Journal - Cancer (United States )

Abstract :

BACKGROUND: Radiotherapy (RT) is used commonly to treat localized prostate cancer, particularly among older men and men with comorbid illnesses. Few population-based studies have reported on the rates of major short-term complications that lead to hospitalization after radiotherapy. METHODS: In this study, the authors identified all men with nonmetastatic prostate cancer who received RT between 1990 and 1999 in Ontario, Canada. Patients who underwent a prior prostate-directed surgery were excluded. Mortality and complications after RT were examined by using administrative data. A comprehensive list of 7 categories of complications was developed by combining published lists from radical prostatectomy series with input from experts. Logistic regression was used to analyze the relations between complications (that occurred within 30 days of RT) and clinical factors. A similar analysis was performed among men who underwent radical prostatectomy during the same period. RESULTS: There were 7661 men (mean age, 69 years) identified who received RT. Nine patients (0.1%) died within 30 days of RT. Any complication within 30 days of RT was experienced by 6.5% of patients. In analyses that were adjusted for year of treatment, increasing age was associated with any, respiratory, bleeding, genitourinary, and miscellaneous medical complications (P<.02) but not with cardiac, vascular, or bowel complications. Over time, any, cardiac, vascular, and genitourinary complications decreased, but the other 4 categories of complications did not decrease. Despite being older and having more comorbidity, men who received RT had lower complication rates in each category compared with 11,010 men who underwent radical prostatectomy. CONCLUSIONS: Short-term complications that required hospital-based management were relatively uncommon after RT, commonly increased with patient age, and generally declined over time.Copyright (c) 2009 American Cancer Society.

Journal - Cancer (United States )

Abstract :

BACKGROUND: Acute myeloid leukemia (AML) is associated with a poor prognosis, particularly in older patients. To the authors' knowledge, few population-based studies of AML treatment patterns and outcomes exist to date. METHODS: The authors used the Ontario Cancer Registry to identify all patients diagnosed with AML between 1965 and 2003. Referral to specialized cancer centers (SCCs) and receipt of chemotherapy were examined as quality of care indicators. Survival outcomes were examined using logistic regression at 30 days, 1 year, and 3 years. RESULTS: A total of 9365 patients (mean age, 58.1 years; range, 0 to 103 years) developed AML between 1965 and 2003. Overall, 75.1%, 32.9%, and 17.3% of patients survived to 30 days, 1 year, and 3 years, respectively. Although survival improved over time among patients aged 19 to 59 years, similar improvements were not seen among older patients. The proportion of patients receiving chemotherapy declined with age (59.0% vs 29.3% among patients ages 19-59 vs > or =60 years). Fewer patients aged > or =60 years were referred to a SCC compared with younger patients (20.8% vs 29.9%). Younger age, less comorbidity, later year of diagnosis, receipt of chemotherapy, and being referred to a SCC were associated with better 30-day and long-term survival in multivariate models. CONCLUSIONS: Although the prognosis has improved over time among younger adults, it remains poor among those aged > or =60 years. Fewer older patients were referred to SCCs or treated with chemotherapy compared with younger patients, whereas both factors were associated with improved survival. Opportunities may exist to improve the quality of care and outcomes among older adults with AML.

Journal - Journal of clinical oncology : official journal of the American Society of Clinical Oncology (United States )

Abstract :

PURPOSE Use of androgen deprivation therapy (ADT) may be associated with an increased risk of diabetes mellitus but the risk of both acute myocardial infarction (AMI) and cardiovascular mortality remain controversial because few outcomes and conflicting findings have been reported. We sought to clarify whether ADT is associated with these outcomes in a large, representative cohort. METHODS Using linked administrative databases in Ontario, Canada, men age 66 years or older with prostate cancer given continuous ADT for at least 6 months or who underwent bilateral orchiectomy (n = 19,079) were matched with men with prostate cancer who had never received ADT. Treated and untreated groups were matched 1:1 (ie, hard-matched) on age, prior cancer treatment, and year of diagnosis and propensity-matched on comorbidities, medications, cardiovascular risk factors, prior fractures, and socioeconomic variables. Primary outcomes were development of AMI, sudden cardiac death, and diabetes. Fragility fracture was also examined. Results The cohort was observed for a mean of 6.47 years. In time-to-event analyses, ADT use was associated with an increased risk of diabetes (hazard ratio [HR], 1.16; 95% CI, 1.11 to 1.21) and fragility fracture (HR, 1.65; 95% CI, 1.53 to 1.77) but not with AMI (HR, 0.91; 95% CI, 0.84 to 1.00) or sudden cardiac death (HR, 0.96; 95% CI, 0.83 to 1.10). Increasing duration of ADT was associated with an excess risk of fragility fractures and diabetes but not cardiac outcomes. CONCLUSION Continuous ADT use for at least 6 months in older men is associated with an increased risk of diabetes and fragility fracture but not AMI or sudden cardiac death.

Journal - Cancer (United States )

Abstract :

BACKGROUND: Comorbidity is an important consideration in oncology practice, particularly among older patients. Although a variety of comorbidity indices have been employed in research studies, it is unclear whether any one index is preferred. METHODS: An age-stratified random sample of 345 men (mean age of 69 years) who were newly diagnosed with prostate cancer were identified from a cancer registry in Ontario, Canada. Comorbidity and treatment information were obtained from chart review. Four comorbidity indices were utilized: Charlson Index, Diagnosis Count, Index of Coexistent Disease (ICED), and number of medications. Logistic regression analysis was used to compare the performance of comorbidity measures with respect to predicting receipt of curative treatment (radical prostatectomy or radiotherapy) and overall 6-year survival. Multivariable model performance including each of the comorbidity measures was compared by calculating the area under the receiver operating characteristic curve (AUROC). RESULTS: Among men with localized disease (n = 231), in models adjusted for age, Gleason score, and prostate-specific antigen level, only the Charlson Index was found to be a statistically significant predictor of receipt of curative treatment (P < .05), although all comorbidity indices had similar AUROC in adjusted models. After a median follow-up of 6.5 years, 116 of 345 men (33.6%) had died. In adjusted models, all 4 comorbidity indices performed similarly in predicting overall survival. CONCLUSIONS: Although comorbidity is an important predictor of both curative treatment and overall survival in prostate cancer, the optimal comorbidity index for use in research remains unclear. Selecting the optimal comorbidity index may depend on both the specific patient population and the outcome being considered.

Journal - The Journal of urology (United States )

Abstract :

PURPOSE: It remains controversial whether short-term surgical complications after radical prostatectomy can be decreased by increasing surgeon or hospital procedural volume. We determined whether hospital or surgeon volumes impacted various short-term surgical complications. MATERIALS AND METHODS: We examined in-hospital mortality and complications following radical prostatectomy in all 25,404 men who underwent this surgery across 8 provinces in Canada between 1990 and 2001. Bayesian multilevel logistic regression models were used, adjusting for patient age, comorbidity, surgery year, and hospital and surgeon volume, while accounting for clustering by surgeon and hospital. RESULTS: Overall 50 men (0.2%) died and 5,087 (20.0%) had 1 or more in-hospital complications following surgery. In models adjusted for age, comorbidity and surgery year hospital volume was associated with in-hospital mortality (p = 0.037). In adjusted models doubling hospital volume was associated with a decreased risk of any, cardiac, respiratory, vascular, genitourinary, miscellaneous medical and miscellaneous surgical complications (each p <0.001), although not wound/bleeding complications (p = 0.40). Similarly doubling surgical volume was associated with a decreased risk of any, respiratory, wound/bleeding, genitourinary, miscellaneous medical and miscellaneous surgical complications (each p <0.01), although not cardiac and vascular complications (p = 0.58 and 0.17, respectively). Adjustment for clustering led to nonsignificant effects of hospital volume on miscellaneous surgical complications, and of surgeon volume on miscellaneous medical and miscellaneous surgical complications. However, this did not alter other findings. CONCLUSIONS: Increasing hospital and surgeon volume are associated with a decreased risk of most complications after radical prostatectomy even after adjusting for the effects of clustering.

Journal - Critical reviews in oncology/hematology (Ireland )

Abstract :

Although intensive chemotherapy (IC) may modestly improve survival compared to supportive care in older people with acute myeloid leukemia (AML), treatment may worsen quality of life (QOL) and functional status. We assessed QOL and functional status at baseline, 1 month, 4 months, and 6 months in 65 consecutive, English-speaking, patients age 60 or older with newly diagnosed AML. At baseline, functional status was high but QOL was negatively affected in global health and most QOL domains. Over time, QOL remained stable or improved in most patients and was generally similar between IC and non-IC groups. Basic activities of daily living (ADL) scores did not change over time, whereas instrumental ADL scores declined slightly regardless of treatment. Receiving IC does not appear to lead to worse QOL or functional status than more palliative approaches. This information may aid treatment discussions in older patients with AML.

Journal - Critical reviews in oncology/hematology (Ireland )

Abstract :

Cancer screening is attracting greater attention as a growing number of studies and practice guidelines exhort physicians to screen for an increasing number of malignancies. Central to the evaluation of these studies is both the quality of the evidence and the impact of screening upon clinically relevant outcomes. Although much has been written about the optimal study design for screening studies, surprisingly little has been written about evaluating specific outcome measures employed in such studies. This paper reviews the strengths and limitations of common outcomes employed in cancer screening studies. The relationship between study design and outcome measure is explored. Three key biases (lead-time, length-time, and volunteer) associated with screening studies and methods to minimize them are also reviewed. Potential harms associated with screening are outlined. Although disease-specific mortality may be the most robust and relevant traditional outcome measure, increasing attention is being paid to composite health outcome measures for older populations, including quality of life and cost-based measures.

Journal - Urology (United States )

Abstract :

OBJECTIVES: To determine the current practice of clinicians in the diagnosis and management of osteoporosis among men taking androgen deprivation therapy (ADT), because ADT leads to decreased bone mineral density (BMD) and fractures. METHODS: We sent out a survey to Canadian urologists and radiation oncologists. The survey included questions about BMD testing, treatment practices, referral patterns, and risk of osteoporosis. RESULTS: The surveys were returned by 170 of 294 respondents (response rate 58%). Few respondents would obtain a baseline BMD in patients starting ADT. Forty percent would order a repeat BMD test after starting ADT if the baseline BMD were normal or unknown, but more than two thirds would if the baseline BMD showed osteoporosis. In men with a normal BMD starting ADT, respondents recommended weight-bearing exercises (58%), calcium (50%), vitamin D (47%), and bisphosphonate (6%) supplements. In men with osteoporosis at baseline, the use of nonprescription therapies increased slightly and bisphosphonate use increased to 44%. If osteoporosis were diagnosed, 11% would treat the patient themselves. The estimated risk of developing osteoporosis within 1 year of starting ADT with a normal baseline BMD ranged from 0% to 90% (median 20%). CONCLUSIONS: To our knowledge, this is the first survey of its kind. The key findings included that few physicians would order a baseline BMD test, would prescribe bisphosphonates for prevention but almost one half would consider bisphosphonates to treat established osteoporosis, and wide variations exist in the practice patterns and risk perception surrounding ADT-related osteoporosis. Evidence-based guidelines are needed to help physicians deal effectively with osteoporosis prevention and management among men taking ADT.

Journal - Critical reviews in oncology/hematology (Ireland )

Abstract :

Increasing numbers of men with non-metastatic disease are receiving androgen deprivation therapy (ADT) for a variety of indications, some of which are supported by evidence from randomized trials. Balanced against possible survival benefits and better disease control are data that ADT adversely affects quality of life, particularly in the areas of sexual function, physical function, and energy. There is some evidence of worsening upper extremity physical strength but no clear evidence of decline in daily function with ADT. The impact of ADT on cognitive function is not clear at this time. ADT is associated with declines in bone mineral density within 6-12 months of commencing treatment, with increased fracture rates within 5 years of treatment. ADT use is also associated with a 10-15g/L decline in hemoglobin, although the clinical significance of this drop appears to be limited for most patients. It is reasonable for physicians who are about to start men on ADT to obtain a baseline bone mineral density, to counsel them about the impact on sexual function and possible treatments for sexual dysfunction, and to encourage regular exercise. Further insight into adverse effects of ADT and strategies to minimize these adverse effects await data from ongoing studies.

Journal - Urology (United States )

Abstract :

OBJECTIVES: Although radical prostatectomy (RP) is associated with greater 30-day mortality in older men, the magnitude of the excess risk in older age groups compared with younger ones has not been well characterized. METHODS: Using data from the Ontario Cancer Registry, we identified 11,010 men who underwent RP from 1990 to 1999 in Ontario, Canada and compared the 30-day mortality risk immediately after RP with the 1-month mortality risk in the same population of men 7 to 12 months after RP and that of an age-matched general population of men. RESULTS: Overall, 53 men (0.48%) died within 30 days of surgery. The absolute excess 30-day mortality risk associated with RP was 0.18%, 0.51%, and 0.59% for men aged 50 to 59, 60 to 69, and 70 to 79 years, respectively, and was similar for men aged 60 to 69 and 70 to 79 years (P >0.05). The relative mortality risk within 30 days of RP was approximately nine times the baseline risk (95% confidence interval 3 to 38) and was similar for men in all three age groups (P >0.05). CONCLUSIONS: The results of our study indicate that men aged 70 to 79 years do not have a greater absolute excess or relative risk of 30-day mortality after RP compared with men aged 60 to 69 years.

Journal - BJU international (England )

Abstract :

OBJECTIVES: To better characterize the cause and location of death after radical prostatectomy (RP), as early mortality is relatively uncommon after RP, with little known about the cause of death among men who die within 30 days of RP, and the trend toward earlier discharge after surgery means that a greater proportion of early mortality after RP may occur out of hospital. PATIENTS AND METHODS: Using the Ontario Cancer Registry, we identified 11,010 men (mean age 68 years) who had a RP in the province of Ontario between 1990 and 1999. We identified the occurrence and location of all deaths within 30 days of RP. The cause of death was obtained from death certificate information. Logistic regression was used to examine factors (age, comorbidity, year of surgery) associated with the location of death. RESULTS: Of the 11,010 men, 53 died within 30 days of RP (0.5%); of these 53 men, 28 (53%) died in hospital. Neither age, comorbidity nor year of surgery were significantly associated with location of death (P > 0.05). Major causes of death included cardiovascular disease (38%) and pulmonary embolism (13%). More than half of the patients who died out of hospital had an unknown cause of death. CONCLUSIONS: Almost half of all deaths within 30 days of RP occur out of hospital; the two most common causes of death are potentially preventable. More detailed cause-of-death information may help to identify opportunities for prevention.

Journal - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne (Canada )

Abstract :

Unintentional weight loss, or the involuntary decline in total body weight over time, is common among elderly people who live at home. Weight loss in elderly people can have a deleterious effect on the ability to function and on quality of life and is associated with an increase in mortality over a 12-month period. A variety of physical, psychological and social conditions, along with age-related changes, can lead to weight loss, but there may be no identifiable cause in up to one-quarter of patients. We review the incidence and prevalence of weight loss in elderly patients, its impact on morbidity and mortality, the common causes of unintentional weight loss and a clinical approach to diagnosis. Screening tools to detect malnutrition are highlighted, and nonpharmacologic and pharmacologic strategies to minimize or reverse weight loss in older adults are discussed.

Journal - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne (Canada )

Journal - Journal of the National Cancer Institute (United States )

Abstract :

BACKGROUND: Radical prostatectomy is associated with excellent long-term disease control for localized prostate cancer. Prior studies have suggested an increased risk of short-term complications among older men who underwent radical prostatectomy, but these studies did not adjust for comorbidity. METHODS: We examined mortality and complications occurring within 30 days following radical prostatectomy among all 11,010 men who underwent this surgery in Ontario, Canada, between 1990 and 1999 using multivariable logistic regression modeling. We adjusted for comorbidity using two common comorbidity indices. Statistical tests were two-sided. RESULTS: Overall, 53 men (0.5%) died, and 2195 [corrected] (19.9%[corrected]) had one or more complications within 30 days of radical prostatectomy. In models adjusted for comorbidity and year of surgery, age was associated with an increased risk of 30-day mortality (odds ratio = 2.04 per decade of age, 95% confidence interval [CI] = 1.23 to 3.39). However, the absolute 30-day mortality risk was low, even in older men, at 0.66% (95% CI = 0.2 to 1.1%) for men aged 70-79 years. In adjusted models, age was associated with an increased risk of cardiac (Ptrend < .001), respiratory (Ptrend = .01), and miscellaneous medical (Ptrend = .058) complications. Similarly, increasing comorbidity was associated with a higher risk of all categories of complications. CONCLUSIONS: Increasing comorbidity is a stronger predictor than age of almost all categories of early complications after radical prostatectomy. The risk of postoperative mortality after radical prostatectomy is relatively low for otherwise healthy older men up to age 79.

Journal - Cancer treatment reviews (England )

Journal - The Canadian journal of urology (Canada )

Abstract :

INTRODUCTION: Most treatment studies of localized prostate cancer are observational in nature. The recent publication of a large randomized trial of radical prostatectomy (RP) versus watchful waiting (WW) has focused increased attention on the treatment of localized prostate cancer. We reviewed all published randomized trials that compared different primary treatment modalities for localized prostate cancer. MATERIALS AND METHODS: We performed a comprehensive Medline search from 1966 to March 2003 to identify all English-language randomized trials of RP, external-beam radiotherapy (EBRT), brachytherapy, watchful waiting, and primary androgen-deprivation therapy in localized prostate cancer. RESULTS: Nine publications dealing with four separate randomized trials were identified. Two studies examined RP and WW; one study examined RP and EBRT; one study examined RP and EBRT, with both groups receiving neoadjuvant and adjuvant androgen-deprivation therapy. WW, in both studies, refers to no treatment until palliative therapy is required. Two of the four trials, conducted in Veterans Administration medical centers, had small sample sizes and were plagued by several methodological limitations. Neither trial was able to convincingly demonstrate an advantage of RP over WW or RP over EBRT. One trial of RP versus EBRT included patients with both localized and locally advanced disease. The fourth trial demonstrated statistically significant reduction in disease-specific mortality, local progression, and development of metastases in patients with primarily clinically detected, well- or moderately well differentiated prostate cancer who underwent RP as compared to WW. CONCLUSIONS: There is high-quality evidence from one randomized trial in favor of surgery over watchful waiting with palliative intent for non-high grade localized prostate cancer. However, most tumors in this study were clinically diagnosed rather than screen-detected. Further randomized trials examining the treatment of screen-detected, localized prostate cancer are needed; several are currently underway.

Journal - BJU international (England )

Abstract :

OBJECTIVES: To investigate the association of age with prostate cancer stage and grade, as the latter factors at the time of diagnosis influence management and prognosis, with some studies suggesting that they may change as a function of patient age. PATIENTS AND METHODS: The charts were reviewed of an age-stratified (<60, 60-69, 70-79 and > or = 80 years) random sample of men with newly diagnosed, histologically confirmed prostate cancer in 1995/96 from three geographical areas in Ontario, Canada. Patients were identified using a comprehensive cancer registry, and the chi-square analysis used to examine the relationship between age and stage, logistic regression for the effect of age on clinically localized disease, and linear regression to assess the age and grade relationships. RESULTS: In all, 347 charts were reviewed; more men in the oldest group had T1 and metastatic disease than had younger men (P = 0.034). The proportion of patients with clinically localized disease (T1 and T2) did not change with age (P > 0.10). Tumour grade, as assessed by Gleason score, increased slightly with age (R(2) = 0.017, P = 0.011). Excluding those patients diagnosed by transurethral prostatectomy did not influence either the age/stage or age/grade relationship. Adjusting for prostate-specific antigen level attenuated the age/grade relationship. CONCLUSION: The stage and grade of prostate cancer at diagnosis changes only slightly with age, probably because of a lower intensity of screening and later diagnosis in older men, rather than any change in prostate cancer biology with age.

Journal - Journal of clinical oncology : official journal of the American Society of Clinical Oncology (United States )

Abstract :

PURPOSE: Prior decision-analytic models are based on outdated or suboptimal efficacy, patient preference, and comorbidity data. We estimated life expectancy (LE) and quality-adjusted life expectancy (QALE) associated with available treatments for localized prostate cancer in men aged >/= 65 years, adjusting for Gleason score, patient preferences, and comorbidity. METHODS: We evaluated three treatments, using a decision-analytic Markov model: radical prostatectomy (RP), external beam radiotherapy (EBRT), and watchful waiting (WW). Rates of treatment complications and pretreatment incontinence and impotence were derived from published studies. We estimated treatment efficacy using three data sources: cancer registry cohort data, pooled case series, and modern radiotherapy studies. Utilities were obtained from 141 prostate cancer patients and from published studies. RESULTS: For men with well-differentiated tumors and few comorbidities, potentially curative therapy (RP or EBRT) prolonged LE up to age 75 years but did not improve QALE at any age. For moderately differentiated cancers, potentially curative therapy resulted in LE and QALE gains up to age 75 years. For poorly differentiated disease, potentially curative therapy resulted in LE and QALE gains up to age 80 years. Benefits of potentially curative therapy were restricted to men with no worse than mild comorbidity. When cohort and pooled case series data were used, RP was preferred over EBRT in all groups but was comparable to modern radiotherapy. CONCLUSION: Potentially curative therapy results in significantly improved LE and QALE for older men with few comorbidities and moderately or poorly differentiated localized prostate cancer. Age should not be a barrier to treatment in this group.

Journal - Cancer (United States )

Abstract :

BACKGROUND: Treatment recommendations for localized prostate carcinoma are based on the patient's remaining life expectancy (RLE), which is influenced by age, comorbidity, and tumor grade. Previous studies have evaluated the influence of age and comorbidity, but to the authors' knowledge not RLE, on actual treatment decisions. METHODS: An age-stratified random sample of 347 patients was generated from a cohort of all patients with newly diagnosed prostate carcinoma in the Ontario Cancer Registry between May 1, 1995 and April 30, 1996 (n = 5192). Chart review was performed to obtain detailed tumor, comorbidity, and treatment information. RLE was estimated from a published model derived from a cohort of 451 men with untreated prostate carcinoma who were followed for 15 years. Multivariable logistic regression was performed to evaluate predictors of treatment, such as radical prostatectomy (RP), radiotherapy (RT), or potentially curative therapy (RP or RT), in relation to patient age, comorbidity, tumor characteristics, and RLE. RESULTS: RP was provided within 6 months of diagnosis to 58.7%, 32.1%, 2.6%, and 0% of patients of ages < 60 years, 60-69 years, 70-79 years, and 80+ years, respectively. The results for RT were 6.4%, 30.9%, 23.4%, and 3.3%, respectively. Increasing comorbidity decreased rates of RP but did not affect use of RT. After controlling for comorbidity and tumor characteristics, older men were found to be treated with RP less often than younger men with similar RLE, whereas RLE did not appear to influence receipt of RT. CONCLUSIONS: Although different mechanisms may account for these results, an age bias may be present among urologists and radiation oncologists treating men with localized prostate carcinoma.Copyright 2003 American Cancer Society.

Journal - Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine (UNITED STATES )

Abstract :

OBJECTIVES: To determine the amount of time spent providing medication education to older patients, the impact of medication education on patients' knowledge and satisfaction, and barriers to providing medication education. DESIGN: Telephone survey of patients within 48 hours of hospital discharge and direct survey of physicians and pharmacists. SETTING: Internal medicine ward in a tertiary care teaching hospital. PARTICIPANTS: Patients 65 years of age and over regularly taking at least one medication. MEASUREMENTS: Patient demographics, medication use, time spent receiving or providing medication education, and satisfaction scores. MAIN RESULTS: Forty-seven respondents with a mean age of 77.1 years reported that physicians spent a mean of 10.5 minutes (range, 0-60 minutes) and pharmacists spent a mean of 5.3 minutes (range, 0-40 minutes) providing medication education. Fifty-one percent reported receiving no education from either physician or pharmacist, and only 30% reported receiving written medication instructions. Respondents were generally quite satisfied with their education. Physicians identified one or more barriers to providing education 51% of the time and pharmacists 80%. Lack of time was the most common barrier (18%) identified by physicians, but pharmacists cited lack of notification of discharge plans (41%) and lack of time (39%) as the main barriers. Respondents made many medication errors and knew little about their medications. CONCLUSIONS: Although older hospitalized patients received little medication education or written information and made many medication errors with and without medication education, approximately one half of physicians perceived no barriers to providing education.

Journal - Journal of Clinical Oncology

Abstract :

Purpose: Use of androgen deprivation therapy (ADT) may be associatedwith an increased risk of diabetes mellitus but the risk ofboth acute myocardial infarction (AMI) and cardiovascular mortalityremain controversial because few outcomes and conflicting findingshave been reported. We sought to clarify whether ADT is associatedwith these outcomes in a large, representative cohort. Methods: Using linked administrative databases in Ontario, Canada, menage 66 years or older with prostate cancer given continuousADT for at least 6 months or who underwent bilateral orchiectomy(n = 19,079) were matched with men with prostate cancer whohad never received ADT. Treated and untreated groups were matched1:1 (ie, hard-matched) on age, prior cancer treatment, and yearof diagnosis and propensity-matched on comorbidities, medications,cardiovascular risk factors, prior fractures, and socioeconomicvariables. Primary outcomes were development of AMI, suddencardiac death, and diabetes. Fragility fracture was also examined. Results: The cohort was observed for a mean of 6.47 years. In time-to-eventanalyses, ADT use was associated with an increased risk of diabetes(hazard ratio [HR], 1.16; 95% CI, 1.11 to 1.21) and fragilityfracture (HR, 1.65; 95% CI, 1.53 to 1.77) but not with AMI (HR,0.91; 95% CI, 0.84 to 1.00) or sudden cardiac death (HR, 0.96;95% CI, 0.83 to 1.10). Increasing duration of ADT was associatedwith an excess risk of fragility fractures and diabetes butnot cardiac outcomes. Conclusion: Continuous ADT use for at least 6 months in older men is associatedwith an increased risk of diabetes and fragility fracture butnot AMI or sudden cardiac death. Supported in part by the Toronto General & Toronto WesternResearch Foundation and a research scientist award from theCanadian Cancer Society (S.M.H.A.) and by a midcareer scientistaward from the Canadian Institutes of Health Research (A.M.C.). Authors' disclosures of potential conflicts of interest andauthor contributions are found at the end of this article.

Journal - Journal of Clinical Oncology

Abstract :

Purpose: Use of androgen deprivation therapy (ADT) may be associatedwith an increased risk of diabetes mellitus but the risk ofboth acute myocardial infarction (AMI) and cardiovascular mortalityremain controversial because few outcomes and conflicting findingshave been reported. We sought to clarify whether ADT is associatedwith these outcomes in a large, representative cohort. Methods: Using linked administrative databases in Ontario, Canada, menage 66 years or older with prostate cancer given continuousADT for at least 6 months or who underwent bilateral orchiectomy(n = 19,079) were matched with men with prostate cancer whohad never received ADT. Treated and untreated groups were matched1:1 (ie, hard-matched) on age, prior cancer treatment, and yearof diagnosis and propensity-matched on comorbidities, medications,cardiovascular risk factors, prior fractures, and socioeconomicvariables. Primary outcomes were development of AMI, suddencardiac death, and diabetes. Fragility fracture was also examined. Results: The cohort was observed for a mean of 6.47 years. In time-to-eventanalyses, ADT use was associated with an increased risk of diabetes(hazard ratio [HR], 1.16; 95% CI, 1.11 to 1.21) and fragilityfracture (HR, 1.65; 95% CI, 1.53 to 1.77) but not with AMI (HR,0.91; 95% CI, 0.84 to 1.00) or sudden cardiac death (HR, 0.96;95% CI, 0.83 to 1.10). Increasing duration of ADT was associatedwith an excess risk of fragility fractures and diabetes butnot cardiac outcomes. Conclusion: Continuous ADT use for at least 6 months in older men is associatedwith an increased risk of diabetes and fragility fracture butnot AMI or sudden cardiac death. Supported in part by the Toronto General & Toronto WesternResearch Foundation and a research scientist award from theCanadian Cancer Society (S.M.H.A.) and by a midcareer scientistaward from the Canadian Institutes of Health Research (A.M.C.). Authors' disclosures of potential conflicts of interest andauthor contributions are found at the end of this article.

Journal - Canadian Medical Association Journal

Abstract :

Abstract UNINTENTIONAL WEIGHT LOSS, or the involuntary decline in totalbody weight over time, is common among elderly people who liveat home. Weight loss in elderly people can have a deleteriouseffect on the ability to function and on quality of life andis associated with an increase in mortality over a 12-monthperiod. A variety of physical, psychological and social conditions,along with age-related changes, can lead to weight loss, butthere may be no identifiable cause in up to one-quarter of patients.We review the incidence and prevalence of weight loss in elderlypatients, its impact on morbidity and mortality, the commoncauses of unintentional weight loss and a clinical approachto diagnosis. Screening tools to detect malnutrition are highlighted,and nonpharmacologic and pharmacologic strategies to minimizeor reverse weight loss in older adults are discussed.

Journal - JNCI Journal of the National Cancer Institute

Abstract :

Shabbir M. H. Alibhai, Marc Leach, George Tomlinson, Murray D. Krahn, Neil Fleshner, Eric Holowaty and Gary NaglieBackground: Radical prostatectomy is associated with excellentlong-term disease control for localized prostate cancer. Priorstudies have suggested an increased risk of short-term complicationsamong older men who underwent radical prostatectomy, but thesestudies did not adjust for comorbidity. Methods: We examinedmortality and complications occurring within 30 days followingradical prostatectomy among all 11 010 men who underwent thissurgery in Ontario, Canada, between 1990 and 1999 using multivariablelogistic regression modeling. We adjusted for comorbidity usingtwo common comorbidity indices. Statistical tests were two-sided.Results: Overall, 53 men (0.5%) died, and 2246 (20.4%) had oneor more complications within 30 days of radical prostatectomy.In models adjusted for comorbidity and year of surgery, agewas associated with an increased risk of 30-day mortality (oddsratio = 2.04 per decade of age, 95% confidence interval [CI]= 1.23 to 3.39). However, the absolute 30-day mortality riskwas low, even in older men, at 0.66% (95% CI = 0.2 to 1.1%)for men aged 70–79 years. In adjusted models, age wasassociated with an increased risk of cardiac (Ptrend<.001),respiratory (Ptrend = .01), and miscellaneous medical (Ptrend= .058) complications. Similarly, increasing comorbidity wasassociated with a higher risk of all categories of complications.Conclusions: Increasing comorbidity is a stronger predictorthan age of almost all categories of early complications afterradical prostatectomy. The risk of postoperative mortality afterradical prostatectomy is relatively low for otherwise healthyolder men up to age 79.