A paradox in cancer research is that the majority of patients enrolled in clinical trials are relatively young and fit while typical patients in daily practice are elderly and have comorbidities and impaired organ fun...A paradox in cancer research is that the majority of patients enrolled in clinical trials are relatively young and fit while typical patients in daily practice are elderly and have comorbidities and impaired organ function. Given these differences, many major studies provide an imperfect guide to optimizing the treatment of the majority of patients. Since cancer incidence is highly correlated with age, and since the world's population is rapidly ageing, this problem can only increase. For this reason, oncologists and geriatricians need to collaborate in developing tools to systematically assess the health status of elderly patients and their fitness to receive cancer therapies of various intensity. Tailoring anti-cancer treatments and supportive care to individual needs should be seen as part of the move towards personalized medicine. Achieving this goal is as much of a challenge to developing and middle-income countries as it is to western nations. The 2015 annual conference of the International Society of Geriatric Oncology(SIOG) held in Prague, Czech Republic, November 2015 and had a global focus on advancing the science of geriatric oncology and supportive care. Central to this approach is the systematic assessment of life expectancy, independent functioning, and the physical and psychological health of older cancer patients. The assumption behind comprehensive geriatric assessment is that elderly cancer patients have complex needs. The implication is that effective intervention will require a multidisciplinary team. Examples of effective geriatric assessment, multidisciplinary working and supportive care were presented at the SIOG conference.展开更多
Objective To reevaluate the age limit for heart transplantation ( HTX) and the long-term outcomes in el derly patients. Methods From Oct. 1984 to Dec. 1996, 161 cases of HTX were performed in Hartford Hospital, wit...Objective To reevaluate the age limit for heart transplantation ( HTX) and the long-term outcomes in el derly patients. Methods From Oct. 1984 to Dec. 1996, 161 cases of HTX were performed in Hartford Hospital, with 35 pa tients aged 60～68 years (mean: 63.5±2.7, group A) and 126 under 60 years (mean: 47.6±11.3, group B). The causes of HTX for group A and group B were ischemic : 60% vs 48%, idiopathic: 29% vs 45%, valvular: 6% vs 4 %, congenital: 0 vs 2%, and graft failure : 6 % vs1% . Results The operative mortality (within 30d) were5.7%(2/35) in group A , and1. 6% (2/126) in group B. The overall late death were 13 (37%) in group A, and 50(40% ) in group B. The main causes of dea th were ( group A vs group B) infection: 46 % vs 24 %, rejection: 0 vs 28 % (P<0.05), malignancy: 23 % vs 8 %, multi-or gan system failure:23% vs 2%, cardiac events:8% vs 10%. The 1-,3-,5- ,8- and 10- year survival rate in group A and group B was 74% vs 88%, 67% vs 77%, 60% vs 65%, 49% vs 43%, and 49% vs 34% respectively. The quality of life for both groups was improved remarkably. Conclusion The survival rate for patients over 60 is as good as that of the younger group. HTX could be successfully performed in patients around 65 years old.展开更多
文摘A paradox in cancer research is that the majority of patients enrolled in clinical trials are relatively young and fit while typical patients in daily practice are elderly and have comorbidities and impaired organ function. Given these differences, many major studies provide an imperfect guide to optimizing the treatment of the majority of patients. Since cancer incidence is highly correlated with age, and since the world's population is rapidly ageing, this problem can only increase. For this reason, oncologists and geriatricians need to collaborate in developing tools to systematically assess the health status of elderly patients and their fitness to receive cancer therapies of various intensity. Tailoring anti-cancer treatments and supportive care to individual needs should be seen as part of the move towards personalized medicine. Achieving this goal is as much of a challenge to developing and middle-income countries as it is to western nations. The 2015 annual conference of the International Society of Geriatric Oncology(SIOG) held in Prague, Czech Republic, November 2015 and had a global focus on advancing the science of geriatric oncology and supportive care. Central to this approach is the systematic assessment of life expectancy, independent functioning, and the physical and psychological health of older cancer patients. The assumption behind comprehensive geriatric assessment is that elderly cancer patients have complex needs. The implication is that effective intervention will require a multidisciplinary team. Examples of effective geriatric assessment, multidisciplinary working and supportive care were presented at the SIOG conference.
文摘Objective To reevaluate the age limit for heart transplantation ( HTX) and the long-term outcomes in el derly patients. Methods From Oct. 1984 to Dec. 1996, 161 cases of HTX were performed in Hartford Hospital, with 35 pa tients aged 60～68 years (mean: 63.5±2.7, group A) and 126 under 60 years (mean: 47.6±11.3, group B). The causes of HTX for group A and group B were ischemic : 60% vs 48%, idiopathic: 29% vs 45%, valvular: 6% vs 4 %, congenital: 0 vs 2%, and graft failure : 6 % vs1% . Results The operative mortality (within 30d) were5.7%(2/35) in group A , and1. 6% (2/126) in group B. The overall late death were 13 (37%) in group A, and 50(40% ) in group B. The main causes of dea th were ( group A vs group B) infection: 46 % vs 24 %, rejection: 0 vs 28 % (P<0.05), malignancy: 23 % vs 8 %, multi-or gan system failure:23% vs 2%, cardiac events:8% vs 10%. The 1-,3-,5- ,8- and 10- year survival rate in group A and group B was 74% vs 88%, 67% vs 77%, 60% vs 65%, 49% vs 43%, and 49% vs 34% respectively. The quality of life for both groups was improved remarkably. Conclusion The survival rate for patients over 60 is as good as that of the younger group. HTX could be successfully performed in patients around 65 years old.
