Effectiveness of Therapeutic Patient Education Interventions for Older Adults with Cancer: A Systematic Review.

The incidence of cancer increases with age and demographics shows that the population of western countries is dramatically ageing. The new discipline of Geriatric Oncology is emerging aiming at providing tailored and patient-centred support to older adults with cancer. With the development of oral cancer therapy and outpatient treatments, Therapeutic Patient Education (TPE), aiming at enabling the patient and their relatives to cope with the disease in partnership with health professionals, appears to be an interesting and useful tool. The purpose of this paper is to search for evidence of the effectiveness of educational interventions for patients in older adults with cancer. The first screening found 2,617 articles, of which 150 were eligible for review. Among them, fourteen finally met the inclusion criteria: experimental and quasi-experimental studies enrolling older adults (over 65 years old), suffering from cancer and receiving an educational intervention. The types of educational intervention were diverse in these studies (support by phone and web base material). The results appear to be positive on anxiety, depression and psychological distress, patient knowledge and pain. However, data currently available on the effectiveness of a TPE program in Geriatric Oncology is lacking. Further studies are needed to assess the effectiveness of TPE programs adapted to the specific circumstances of the older adult.

Drug Prescription Including Interactions with Anticancer Treatments in the Elderly: A Global Approach.

BACKGROUND: Consequences of inappropriate prescriptions and polymedication in patients suffering from cancer are beginning to be well documented. However, the methods used to evaluate these consequences are often discussed. Few studies evaluate the risk of interaction with anticancer drugs in elderly patients suffering from cancer. OBJECTIVES: To describe the prevalence (i) of polypharmacy, (ii) of potentially inappropriate drug prescriptions and (iii) of drug interactions involving anticancer treatments, using a multiple reference tools. DESIGN: A retrospective, cross-sectional, multicenter study performed from January to December 2012. PARTICIPANTS: Patients aged 65 years or older suffering from cancer presented at the oncogeriatric multidisciplinary meeting. MEASUREMENTS: Polymedication (>6 drugs), potentially inappropriate prescriptions and drug interactions involving anticancer treatment were analyzed in combination with explicit and implicit criteria within a global approach. RESULTS: Among the 106 patients included in this study, polypharmacy was present in 60.4% of cases, potentially inappropriate drug prescription in 63.1% and drug interactions in 16% of case, of which 47% involved anti-cancer treatments. Twenty-seven major drug interactions were identified and eight interactions involved chemotherapy. CONCLUSION: Polymedication, inappropriate prescribing and drug interactions involving anti-cancer drugs are common and largely underestimated in elderly cancer patients.

Visual Impairment Screening at the Geriatric Frailty Clinic for Assessment of Frailty and Prevention of Disability at the Gérontopôle.

OBJECTIVES: To evaluate visual performance and factors associated with abnormal vision in patients screened for frailty at the Geriatric Frailty Clinic (GFC) for Assessment of Frailty and Prevention of Disability at Toulouse University Hospital. DESIGN: Retrospective, observational cross-sectional, single-centre study. SETTING: Institutional practice. PARTICIPANTS: Patients were screened for frailty during a single-day hospital stay between October 2011 and October 2014 (n = 1648). MEASUREMENTS: Collected medical records included sociodemographic data (including living environment and educational level), anthropometric data, and clinical data. The general evaluation included the patient's functional status using the Activities of Daily Living (ADL) scale and the Instrumental Activity of Daily Living (IADL) scale, the Mini-Mental State Examination (MMSE) for cognition testing, and the Short Physical Performance Battery (SPPB) for physical performance. We also examined Body Mass Index (BMI), the Mini-Nutritional Assessment (MNA), and the Hearing Handicap Inventory for the Elderly Screening (HHIE-S) tool. The ophthalmologic evaluation included assessing visual acuity using the Snellen decimal chart for distant vision, and the Parinaud chart for near vision. Patients were divided into groups based on normal distant/near vision (NDV and NNV groups) and abnormal distant/near vision (ADV and ANV groups). Abnormal distant or near vision was defined as visual acuity inferior to 20/40 or superior to a Parinaud score of 2, in at least one eye. Associations with frailty-associated factors were evaluated in both groups. RESULTS: The mean age of the population was 82.6 ± 6.2 years. The gender distribution was 1,061 females (64.4%) and 587 males (35.6%). According to the Fried criteria, 619 patients (41.1%) were pre-frail and 771 (51.1%) were frail. Distant and near vision data were available for 1425 and 1426 patients, respectively. Distant vision was abnormal for 437 patients (30.7%). Near vision was abnormal for 199 patients (14%). Multiple regression analysis showed that abnormal distant vision as well as abnormal near vision were independently associated with greater age (P < 0.01), lower educational level (P < 0.05), lower performance on the MMSE (P < 0.001), and lower autonomy (P < 0.02), after controlling for age, gender, educational level, Fried criteria, and MMSE score. CONCLUSION: The high prevalence of visual disorders observed in the study population and their association with lower autonomy and cognitive impairment emphasises the need for systematic screening of visual impairments in the elderly. Frailty was not found to be independently associated with abnormal vision.

Body Composition and Anti-Neoplastic Treatment in Adult and Older Subjects - A Systematic Review.

BACKGROUND: The estimation of the risk of poor tolerance and overdose of antineoplastic agents protocols represents a major challenge in oncology, particularly in older patients. We hypothesize that age-related modifications of body composition (i.e. increased fat mass and decreased lean mass) may significantly affect tolerance to chemotherapy. METHOD: We conducted a systematic review for the last 25 years (between 1990 and 2015), using US National library of Medicine Medline electronic bibliographic database and Embase database of cohorts or clinical trials exploring (i) the interactions of body composition (assessed by Dual X-ray Absorptiometry, Bioelectrical Impedance Analyses, or Computerized Tomography) with pharmacokinetics parameters, (ii) the tolerance to chemotherapy, and (iii) the consequences of chemotherapies or targeted therapies on body composition. RESULTS: Our search identified 1504 articles. After a selection (using pre-established criteria) on titles and abstract, 24 original articles were selected with 3 domains of interest: impact of body composition on pharmacokinetics (7 articles), relationship between body composition and chemotoxicity (14 articles), and effect of anti-cancer chemotherapy on body composition (11 articles). The selected studies suggested that pharmacokinetic was influenced by lean mass, that lower lean mass could be correlated with toxicity, and that sarcopenic patients experienced more toxicities that non-sarcopenic patients. Regarding fat mass, results were less conclusive. No studies specifically explored the topic of body composition in older cancer patients. CONCLUSIONS: Plausible pathophysiological pathways linking body composition, toxicity, and pharmacokinetics are sustained by the actual review. However, despite the growing number of older cancer patients, our review highlighted the lack of specific studies in the field of anti-neoplastic agents toxicity regarding body composition conducted in elderly.

[Reynolds syndrome revealing a malignant thymoma]. / Un syndrome de Reynolds révélant un thymome malin.

INTRODUCTION: Thymomas, benign or malignant, may be associated with autoimmune diseases. They are classically associated with myasthenia gravis, neuromyotonia, or pure red cell aplasia. CASE REPORT: We here report, to the best of our knowledge, the first description of an association between thymoma and Reynolds syndrome (systemic sclerosis associated with primary biliary cirrhosis) in an 80-year-old woman. CONCLUSION: The suspected pathogenesis of this association could be a thymus escape of auto-reactive T lymphocytes and the consecutive development of an auto-immune disorder.

Diffuse pulmonary uptake on FDG-PET with normal CT diagnosed as intravascular large B-cell lymphoma: a case report and a discussion of the causes of diffuse FDG uptake in the lungs.

A 71-year-old woman was admitted to our hospital with asthenia, weight loss, fever, cognitive impairment and shortness of breath. Physical examination showed hemiparesis and cerebellar ataxia. There was no superficial lymphadenopathy. Blood tests showed raised levels of C-reactive protein and lactate dehydrogenase. Bone marrow aspiration and biopsy were negative. [18F]fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) showed intense uptake within a right apical nodule and intense and diffuse uptake of FDG in the lungs without corresponding structural CT abnormality. Lung biopsy showed intravascular large B-cell lymphoma (IVLBCL). FDG-PET findings in IVLBCL and causes of diffuse FDG lung uptake with and without CT abnormalities are discussed.

Properties and subcellular localization of elastase-like activities of arterial smooth muscle cells in culture.

The properties and subcellular localization of the elastase-like activities of smooth muscle cells cultured from pig aortas have been investigated. Homogenates of the cells hydrolysed N-succinyl-L-alanyl-L-alanyl-L-alanine-p-nitroanilide, a synthetic substrate for elastases, with a distinct pH optimum of 8.2 and hydrolysed insoluble elastin with a distinct pH optimum of 8.5. Both enzyme activities were directly proportional to the concentration of homogenate in the assay mixture. The activities toward both substrates were inhibited by phenylmethylsulphonyl fluoride and were therefore probably due to a serine peptidase(s). The activities were also inhibited by EDTA and, in a dose-related manner, by alpha 1-antiprotease. Pepstatin, which inhibits cathepsin D, and leupeptin, which inhibits cathepsin B, did not significantly inhibit the elastase-like activities in these cells. The cells were homogenized and a post-nuclear supernatant subjected to sucrose density gradient centrifugation. The distribution of elastase-like activity toward both substrates was similar to that of the plasma membrane marker 5'-nucleotidase, and distinct from those of marker enzymes for the other organelles. Cells were also homogenized with digitonin, which selectively increases the equilibrium density of the plasma membrane. The equilibrium densities of both 5'-nucleotidase and of the elastase-like activities were increased considerably, confirming the plasma membrane localization of the elastase-like activities. The subcellular localization of the elastase-like activities of arterial smooth muscle cells is therefore consistent with a role for them in the degradation of elastin in the normal arterial wall and in atherosclerotic lesions.

Isolation and partial characterization of an elastase-type protease in human vulva fibroblasts: its possible involvement in vulvar elastic tissue destruction of patients with lichen sclerosus et atrophicus.

A complete disappearance of orcein positive material was observed in the superficial dermis of patients suffering from Lichen sclerosus et atrophicus. An elastase-type protease was isolated and partially purified from Triton X-100 extracts of human vulvar fibroblasts by gel permeation chromatography. It presents the characteristics of a metalloenzyme hydrolyzing Succinoyl-tri-alanine paranitroanilide maximally at pH 8.0 and is also active towards insoluble elastin. When partially purified enzyme is directly applied on to rabbit skin sections or when injected intradermally to young rabbits, it produces appreciable degradation of elastic fibers. The involvement of this protease in the disappearance of elastic fibers in Lichen sclerosus et atrophicus is postulated.

Variation of elastase-type protease activity and elastin biosynthesis in rabbit aorta induced by cholesterol diet and immunization with elastin peptides.

Elastase-type proteases were shown to be produced by arterial smooth muscle cells and fibroblasts in culture and are probably involved in the development of the arterio-atherosclerotic process (1-4). The present investigation was aimed at the quantitative determination of the elastase-type enzyme activity in the aortas of rabbits submitted to two different athero-arteriosclerosis inducing treatments: high cholesterol diet and immunization with kappa-elastin peptides. Simultaneously we determined the incorporation of 14C-lysine in cross-linked elastin peptides by the surviving aorta extracts, determined with a synthetic substrate (Suc-(Ala)3-pNA) increased two fold after 1.5 month cholesterol diet, and three fold after 8 weeks of immunization with kappa-elastin in complete Freund's adjuvant. The incorporation of 14C-lysine in cross-linked elastin slightly increased (+20%) in cholesterol-fed aorta-explants and strongly decreased (-65%) in the immunized aorta-explants, on a DNA basis. These results confirm our contention that atherogenic stimuli produce an increase of elastase-type enzyme activity in the arterial wall. This increase appears to be correlated with elastic fibers degradation. It may also be accompanied by a decrease of elastin biosynthesis as in the kappa-elastin induced immuno-arteriosclerosis model.

Isolation and partial characterization of an elastase-like protease from rat aorta smooth muscle cells. Possible role in the regulation of elastin biosynthesis.

An elastase-like protease was isolated from rat aorta smooth muscle cells and partially characterized. It appears to behave as an intracellular enzyme and may be involved in the regulation of elastin biosynthesis.

Influence of anthocyanoside treatment on the cholesterol-induced atherosclerosis in the rabbit.

We have studied the effect of treatment with anthocyanosides from Vaccinium myrtillis on cholesterol-induced atheroma of rabbits. We have found that the drug did not modify the serum cholesterol levels, but decreased the proliferation of the intima the extracellular matrix production the calcium and lipid deposition in the aorta, and the DNA and lipid contents. The alterations in the biochemical composition of the isolated brain microvessels were also diminished. The following mechanism may explain the protective action of the treatment: the collagen of the vessel walls participates in the control of vascular permeability. This permeability is increased by a cholesterol-rich diet. The protective drug interacts with collagen, increasing its cross-links, thus diminishing the permeability in small, as well as in large blood vessels.

Elastogenesis and elastinolytic activity in human breast cancer.

Polymeric elastin was isolated and chemically characterized from 34 human breast cancers. There exists a good correlation between the histological and biochemical determinations of elastin; the breast cancer elastin resembles the other elastins isolated from ligamentum nuchae or aorta. Meanwhile it differs by its lower proline content and by its degree of crosslinking as determined by the ratio (Des + IDes/4)Lys. An elastinolytic activity (elastase) was found in human breast cancer extracts. This activity increased with the elastin content of the tumors.