Effectiveness of geriatric assessment and management in older cancer patients: a systematic review and meta-analysis.

BACKGROUND: Frailty and multimorbidity among older cancer patients affect treatment tolerance and efficacy. Comprehensive geriatric assessment and management is recommended to optimize cancer treatment, but its effect on various outcomes remains uncertain. OBJECTIVE: Our objective was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) and cost-effectiveness studies comparing comprehensive geriatric assessment (with or without implementation of recommendations) to usual care in older cancer patients. METHODS: We searched MEDLINE, EMBASE, CINAHL, and Cochrane trials from inception to January 27, 2023, for RCTs and cost-effectiveness studies. Pooled estimates for outcomes were calculated using random-effects models. RESULTS: A total of 19 full-text articles representing 17 RCTs were included. Average participant age was 72-80 years, and 31%-62% were female. Comprehensive geriatric assessment type, mode of delivery, and evaluated outcomes varied across studies. Meta-analysis revealed no difference in risk of mortality (risk ratio [RR] = 1.08. 95% confidence interval [CI] = 0.91 to 1.29), hospitalization (RR = 0.92, 95% CI = 0.77 to 1.10), early treatment discontinuation (RR = 0.89, 95% CI = 0.67 to 1.19), initial dose reduction (RR = 0.99, 95% CI = 0.99 to 1.26), and subsequent dose reduction (RR = 0.87, 95% CI = 0.70 to 1.09). However, the risk of treatment toxicity was statistically significantly lower in the comprehensive geriatric assessment group (RR = 0.78, 95% CI = 0.70 to 0.86). No cost-effectiveness studies were identified. CONCLUSION: Compared with usual care, comprehensive geriatric assessment was not associated with a difference in risk of mortality, hospitalization, treatment discontinuation, and dose reduction but was associated with a lower risk of treatment toxicity indicating its potential to optimize cancer treatment in this population. Further research is needed to evaluate cost-effectiveness.

Sex differences in the prevalence and factors associated with anxiety disorders in Canada: A population-based study.

The prevalence of anxiety disorders continues to increase in Canada. The study aimed to evaluate sex differences in the prevalence of anxiety disorders, associated identity factors and social determinants, and their interactions among the Canadian population. We used data from the 2017-2018 Canadian Community Health Survey (CCHS), a nationally representative survey. We evaluated associations between sex, other identity characteristics and social determinants, and anxiety disorders using multivariable logistic regression. To account for the complex sampling design, we applied sampling and bootstrap weights. The CCHS included 113,290 respondents, representative of 98% of the Canadian population over 12 years old. The prevalence of self-reported anxiety disorders was higher among females than males (11.6% vs 6.3%, p < 0.001). Adjusted regression analysis revealed higher odds of having mood disorders for those who were female, non-White, non-immigrant, homosexual or bisexual, unemployed, had lower income or food insecurity, had a disability and a weak sense of community belonging. Younger age was associated with higher odds of anxiety disorders among females (aOR: 1.50, 95%CI: 1.10-2.05) but not among males (aOR: 0.99, 95%CI: 0.64-1.56). An association between employment and higher income with lower odds of anxiety disorders, and bisexuality with higher odds of anxiety disorders, was stronger among males compared with females. Anxiety disorders are more prevalent among females than males in Canada. Age, employment, income, and sexual orientation have varying associations with anxiety disorders among the sexes. Strategies for improving mental health must recognize the complex links between sex and intersecting factors.

Evaluating sex-differences in the prevalence and associated factors of mood disorders in Canada.

BACKGROUND: We assessed the sex-differences in the prevalence and associated factors of mood disorders in Canada using a nationally representative survey, focusing on identity characteristics and socioeconomic factors. METHODS: A secondary analysis of the 2017-2018 Canadian Community Health Survey (CCHS) - Annual Component was conducted using Gender-Based Analysis Plus, which is an analytical process for incorporating various intersecting identity factors into research, programs, and policies. The presence of mood disorders was assessed through self-reporting. Factors associated with mood disorders were evaluated using multivariable logistic regression analysis after the application of sampling and bootstrap weights. RESULTS: The CCHS was completed by 113,290 Canadians, representative of 98 % of the population over the age of 12. Self-reported mood disorders were more prevalent among females than males (11.0 % vs 6.4 %, p < 0.001). Adjusted regression analysis revealed higher odds of reporting mood disorders for those who were female, unemployed, non-immigrant, non-White, smokers, homosexual or bisexual, had lower income, suffered from food insecurity, had a disability and weak sense of community belonging. Employment and higher income were more protective against mood disorders among males than females, and the association of older age with mood disorders was stronger in males than in females. LIMITATIONS: Mood disorders were assessed through self-reporting, and certain population groups were excluded from the survey. CONCLUSIONS: Females in Canada are affected by mood disorders at higher rates than males and certain factors have differential associations with mood disorders among the sexes. Strategies targeting mental disorders must be tailored towards the needs of specific groups.