Under-treatment of elderly patients with ovarian cancer: a population based study.

BACKGROUND: Ovarian cancer is the fourth most common cancer among women in France, and mainly affects the elderly. The primary objective of this study was to compare treatment of ovarian cancer according to age. METHODS: All patients with invasive cancer (n=1151) diagnosed between 1997 and 2011 in the Herault Department of southern France were included. Demographic data (age, area of residence), cancer characteristics (stage, histology, grade) and treatment modality (type, period and location of treatment) were analysed. Univariate and multivariate logistic regression was used to compare treatment by age. RESULTS: Ovarian cancer was less treated in elderly compared to younger patients, regardless of the type of treatment. This difference was more pronounced for chemotherapy, and was maximal for surgery followed by chemotherapy (odds ratio (OR) for surgery for patients aged >70 vs those aged <70 years=0.47 [0.24-0.91], OR for chemotherapy, age>70 vs <70=0.30 [0.16-0.55] and OR for surgery plus chemotherapy, age>70 vs <70=0.14 [0.08-0.28]). This effect of age was independent of other variables, including stage and grade. The probability of receiving standard treatment, in accordance with recommendations, was reduced by 50% in elderly patients compared to their younger counterparts. Overall and net survival of elderly patients with standard treatment was similar to those of younger patients treated outside standard treatment. CONCLUSIONS: Elderly women with ovarian cancer were therapeutically disadvantaged compared to younger women. Further studies including co morbidities are necessary to refine these results and to improve therapeutic management of elderly patients with ovarian cancer.

Aminoglycosides use in patients over 75 years old.

OBJECTIVE: to describe aminoglycoside use and nephrotoxicity in patients older than 75 years. DESIGN: retrospective multicenter study. SETTING: hospital department, rehabilitation, long-term care center. POPULATION: patients ≥75 years old treated by aminoglycosides. RESULTS: 184 patients, mean age: 84.4 years (range: 75-101). One hundred and twenty-seven patients received other nephrotoxic drug(s). Gentamicin (70%) and amikacin (30%) were used and the once-daily dosing was preferred (92%). Average treatment period was 2.75 (1-10) days for amikacin and 4.4 (1-30) for gentamicin with average dosage 13.5 and 3.5 mg/kg/day, respectively. The monitoring of maximal plasmatic concentration (Cmax) was done in 37 patients, 9 of them had probabilistic treatment. Only one had a Cmax fulfilling the objective of French recommendations (gentamicin >30 mg/l, amikacin >60 mg/l). When infection was documented, the objective of Cmax >10 × minimal inhibitory concentration of the strain was reached for 27%. Minimal plasmatic concentration was checked in 38% of cases, with adequate value (gentamicin <0.5 mg/l, amikacin <2.5 mg/l) for 37%. At the end of aminoglycoside course, 40 patients increased their serum creatinine >25% of the baseline value. In multivariate analysis, this was associated with treatment length ≥3 days and concomitant use of nephrotoxic drugs. CONCLUSION: aminoglycosides dosing used in elderly patients probably need therapeutic drug monitoring and dose adjustment. Aminoglycosides are used to treat severe infections. One of the most important side effects is nephrotoxicity in oldest patients. To minimise nephrotoxicity, short treatments are necessary and avoiding others nephrotoxic drugs could be relevant.

Have French recommendations had an impact on the treatment and survival of middle and lower rectal cancer patients?

OBJECTIVE: Compare the survival of middle and lower rectal cancer (MLRC) patients before and after the 1994 issue of rectal cancer (RC) consensus conference recommendations. METHODS: Cases of MLRC noted in the Hérault department of France in 1992 (n=58) and 2000 (n=93) yielded exhaustive epidemiological, clinical-pathological and treatment data that were used to compare MLRC patient management and survival in these two periods. RESULTS: Significantly more lymph nodes (≥ 8) were harvested in 2000 (≥ 8, 47%) than in 1992. In all, 45 patients (77.6%) received radiotherapy in 1992, and 74 (82%) in 2000. Chemotherapy was employed in 15 patients (25.9%) in 1992 and in 39 patients (43%) in 2000. Chemotherapy and radiotherapy, together with sphincter conservation, were dependent upon the year. Overall 5-year relative survival for rectal cancer in the Hérault department did not vary between 1992 (56%) and 2000 (56%). Independent poor prognostic factors were the same in both years: age over 75 years, lymph node involvement and metastases. Management place and year had no significant impact on prognosis. CONCLUSION: The recommendations made have had little impact on disease management and the quality of anatomic pathology reports, and have not improved 5-year relative survival.

Primitive liver cancers: epidemiology and geographical study in France.

OBJECTIVES: The objectives of this study are, first, to describe the incidence of primary liver cancer (PLC) and, second, to highlight its epidemiological characteristics from a geographical point of view. METHODS: The nine French administrative areas, which are covered by population-based cancer registries, diagnosed a total of 1100 new cases of PLC (of which 898 occurred in males), between 1997 and 1998; 91.5% of these were identified as hepatocellular carcinoma, and 6.2% corresponded to intrahepatic cholangiocarcinoma. The incidence rates of these new cases were studied as a function of their clinico-pathological features and geographical location. RESULTS: The age-adjusted incidence was 9.5 per 100,000 persons amongst males, and 3.1 per 100,000 persons amongst females. The origin of cirrhosis was found to be alcohol consumption (69%), followed by viral contamination, and lastly 4.9% for both. A north-south gradient was found for the age-standardized incidence rates in men (10.1 per 100,000 in the north vs. 6.5 per 100,000 in the south; P=0.029). Amongst men in the north, the most frequent etiological type was cirrhosis (79.8 vs. 72.5%; P=0.0018). The alcoholic origin of cirrhosis was more frequent in the north than in the south (66 vs. 27.5%; P<10). Viral cirrhosis was more frequent in the south than in the north (42.9 vs. 13.6%; P<10). CONCLUSION: In France, excessive alcohol consumption remains the main risk factor for PLC, although the viral etiology of this disease is growing. An opposition was found between the two groups. North-men-alcoholic cirrhosis and south-women-viral cirrhosis.