterize the "functional age" of older patients with cancer in order to tailor treatment decisions and stratify outcomes based on factors other than chronological age and to develop interventions to optimize cancer treatment. In this paper, we discuss the formulation of a geriatric assessment for older patients with cancer. The measures included in this assessment were chosen based on their validity, reliability, brevity, adaptability for self-administration, and ability to prognosticate risk for morbidity or mortality in an older patient. The proposed geriatric assessment covers the essential domains of assessment predictive of survival in the geriatric population, is primarily self-administered, and limited personnel time is required. Our eventual goal is to determine if this geriatric assessment measure can identify factors independent of age that predict cancer treatment morbidity and mortality and result in rationale interventions to optimize oncologic care.

Authors
Hurria, A; Lachs, MS; Cohen, HJ; Muss, HB; Kornblith, AB
MLA Citation
Hurria, A, Lachs, MS, Cohen, HJ, Muss, HB, and Kornblith, AB. "Geriatric assessment for oncologists: rationale and future directions." Crit Rev Oncol Hematol 59.3 (September 2006): 211-217. (Review)
PMID
16806961
Source
pubmed
Published In
Critical Reviews in Oncology/Hematology
Volume
59
Issue
3
Publish Date
2006
Start Page
211
End Page
217
DOI
10.1016/j.critrevonc.2006.03.007

The older cancer patient.

Providing effective and tolerable cancer treatment for the growing number of older adult patients who have cancer will require an understanding of the role of aging, comorbidity, functional status, and frailty on treatment outcomes. The incorporation of CGA into the care of older patients who have cancer will ensure that the heterogeneity of this population is considered in the development of treatment plans. It also may improve outcomes by identifying and optimally treating comorbid conditions and functional impairments. Optimal treatment of the older adult patient who has cancer starts with careful delineation of goals through conversation. The treatment plan should be comprehensive and address cancer-specific treatment, symptom-specific treatment, supportive treatment modalities, and end-of-life care.

Authors
White, HK; Cohen, HJ
MLA Citation
White, HK, and Cohen, HJ. "The older cancer patient." Med Clin North Am 90.5 (September 2006): 967-982. (Review)
PMID
16962852
Source
pubmed
Published In
Medical Clinics of North America
Volume
90
Issue
5
Publish Date
2006
Start Page
967
End Page
982
DOI
10.1016/j.mcna.2006.05.017

Lifestyle intervention development study to improve physical function in older adults with cancer: outcomes from Project LEAD.

PURPOSE: Declines in physical functioning (PF) among elderly cancer patients threaten quality of life and the ability to maintain independence. Adherence to healthy lifestyle behaviors may prevent functional decline. PATIENTS AND METHODS: Project Leading the Way in Exercise and Diet (LEAD), an intervention development study of the Pepper Older Americans Independence Center, aimed to determine whether breast and prostate cancer survivors (age 65+ years) assigned to a 6-month home-based diet and exercise intervention experienced improvements in PF when compared with an attention control arm receiving general health information. An accrual target was set at 420, and PF (Short Form-36 subscale), physical activity (Community Healthy Activities Models Program for Seniors), and diet quality (index from 3-day recalls) were assessed at baseline and at 6 and 12 months (6 months after intervention). RESULTS: This developmental project did not achieve its accrual target (N = 182); however, PF change scores were in the direction and of the magnitude projected. Baseline to 6-month change scores in the intervention versus the control arms were as follows: PF, +3.1 v -0.5 (P = .23); physical activity energy expenditure, +111 kcal/wk v -400 kcal/wk (P = .13); and diet quality index, +2.2 v -2.9 (P = .003), respectively. Differences between arms diminished during the postintervention period. CONCLUSION: These findings suggest that home-based diet and exercise interventions hold promise in improving lifestyle behaviors among older cancer survivors, changes that trend toward improved PF. Future studies should incorporate larger sample sizes and interventions that sustain long-term effects and also take into account secular trends; these efforts will require adequate planning and resources to overcome the numerous barriers to intervening in this difficult to reach yet vulnerable population.

Authors
Demark-Wahnefried, W; Clipp, EC; Morey, MC; Pieper, CF; Sloane, R; Snyder, DC; Cohen, HJ
MLA Citation
Demark-Wahnefried, W, Clipp, EC, Morey, MC, Pieper, CF, Sloane, R, Snyder, DC, and Cohen, HJ. "Lifestyle intervention development study to improve physical function in older adults with cancer: outcomes from Project LEAD." J Clin Oncol 24.21 (July 20, 2006): 3465-3473.
PMID
16849763
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
24
Issue
21
Publish Date
2006
Start Page
3465
End Page
3473
DOI
10.1200/JCO.2006.05.7224

Prevalence of monoclonal gammopathy of undetermined significance.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Prevalence of monoclonal gammopathy of undetermined significance." N Engl J Med 354.26 (June 29, 2006): 2832-. (Letter)
PMID
16807426
Source
pubmed
Published In
The New England journal of medicine
Volume
354
Issue
26
Publish Date
2006
Start Page
2832
DOI
10.1056/NEJMc061160

The cancer and leukemia group B cancer in the elderly committee: addressing a major cancer need.

Cancer is a disease of aging, and the majority of cancers occur in persons over 65 years of age. In spite of this, few elders have been represented in clinical trials, and the need for information regarding the treatment of elders with cancer remains great. Recognizing these needs, the Cancer and Leukemia Group B (CALGB) formed an elderly Working Group in 1995, and after initial success in developing clinical studies focused on elders, a Cancer in the Elderly Committee. The Committee's objective is to focus attention on issues specifically relevant to the treatment of cancer in the older patient. Two strategies were developed to achieve this objective: (a) to initiate projects and protocols within the Committee and (b) to foster the initiation of studies by other CALGB committees. The research themes of the Committee and the main thrust of committee's research activities are (a) understanding and overcoming barriers to clinical trials participation; (b) treatment efficacy and pharmacokinetic/pharmacologic issues related to chemotherapy and hormone therapy in the older cancer patient; and (c) improving the quality of life for older cancer patients. The Cancer in the Elderly Committee has been successful in developing, implementing, and completing trials in all these areas and serves as a major resource for clinical trials development for the CALGB.

Authors
Cohen, HJ; Muss, HB
MLA Citation
Cohen, HJ, and Muss, HB. "The cancer and leukemia group B cancer in the elderly committee: addressing a major cancer need." Clin Cancer Res 12.11 Pt 2 (June 1, 2006): 3606s-3611s. (Review)
PMID
16740793
Source
pubmed
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
12
Issue
11 Pt 2
Publish Date
2006
Start Page
3606s
End Page
3611s
DOI
10.1158/1078-0432.CCR-06-9007

Impact of anemia on mortality, cognition, and function in community-dwelling elderly.

PURPOSE: To explore the impact of varying hemoglobin levels on mortality, function, and cognition in a representative population of older persons. METHODS: Participants in this prospective cohort study included 1 744 men and women, aged 71 years or older, from a random household sample living in Durham and surrounding counties in North Carolina. Hemoglobin levels were obtained from participants at baseline in 1992. Functional status was measured at the 4-year follow-up interview using Katz and instrumental activities of daily living. Cognition was measured using the Short Portable Mental Status Questionnaire (SPMSQ). Death was determined by search of the National Death Index, and all deaths through 2000 are included. RESULTS: Using World Health Organization (WHO) criteria, the prevalence of anemia was 24%. There was a strong racial difference with an odds ratio, adjusted for age, education, estimated glomerular filtration rate and comorbidity of 3.0 (95% CI, 2.3-3.9) in African Americans compared with Caucasians. The risk ratio for 8-year mortality was 1.7 (95% CI, 1.5-2.0) for anemic subjects (P = .0001) and did not differ by sex or race. Anemia was strongly associated with poorer physical function (P = .0001) and cognitive function (P = .0001), and predicted decreases in both over a 4-year period. CONCLUSIONS: In an elderly community-based population, anemia is more prevalent in African Americans and is independently associated with increased mortality over 8 years for both races and sexes. Anemia also is a risk factor for functional and cognitive decrease.

Authors
Denny, SD; Kuchibhatla, MN; Cohen, HJ
MLA Citation
Denny, SD, Kuchibhatla, MN, and Cohen, HJ. "Impact of anemia on mortality, cognition, and function in community-dwelling elderly." Am J Med 119.4 (April 2006): 327-334.
PMID
16564775
Source
pubmed
Published In
American Journal of Medicine
Volume
119
Issue
4
Publish Date
2006
Start Page
327
End Page
334
DOI
10.1016/j.amjmed.2005.08.027

The effect of geriatrics evaluation and management on nursing home use and health care costs: results from a randomized trial.

BACKGROUND: The Geriatric Evaluation and Management study was developed to assess the impact of a comprehensive geriatric assessment service on the care of the elderly. OBJECTIVES: We sought to evaluate the cost and clinical impact of inpatient units and outpatient clinics for geriatric evaluation and management. RESEARCH DESIGN: We undertook a prospective, randomized, controlled trial using a 2x2 factorial design, with 1-year follow-up. SUBJECTS: A total of 1388 participants hospitalized on either a medical or surgical ward at 11 participating Veterans Affairs medical centers were randomized to receive either inpatient geriatric unit (GEMU) or usual inpatient care (UCIP), followed by either outpatient care from a geriatric clinic (GEMC) versus usual outpatient care (UCOP). MEASURES: We measured health care utilization and costs. RESULTS: Patients assigned to the GEMU had a significantly decreased rate of nursing home placement (odds ratio=0.65; P=0.001). Neither the GEMU nor GEMC had any statistically significant improvement effects on survival and only modest effects on health status. There were statistically insignificant mean cost savings of $1027 (P=0.29) per patient for the GEMU and $1665 (P=0.69) per patient for the GEMC. CONCLUSIONS: Inpatient or outpatient geriatric evaluation and management units didn't increase the costs of care. Although there was no effect on survival and only modest effects on SF-36 scores at 1-year follow-up, there was a statistically significant reduction in nursing home admissions for patients treated in the GEMU.

Authors
Phibbs, CS; Holty, J-EC; Goldstein, MK; Garber, AM; Wang, Y; Feussner, JR; Cohen, HJ
MLA Citation
Phibbs, CS, Holty, J-EC, Goldstein, MK, Garber, AM, Wang, Y, Feussner, JR, and Cohen, HJ. "The effect of geriatrics evaluation and management on nursing home use and health care costs: results from a randomized trial." Med Care 44.1 (January 2006): 91-95.
PMID
16365618
Source
pubmed
Published In
Medical Care
Volume
44
Issue
1
Publish Date
2006
Start Page
91
End Page
95

Is the prevalence of dehydration among community-dwelling older adults really low? Informing current debate over the fluid recommendation for adults aged 70+years.

OBJECTIVE: The fluid recommendation for adults aged 70+ years has been criticised on the basis of a low prevalence of dehydration in community-dwelling older adults. This study explores whether the low prevalence might reflect limitations of individual dehydration indices. DESIGN: Cross-sectional data on plasma sodium, blood urea nitrogen (BUN), creatinine, glucose and potassium were used to classify 1,737 participants of the 1992 Established Populations for Epidemiologic Studies of the Elderly (EPESE) (70+ years) according to multiple dehydration indices. Associations between dehydration indices, health and functional status were evaluated. RESULTS: Depending on the indicator used, the prevalence of dehydration ranged from 0.5% for hypotonic hypovolaemia only (plasma tonicity < 285 mOsm l(-1) with orthostatic hypotension) to 60% with dehydration defined as either plasma sodium >or=145 mEq l(-1), BUN/creatinine ratio >or=20, tonicity >or=295 mOsm l(-1), or hypotonic hypovolaemia. Elevated tonicity and BUN/creatinine ratio were respectively associated with chronic disease and functional impairment. CONCLUSIONS: The true prevalence of dehydration among community-dwelling adults may be low or high, depending on the indicator(s) used to define dehydration. Before we can pinpoint a generalisable prevalence of dehydration for community-dwelling seniors and draw conclusions about fluid recommendations, validation studies of dehydration indices and longitudinal studies of dehydration, health and functional status are needed.

Authors
Stookey, JD; Pieper, CF; Cohen, HJ
MLA Citation
Stookey, JD, Pieper, CF, and Cohen, HJ. "Is the prevalence of dehydration among community-dwelling older adults really low? Informing current debate over the fluid recommendation for adults aged 70+years." Public Health Nutr 8.8 (December 2005): 1275-1285.
PMID
16372923
Source
pubmed
Published In
Public health nutrition
Volume
8
Issue
8
Publish Date
2005
Start Page
1275
End Page
1285

Developing a cancer-specific geriatric assessment: a feasibility study.

BACKGROUND: As the U.S. population ages, there is an emerging need to characterize the "functional age" of older patients with cancer to tailor treatment decisions and stratify outcomes based on factors other than chronologic age. The goals of the current study were to develop a brief, but comprehensive, primarily self-administered cancer-specific geriatric assessment measure and to determine its feasibility as measured by 1) the percentage of patients able to complete the measure on their own, 2) the length of time to complete, and 3) patient satisfaction with the measure. METHODS: The geriatric and oncology literature was reviewed to choose validated measures of geriatric assessment across the following domains: functional status, comorbidity, cognition, psychological status, social functioning and support, and nutritional status. Criteria applied to geriatric assessment measurements included reliability, validity, brevity, and ability to self-administer. The measure was administered to patients with breast carcinoma, lung carcinoma, colorectal carcinoma, or lymphoma who were fluent in English and receiving chemotherapy at Memorial Sloan-Kettering Cancer Center (New York, NY) or the University of Chicago (Chicago, IL). RESULTS: The instrument was completed by 43 patients (mean age, 74 yrs; range, 65-87 yrs). The majority had AJCC Stage IV disease (68%). The mean time to completion of the assessment was 27 minutes (range, 8-45 mins). Most patients were able to complete the self-administered portion of the assessment without assistance (78%) and were satisfied with the questionnaire length (90%). There was no association noted between age (P = 0.56) or educational level (P = 0.99) and the ability to complete the assessment without assistance. CONCLUSIONS: In this cohort, this brief but comprehensive geriatric assessment could be completed by the majority of patients without assistance. Prospective trials of its generalizability, reliability, and validity are justified.

Authors
Hurria, A; Gupta, S; Zauderer, M; Zuckerman, EL; Cohen, HJ; Muss, H; Rodin, M; Panageas, KS; Holland, JC; Saltz, L; Kris, MG; Noy, A; Gomez, J; Jakubowski, A; Hudis, C; Kornblith, AB
MLA Citation
Hurria, A, Gupta, S, Zauderer, M, Zuckerman, EL, Cohen, HJ, Muss, H, Rodin, M, Panageas, KS, Holland, JC, Saltz, L, Kris, MG, Noy, A, Gomez, J, Jakubowski, A, Hudis, C, and Kornblith, AB. "Developing a cancer-specific geriatric assessment: a feasibility study." Cancer 104.9 (November 1, 2005): 1998-2005.
PMID
16206252
Source
pubmed
Published In
Cancer
Volume
104
Issue
9
Publish Date
2005
Start Page
1998
End Page
2005
DOI
10.1002/cncr.21422

The association between oral health and general health and quality of life in older male cancer patients.

OBJECTIVES: To describe the long-term effects of oral health problems on quality of life (QoL), functional status, pain, and general health in older male cancer patients. DESIGN: Secondary analysis of a prospective observational study. SETTING: Community dwelling cancer patients served by a Department of Veterans Affairs hospital. PARTICIPANTS: One hundred fifty male cancer patients responded to the question "Do you have tooth or mouth problems making it hard to eat?" The relationship between patients answering "yes" and the following parameters was assessed: demographics, comorbid conditions, habits, activities of daily living, pain, anxiety, depression, social support, spirituality, QoL, and overall health ratings. MEASUREMENTS: Chi-square contingency tables for dichotomous variables, Cochran-Mantel-Haenszel for ordered categorical variables, and t tests for associations with continuous variables. RESULTS: The median age of respondents was 67. Those reporting tooth or mouth problems had had their cancer diagnosed on average 2.9 years before, and 83.3% were found clinically to be cancer free. Patients with these problems had significantly lower global (P=.003) and subscale scores on QoL analysis and higher levels of anxiety (P<.001) and depression (P=.01) than those without tooth or mouth problems; they also had significantly more pain (P<.001) and lower physical functioning (P<.001) and were more impaired in activities of daily living (P<.001). Those with tooth or mouth problems were more likely to describe their overall health as fair or poor (P=.01). Having cancer located in the head and neck region related significantly to having mouth or tooth problems (P=.005), but these problems were not associated with race, education, income, insurance coverage, age, comorbid conditions, alcohol consumption, tobacco or medication usage, type of cancer treatment, tumor stage at diagnosis or follow-up, perceived social support, or spirituality. CONCLUSION: Older male cancer patients with mouth or tooth problems making it hard to eat are more likely to have a lower QoL, poorer emotional health, lower levels of physical functioning, and greater pain than patients without these problems.

Authors
Ingram, SS; Seo, PH; Sloane, R; Francis, T; Clipp, EC; Doyle, ME; Montana, GS; Cohen, HJ
MLA Citation
Ingram, SS, Seo, PH, Sloane, R, Francis, T, Clipp, EC, Doyle, ME, Montana, GS, and Cohen, HJ. "The association between oral health and general health and quality of life in older male cancer patients." J Am Geriatr Soc 53.9 (September 2005): 1504-1509.
PMID
16137279
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
53
Issue
9
Publish Date
2005
Start Page
1504
End Page
1509
DOI
10.1111/j.1532-5415.2005.53452.x

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.

Authors
Extermann, M; Aapro, M; Bernabei, R; Cohen, HJ; Droz, J-P; Lichtman, S; Mor, V; Monfardini, S; Repetto, L; Sørbye, L; Topinkova, E; Task Force on CGA of the International Society of Geriatric Oncology,
MLA Citation
Extermann, M, Aapro, M, Bernabei, R, Cohen, HJ, Droz, J-P, Lichtman, S, Mor, V, Monfardini, S, Repetto, L, Sørbye, L, Topinkova, E, and Task Force on CGA of the International Society of Geriatric Oncology, . "Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG)." Crit Rev Oncol Hematol 55.3 (September 2005): 241-252. (Review)
PMID
16084735
Source
pubmed
Published In
Critical Reviews in Oncology/Hematology
Volume
55
Issue
3
Publish Date
2005
Start Page
241
End Page
252
DOI
10.1016/j.critrevonc.2005.06.003

Senior adult oncology clinical practice guidelines in oncology.

Authors
Balducci, L; Cohen, HJ; Engstrom, PF; Ettinger, DS; Halter, J; Gordon, LI; Kiel, K; Kneier, A; Lim, D; Petersdorf, SH; Rosenthal, R; Silliman, R; Vose, JM; Walker, MJ; Zachariah, B; National Comprehensive Cancer Network,
MLA Citation
Balducci, L, Cohen, HJ, Engstrom, PF, Ettinger, DS, Halter, J, Gordon, LI, Kiel, K, Kneier, A, Lim, D, Petersdorf, SH, Rosenthal, R, Silliman, R, Vose, JM, Walker, MJ, Zachariah, B, and National Comprehensive Cancer Network, . "Senior adult oncology clinical practice guidelines in oncology." J Natl Compr Canc Netw 3.4 (July 2005): 572-590.
PMID
16038647
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
3
Issue
4
Publish Date
2005
Start Page
572
End Page
590

Walking speed predicts health status and hospital costs for frail elderly male veterans.

This study evaluated the use of walking speed as an indicator of function and health status in acutely ill, hospitalized, older male veterans. Hospital inpatients in a Department of Veterans Affairs (VA) study of Geriatric Evaluation and Management (GEM) (n = 1,388, age 74.2 +/- 5.7, 98% male) were followed for 1 year. The results indicate that each 0.10 m/s reduction in baseline walking speed was associated with poorer health status (36-item short form [SF-36] beta = 4.5 [95% confidence interval (CI) 2.8 to 6.1]), poorer physical functioning (beta = 2.1 [6.9 to 14.8]), more disabilities (beta = 0.63 [0.53 to 0.73]), additional rehabilitation visits (2.0 [1.4 to 2.5]), increased medical-surgical visits (2.8 [1.9 to 3.7]), longer hospital stays (2.2 [1.4 to 2.9]), and higher costs ($1,334 [$869 to $1,798]). In addition, each 0.10 m/ s/yr increase in walking speed resulted in improved health status (SF-36 beta = 8.4 [6.0 to 10.7]), improved physical function (beta = 2.9 [2.5 to 3.3]), fewer basic disabilities (0.30 [0.2 to 0.4]), fewer instrumental disabilities (0.7 [0.6 to 0.8]), fewer hospitalization days (2.3 [1.3 to 3.3]), and 1-year cost reductions of $1,188 [-$65 to $2,442]. Walking speed is useful for the functional assessment of acutely ill, hospitalized older adults. Measurement of walking speed over time may help predict those who will need and use more health-related services.

Authors
Purser, JL; Weinberger, M; Cohen, HJ; Pieper, CF; Morey, MC; Li, T; Williams, GR; Lapuerta, P
MLA Citation
Purser, JL, Weinberger, M, Cohen, HJ, Pieper, CF, Morey, MC, Li, T, Williams, GR, and Lapuerta, P. "Walking speed predicts health status and hospital costs for frail elderly male veterans." J Rehabil Res Dev 42.4 (July 2005): 535-546.
PMID
16320148
Source
pubmed
Published In
Journal of Rehabilitation Research and Development
Volume
42
Issue
4
Publish Date
2005
Start Page
535
End Page
546

Geriatric evaluation and management units in the care of the frail elderly cancer patient.

BACKGROUND: Geriatric assessment has been suggested as a possibly useful approach in dealing with frail elderly cancer patients. METHODS: This was a secondary subset analysis from a randomized 2 x 2 factorial trial in 11 Department of Veterans Affairs medical centers. Hospitalized, frail patients at least 65 years old, after stabilization of their acute illness, were randomized to receive care in a geriatric inpatient unit, a geriatric outpatient clinic, both, or neither. The interventions involved core teams that provided geriatric assessment and patient management. We identified 99 patients with a diagnosis of cancer by The International Classification of Diseases, 9th Revision (ICD-9) codes, excluding all nonmelanoma skin cancers. Outcomes collected at discharge, 6 months, and 1 year after randomization were survival, changes in health-related quality of life (using the Medical Outcomes Study 36-Item Short-Form general health survey [SF-36]), activities of daily living, physical performance, health service utilization, and costs. RESULTS: There was no effect on mortality (1-year survival 59.6%). The changes in the SF-36 scores from randomization for emotional limitation, mental health and bodily pain (also sustained at 1 year) on the SF-36 were better for geriatric inpatient care cancer patients at discharge. There was no difference in SF-36 scores between geriatric outpatient and usual outpatient care. Days of hospitalization and overall costs were equivalent for the interventions and usual care over the 1-year study. CONCLUSIONS: This study suggests that inpatient geriatric assessment and management may be an effective approach to the management of pain and psychological status in the elderly cancer inpatient at no greater length of hospitalization or extra cost than usual care.

Authors
Rao, AV; Hsieh, F; Feussner, JR; Cohen, HJ
MLA Citation
Rao, AV, Hsieh, F, Feussner, JR, and Cohen, HJ. "Geriatric evaluation and management units in the care of the frail elderly cancer patient." J Gerontol A Biol Sci Med Sci 60.6 (June 2005): 798-803.
PMID
15983186
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
60
Issue
6
Publish Date
2005
Start Page
798
End Page
803

Improving accrual of older persons to cancer treatment trials: a randomized trial comparing an educational intervention with standard information: CALGB 360001.

PURPOSE: To design and test a geriatric educational intervention to improve accrual of cancer patients age 65 years and older to cooperative group-sponsored treatment trials. METHODS: Main member institutions of the Cancer and Leukemia Group B (CALGB) and its affiliates were randomly assigned to receive standard information (n = 73) or educational intervention (n = 53). Standard information included CALGB Web site access and periodic notification about existing trials. The geriatric educational intervention included standard information plus: (1) an educational seminar; (2) educational materials; (3) a list of available protocols for use on charts; (4) a monthly e-mail and mail reminders for 1 year; and (5) a case discussion seminar. The main outcome was percentage of accrual of older persons to phase II and III treatment protocols after study initiation compared with baseline. RESULTS: There were 3,032 patients entered onto trials in the baseline year, and 2,160 and 1,239 during the 2 years postintervention, respectively. Overall percentage of accrual of older patients was 37% at baseline, and 33% and 31% during the first and second years after intervention. There was no improvement in accrual in the intervention versus control arm: 36% v 32% in the first year and 31% v 31% in the second year. CONCLUSION: Accrual of older patients was not increased by this intervention. Reasons for lack of effect include low intervention intensity, high baseline accrual rates, and closure of several high-accruing protocols during the study. More intense and multifaceted approaches will be needed to change physician (and patient) behavior and to increase accrual of older persons to clinical trials.

Authors
Kimmick, GG; Peterson, BL; Kornblith, AB; Mandelblatt, J; Johnson, JL; Wheeler, J; Heinze, R; Cohen, HJ; Muss, HB
MLA Citation
Kimmick, GG, Peterson, BL, Kornblith, AB, Mandelblatt, J, Johnson, JL, Wheeler, J, Heinze, R, Cohen, HJ, and Muss, HB. "Improving accrual of older persons to cancer treatment trials: a randomized trial comparing an educational intervention with standard information: CALGB 360001." J Clin Oncol 23.10 (April 1, 2005): 2201-2207.
PMID
15800312
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
23
Issue
10
Publish Date
2005
Start Page
2201
End Page
2207
DOI
10.1200/JCO.2005.01.222

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.

Authors
Aapro, MS; Köhne, C-H; Cohen, HJ; Extermann, M
MLA Citation
Aapro, MS, Köhne, C-H, Cohen, HJ, and Extermann, M. "Never too old? Age should not be a barrier to enrollment in cancer clinical trials." Oncologist 10.3 (March 2005): 198-204. (Review)
PMID
15793223
Source
pubmed
Published In
The oncologist
Volume
10
Issue
3
Publish Date
2005
Start Page
198
End Page
204
DOI
10.1634/theoncologist.10-3-198

Approach to monoclonal gammopathy of unknown significance in the older patient

Authors
Wu, J; Seo, PH; Cohen, HJ
MLA Citation
Wu, J, Seo, PH, and Cohen, HJ. "Approach to monoclonal gammopathy of unknown significance in the older patient." Clinical Geriatrics 13.6 (2005): 18-24.
Source
scival
Published In
Clinical Geriatrics
Volume
13
Issue
6
Publish Date
2005
Start Page
18
End Page
24

Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer

Context: Adjuvant chemotherapy improves survival for patients with local-regional breast cancer, but healthy older patients at high risk of recurrence are frequently not offered adjuvant chemotherapy, and the benefit of adjuvant chemotherapy in older patients is uncertain. Objective: To compare the benefits and toxic effects of adjuvant chemotherapy among breast cancer patients in age groups of 50 years or younger, 51 to 64 years, and 65 years or older. Design and Setting: Retrospective review of data from 4 randomized trials that accrued patients from academic and community medical centers between 1975 and 1999. Median follow-up for all patients was 9.6 years. All trials randomized patients to different regimens, doses, schedules, and durations of chemotherapy and all had a treatment arm with doses or schedules that were regarded to be "high" and potentially more toxic. Patients: A total of 6487 women with lymph node-positive breast cancer; 542 (8%) patients were 65 years or older and 159 (2%) were 70 years or older. Main Outcome Measure: Comparison of disease-free survival, overall survival, and treatment-related mortality among different age groups. Results Multivariate analysis showed that smaller tumor size, fewer positive lymph nodes, more chemotherapy, and tamoxifen use were all significantly (P<.001) related to longer disease-free and overall survival. There was no association between age and disease-free survival. Overall survival was significantly (P<.001) worse for patients aged 65 or older because of death from causes other than breast cancer. Thirty-three deaths (0.5% of all patients) were attributed to treatment, and older women had higher treatment-related mortality. Older women and younger women derived similar reductions in breast cancer mortality and recurrence from regimens containing more chemotherapy. Conclusion: Age alone should not be a contraindication to the use of optimal chemotherapy regimens in older women who are in good general health.

Authors
Muss, HB; Woolf, S; Berry, D; Cirrincione, C; Weiss, RB; Budman, D; Wood, WC; Henderson, IC; Hudis, C; Winer, E; Cohen, H; Wheeler, J; Norton, L
MLA Citation
Muss, HB, Woolf, S, Berry, D, Cirrincione, C, Weiss, RB, Budman, D, Wood, WC, Henderson, IC, Hudis, C, Winer, E, Cohen, H, Wheeler, J, and Norton, L. "Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer." Journal of the American Medical Association 293.9 (2005): 1073-1081.
PMID
15741529
Source
scival
Published In
JAMA : the journal of the American Medical Association
Volume
293
Issue
9
Publish Date
2005
Start Page
1073
End Page
1081
DOI
10.1001/jama.293.9.1073

In reply [10]

Authors
Kimmick, GG; Peterson, BL; Kornblith, AB; Mandelblatt, J; Johnson, JL; Wheeler, J; Heinze, R; Cohen, HJ; Muss, HB
MLA Citation
Kimmick, GG, Peterson, BL, Kornblith, AB, Mandelblatt, J, Johnson, JL, Wheeler, J, Heinze, R, Cohen, HJ, and Muss, HB. "In reply [10]." Journal of Clinical Oncology 23.30 (2005): 7752-7753.
Source
scival
Published In
Journal of Clinical Oncology
Volume
23
Issue
30
Publish Date
2005
Start Page
7752
End Page
7753
DOI
10.1200/JCO.2005.02.8787

Perspectives, preferences, care practices, and outcomes among older and middle-aged patients with late-stage cancer.

PURPOSE: To evaluate relationships among physician and cancer patient survival estimates, patients' perceived quality of life, care preferences, and outcomes, and how they vary across middle-aged and older patient groups. PATIENTS AND METHODS: Subjects were from the Study to Understand Prognoses and Preferences for Risks of Treatments (SUPPORT) prospective cohort studied in five US teaching hospitals (from 1989 to 1994), and included 720 middle-aged (45 to 64 years) and 696 older (> or = 65 years) patients receiving care for advanced cancer. Perspectives were assessed in physician and patient/surrogate interviews; care practices and outcomes were determined from hospital records and the National Death Index. General linear models were used within age groups to obtain adjusted estimates. RESULTS: Although most patients had treatment goals to relieve pain, treatment preferences and care practices were linked only in the older group. For older patients, preference for life-extending treatment was associated with more therapeutic interventions and more documented discussions; cardiopulmonary resuscitation (CPR) preference was linked to more therapeutic interventions and longer survival. For middle-aged patients, better perceived quality of life was associated with preferring CPR. In both groups, patients' higher survival estimates were associated with preferences for life-prolonging treatment and CPR; physicians' higher survival estimates were associated with patients' preferences for CPR, fewer documented treatment limitation discussions about care, and actual 6-month survival. More discussions were associated with readmissions and earlier death. More aggressive care was not related to outcomes. CONCLUSION: Fewer older patients preferred CPR or life-prolonging treatments. Although older patients' goals for aggressive treatment were related to care, this was not so for middle-aged patients. Aggressive care was not related to prolonged life in either group.

Authors
Rose, JH; O'Toole, EE; Dawson, NV; Lawrence, R; Gurley, D; Thomas, C; Hamel, MB; Cohen, HJ
MLA Citation
Rose, JH, O'Toole, EE, Dawson, NV, Lawrence, R, Gurley, D, Thomas, C, Hamel, MB, and Cohen, HJ. "Perspectives, preferences, care practices, and outcomes among older and middle-aged patients with late-stage cancer." J Clin Oncol 22.24 (December 15, 2004): 4907-4917.
PMID
15520054
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
22
Issue
24
Publish Date
2004
Start Page
4907
End Page
4917
DOI
10.1200/JCO.2004.06.050

Effects of cancer history and comorbid conditions on mortality and healthcare use among older cancer survivors.

BACKGROUND: Older cancer survivors use healthcare services to an increased extent relative to their counterparts who have no history of malignant disease. In the current study, the authors set out to assess the effects of cancer history and comorbid conditions on healthcare use and mortality. METHODS: Using information from the 1992 North Carolina Established Populations for Epidemiologic Study of the Elderly database, study participants were classified as having no history of malignant disease or as having a recent (cancer diagnosed < 1 year earlier), intermediate (cancer diagnosed 1-6 years earlier), or remote (cancer diagnosed > 6 years earlier) history of malignancy. Overall, 15 different comorbid conditions were ascertained. Logistic regression models adjusted for sociodemographic factors, tobacco and alcohol use, and functional measures were used to determine the risk of emergency room, hospital, and nursing home (NH) admission in 1992 and also in 1996 according to history of malignancy and presence of comorbid conditions. Using data from the National Death Registry, a similar controlled analysis of 7-year mortality also was performed. RESULTS: There were 2567 participants in the current study (mean age, 79 years; range, 71-102 years); 69% of all participants were women, 55% were African American, and 14% reported having a history of malignancy. Participants with a history of malignancy had an average of 3 comorbid conditions, and differences across groups in terms of cardiovascular and lung disease incidence were noted. Controlled analyses revealed that recent cancer history (odds ratio [OR], 15.5; 95% confidence interval [CI], 7.0-34.2) and intermediate cancer history (OR, 2.1; 95% CI, 1.4-3.3) were associated with same-year hospital admission. In addition, having a recent history of malignancy in 1992 was found to be correlated with NH admission 4 years later (OR, 3.1; 95% CI, 1.1-9.1). History of malignancy was not associated with mortality. CONCLUSIONS: Cancer history had limited influence on healthcare use and mortality. Efforts aimed at improving health-related outcomes in older cancer survivors should continue to focus on attenuating the impact of comorbid conditions.

Authors
Seo, PH; Pieper, CF; Cohen, HJ
MLA Citation
Seo, PH, Pieper, CF, and Cohen, HJ. "Effects of cancer history and comorbid conditions on mortality and healthcare use among older cancer survivors." Cancer 101.10 (November 15, 2004): 2276-2284.
PMID
15470712
Source
pubmed
Published In
Cancer
Volume
101
Issue
10
Publish Date
2004
Start Page
2276
End Page
2284
DOI
10.1002/cncr.20606

Physical function and associations with diet and exercise: Results of a cross-sectional survey among elders with breast or prostate cancer.

BACKGROUND: Functional decline threatens independent living and is common among individuals diagnosed with cancer, especially those who are elderly. The purpose of this study was to explore whether dietary and exercise practices are associated with physical function status among older cancer survivors. METHODS: Mailed surveys were used to ascertain data on physical function, dietary fat, fruit and vegetable (F&V) consumption, and exercise among elderly diagnosed with early stage (I-II) breast (N = 286) or prostate cancer (N = 402) within the past 18 months. RESULTS: Sixty-one percent of respondents reported diets with <30% of energy from fat, 20.4% reported F&V intakes of 5+ daily servings, and 44.6% reported regular vigorous exercise. Significant, independent associations were found between physical functioning and reported dietary fat intake, F&V consumption, and exercise. A simultaneous multiple regression model controlled for age, race, gender, time since diagnosis and concurrent health behaviors yielded the following estimates: (1) 0.2 increase in the SF-36 physical function subscale (PFS) score with each reported 1% decrease in percent energy from fat (p < .0001); (2) 0.9 increase in the SF-36 PFS score for each reported serving of F&V/day (p = .0049); and (3) 15.4 increase in the SF-36 PFS score with a positive response for regular vigorous exercise (p < .0001). CONCLUSIONS: Results of this cross-sectional survey suggest that regular vigorous exercise and consumption of diets low in fat and rich in F&Vs are associated with higher levels of physical functioning among older cancer survivors. Interventions that promote healthful lifestyle change may deliver considerable benefit within this ever increasing and vulnerable population.

Authors
Demark-Wahnefried, W; Clipp, EC; Morey, MC; Pieper, CF; Sloane, R; Snyder, DC; Cohen, HJ
MLA Citation
Demark-Wahnefried, W, Clipp, EC, Morey, MC, Pieper, CF, Sloane, R, Snyder, DC, and Cohen, HJ. "Physical function and associations with diet and exercise: Results of a cross-sectional survey among elders with breast or prostate cancer. (Published online)" Int J Behav Nutr Phys Act 1.1 (October 29, 2004): 16-.
Website
http://hdl.handle.net/10161/14616
PMID
15516261
Source
pubmed
Published In
International Journal of Behavioral Nutrition and Physical Activity
Volume
1
Issue
1
Publish Date
2004
Start Page
16
DOI
10.1186/1479-5868-1-16

Inpatient care for elderly cancer patients: the role for Geriatric Evaluation and Management Units in fulfilling goals for care.

PURPOSE: To describe patterns of functional status, symptoms, therapeutic goals and outcomes among older adults with cancer diagnoses hospitalized on a Geriatric Evaluation and Management Unit (GEMU). DESIGN AND METHODS: Retrospective chart review of veterans with a cancer diagnosis consecutively admitted to a Department of Veterans Affairs GEMU between 1996 and 1999. RESULTS: Thirty-six veterans with cancer diagnoses, average age of 80+/-5.0 years, 100% men, 50% white, 39% married were admitted during the target period. Comorbid illness was common (mean +/- S.D. = 4.6+/-2.0) as were associated symptoms (mean = 2.5+/-1.9). Average Karnofsky performance status was 55+/-7. Goals were accomplished 78% of the time for diagnosis, 73% for symptom management, 79% for functional improvement, and 100% for disposition/caregiver support. IMPLICATIONS: Elderly oncology patients admitted to a GEMU display diverse needs and goals that are realistic and attainable in this context. In-patient GEMU services represent a promising approach to care for older cancer patients, and deserve further evaluation of benefits and risks.

Authors
Garman, KS; McConnell, ES; Cohen, HJ
MLA Citation
Garman, KS, McConnell, ES, and Cohen, HJ. "Inpatient care for elderly cancer patients: the role for Geriatric Evaluation and Management Units in fulfilling goals for care." Crit Rev Oncol Hematol 51.3 (September 2004): 241-247.
PMID
15331081
Source
pubmed
Published In
Critical Reviews in Oncology/Hematology
Volume
51
Issue
3
Publish Date
2004
Start Page
241
End Page
247
DOI
10.1016/j.critrevonc.2004.03.002

Plasma hypertonicity: another marker of frailty?

OBJECTIVES: To determine whether plasma hypertonicity might be a marker of early frailty, this study tested the associations between plasma hypertonicity, incident disability, and mortality in nondisabled older adults. DESIGN: Longitudinal, observational study. SETTING: Community-based. PARTICIPANTS: Older adults (> or =70), who reported no disability and gave blood in the 1992 Duke Established Populations for Epidemiologic Studies of the Elderly survey (n=705), were re-interviewed in 1996 for functional status (n=561) and followed for all deaths up to January 1, 2000. MEASUREMENTS: Plasma tonicity was estimated from plasma glucose, sodium, and potassium measures and used to classify subjects as normo- (285-294 mOsm/L) or hypertonic (> or =300 mOsm/L). Disability was defined as any impairment on the Rosow-Breslau, activity of daily living (ADL), and instrumental activity of daily living (IADL) scales. The relative risk (RR) of any new disability and relative hazard of death associated with hypertonicity were estimated using logistic regression models and Cox proportional hazards models, respectively. All models were controlled for age, sex, race, weight status, current smoking, activity level, plasma blood urea nitrogen and creatinine, cognitive impairment, depression, and chronic disease status. To determine whether observed effects were attributable to plasma glucose alone, all models were repeated on a subsample of nondiabetic, normoglycemic subjects. RESULTS: Plasma hypertonicity (observed in 15% of subjects) was associated with increased risk of new Rosow-Breslau (RR=2.1, 95% confidence interval (CI)=1.2-3.6), IADL (RR=2.3, 95% CI=1.2-4.3), and ADL (RR=2.7 95% CI=1.3-5.6) disability by 1996 and mortality by 2000 (RR=1.4, 95% CI=1.0-1.9). Results were similar for the normoglycemic subgroup (ADL: RR=2.9, 95% CI=1.0-8.0; IADL: RR=2.5, 95% CI=1.0-6.3; Rosow-Breslau: RR=1.8, 95% CI=0.8-3.9; mortality: RR=1.5, 95% CI=0.9-2.3). CONCLUSION: Plasma hypertonicity may be a marker of early frailty. It was prevalent in this sample of nondisabled community-dwelling older adults and predicted incident disability and mortality. Further research to identify its determinants and consequences may help inform interventions against frailty.

Authors
Stookey, JD; Purser, JL; Pieper, CF; Cohen, HJ
MLA Citation
Stookey, JD, Purser, JL, Pieper, CF, and Cohen, HJ. "Plasma hypertonicity: another marker of frailty?." J Am Geriatr Soc 52.8 (August 2004): 1313-1320.
PMID
15271119
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
52
Issue
8
Publish Date
2004
Start Page
1313
End Page
1320
DOI
10.1111/j.1532-5415.2004.52361.x

Duke University School of Medicine.

Authors
Cohen, HJ; Heflin, MT
MLA Citation
Cohen, HJ, and Heflin, MT. "Duke University School of Medicine." Academic medicine : journal of the Association of American Medical Colleges 79.7 Suppl (July 1, 2004).
Source
scopus
Published In
Academic Medicine
Volume
79
Issue
7 Suppl
Publish Date
2004

Duke University School of Medicine.

Authors
Cohen, HJ; Heflin, MT
MLA Citation
Cohen, HJ, and Heflin, MT. "Duke University School of Medicine." Acad Med 79.7 Suppl (July 2004): S37-S44.
PMID
15240215
Source
pubmed
Published In
Academic Medicine
Volume
79
Issue
7 Suppl
Publish Date
2004
Start Page
S37
End Page
S44

Aging and cancer.

A substantial increase in the number of elderly people in the populations of developed nations in the coming years has been projected. Persons 65 years and older are at significantly higher risk of developing cancer when compared to younger individuals. There is a resulting increase in cancer incidence as well as mortality in this advanced age group. It is important to know how changes in physiological reserve and functional status in elderly patients, polypharmacy issues, comorbidities, and other age-related problems can affect cancer prognosis and management. Elderly patients are not adequately represented in clinical trials, thus creating a relative lack of information related to specific issues about elderly cancer patients and their care. Nevertheless, there is a substantial amount of guidance available, and in this review we will address selected issues of importance when considering the approach to the older cancer patient.

Authors
Misra, D; Seo, PH; Cohen, HJ
MLA Citation
Misra, D, Seo, PH, and Cohen, HJ. "Aging and cancer." Clin Adv Hematol Oncol 2.7 (July 2004): 457-465.
PMID
16163222
Source
pubmed
Published In
Clinical advances in hematology & oncology : H&O
Volume
2
Issue
7
Publish Date
2004
Start Page
457
End Page
465

Geriatric assessment and comorbidity.

Elderly persons, a rapidly growing population segment, have an increased incidence of cancer. The older cancer patient's clinical evaluation and treatment is influenced by conditions such as disabilities, comorbidity, and functional status, along with tumor type and stage. These conditions and other geriatric syndromes can be identified by comprehensive geriatric assessment to guide therapy and affect prognosis and quality of life. Comprehensive geriatric assessment involves the medical, functional, affective, social, spiritual, and environmental assessments. The medical assessment, which includes a nutrition, vision, hearing, continence, gait and balance, and cognition evaluation, can provide additional information to performance status and comorbidity. Although there are many assessment domains using several instruments, comprehensive geriatric assessment can be focused and efficient, especially with a multidisciplinary team of nurses, social workers, pharmacists, and other personnel. Comorbid illnesses may have complex interactions, with the underlying cancer influencing cancer diagnosis, disease course, treatment-related side effects, and mortality. Many instruments are available for comorbidity measurement, and retrospective studies in elderly cancer cohorts have shown comorbidity to influence survival. However, the ultimate aim would be to use comorbidity and comprehensive geriatric assessments prospectively in the older cancer patient to help predict the suitability and success of treatment with various antineoplastic modalities.

Authors
Rao, AV; Seo, PH; Cohen, HJ
MLA Citation
Rao, AV, Seo, PH, and Cohen, HJ. "Geriatric assessment and comorbidity." Semin Oncol 31.2 (April 2004): 149-159.
PMID
15112146
Source
pubmed
Published In
Seminars in Oncology
Volume
31
Issue
2
Publish Date
2004
Start Page
149
End Page
159

Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly.

PURPOSE: To determine if inpatient or outpatient geriatric evaluation and management, as compared with usual care, reduces adverse drug reactions and suboptimal prescribing in frail elderly patients. METHODS: The study employed a randomized 2 x 2 factorial controlled design. Subjects were patients in 11 Veterans Affairs (VA) hospitals who were > or =65 years old and met criteria for frailty (n = 834). Inpatient geriatric unit and outpatient geriatric clinic teams evaluated and managed patients according to published guidelines and VA standards. Patients were followed for 12 months. Blinded physician-pharmacist pairs rated adverse drug reactions for causality (using Naranjo's algorithm) and seriousness. Suboptimal prescribing measures included unnecessary and inappropriate drug use (Medication Appropriateness Index), inappropriate drug use (Beers criteria), and underuse. RESULTS: For serious adverse drug reactions, there were no inpatient geriatric unit effects during the inpatient or outpatient follow-up periods. Outpatient geriatric clinic care resulted in a 35% reduction in the risk of a serious adverse drug reaction compared with usual care (adjusted relative risk = 0.65; 95% confidence interval: 0.45 to 0.93). Inpatient geriatric unit care reduced unnecessary and inappropriate drug use and underuse significantly during the inpatient period (P <0.05). Outpatient geriatric clinic care reduced the number of conditions with omitted drugs significantly during the outpatient period (P <0.05). CONCLUSION: Compared with usual care, outpatient geriatric evaluation and management reduces serious adverse drug reactions, and inpatient and outpatient geriatric evaluation and management reduces suboptimal prescribing, in frail elderly patients.

Authors
Schmader, KE; Hanlon, JT; Pieper, CF; Sloane, R; Ruby, CM; Twersky, J; Francis, SD; Branch, LG; Lindblad, CI; Artz, M; Weinberger, M; Feussner, JR; Cohen, HJ
MLA Citation
Schmader, KE, Hanlon, JT, Pieper, CF, Sloane, R, Ruby, CM, Twersky, J, Francis, SD, Branch, LG, Lindblad, CI, Artz, M, Weinberger, M, Feussner, JR, and Cohen, HJ. "Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly." Am J Med 116.6 (March 15, 2004): 394-401.
PMID
15006588
Source
pubmed
Published In
The American Journal of Medicine
Volume
116
Issue
6
Publish Date
2004
Start Page
394
End Page
401
DOI
10.1016/j.amjmed.2003.10.031

Symptom management in the elderly cancer patient: fatigue, pain, and depression.

Patients who are > or =65 years of age are the fastest growing segment of the U.S. population. These patients with already existing physiologic decline and comorbidities, when diagnosed with cancer, provide considerable challenges in management issues. Along with therapy for the tumor the practicing oncologist must also keep in mind the various symptoms, like fatigue, pain, and depression, that may occur due to the tumor itself or due to therapy. The prevalence of fatigue is greater than 50-70% in advanced cancer. The tools to measure fatigue are all subjective in nature and no one tool has been tested in the elderly cancer patient. Treatment of fatigue in the elderly may involve education, antidepressants, treatment of anemia, exercise, and use of psychostimulants. Pain is present is 80% of elderly patients with advanced cancer. Pain should be assessed in a systematic way and it has been shown that the Visual Descriptor Scale is the tool most preferred by the elderly. Several guidelines for management of pain exist and options include acetaminophen, nonsteroidal anti-inflammatory drugs, opioids, adjuvant analgesics, and education of patients and caregivers. Depression is also a prevalent symptom arising from a variety of causes. There are many validated tools to measure depression in the elderly like the Geriatric Depression Scale. Treatment includes use of education, selective serotonin reuptake inhibitors, psychotherapy, and electroconvulsive therapy. There exists an interplay of many of these symptoms and quite often they can occur simultaneously in the elderly cancer patient. Future research is needed to expand our base of knowledge on the occurrence and management of each of these symptoms and to better understand how aging systems interact with these phenomena to produce unique situations in older adults.

Authors
Rao, A; Cohen, HJ
MLA Citation
Rao, A, and Cohen, HJ. "Symptom management in the elderly cancer patient: fatigue, pain, and depression." J Natl Cancer Inst Monogr 32 (2004): 150-157. (Review)
PMID
15263059
Source
pubmed
Published In
Journal of the National Cancer Institute. Monographs
Issue
32
Publish Date
2004
Start Page
150
End Page
157
DOI
10.1093/jncimonographs/lgh031

Hypertonic hyperglycemia progresses to diabetes faster than normotonic hyperglycemia.

To explore whether elevated plasma glucose might progress to diabetes via a mechanism that involves plasma hypertonicity, we evaluated the independent and joint effects of these variables on diabetes risk. Community-dwelling older adults (70+years), who reported no previous diagnosis of diabetes and had glucose levels below 200 mg/dl in the 1992 Duke EPESE survey, were re-interviewed in 1996 for diabetes status (n = 979). Plasma tonicity at baseline was estimated from serum glucose, sodium, and potassium measures. In logistic regression models that controlled for glucose, as well as age, sex, race, weight status, activity level, serum creatinine, history of heart disease, stroke and cancer, plasma hypertonicity (> or = 300 mOsm/l) was independently associated with increased odds of developing diabetes (OR = 2.0, 95% CI: 0.9-4.2). Hypertonicity magnified the effects of elevated glucose (> or = 125 mg/dl), such that individuals with both exposures were over four times more likely to develop diabetes than those with elevated glucose only (OR = 4.9, 95%CI: 1.7-14.3), adjusting for all covariates. When tonicity was replaced by its determinant variables, glucose, sodium and potassium, in the multivariable models, independent effects of sodium were also observed. Further work is needed to pursue plasma hypertonicity as a factor in the progression of elevated plasma glucose to diabetes.

Authors
Stookey, JD; Pieper, CF; Cohen, HJ
MLA Citation
Stookey, JD, Pieper, CF, and Cohen, HJ. "Hypertonic hyperglycemia progresses to diabetes faster than normotonic hyperglycemia." Eur J Epidemiol 19.10 (2004): 935-944.
PMID
15575352
Source
pubmed
Published In
European Journal of Epidemiology
Volume
19
Issue
10
Publish Date
2004
Start Page
935
End Page
944

Function in elderly cancer survivors depends on comorbidities.

BACKGROUND: Factors associated with functional status in elderly cancer survivors, in particular, comorbidity, have been inadequately studied. METHODS: Of 4162 participants aged 65 and older enrolled in the Duke Established Populations for Epidemiologic Studies of the Elderly study in 1986, 376 of the participants self-reported a diagnosis of cancer. Participants were divided into 2 comorbidity groups and 4 cancer groups. Cancer groups included 132 participants diagnosed 0-4 years ago, 117 diagnosed 5-15 years ago, 127 diagnosed >15 years ago, and 3784 participants who had never been diagnosed with cancer. Comorbidity (self-reported stroke, diabetes, hypertension, and myocardial infarction) was classified as presence of 1 or no comorbidities (n = 3089) or 2 or more comorbidities (n = 1073). Function was assessed by Katz Activities of Daily Living, Rosow-Breslau, Nagi, and Instrumental Activities of Daily Living scales at the time of interview. RESULTS: In a two-way analysis of covariance model of comorbidity and cancer group controlling for age, race, sex, education, marital status, depression, and cognitive status, duration of cancer survivorship does not influence most measures of function. In the subset of 376 cancer survivors, comorbidity significantly correlates with the functional status of these older cancer survivors (<0.02, for all 4 measures of function). CONCLUSIONS: In the older cancer survivor, regardless of duration following diagnosis, the presence of comorbidity rather than the history of cancer per se correlates with impaired functional status.

Authors
Garman, KS; Pieper, CF; Seo, P; Cohen, HJ
MLA Citation
Garman, KS, Pieper, CF, Seo, P, and Cohen, HJ. "Function in elderly cancer survivors depends on comorbidities." J Gerontol A Biol Sci Med Sci 58.12 (December 2003): M1119-M1124.
PMID
14684709
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
58
Issue
12
Publish Date
2003
Start Page
M1119
End Page
M1124

The origin of the word geriatrics.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "The origin of the word geriatrics." J Am Geriatr Soc 51.11 (November 2003): 1676-1677. (Letter)
PMID
14687409
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
51
Issue
11
Publish Date
2003
Start Page
1676
End Page
1677

Cross-linked fibrin degradation products (D-dimer), plasma cytokines, and cognitive decline in community-dwelling elderly persons.

OBJECTIVES: To investigate the effect of coagulation and inflammatory pathway activation on future cognitive decline in older persons. DESIGN: Prospective cohort study. SETTING: Rural and urban communities in North Carolina. PARTICIPANTS: Community-dwelling older people enrolled in the Duke Established Populations for Epidemiologic Studies of the Elderly in 1986. MEASUREMENTS: In 1992, blood was drawn for assay of D-dimer (1,723 subjects), Interleukin-6 (1,726 subjects), and other cytokines (1,551 subjects). Cognitive and functional assessments were performed in 1986, 1989, 1992, and 1996. Cognition was measured using the Short Portable Mental Status Questionnaire. RESULTS: Cognitive decline over a 4-year period was significantly correlated (P<.001) with D-dimer, age, race, and physical performance status as measured using the Rosow-Breslau and Nagi instruments. After controlling for demographics, functional status, and comorbidities, D-dimer remained predictive of cognitive decline. Proinflammatory cytokines were not associated with current cognitive status in cross-sectional analyses or with incident cognitive decline in prospective analyses. CONCLUSION: In a large sample of community-dwelling elders, higher levels of D-dimer were predictive of cognitive decline over a 4-year period. No clinically significant associations were found between age-related peripheral cytokine dysregulation and cognition.

Authors
Wilson, CJ; Cohen, HJ; Pieper, CF
MLA Citation
Wilson, CJ, Cohen, HJ, and Pieper, CF. "Cross-linked fibrin degradation products (D-dimer), plasma cytokines, and cognitive decline in community-dwelling elderly persons." J Am Geriatr Soc 51.10 (October 2003): 1374-1381.
PMID
14511156
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
51
Issue
10
Publish Date
2003
Start Page
1374
End Page
1381

An overview of variance inflation factors for sample-size calculation.

For power and sample-size calculations, most practicing researchers rely on power and sample-size software programs to design their studies. There are many factors that affect the statistical power that, in many situations, go beyond the coverage of commercial software programs. Factors commonly known as design effects influence statistical power by inflating the variance of the test statistics. The authors quantify how these factors affect the variances so that researchers can adjust the statistical power or sample size accordingly. The authors review design effects for factorial design, crossover design, cluster randomization, unequal sample-size design, multiarm design, logistic regression, Cox regression, and the linear mixed model, as well as missing data in various designs. To design a study, researchers can apply these design effects, also known as variance inflation factors to adjust the power or sample size calculated from a two-group parallel design using standard formulas and software.

Authors
Hsieh, FY; Lavori, PW; Cohen, HJ; Feussner, JR
MLA Citation
Hsieh, FY, Lavori, PW, Cohen, HJ, and Feussner, JR. "An overview of variance inflation factors for sample-size calculation." Eval Health Prof 26.3 (September 2003): 239-257. (Review)
PMID
12971199
Source
pubmed
Published In
Evaluation & the Health Professions
Volume
26
Issue
3
Publish Date
2003
Start Page
239
End Page
257
DOI
10.1177/0163278703255230

Barriers to clinical trial participation by older women with breast cancer.

PURPOSE: Although 48% of breast cancer patients are 65 years old or older, these older patients are severely underrepresented in breast cancer clinical trials. This study tested whether older patients were offered trials significantly less often than younger patients and whether older patients who were offered trials were more likely to refuse participation than younger patients. PATIENTS AND METHODS: In 10 Cancer and Leukemia Group B institutions, using a retrospective case-control design, breast cancer patients eligible for an open treatment trial were paired: less than 65 years old and > or = 65 years old. Each of the 77 pairs were matched by disease stage and treating physician. Patients were interviewed as to their reasons for participating or refusing to participate in a trial. The treating physicians were also given questionnaires about their reasons for offering or not offering a trial. RESULTS: Sixty-eight percent of younger stage II patients were offered a trial compared with 34% of the older patients (P =.0004). In multivariate analyses, disease stage and age remained highly significant in predicting trial offering (P =.0008), when controlling for physical functioning and comorbidity. Of those offered a trial, there was no significant difference in participation between younger (56%) and older (50%) patients (P =.67). CONCLUSION: In a multivariate analysis including comorbid conditions, age and stage were the only predictors of whether a patient was offered a trial. The greatest impediment to enrolling older women onto trials in the setting of this study was the physicians' perceptions about age and tolerance of toxicity.

Authors
Kemeny, MM; Peterson, BL; Kornblith, AB; Muss, HB; Wheeler, J; Levine, E; Bartlett, N; Fleming, G; Cohen, HJ
MLA Citation
Kemeny, MM, Peterson, BL, Kornblith, AB, Muss, HB, Wheeler, J, Levine, E, Bartlett, N, Fleming, G, and Cohen, HJ. "Barriers to clinical trial participation by older women with breast cancer." J Clin Oncol 21.12 (June 15, 2003): 2268-2275.
PMID
12805325
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
21
Issue
12
Publish Date
2003
Start Page
2268
End Page
2275
DOI
10.1200/JCO.2003.09.124

Leading the Way in Exercise and Diet (Project LEAD): intervening to improve function among older breast and prostate cancer survivors.

The U.S. population is aging, bringing with it an increased prevalence of chronic disease and concomitant declines in physical function. The risk of developing cancer increases significantly with age, and functional decline is much more likely once a cancer diagnosis is rendered. Thus, functional status in later life is a key concern, one that is heightened among elders who have been diagnosed with cancer. To date, however, there have been few trials that have exclusively addressed issues related to cancer survivorship among older cancer patients, and to our knowledge, none has focused on preserving or enhancing physical functioning. This paper describes the study design and methodological considerations of a randomized controlled trial to determine if a personally tailored workbook and telephone counseling program can positively affect physical activity and dietary behaviors and ultimately the physical functioning of up to 420 older men and women newly diagnosed with breast or prostate cancer. This trial is unique because the cancer diagnosis is used not only as a marker of risk for functional decline, but also as a "teachable moment" - an opportune time when elders may be more receptive to making beneficial lifestyle changes. Undoubtedly, as cure rates for cancer increase and intersect with ever-growing numbers of elderly, there will be numerous opportunities to provide and test interventions within this vulnerable population and to target functional status as a primary outcome. In reporting our methods, we hope to give others "a leg up," so that they can hurdle with greater ease the barriers we experienced, and thus advance the field more rapidly.

Authors
Demark-Wahnefried, W; Morey, MC; Clipp, EC; Pieper, CF; Snyder, DC; Sloane, R; Cohen, HJ
MLA Citation
Demark-Wahnefried, W, Morey, MC, Clipp, EC, Pieper, CF, Snyder, DC, Sloane, R, and Cohen, HJ. "Leading the Way in Exercise and Diet (Project LEAD): intervening to improve function among older breast and prostate cancer survivors." Control Clin Trials 24.2 (April 2003): 206-223.
PMID
12689742
Source
pubmed
Published In
Controlled Clinical Trials
Volume
24
Issue
2
Publish Date
2003
Start Page
206
End Page
223

Anemia in the elderly: clinical impact and practical diagnosis.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Anemia in the elderly: clinical impact and practical diagnosis." J Am Geriatr Soc 51.3 Suppl (March 2003): S1-.
PMID
12588564
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
51
Issue
3 Suppl
Publish Date
2003
Start Page
S1

Coagulation and activation of inflammatory pathways in the development of functional decline and mortality in the elderly.

PURPOSE: This study was performed to determine the effects of markers of inflammation (interleukin 6) and coagulation (D-dimer) on mortality and functional status in older persons. METHODS: Subjects were selected for the Duke Established Populations for Epidemiologic Studies of the Elderly. In 1992, 2569 subjects (age >71 years) were interviewed, of whom 1,723 had interleukin-6 and D-dimer measurements. Values of interleukin 6 and D-dimer were categorized into quartiles. Outcomes were mortality (through 5 years) and functional status (through 4 years). Relative risks were estimated with proportional hazards models that adjusted for potential confounders. RESULTS: The relative risk of mortality was 1.28 (95% confidence interval [CI]: 0.98 to 1.69; P = 0.06) for those with only interleukin-6 levels in the highest quartile, 1.53 (95% CI: 1.18 to 1.97; P = 0.001) for subjects with only D-dimer levels in the highest quartile, and 2.00 (95% CI: 1.53 to 2.62; P = 0.0001) for those with levels of both in the highest quartile, as compared with those who were not in either of the highest quartiles. Those with high interleukin-6 and high D-dimer levels had the greatest declines in all measures of function. CONCLUSION: Activation of the coagulation and inflammatory pathways is associated with mortality and decline in function, and may be part of the explanation for the development of a frailty phenotype in the elderly.

Authors
Cohen, HJ; Harris, T; Pieper, CF
MLA Citation
Cohen, HJ, Harris, T, and Pieper, CF. "Coagulation and activation of inflammatory pathways in the development of functional decline and mortality in the elderly." Am J Med 114.3 (February 15, 2003): 180-187.
PMID
12637131
Source
pubmed
Published In
The American Journal of Medicine
Volume
114
Issue
3
Publish Date
2003
Start Page
180
End Page
187

Cancer in the elderly: To screen or not to screen? [3] (multiple letters)

Authors
Capurso, S; Gambassi, G; Bernabei, R; Heflin, MT; Oddone, EZ; Pieper, CF; Burchett, BM; Cohen, HJ
MLA Citation
Capurso, S, Gambassi, G, Bernabei, R, Heflin, MT, Oddone, EZ, Pieper, CF, Burchett, BM, and Cohen, HJ. "Cancer in the elderly: To screen or not to screen? [3] (multiple letters)." Journal of the American Geriatrics Society 51.12 (2003): 1816-1817.
PMID
14687368
Source
scival
Published In
Journal of the American Geriatrics Society
Volume
51
Issue
12
Publish Date
2003
Start Page
1816
End Page
1817

Anemia in the elderly: Clinical impact and practical diagnosis

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Anemia in the elderly: Clinical impact and practical diagnosis." Journal of the American Geriatrics Society 51.3 SUPPL. (2003): S1-.
Source
scival
Published In
Journal of the American Geriatrics Society
Volume
51
Issue
3 SUPPL.
Publish Date
2003
Start Page
S1

Cytokines and cognition--the case for a head-to-toe inflammatory paradigm.

The brain is not only immunologically active of its own accord, but also has complex peripheral immune interactions. Given the central role of cytokines in neuroimmmunoendocrine processes, it is hypothesized that these molecules influence cognition via diverse mechanisms. Peripheral cytokines penetrate the blood-brain barrier directly via active transport mechanisms or indirectly via vagal nerve stimulation. Peripheral administration of certain cytokines as biological response modifiers produces adverse cognitive effects in animals and humans. There is abundant evidence that inflammatory mechanisms within the central nervous system (CNS) contribute to cognitive impairment via cytokine-mediated interactions between neurons and glial cells. Cytokines mediate cellular mechanisms subserving cognition (e.g., cholinergic and dopaminergic pathways) and can modulate neuronal and glial cell function to facilitate neuronal regeneration or neurodegeneration. As such, there is a growing appreciation of the role of cytokine-mediated inflammatory processes in neurodegenerative diseases such as Alzheimer's disease and vascular dementia. Consistent with their involvement as mediators of bidirectional communication between the CNS and the peripheral immune system, cytokines play a key role in the hypothalamic-pituitary-adrenal axis activation seen in stress and depression. In addition, complex cognitive systems such as those that underlie religious beliefs, can modulate the effects of stress on the immune system. Indirect means by which peripheral or central cytokine dysregulation could affect cognition include impaired sleep regulation, micronutrient deficiency induced by appetite suppression, and an array of endocrine interactions. Given the multiple levels at which cytokines are capable of influencing cognition it is plausible that peripheral cytokine dysregulation with advancing age interacts with cognitive aging.

Authors
Wilson, CJ; Finch, CE; Cohen, HJ
MLA Citation
Wilson, CJ, Finch, CE, and Cohen, HJ. "Cytokines and cognition--the case for a head-to-toe inflammatory paradigm." J Am Geriatr Soc 50.12 (December 2002): 2041-2056. (Review)
PMID
12473019
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
50
Issue
12
Publish Date
2002
Start Page
2041
End Page
2056

The effect of comorbid illness on receipt of cancer screening by older people.

OBJECTIVES: To identify associations between the type and number of diagnoses and receipt of screening for breast, cervical, and colorectal cancer by older people. DESIGN: Sixth annual follow-up of a community-based survey with 4,162 participants aged 65 and older at baseline in 1986. SETTING: Piedmont area of North Carolina. PARTICIPANTS: Two thousand two hundred twenty-five subjects with a mean age of 79 who responded in 1992. MEASUREMENTS: Self-reported receipt of clinical breast examination, mammography, Papanicolaou (Pap) smear, and fecal occult blood testing (FOBT) within the 2 years before the survey. RESULTS: Hip fracture was associated with lower rates of mammography (odds ratio (OR) = 0.53, 95% confidence interval (CI) = 0.32-0.87) and cognitive impairment with lower rates of FOBT (OR = 0.71, 95% CI = 0.54-0.94). Hypertension was associated with higher rates of breast examination (OR = 1.56, 95% CI = 1.18-2.07), Pap smear (OR = 1.41, 95% CI = 1.09-1.83), and FOBT (OR = 1.37, 95% CI = 1.12-1.66) and a trend toward increasing rates of mammography (OR = 1.28, 95% CI = 0.98-1.69). The presence of three or more comorbid conditions was associated with an increased rate of mammography (OR = 1.35, 95% CI = 1.06-1.71), breast examination (OR = 1.46, 95% CI = 1.12-1.89), and Pap smear (OR = 1.31, 95% CI = 1.04-1.65). CONCLUSIONS: With few exceptions, the presence of comorbid conditions is not associated with a decreased rate of receipt of screening. In fact, hypertension and the presence of a higher number of comorbid conditions are associated with a higher rate of receipt of cancer screening. This finding may be due to an increase in the frequency of office visits increasing the opportunity for cancer screening.

Authors
Heflin, MT; Oddone, EZ; Pieper, CF; Burchett, BM; Cohen, HJ
MLA Citation
Heflin, MT, Oddone, EZ, Pieper, CF, Burchett, BM, and Cohen, HJ. "The effect of comorbid illness on receipt of cancer screening by older people." J Am Geriatr Soc 50.10 (October 2002): 1651-1658.
PMID
12366618
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
50
Issue
10
Publish Date
2002
Start Page
1651
End Page
1658

Survey of oncologists' perceptions of barriers to accrual of older patients with breast carcinoma to clinical trials.

BACKGROUND: Prior research has documented the under-representation in clinical trials of older patients with cancer. In part of a larger study to test the magnitude of these barriers to entering eligible older patients with carcinoma of the breast into clinical trials (Cancer and Leukemia Group B [CALGB] trial 9670), barriers to accruing eligible older patients to clinical trials were obtained from the physician's perspective. METHODS: One hundred fifty-six physicians (85% oncologists) who treated patients with breast carcinoma at 10 CALGB institutions completed a questionnaire concerning what they perceived as barriers to enrolling older patients with breast carcinoma on clinical trials and possible interventions that may improve accrual. RESULTS: Physicians' perceptions of the most important barriers to accrual of older patients were: 1) elderly patients have significant comorbid conditions that are not excluded by the protocol but that may affect how they would respond to treatment (16%); elderly patients have difficulty understanding what is required in a complicated treatment trial, resulting in poor compliance (16%); treatment toxicity (14%); and elderly patients often do not meet the eligibility criteria (15%). Oncologists most frequently suggested that the most effective interventions for improving the accrual of elderly patients to trials included making personnel available in the clinic to explain clinical trials to older patients and their families (25%) and providing physicians with educational materials concerning treatment toxicity in the elderly (18%). CONCLUSIONS: Physicians viewed barriers to accruing older patients with breast carcinoma to clinical trials as multidimensional, with the most important involving protocol requirements, treatment specific issues, and older patients' medical and cognitive characteristics. Thus, a variety of interventions would be needed to improve accrual of older patients to clinical trials, including increasing physicians' knowledge concerning treatment toxicity in the elderly, simplifying protocol requirements, and reducing treatment toxicity.

Authors
Kornblith, AB; Kemeny, M; Peterson, BL; Wheeler, J; Crawford, J; Bartlett, N; Fleming, G; Graziano, S; Muss, H; Cohen, HJ; Cancer and Leukemia Group B,
MLA Citation
Kornblith, AB, Kemeny, M, Peterson, BL, Wheeler, J, Crawford, J, Bartlett, N, Fleming, G, Graziano, S, Muss, H, Cohen, HJ, and Cancer and Leukemia Group B, . "Survey of oncologists' perceptions of barriers to accrual of older patients with breast carcinoma to clinical trials." Cancer 95.5 (September 1, 2002): 989-996.
PMID
12209681
Source
pubmed
Published In
Cancer
Volume
95
Issue
5
Publish Date
2002
Start Page
989
End Page
996
DOI
10.1002/cncr.10792

Functional status and the elderly cancer patient.

Evaluation of functional status plays a unique role in the assessment of older cancer patients. While performance status has been the traditional method for oncologists to assess the impact of a cancer patient's disease, older cancer patients may require a more thorough evaluation of their functional status. Evaluation of functional status provides information that can predict outcomes and may provide information that can be utilized to improve function. Functional status evaluation can be useful throughout the patient's illness, at the initial diagnostic evaluation, for determining appropriate therapies, for the monitoring of therapeutic effect and finally in the palliative phase. There are many different methods available to assess functional status. Individual assessment of functional status in the context of a geriatric assessment may be an important component of the care older cancer patients receive.

Authors
Garman, KS; Cohen, HJ
MLA Citation
Garman, KS, and Cohen, HJ. "Functional status and the elderly cancer patient." Crit Rev Oncol Hematol 43.3 (September 2002): 191-208. (Review)
PMID
12270776
Source
pubmed
Published In
Critical Reviews in Oncology/Hematology
Volume
43
Issue
3
Publish Date
2002
Start Page
191
End Page
208

Analysis of age, estimated creatinine clearance and pretreatment hematologic parameters as predictors of fludarabine toxicity in patients treated for chronic lymphocytic leukemia: a CALGB (9011) coordinated intergroup study.

PURPOSE: Fludarabine is a renally excreted agent that is an effective treatment for chronic lymphocytic leukemia (CLL), a disease predominantly of the elderly. We sought to determine whether age, renal function or pretreatment hematologic status predicted toxicity of fludarabine treatment for CLL. METHODS: We evaluated 192 patients with previously untreated B-cell CLL who were entered onto the fludarabine treatment arm (25 mg/m(2) daily for 5 days every 28 days) of CALGB study 9011, an intergroup study with participation from SWOG, CTG/NCI-C and ECOG. Patients were required to have serum creatinine within 1.5 times normal. Hematologic indices and infections were recorded during the first 28-day cycle of treatment. A time-to-toxicity endpoint was evaluated over the entire course of fludarabine treatment. Creatinine clearance (CrCl(est)) was estimated using serum creatinine, age and body mass index. RESULTS: The median age was 64 years (range 37-87 years) and median CrCl(est) was 62 ml/min (range 27-162 ml/min, interquartile range 52-79 ml/min). We found no association between age and incidence of hematologic toxicity or infection during the first cycle of treatment. There was a strong association between CrCl(est) and the time-to-toxicity endpoint. Patients with CrCl(est) below 80 ml/min had increased incidence of toxicity during their treatment course ( P<0.0001). Pretreatment anemia, thrombocytopenia and Rai stage were highly associated with the incidence of neutrophil toxicity and grade III/IV hematologic toxicities during the first cycle of treatment ( P<0.0001). CONCLUSIONS: Patient age was not an independent risk factor for fludarabine-related toxicity, but CrCl(est) was associated with time to toxicity.

Authors
Martell, RE; Peterson, BL; Cohen, HJ; Petros, WP; Rai, KR; Morrison, VA; Elias, L; Shepherd, L; Hines, J; Larson, RA; Schiffer, CA; Hurwitz, HI
MLA Citation
Martell, RE, Peterson, BL, Cohen, HJ, Petros, WP, Rai, KR, Morrison, VA, Elias, L, Shepherd, L, Hines, J, Larson, RA, Schiffer, CA, and Hurwitz, HI. "Analysis of age, estimated creatinine clearance and pretreatment hematologic parameters as predictors of fludarabine toxicity in patients treated for chronic lymphocytic leukemia: a CALGB (9011) coordinated intergroup study." Cancer Chemother Pharmacol 50.1 (July 2002): 37-45.
PMID
12111110
Source
pubmed
Published In
Cancer Chemotherapy and Pharmacology
Volume
50
Issue
1
Publish Date
2002
Start Page
37
End Page
45
DOI
10.1007/s00280-002-0443-5

A controlled trial of inpatient and outpatient geriatric evaluation and management.

BACKGROUND: Over the past 20 years, both inpatient units and outpatient clinics have developed programs for geriatric evaluation and management. However, the effects of these interventions on survival and functional status remain uncertain. METHODS: We conducted a randomized trial involving frail patients 65 years of age or older who were hospitalized at 11 Veterans Affairs medical centers. After their condition had been stabilized, patients were randomly assigned, according to a two-by-two factorial design, to receive either care in an inpatient geriatric unit or usual inpatient care, followed by either care at an outpatient geriatric clinic or usual outpatient care. The interventions involved teams that provided geriatric assessment and management according to Veterans Affairs standards and published guidelines. The primary outcomes were survival and health-related quality of life, measured with the use of the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36), one year after randomization. Secondary outcomes were the ability to perform activities of daily living, physical performance, utilization of health services, and costs. RESULTS: A total of 1388 patients were enrolled and followed. Neither the inpatient nor the outpatient intervention had a significant effect on mortality (21 percent at one year overall), nor were there any synergistic effects between the two interventions. At discharge, patients assigned to the inpatient geriatric units had significantly greater improvements in the scores for four of the eight SF-36 subscales, activities of daily living, and physical performance than did those assigned to usual inpatient care. At one year, patients assigned to the outpatient geriatric clinics had better scores on the SF-36 mental health subscale, even after adjustment for the score at discharge, than those assigned to usual outpatient care. Total costs at one year were similar for the intervention and usual-care groups. CONCLUSIONS: In this controlled trial, care provided in inpatient geriatric units and outpatient geriatric clinics had no significant effects on survival. There were significant reductions in functional decline with inpatient geriatric evaluation and management and improvements in mental health with outpatient geriatric evaluation and management, with no increase in costs.

Authors
Cohen, HJ; Feussner, JR; Weinberger, M; Carnes, M; Hamdy, RC; Hsieh, F; Phibbs, C; Courtney, D; Lyles, KW; May, C; McMurtry, C; Pennypacker, L; Smith, DM; Ainslie, N; Hornick, T; Brodkin, K; Lavori, P
MLA Citation
Cohen, HJ, Feussner, JR, Weinberger, M, Carnes, M, Hamdy, RC, Hsieh, F, Phibbs, C, Courtney, D, Lyles, KW, May, C, McMurtry, C, Pennypacker, L, Smith, DM, Ainslie, N, Hornick, T, Brodkin, K, and Lavori, P. "A controlled trial of inpatient and outpatient geriatric evaluation and management." N Engl J Med 346.12 (March 21, 2002): 905-912.
PMID
11907291
Source
pubmed
Published In
The New England journal of medicine
Volume
346
Issue
12
Publish Date
2002
Start Page
905
End Page
912
DOI
10.1056/NEJMsa010285

Comprehensive assessment of the elderly cancer patient: the feasibility of self-report methodology.

PURPOSE: Comprehensive geriatric assessment (CGA) has aided the medical community greatly in understanding the quality-of-life issues and functional needs of older patients. With its professional team assessment approach, however, CGA may be time consuming and costly. The goal of the present study was to assess the ability of cancer patients to complete a self-administered CGA and then to characterize cancer patients across multiple domains and age groups. PATIENTS AND METHODS: Two hundred sixty-six male outpatient oncology patients at the Durham Veterans Affairs Medical Center were asked to fill out a survey assessing 10 domains (demographics, comorbid conditions, activities of daily living, functional status, pain, financial well being, social support, emotional state, spiritual well-being, and quality of life). RESULTS: Seventy-six percent of the patients who received their surveys and kept their appointments returned the assessment tool. Older oncology patients had significantly less education (P <.0001), income (P =.05), frequent exercise (P =.01), and chance of being disease free (P =.003) than younger patients. Other findings in older patients were a higher rate of marriage (P =.02), more difficulty in taking medications (P =.05), and less cigarette (P =.03) and alcohol (P =.03) use. Members of all age cohorts reported a sense of social support, with younger patients deriving this more from family and friends than older patients, and older patients deriving social support more from membership in religious communities than younger patients. No differences were found across age groups for number and impact of comorbid illnesses, number of medications, basic and instrumental activities of daily living, pain, overall health rating, financial adequacy, anxiety, depression, and quality of life. CONCLUSION: CGA can be conducted in an outpatient cancer community using a self-report format. Despite the fact that this population varied demographically across age groups and is limited to veterans, this study demonstrated remarkable similarities between younger and older cancer patients in terms of functional status, health states, and quality of life.

Authors
Ingram, SS; Seo, PH; Martell, RE; Clipp, EC; Doyle, ME; Montana, GS; Cohen, HJ
MLA Citation
Ingram, SS, Seo, PH, Martell, RE, Clipp, EC, Doyle, ME, Montana, GS, and Cohen, HJ. "Comprehensive assessment of the elderly cancer patient: the feasibility of self-report methodology." J Clin Oncol 20.3 (February 1, 2002): 770-775.
PMID
11821460
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
20
Issue
3
Publish Date
2002
Start Page
770
End Page
775
DOI
10.1200/JCO.2002.20.3.770

A controlled trial of geriatric evaluation [6] (multiple letters)

Authors
Stuck, AE; Egger, M; Beck, JC; Bernabei, R; Gambassi, G; Carbonin, P; Nikolaus, T; Becker, C; Meuleman, J; Cohen, HJ; Weinberger, M; Feussner, JR
MLA Citation
Stuck, AE, Egger, M, Beck, JC, Bernabei, R, Gambassi, G, Carbonin, P, Nikolaus, T, Becker, C, Meuleman, J, Cohen, HJ, Weinberger, M, and Feussner, JR. "A controlled trial of geriatric evaluation [6] (multiple letters)." New England Journal of Medicine 347.5 (2002): 371-373.
PMID
12151481
Source
scival
Published In
New England Journal of Medicine
Volume
347
Issue
5
Publish Date
2002
Start Page
371
End Page
373
DOI
10.1056/NEJM200208013470518

Inpatient geriatric units and outpatient geriatric clinics improve quality of life, but not survival for frail older adults

Authors
Cohen, H; Feussner, J; Weinberger, M; Carnes, M; Hamdy, R; Hsieh, F; Phibbs, C; Lavori, P; Kominski, GF
MLA Citation
Cohen, H, Feussner, J, Weinberger, M, Carnes, M, Hamdy, R, Hsieh, F, Phibbs, C, Lavori, P, and Kominski, GF. "Inpatient geriatric units and outpatient geriatric clinics improve quality of life, but not survival for frail older adults." Evidence-Based Healthcare 6.4 (2002): 146-147.
Source
scival
Published In
Evidence-Based Healthcare
Volume
6
Issue
4
Publish Date
2002
Start Page
146
End Page
147
DOI
10.1054/ebhc.2002.0538

Comparison of methods for detecting potential adverse drug events in frail elderly inpatients and outpatients.

Authors
Hanlon, JT; Maher, RL; Lindblad, CI; Ruby, CM; Twersky, J; Cohen, HJ; Schmader, KE
MLA Citation
Hanlon, JT, Maher, RL, Lindblad, CI, Ruby, CM, Twersky, J, Cohen, HJ, and Schmader, KE. "Comparison of methods for detecting potential adverse drug events in frail elderly inpatients and outpatients." Am J Health Syst Pharm 58.17 (September 1, 2001): 1622-1626.
PMID
11556656
Source
pubmed
Published In
American Journal of Health-System Pharmacy
Volume
58
Issue
17
Publish Date
2001
Start Page
1622
End Page
1626

Accuracy of self-reported stroke among elderly veterans.

The objective was to use secondary analysis of prevalence data from a prospective cohort study to ascertain the accuracy of self-reported stroke among veterans. The study comprised a community-dwelling population of 88 elderly veterans (from five counties in the Northern Piedmont of North Carolina, USA) who received health care at the local Veterans Health Administration (VHA) medical center and were respondents at the North Carolina site of the NIH-funded Established Populations for Epidemiologic Studies of the Elderly (EPESE) project. Self-report of stroke from the baseline interview of the EPESE project; and occurrence of stroke as verified by the national VHA hospital discharge database and the patients' medical records was measured. Results showed that self-report of stroke had a sensitivity of 86% and a specificity of 100%; the predictive value of a positive report was 100%. Veterans' self-reports of stroke are sufficiently accurate to use in preliminary epidemiological studies and health services research of cerebrovascular disease.

Authors
Horner, RD; Cohen, HJ; Blazer, DG
MLA Citation
Horner, RD, Cohen, HJ, and Blazer, DG. "Accuracy of self-reported stroke among elderly veterans." Aging Ment Health 5.3 (August 2001): 275-281.
PMID
11575067
Source
pubmed
Published In
Aging & Mental Health
Volume
5
Issue
3
Publish Date
2001
Start Page
275
End Page
281
DOI
10.1080/13607860120065041

Cancer screening in the elderly.

A number of disease- and patient-specific factors need to be taken into account when cancer screening is considered in an older patient. They include the impact of aging on the cancer's biology and screening test performance, the patient's remaining years of life and candidacy for further diagnostic testing and available therapies, potential barriers to compliance with screening, and the patient's values and preferences about the screening.

Authors
Heflin, MT; Cohen, HJ
MLA Citation
Heflin, MT, and Cohen, HJ. "Cancer screening in the elderly." Hosp Pract (1995) 36.3 (March 15, 2001): 61-69. (Review)
PMID
11263800
Source
pubmed
Published In
Hospital practice (1995)
Volume
36
Issue
3
Publish Date
2001
Start Page
61
End Page
69

Considerations of psychosocial illness phase in cancer survival.

Rarely are biomedical, clinical and psychosocial data considered simultaneously as influences on cancer patient outcomes. This study utilized medical record and interview data from 152 adult cancer patients with various tumor types in a model of survival estimation. Predictors included disease stage of the neoplasm (TNM stage), clinical functioning of the patient (Karnofsky performance status), and psychosocial demands of the disease course (psychosocial illness phase). Psychosocial illness phase captures developmental time phases of illness (i.e. 'crisis', 'early chronic', 'late chronic' and 'terminal'), essentially locating patients along the disease course relative to treatment and treatment response. The analysis utilized the Kaplan-Meier (product-limit) method to estimate stratum specific survival functions. Model comparisons employed the differences in the likelihood ratio chi-squares between nested models, and Cox proportional hazard models assisted in explaining the effects of the predictors on survival times. Results indicate that psychosocial illness phase makes an independent contribution to survival time estimation (p<0.05) when all three dimensions are considered simultaneously.

Authors
Clipp, EC; Hollis, DR; Cohen, HJ
MLA Citation
Clipp, EC, Hollis, DR, and Cohen, HJ. "Considerations of psychosocial illness phase in cancer survival." Psychooncology 10.2 (March 2001): 166-178.
PMID
11268143
Source
pubmed
Published In
Psycho-Oncology
Volume
10
Issue
2
Publish Date
2001
Start Page
166
End Page
178

In search of the underlying mechanisms of frailty.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "In search of the underlying mechanisms of frailty." J Gerontol A Biol Sci Med Sci 55.12 (December 2000): M706-M708. (Review)
PMID
11129391
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
55
Issue
12
Publish Date
2000
Start Page
M706
End Page
M708

Age, functional status, and racial differences in plasma D-dimer levels in community-dwelling elderly persons.

BACKGROUND: Dysregulation of immunologic and coagulation systems is common in elderly persons and is associated with many diseases of aging. Thrombotic events are a major cause of morbidity and mortality in the elderly population. This study assesses whether D-dimer, a marker of fibrinolytic activity, varies systematically by demographic, health, and functional measures, and derives a prediction model for factors related to D-dimer in a sample of community-dwelling elderly persons. METHODS: D-dimer levels were assessed in a random sample of 1,727 community-dwelling elderly persons from five rural and urban counties in North Carolina in 1992, as part of the Established Populations for the Epidemiologic Studies of the Elderly (Duke University). All subjects were 72 years or older at the time of the blood draw. In addition, all subjects were surveyed yearly by telephone or in person each year from 1986 to 1992 for a variety of health, functional, and social factors. Levels of D-dimer in 1992 were related cross-sectionally to demographics (age, race, education, income, gender, smoking), function (Nagi, Rosow-Breslau, Katz, Older Americans Resources and Services procedures instrumental activities of daily living), life satisfaction and self-rated health, self-reported diseases (heart attack, cancer, stroke, diabetes, and hypertension), and weight change from 1986 to 1992. RESULTS: D-dimer levels increased with increasing age and functional disability. Among the health variables, only high blood pressure was predictive of D-dimer level. D-dimer levels were dramatically higher in blacks. Blacks were nearly four times more likely to have an extreme value of D-dimer (>600 microg/l) than whites when high D-dimer (yes/no) was analyzed, and blacks had an average level that was nearly 40% higher than whites in analyses of the continuous version of the outcome. This racial effect was not substantively affected in multivariable analyses with demographic and socioeconomic variables controlled. Race, age, functional status, current smoking, high blood pressure, and weight loss were related to level of D-dimer, and race, age, and functional status were related to the presence of a high D-dimer level (in the top 10% of the sample). CONCLUSIONS: Black, older, and functionally impaired persons had significantly higher levels of D-dimer in this sample of community-dwelling elderly persons. The findings for race were particularly striking and persisted even after controlling for smoking and other factors known to be related to thrombosis and were not mediated by social factors. This result may contribute to our understanding of the increased levels of thrombotic events found in these groups.

Authors
Pieper, CF; Rao, KM; Currie, MS; Harris, TB; Cohen, HJ
MLA Citation
Pieper, CF, Rao, KM, Currie, MS, Harris, TB, and Cohen, HJ. "Age, functional status, and racial differences in plasma D-dimer levels in community-dwelling elderly persons." J Gerontol A Biol Sci Med Sci 55.11 (November 2000): M649-M657.
PMID
11078094
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
55
Issue
11
Publish Date
2000
Start Page
M649
End Page
M657

Generalists and oncologists show similar care practices and outcomes for hospitalized late-stage cancer patients. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks for Treatment.

OBJECTIVE: The objective of this work was to identify similarities and differences in primary attending physicians' (generalists' versus oncologists') care practices and outcomes for seriously ill hospitalized patients with malignancy. DESIGN: This was a prospective cohort study (SUPPORT project). SETTING: Subjects were recruited from 5 US teaching hospitals; data were gathered from 1989 to 1994. SUBJECTS: Included in the study was a matched sample of 642 hospitalized patients receiving care for non-small-cell lung cancer, colon cancer metastasized to the liver, or multiorgan system failure associated with malignancy with either a generalist or an oncologist as the primary attending physician. MEASUREMENTS: Care practices and patient outcomes were determined from hospital records. Length of survival was identified with the National Death Index. Physicians' perceptions of patient's prognosis, preference for cardiopulmonary resuscitation (CPR), and length of relationship were assessed by interview. A propensity score for receiving care from an oncologist was constructed. After propensity-based matching of patients, practices and outcomes of oncologists' and generalists' patients were assessed through group comparison techniques. RESULTS: Generalist and oncologist attendings showed comparable care practices, including the number of therapeutic interventions, eg, "rescue care" and chemotherapy, and the number of care topics discussed with patients/ families. Length of stay, discharge to supportive care, readmission, total hospital costs, and survival rates were similar. For both physician groups, perception of patients' wish for CPR was associated with rescue care (P < 0.03), and such care was related to higher hospital costs (P < 0.000). Poorer prognostic estimates predicted aggressiveness-of-care discussions by both types of physicians. Length of the patient-doctor relationship was associated with oncologists' care practices. More documented discussion about aggressiveness of care was related to higher hospital costs and shorter survival for patients in both physician groups (P < 0.001). CONCLUSIONS: Generalists and oncologists showed similar care practices and outcomes for comparable hospitalized late-stage cancer patients. Physicians' perceptions about patients' preferences for CPR and prognosis influenced decision making and outcomes for patients in both physician groups. Length of relationship with patients was associated only with oncologists' care practices. Rescue care increased hospital costs but had no effect on patient survival. Future studies should compare physicians' palliative care as well as acute-care practices in both inpatient and ambulatory care settings. Patients' end-of-life quality and interchange between physician groups should also be documented and compared.

Authors
Rose, JH; O'Toole, EE; Dawson, NV; Thomas, C; Connors, AF; Wenger, N; Phillips, RS; Hamel, MB; Reding, DT; Cohen, HJ; Lynn, J
MLA Citation
Rose, JH, O'Toole, EE, Dawson, NV, Thomas, C, Connors, AF, Wenger, N, Phillips, RS, Hamel, MB, Reding, DT, Cohen, HJ, and Lynn, J. "Generalists and oncologists show similar care practices and outcomes for hospitalized late-stage cancer patients. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks for Treatment." Med Care 38.11 (November 2000): 1103-1118.
PMID
11078051
Source
pubmed
Published In
Medical Care
Volume
38
Issue
11
Publish Date
2000
Start Page
1103
End Page
1118

Racial differences in use of cancer prevention services among older Americans.

CONTEXT: Racial differences in receipt of cancer prevention services may be related to poorer outcomes for minorities. Understanding reasons for such differences could help target appropriate interventions. OBJECTIVES: To determine if racial differences exist in the use of cancer prevention services among older blacks and whites and to explore explanatory factors. DESIGN: Sixth follow-up survey of probability sample, four-stage stratified household design with 4,162 at baseline in 1986-1987 and 2,846 surveyed in 1992-1993. SETTING: The Piedmont area of North Carolina. PARTICIPANTS: At time of follow-up survey in 1992-1993 there were 1,486 women and 726 men age >70 years, of whom 1,246 were black and 966 were white. MEASUREMENTS: Self-reported use of Papanicolou (pap) testing, clinical breast examination, mammography, rectal examination, and fecal occult blood testing on a regular basis within the last two years. RESULTS: Compared with older whites, older black persons are less likely to receive pap test (48.1% black vs 56.6% white, P < .001), clinical breast examination (64.6% black vs 69.2% white, P < .007), mammography (30.2% black vs 40.5% white, P < .001), rectal examination (50.2% black vs 62.4% white, P < .001), and fecal occult blood testing (37.5% black vs 46.2% white, P < .001). Effect of race on receipt of cancer prevention services was not significant when levels of education, income, and insurance coverage were considered. CONCLUSION: Racial differences exist in the use of cancer prevention services among older Americans. However, these differences are related to educational, income, and insurance differences between blacks and whites.

Authors
Hegarty, V; Burchett, BM; Gold, DT; Cohen, HJ
MLA Citation
Hegarty, V, Burchett, BM, Gold, DT, and Cohen, HJ. "Racial differences in use of cancer prevention services among older Americans." J Am Geriatr Soc 48.7 (July 2000): 735-740.
PMID
10894310
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
48
Issue
7
Publish Date
2000
Start Page
735
End Page
740

Age differences in care practices and outcomes for hospitalized patients with cancer.

OBJECTIVE: To identify age group differences in care practices and outcomes for seriously ill hospitalized patients with malignancy. DESIGN: Prospective cohort study (SUPPORT project). SETTING: Five United States teaching hospitals; data was gathered between 1989 and 1994. SUBJECTS: Nine hundred twenty five older (age > or = 65 years), 983 middle aged (age = 45-64 years), and 274 younger (age = 18-44 years) hospitalized patients receiving care for non-small cell lung cancer, colon cancer metastasized to the liver, or multi-organ system failure associated with malignancy. MEASUREMENTS: Care practices and patient outcomes were determined from hospital records. Length of survival was identified using the National Death Index. After adjusting for important variables, including severity of illness (i.e., SUPPORT model estimate for 2-month survival, cancer condition), hospital site, selection to intervention and sociodemographic variables, age group differences in care practices and outcomes were identified using general linear models. RESULTS: Older patients with cancer had lower resource utilization during hospitalization (P < .04) and were less likely to receive cancer-related treatments (i.e., chemotherapy, platelet infusions, scheduled intravenous medications) than middle-aged and young-adult patients in the first week of hospitalization (P < or = .01). More care topics were discussed with older patients and their families then with younger patients and their families (P < .001). Length of stay and total hospital costs were lower for older and middle-aged patients than for younger patients. Although more older patients had discussions about transfer to hospice (P < .001), older patients were no more likely to be discharged with supportive care (inpatient hospice or home with home/ hospice care). Older patients died sooner than middle-aged patients (P < .01). CONCLUSIONS: Patient age influenced care decisions and outcomes. Older patients (age > or = 65 years) received less aggressive care, had more discussions about care decisions, and died sooner than younger patients with cancer. Younger patients had longer stays, higher hospital costs, and greater probability of rehospitalization. Although well over half of patients died within 6 months of hospitalization, few patients in any age group were discharged with supportive care. Future studies should examine age differences in palliation, as well as acute care of cancer patients across inpatient and ambulatory care settings and should assess quality of care at the end of life.

Authors
Rose, JH; O'Toole, EE; Dawson, NV; Thomas, C; Connors, AF; Wenger, NS; Phillips, RS; Hamel, MB; Cohen, HJ; Lynn, J
MLA Citation
Rose, JH, O'Toole, EE, Dawson, NV, Thomas, C, Connors, AF, Wenger, NS, Phillips, RS, Hamel, MB, Cohen, HJ, and Lynn, J. "Age differences in care practices and outcomes for hospitalized patients with cancer." J Am Geriatr Soc 48.5 Suppl (May 2000): S25-S32.
PMID
10809453
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
48
Issue
5 Suppl
Publish Date
2000
Start Page
S25
End Page
S32

Calcium channel blockers and cancer.

PURPOSE: We sought to explore the relation that has been previously reported between calcium channel blockers and an increased risk of cancer. SUBJECTS AND METHODS: We followed 3,511 participants, age 65 years or older, in the Duke Established Populations for Epidemiologic Studies of the Elderly for up to 10 years. Information about use of medications was obtained at baseline and 3 and 6 years later. Information about hospitalization for cancer, or death from cancer, was obtained from Health Care Financing Administration data and death certificates. RESULTS: Of the 133 users of calcium channel blockers, 16 (12%) developed cancer, compared with 548 (16%) of 3,378 nonusers (hazard ratio = 0.9; 95% confidence interval, 0.5 to 1.5). Adjusting for baseline and time-dependent covariates, such as race, diabetes, or blood pressure, for dose or class of calcium channel blockers, or for length of follow-up, had no effect. CONCLUSIONS: Use of calcium channel blockers does not appear to be related to cancer risk. Earlier reports showing such a relation may have been the result of chance.

Authors
Cohen, HJ; Pieper, CF; Hanlon, JT; Wall, WE; Burchett, BM; Havlik, RJ
MLA Citation
Cohen, HJ, Pieper, CF, Hanlon, JT, Wall, WE, Burchett, BM, and Havlik, RJ. "Calcium channel blockers and cancer." Am J Med 108.3 (February 15, 2000): 210-215.
PMID
10723975
Source
pubmed
Published In
The American Journal of Medicine
Volume
108
Issue
3
Publish Date
2000
Start Page
210
End Page
215

Clinical research in the older cancer patient.

The opportunities for conducting focused research in older patients with cancer continue to increase and reflect the increasing awareness of the incidence of cancer in older persons. As the population ages, cancer will become more and more a problem of the elderly. Despite the magnitude of this problem, exploration of the unique problems associated with cancer in the aging has only begun. Economic issues, access to care, and the frequency of other serious illness in older patients often make screening and treatment of malignancy in older patients a great challenge. Oncologists and geriatricians must work together to guarantee that appropriate funding is made available for cancer research in the elderly population.

Authors
Muss, HB; Cohen, HJ; Lichtman, SM
MLA Citation
Muss, HB, Cohen, HJ, and Lichtman, SM. "Clinical research in the older cancer patient." Hematol Oncol Clin North Am 14.1 (February 2000): 283-291. (Review)
PMID
10680083
Source
pubmed
Published In
Hematology/Oncology Clinics of North America
Volume
14
Issue
1
Publish Date
2000
Start Page
283
End Page
291

Comorbidity of five chronic health conditions in elderly community residents: determinants and impact on mortality.

BACKGROUND: Comorbidity is common in elderly persons. Its extent, correlates, and life-threatening impact in representative community residents are unclear. METHODS: Self-reported information of physician-diagnosed coronary artery disease (CAD), cerebrovascular disease (CVD), diabetes, and cancer was obtained annually between 1986-87 and 1992-93, and hypertension was obtained triennially from the participants of the Duke Established Populations for Epidemiologic Studies of the Elderly, a stratified multistage sample of 4,126 Black and White community residents aged 65-100, living in a five-county area of North Carolina. Date of death was obtained from death certificates identified through search of the National Death Index. Statistical procedures included descriptive statistics, logistic regression, and survival analysis. RESULTS: Of this sample, 57% reported hypertension, 20% diabetes, 15% CAD, 9% cancer, and 9% CVD; 29% reported none of these conditions, whereas 29% reported two or more. Demographic characteristics were not related to comorbidity with CVD or cancer. Increased education tended to be protective. The effect of age, gender, and race varied with condition. At baseline there was substantial comorbidity among hypertension, CAD, CVD, and diabetes, but not with cancer. Hypertension, CVD, and diabetes were risk factors for CAD, whereas diabetes was a risk factor for CVD. After controlling for demographic characteristics, all health conditions except hypertension were predictive of 6-year mortality, as was the presence of comorbidity. CONCLUSION: We found significant comorbidity in older persons who have hypertension, CAD, CVD, or diabetes; particular risk of developing comorbidity, particularly CAD, among those with hypertension, CVD, and diabetes; and risk of CVD in those with diabetes. With the exception of hypertension, these conditions, and comorbidity per se, are life-threatening.

Authors
Fillenbaum, GG; Pieper, CF; Cohen, HJ; Cornoni-Huntley, JC; Guralnik, JM
MLA Citation
Fillenbaum, GG, Pieper, CF, Cohen, HJ, Cornoni-Huntley, JC, and Guralnik, JM. "Comorbidity of five chronic health conditions in elderly community residents: determinants and impact on mortality." J Gerontol A Biol Sci Med Sci 55.2 (February 2000): M84-M89.
PMID
10737690
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
55
Issue
2
Publish Date
2000
Start Page
M84
End Page
M89

Generalists and oncologists show similar care practices and outcomes for hospitalized late-stage cancer patients

OBJECTIVE. The objective of this work was to identify similarities and differences in primary attending physicians' (generalists' versus oncologists') care practices and outcomes for seriously ill hospitalized patients with malignancy. DESIGN. This was a prospective cohort study (SUPPORT project). SETTING. Subjects were recruited from 5 US teaching hospitals; data were gathered from 1989 to 1994. SUBJECTS. Included in the study was a matched sample of 642 hospitalized patients receiving care for non-small-cell lung cancer, colon cancer metastasized to the liver, or multiorgan system failure associated with malignancy with either a generalist or an oncologist as the primary attending physician. MEASUREMENTS. Care practices and patient outcomes were determined from hospital records. Length of survival was identified with the National Death Index. Physicians' perceptions of patient's prognosis, preference for cardiopulmonary resuscitation (CPR), and length of relationship were assessed by interview. A propensity score for receiving care from an oncologist was constructed. After propensity-based matching of patients, practices and outcomes of oncologists' and generalists' patients were assessed through group comparison techniques. RESULTS. Generalist and oncologist attendings showed comparable care practices, including the number of therapeutic interventions, eg, "rescue care" and chemotherapy, and the number of care topics discussed with patients/ families. Length of stay, discharge to supportive care, readmission, total hospital costs, and survival rates were similar. For both physician groups, perception of patients' wish for CPR was associated with rescue care (P <0.03), and such care was related to higher hospital costs (P <0.000). Poorer prognostic estimates predicted aggressiveness-of-care discussions by both types of physicians. Length of the patient-doctor relationship was associated with oncologists' care practices. More documented discussion about aggressiveness of care was related to higher hospital costs and shorter survival for patients in both physician groups (P <0.001). CONCLUSIONS. Generalists and oncologists showed similar care practices and outcomes for comparable hospitalized late-stage cancer patients. Physicians' perceptions about patients' preferences for CPR and prognosis influenced decision making and outcomes for patients in both physician groups. Length of relationship with patients was associated only with oncologists' care practices. Rescue care increased hospital costs but had no effect on patient survival. Future studies should compare physicians' palliative care as well as acute-care practices in both inpatient and ambulatory care settings. Patients' end-of-life quality and interchange between physician groups should also be documented and compared.

Authors
Rose, JH; O'Toole, EE; Dawson, NV; Thomas, C; Jr, AFC; Wenger, N; Phillips, RS; Hamel, MB; Reding, DT; Cohen, HJ; Lynn, J
MLA Citation
Rose, JH, O'Toole, EE, Dawson, NV, Thomas, C, Jr, AFC, Wenger, N, Phillips, RS, Hamel, MB, Reding, DT, Cohen, HJ, and Lynn, J. "Generalists and oncologists show similar care practices and outcomes for hospitalized late-stage cancer patients." Medical Care 38.11 (2000): 1103-1118.
Source
scival
Published In
Medical Care
Volume
38
Issue
11
Publish Date
2000
Start Page
1103
End Page
1118

Antihypertensive drugs and gastrointestinal hemorrhage: causation or confounding?

Authors
Havlik, RJ; Guralnik, J; Sayer, B; Pahor, M; Cohen, H
MLA Citation
Havlik, RJ, Guralnik, J, Sayer, B, Pahor, M, and Cohen, H. "Antihypertensive drugs and gastrointestinal hemorrhage: causation or confounding?." Gastroenterology 119.5 (2000): 1416-1417.
PMID
11185465
Source
scival
Published In
Gastroenterology
Volume
119
Issue
5
Publish Date
2000
Start Page
1416
End Page
1417

The Lichtman/Skirvin article reviewed

Authors
Seo, PH; Cohen, HJ
MLA Citation
Seo, PH, and Cohen, HJ. "The Lichtman/Skirvin article reviewed." ONCOLOGY 14.12 (2000): 1760-1763.
Source
scival
Published In
Oncology
Volume
14
Issue
12
Publish Date
2000
Start Page
1760
End Page
1763

Age differences in care practices and outcomes for hospitalized patients with cancer

OBJECTIVE: To identify age group differences in care practices and outcomes for seriously ill hospitalized patients with malignancy. DESIGN: Prospective cohort study (SUPPORT project). SETTING: Five United States teaching hospitals; data was gathered between 1989 and 1994. SUBJECTS: Nine hundred twenty five older (age ≥ 65 years), 983 middle aged (age = 45-64 years), and 274 younger (age = 18-44 years) hospitalized patients receiving care for non-small cell lung cancer, colon cancer metastasized to the liver, or multi-organ system failure associated with malignancy. MEASUREMENTS: Care practices and patient outcomes were determined from hospital records. Length of survival was identified using the National Death Index. After adjusting for important variables, including severity of illness (i.e., SUPPORT model estimate for 2-month survival, cancer condition), hospital site, selection to intervention and sociodemographic variables, age group differences in care practices and outcomes were identified using general linear models. RESULTS: Older patients with cancer had lower resource utilization during hospitalization (P < .04) and were less likely to receive cancer-related treatments (i.e., chemotherapy, platelet infusions, scheduled intravenous medications) than middle-aged and young-adult patients in the first week of hospitalization (P ≤ .01). More care topics were discussed with older patients and their families then with younger patients and their families (P < .001). Length of stay and total hospital costs were lower for older and middle-aged patients than for younger patients. Although more older patients had discussions about transfer to hospice (P < .001), older patients were no more likely to be discharged with supportive care (inpatient hospice or home with home/hospice care). Older patients died sooner than middle-aged patients (P < .01). CONCLUSIONS: Patient age influenced care decisions and outcomes. Older patients (age ≥ 65 years) received less aggressive care, had more discussions about care decisions, and died sooner than younger patients with cancer. Younger patients had longer stays, higher hospital costs, and greater probability of rehospitalization. Although well over half of patients died within 6 months of hospitalization, few patients in any age group were discharged with supportive care. Future studies should examine age differences in palliation, as well as acute care of cancer patients across inpatient and ambulatory care settings and should assess quality of care at the end of life.

Authors
Rose, JH; O'Toole, EE; Dawson, NV; Thomas, C; Jr, CAF; Wenger, NS; Phillips, RS; Hamel, MB; Cohen, HJ; Lynn, J
MLA Citation
Rose, JH, O'Toole, EE, Dawson, NV, Thomas, C, Jr, CAF, Wenger, NS, Phillips, RS, Hamel, MB, Cohen, HJ, and Lynn, J. "Age differences in care practices and outcomes for hospitalized patients with cancer." Journal of the American Geriatrics Society 48.5 SUPPL. (2000): S25-S32.
Source
scival
Published In
Journal of the American Geriatrics Society
Volume
48
Issue
5 SUPPL.
Publish Date
2000
Start Page
S25
End Page
S32

Does religious attendance prolong survival? A six-year follow-up study of 3,968 older adults.

METHODS: A probability sample of 3,968 community-dwelling adults aged 64-101 years residing in the Piedmont of North Carolina was surveyed in 1986 as part of the Established Populations for the Epidemiologic Studies of the Elderly (EPESE) program of the National Institutes of Health. Attendance at religious services and a wide variety of sociodemographic and health variables were assessed at baseline. Vital status of members was then determined prospectively over the next 6 years (1986 1992). Time (days) to death or censoring in days was analyzed using a Cox proportional hazards regression model. RESULTS: During a median 6.3-year follow-up period, 1,777 subjects (29.7%) died. Of the subjects who attended religious services once a week or more in 1986 (frequent attenders), 22.9% died compared to 37.4% of those attending services less than once a week (infrequent attenders). The relative hazard (RH) of dying for frequent attenders was 46% less than for infrequent attenders (RH: 0.54, 95% CI 0.48-.0.61), an effect that was strongest in women (RH 0.51, CI 0.434).59) but also present in men (RH 0.63, 95% CI 0.52-0.75). When demographics, health conditions, social connections, and health practices were controlled, this effect remained significant for the entire sample (RH 0.72, 95% CI 0.64-.81), and for both women (RH 0.65, 95% CI 0.554-.76, p<.0001) and men (RH 0.83, 95% CI 0.69-1.00, p=.05). CONCLUSIONS: Older adults, particularly women, who attend religious services at least once a week appear to have a survival advantage over those attending services less frequently.

Authors
Koenig, HG; Hays, JC; Larson, DB; George, LK; Cohen, HJ; McCullough, ME; Meador, KG; Blazer, DG
MLA Citation
Koenig, HG, Hays, JC, Larson, DB, George, LK, Cohen, HJ, McCullough, ME, Meador, KG, and Blazer, DG. "Does religious attendance prolong survival? A six-year follow-up study of 3,968 older adults." J Gerontol A Biol Sci Med Sci 54.7 (July 1999): M370-M376.
PMID
10462170
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
54
Issue
7
Publish Date
1999
Start Page
M370
End Page
M376

Serum IL-6 level and the development of disability in older persons.

BACKGROUND: The serum concentration of interleukin 6 (IL-6), a cytokine that plays a central role in inflammation, increases with age. Because inflammation is a component of many age-associated chronic diseases, which often cause disability, high circulating levels of IL-6 may contribute to functional decline in old age. We tested the hypothesis that high levels of IL-6 predict future disability in older persons who are not disabled. METHODS: Participants at the sixth annual follow-up of the Iowa site of the Established Populations for Epidemiologic Studies of the Elderly aged 71 years or older were considered eligible for this study if they had no disability in regard to mobility or in selected activities of daily living (ADL), and they were re-interviewed 4 years later. Incident cases of mobility-disability and of ADL-disability were identified based on responses at the follow-up interview. Measures of IL-6 were obtained from specimens collected at baseline from the 283 participants who developed any disability and from 350 participants selected randomly (46.9%) from those who continued to be non-disabled. FINDINGS: Participants in the highest IL-6 tertile were 1.76 (95% CI, 1.17-2.64) times more likely to develop at least mobility-disability and 1.62 (95% CI, 1.02-2.60) times more likely to develop mobility plus ADL-disability compared with to the lowest IL-6 tertile. The strength of this association was almost unchanged after adjusting for multiple confounders. The increased risk of mobility-disability over the full spectrum of IL-6 concentration was nonlinear, with the risk rising rapidly beyond plasma levels of 2.5 pg/mL. INTERPRETATION: Higher circulating levels of IL-6 predict disability onset in older persons. This may be attributable to a direct effect of IL-6 on muscle atrophy and/or to the pathophysiologic role played by IL-6 in specific diseases.

Authors
Ferrucci, L; Harris, TB; Guralnik, JM; Tracy, RP; Corti, MC; Cohen, HJ; Penninx, B; Pahor, M; Wallace, R; Havlik, RJ
MLA Citation
Ferrucci, L, Harris, TB, Guralnik, JM, Tracy, RP, Corti, MC, Cohen, HJ, Penninx, B, Pahor, M, Wallace, R, and Havlik, RJ. "Serum IL-6 level and the development of disability in older persons." J Am Geriatr Soc 47.6 (June 1999): 639-646.
PMID
10366160
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
47
Issue
6
Publish Date
1999
Start Page
639
End Page
646

Associations of elevated interleukin-6 and C-reactive protein levels with mortality in the elderly.

PURPOSE: To investigate whether interleukin-6 and C-reactive protein levels predict all-cause and cause-specific mortality in a population-based sample of nondisabled older people. SUBJECTS AND METHODS: A sample of 1,293 healthy, nondisabled participants in the Iowa 65+ Rural Health Study was followed prospectively for a mean of 4.6 years. Plasma interleukin-6 and C-reactive protein levels were measured in specimens obtained from 1987 to 1989. RESULTS: Higher interleukin-6 levels were associated with a twofold greater risk of death [relative risk (RR) for the highest quartile (> or = 3.19 pg/mL) compared with the lowest quartile of 1.9 [95% confidence interval, CI, 1.2 to 3.1]). Higher C-reactive protein levels (> or = 2.78 mg/L) were also associated with increased risk (RR = 1.6; CI, 1.0 to 2.6). Subjects with elevation of both interleukin-6 and C-reactive protein levels were 2.6 times more likely (CI, 1.6 to 4.3) to die during follow-up than those with low levels of both measurements. Similar results were found for cardiovascular and noncardiovascular causes of death, as well as when subjects were stratified by sex, smoking status, and prior cardiovascular disease, and for both early (<2.3 years) and later follow-up. Results were independent of age, sex, body mass index, and history of smoking, diabetes, and cardiovascular disease, as well as known indicators of inflammation including fibrinogen and albumin levels and white blood cell count. CONCLUSIONS: Higher circulating levels of interleukin-6 and C-reactive protein were associated with mortality in this population-based sample of healthy older persons. These measures may be useful for identification of high-risk subgroups for anti-inflammatory interventions.

Authors
Harris, TB; Ferrucci, L; Tracy, RP; Corti, MC; Wacholder, S; Ettinger, WH; Heimovitz, H; Cohen, HJ; Wallace, R
MLA Citation
Harris, TB, Ferrucci, L, Tracy, RP, Corti, MC, Wacholder, S, Ettinger, WH, Heimovitz, H, Cohen, HJ, and Wallace, R. "Associations of elevated interleukin-6 and C-reactive protein levels with mortality in the elderly." Am J Med 106.5 (May 1999): 506-512.
PMID
10335721
Source
pubmed
Published In
The American Journal of Medicine
Volume
106
Issue
5
Publish Date
1999
Start Page
506
End Page
512

Evidence for a black-white crossover in all-cause and coronary heart disease mortality in an older population: the North Carolina EPESE.

OBJECTIVES: This cohort study evaluated racial differences in mortality among Blacks and Whites 65 years and older. METHODS: A total of 4136 men and women (1875 Whites and 2261 Blacks) living in North Carolina were interviewed in 1986 and followed up for mortality until 1994. Hazard ratios (HRs) for all-cause and cause-specific mortality were calculated, with adjustment for sociodemographic and coronary heart disease (CHD) risk factors. RESULTS: Black persons had higher mortality rates than Whites at young-old age (65-80 years) but had significantly lower mortality rates after age 80. Black persons age 80 or older had a significantly lower risk of all-cause mortality (HR of Blacks vs Whites, 0.75; 95% confidence interval [CI] = 0.62, 0.90) and of CHD mortality (HR 0.44: 95% CI = 0.30, 0.66). These differences were not observed for other causes of death. CONCLUSIONS: Racial differences in mortality are modified by age. This mortality crossover could be attributed to selective survival of the healthiest oldest Blacks or to other biomedical factors affecting longevity after age 80. Because the crossover was observed for CHD deaths only, age overreporting by Black older persons seems an unlikely explanation of the mortality differences.

Authors
Corti, MC; Guralnik, JM; Ferrucci, L; Izmirlian, G; Leveille, SG; Pahor, M; Cohen, HJ; Pieper, C; Havlik, RJ
MLA Citation
Corti, MC, Guralnik, JM, Ferrucci, L, Izmirlian, G, Leveille, SG, Pahor, M, Cohen, HJ, Pieper, C, and Havlik, RJ. "Evidence for a black-white crossover in all-cause and coronary heart disease mortality in an older population: the North Carolina EPESE." Am J Public Health 89.3 (March 1999): 308-314.
PMID
10076478
Source
pubmed
Published In
American journal of public health
Volume
89
Issue
3
Publish Date
1999
Start Page
308
End Page
314

Association of interleukin-6 and other biologic variables with depression in older people living in the community.

OBJECTIVES: The prevalence of depression increases with age, as does the prevalence of higher levels of the cytokine interleukin-6 (IL-6). This analysis was performed to determine the association between increased levels of this cytokine and depression in a population-based sample. DESIGN: Cross-sectional cohort study. SETTING: Rural and urban counties in North Carolina. PARTICIPANTS: Community-dwelling older people. MEASUREMENTS: The association between IL-6 and other biologic variables with self-report depression was examined in 1686 persons aged 70 years and older in the third in-person survey wave (1991) of the Duke Established Population for Epidemiologic Studies of the Elderly (EPESE). Bivariate associations were established by the Spearman correlation, adjusted for age. A stepwise linear logistic regression model was used to derive a final model to assess multivariable effects on CES-D scores. RESULTS: Depression was correlated with IL-6 (P = .011), D-Dimer (P = .017), alpha-1-globulin (P = .023), alpha-2-globulin (P = .002), and beta globulin (P = .012). After controlling for age, race, and gender, IL-6 levels remained the only biologic variable significantly associated with depression (P = .035). CONCLUSION: These data suggest that the inflammatory marker, IL-6, is associated with depression in older people in this cross-sectional study. These results are compatible with the hypothesis of cytokine (IL-6) stimulation in geriatric depression as part of an overall immunoendocrine dysregulation.

Authors
Dentino, AN; Pieper, CF; Rao, MK; Currie, MS; Harris, T; Blazer, DG; Cohen, HJ
MLA Citation
Dentino, AN, Pieper, CF, Rao, MK, Currie, MS, Harris, T, Blazer, DG, and Cohen, HJ. "Association of interleukin-6 and other biologic variables with depression in older people living in the community." J Am Geriatr Soc 47.1 (January 1999): 6-11.
PMID
9920223
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
47
Issue
1
Publish Date
1999
Start Page
6
End Page
11

Benzodiazepine use and cognitive function among community-dwelling elderly.

OBJECTIVE: To evaluate the relation between benzodiazepine use and cognitive function among community-dwelling elderly. METHODS: This prospective cohort study included 2765 self-reporting subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly. The subjects were cognitively intact at baseline (1986-1987) and alive at follow-up data collection 3 years later. Cognitive function was assessed with the Short Portable Mental Status Questionnaire (unimpaired versus impaired and change in score) and on the basis of the number of errors on the individual domains of the Orientation-Memory-Concentration Test. Benzodiazepine use was determined during in-home interviews and classified by dose, half-life, and duration. Covariates included demographic characteristics, health status, and health behaviors. RESULTS: After control for covariates, current users of benzodiazepine made more errors on the memory test (beta coefficient, 0.35; 95% confidence interval [CI], 0.10 to 0.61) than nonusers. Further assessment of the negative effects on memory among current users suggested a dose response in which users taking the recommended or higher dose made more errors (beta coefficient, 0.57; 95% CI, 0.26 to 0.88) and a duration response in which long-term users made more errors (beta coefficient, 0.39; 95% CI, 0.05 to 0.73) than nonusers. Users of agents with long half-lives and users of agents with short half-lives both had increased memory impairment (beta coefficient, 0.32; 95% CI, 0.01 to 0.64 and beta coefficient, 0.38; 95% CI, 0.02 to 0.75, respectively) relative to nonusers. Previous benzodiazepine use was unrelated to memory problems, and current and previous benzodiazepine use was unrelated to level of cognitive functioning as measured with the other 4 tests. CONCLUSIONS: The results suggested that current benzodiazepine use, especially in recommended or higher doses, is associated with worse memory among community-dwelling elderly.

Authors
Hanlon, JT; Horner, RD; Schmader, KE; Fillenbaum, GG; Lewis, IK; Wall, WE; Landerman, LR; Pieper, CF; Blazer, DG; Cohen, HJ
MLA Citation
Hanlon, JT, Horner, RD, Schmader, KE, Fillenbaum, GG, Lewis, IK, Wall, WE, Landerman, LR, Pieper, CF, Blazer, DG, and Cohen, HJ. "Benzodiazepine use and cognitive function among community-dwelling elderly." Clin Pharmacol Ther 64.6 (December 1998): 684-692.
PMID
9871433
Source
pubmed
Published In
Clinical Pharmacology & Therapeutics (Nature)
Volume
64
Issue
6
Publish Date
1998
Start Page
684
End Page
692
DOI
10.1016/S0009-9236(98)90059-5

The relationship between religious activities and cigarette smoking in older adults.

BACKGROUND: The objective of this study was to examine the relationship between religious activities and cigarette smoking in community-dwelling older adults. METHODS: Cigarette smoking and religious activities were assessed in a probability sample of 3968 persons age 65 years or older participating in the Duke Populations for Epidemiologic Studies of the Elderly (EPESE) survey. Participants were asked if they currently smoked, if they ever smoked, and how many cigarettes per day they smoked. Attendance at religious services, participation in private religious activities (prayer or Bible study), and use of religious media (religious TV or radio) were also assessed. Data were available for Waves I-III of the survey (1986, 1989, and 1992). Analyses were controlled for age, race, sex, education, alcohol use, physical health, and in the longitudinal analyses, smoking status at prior waves. RESULTS: Cross-sectional analyses revealed that participants who frequently attended religious services were significantly less likely to smoke cigarettes at all three waves. Likewise, elders frequently involved in private religious activity were less likely to smoke (Waves II and III). Total number of pack-years smoked was also inversely related to both attendance at religious services and private religious activities. Watching religious TV or listening to religious radio, on the other hand, was not related to smoking at Waves I and II nor to total pack-years smoked, but was positively related to current smoking at Wave III. Among those who smoked, number of cigarettes smoked was inversely related to frequency of attendance at religious services (Wave I), private religious activities (Wave III), and religious TV/radio (Waves II and III). Retrospective and prospective analyses revealed that religiously active persons were less likely to ever start smoking, not more likely to quit smoking. CONCLUSIONS: Religiously active persons are less likely to smoke cigarettes, and if they do smoke, smoke fewer cigarettes. Given the association between smoking and disease, and the widespread prevalence of both smoking and religious activity, this finding has implications for public health.

Authors
Koenig, HG; George, LK; Cohen, HJ; Hays, JC; Larson, DB; Blazer, DG
MLA Citation
Koenig, HG, George, LK, Cohen, HJ, Hays, JC, Larson, DB, and Blazer, DG. "The relationship between religious activities and cigarette smoking in older adults." J Gerontol A Biol Sci Med Sci 53.6 (November 1998): M426-M434.
PMID
9823746
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
53
Issue
6
Publish Date
1998
Start Page
M426
End Page
M434

Developing a summary measure of medical status.

Health status surveys and assessments typically obtain detailed information on specific physical health conditions. While such specific details are important, it is frequently also valuable to have a summarized evaluation of medical conditions which can be used to compare subjects, or for statistical analyses. Using data from the Duke Established Populations for Epidemiologic Studies of the Elderly survey, we indicate how to obtain a weighted sum of chronic medical conditions. Like the sum of the same conditions, it explains variance in selected measures of health service use and health status, in some instances making a contribution beyond that of the summed measure. It is a significantly better predictor of mortality within six years.

Authors
Fillenbaum, GG; Leiss, JK; Pieper, CF; Cohen, HJ
MLA Citation
Fillenbaum, GG, Leiss, JK, Pieper, CF, and Cohen, HJ. "Developing a summary measure of medical status." Aging (Milano) 10.5 (October 1998): 395-400.
PMID
9932143
Source
pubmed
Published In
Aging
Volume
10
Issue
5
Publish Date
1998
Start Page
395
End Page
400

Religious activity and depression among community-dwelling elderly persons with cancer: the moderating effect of race.

OBJECTIVES: Research has been oriented toward elucidating the links between religion and mental health. The purpose of this article is to further our knowledge in this area by examining the effect of religious activity on depressive symptomatology among community-dwelling elderly persons with cancer. We also test whether these effects differ between Blacks and Whites. METHODS: We use two waves of data collected from a community-dwelling sample of elderly persons living in North Carolina. Depressive symptomatology is measured using four subscales from the CES-D 20 scale: somatic-retarded activity, depressed affect, positive affect, and interpersonal relations. Measures of religious activity include service attendance, religious devotion, and watching or listening to religious programs. RESULTS: The findings indicate that among Blacks with cancer, religious activity is related to lower levels of depressive symptomatology; no such relationship is found for respondent with other illnesses or no illness. Further, the effects of religious activity are stronger among Blacks than Whites. DISCUSSION: The analyses lend support to the hypothesis that religious activity is a strong predictor of depression in elderly adults with cancer. This finding, however, is not as strong as we had anticipated.

Authors
Musick, MA; Koenig, HG; Hays, JC; Cohen, HJ
MLA Citation
Musick, MA, Koenig, HG, Hays, JC, and Cohen, HJ. "Religious activity and depression among community-dwelling elderly persons with cancer: the moderating effect of race." J Gerontol B Psychol Sci Soc Sci 53.4 (July 1998): S218-S227.
PMID
9679523
Source
pubmed
Published In
Journals of Gerontology: Series B
Volume
53
Issue
4
Publish Date
1998
Start Page
S218
End Page
S227

Racial differences in the prevalence of monoclonal gammopathy in a community-based sample of the elderly.

PURPOSE: To determine if there is an increased prevalence of monoclonal gammopathy in elderly blacks compared with whites, analogous to the difference in incidence of multiple myeloma reported for the two racial groups and to confirm age and gender relationships. PATIENTS AND METHODS: Subjects were from the Duke Established Populations for the Epidemiologic Study of the Elderly, selected on the basis of stratified random household sampling. Blacks were oversampled to allow for increased statistical precision in racial comparisons. In all, 1,732 subjects (aged > 70 years) consented to blood drawing and constitute the sample for this study. Monoclonal immunoglobulins were determined by agarose gel electrophoresis and immunofixation. RESULTS: One hundred six subjects (6.1%) had a monoclonal gammopathy. There was a greater than twofold difference in prevalence between blacks (8.4%) and whites (3.8%) (P < 0.001); monoclonal gammopathy prevalence increased with age, and was greater in men than women. Those with monoclonal gammopathy did not differ from those without in socioeconomic status, urban/rural residence, or education. The presence of monoclonal gammopathy was not associated with any specific diseases nor with impaired functional status. There was a slight increase in serum creatinine levels and decrease in hemoglobin and albumin levels in patients with monoclonal gammopathy, but no difference in interleukin-6 (IL-6) levels. Moreover, IL-6 levels were not correlated significantly with the level of monoclonal protein. CONCLUSION: Prevalence of monoclonal gammopathy is significantly greater among blacks than whites in a community-based sample, in approximately the same ratio that multiple myeloma has been reported in the two groups. Given the absence of correlation with environmental factors, there may be a biological racial difference in susceptibility to an early event in the carcinogenic process leading to multiple myeloma.

Authors
Cohen, HJ; Crawford, J; Rao, MK; Pieper, CF; Currie, MS
MLA Citation
Cohen, HJ, Crawford, J, Rao, MK, Pieper, CF, and Currie, MS. "Racial differences in the prevalence of monoclonal gammopathy in a community-based sample of the elderly." Am J Med 104.5 (May 1998): 439-444.
PMID
9626026
Source
pubmed
Published In
The American Journal of Medicine
Volume
104
Issue
5
Publish Date
1998
Start Page
439
End Page
444

The cost-effectiveness of a clinical pharmacist intervention among elderly outpatients.

We estimated the cost and cost-effectiveness of a clinical pharmacist intervention known to improve the appropriateness of drug prescribing. Elderly veteran outpatients prescribed at least five drugs were randomized to an intervention (105 patients) or control (103) group and followed for 1 year. The intervention pharmacist provided advice to patients and their physicians during all general medicine visits. Mean fixed and variable costs/intervention patient were $36 and $84, respectively Health services use and costs were comparable between groups. Intervention costs ranged from $7.50-30/patient/unit change in drug appropriateness. The cost to improve the appropriateness of drug prescribing is thus relatively low.

Authors
Cowper, PA; Weinberger, M; Hanlon, JT; Landsman, PB; Samsa, GP; Uttech, KM; Schmader, KE; Lewis, IK; Cohen, HJ; Feussner, JR
MLA Citation
Cowper, PA, Weinberger, M, Hanlon, JT, Landsman, PB, Samsa, GP, Uttech, KM, Schmader, KE, Lewis, IK, Cohen, HJ, and Feussner, JR. "The cost-effectiveness of a clinical pharmacist intervention among elderly outpatients." Pharmacotherapy 18.2 (March 1998): 327-332.
PMID
9545151
Source
pubmed
Published In
Pharmacotherapy
Volume
18
Issue
2
Publish Date
1998
Start Page
327
End Page
332

The relationship between religious activities and blood pressure in older adults.

OBJECTIVE: To examine the relationship between religious activities and blood pressure in community-dwelling older adults. METHOD: Blood pressure and religious activities were assessed in a probability sample of 3,963 persons age sixty-five years or older participating in the Duke EPESE survey. Participants were asked if their doctor had ever informed them that they had high blood pressure and if they were currently taking medication for high blood pressure. After the interview, systolic and diastolic blood pressure were measured following a standardized protocol. Data were available for three waves of the survey (1986, 1989-90, and 1993-94). Analyses were stratified by age (65-74 vs. over 75) and by race (Whites vs. Blacks) and were controlled for age, race, gender, education, physical functioning, body mass index, and, in longitudinal analyses, blood pressure from the previous wave. RESULTS: Cross-sectional analyses revealed small (1-4 mm Hg) but consistent differences in measured systolic and diastolic blood pressures between frequent (once/wk) and infrequent (< once/wk) religious service attenders. Lower blood pressures were also observed among those who frequently prayed or studied the Bible (daily or more often). Blood pressure differences were particularly notable in Black and younger elderly, in whom religious activity at one wave predicted blood pressures three years later. Among participants who both attended religious services and prayed or studied the Bible frequently, the likelihood of having a diastolic blood pressure of 90 mm Hg or higher was 40 percent lower than found in participants who attended religious services infrequently and prayed or studied the Bible infrequently (OR 0.60, 95% CI, 0.48-0.75, p < .0001). Among participants told they had high blood pressure, religiously active persons were more likely to be taking their blood pressure medication; this could not, however, explain the differences in blood pressure observed. While most religious activity was associated with lower blood pressure, those who frequently watched religious TV or listened to religious radio actually had higher blood pressures. CONCLUSIONS: Religiously active older adults tend to have lower blood pressures than those who are less active. This applies to attendance at religious services and private religious activities, but not to religious media. Physiological mechanisms are discussed.

Authors
Koenig, HG; George, LK; Hays, JC; Larson, DB; Cohen, HJ; Blazer, DG
MLA Citation
Koenig, HG, George, LK, Hays, JC, Larson, DB, Cohen, HJ, and Blazer, DG. "The relationship between religious activities and blood pressure in older adults." Int J Psychiatry Med 28.2 (1998): 189-213.
PMID
9724889
Source
pubmed
Published In
International journal of psychiatry in medicine
Volume
28
Issue
2
Publish Date
1998
Start Page
189
End Page
213
DOI
10.2190/75JM-J234-5JKN-4DQD

Erratum: Racial differences in the prevalence of monoclonal gammopathy in a community-based sample of the elderly (The American Journal of Medicine (1998) 104 (439-444))

Authors
Cohen, HJ; Crawford, J; Rao, MK
MLA Citation
Cohen, HJ, Crawford, J, and Rao, MK. "Erratum: Racial differences in the prevalence of monoclonal gammopathy in a community-based sample of the elderly (The American Journal of Medicine (1998) 104 (439-444))." American Journal of Medicine 105.4 (1998): 362--.
Source
scival
Published In
American Journal of Medicine
Volume
105
Issue
4
Publish Date
1998
Start Page
362-

The cost-effectiveness of a clinical pharmacist intervention among elderly outpatients

We estimated the cost and cost-effectiveness of a clinical pharmacist intervention known to improve the appropriateness of drug prescribing. Elderly veteran outpatients prescribed at least five drugs were randomized to an intervention (105 patients) or control (103) group and followed for i year. The intervention pharmacist provided advice to patients and their physicians during all general medicine visits. Mean fixed and variable costs/intervention patient were $36 and $84, respectively Health services use and costs were comparable between groups. Intervention costs ranged from $7.50-30/patient/unit change in drug appropriateness. The cost to improve the appropriateness of drug prescribing is thus relatively low.

Authors
Cowper, PA; Weinberger, M; Hanlon, JT; Landsman, PB; Samsa, GP; Uttech, KM; Schmader, KE; Lewis, IK; Cohen, HJ; Feussner, JR
MLA Citation
Cowper, PA, Weinberger, M, Hanlon, JT, Landsman, PB, Samsa, GP, Uttech, KM, Schmader, KE, Lewis, IK, Cohen, HJ, and Feussner, JR. "The cost-effectiveness of a clinical pharmacist intervention among elderly outpatients." Pharmacotherapy 18.2 I (1998): 327-332.
Source
scival
Published In
Pharmacotherapy
Volume
18
Issue
2 I
Publish Date
1998
Start Page
327
End Page
332

Cancer and the functional status of the elderly.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Cancer and the functional status of the elderly." Cancer 80.10 (November 15, 1997): 1883-1886.
PMID
9366287
Source
pubmed
Published In
Cancer
Volume
80
Issue
10
Publish Date
1997
Start Page
1883
End Page
1886

An agenda for clinical research in geriatrics.

The health of the older segment of the population is affected by two types of problems: those that cause death and those that cause disability. Both types need to be studied. All levels of investigation, from basic clinical research to applied health services research, are needed. Areas of investigation must include the killer diseases (cardiovascular disease, cerebrovascular disease, and cancer) and disability-causing conditions, such as Alzheimer's disease and metabolic, genitourinary, musculoskeletal, and special sense disorders. Pharmacotherapeutics and disease management are also subjects that deserve attention. Problems related to race and gender differences, health services research, and technology development and assessment need to be addressed. Clinical investigators in geriatrics must be recruited and trained, and funding for their activities must be increased.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "An agenda for clinical research in geriatrics." Cancer 80.7 (October 1, 1997): 1294-1301.
PMID
9317182
Source
pubmed
Published In
Cancer
Volume
80
Issue
7
Publish Date
1997
Start Page
1294
End Page
1301

The Oncology Geriatric Education Retreat: commentary and conclusions.

The aging of the population will result in more older people with cancer. Thus, it is important to consider mechanisms by which geriatrics content could be incorporated into oncology training. The Oncology Geriatric Education Retreat was held February 21-26, 1997, in San Juan, Puerto Rico, for the discussion of possible approaches to this topic. A series of didactic sessions accompanied by commentaries was held. This was followed by three sets of sessions during which different small groups met simultaneously to discuss approaches to the treatment of specific types of tumors, educational process, and research issues. A general group discussion ensued after each set of sessions. The assembly concluded that incorporating geriatrics content into oncology training was an issue worthy of aggressive pursuit. A number of approaches were suggested, including consultation with the Residency Review Committees, the American Board of Internal Medicine, and other organizations. The importance of developing a research agenda to accompany clinical and educational activities was stressed, as was the importance of acquiring funding for these activities.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "The Oncology Geriatric Education Retreat: commentary and conclusions." Cancer 80.7 (October 1, 1997): 1354-1356.
PMID
9317191
Source
pubmed
Published In
Cancer
Volume
80
Issue
7
Publish Date
1997
Start Page
1354
End Page
1356

The association of plasma IL-6 levels with functional disability in community-dwelling elderly.

BACKGROUND: IL-6 is a multifunctional cytokine that has been shown to increase with age. METHODS: Plasma IL-6 was measured by ELISA in 1,727 community-dwelling elderly subjects whose blood was drawn during the third in-person survey of the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE). Demographics, functional status (disability), and disease states were determined. Correlations of these factors with IL-6 were analyzed with Spearman's Rho while differences between groups were assessed by Wilcoxon test. RESULTS: IL-6 levels were higher with age (p = .0001) even in this older population (> 70 years). There was a positive correlation between IL-6 and functional disability for each of the functional status measures (p = .0001), as well as a correlation between self-rated health and IL-6. Significantly higher median levels of IL-6 were found in subjects reporting prevalent cancer, heart attack, and high blood pressure, but not diabetes or arthritis. The association between age and functional status with high IL-6 remained when all other variables were controlled, in multivariable analysis. CONCLUSIONS: This association between increased plasma IL-6 levels and functional status suggests that dysregulation of IL-6 may be related to the functional disability seen with aging, and that IL-6 may be useful as a component of an overall marker of health.

Authors
Cohen, HJ; Pieper, CF; Harris, T; Rao, KM; Currie, MS
MLA Citation
Cohen, HJ, Pieper, CF, Harris, T, Rao, KM, and Currie, MS. "The association of plasma IL-6 levels with functional disability in community-dwelling elderly." J Gerontol A Biol Sci Med Sci 52.4 (July 1997): M201-M208.
PMID
9224431
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
52
Issue
4
Publish Date
1997
Start Page
M201
End Page
M208

Alterations in stimulus-induced integrin expression in peripheral blood neutrophils of patients with diabetic retinopathy.

Adhesion molecule expression on peripheral blood leukocytes from diabetic patients with severe retinopathy and age-matched control subjects was assessed. Expression of CD11b, CD18, and L-selectin was measured on granulocytes and lymphocytes in whole blood within 1 hour of blood collection. Adhesion molecule expression was determined at 4 degrees C, 37 degrees C, and after stimulation with one of the chemotactic peptides, N-formyl-methionyl-leucyl-phenyl-alanine or beta-phorbol 12-myristate 13-acetate. There were no differences between diabetics and controls in CD11b expression in neutrophils at 4 degrees C, 37 degrees C, or after N-formyl-methionyl-leucyl-phenylalanine stimulation. However, during stimulation with beta-phorbol 12-myristate 13-acetate, the increase in CD11b expression in neutrophils from patients with diabetes was significantly less than in controls. In neutrophils, there was no difference between the control and diabetic participants in CD18 expression at 4 degrees C, but after warming the cells to 37 degrees C, the expression was significantly higher in patients with diabetes. The difference became even more apparent after N-formyl-methionyl-leucyl-phenyl-alanine stimulation. The increase in CD18 expression after beta-phorbol 12-myristate 13-acetate stimulation of neutrophils was similar in control and diabetic participants. There was no difference in L-selectin expression in neutrophils under any conditions. There was no difference in adhesion molecule expression on lymphocytes under similar conditions. In summary, these observations indicate that integrin expression of neutrophils from patients with diabetes and retinopathy is altered after stimulation with neutrophil-activating agents. The changes were integrin-, stimulus-, and cell-specific, which suggests that the signal transduction mechanisms may be altered in diabetic neutrophils. These alterations may be responsible for abnormal leukocyte/endothelial interactions and microvascular complications in diabetic retinopathy.

Authors
Rao, KM; Hatchell, DL; Cohen, HJ; De La Paz, MA
MLA Citation
Rao, KM, Hatchell, DL, Cohen, HJ, and De La Paz, MA. "Alterations in stimulus-induced integrin expression in peripheral blood neutrophils of patients with diabetic retinopathy." Am J Med Sci 313.3 (March 1997): 131-137.
PMID
9075429
Source
pubmed
Published In
American Journal of the Medical Sciences
Volume
313
Issue
3
Publish Date
1997
Start Page
131
End Page
137

Relation of prescription nonsteroidal antiinflammatory drug use to cognitive function among community-dwelling elderly.

PURPOSE: To evaluate the relationship of nonsteroidal antiinflammatory drug (NSAID) use to level of cognitive function in community-dwelling elderly persons. METHODS: The prospective cohort study included 2765 nonproxy subjects from the Duke University Established Populations for Epidemiologic Studies of the Elderly who were cognitively intact at baseline (1986-1987) and alive at follow-up three year later. Cognitive function was assessed by the Short Portable Mental Status Questionnaire (i.e., intact vs. impaired and change in score) and by the individual domains of the Orientation-Memory-Concentration Test (i.e., number of errors). NSAID use, determined from in-home interviews, was coded for chronicity, dose, frequency of use, and prescription status. RESULTS: After controlling for demographic factors as well as health status and behavior, continuous, regularly-scheduled, prescription use of NSAID was associated with preservation of one aspect of cognitive functioning: concentration (beta coefficient, 0.29; 95% confidence interval [CI] -0.54 to -0.04, indicating fewer errors). However, no consistent dose-response relationship was found. Current and prior NSAID use was unrelated to level of cognitive functioning across all five measures; among current users, those taking moderate or high doses (beta coefficient, 0.41; 95% CI, 0.08 to 0.74) made more errors on the memory test compared with those taking low doses (beta coefficient 0.03; 95% CI, -.85 to 0.91). CONCLUSIONS: These results suggest no substantial or consistent protective effect of prescription NSAID use on cognitive function in community-dwelling elderly. However, recent use at higher doses may be associated with memory deterioration in this population.

Authors
Hanlon, JT; Schmader, KE; Landerman, LR; Horner, RD; Fillenbaum, GG; Pieper, CF; Wall, WE; Koronkowski, MJ; Cohen, HJ
MLA Citation
Hanlon, JT, Schmader, KE, Landerman, LR, Horner, RD, Fillenbaum, GG, Pieper, CF, Wall, WE, Koronkowski, MJ, and Cohen, HJ. "Relation of prescription nonsteroidal antiinflammatory drug use to cognitive function among community-dwelling elderly." Ann Epidemiol 7.2 (February 1997): 87-94.
PMID
9099396
Source
pubmed
Published In
Annals of Epidemiology
Volume
7
Issue
2
Publish Date
1997
Start Page
87
End Page
94

Attendance at religious services, interleukin-6, and other biological parameters of immune function in older adults.

OBJECTIVE: First, to examine and explain the relationship between religious service attendance and plasma Interleukin-6 (IL-6) levels, and second, to examine the relationship between religious attendance and other immune-system regulators and inflammatory substances. METHODS: During the third in-person interview (1992) of the Establishment of Populations for Epidemiologic Studies of the Elderly (EPESE) project, Duke site, 1718 subjects age sixty-five or over had blood drawn for analysis of immune regulators and inflammatory factors, including IL-6 measurements. IL-6 was examined both as a continuous variable and at a cutoff of 5 pg/ml. Information on attendance at religious services was available from the 1992 interview and two prior interviews (1986 and 1989). RESULTS: Religious attendance was inversely related to high IL-6 levels (> 5 pg/ml), but not to IL-6 measured as a continuous variable. Bivariate analyses revealed that high religious attendance in 1989 predicted a lower proportion of subjects with high IL-6 in 1992 (beta-.10, p = .01) High religious attendance in 1992 also predicted a lower proportion of subjects with high IL-6 levels in 1992 (beta-.14, p = .0005). When age, sex, race, education, chronic illnesses, and physical functioning were controlled, 1989 religious attendance weakened as a predictor of high IL-6 (beta-.07, p = .10), but 1992 religious attendance retained its effect (beta-.10, p = .02). When religious attenders were compared to non- attenders, they were only about one-half as likely to have IL-6 levels greater than 5 ng/ml (OR 0.58, 95% CI 0.40-0.84, p < .005). Religious attendance was also related to lower levels of the immune-inflammatory markers alpha-2 globulin, fibrin d-dimers, polymorphonuclear leukocytes, and lymphocytes. While controlling for covariates weakened most of these relationships, adjusting analyses for depression and negative life events had little effect. CONCLUSIONS: There is a weak relationship between religious attendance and high IL-6 levels that could not be explained by other covariates, depression, or negative life events. This finding provides some support for the hypothesis that older adults who frequently attend religious services have healthier immune systems, although mechanism of effect remains unknown.

Authors
Koenig, HG; Cohen, HJ; George, LK; Hays, JC; Larson, DB; Blazer, DG
MLA Citation
Koenig, HG, Cohen, HJ, George, LK, Hays, JC, Larson, DB, and Blazer, DG. "Attendance at religious services, interleukin-6, and other biological parameters of immune function in older adults." Int J Psychiatry Med 27.3 (1997): 233-250.
PMID
9565726
Source
pubmed
Published In
International journal of psychiatry in medicine
Volume
27
Issue
3
Publish Date
1997
Start Page
233
End Page
250
DOI
10.2190/40NF-Q9Y2-0GG7-4WH6

Race and myeloma survival.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Race and myeloma survival." J Clin Oncol 14.12 (December 1996): 3175-. (Letter)
PMID
8955663
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
14
Issue
12
Publish Date
1996
Start Page
3175
DOI
10.1200/JCO.1996.14.12.3175

Physician agreement with pharmacist-suggested drug therapy changes for elderly outpatients.

Authors
Hanlon, JT; Landsman, PB; Cowan, K; Schmader, KE; Weinberger, M; Uttech, KM; Samsa, GP; Cohen, HJ
MLA Citation
Hanlon, JT, Landsman, PB, Cowan, K, Schmader, KE, Weinberger, M, Uttech, KM, Samsa, GP, and Cohen, HJ. "Physician agreement with pharmacist-suggested drug therapy changes for elderly outpatients." Am J Health Syst Pharm 53.22 (November 15, 1996): 2735-2737.
PMID
8931817
Source
pubmed
Published In
American Journal of Health-System Pharmacy
Volume
53
Issue
22
Publish Date
1996
Start Page
2735
End Page
2737

Factors predicting change in prescription and nonprescription drug use in a community-residing black and white elderly population.

The current study identifies characteristics that predict change in use of prescription and nonprescription drugs over a period of 3 years. A modified health care services use model was applied to information obtained from a probability-based sample of black (n = 1778) and white (n = 1446) community-resident elderly, interviewed in 1986-1987 and 1989-1990. Analysis was by means of logistic and ordinary least-squares regression, with sample weights and design effects taken into account. The number of users and average number of prescription drugs used increased over the 3 years, and was best predicted by extent of prior drug use, older age, white race, poorer health, and number of health care visits. Conversely, nonprescription drug use declined significantly, and was best predicted by prior use, white race, and female gender. The reduced use of prescription drugs by blacks as compared to whites is of concern, suggesting that attention is needed to assure equitable access to prescription drugs.

Authors
Fillenbaum, GG; Horner, RD; Hanlon, JT; Landerman, LR; Dawson, DV; Cohen, HJ
MLA Citation
Fillenbaum, GG, Horner, RD, Hanlon, JT, Landerman, LR, Dawson, DV, and Cohen, HJ. "Factors predicting change in prescription and nonprescription drug use in a community-residing black and white elderly population." J Clin Epidemiol 49.5 (May 1996): 587-593.
PMID
8636733
Source
pubmed
Published In
Journal of Clinical Epidemiology
Volume
49
Issue
5
Publish Date
1996
Start Page
587
End Page
593

Is medication use by community-dwelling elderly people influenced by cognitive function?

To determine whether medication use differs by cognitive status among community dwelling elderly, a survey was made of a stratified random sample of 4110 black and white participants, aged 65 or older from the Duke Established Populations for Epidemiologic Studies of the Elderly in five adjacent urban and rural counties in the Piedmont area of North Carolina. Main outcome measures were usage of prescription medications, non-prescription medications, and medicines within therapeutic classes in the previous 2 weeks as determined during an in-home interview; and total number of prescription and non-prescription medicines used in the previous 2 weeks. Multivariate analyses, using weighted data adjusted for sampling design, were conducted to assess the association between drug use patterns and cognitive status, as assessed by the Short Portable Mental Status Questionnaire, while adjusting for demographic, health status, and access to health care factors. Participants with cognitive impairment (13.7% of sample) were less likely to use any prescription medications (Adjusted OR = 0.66, 95% CI = 0.48-0.90) or any non-prescription medications (Adjusted OR = 0. 71, 95% CI = 0.56-0.89) than cognitively intact subjects. Both groups took a similar number of prescription and non-prescription medications. Those who were cognitively impaired were less likely to take analgesics (Adjusted OR = 0.66, 95% CI = 0.52-0.83), but were more likely to take central nervous drugs (Adjusted OR = 1.55, 95% CI 1.18-2.04) than those who were cognitively intact. We conclude that drug use patterns by community-dwelling elderly people differ with cognitive status. Future research needs to examine medication use by specific causes of cognitive impairment.

Authors
Hanlon, JT; Landerman, LR; Wall, WE; Horner, RD; Fillenbaum, GG; Dawson, DV; Schmader, KE; Cohen, HJ; Blazer, DG
MLA Citation
Hanlon, JT, Landerman, LR, Wall, WE, Horner, RD, Fillenbaum, GG, Dawson, DV, Schmader, KE, Cohen, HJ, and Blazer, DG. "Is medication use by community-dwelling elderly people influenced by cognitive function?." Age Ageing 25.3 (May 1996): 190-196.
PMID
8670550
Source
pubmed
Published In
Age and Ageing
Volume
25
Issue
3
Publish Date
1996
Start Page
190
End Page
196

A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy.

PURPOSE: To evaluate the effect of sustained clinical pharmacist interventions involving elderly outpatients with polypharmacy and their primary physicians. PATIENTS AND METHODS: Randomized, controlled trial of 208 patients aged 65 years or older with polypharmacy (> or = 5 chronic medications) from a general medicine clinic of a Veterans Affairs Medical Center. A clinical pharmacist met with intervention group patients during all scheduled visits to evaluate their drug regimens and make recommendations to them and their physicians. Outcome measures were prescribing appropriateness, health-related quality of life, adverse drug events, medication compliance and knowledge, number of medications, patient satisfaction, and physician receptivity. RESULTS: Inappropriate prescribing scores declined significantly more in the intervention group than in the control group by 3 months (decrease 24% versus 6%, respectively; P = 0.0006) and was sustained at 12 months (decrease 28% versus 5%, respectively; P = 0.0002). There was no difference between groups at closeout in health-related quality of life (P = 0.99). Fewer intervention than control patients (30.2%) versus 40.0%; P = 0.19) experienced adverse drug events. Measures for most other outcomes remained unchanged in both groups. Physicians were receptive to the intervention and enacted changes recommended by the clinical pharmacist more frequently than they enacted changes independently for control patients (55.1% versus 19.8%; P <0.001). CONCLUSIONS: This study demonstrates that a clinical pharmacist providing pharmaceutical care for elderly primary care patients can reduce inappropriate prescribing and possibly adverse drug effects without adversely affecting health-related quality of life.

Authors
Hanlon, JT; Weinberger, M; Samsa, GP; Schmader, KE; Uttech, KM; Lewis, IK; Cowper, PA; Landsman, PB; Cohen, HJ; Feussner, JR
MLA Citation
Hanlon, JT, Weinberger, M, Samsa, GP, Schmader, KE, Uttech, KM, Lewis, IK, Cowper, PA, Landsman, PB, Cohen, HJ, and Feussner, JR. "A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy." Am J Med 100.4 (April 1996): 428-437.
PMID
8610730
Source
pubmed
Published In
The American Journal of Medicine
Volume
100
Issue
4
Publish Date
1996
Start Page
428
End Page
437
DOI
10.1016/S0002-9343(97)89519-8

Geriatric oncology.

Authors
Kennedy, BJ; Cohen, HJ
MLA Citation
Kennedy, BJ, and Cohen, HJ. "Geriatric oncology." Cancer 77.6 (March 15, 1996): 1017-1019.
PMID
8635117
Source
pubmed
Published In
Cancer
Volume
77
Issue
6
Publish Date
1996
Start Page
1017
End Page
1019

Do older women use estrogen replacement? Data from the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE)

OBJECTIVES: The primary purpose of this study was to determine the prevalence of current and past estrogen use among older, community-dwelling, postmenopausal women. The secondary purpose was to describe factors associated with estrogen use in this population. DESIGN: A survey. SETTING: The Piedmont region of North Carolina. PARTICIPANTS: The sample included 2602 community-dwelling women over the age of 65 who were interviewed for the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE). MEASUREMENTS: Current and past use of estrogen. RESULTS: Of the women surveyed, 6.1% reported current estrogen use, and 18.5% reported past use. Approximately half of the participants reported using estrogen for more than 2 years. Multivariate analysis demonstrated that current estrogen users were younger, more affluent, had smaller families, and were more likely to be white and to live in an urban area than were never users. Current users were also more likely to drink alcohol and to take calcium supplements; and compared with past estrogen users, they were more likely to be white, have smaller families, and to drink alcohol. CONCLUSION: Estrogen replacement therapy is used by a small minority of older women, especially blacks. Moreover, although women with some risk factors for osteoporosis are more likely to use estrogen, the chief determinants of estrogen utilization are socioeconomic.

Authors
Handa, VL; Landerman, R; Hanlon, JT; Harris, T; Cohen, HJ
MLA Citation
Handa, VL, Landerman, R, Hanlon, JT, Harris, T, and Cohen, HJ. "Do older women use estrogen replacement? Data from the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE)." J Am Geriatr Soc 44.1 (January 1996): 1-6.
PMID
8537578
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
44
Issue
1
Publish Date
1996
Start Page
1
End Page
6

Medical illness, religion, health control and depression of institutionalized medically ill veterans in long-term care

Utilizing multivariable multivariate regression procedures, we examine the relationships among medical illness, religion, health control beliefs and depression in 97 mostly elderly, institutionalized medically ill veterans in long term-care. Controlling for other domains of indicators, conditional canonical correlations showed that (1) religious motivation alone predicts religious coping, (2) religious coping alone predicts health control beliefs, and (3) both severity of illness/length of stay and health control beliefs predict depression. Result (1) is incompatible with the prediction by the multivariate belief-motivation theory of religiousness (MBMTR) that both religious belief and religious motivation determine religious coping. Results (2) and (3) are consistent with our hypothesis that control beliefs mediate the relationship between religious coping and depression. It is argued that a different operationalization of religious belief may still support the MBMTR. The role of religion in coping with health problems is discussed.

Authors
Grosse-Holtforth, M; Pathak, A; Koenig, HG; Cohen, HJ; Pieper, CF; Vanhook, LG
MLA Citation
Grosse-Holtforth, M, Pathak, A, Koenig, HG, Cohen, HJ, Pieper, CF, and Vanhook, LG. "Medical illness, religion, health control and depression of institutionalized medically ill veterans in long-term care." International Journal of Geriatric Psychiatry 11.7 (1996): 613-620.
Source
scival
Published In
International Journal of Geriatric Psychiatry
Volume
11
Issue
7
Publish Date
1996
Start Page
613
End Page
620
DOI
10.1002/(SICI)1099-1166(199607)11:7<613::AID-GPS357>3.0.CO;2-W

The duke approach to faculty development in geriatric medicine

A number of studies have documented that there is an inadequate number of physicians trained in geriatrics in the United States. Over the last 15 years, we have developed a Geriatric Physician Fellowship Program directed at developing academic geriatric physicians. The first year of the program offers physicians experience in caring for older patients in unique settings such as continuing care retirement communities, long-term care facilities, subspeciafty clinics (e.g., those dealing with falls, metabolic bone disease, memory disorders, and gynecological bladder dysfunction), a geriatric evaluation and management unit, and an extended care rehabilitation center. During the second year of the fellowship, the majority of the time is spent on a research project under the supervision of a mentor. For fellows who wish to pursue this research experience, a third year of training is available. In addition to opportunities for geriatrics fellows, junior faculty have access to substantial resources through our Claude D. Pepper Older Americans Independence Center, which provides salary support, seed grant funds, and a lecture and seminar series. Duke University has been successful in the last 30 years in providing a milieu that allows junior faculty members to develop as clinician investigators. We believe that this program will also provide future academic geriatric physicians to meet the growing need in this country. Copyright © 1996 Taylor & Francis.

Authors
Cohen, HJ; Lyles, KW
MLA Citation
Cohen, HJ, and Lyles, KW. "The duke approach to faculty development in geriatric medicine." Educational Gerontology 22.1 (1996): 23-36.
Source
scival
Published In
Educational Gerontology
Volume
22
Issue
1
Publish Date
1996
Start Page
23
End Page
36

Nonabandonment: medical ethics.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Nonabandonment: medical ethics." Ann Intern Med 123.6 (September 15, 1995): 474-. (Letter)
PMID
7639458
Source
pubmed
Published In
Annals of internal medicine
Volume
123
Issue
6
Publish Date
1995
Start Page
474

Religious coping and cognitive symptoms of depression in elderly medical patients.

The investigators examined associations between depressive symptom type and religious coping in 832 consecutively admitted older medical inpatients. Cognitive symptoms of depression, but not somatic symptoms, were related to religious coping. Boredom, loss of interest, social withdrawal, feeling downhearted and blue, restlessness, feeling like a failure, feeling hopeless, or feeling that other people were better off were all significantly less common among religious copers. Difficulty initiating new activities was the only somatic symptom related to this coping behavior. Religious coping, a strategy heavily dependent on cognitive processes, is associated with fewer cognitive but not somatic symptoms of depression in medically ill older patients

Authors
Koenig, HG; Cohen, HJ; Blazer, DG; Kudler, HS; Krishnan, KR; Sibert, TE
MLA Citation
Koenig, HG, Cohen, HJ, Blazer, DG, Kudler, HS, Krishnan, KR, and Sibert, TE. "Religious coping and cognitive symptoms of depression in elderly medical patients." Psychosomatics 36.4 (July 1995): 369-375.
PMID
7652139
Source
pubmed
Published In
Psychosomatics
Volume
36
Issue
4
Publish Date
1995
Start Page
369
End Page
375

Geriatric principles of treatment applied to medical oncology: an overview.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Geriatric principles of treatment applied to medical oncology: an overview." Semin Oncol 22.1 Suppl 1 (February 1995): 1-2.
PMID
7863343
Source
pubmed
Published In
Seminars in Oncology
Volume
22
Issue
1 Suppl 1
Publish Date
1995
Start Page
1
End Page
2

Tumor necrosis factor, natural killer activity and other measures of immune function and inflammation in elderly men with heart failure.

OBJECTIVE: To determine the status of tumor necrosis factor (TNF) and other measures of immunity and inflammation in chronic heart failure (CHF) in the elderly. DESIGN: Comparative survey study of subjects with heart failure and age-matched controls. SETTINGS: University affiliated tertiary care VA Medical Center, Heart Failure Clinic. PATIENTS: Twenty men with New York Class II and III heart failure and 17 age-matched controls. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Levels of lymphocyte mitogenesis, TNF, natural killer (NK) cell activity, elastase-alpha 1-antitrypsin (E/alpha) and cross-linked fibrin D-dimers (XDP). RESULTS: TNF levels (p = 0.27), NK activity (p = 0.56), and lymphocyte mitogenesis (p = 0.67) were similar in patients and controls. E/alpha levels were somewhat lower in CHF patients (p = 0.05) and XDP were similar (p = 0.59). However, TNF levels were significantly related to NK activity and to E/alpha activity in elderly men with heart failure but not controls. XDP were positively related to NK in heart failure patients but not controls. CONCLUSION: TNF and other measures of immune function and inflammation do not appear to be significantly elevated in elderly patients with heart failure of moderate severity. However, significant relationships exist between TNF, NK activity, XDP and E/alpha in the heart failure patients only, suggesting that immune activation and subclinical inflammation does exist in these patients.

Authors
Prichett, G; Cohen, HJ; Rao, KM; Cobb, F; Sullivan, M; Currie, MS
MLA Citation
Prichett, G, Cohen, HJ, Rao, KM, Cobb, F, Sullivan, M, and Currie, MS. "Tumor necrosis factor, natural killer activity and other measures of immune function and inflammation in elderly men with heart failure." Gerontology 41.1 (1995): 45-56.
PMID
7737534
Source
pubmed
Published In
Gerontology
Volume
41
Issue
1
Publish Date
1995
Start Page
45
End Page
56

Geriatric principles of treatment applied to medical oncology: An overview

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Geriatric principles of treatment applied to medical oncology: An overview." Seminars in Oncology 22.1 SUPPL. 1 (1995): 1-2.
Source
scival
Published In
Seminars in Oncology
Volume
22
Issue
1 SUPPL. 1
Publish Date
1995
Start Page
1
End Page
2

Alterations in L-selectin expression and elastase activity in neutrophils from patients receiving granulocyte colony-stimulating factor alone or in conjunction with high-dose chemotherapy with autologous bone marrow transplantation.

We determined L-selectin expression and elastase levels in neutrophils obtained from patients receiving granulocyte colony-stimulating factor (G-CSF) either alone (given for increasing peripheral progenitor cells for harvest) or in combination with high-dose chemotherapy with autologous bone transplantation support (BMT). Administration of G-CSF alone for 3-5 days produced a decrease in L-selectin expression in neutrophils (25 +/- 4 versus 7 +/- 1, mean +/- SEM; mean channel fluorescence, n = 10) with no effect on neutrophil elastase activity (3.1 +/- 0.3 versus 3.4 +/- 0.6; micrograms elastase/million cells; n = 9). In contrast, in patients in the BMT group the L-selectin expression was increased (26 +/- 2 versus 38 +/- 3; n = 20) and elastase activity was markedly decreased (2.9 +/- 0.2 versus 1.4 +/- 0.2, n = 12) compared with values before BMT. The changes in L-selectin expression correlated with the ability of neutrophils to adhere to human umbilical vein endothelial cells. The decrease in the neutrophil elastase activity was not associated with an increase in the plasma elastase/alpha 1-antitrypsin complex levels, indicating that the decrease in the neutrophil elastase activity is not caused by activation of neutrophils and release of the enzyme into the plasma. Administration of G-CSF alone did not cause a decrease in the neutrophil elastase activity but increased plasma elastase/alpha 1-antitrypsin complex levels. There was no change in CR3 expression on neutrophils under any of these conditions. These observations suggest that the changes seen in neutrophils during BMT are influenced by various factors associated with BMT other than the administered cytokine alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors
Rao, KM; Currie, MS; Cohen, HJ; Peters, WP
MLA Citation
Rao, KM, Currie, MS, Cohen, HJ, and Peters, WP. "Alterations in L-selectin expression and elastase activity in neutrophils from patients receiving granulocyte colony-stimulating factor alone or in conjunction with high-dose chemotherapy with autologous bone marrow transplantation." Lymphokine Cytokine Res 13.6 (December 1994): 383-390.
PMID
7535570
Source
pubmed
Published In
Lymphokine and Cytokine Research
Volume
13
Issue
6
Publish Date
1994
Start Page
383
End Page
390

Variability of plasma IL-6 and crosslinked fibrin dimers over time in community dwelling elderly subjects.

Because obtaining multiple blood samples from individuals involved in epidemiologic studies is difficult, conclusions must be drawn on the basis of one or two samples. In this study, the authors attempted to determine the variability of two plasma markers over time, namely IL-6 levels and crosslinked fibrin degradation products (D-Dimers), in 16 elderly community-dwelling individuals. The study group included both men and women and black and white subjects (four in each group). Eight blood samples were obtained from each subject over a period of 36 days. Blood was separated within 1 hour after collection and aliquots of plasma were stored at -70 degrees C until all samples were collected. All samples from an individual were analyzed at one time. IL-6 and D-Dimers were measured by commercially available ELISA kits. The variability in the levels of plasma IL-6 and D-Dimers was assessed by means of intra-class correlation coefficient (ICC). The estimates of the ICCs for one measurement of IL-6 and D-Dimers were .87 and .86, respectively. Reliability values of this magnitude indicate excellent reproducibility in the measurement. These values indicate that obtaining a single sample from a subject is fairly representative of that individual's IL-6 and D-Dimer levels over an extended period of time.

Authors
Rao, KM; Pieper, CS; Currie, MS; Cohen, HJ
MLA Citation
Rao, KM, Pieper, CS, Currie, MS, and Cohen, HJ. "Variability of plasma IL-6 and crosslinked fibrin dimers over time in community dwelling elderly subjects." Am J Clin Pathol 102.6 (December 1994): 802-805.
PMID
7801895
Source
pubmed
Published In
American Journal of Clinical Pathology
Volume
102
Issue
6
Publish Date
1994
Start Page
802
End Page
805

Assessing health-related quality of life in elderly outpatients: telephone versus face-to-face administration.

OBJECTIVE: While health-related quality of life (HRQOL) is increasingly being used as an outcome in clinical trials, it is unknown whether HRQOL assessments are influenced by the method of administration. Within the context of a randomized, controlled trial evaluating a pharmacist intervention for elderly outpatients prescribed at least five medications, we compared telephone and face-to-face administration of the SF-36, a widely used HRQOL measure. DESIGN: Survey. SETTING: General Medicine Clinic, Veterans Affairs Medical Center. PATIENTS: At entry, participants in the randomized trial received continuous care from a general medicine clinic physician, were > or = 65 years of age, and were prescribed > or = 5 regularly scheduled medications. Patients were excluded if they were cognitively impaired and had no caregiver available to participate in the study as a proxy or if they resided in a nursing home. MEASUREMENTS: Subjects completed the SF-36 by telephone at closeout and face-to-face at clinic visits within 1 month (mean = 16.7 days). MAIN RESULTS: Telephone administration required significantly less time than face-to-face interviews (10.2 vs 14.0 minutes, P < 0.001). Although systematic differences between modes of administration were generally small, there were substantial nonsystematic discrepancies for all eight SF-36 scales (mean absolute difference scores ranged from 10.8 to 30.1). Discrepancies were greatest for emotional role functioning, physical role functioning, social functioning, and bodily pain; these four scales also demonstrated low to moderate correlations (.33 to .58). CONCLUSIONS: The two modes of administration may not produce interchangeable results. Researchers should be cautious when mixing modes of administration to elderly patients.

Authors
Weinberger, M; Nagle, B; Hanlon, JT; Samsa, GP; Schmader, K; Landsman, PB; Uttech, KM; Cowper, PA; Cohen, HJ; Feussner, JR
MLA Citation
Weinberger, M, Nagle, B, Hanlon, JT, Samsa, GP, Schmader, K, Landsman, PB, Uttech, KM, Cowper, PA, Cohen, HJ, and Feussner, JR. "Assessing health-related quality of life in elderly outpatients: telephone versus face-to-face administration." J Am Geriatr Soc 42.12 (December 1994): 1295-1299.
PMID
7983296
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
42
Issue
12
Publish Date
1994
Start Page
1295
End Page
1299

Appropriateness of medication prescribing in ambulatory elderly patients.

OBJECTIVE: To assess the quality of medication prescribing in ambulatory elderly patients on multiple medications using the Medication Appropriateness Index (MAI). DESIGN: Cross-sectional study. SETTING: General Medical Clinic of the Durham VA Medical Center. PATIENTS: 208 elderly outpatients on five or more regularly scheduled medications. MEASUREMENTS: Medication prescribing appropriateness was measured with the MAI, a reliable method that employs 10 implicit criteria. A weighted MAI score (range 0-18 per drug) served as a summary measure of appropriateness. RESULTS: There were 1644 medications evaluated; 26% received no inappropriate ratings, 37% had one, 19% had two, and 18% had three or more. Of 16,440 ratings, 2295 (14%) were evaluated as inappropriate. The percentage of inappropriate ratings varied across prescribing dimensions: drug-drug interactions, 0%; drug-disease interactions, 1.4%; medication effectiveness, 4.7%; therapeutic duplication, 5.7%; indication, 11.5%; duration of treatment, 16.5%; dosage, 17.3%; practical directions, 20.3%; cost, 29.7%; and correct directions, 32.4%. The mean MAI score for all medications was 2.2 +/- 2.1 (range 0-10) and varied by therapeutic class. MAI scores were significantly lower for medications with a high potential for adverse effects compared with those with a low potential (MAI score of 1.8 vs 2.9, P < 0.001). Regression analysis revealed that no patient characteristics were associated with a higher likelihood of inappropriate prescribing. CONCLUSIONS: Medication prescribing for elderly outpatients taking multiple medications was substantially appropriate. Prescribing dimensions with the most room for improvement were more exact directions, less expensive drugs, and practical directions. Drugs at high risk for adverse effects were prescribed more appropriately than those at low risk.

Authors
Schmader, K; Hanlon, JT; Weinberger, M; Landsman, PB; Samsa, GP; Lewis, I; Uttech, K; Cohen, HJ; Feussner, JR
MLA Citation
Schmader, K, Hanlon, JT, Weinberger, M, Landsman, PB, Samsa, GP, Lewis, I, Uttech, K, Cohen, HJ, and Feussner, JR. "Appropriateness of medication prescribing in ambulatory elderly patients." J Am Geriatr Soc 42.12 (December 1994): 1241-1247.
PMID
7983285
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
42
Issue
12
Publish Date
1994
Start Page
1241
End Page
1247

Geriatrics faculty and program development at Duke University.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Geriatrics faculty and program development at Duke University." Am J Med 97.4A (October 17, 1994): 51S-52S.
PMID
7942975
Source
pubmed
Published In
The American Journal of Medicine
Volume
97
Issue
4A
Publish Date
1994
Start Page
51S
End Page
52S

Biology of aging as related to cancer.

The relationship of the biology of aging to cancer in older patients is of importance at several levels. The striking increase of cancer incidence with age may be related to a number of biologic factors. Potential age-related etiologic factors include decreased immune surveillance, longer duration of carcinogenic exposure, increased susceptibility of cells to carcinogens, decreased DNA repair, oncogene activation or amplification, and defects in tumor-suppressor genes. Moreover, at the cellular level, the uncontrolled proliferation characteristic of cancer and the reduced proliferation characteristic of senescence may be "opposite sides of the coin," governed by similar mechanisms of gene regulation. The biologic behavior of neoplasma, once initiated, may vary in different age groups depending on tumor type, immune system status, and alterations in other regulatory factors such as angiogenesis. In the clinical approach to the older cancer patient, attention to age-related biologic changes leading to decreased homeostatic reserve, especially in such areas as the hematopoietic, renal, immune, and cardiovascular systems, is essential to the designing of successful therapies.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Biology of aging as related to cancer." Cancer 74.7 Suppl (October 1, 1994): 2092-2100. (Review)
PMID
8087776
Source
pubmed
Published In
Cancer
Volume
74
Issue
7 Suppl
Publish Date
1994
Start Page
2092
End Page
2100

The comprehensive assessment of community dwelling elderly: why functional status is not enough.

The present study attempts to determine empirically the relationship of measures of functional status to other domains common to geriatric assessment, and to ascertain whether functional status can substitute for other domains of clinical assessment. A comprehensive research survey was administered in the home to a randomly selected population of 4163 community residents aged 65 and over in the Duke EPESE, one of the four sites of the National Institute on Aging-funded Established Populations for Epidemiologic Studies of the Elderly. Sample members were predominantly black (55%), female (65%), between 65 and 74 years of age (61%), and lived in five contiguous counties within the state of North Carolina. Measurements included three measures of functional status ranging from basic activities of daily living (ADL) to strenuous mobility items, and summary measures of cognition, depression, and overall physical health. The three functional status measures were inter-correlated. However, with the exception of cognitive status and performance of instrumental ADL, the functional status measures failed to show a clinically significant relationship with the domains of cognition, depression, or overall physical health status. Furthermore, even among those sample members impaired in all three domains, 8% could still perform strenuous activities, and over 50% could still perform the basic activities of daily living. The data show that functional status measures are not necessarily indicative of an elder's mental or physical health. Each domain of assessment contributes unique data, and no one area can fully substitute for another.

Authors
Galanos, AN; Fillenbaum, GG; Cohen, HJ; Burchett, BM
MLA Citation
Galanos, AN, Fillenbaum, GG, Cohen, HJ, and Burchett, BM. "The comprehensive assessment of community dwelling elderly: why functional status is not enough." Aging (Milano) 6.5 (October 1994): 343-352.
PMID
7893780
Source
pubmed
Published In
Aging
Volume
6
Issue
5
Publish Date
1994
Start Page
343
End Page
352

A summated score for the medication appropriateness index: development and assessment of clinimetric properties including content validity.

Inappropriate medication prescribing is an important problem in the elderly, but is difficult to measure. As part of a randomized controlled trial to evaluate the effectiveness of a pharmacist intervention among elderly veterans using many medications, we developed the Medication Appropriateness Index (MAI), which uses implicit criteria to measure elements of appropriate prescribing. This paper describes the development and validation of a weighting scheme used to produce a single summated MAI score per medication. Using this weighting scheme, two clinical pharmacists rated 105 medications prescribed to 10 elderly veterans from a general medicine clinic. The summated score demonstrated acceptable reliability (intraclass correlation co-efficient = 0.74). In addition, the summated MAI adequately reflected the putative heterogeneity in prescribing appropriateness among 1644 medications prescribed to 208 elderly veterans in the same general medicine clinic. These data support the content validity of the summated MAI. The MAI appears to be a relatively reliable, valid measure of prescribing appropriateness and may be useful for research studies, quality improvement programs, and patient care.

Authors
Samsa, GP; Hanlon, JT; Schmader, KE; Weinberger, M; Clipp, EC; Uttech, KM; Lewis, IK; Landsman, PB; Cohen, HJ
MLA Citation
Samsa, GP, Hanlon, JT, Schmader, KE, Weinberger, M, Clipp, EC, Uttech, KM, Lewis, IK, Landsman, PB, and Cohen, HJ. "A summated score for the medication appropriateness index: development and assessment of clinimetric properties including content validity." J Clin Epidemiol 47.8 (August 1994): 891-896.
PMID
7730892
Source
pubmed
Published In
Journal of Clinical Epidemiology
Volume
47
Issue
8
Publish Date
1994
Start Page
891
End Page
896

Age and functional correlations of markers of coagulation and inflammation in the elderly: functional implications of elevated crosslinked fibrin degradation products (D-dimers).

OBJECTIVE: To measure markers of inflammation in a cohort of young and old subjects and relate these findings to the functional level of the individuals. DESIGN: For the pilot study, blood samples were obtained from 18 young (age 20-35 years) and 18 old (age 68-83 years) subjects. The main study population included community-dwelling subjects between the ages of 70 and 79. The group consisted of 282 subjects with minimal physical limitations, 17 subjects from the middle third, and 16 from the lower third of physical function rankings. METHODS: Plasma markers were measured by ELISA techniques, and certain biochemical values were obtained through routine clinical tests performed by a commercial laboratory. RESULTS: D-Dimers were higher for physically impaired subjects in all groups, but most prominently among black females, who also had significantly higher D-Dimer levels in every functional group. To inquire whether higher D-Dimers were associated with markers of inflammation, we also examined the macrophage metabolite, neopterin, the neutrophil product, elastase complexed to antitrypsin (E/a), and the albumin globulin ratio (A/G ratio). No differences were found in neopterin or E/a levels on the basis of gender, race, or functional status. The A/G ratio was significantly lower in functionally impaired subjects. CONCLUSION: These preliminary findings demonstrate racial/ethnic and gender differences in D-Dimers in a population of community-dwelling elderly, and suggest that factors influencing hemostasis may be particularly relevant to physical functional status in black women. A sample containing more subjects with lower physical function will be needed to establish the relationship between inflammation, altered hemostasis, and physical function decline.

Authors
Currie, MS; Rao, MK; Blazer, DG; Cohen, HJ
MLA Citation
Currie, MS, Rao, MK, Blazer, DG, and Cohen, HJ. "Age and functional correlations of markers of coagulation and inflammation in the elderly: functional implications of elevated crosslinked fibrin degradation products (D-dimers)." J Am Geriatr Soc 42.7 (July 1994): 738-742.
PMID
8014349
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
42
Issue
7
Publish Date
1994
Start Page
738
End Page
742

Multiple myeloma in the elderly.

While multiple myeloma is an incurable disease for nearly all patients, current chemotherapy and supportive care can result in significant disease control and improved duration of survival and quality of life. With the average age of patients about 70, most of the high-dose curative strategies exclude the bulk of patients affected by the disease. Recent advances in understanding the biology and pathophysiology of myeloma have led to novel therapies aimed at altering drug resistance, improving duration of the plateau phase, interrupting the cytokine growth stimulation, and improving management of common complications including infections, anemia, and bone lesions. These latter approaches are not restricted to younger patients, and early evidence indicates that elderly patients are also likely to benefit.

Authors
Gautier, M; Cohen, HJ
MLA Citation
Gautier, M, and Cohen, HJ. "Multiple myeloma in the elderly." J Am Geriatr Soc 42.6 (June 1994): 653-664. (Review)
PMID
8201152
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
42
Issue
6
Publish Date
1994
Start Page
653
End Page
664

Increased adhesion of neutrophils to retinal vascular endothelial cells exposed to hyperosmolarity.

Recent studies suggest that leukocytes may contribute to capillary occlusion and endothelial cell injury in diabetic retinopathy. The present study is an attempt to determine whether high glucose concentration/hyperosmolar conditions would increase neutrophil adhesion to retinal endothelial cell monolayers. Confluent monolayers of bovine retinal endothelial cells were incubated for 24 hr in 96-well microtiter plates in 5.5, 20, 50 or 100 mM glucose using 20, 50 or 100 mM mannitol as osmotic controls. After 24 hr the cells were observed by phase microscopy, washed, and then incubated with isolated human neutrophils for 20 min. Non-adherent neutrophils were washed from the monolayers, and the number of adherent neutrophils was determined using an Elisa assay for neutrophil elastase. Adhesion of neutrophils to confluent monolayers of human umbilical vein and bovine aortic endothelial cells at all levels of glucose were assayed in a similar fashion for comparison. Neutrophil adherence to bovine retinal endothelial cells was significantly increased (P < 0.05, n = 8; paired t-test) at all elevated glucose concentrations compared with adherence at control (5.5 mM) glucose concentration. The effect was also concentration dependent with 20, 50 and 100 mM glucose resulting in 35, 57 and 70% increases respectively over controls. However, mannitol at equal concentrations produced similar increases in neutrophil adherence, indicating that the increases in adhesion caused by elevated glucose concentration were due to hyperosmolarity and not some special effect of glucose.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors
Bullard, SR; Hatchell, DL; Cohen, HJ; Rao, KM
MLA Citation
Bullard, SR, Hatchell, DL, Cohen, HJ, and Rao, KM. "Increased adhesion of neutrophils to retinal vascular endothelial cells exposed to hyperosmolarity." Exp Eye Res 58.6 (June 1994): 641-647.
PMID
7925703
Source
pubmed
Published In
Experimental Eye Research
Volume
58
Issue
6
Publish Date
1994
Start Page
641
End Page
647

Substance P and adrenocorticotropic hormone do not affect T-lymphocyte adhesion to vascular endothelium or surface expression of adhesion receptors.

Substance P (SP) and adrenocorticotropic hormone (ACTH) are peptides that have been shown to have both neurological and immunological effects. Because of the demonstrated effects upon immune function, we examined the effects of these peptides on T-lymphocyte adhesion to vascular endothelium and surface adhesion receptor expression. Neither the adhesion assays nor the expression assays showed any statistically significant effect of SP (10 microM) or ACTH (1 microM) for any incubation period used. We conclude that, while SP and ACTH have a variety of immunomodulatory effects, direct modulation of T-lymphocyte adhesion to vascular endothelium is probably not one of them.

Authors
Smart, BA; Rao, KM; Cohen, HJ
MLA Citation
Smart, BA, Rao, KM, and Cohen, HJ. "Substance P and adrenocorticotropic hormone do not affect T-lymphocyte adhesion to vascular endothelium or surface expression of adhesion receptors." Int J Immunopharmacol 16.2 (February 1994): 137-149.
PMID
7514158
Source
pubmed
Published In
International Journal of Immunopharmacology
Volume
16
Issue
2
Publish Date
1994
Start Page
137
End Page
149

Geriatrics faculty and program development at Duke University

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Geriatrics faculty and program development at Duke University." American Journal of Medicine 97.4 SUPPL.1 (1994): 4A-51S-4A-52S-.
Source
scival
Published In
American Journal of Medicine
Volume
97
Issue
4 SUPPL.1
Publish Date
1994
Start Page
4A-51S-4A-52S

Increased Adhesion of Neutrophils to Retinal Vascular Endothelial Cells Exposed to Hyperosmolarity

Recent studies suggest that leukocytes may contribute to capillary occlusion and endothelial cell injury in diabetic retinopathy. The present study is an attempt to determine whether high glucose concentration/hyperosmolar conditions would increase neutrophil adhesion to retinal endothelial cell monolayers. Confluent monolayers of bovine retinal endothelial cells were incubated for 24 hr in 96-well microtiter plates in 5·5, 20, 50 or 100 mM glucose using 20, 50 or 100 mM mannitol as osmotic controls. After 24 hr the cells were observed by phase microscopy, washed, and then incubated with isolated human neutrophils for 20 min. Non-adherent neutrophils were washed from the monolayers, and the number of adherent neutrophils was determined using an Elisa assay for neutrophil elastase. Adhesion of neutrophils to confluent monolayers of human umbilical vein and bovine aortic endothelial cells at all levels of glucose were assayed in a similar fashion for comparison. Neutrophil adherence to bovine retinal endothelial cells was significantly increased (P < 0·05, n = 8; paired Mest) at all elevated glucose concentrations compared with adherence at control (5·5 mM) glucose concentration. The effect was also concentration dependent with 20, 50 and 100 mM glucose resulting in 35, 57 and 70% increases respectively over controls. However, mannitol at equal concentrations produced similar increases in neutrophil adherence, indicating that the increases in adhesion caused by elevated glucose concentration were due to hyperosmolarity and not some special effect of glucose. Neutrophil adherence was not significantly increased to human umbilical vein endothelial cells, at any of the elevated concentrations of glucose. Neutrophil adherence to bovine aortic endothelial cells was significantly higher for 50 and 100 mM glucose compared to control (13% and 25% increases in adhesion, respectively). These data support the hypothesis that increased adhesion of neutrophils to retinal endothelial cells exposed to a hyperosmotic environment (as is present in diabetes) may play a significant role in the pathogenesis of diabetic retinopathy. Copyright ©1994 Academic Press. All rights reserved.

Authors
Bullard, SR; Hatchell, DL; Cohen, HJ; Rao, KMK
MLA Citation
Bullard, SR, Hatchell, DL, Cohen, HJ, and Rao, KMK. "Increased Adhesion of Neutrophils to Retinal Vascular Endothelial Cells Exposed to Hyperosmolarity." Experimental Eye Research 58.6 (1994): 647-648.
Source
scival
Published In
Experimental Eye Research
Volume
58
Issue
6
Publish Date
1994
Start Page
647
End Page
648
DOI
10.1006/exer.1994.1061

Biology of aging as related to cancer

The relationship of the biology of aging to cancer in older patients is of importance at several levels. The striking increase of cancer incidence with age may be related to a number of biologic factors. Potential age-related etiologic factors include decreased immune surveillance, longer duration of carcinogenic exposure, increased susceptibility of cells to carcinogens, decreased DNA repair, oncogene activation or amplification, and defects in tumor-suppressor genes. Moreover, at the cellular level, the uncontrolled proliferation characteristic of cancer and the reduced proliferation characteristic of senescence may be 'opposite sides of the coin,' governed by similar mechanisms of gene regulation. The biologic behavior of neoplasia, once initiated, may vary in different age groups depending on tumor type, immune system status, and alterations in other regulatory factors such as angiogenesis. In the clinical approach to the older cancer patient, attention to age-related biologic changes leading to decreased homeostatic reserve, especially in such areas as the hematopoietic, renal, immune, and cardiovascular systems, is essential to the designing of successful therapies.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Biology of aging as related to cancer." Cancer 74.7 SUPPL. (1994): 2092-2100.
Source
scival
Published In
Cancer
Volume
74
Issue
7 SUPPL.
Publish Date
1994
Start Page
2092
End Page
2100

Geriatrics faculty and program development at Duke University

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Geriatrics faculty and program development at Duke University." American Journal of Medicine 97.4 A (1994): 51S-52S.
Source
scival
Published In
American Journal of Medicine
Volume
97
Issue
4 A
Publish Date
1994
Start Page
51S
End Page
52S

Age-related increase in phorbol myristate acetate-induced lymphocyte adhesion to vascular endothelium.

Lymphocyte adhesion to vascular endothelium is an important part of immune function. This investigation sought to detect differences between the adhesion of lymphocytes from young and aged human donors to vascular endothelium with and without treatment of the lymphocytes with phorbol myristate acetate (PMA), an activator of protein kinase C (PKC) that stimulates this adhesive process. T-lymphocytes were isolated from young and aged donors and adhesion assays were conducted with human umbilical vein endothelial cells (HUVEC). In some cases the HUVEC were activated by pre-incubation with tumor necrosis factor, a cytokine that increases their adhesiveness, before the addition of lymphocytes in the presence or absence of PMA. The results show that, in the basal state, lymphocytes from young and aged donors had similar levels of adherence, while with PMA activation, lymphocytes from aged donors had a significantly higher level of adherence to both activated and non-activated HUVEC. No cytotoxic effect on the HUVEC was detected. These results suggest a role for lymphocytes in diseases that predominantly affect the elderly and that are thought to involve interaction between lymphocytes and endothelium. In addition, these results indicate that there may be a change in PKC function in lymphocytes with aging.

Authors
Smart, BA; Rao, KM; Cohen, HJ
MLA Citation
Smart, BA, Rao, KM, and Cohen, HJ. "Age-related increase in phorbol myristate acetate-induced lymphocyte adhesion to vascular endothelium." Mech Ageing Dev 72.1 (November 1993): 77-87.
PMID
8114522
Source
pubmed
Published In
Mechanisms of Ageing and Development
Volume
72
Issue
1
Publish Date
1993
Start Page
77
End Page
87

Profile of depressive symptoms in younger and older medical inpatients with major depression.

OBJECTIVE: To examine and compare the profile of cognitive symptoms, somatic symptoms, and somatic complaints in younger and older medical inpatients diagnosed with major depressive disorder (MDD). DESIGN: Cross-sectional cohort. PATIENTS AND SETTING: Male patients aged 20-39 years (n = 116) and aged 70-102 years (n = 332), consecutively admitted to the medical and neurological services of a VA medical center, underwent psychiatric evaluations for depression. MEASUREMENTS: Depressive symptoms were measured using the observer-rated Hamilton Depression Scale and the self-rated Geriatric Depression Scale using an "inclusive" approach (symptoms rated regardless of etiology). Data on 12 common somatic complaints were also collected. Clinical diagnoses of MDD were made by a psychiatrist based on the Diagnostic Interview Schedule and other psychiatric and physical health data. RESULTS: After controlling for severity of medical illness, functional status, and alcohol use, symptoms that discriminated MDD best among younger men were loss of interest, feelings of guilt or of being a burden, suicidal thoughts, and depressed mood (primarily cognitive and affective symptoms). Among older men, loss of interest, insomnia, suicidal thoughts, and hypochondriasis most strongly differentiated depressed from non-depressed patients (mixture of cognitive and somatic symptoms); fatigue, weight loss, genital symptoms, and somatic anxiety were weakly related or unrelated to MDD. Number of somatic complaints (headache, dizziness, palpitations, etc.) helped differentiate patients with MDD; although equally common among depressed young and older patients, a distinct pattern of complaints emerged in each age group. CONCLUSIONS: Cognitive symptoms of depression can help to distinguish medical inpatients with and without MDD. In older adults, however, somatic symptoms cannot be ignored and may be more important for diagnosing MDD than previously realized. These findings will help clinicians identify patients with MDD and differentiate them from non-depressed patients with medical illness.

Authors
Koenig, HG; Cohen, HJ; Blazer, DG; Krishnan, KR; Sibert, TE
MLA Citation
Koenig, HG, Cohen, HJ, Blazer, DG, Krishnan, KR, and Sibert, TE. "Profile of depressive symptoms in younger and older medical inpatients with major depression." J Am Geriatr Soc 41.11 (November 1993): 1169-1176.
PMID
8227889
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
41
Issue
11
Publish Date
1993
Start Page
1169
End Page
1176

Determining the service lives of organic-vapor respirator cartridges for nitroglycerin under workplace conditions.

Results of a field study that estimated the service lives of several different brands of organic-vapor respirator cartridges for nitroglycerin are presented. Respirator carbon tubes (RCTs) were used to sample in a workplace where gun powder was manufactured and where nitroglycerin levels varied from approximately 0.1-0.7 mg/m3. Tenax adsorbent tubes were used to monitor for nitroglycerin upstream and downstream of RCTs and were subsequently analyzed by a gas-chromatography method. A series of 10 trials failed to find evidence of nitroglycerin breakthrough. Estimates of the minimum service lives of respirator cartridges varied from 7-81 hours for nitroglycerin levels of 1.0 mg/m3, 10 times the current Occupational Safety and Health Administration Permissible Exposure Level. One trial specifically examined the potential of nitroglycerin to prematurely break through a cartridge due to bed migration, and results failed to indicate this as a potential problem. A field validation of the Tenax adsorbent tube method for nitroglycerin monitoring resulted in an accuracy of +/- 77-88% at the 95% confidence level. An unexpected finding was that up to 10% of the ambient nitroglycerin collected was adsorbed to an aerosol. This finding led to the recommendation that the addition of a prefilter to an organic vapor cartridge may be required when using air-purifying respirators to protect workers from some nitroglycerin exposures.

Authors
Cohen, HJ
MLA Citation
Cohen, HJ. "Determining the service lives of organic-vapor respirator cartridges for nitroglycerin under workplace conditions." Am Ind Hyg Assoc J 54.8 (August 1993): 432-439.
PMID
8213486
Source
pubmed
Published In
American Industrial Hygiene Association Journal
Volume
54
Issue
8
Publish Date
1993
Start Page
432
End Page
439
DOI
10.1080/15298669391354928

A fatal case of constrictive pericarditis due to a marked, selective pericardial accumulation of amyloid.

Distinguishing constrictive pericarditis from restrictive cardiomyopathy, usually due to amyloidosis, is a relatively frequent and difficult diagnostic problem. This report describes, for the first time, a patient with constrictive pericarditis caused by direct, extensive infiltration of the pericardium by amyloid, with only minimal amyloid in the myocardium, and a normal heart weight of 320 g. This patient demonstrates that amyloid may be predominantly deposited in the pericardium and actually cause constrictive pericarditis, as well as simulate its hemodynamic presentation by myocardial deposition. Given a clinical and hemodynamic presentation compatible with either constrictive or restrictive disease, an endomyocardial biopsy or other biopsy revealing amyloidosis does not necessarily rule out pericardial constriction that may be due to amyloid infiltration. The relationship between constrictive pericarditis, seen in this patient, and the other more common manifestations of amyloid heart disease, and the hemodynamic profiles of amyloid cardiomyopathy and constrictive pericarditis are reviewed.

Authors
Daubert, JP; Gaede, J; Cohen, HJ
MLA Citation
Daubert, JP, Gaede, J, and Cohen, HJ. "A fatal case of constrictive pericarditis due to a marked, selective pericardial accumulation of amyloid." Am J Med 94.3 (March 1993): 335-340. (Review)
PMID
8452158
Source
pubmed
Published In
The American Journal of Medicine
Volume
94
Issue
3
Publish Date
1993
Start Page
335
End Page
340

A comparative study of monoclonal gammopathies and immunoglobulin levels in Japanese and United States elderly.

OBJECTIVE: To define the prevalence of monoclonal immunoglobulin (Ig) proteins and quantitative serum immunoglobulin levels in elderly Japanese in comparison with elderly Caucasians as possible factors related to the reported lower incidence of multiple myeloma in elderly Japanese than in elderly Caucasians. DESIGN: Survey study SETTING: Community Center in Yokohama, Japan and Retirement Community in the United States. PARTICIPANTS: Convenience sample of community-dwelling elderly subjects (age 63-95) presenting for health screening examinations in each setting. Frozen serum samples were obtained from routine screening from 146 consecutive Japanese subjects and 111 US subjects. INTERVENTION: None MEASUREMENTS: Presence of monoclonal immunoglobulin protein determined by serum protein electrophoresis and immunofixation and quantitative Ig by laser nephelometry. RESULTS: Four (2.7%) of the Japanese cohort had monoclonal gammopathies compared with 11 (10%) of the American cohort. Two of the monoclonal gammopathies were IgG Kappa and two were IgG Lambda. No cases of multiple monoclonal gammopathy were identified in the Japanese group, compared with 25% of the monoclonal gammopathies in the American group. The mean quantitative serum IgG level for the Japanese group was 1,685 +/- 520 mg/dL versus 1,118 +/- 402 mg/dL for the American group; mean quantitative IgA levels were 283 +/- 116 mg/dL versus 226 +/- 116 mg/dL (P < 0.001). Albumin levels were normal in both populations, suggesting that there was not an increase in occult inflammatory disorders in the Japanese population. CONCLUSION: The low prevalence of monoclonal gammopathy in elderly Japanese is consistent with the reported lower frequency of multiple myeloma. The reason for the higher quantitative immunoglobulin levels in this population is unclear. Further cross-cultural investigation is warranted to explore the genetic influences on altered immune regulation with aging.

Authors
Bowden, M; Crawford, J; Cohen, HJ; Noyama, O
MLA Citation
Bowden, M, Crawford, J, Cohen, HJ, and Noyama, O. "A comparative study of monoclonal gammopathies and immunoglobulin levels in Japanese and United States elderly." J Am Geriatr Soc 41.1 (January 1993): 11-14.
PMID
8418116
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
41
Issue
1
Publish Date
1993
Start Page
11
End Page
14

MEDICAL-EDUCATION IN GERIATRICS - THE LASTING IMPACT OF THE AGING GAME

Authors
GALANOS, AN; COHEN, HJ; JACKSON, TW
MLA Citation
GALANOS, AN, COHEN, HJ, and JACKSON, TW. "MEDICAL-EDUCATION IN GERIATRICS - THE LASTING IMPACT OF THE AGING GAME." EDUCATIONAL GERONTOLOGY 19.7 (1993): 675-682.
Source
wos-lite
Published In
Educational Gerontology
Volume
19
Issue
7
Publish Date
1993
Start Page
675
End Page
682
DOI
10.1080/0360127930190708

Predictors of two-year post-hospitalization mortality among elderly veterans in a study evaluating a geriatric consultation team.