Publications by authors named "Evelyne Liuu"

28 Publications

  • Page 1 of 1

Do diabetic complications influence cancer-related events in people with type 2 diabetes? A cohort approach.

Diabetes Metab 2021 Oct 10:101289. Epub 2021 Oct 10.

Institut du thorax, INSERM, CNRS, Université de Nantes, CHU Nantes, Nantes, France.

Aim: To investigate whether diabetic micro- and macrovascular complications (mMVC) influence cancer-related events in people with type 2 diabetes.

Methods: People with type 2 diabetes from the SURDIAGENE cohort were characterized (duration of diabetes, HbA1c, mMVC, history of cancer) and prospectively followed-up for death and cancer-related events (occurrence, dissemination and cancer-related death).

Results: Between 2002 and 2012, 1468 participants (58% men, mean age 64.8 ± 10.7 years, mean duration of diabetes 14.5 ± 9.9 years at baseline) were enrolled. At baseline, 119 (8%) had a personal history of cancer. Incident cancer occurred in 207 (14%) patients during a mean follow-up of 7.3 ± 3.7 years and was associated with older age, smoking status and personal history of cancer. mMVC were not associated with cancer-related events, considering cancer occurrence, node/metastasis dissemination and cancer-specific death. Risk of all-cause mortality was increased in diabetic patients cumulating cancer history and mMVC (HR 1.73, 95%CI 1.25-2.38) compared to those with neither cancer nor mMVC. In our cohort, cancer-related death was not associated with mMVC (HR 1.05, 95%CI 0.67-1.64), but conversely history of cancer was significantly associated with cardiovascular-related death (HR 2.41, 95%CI 1.36-4.26).

Conclusion: In our cohort, mMVC were not associated with cancer-related events, while history of cancer was significantly associated with cardiovascular death.
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http://dx.doi.org/10.1016/j.diabet.2021.101289DOI Listing
October 2021

Prevalence and prognostic impact of cachexia among older patients with cancer: a nationwide cross-sectional survey (NutriAgeCancer).

J Cachexia Sarcopenia Muscle 2021 Sep 14. Epub 2021 Sep 14.

Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France.

Background: Nutritional impairment is common in cancer patients and is associated with poor outcomes. Only few studies focused on cachexia. We assessed the prevalence of cachexia in older cancer patients, identified associated risk factors, and evaluated its impact on 6 month overall mortality.

Methods: A French nationwide cross-sectional survey (performed in 55 geriatric oncology clinics) of older cancer patients aged ≥70 referred for geriatric assessment prior to treatment choice and initiation. Demographic, clinical, and nutritional data were collected. The first outcome was cachexia, defined as loss of more than 5% of bodyweight over the previous 6 months, or a body mass index below 20 kg/m with weight loss of more than 2%, or sarcopenia (an impaired Strength, Assistance with walking, Rise from chair, Climb stairs and Falls score) with weight loss of more than 2%. The second outcome was 6 month overall mortality.

Results: Of the 1030 patients included in the analysis [median age (interquartile range): 83 (79-87); males: 48%; metastatic cancer: 42%; main cancer sites: digestive tract (29%) and breast (16%)], 534 [52% (95% confidence interval: 49-55%)] had cachexia. In the multivariate analysis, patients with breast (P < 0.001), gynaecologic (P < 0.001), urinary (P < 0.001), skin (P < 0.001), and haematological cancers (P = 0.006) were less likely to have cachexia than patients with colorectal cancer. Patients with upper gastrointestinal tract cancers (including liver and pancreatic cancers; P = 0.052), with previous surgery for cancer (P = 0.001), with metastases (P = 0.047), poor performance status (≥2; P < 0.001), low food intake (P < 0.001), unfeasible timed up-and-go test (P = 0.002), cognitive disorders (P = 0.03) or risk of depression (P = 0.005), were more likely to have cachexia. At 6 months, 194 (20.5%) deaths were observed. Cachexia was associated with 6 month mortality risk (adjusted hazard ratio = 1.49; 95% confidence interval: 1.05-2.11) independently of age, in/outpatient status, cancer site, metastatic status, cancer treatment, dependency, cognition, and number of daily medications.

Conclusions: More than half of older patients with cancer managed in geriatric oncology clinics had cachexia. The factors associated with cachexia were upper gastrointestinal tract cancer, metastases, poor performance status, poor mobility, previous surgery for cancer, cognitive disorders, a risk of depression, and low food intake. Cachexia was independently associated with 6 month mortality.
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http://dx.doi.org/10.1002/jcsm.12776DOI Listing
September 2021

Chlorhexidine plus alcohol versus povidone iodine plus alcohol, combined or not with innovative devices, for prevention of short-term peripheral venous catheter infection and failure (CLEAN 3 study): an investigator-initiated, open-label, single centre, randomised-controlled, two-by-two factorial trial.

Lancet Infect Dis 2021 07 1;21(7):1038-1048. Epub 2021 Feb 1.

Service des Urgences et SAMU 86 Centre 15, CHU de Poitiers, France; Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France; INSERM U1070, Pharmacologie des Agents Anti-Infectieux, Poitiers, France. Electronic address:

Background: Two billion peripheral venous catheters are sold globally each year, but the optimal skin disinfection and types of devices are not well established. We aimed to show the superiority of disinfection with 2% chlorhexidine plus alcohol over 5% povidone iodine plus alcohol in preventing infectious complications, and of closed integrated catheters, positive displacement needleless-connectors, disinfecting caps, and single-use prefilled flush syringes used in combination (innovation group) over open catheters and three-way stopcocks for treatment administration (standard group) in preventing catheter failure.

Methods: We did an open-label, randomised-controlled trial with a two-by-two factorial design, for which we enrolled adults (age ≥18 years) visiting the emergency department at the Poitiers University Hospital, France, and requiring one peripheral venous catheter before admission to the medical wards. Before catheter insertion, patients were randomly assigned (1:1:1:1) using a secure web-based random-number generator to one of four treatment groups based on skin preparation and type of devices (innovative devices or standard devices; 2% chlorhexidine plus alcohol or 5% povidone iodine plus alcohol). Primary outcomes were the incidence of infectious complications (local infection, catheter colonisation, or bloodstream infections) and time between catheter insertion and catheter failure (occlusion, dislodgment, infiltration, phlebitis, or infection). This study is registered with ClinicalTrials.gov, NCT03757143.

Findings: 1000 patients were recruited between Jan 7, and Sept 6, 2019, of whom 500 were assigned to the chlorhexidine plus alcohol group and 500 to the povidone iodine plus alcohol group (250 with innovative solutions and 250 with standard devices in each antiseptic group). No significant interaction was found between the two study interventions. Local infections occurred less frequently with chlorhexidine plus alcohol than with povidone iodine plus alcohol (0 [0%] of 496 patients vs six [1%] of 493 patients) and the same was observed for catheter colonisation (4/431 [1%] vs 70/415 [17%] catheters among the catheters cultured; adjusted subdistribution hazard ratio 0·08 [95% CI 0·02-0·18]). Median time between catheter insertion and catheter failure was longer in the innovation group compared with the standard group (50·4 [IQR 29·6-69·4] h vs 30·0 [16·6-52·6] h; p=0·0017). Minor skin reactions occurred in nine (2%) patients in the chlorhexidine plus alcohol group and seven (1%) patients in the povidone iodine plus alcohol group.

Interpretation: For skin antisepsis, chlorhexidine plus alcohol provides greater protection of peripheral venous catheter-related infectious complications than does povidone iodine plus alcohol. Use of innovative devices extends the catheter complication-free dwell time.

Funding: Becton Dickinson.
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http://dx.doi.org/10.1016/S1473-3099(20)30738-6DOI Listing
July 2021

Multiple Myeloma: An Overview of the Current and Novel Therapeutic Approaches in 2020.

Cancers (Basel) 2020 Oct 8;12(10). Epub 2020 Oct 8.

Department of Internal Medicine, and CIC1402 INSERM unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France.

The survival rate of multiple myeloma (MM) patients has drastically increased recently as a result of the wide treatment options now available. Younger patients truly benefit from these innovations as they can support more intensive treatment, such as autologous stem cell transplant or multiple drug association (triplet, quadruplet). The emergence of immunotherapy allowed new combinations principally based on monoclonal anti-CD38 antibodies for these patients. Still, the optimal induction treatment has not been found yet. While consolidation is still debated, maintenance treatment is now well acknowledged to prolong survival. Lenalidomide monotherapy is the only drug approved in that setting, but many innovations are expected. Older patients, now logically named not transplant-eligible, also took advantage of these breakthrough innovations as most of the recent drugs have a more acceptable safety profile than previous cytotoxic agents. For this heterogenous subgroup, geriatric assessment has become an essential tool to identify frail patients and provide tailored strategies. At relapse, options are now numerous, especially for patients who were not treated with lenalidomide, or not refractory at least. Concerning lenalidomide refractory patients, approved combinations are lacking, but many trials are ongoing to fill that space. Moreover, innovative therapeutics are increasingly being developed with modern immunotherapy, such as chimeric antigen receptor T-cells (CAR-T cells), bispecific antibodies, or antibody-drug conjugates. For now, these treatments are usually reserved to heavily pre-treated patients with a poor outcome. MM drug classes have tremendously extended from historical alkylating agents to current dominant associations with proteasome inhibitors, immunomodulatory agents, and monoclonal anti-CD38/anti SLAMF7 antibodies. Plus, in only a couple of years, several new classes will enter the MM armamentarium, such as cereblon E3 ligase modulators (CELMoDs), selective inhibitors of nuclear export, and peptide-drug conjugates. Among the questions that will need to be answered in the years to come is the position of these new treatments in the therapeutic strategy, as well as the role of minimal residual disease-driven strategies which will be a key issue to elucidate. Through this review, we chose to enumerate and comment on the most recent advances in MM therapeutics which have undergone major transformations over the past decade.
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http://dx.doi.org/10.3390/cancers12102885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600346PMC
October 2020

Comprehensive geriatric assessment in older patients with cancer: an external validation of the multidimensional prognostic index in a French prospective cohort study.

BMC Geriatr 2020 08 18;20(1):295. Epub 2020 Aug 18.

Department of Geriatrics, Poitiers University Hospital, Poitiers, France.

Background: Older patients with cancer require specific and individualized management. The 3-group Multidimensional Prognostic Index (MPI) based on the Comprehensive Geriatric Assessment (CGA) has shown a predictive interest in terms of mortality. The objective of our study was to assess the prognostic value of MPI for 1-year mortality in an external prospective French cohort of elderly patients with cancer.

Methods: From March 2015 to March 2017 a prospective single-center cohort study enrolled all patients with cancer, aged 75 years and older referred to the geriatric oncology clinic. We used a proportional hazard model for 1-year mortality adjusted for age, sex, tumor sites and metastatic status. C-statistics were used to assess the incremental predictive value of MPI index to these risk factors.

Results: overall, 433 patients underwent CGA with MPI (women 42%; mean age 82.8 ± 4.8 years). The most common tumor sites were prostate (23%), skin (17%), colorectum (15%) and breast (12%); 29% of patients had a metastatic disease; 231 patients (53%) belonged to the "MPI-1" group, 172 (40%) to the "MPI-2" group and 30 patients were classified in the "MPI-3" group. One-year mortality rate was 32% (23% in MPI-1, 41% in MPI-2 and 53% in MPI-3, p = 0.024). All domains of MPI except cognition and living status were significantly associated with mortality at one-year, as well as tumor sites and metastatic status. Higher MPI was associated with a higher mortality risk (adjusted HR 1.56 [95%CI 1.70-2.09] and 1.72 [1.33-2.22] for MPI groups 2 and 3 compared to 1; p < 0.0001).

Conclusions: In addition to established risk factors, MPI improves risk prediction of 1-year mortality. This practical prognostic tool may help to optimize management of these vulnerable patients.
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http://dx.doi.org/10.1186/s12877-020-01692-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7433061PMC
August 2020

Surgical and regional treatments for colorectal cancer metastases in older patients: A systematic review and meta-analysis.

PLoS One 2020 22;15(4):e0230914. Epub 2020 Apr 22.

Department of Geriatrics, CHU La Milétrie, Poitiers University Hospital, Grand Poitiers, France.

Objective: The present study explored the existing literature to describe the outcomes of surgical and regional treatments for colorectal cancer metastases (mCRC) in older patients.

Methods: A literature search was conducted in PubMed, EMBASE, Cochrane and ClinicalTrials.gov for studies published since 2000 that investigated the short- and long-term outcomes of regional treatments (surgical or non-surgical) for mCRC in patients aged ≥65 years. Pooled data analyses were conducted by calculating the risk ratio (RR), mean differences (MD) and hazard ratio (HR) between older and younger patients or between two different approaches in older patients.

Results: After screening 266 articles, 29 were included in this review. These studies reported the outcomes of surgery (n = 19) and non-surgical local ablation treatments (n = 3) for CRC metastases in older vs. younger patients or compared the outcomes of different interventions in older patients (n = 7). When comparing older vs. younger patients undergoing liver surgery for mCRC, pooled data analysis showed higher postoperative mortality [RR = 2.53 (95%CI: 2.00-3.21)] and shorter overall survival [HR = 1.17 (95%CI: 1.07-1.18)] in older patients, whereas no differences in operative outcomes, postoperative complications and disease-free survival were found. When comparing laparoscopy vs. open surgery for liver resection in older mCRC patients, laparoscopy was associated with fewer postoperative complications [RR = 0.27 (95%CI: 0.10-0.73)].

Conclusion: Liver resection for mCRC should not be disregarded a priori in older patients, who show similar operative and postoperative outcomes as younger patients. However, clinicians should consider that they are at increased risk of postoperative mortality and have a worse overall survival, which may reflect comorbidities and frailty.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230914PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176093PMC
July 2020

Frailty and diabetes status in older patients with cancer: impact on mortality in the ANCRAGE cohort.

Aging Clin Exp Res 2020 Sep 2;32(9):1809-1819. Epub 2020 Jan 2.

Department of Geriatrics, CHU Poitiers, 2 rue de la Milétrie, 86021, Poitiers Cedex, France.

Background: Frailty, diabetes and cancer are associated with aging, but the relationship between these conditions is not well defined.

Aims: We studied older patients with cancer from the prospective single-center cohort ANCRAGE (ANalyses of CanceR in AGEd) aiming to determine the impact of type 2 diabetes (T2D) and its vascular complications (VC) on frailty and adverse outcomes (mortality, unplanned readmission) during follow-up.

Methods: Analysis of cohort patients ≥ 75 years, included between 2009 and 2017, who underwent a comprehensive geriatric assessment (CGA). Variables of interest were history of T2D and VC, tumor site and metastatic status, CGA including eight domains (social environment, functional status, mobility, nutrition, mood, cognition, polypharmacy and comorbidities) and frailty.

Results: Among 1092 patients (47% female, mean age 82 ± 5 years), 219 (20%) had a reported diagnosis of T2D at baseline including 152 (69%) with VC. The most common tumor sites were prostate (15%), breast (15%), skin (12%), and colorectum (11%); 29% of patients had a metastatic disease. Frailty was highly prevalent (84%). During follow-up (median of 15.3 months), 653 (60%) patients died (60% no T2D, 43% T2D without VC, 66% with VC). After adjustment for age, gender and metastatic status, diabetics with VC had a higher risk of all-cause death (aHR1.89, 1.24-2.86, p = 0.004). Death was more frequently due to a non-cancer cause (p < 0.001). No difference in unplanned readmissions was observed in the three groups. Frailty was an independent risk factor for mortality and unplanned readmissions (p < 0.001 both).

Conclusion: In older cancer patients from the prospective ANCRAGE cohort, all-cause mortality was significantly higher in frail patients and those with complicated T2D, a finding questioning the quality of care management in such vulnerable patients, and stimulating further research in this multidisciplinary field.
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http://dx.doi.org/10.1007/s40520-019-01362-9DOI Listing
September 2020

[Interest of the multidimensional prognostic index (MPI) as an assessment tool in hospitalized patients in geriatrics].

Geriatr Psychol Neuropsychiatr Vieil 2019 12;17(4):386-392

Service de gériatrie, CHU La Milétrie, Poitiers, France, Centre d'investigation clinique, CIC Inserm 1402, CHU La Milétrie, Poitiers, France.

The collection of prognostic information in the elderly is essential. The main objective was to perform a replication of the multidimensional prognostic index (MPI), to predict mortality at one-year in patients hospitalized in geriatric wards. Secondary objectives were to evaluate if the MPI was predictive of the length of hospital stay, and of rehospitalization in the following year.

Methods: Prospective study conducted from February 2015 to November 2016 at the University Hospital of Poitiers (Geriatrics department). A comprehensive geriatric assessment (number of treatment, lifestyle, autonomy, comorbidities, risk of pressure sore, nutritional and cognitive status) was used to calculate the MPI score and to categorize patients into three groups: low (MPI-1), moderate (MPI-2) and high (MPI-3) risk of mortality.

Results: 153 patients were included, with mean age 85.9 ± 5.4 years. Twenty-one patients (13.7%) belonged to MPI-1 group, 98 (64.1%) to MPI-2 group, and 34 (22.2%) to MPI-3 group. The number of deaths at one-year according to the MPI group was different (p < 0.01). The one-year prognostic performance of MPI was good (AUC at 0.76). MPI was also predictive of hospital length stay (p < 0.05).

Conclusion: MPI appears to be a relevant prognostic tool in the stratification of one-year mortality risk in elderly patients hospitalized in geriatrics.
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http://dx.doi.org/10.1684/pnv.2019.0823DOI Listing
December 2019

[Non-programmed hospitalization of elderly patients with cancer: Which care pathway?]

Bull Cancer 2019 Apr 1;106(4):293-303. Epub 2019 Mar 1.

CHU La Milétrie, pôle de gériatrie, 2, rue de La Milétrie, 86021 Poitiers cedex, France.

Introduction: Management of elderly patients with cancer is challenging worldwide. Improvement of their care pathway should focus on unplanned hospitalizations. This study aimed to compare the geriatric and oncologic profiles of elderly patients with cancer, hospitalized for an acute pathology either in medical oncology or acute geriatric medicine units.

Methods: Epidemiological, analytical, monocentric, transversal study performed in the geriatric and oncological short-stay units of the university hospital of Poitiers (France) from 07/01/2014 to 06/30/2015. Only patients with diagnosed cancer prior to hospitalization were included. The geriatric, oncological and hospitalization data were collected and analyzed.

Results: In total, 230 patients were included (156 in geriatrics, 74 in oncology). Alteration of the general condition was the most frequent reason for admission. In multivariate age-adjusted analyses, factors associated with admission to a geriatric unit were co-morbidities (OR=0.18 [95% CI: 0.07-0.46], P<0.01) and dependence (OR=0.07 [95% CI: 0.01-0.36], P<0.01). Ongoing antineoplastic treatment (OR=2.60 [95%CI: 1.14-5.89], P=0.02) and metastatic cancer (OR=2.63 [95%CI: 1.18-5.86], P=0.02) influenced hospitalization in the oncology unit. During the hospital stay there was more frequent psychological support in oncology (OR=45.59 [95%CI: 9.79-212.23], P<0.01) and social support in Geriatrics (OR=0.13 [95% CI: 0.04-0.40], P<0.01).

Conclusion: This first comparative study showed a significant difference in profiles of elderly patients with cancer hospitalized for an acute problem, depending on the hospital unit. This finding paves the way of improvement of care pathway by formalizing links between these two departments to optimize care and referrals to the most appropriate care unit, according to patients condition, in case of unscheduled hospitalization.
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http://dx.doi.org/10.1016/j.bulcan.2018.12.012DOI Listing
April 2019

Prognosis of geriatric patients with severe kidney disease.

Geriatr Psychol Neuropsychiatr Vieil 2018 Dec;16(4):376-382

Pôle de gériatrie, CHU de Poitiers, Poitiers, France, Inserm, CIC1402, CHU de Poitiers, France.

Over three million French people present a severe chronic kidney disease, among which there is a high prevalence of elder subjects. We conducted a prospective monocentric study in a geriatric acute care ward. The aims were to determine the short-term prognosis of patients with severe chronic kidney disease and to determine the factors associated with mortality at six-months.

Methods: Patients 75 years of age and older, with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m (chronic kidney disease epidemiology CKD-EPI) were recruited. A comprehensive geriatric assessment was performed at hospital discharge. Comprehensive geriatric assessment was performed: Activities of daily livings and Instrumental activities of daily livings scores, of the risk of pressure sore with Exton-Smith scale, the cognitive status with MMSE score, nutritional status according to Mini-nutritional assessment short form and albuminemia, comorbidities with Cumulative illness rating scale, number of drugs in presciption and living status. Six months follow-up was performed to assess vital status and evolution of the eGFR.

Results: Sixty-seven patients were included, mean age 88.6±4.82 years with a mean eGFR of 21.3±6 mL/min. Mortality rate at six months was 36%. Multivariate analysis showed that a high CIRS score (RR=1.52; IC 95% 1.05-2.19) and a decline of creatinine clearance≥ 2 mL/min (4.72; 1.27-17.52) were predictive of mortality. On the opposite, a high MNA-SF score was protective (0.76; 0.62-0.94).

Conclusion: Prognosis of geriatric patients with severe chronic kidney disease is poor. Comprehensive geriatric assessment helps to assess short-term prognosis, in a focus of person-centered care.
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http://dx.doi.org/10.1684/pnv.2018.0756DOI Listing
December 2018

Prevalence of cancer and management in elderly nursing home residents. A descriptive study in 45 French nursing homes.

Eur J Cancer Care (Engl) 2019 Mar 29;28(2):e12957. Epub 2018 Oct 29.

Department of Geriatrics, Poitiers University Hospital, Poitiers, France.

This study aimed to determine cancer prevalence occurring after the age of 75 in 45 French nursing homes (NH), as well as residents' characteristics and parameters associated with cancer-specific management. Descriptive retrospective study including 214 residents (mean age, 89.7 years) with cancer diagnosed after age 75. The studied parameters were sociodemographic, functional, nutritional and cognitive data; comorbidity assessment; date of tumoral diagnosis; cancer type; tumoral stage; treatment plan; multidisciplinary staff decision and oncologic follow-up. Our results showed that cancer prevalence in NH was 8.4 ± 1.1%, diagnosed before admission in 63% of cases. The most common tumoral sites were skin (26%), digestive tract and breast (18% for both); 12% had metastasis. Cognitive impairment was the most common comorbidity (42%), and 44% of the residents were highly dependent. Multivariate analysis showed that therapeutic decisions were associated with age. Older patients had less staging exploration (odd ratios [ORs], 0.90, 95% confidence interval [CI], 0.85-0.97) and underwent less cancer-specific treatment (ORs, 0.92; 95%CI, 0.86-0.99). Oncologic follow-up was more frequent in younger patients (ORs, 0.90; 95%CI, 0.81-0.99) and those with recent diagnosis (ORs, 0.37; 95%CI, 0.23-0.61). This study identified factors associated with substandard neoplastic management in elderly NH residents. It highlights needs for information, education and training in cancer detection to improve cancer consideration and care in NH.
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http://dx.doi.org/10.1111/ecc.12957DOI Listing
March 2019

How to Optimize Cancer Treatment in Older Patients: An Overview of Available Geriatric Tools.

Am J Clin Oncol 2019 02;42(2):109-116

University Paris-Est, UPEC, DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit).

Cancer is a disease of older people, but this age group has often been excluded from clinical trials of cancer, which leads to poor transportability of standardized treatments in older cancer patients. One of the main reasons for the exclusion is the heterogeneity of older people in several domains: social environment, comorbidities, dependency, functional status, nutritional status, cognition status, and mood status. Comprehensive geriatric assessment aims to assess this heterogeneity and has identified frequent health problems often unknown before therapeutic decisions, which allows for targeted geriatric interventions with or without follow-up and appropriate cancer treatment selection. Several tools and scores have been developed for a complementary approach. These tools have the following characteristics: they screen for vulnerability to select patients who may benefit from a comprehensive geriatric assessment; are predictive tools for survival, postoperative complications, or chemotherapy-related toxicity; are decisional algorithms for cancer treatment; or define a core set of geriatric data to be collected in clinical cancer trials. Here, we present an overview of the geriatric tools that were published in PubMed from 2000 to 2017, that could help in the therapeutic decision-making for older cancer patients.
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http://dx.doi.org/10.1097/COC.0000000000000488DOI Listing
February 2019

Positive perception of aging is a key predictor of quality-of-life in aging people.

PLoS One 2018 3;13(10):e0204044. Epub 2018 Oct 3.

Pôle Biologie, Pharmacie et Santé Publique, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France.

Objective: We conducted a cross-sectional survey in France in a cohort over 55 years of age to characterize the impact of psychological dimensions on quality-of-life (QoL).

Methods: The predictors of QoL in relation with aging were studied using an adapted quality-of-life model, based on emotional, cognitive and physical symptoms, functional status, and general health perception. Adding psychological dimensions such as self-esteem, psychological distress, perceptions of ageing and coping, was hypothesized to improve the QoL model. Responses were analyzed using structural equation modeling and path analysis.

Results: The study involved 258 participants, mean age 66.9±7.9 years. Psychological distress and positive perception of aging exhibited the strongest direct impact on QoL (p<0.0001). Psychological distress also appeared to be mediator on QoL for perceived health status, self-esteem and negative perception of aging. Coping centred on emotion exhibited direct impact on self-esteem and so, indirect impact on QoL (p = 0.0002). Perception of personal financial situation (p = 0.0007) and coping centred on social support (p = 0.02) appeared as direct mediators influencing QoL.

Conclusions: Psychological dimensions are predictors of QOL and have to be taken into account to maximize the resources with a view to successful aging. Further interventions targeting successful aging should focus on positive perception aging.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0204044PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169874PMC
April 2019

[Geriatric assessment and prognostic scores in older cancer patient: Additional support to the therapeutic decision?]

Bull Cancer 2017 Nov 14;104(11):946-955. Epub 2017 Nov 14.

Université Paris-Est, UPEC, DHU A-TVB, IMRB-EA 7376 CEpiA (clinical epidemiology and ageing unit), 94000 Créteil, France; AP-HP, hôpital Henri-Mondor, département de médecine interne et gériatrie, unité de coordination en onco-gériatrie, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.

Cancer is a disease of the elderly as demonstrated by the epidemiological evolution of Western countries. Indeed, two third of cancers newly diagnosed occur over 65 years. However, older cancer patients have been often excluded from clinical trials in oncology and the extrapolation of cancer treatments in this population remains difficult in practice. Scientific societies recommend that a comprehensive geriatric assessment (CGA) be performed in patients aged 70 and over and selected using screening tools for frailty such as the G8 index. The CGA allows to detect aging-related vulnerabilities in various domains (comorbidities, polypharmacy, autonomy, nutrition, mobility, cognition, mood, social) and associated with adverse outcomes during cancer treatment (reduced overall survival, perioperative complications, toxicity-related chemotherapy). The CGA is allow to elaborate a personalized treatment plan in geriatric oncology. However, to date, no algorithms based on CGA is validated to guide therapeutic decision in geriatric oncology. The collaboration between geriatrician and oncologist remains essential to elaborate an appropriate therapeutic strategy and limit the situations of over- and under-treatment. This article presents the set of tools and scores used in geriatric oncology to guide the therapeutic decision.
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http://dx.doi.org/10.1016/j.bulcan.2017.10.004DOI Listing
November 2017

Prognostic value of the G8 and modified-G8 screening tools for multidimensional health problems in older patients with cancer.

Eur J Cancer 2017 09 24;83:211-219. Epub 2017 Jul 24.

DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Université Paris-Est, UPEC, 51 Avenue Du Maréchal de Lattre de Tassigny, F-94010, Créteil, France; Public Health Department, AP-HP, Henri-Mondor Hospital, 51 Avenue Du Maréchal de Lattre de Tassigny, F-94010, Créteil, France. Electronic address:

Background: The G8 screening tool has been developed to identify older cancer patients requiring a geriatric assessment for tailoring therapy. Little is known about its prognostic value, particularly by tumour site. An optimised version has been recently developed, but no prognostic information is available. We compared the prognostic value of both instruments overall and by tumour site.

Methods: Data were from a prospective cohort of cancer patients ≥70 years old referred to 1 of 6 French geriatric oncology clinics between 2007 and 2014 (n = 1333). Endpoints were overall 1- and 3-year survival. Cox proportional-hazards models were built to assess the predictive value of abnormal G8 and modified-G8 scores, based on published cut-offs or by classes of increasing risk. Sensitivity analyses involved adjusting for age, gender, treatment, metastasis, and tumour site (digestive, breast, urinary tract, prostate, other solid cancers, and haematological malignancies) and stratifying by tumour site and metastatic status.

Results: Abnormal scores were independently associated with overall 1-year survival: adjusted hazard ratio [aHR] = 4.3[G8]/4.9[modified-G8] and 3-year survival: aHR = 2.9/2.6; all p <0.0001. Associations persisted after stratifying by metastatic status and in most cancer sites (exceptions: colorectal (G8) and upper digestive cancer (both tools) [1-year analysis]; digestive cancers (both tools) [3-year analysis]). For both tools, classes of increasing risk showed a graded relationship with mortality (p < 0.0001).

Conclusions: Our results identified both abnormal G8 and modified-G8 scores as strong and consistent predictors of overall survival, regardless of metastatic status or tumour site. These findings strengthen the clinical utility of these instruments in the geriatric oncology setting.
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http://dx.doi.org/10.1016/j.ejca.2017.06.027DOI Listing
September 2017

Using a multidimensional prognostic index (MPI) based on comprehensive geriatric assessment (CGA) to predict mortality in elderly undergoing transcatheter aortic valve implantation.

Int J Cardiol 2017 Jun 16;236:381-386. Epub 2017 Feb 16.

Pôle de Gériatrie, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France; INSERM, CIC-P 1402, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France.

Background: Selection of appropriate elderly who can benefit from transcatheter aortic valve implantation (TAVI) is challenging. We evaluated the prognosis of this procedure according to the comprehensive geriatric assessment (CGA) based on the multidimensional prognostic index (MPI).

Methods: Prospective observational monocentric study from January 2013 to December 2015. Consecutive patients aged ≥75 who underwent TAVI and a complete CGA were included. Baseline demographic, geriatric and cardiologic data were collected. CGA was used to calculate the MPI score that is divided in three groups according to the mortality risk. Follow up was performed until December 2016 and mortality rate was assessed at one, six and 12months.

Results: 116 patients were included. Mean age was 86.2±4.2years, mean European system for cardiac operative risk evaluation (EuroSCORE) was 19.2±11.3%, mean MPI score was 0.39±0.13. Forty-five (38.8%) patients belonged to MPI-1 group, 68 (58.6%) to MPI-2 group and three to MPI-3 group. MPI score and Euroscore were moderately correlated (Spearman correlation coefficient r=0.27, p=0.0035). Mortality rate was significantly different between MPI groups at six and 12months (p=0.040 and p=0.022). Kaplan Meier survival estimates at one year stratified by MPI groups was significantly different (hazard ratio HR=2.83, 95%confidence interval (CI) 1.38-5.82, p=0.004). Among variables retained to perform logistic regression analysis, the score of instrumental activities of daily living appeared the most relevant (p<0.001).

Conclusion: This study indicates that CGA based on MPI tool is accurate to predict prognosis in elderly patients undergoing TAVI procedure.
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http://dx.doi.org/10.1016/j.ijcard.2017.02.048DOI Listing
June 2017

Association between cachexia, chemotherapy and outcomes in older cancer patients: A systematic review.

Clin Nutr 2017 12 18;36(6):1473-1482. Epub 2016 Dec 18.

AP-HP, Henri-Mondor Teaching Hospital, Department of Geriatrics, Geriatric Oncology Clinic, F-94010 Créteil, France; Expert Group on Geriatric Oncology, Société Francophone d'OncoGériatrie (SoFOG), Rheims, France; Expert Group on Nutrition and Geriatrics (GEGN), Société Française de Gériatrie et Gérontologie (SFGG), Paris, France. Electronic address:

Background & Aims: The aims of this systematic review were (i) to determine the prevalence of malnutrition and cachexia in older cancer patients in a chemotherapy setting, and (ii) to report the chemotherapy-related causes of malnutrition and (iii) the consequences of malnutrition on the outcomes of these patients.

Methods: We searched MEDLINE for articles published in English or French between 2005 and 2016 and which reported retrospective or prospective, observational or interventional studies of the prevalence of malnutrition and its consequences in patients 65 years or older with solid tumors and chemotherapy-related causes of malnutrition.

Results And Conclusion: Malnutrition is prevalent up to 83% in older patients with cancer scheduled to receive chemotherapy. One third or more of patients were malnourished before receiving chemotherapy. A weight loss of 10% or more during the past three or six months was reported in 8%-40% of cancer patients, while a body mass index <21 kg/m was found in 10.7%-23%. Malnutrition was more prevalent in digestive (28%-75%) than in non-digestive cancers (8%-46.9%), and also in metastatic cancers (64%-76.5%). During the course of chemotherapy, weight loss was observed in 40%-91.6% of patients, depending on cancer location. The most frequently reported chemotherapy-related digestive symptoms likely to impair nutritional status were dry mouth, nausea, stomach pain, diarrhea and constipation. Low Mini-Nutritional-Assessment score was an independent predictor of early discontinuation of chemotherapy and increased the risk of mortality.
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http://dx.doi.org/10.1016/j.clnu.2016.12.003DOI Listing
December 2017

What Do Older Adults Know About Their Cancer Diagnosis and Treatment? The ELCAPA-08 Cohort Study.

J Am Geriatr Soc 2016 06;64(6):1360-2

Clinical Epidemiology and Aging Unit CEpiA-EA 7376-Institut Mondor de Recherche Biomédicale, Ageing Thorax-Vessels-Blood Département Hospitalo-Universitaire, Université Paris-Est, Créteil, France.

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http://dx.doi.org/10.1111/jgs.14154DOI Listing
June 2016

Four Distinct Health Profiles in Older Patients With Cancer: Latent Class Analysis of the Prospective ELCAPA Cohort.

J Gerontol A Biol Sci Med Sci 2016 12 22;71(12):1653-1660. Epub 2016 Mar 22.

Clinical Epidemiology and Ageing (CEpiA) Unit EA 7376, Université Paris Est (UPEC), A-TVB DHU, IMRB, F-94010 Créteil, France.

Background: Several studies have evaluated the independent prognostic value of impairments in single geriatric-assessment (GA) components in elderly cancer patients. None identified homogeneous subgroups. Our aims were to identify such subgroups based on combinations of GA components and to assess their associations with treatment decisions, admission, and death.

Methods: We prospectively included 1,021 patients aged ≥70 years who had solid or hematologic malignancies and who underwent a GA in one of two French teaching hospitals. Two geriatricians independently selected candidate GA parameters for latent class analysis, which was then performed on the 821 cases without missing data. Age, gender, tumor site, metastatic status, and inpatient versus outpatient status were used as active covariates and predictors of class membership. Outcomes were cancer treatment decisions, overall 1-year mortality, and 6-month unscheduled admissions. Sensitivity analyses were performed on the overall population of 1,021 patients and on 375 newly enrolled patients.

Results: We identified four classes: relatively healthy (LC1, 28%), malnourished (LC2, 36%), cognitive and mood impaired (LC3, 15%), and globally impaired (LC4, 21%). Tumor site, metastatic status, age, and in/outpatient status independently predicted class membership (p < .001). In adjusted pairwise comparisons, compared to LC1, the three other LCs were associated with higher risks of palliative treatment, death, and unscheduled admission (p ≤ .05). LC4 was associated with 1-year mortality and palliative treatment compared to LC2 and LC3 (p ≤ .05).

Conclusion: We identified four health profiles that may help physicians select cancer treatments and geriatric interventions. Researchers may find these profiles useful for stratifying patients in clinical trials.
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http://dx.doi.org/10.1093/gerona/glw052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5106853PMC
December 2016

[Orthostatic hypotension in elderly: a case-control study].

Soins Gerontol 2016 Jan-Feb(117):37-43

Département de médecine interne et de gériatrie, université Paris Est-Créteil, groupe hospitalier Henri-Mondor, AP-HP, 51 avenue du Maréchal-de-Lattre de Tassigny, 94010 Créteil, France.

Orthostatic hypotension is common in the elderly and is often associated with increased morbidity and mortality. Compression bandages are recommended as a first-line treatment but there is little evidence of their efficacy in literature. A case-control study involving 52 patients was carried out to test the efficacy of the bandages. In the group with orthostatic hypotension, compression improved the symptoms without correcting the blood pressure readings.
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http://dx.doi.org/10.1016/j.sger.2015.11.010DOI Listing
May 2016

Factors associated with orthostatic hypotension in hospitalized elderly patients.

Aging Clin Exp Res 2016 Jun 19;28(3):513-7. Epub 2015 Oct 19.

Pôle de Gériatrie, CHU La Milétrie, 86021, Poitiers Cedex, France.

Objective: To assess the factors associated with orthostatic hypotension (OH) in hospitalized elderly patients.

Design: Prospective observational single center study.

Setting: A French academic center.

Participants: One hundred and thirty-one patients without OH symptoms who underwent OH testing.

Measurements: The OH test was performed when the patient was able to get out of the bed and was no longer receiving parenteral fluids. The blood pressure was measured after a 10-min rest while the patients were sitting and then standing at 1 and 3 min. Demographic data, co-morbidities, current medications and biological parameters were recorded.

Results: The mean patient age was 84.3 ± 7 years. The mean CIRS-G score was 10.6 ± 3.8. The OH test was performed 6.3 ± 3.9 days after admission and was positive in 39 (29.8 %) patients (95 % confidence interval (CI) 22, 38) and positive at 1 min in 87.2 % of the cases. Multivariate analysis showed that OH prevalence correlated with diabetes (odds ratio (OR) = 4.23; 95 % CI 1.10, 16.24; P = 0.03), serum 25-hydroxyvitamin D <20 ng/ml (OR = 3.38; 95 % CI 1.36, 8.42; P = 0.008), use of tranquilizers (anxiolytic and hypnotic) (OR = 2.96; 95 % CI 1.18, 7.4; P = 0.02), CIRS-G score (OR = 1.15; 95 % CI 1.01, 1.31; P = 0.03) and lack of diuretics (OR = 0.20; 95 % CI 0.06, 0.63; P = 0.005).

Conclusion: In older adults, OH is often misdiagnosed because it is asymptomatic. As practitioners may be reluctant to perform the OH test because of time constraints, targeting a subgroup of patients with a higher risk of OH should be worthwhile to prevent further OH complications.
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http://dx.doi.org/10.1007/s40520-015-0451-zDOI Listing
June 2016

[Kidney and bladder cancers in the elderly].

Soins Gerontol 2014 Sep-Oct(109):38-42

Kidney and bladder cancers are common in the elderly. Treatments used in younger patients may be considered for the latter, subject to an individual estimation of the/risk-benefit ratio that takes into consideration the geriatric evaluation parameters. Surgery is the only curative treatment for both cancers. Supportive care should be integrated early in comprehensive care to preserve the quality of life of elderly patients with these cancers.
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December 2014

Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment.

Clin Interv Aging 2014 29;9:1645-60. Epub 2014 Sep 29.

Laboratoire d'Investigation Clinique (LIC), Faculté de Medecine, Université Paris Est Créteil (UPEC), Créteil, Paris ; Unité de Coordination d'Onco-Gériatrie, Département de Médecine Interne et Gériatrie, Hôpital Henri-Mondor, Assistance Publique - Hopitaux de Paris (AP-HP), Créteil, France.

Background: Cancer is common in older patients, who raise specific treatment challenges due to aging-related, organ-specific physiologic changes and the presence in most cases of comorbidities capable of affecting treatment tolerance and outcomes. Identifying comorbid conditions and physiologic changes due to aging allows oncologists to better assess the risk/benefit ratio and to adjust the treatment accordingly. Conducting a Comprehensive Geriatric Assessment (CGA) is one approach developed for this purpose. We reviewed the evidence on the usefulness of CGA for assessing health problems and predicting cancer treatment outcomes, functional decline, morbidity, and mortality in older patients with solid malignancies.

Methods: We searched Medline for articles published in English between January 1, 2000 and April 14, 2014, and reporting prospective observational or interventional studies of CGA feasibility or effectiveness in patients aged ≥65 years with solid malignancies. We identified studies with at least 100 patients, a multivariate analysis, and assessments of at least five of the following CGA domains: nutrition, cognition, mood, functional status, mobility and falls, polypharmacy, comorbidities, and social environment.

Results: All types of CGA identified a large number of unrecognized health problems capable of interfering with cancer treatment. CGA results influenced 21%-49% of treatment decisions. All CGA domains were associated with chemotoxicity or survival in at least one study. The abnormalities that most often predicted mortality and chemotoxicity were functional impairment, malnutrition, and comorbidities.

Conclusion: The CGA uncovers numerous health problems in elderly patients with cancer and can affect treatment decisions. Functional impairment, malnutrition, and comorbidities are independently associated with chemotoxicity and/or survival. Only three randomized published studies evaluated the effectiveness of CGA-linked interventions. Further research into the effectiveness of the CGA in improving patient outcomes is needed.
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http://dx.doi.org/10.2147/CIA.S57849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189720PMC
April 2015

Accuracy of the G-8 geriatric-oncology screening tool for identifying vulnerable elderly patients with cancer according to tumour site: the ELCAPA-02 study.

J Geriatr Oncol 2014 Jan 16;5(1):11-9. Epub 2013 Sep 16.

AP-HP, hôpital Henri-Mondor, Department of Internal Medicine and Geriatrics, Onco-Geriatric Clinic, F-94010 Créteil, France; Université Paris Est Créteil (UPEC), LIC EA 4393, F-94010 Créteil, France.

Background/objective: G-8 screening tool showed good screening properties for identifying vulnerable elderly patients with cancer who would benefit from a comprehensive geriatric assessment (CGA). We investigated whether tumour site and metastatic status affected its accuracy.

Materials And Methods:

Design: Cross-sectional analysis of a prospective cohort study.

Setting: Geriatric-oncology clinics of two teaching hospitals in the urban area of Paris.

Participants: Patients aged 70 or over (n = 518) with breast ( n= 113), colorectal (n = 108), urinary-tract (n = 89), upper gastrointestinal/liver (n = 85), prostate (n = 69), or other cancers (n = 54).

Measurements: Reference standard for diagnosing vulnerability was the presence of at least one abnormal test among the Activities of Daily Living (ADLs), Instrumental ADL, Mini-Mental State Examination, Mini Nutritional Assessment, Cumulative Illness Rating Scale-Geriatrics, Timed Get-Up-and-Go, and Mini-Geriatric Depression Scale. Sensitivity, specificity and likelihood ratios of G-8 scores ≤ 14 were compared according to tumour site and patient characteristics.

Results: Median age was 80; 48.2% had metastases. Prevalence of vulnerability and abnormal G-8 score was 84.2% (95% confidence interval [95% CI], 81-87.3) and 79.5% (95% CI, 76-83). The G-8 was 86.9% sensitive (95% CI, 83.4-89.9) and 59.8% specific (95% CI, 48.3-70.4). G-8 performance varied significantly (all p values < 0.001) across tumour sites (sensitivity, 65.2% in prostate cancer to 95.1% in upper gastrointestinal/liver cancer; and specificity, 23.1% in colorectal cancer to 95.7% in prostate cancer) and metastatic status (sensitivity and specificity, 93.8% and 53.3% in patients with metastases vs. 79.5% and 63.3% in those without, respectively). Differences remained significant after adjustment on age and performance status.

Conclusion: These G-8 accuracy variations across tumour sites should be considered when using G-8 to identify elderly patients with cancer who could benefit from CGA.
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http://dx.doi.org/10.1016/j.jgo.2013.08.003DOI Listing
January 2014

Interleukin-10 promoter (-1082) polymorphism in association with repeated hospital-acquired infections in elderly patients.

Aging Clin Exp Res 2014 Feb 4;26(1):25-31. Epub 2013 Dec 4.

Service de Biochimie, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75679 Paris cedex 04, France,

Background: Infections are frequent complications of hospitalization, particularly in the elderly. Pro- and anti-inflammatory cytokines are essential components of the host response to pathogens and polymorphisms in their genes may contribute to inter-individual variations of the inflammatory response. The aim of this study was to investigate whether cytokine polymorphisms, separately or in combination, could be determining factors in the development of repeated nosocomial infections in elderly hospitalized patients.

Methods: Tumor necrosis factor-α (-308) and (-238), interleukin-6 (-174) and (-6331), interleukin-10 (-1082) and (-592) polymorphisms were genotyped by PCR and hybridization with fluorescent-labeled probes in 245 hospitalized elderly patients (mean age 85.2 years; SD 6) and compared with those in 145 healthy adults.

Results: The distribution of genotypes did not differ between elderly patients and control subjects. The presence of the interleukin-10 A(592) or A(1082) allele was more frequent individually and after adjustment for multiple comparisons in patients who suffered from several infections (p = 0.012, odds ratio = 5.3; 95 % confidence interval = 1.2-23.1).

Conclusion: Our data support a determinant role for interleukin-10 (-1082) polymorphism in the development of nosocomial infections.
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http://dx.doi.org/10.1007/s40520-013-0177-8DOI Listing
February 2014

[Cognitive-behavioral specialized units: predictive factors of readmissions within three months].

Geriatr Psychol Neuropsychiatr Vieil 2012 Sep;10(3):277-83

Centre mémoire de ressources et de recherche, CHU La Milétrie, Poitiers, France.

Background: Behavioral and psychological symptoms of dementia (BPSD) are frequent and belong to the natural evolution of the disease. Specialized cognitive-behavioral units (Unités cognitivo-comportementales) were created, in France (plan Alzheimer 2008-2012), to cope with this problem. Despite a stay in such a unit, some patients have to be rehospitalized. The main aim of the current study was to highlight the predictive factors of readmissions.

Method: Descriptive, retrospective study of demented patients ≥75 years, hospitalized between January 2010 and April 2011. We compared patients that had to be rehospitalized within 3 months (group 1), with the patients that did not need to be rehospitalized or after 3 months of time (group 2). Patients characteristics included: basic daily living activities (French GIR score), MMSE score, neuropsychiatric inventory score, type of BPSD, length of stay and antipsychotropic drugs.

Results: Two hundred thirty-five patients were included including, 147 women (62.5%), with mean age of 82.74±7.13 years. SPCD was the main reason for hospitalization. Thirty patients (12.77%) belonged to group 1. The mean number of psychotropic treatments increased during the stay (p=0.02), particularly in group 2 (p=0.01). The NPI score decreased during the hospitalization in both groups. Linear regression analysis showed that behavioral type of symptoms (OR: 3.18; 95% CI 1.32-7.65) and association of antidepressant and antipsychotic drugs (OR: 4.77; 95% CI 1.35-16.83) were significantly predictive of an early readmission. The risk of readmission also significantly decreased as the length of stay increased.

Conclusion: This work confirms the specificity and the need for such units. The results will help improving the outcome of demented patients with BPSD and treated with different antipsychotropic drugs.
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http://dx.doi.org/10.1684/pnv.2012.0366DOI Listing
September 2012

Impact of comorbidities on hospital-acquired infections in a geriatric rehabilitation unit: prospective study of 252 patients.

J Am Med Dir Assoc 2012 Oct 11;13(8):760.e7-12. Epub 2012 Aug 11.

Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Henri-Mondor, Département de médecine interne et gériatrie, Creteil, France.

Objectives: Hospital-acquired infections (HAIs) remain a major source of morbidity and mortality in long-term care units, despite advances in antimicrobial therapy and preventive measures. Our aim was to investigate risk factors for HAIs, especially in the elderly, and to describe the relationship between comorbidities (number, severity, and specific diseases) and HAIs using a comprehensive inventory of comorbidities.

Design: Prospective cohort study

Setting: Geriatric rehabilitation unit in a university hospital in the Paris metropolitan area.

Participants: Participants were 252 consecutive patients aged 75 years or older (mean age, 85 ± 6.2 years) and admitted between 2006 and 2008.

Measurements: Surveillance of HAI was conducted. A complete inventory of comorbidities was done using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Potential risk factors were evaluated in 2 risk models, one with HAI acquisition, CIRS-G, activities of daily living score less than 10, and at least 1 invasive procedure (yes/no) and the other with HAI acquisition and specific invasive procedures and diseases.

Results: Of the 252 patients, 97 experienced HAIs, for an incidence of 5.6 infections per 1000 bed-days. The most common HAI sites were the respiratory tract (48%; 65/136) and urinary tract (37%; 51/136). The CIRS-G global score and comorbidity index were higher in patients with than without HAIs. Among HAI categories, respiratory and urogenital diseases were more prevalent in the group with HAIs. In the model combining CIRS-G, activities of daily living score less than 10, and at least 1 invasive procedure, independent risk factors for HAI were CIRS-G index (odds ratio [OR], 1.55; 95% confidence interval [95% CI], 1.13-2.11; P = .005) and invasive procedures (OR, 5.18; 95% CI, 2.77-9.71; P < .001). In the model including specific procedures and diseases, independent risk factors for HAI were intravenous catheter (OR, 7.39; 95% CI, 2.94-18.56; P < .001), urinary catheter (OR, 3.33; 95% CI, 1.40-7.88; P = .006), gastrointestinal endoscopy (OR, 3.69; 95% CI, 1.12-12.16; P = .03), pressure sores (OR, 2.52; 95% CI, 1.04-6.10; P = .03), and swallowing impairment (OR, 3.37; 95% CI, 1.16-9.74; P = .02).

Conclusions: This study identified several important risk factors for HAIs. There is a need for HAI prevention via the implementation of infection-control programs, including surveillance, in rehabilitation units.
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http://dx.doi.org/10.1016/j.jamda.2012.07.002DOI Listing
October 2012
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