ABSTRACT
Vitamin D supplementation has been suggested for many diseases and symptoms that are frequent in older people: loss of bone mineral density, falls, loss of muscle mass, infections (including COVID-19) and mortality. In observational studies, vitamin D concentration has been associated with many poor outcomes, but in most Randomized Controlled Trials, there is no beneficial effect of vitamin D supplementation on these outcomes, except for bone mineral density. An alternative explanation of the observed association may be 'confounding': older people with poor mobility have lower vitamin D, and irrespective of that also have poor outcomes. The recent COVIT-TRIAL seems to suggest there is benefit of high dose vitamin D supplementation compared to low dose on mortality in older people with COVID-19, but on closer methodological look this conclusion does not hold. Clinical guidelines rightly do not advise vitamin D supplementation for a whole range of diseases, including COVID-19.
ABSTRACT
Background: Among women, breast cancer (BC) is the most frequently diagnosed cancer and is ranked as the leading cause of cancer death. Given that aging is one of the strongest risk factors for the development of breast cancer, older adults (65+) are disproportionately affected. At the same time, more than half of older cancer patients are considered frail or pre-frail and are at increased risk of adverse outcomes including treatment intolerance, as well as morbidity, and mortality. Frailty is thus recognized as an important metric to guide decision-making in geriatric oncology. This study characterizes the use of frailty measurements in observational studies on older women with breast cancer. Material(s) and Method(s): MEDLINE, EMBASE, and Cochrane Library were systematically queried to identify observational studies (cohort, casecontrol, cross-sectional) on older women with breast cancer which evaluate survival or mortality before or after treatment, published from 2017-2022. Studies were managed using Covidence software and assessed for inclusion with predefined criteria by independent reviewers. Data was extracted with respect to the characteristics of the studies. Frailty measurements were identified, the proportion of studies using frailty measurements was calculated, and the prevalence of frailty among BC patients was determined. Result(s): A total of 9823 studies were screened on title and after deduplication. Based on specified criteria, 217 full text studies were assessed for eligibility, 71 of which were excluded, mainly due to incorrect target population with respect to age, or incorrect outcome assessment. Overall, 146 studies were included. Preliminary results revealed that frailty status was not considered in all identified observational studies. Among studies that measured frailty, a relevant proportion of female BC patients were considered frail. Detailed results will be shown at the conference. Conclusion(s): Despite having significant prognostic importance, the use of frailty measurements is not a compulsory practice in observational studies on breast cancer in older women. Additionally, although multiple frailty screening tools have been developed, there is no gold standard measurement used to detect frailty. As a result of such heterogeneity in clinical practice, an established definition of frailty remains elusive. Efforts to create a unified definition and gold standard may improve targeted care and health outcomes for older breast cancer patients. No conflict of interest. Copyright © 2022 Elsevier Ltd. All rights reserved