Chronic Diseases among Older Cancer Survivors

Objective. To compare the occurrence of pre-existing and subsequent comorbidity among older cancer patients (≥60 years) with older non-cancer patients. Material and Methods. Each cancer patient (n=3835, mean age 72) was matched with four non-cancer patients in terms of age, sex, and practice. The occurrence of chronic diseases was assessed cross-sectionally (lifetime prevalence at time of diagnosis) and longitudinally (incidence after diagnosis) for all cancer patients and for breast, prostate, and colorectal cancer patients separately. Cancer and non-cancer patients were compared using logistic and Cox regression analysis. Results. The occurrence of the most common pre-existing and incident chronic diseases was largely similar in cancer and non-cancer patients, except for pre-existing COPD (OR 1.21, 95% CI 1.06–1.37) and subsequent venous thrombosis in the first two years after cancer diagnosis (HR 4.20, 95% CI 2.74–6.44), which were significantly more frequent (P<0.01) among older cancer compared to non-cancer patients. Conclusion. The frequency of multimorbidity in older cancer patients is high. However, apart from COPD and venous thrombosis, the incidence of chronic diseases in older cancer patients is similar compared to non-cancer patients of the same age, sex, and practice

Oral Vitamin C supplements to prevent and treat acute upper respiratory tract infections

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of oral vitamin C supplements to prevent and treat acute upper respiratory tract infections in adults and children

Changing the antibiotic prescribing of general practice registrars: The ChAP study protocol for a prospective controlled study of a multimodal educational intervention

Background: Australian General Practitioners (GPs) are generous prescribers of antibiotics, prompting concerns including increasing antimicrobial resistance in the community. Recent data show that GPs in vocational training have prescribing patterns comparable with the high prescribing rate of their established GP supervisors. Evidence-based guidelines consistently advise that antibiotics are not indicated for uncomplicated upper respiratory tract infections (URTI) and are rarely indicated for acute bronchitis. A number of interventions have been trialled to promote rational antibiotic prescribing by established GPs (with variable effectiveness), but the impact of such interventions in a training setting is unclear. We hypothesise that intervening while early-career GPs are still developing their practice patterns and prescribing habits will result in better adherence to evidence-based guidelines as manifested by lower antibiotic prescribing rates for URTIs and acute bronchitis. Methods/design: The intervention consists of two online modules, a face-to-face workshop for GP trainees, a face-to-face workshop for their supervisors and encouragement for the trainee-supervisor dyad to include a case-based discussion of evidence-based antibiotic prescribing in their weekly one-on-one teaching meetings. We will use a non-randomised, non-equivalent control group design to assess the impact on antibiotic prescribing for acute upper respiratory infections and acute bronchitis by GP trainees in vocational training. Discussion: Early-career GPs who are still developing their clinical practice and prescribing habits are an underutilized target-group for interventions to curb the growth of antimicrobial resistance in the community. Interventions that are embedded into existing training programs or are linked to continuing professional development have potential to increase the impact of existing interventions at limited additional cost. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12614001209684 (registered 17/11/2014)

Study protocol of KLIMOP: a cohort study on the wellbeing of older cancer patients in Belgium and the Netherlands

<p>Abstract</p> <p>Background</p> <p>Cancer is mainly a disease of older patients. In older cancer patients, additional endpoints such as quality of survival and daily functioning might be considered equally relevant as overall or disease free survival. However, these factors have been understudied using prospective designs focussing on older cancer patients. Therefore, this study will focus on the impact of cancer, ageing, and their interaction on the long-term wellbeing of older cancer patients.</p> <p>Methods/Design</p> <p>This study is an observational cohort study. We aim to recruit 720 cancer patients above 70 years with a new diagnosis of breast, prostate, lung or gastrointestinal cancer and two control groups: one control group of 720 patients above 70 years without a previous diagnosis of cancer and one control group of 720 cancer patients between 50 - 69 years newly diagnosed with breast, prostate, lung or gastrointestinal cancer. Data collection will take place at inclusion, after six months, after one year and every subsequent year until death or end of the study. Data will be collected through personal interviews (consisting of socio-demographic information, general health information, a comprehensive geriatric assessment, quality of life, health locus of control and a loneliness scale), a handgrip test, assessment of medical records, two buccal swabs and a blood sample from cancer patients (at baseline). As an annex study, caregivers of the participants will be recruited as well. Data collection for caregivers will consist of a self-administered questionnaire examining depression, coping, and burden.</p> <p>Discussion</p> <p>This extensive data collection will increase insight on how wellbeing of older cancer patients is affected by cancer (diagnosis and treatment), ageing, and their interaction. Results may provide new insights, which might contribute to the improvement of care for older cancer patients.</p

The older cancer survivor: consequences of cancer and ageing.

The increasing number of older cancer patients will become an important challenge for healthcare services, as older cancer patients often present with complex combinations of both cancer- and ageing-related problems. Older cancer patients represent the largest and fastest growing group of cancer patients, and despite overall agreement that –in addition to prolongation of survival– the main goal of treating older cancer patients is “quality of survival”, questions regarding the quality of survival of older cancer patients after initial treatment remain largely unanswered and unexplored. The aim of this thesis was to gain a deeper insight into the impact of a diagnosis and treatment of cancer, ageing, and the interaction between both, on subsequent well-being of older cancer patients. Well-being was operationalized as comorbidity (an indicator of physical well-being), loneliness (an indicator of social well-being), depression, cognitive impairment, and fatigue (indicators of mental well-being). Subsequently, we explored ways to facilitate the identification of older cancer patients at risk for negative outcomes, focusing on functional decline, decline in quality of life, and the emergence of depression. The majority of our research questions were addressed with data of the KLIMOP-study, an observational cohort study that includes Belgian and Dutch older cancer patients (≥70 years) with a new diagnosis of breast, prostate, lung or gastrointestinal cancer and two control groups: younger cancer patients (50 – 69 years) with a new diagnosis of breast, prostate, lung or gastrointestinal cancer were included to act as a control for ageing; older patients (≥70 years) without a previous diagnosis of cancer were included as a control for a diagnosis and treatment of cancer. The study on comorbidity was addressed with data from the Registration Network Family Practices of Maastricht University. This is a primary care database including a population of approximately 135,000 people. We also conducted a systematic literature review and meta-analysis on the topic of loneliness. We found that the frequency of comorbidity in older cancer patients was high, but it appeared to be predominantly associated with high age, and the absolute increase in disease occurrence due to cancer was small. For loneliness we found that it is an important and common concern in cancer patients. We showed that at time of diagnosis, older cancer patients were less lonely compared to their peers without cancer, but over the course of one year, levels of loneliness –in particular emotional loneliness– significantly increased in cancer patients, young and old. Risk factors for loneliness were changes in fatigue, cognitive functioning, or having no partner. For other psychosocial problems we showed that within a one-year timeframe from cancer diagnosis, older as well as younger cancer patients experienced an increase in the frequency of depression, slight worsening of cognitive functioning, and relatively stable levels of fatigue, albeit more than half of the cancer patients reported fatigue. Multivariate analyses showed that the main risk factors for psychosocial problems were presence of the problem at baseline and functional impairment. For the second objective of this thesis –to identify older cancer patients at risk for negative outcomes– we showed that in older persons with a relatively good prognosis, geriatric screening tools are of limited use in identifying those who are at risk for decline in functional status or quality of life after one year. Furthermore, we explored the added value of using fatigue severity as a cue to further investigate the presence of depression. We showed that fatigue severity cannot replace proper clinical assessment of depression, but it offers a useful trigger for increased alertness and additional testing for depression in older cancer patients. In conclusion, the overall message of this thesis is rather optimistic: older cancer patients are doing better than expected. The amount of problems older cancer patients face is not disproportionate compared to the problems faced by younger cancer patients or older people without cancer. However, this is only true for the population described in this study: mainly female patients with breast or colorectal cancer with a good prognosis. Nonetheless these optimistic results, a diagnosis and treatment of cancer has a serious impact on a person’s life, and at an individual level there are persons who face enormous challenges. This was true for all three groups; older cancer patients, younger cancer patients and older persons without cancer. With those people who are vulnerable in mind, we believe that attention is needed especially for the social and mental aspects of functioning.status: publishe