Long Term Outcomes of a Geriatric Liaison Intervention in Frail Elderly Cancer Patients

Background The aim of this study was to evaluate the long term effects after discharge of a hospital-based geriatric liaison intervention to prevent postoperative delirium in frail elderly cancer patients treated with an elective surgical procedure for a solid tumour. In addition, the effect of a postoperative delirium on long term outcomes was examined. Methods A three month follow-up was performed in participants of the Liaison Intervention in Frail Elderly study, a multicentre, prospective, randomized, controlled trial. Patients were randomized to standard treatment or a geriatric liaison intervention. The intervention consisted of a preoperative geriatric consultation, an individual treatment plan targeted at risk factors for delirium and daily visits by a geriatric nurse during the hospital stay. The long term outcomes included: mortality, rehospitalisation, Activities of Daily Living (ADL) functioning, return to the independent pre-operative living situation, use of supportive care, cognitive functioning and health related quality of life. Results Data of 260 patients (intervention n = 127, Control n = 133) were analysed. There were no differences between the intervention group and usual-care group for any of the outcomes three months after discharge. The presence of postoperative delirium was associated with: an increased risk of decline in ADL functioning (OR: 2.65, 95% CI: 1.02-6.88), an increased use of supportive assistance (OR: 2.45, 95% CI: 1.02-5.87) and a decreased chance to return to the independent preoperative living situation (OR: 0.18, 95% CI: 0.07-0.49). Conclusions A hospital-based geriatric liaison intervention for the prevention of postoperative delirium in frail elderly cancer patients undergoing elective surgery for a solid tumour did not improve outcomes 3 months after discharge from hospital. The negative effect of a postoperative delirium on late outcome was confirmed

The cumulative risk of multiple CT exposures using two different methods

The aim of this study was to compare the summing method (A) with the complement method (B) for calculating the cumulative lifetime-attributable-risk (LAR(tot)) of tumor incidence and mortality of multiple CT exposures. Method A defines LAR(tot) as the summation of the risk of each separate exposure. Method B was defined as the complement of the probability of inducing no cancer in N separate exposures. The risk of each separate exposure was estimated using dose, gender, and age at exposure (BEIR VII phase 2). Both methods were compared in a simulation and applied to a database of 11,884 patients exposed to multiple CTs. The relative difference between the methods was defined as ΔP%. Simulation confirmed that Method A always overestimates LAR(tot). ΔP% was proportional to the dose per exposure and the number of exposures. The differences between Methods A and B were small. Average LAR(tot) of tumor incidence was 0.140% (Method A) and 0.139% (Method B) with maxima of 5.70% and 5.56%, respectively. Average LAR(tot) of mortality was 0.085% for both methods, with maxima of 2.20% and 2.18%, respectively. ΔP% was highest (2.43%) for a female patient (3-y old) exposed to eight recurrent scans and a cumulative dose of 144 mSv. Although Method B is more accurate, both methods can be used to estimate the cumulative risk of multiple CT exposures. These results have to be interpreted, however, in the perspective of the uncertainties in the cancer risk model, which have been estimated at a factor of 2 or 3

Classification of the type of surgery by duration of the procedure and tumour localization.

<p>Classification of the type of surgery by duration of the procedure and tumour localization.</p

Univariate logistic regression analyses for the influence of postoperative delirium on 3-month outcomes.

<p>Univariate logistic regression analyses for the influence of postoperative delirium on 3-month outcomes.</p

CONSORT diagram for the study.

<p>CONSORT diagram for the study.</p

Characteristics of the patients at discharge according to study group.

<p>Characteristics of the patients at discharge according to study group.</p

Effect of implementation of the mass breast cancer screening programme in older women in the Netherlands:population based study

OBJECTIVE: To assess the incidence of early stage and advanced stage breast cancer before and after the implementation of mass screening in women aged 70-75 years in the Netherlands in 1998. DESIGN: Prospective nationwide population based study. SETTING: National cancer registry, the Netherlands. PARTICIPANTS: Patients aged 70-75 years with a diagnosis of invasive or ductal carcinoma in situ breast cancer between 1995 and 2011 (n=25 414). Incidence rates were calculated using population data from Statistics Netherlands. MAIN OUTCOME MEASURE: Incidence rates of early stage (I, II, or ductal carcinoma in situ) and advanced stage (III and IV) breast cancer before and after implementation of screening. Hypotheses were formulated before data collection. RESULTS: The incidence of early stage tumours significantly increased after the extension for implementation of screening (248.7 cases per 100 000 women before screening up to 362.9 cases per 100 000 women after implementation of screening, incidence rate ratio 1.46, 95% confidence interval 1.40 to 1.52, P<0.001). However, the incidence of advanced stage breast cancers decreased to a far lesser extent (58.6 cases per 100 000 women before screening to 51.8 cases per 100 000 women after implementation of screening, incidence rate ratio 0.88, 0.81 to 0.97, P<0.001). CONCLUSIONS: The extension of the upper age limit to 75 years has only led to a small decrease in incidence of advanced stage breast cancer, while that of early stage tumours has strongly increased