Giuseppe Colloca - Academia.edu (original) (raw)

Papers by Giuseppe Colloca

Research paper thumbnail of Perspectives and limits of cancer treatment in an oldest old population

Aging Clinical and Experimental Research, Mar 11, 2021

Research paper thumbnail of Performance status as prognostic factor in phase III trials of first‐line chemotherapy of unresectable or metastatic pancreatic cancer: A trial‐level meta‐analysis

Asia-Pacific Journal of Clinical Oncology, 2021

For patients with unresectable or metastatic pancreatic adenocarcinoma (mPDAC), there are no stan... more For patients with unresectable or metastatic pancreatic adenocarcinoma (mPDAC), there are no standardized prognostic and predictive factors beyond performance status (PS). A poor PS, as defined by Eastern Cooperative Oncology Group (ECOG) score of 2 or more, has been related with a detrimental effect of chemotherapy. Therefore, even more trials enrolled patients with good PS. The current analysis aims to evaluate the results of PS as a prognostic factor in phase III trials of patients with mPDAC receiving first‐line chemotherapy. A literature search on two databases, from 2000 to 2019, and a further selection of clinical trials were performed by predefined criteria. Twelve phase III studies have been included in the analysis: the trials, enrolling 5619 patients, confirmed the worse prognosis of patients with higher ECOG PS scores (hazard ratio [HR] = 1.45; 95% confidence interval [CI], 1.21–1.74; p‐value < 0.001), and a similar trend was evident for patients with an ECOG PS 1 ver...

Research paper thumbnail of Immunotherapy and radiotherapy in melanoma: a multidisciplinary comprehensive review

Human Vaccines & Immunotherapeutics, 2021

Melanoma is an extremely aggressive tumor and is considered to be an extremely immunogenic tumor ... more Melanoma is an extremely aggressive tumor and is considered to be an extremely immunogenic tumor because compared to other cancers it usually presents a well-expressed lymphoid infiltration. The aim of this paper is to perform a multidisciplinary comprehensive review of the evidence available about the combination of radiotherapy and immunotherapy for melanoma. Radiation, in fact, can increase tumor antigens visibility and promote priming of T cells but can also exert immunosuppressive action on tumor microenvironment. Combining radiotherapy with immunotherapy provides an opportunity to increase immunostimulatory potential of radiation. We therefore provide the latest clinical evidence about radiobiological rationale, radiotherapy techniques, timing, and role both in advanced and systemic disease (with a special focus on ocular melanoma and brain, liver, and bone metastases) with a particular attention also in geriatric patients. The combination of immunotherapy and radiotherapy seems to be a safe therapeutic option, supported by a clear biological rationale, even though the available data confirm that radiotherapy is employed more for metastatic than for non-metastatic disease. Such a combination shows promising results in terms of survival outcomes; however, further studies, hopefully prospective, are needed to confirm such evidence.

Research paper thumbnail of Frailty screening in dermato‐oncology practice: a modified Delphi study and a systematic review of the literature

Journal of the European Academy of Dermatology and Venereology, 2020

BackgroundAppropriate management and prevention of both under‐ and overtreatment in older skin ca... more BackgroundAppropriate management and prevention of both under‐ and overtreatment in older skin cancer patients can be challenging. It could be helpful to incorporate frailty screening in dermato‐oncology care, since frailty is associated with adverse health outcomes.ObjectivesThis study aimed to identify and prioritize the requirements a frailty screening tool (FST) should fulfil in dermato‐oncology practice and to select the best existing FST(s) for this purpose.MethodsA modified two‐round Delphi procedure was performed among 50 Italian and Dutch specialists and patients to review and prioritize a list of potential FST requirements, using a 5‐point Likert scale. Consensus was defined as a mean score of ≥4.0. A systematic literature search was performed to identify existing multidomain FSTs, which were then assessed on the requirements resulting from the modified Delphi procedure.ResultsConsensus was achieved on evaluation of comorbidities (4.3 ± 0.7), polypharmacy (4.0 ± 0.9) and c...

Research paper thumbnail of The Older Patients and the Epidemiological Change after COVID-19 Pandemic. The Simplicity of the Complexity Management and the Personalization in Cancer Care

Annals of Clinical Oncology

The SARS-CoV-2 pandemic has led us to imagine the current scenario as something terrible, disastr... more The SARS-CoV-2 pandemic has led us to imagine the current scenario as something terrible, disastrous, but temporary. However, history teaches us that an event of this magnitude can only evolve towards “new” normality, a new equilibrium, but it will only be reached through a transition that will last over the years. In this scenario, the term “frailty”, which is known to few, has become common. The need for healthcare that, alongside high specialization, focuses on the complexity of the individual is increasingly intense. Geriatric oncology probably represents the clearest example of how much the current scenario has impacted the health and social fields, as it involves frail adults with cancer. How to draw the future?

Research paper thumbnail of Cognitive decline in older long-term survivors from Non-Hodgkin Lymphoma: a multicenter cross-sectional study

Journal of Geriatric Oncology, 2020

Objectives: To compare cognition in a group of older long-term survivors from Non-Hodgkin Lymphom... more Objectives: To compare cognition in a group of older long-term survivors from Non-Hodgkin Lymphoma (NHL) and in a corresponding group of non-cancer controls of the same age. Functional status, polypharmacy and multimorbidity were also evaluated. Methods: A cross-sectional study was performed in a population of 63 outpatient long-term survivors from NHL, aged 65 or more and 61 non-cancer controls. Socio-demographic, clinical and functional data were collected. Cognitive function was assessed through neuropsychological tests. Results: NHL survivors showed a slightly worse functional status than controls, they were affected by more chronic conditions (3.4 vs 2.3; p = .003) and were taking a higher number of medications (3.4 vs 2.3; p = .03). The Mini Mental State Examination (MMSE) was not significantly different between the groups. NHL survivors performed worse than controls in executive functioning (Trail Making Test B-A 47.9 vs 32.1 p = .04, OR for Stroop test time over 75th percentile in survivors: 2.66; CI 95% 1.04-6.61; OR for Multiple Features Target Cancellation time over 75th percentile in survivors: 2.84; CI 95% 1.10-7.31). A small, statistically significant difference was also observed in verbal memory scores between the two groups.. Conclusions: The findings of this study suggest that, compared with non-cancer controls, older survivors from NHL may have a lower cognitive performance, especially in the executive functioning and attention domains, regardless of multimorbidity and polypharmacy. Further evidence from larger samples is needed to confirm such findings and better characterize cognitive decline in NHL survivors.

Research paper thumbnail of Comorbidity assessment to determine prognosis in older adult patients with classical Hodgkin lymphoma

Hematological Oncology, 2020

The clinical management of older adult patients with Hodgkin lymphoma (HL) remains a major challe... more The clinical management of older adult patients with Hodgkin lymphoma (HL) remains a major challenge. The aim of this study was to evaluate the impact of comorbidity assessment according to a standardized approach, the Cumulative Illness Rating Scale (CIRS), on prognosis in patients with classical HL aged 60 years and older. We studied 76 consecutive older adult patients with HL (median age 69 y, range 60‐84) who had been treated in our institution between 1999 and 2018. Comorbidity was assessed at diagnosis according to CIRS. Anthracycline‐containing chemotherapy with curative intent was administered in 59 (78%) patients. We identified 41 (54%) patients with at least one severe comorbidity rated on CIRS grade ≥ 3. Patients with severe comorbidity were more likely to have advanced‐stage disease (P = .003), to have an International Prognostic Score (IPS) > 3 (P = .03), and to not receive anthracycline‐containing chemotherapy (P = .008). The probability of overall survival (OS) at ...

Research paper thumbnail of The role of personalized Interventional Radiotherapy (brachytherapy) in the management of older patients with non-melanoma skin cancer

Journal of Geriatric Oncology, 2018

Objective: Non-melanoma skin cancer (NMSC) has been rapidly increasing in incidence over the past... more Objective: Non-melanoma skin cancer (NMSC) has been rapidly increasing in incidence over the past 30 years. Mainstays of treatment remain surgery and radiotherapy, particularly in older and/or frail patients (≥75 years old) that often require a personalized treatment strategy using innovative biotechnologies. High-dose-rate interventional radiotherapy (HDR-IRT) seems to be an excellent option for NMSC. Material and Methods: Nineteen aged patients with advanced, biopsy proven NMSC were treated with exclusively HDR-IRT. A personalized double-layer mould of thermoplastic mask material was applied to the skin surface. Plastic tubes were fixed on the mould in appropriate geometry over the target area. Planning computed tomography (CT) images were acquired with 2.5 mm slice thickness and transmitted to the planning system. Treatment intention was to deliver ≥95% of the prescribed dose to the Planning Target Volume (PTV), accepting 90% as satisfactory. Toxicities were assessed using the Common Terminology Criteria for Adverse Events scale (CTCAE) v. 4.0. Results: Median age was 86 years. Acute toxicity: Grade 2 erythema appeared in all 19 patients. Towards the end of each treatment schedule, epidermolysis developed which was resolved within 6 weeks of completing HDR-IRT. Late toxicity: Grade 1 skin atrophy, pigmentation changes and alopecia in field were observed in all patients. At last follow-up, all patients were disease free. Conclusions: Personalized HDR-IRT appears to be safe and effective for frail older patients and a valid alternative to supportive care for those with contraindication to surgery. Future investigations using also large database analysis seem to be advisory.

Research paper thumbnail of Muscoloskeletal aging, sarcopenia and cancer

Journal of Geriatric Oncology, 2018

Research paper thumbnail of A new standardized data collection system for interdisciplinary thyroid cancer management: Thyroid COBRA

European journal of internal medicine, Jul 21, 2018

The big data approach offers a powerful alternative to Evidence-based medicine. This approach cou... more The big data approach offers a powerful alternative to Evidence-based medicine. This approach could guide cancer management thanks to machine learning application to large-scale data. Aim of the Thyroid CoBRA (Consortium for Brachytherapy Data Analysis) project is to develop a standardized web data collection system, focused on thyroid cancer. The Metabolic Radiotherapy Working Group of Italian Association of Radiation Oncology (AIRO) endorsed the implementation of a consortium directed to thyroid cancer management and data collection. The agreement conditions, the ontology of the collected data and the related software services were defined by a multicentre ad hoc working-group (WG). Six Italian cancer centres were firstly started the project, defined and signed the Thyroid COBRA consortium agreement. Three data set tiers were identified: Registry, Procedures and Research. The COBRA-Storage System (C-SS) appeared to be not time-consuming and to be privacy respecting, as data can be...

Research paper thumbnail of SP-0253 Comprehensive Assessment in Elderly Patients with Cancer

Radiotherapy and Oncology, 2012

Research paper thumbnail of Age-related physiologic changes and perioperative management of elderly patients

Surgical Oncology, 2010

Aging itself only minimally increases operative risk, but with aging, there is an increase of the... more Aging itself only minimally increases operative risk, but with aging, there is an increase of the prevalence of chronic diseases and a progressive deterioration of organ function. Aging is associated with a progressive decrease in heart, lung and kidney performance. Under normal conditions, these physiologic changes do not produce any problems for the elderly, but when these patients are subjected to the stress of surgery or its complications, there may be inadequate functional reserve. It is very important to know age-related patho-physiological changes in order to be able to better evaluate elderly patients undergoing surgery, and to prevent and manage preoperative complications. In this review we try to identify and to describe the most frequent physiological changes in the elderly, how those impact pharmacodynamic and pharmacokinetic parameters, and how to assess and manage them.

Research paper thumbnail of Prevalence of the seven cardiovascular health metrics in a Mediterranean country: results from a cross-sectional study

European journal of public health, Sep 26, 2013

Primordial prevention is essential for reaching cardiovascular (CV) health. This is defined by se... more Primordial prevention is essential for reaching cardiovascular (CV) health. This is defined by seven health metrics identified by the American Heart Association. Aim of the present study was to assess prevalence and distribution of these seven CV health metrics within an unselected population. Methods: All the 1110 consecutive individuals (mean age 56 AE 13 years; 56% women) who agreed to be screened within the context of a national campaign of CV prevention were included. The following findings have been considered as ideal: never/former smoker, regular participation in physical activity, body mass index lower than 25.0, healthy diet, cholesterol lower than 200 mg/dl, diabetes absence and a blood pressure lower than 120/80 mmHg. Results: Participants presented, on average, 4.1 AE 1.2 ideal CV health metrics, with a decreasing number across age-groups. Only 10.4% covered more than five ideal CV health metrics and 8.3% covered less than three ideal health metrics. Only 1.9% of the study population met all the seven ideal metrics. In particular, only 34% (379 subjects) in our population presented an ideal level of cholesterol. The higher prevalence was observed in younger subjects (45%) and the lower (28%) in people older than 62 years (P < 0.001). Conclusion: Prevalence of the seven CV health metrics was low in our population and just 1 in 10 met more than five ideal CV health metrics. Social initiatives and awareness policies from governments are mandatory to promote CV health. Further studies should address the impact of such CV metrics on several outcomes in European countries.

Research paper thumbnail of Sarcopenia (and sarcopenic obesity) in older patients with gynecological malignancies

Journal of Geriatric Oncology, Apr 1, 2021

Research paper thumbnail of International Society of Geriatric Oncology Consensus on Geriatric Assessment in Older Patients With Cancer

Journal of Clinical Oncology, Aug 20, 2014

To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatri... more To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. Methods SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment-related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. Results GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. Conclusion There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base.

Research paper thumbnail of Self-Assessed Health Status, Walking Speed and Mortality in Older Mexican-Americans

Gerontology, Nov 18, 2008

Research paper thumbnail of Cognitive performance is associated with left ventricular function in older chronic hemodialysis patients: result of a pilot study

Aging Clinical and Experimental Research, Dec 19, 2013

Cognitive impairment is a common finding in end-stage renal disease patients on chronic hemodialy... more Cognitive impairment is a common finding in end-stage renal disease patients on chronic hemodialysis, but data on the associated factors are still scanty. The present study evaluated the association between cognitive function and left ventricular systolic function in hemodialysis patients. We enrolled 72 patients admitted to the Hemodialysis Unit of the Catholic University, Rome. Cognitive performance was evaluated using the Mini Mental State Examination (MMSE); a cutoff of 24 was used to diagnose cognitive impairment. Left ventricular ejection fraction (LVEF) was assessed by echocardiography. Multivariable linear and logistic regressions were adopted to assess the adjusted association between cognitive performance and LVEF. Also, linear discriminant analysis was performed to ascertain the cutoff level of LVEF which best predicted cognitive impairment. Cognitive impairment was found in 37 (51 %) patients. According to linear regression, MMSE was independently associated with LVEF (B = 0.06; 95 % CI = 0.01-0.12; P = 0.040). Logistic regression confirmed the inverse association between LVEF and cognitive impairment (OR = 0.87; 95 % CI = 0.78-0.98; P = 0.022). In linear discriminant analysis, the LVEF cutoff level that best predicted cognitive impairment was ≤51 %. Cognitive impairment is a common finding in hemodialysis patients. Even mildly depressed LVEF is independently associated with cognitive impairment. This association and its potential therapeutic implications should be assessed in dedicated studies.

Research paper thumbnail of Onco-Geriatric Approach for the Management of Older Patients with Cancer

Journal of the American Medical Directors Association, Feb 1, 2011

Research paper thumbnail of Inappropriate Drugs in Elderly Patients with Severe Cognitive Impairment: Results from the Shelter Study

PLOS ONE, Oct 3, 2012

Background: It has been estimated that Nursing Home (NH) residents with impaired cognitive status... more Background: It has been estimated that Nursing Home (NH) residents with impaired cognitive status receive an average of seven to eight drugs daily. The aim of this study was to determine prevalence and factors associated with use of inappropriate drugs in elderly patients with severe cognitive impairment living in NH in Europe. Methods: Cross-sectional data from a sample of 1449 NH residents with severe cognitive impairment, participating in the Services and Health for Elderly in Long TERm care (SHELTER) study were analysed. Inappropriate drug use was defined as the use of drugs classified as rarely or never appropriate in patients with severe cognitive impairment based on the Holmes criteria published in 2008. Results: Mean age of participating residents was 84.268.9 years, 1087 (75.0%) were women. Inappropriate drug use was observed in 643 (44.9%) residents. Most commonly used inappropriate drugs were lipid-lowering agents (9.9%), antiplatelet agents (excluding Acetylsalicylic Acid-ASA-) (9.9%), acetylcholinesterase, inhibitors (7.2%) and antispasmodics (6.9%). Inappropriate drug use was directly associated with specific diseases including diabetes (OR 1.64; 95% CI 1.21-2.24), heart failure (OR 1.48; 95% CI 1.04-2.09), stroke (OR 1.43; 95% CI 1.06-1.93), and recent hospitalization (OR 1.69; 95% CI 1.20-2.39). An inverse relation was shown between inappropriate drug use and presence of a geriatrician in the facility (OR 0.55; 95% CI 0.39-0.77). Conclusion: Use of inappropriate drugs is common among older EU NH residents. Determinants of inappropriate drug use include comorbidities and recent hospitalization. Presence of a geriatrician in the facility staff is associated with a reduced rate of use of these medications.

Research paper thumbnail of Causes of deaths in long-term care and hospice care facilities during the first year of COVID-19 pandemic: a snapshot of Italy during 2020

Aging Clinical and Experimental Research

Background Older adults living in long-term care facilities (LTCF) have been severely affected by... more Background Older adults living in long-term care facilities (LTCF) have been severely affected by COVID-19. Hospice care (HC) facilities and palliative care are essential in treating patients dying from COVID-19. In Italy, little is known about the impact of COVID-19 on deaths in LTCF and the care provided in HC to COVID-19 patients. Aim To assess overall and case-specific mortality in 2020 in LTC and HC facilities in comparison to the previous five years (2015–2019). Methods We performed a descriptive study using data derived from the Italian national “Cause of Death” registry—managed by the Italian National Institute of Statistics—on deaths occurred in LTC and HC facilities during 2020 and the period 2015–2019. Results Number of deaths significantly increased in 2020 compared with 2015–2019 in LTCF (83,062 deaths vs. 59,200) and slightly decreased in hospices (38,788 vs. 39,652). COVID-19 caused 12.5% of deaths in LTCF and only 2% in hospices. Other than COVID-19, in 2020, cancer ...

Research paper thumbnail of Perspectives and limits of cancer treatment in an oldest old population

Aging Clinical and Experimental Research, Mar 11, 2021

Research paper thumbnail of Performance status as prognostic factor in phase III trials of first‐line chemotherapy of unresectable or metastatic pancreatic cancer: A trial‐level meta‐analysis

Asia-Pacific Journal of Clinical Oncology, 2021

For patients with unresectable or metastatic pancreatic adenocarcinoma (mPDAC), there are no stan... more For patients with unresectable or metastatic pancreatic adenocarcinoma (mPDAC), there are no standardized prognostic and predictive factors beyond performance status (PS). A poor PS, as defined by Eastern Cooperative Oncology Group (ECOG) score of 2 or more, has been related with a detrimental effect of chemotherapy. Therefore, even more trials enrolled patients with good PS. The current analysis aims to evaluate the results of PS as a prognostic factor in phase III trials of patients with mPDAC receiving first‐line chemotherapy. A literature search on two databases, from 2000 to 2019, and a further selection of clinical trials were performed by predefined criteria. Twelve phase III studies have been included in the analysis: the trials, enrolling 5619 patients, confirmed the worse prognosis of patients with higher ECOG PS scores (hazard ratio [HR] = 1.45; 95% confidence interval [CI], 1.21–1.74; p‐value < 0.001), and a similar trend was evident for patients with an ECOG PS 1 ver...

Research paper thumbnail of Immunotherapy and radiotherapy in melanoma: a multidisciplinary comprehensive review

Human Vaccines & Immunotherapeutics, 2021

Melanoma is an extremely aggressive tumor and is considered to be an extremely immunogenic tumor ... more Melanoma is an extremely aggressive tumor and is considered to be an extremely immunogenic tumor because compared to other cancers it usually presents a well-expressed lymphoid infiltration. The aim of this paper is to perform a multidisciplinary comprehensive review of the evidence available about the combination of radiotherapy and immunotherapy for melanoma. Radiation, in fact, can increase tumor antigens visibility and promote priming of T cells but can also exert immunosuppressive action on tumor microenvironment. Combining radiotherapy with immunotherapy provides an opportunity to increase immunostimulatory potential of radiation. We therefore provide the latest clinical evidence about radiobiological rationale, radiotherapy techniques, timing, and role both in advanced and systemic disease (with a special focus on ocular melanoma and brain, liver, and bone metastases) with a particular attention also in geriatric patients. The combination of immunotherapy and radiotherapy seems to be a safe therapeutic option, supported by a clear biological rationale, even though the available data confirm that radiotherapy is employed more for metastatic than for non-metastatic disease. Such a combination shows promising results in terms of survival outcomes; however, further studies, hopefully prospective, are needed to confirm such evidence.

Research paper thumbnail of Frailty screening in dermato‐oncology practice: a modified Delphi study and a systematic review of the literature

Journal of the European Academy of Dermatology and Venereology, 2020

BackgroundAppropriate management and prevention of both under‐ and overtreatment in older skin ca... more BackgroundAppropriate management and prevention of both under‐ and overtreatment in older skin cancer patients can be challenging. It could be helpful to incorporate frailty screening in dermato‐oncology care, since frailty is associated with adverse health outcomes.ObjectivesThis study aimed to identify and prioritize the requirements a frailty screening tool (FST) should fulfil in dermato‐oncology practice and to select the best existing FST(s) for this purpose.MethodsA modified two‐round Delphi procedure was performed among 50 Italian and Dutch specialists and patients to review and prioritize a list of potential FST requirements, using a 5‐point Likert scale. Consensus was defined as a mean score of ≥4.0. A systematic literature search was performed to identify existing multidomain FSTs, which were then assessed on the requirements resulting from the modified Delphi procedure.ResultsConsensus was achieved on evaluation of comorbidities (4.3 ± 0.7), polypharmacy (4.0 ± 0.9) and c...

Research paper thumbnail of The Older Patients and the Epidemiological Change after COVID-19 Pandemic. The Simplicity of the Complexity Management and the Personalization in Cancer Care

Annals of Clinical Oncology

The SARS-CoV-2 pandemic has led us to imagine the current scenario as something terrible, disastr... more The SARS-CoV-2 pandemic has led us to imagine the current scenario as something terrible, disastrous, but temporary. However, history teaches us that an event of this magnitude can only evolve towards “new” normality, a new equilibrium, but it will only be reached through a transition that will last over the years. In this scenario, the term “frailty”, which is known to few, has become common. The need for healthcare that, alongside high specialization, focuses on the complexity of the individual is increasingly intense. Geriatric oncology probably represents the clearest example of how much the current scenario has impacted the health and social fields, as it involves frail adults with cancer. How to draw the future?

Research paper thumbnail of Cognitive decline in older long-term survivors from Non-Hodgkin Lymphoma: a multicenter cross-sectional study

Journal of Geriatric Oncology, 2020

Objectives: To compare cognition in a group of older long-term survivors from Non-Hodgkin Lymphom... more Objectives: To compare cognition in a group of older long-term survivors from Non-Hodgkin Lymphoma (NHL) and in a corresponding group of non-cancer controls of the same age. Functional status, polypharmacy and multimorbidity were also evaluated. Methods: A cross-sectional study was performed in a population of 63 outpatient long-term survivors from NHL, aged 65 or more and 61 non-cancer controls. Socio-demographic, clinical and functional data were collected. Cognitive function was assessed through neuropsychological tests. Results: NHL survivors showed a slightly worse functional status than controls, they were affected by more chronic conditions (3.4 vs 2.3; p = .003) and were taking a higher number of medications (3.4 vs 2.3; p = .03). The Mini Mental State Examination (MMSE) was not significantly different between the groups. NHL survivors performed worse than controls in executive functioning (Trail Making Test B-A 47.9 vs 32.1 p = .04, OR for Stroop test time over 75th percentile in survivors: 2.66; CI 95% 1.04-6.61; OR for Multiple Features Target Cancellation time over 75th percentile in survivors: 2.84; CI 95% 1.10-7.31). A small, statistically significant difference was also observed in verbal memory scores between the two groups.. Conclusions: The findings of this study suggest that, compared with non-cancer controls, older survivors from NHL may have a lower cognitive performance, especially in the executive functioning and attention domains, regardless of multimorbidity and polypharmacy. Further evidence from larger samples is needed to confirm such findings and better characterize cognitive decline in NHL survivors.

Research paper thumbnail of Comorbidity assessment to determine prognosis in older adult patients with classical Hodgkin lymphoma

Hematological Oncology, 2020

The clinical management of older adult patients with Hodgkin lymphoma (HL) remains a major challe... more The clinical management of older adult patients with Hodgkin lymphoma (HL) remains a major challenge. The aim of this study was to evaluate the impact of comorbidity assessment according to a standardized approach, the Cumulative Illness Rating Scale (CIRS), on prognosis in patients with classical HL aged 60 years and older. We studied 76 consecutive older adult patients with HL (median age 69 y, range 60‐84) who had been treated in our institution between 1999 and 2018. Comorbidity was assessed at diagnosis according to CIRS. Anthracycline‐containing chemotherapy with curative intent was administered in 59 (78%) patients. We identified 41 (54%) patients with at least one severe comorbidity rated on CIRS grade ≥ 3. Patients with severe comorbidity were more likely to have advanced‐stage disease (P = .003), to have an International Prognostic Score (IPS) > 3 (P = .03), and to not receive anthracycline‐containing chemotherapy (P = .008). The probability of overall survival (OS) at ...

Research paper thumbnail of The role of personalized Interventional Radiotherapy (brachytherapy) in the management of older patients with non-melanoma skin cancer

Journal of Geriatric Oncology, 2018

Objective: Non-melanoma skin cancer (NMSC) has been rapidly increasing in incidence over the past... more Objective: Non-melanoma skin cancer (NMSC) has been rapidly increasing in incidence over the past 30 years. Mainstays of treatment remain surgery and radiotherapy, particularly in older and/or frail patients (≥75 years old) that often require a personalized treatment strategy using innovative biotechnologies. High-dose-rate interventional radiotherapy (HDR-IRT) seems to be an excellent option for NMSC. Material and Methods: Nineteen aged patients with advanced, biopsy proven NMSC were treated with exclusively HDR-IRT. A personalized double-layer mould of thermoplastic mask material was applied to the skin surface. Plastic tubes were fixed on the mould in appropriate geometry over the target area. Planning computed tomography (CT) images were acquired with 2.5 mm slice thickness and transmitted to the planning system. Treatment intention was to deliver ≥95% of the prescribed dose to the Planning Target Volume (PTV), accepting 90% as satisfactory. Toxicities were assessed using the Common Terminology Criteria for Adverse Events scale (CTCAE) v. 4.0. Results: Median age was 86 years. Acute toxicity: Grade 2 erythema appeared in all 19 patients. Towards the end of each treatment schedule, epidermolysis developed which was resolved within 6 weeks of completing HDR-IRT. Late toxicity: Grade 1 skin atrophy, pigmentation changes and alopecia in field were observed in all patients. At last follow-up, all patients were disease free. Conclusions: Personalized HDR-IRT appears to be safe and effective for frail older patients and a valid alternative to supportive care for those with contraindication to surgery. Future investigations using also large database analysis seem to be advisory.

Research paper thumbnail of Muscoloskeletal aging, sarcopenia and cancer

Journal of Geriatric Oncology, 2018

Research paper thumbnail of A new standardized data collection system for interdisciplinary thyroid cancer management: Thyroid COBRA

European journal of internal medicine, Jul 21, 2018

The big data approach offers a powerful alternative to Evidence-based medicine. This approach cou... more The big data approach offers a powerful alternative to Evidence-based medicine. This approach could guide cancer management thanks to machine learning application to large-scale data. Aim of the Thyroid CoBRA (Consortium for Brachytherapy Data Analysis) project is to develop a standardized web data collection system, focused on thyroid cancer. The Metabolic Radiotherapy Working Group of Italian Association of Radiation Oncology (AIRO) endorsed the implementation of a consortium directed to thyroid cancer management and data collection. The agreement conditions, the ontology of the collected data and the related software services were defined by a multicentre ad hoc working-group (WG). Six Italian cancer centres were firstly started the project, defined and signed the Thyroid COBRA consortium agreement. Three data set tiers were identified: Registry, Procedures and Research. The COBRA-Storage System (C-SS) appeared to be not time-consuming and to be privacy respecting, as data can be...

Research paper thumbnail of SP-0253 Comprehensive Assessment in Elderly Patients with Cancer

Radiotherapy and Oncology, 2012

Research paper thumbnail of Age-related physiologic changes and perioperative management of elderly patients

Surgical Oncology, 2010

Aging itself only minimally increases operative risk, but with aging, there is an increase of the... more Aging itself only minimally increases operative risk, but with aging, there is an increase of the prevalence of chronic diseases and a progressive deterioration of organ function. Aging is associated with a progressive decrease in heart, lung and kidney performance. Under normal conditions, these physiologic changes do not produce any problems for the elderly, but when these patients are subjected to the stress of surgery or its complications, there may be inadequate functional reserve. It is very important to know age-related patho-physiological changes in order to be able to better evaluate elderly patients undergoing surgery, and to prevent and manage preoperative complications. In this review we try to identify and to describe the most frequent physiological changes in the elderly, how those impact pharmacodynamic and pharmacokinetic parameters, and how to assess and manage them.

Research paper thumbnail of Prevalence of the seven cardiovascular health metrics in a Mediterranean country: results from a cross-sectional study

European journal of public health, Sep 26, 2013

Primordial prevention is essential for reaching cardiovascular (CV) health. This is defined by se... more Primordial prevention is essential for reaching cardiovascular (CV) health. This is defined by seven health metrics identified by the American Heart Association. Aim of the present study was to assess prevalence and distribution of these seven CV health metrics within an unselected population. Methods: All the 1110 consecutive individuals (mean age 56 AE 13 years; 56% women) who agreed to be screened within the context of a national campaign of CV prevention were included. The following findings have been considered as ideal: never/former smoker, regular participation in physical activity, body mass index lower than 25.0, healthy diet, cholesterol lower than 200 mg/dl, diabetes absence and a blood pressure lower than 120/80 mmHg. Results: Participants presented, on average, 4.1 AE 1.2 ideal CV health metrics, with a decreasing number across age-groups. Only 10.4% covered more than five ideal CV health metrics and 8.3% covered less than three ideal health metrics. Only 1.9% of the study population met all the seven ideal metrics. In particular, only 34% (379 subjects) in our population presented an ideal level of cholesterol. The higher prevalence was observed in younger subjects (45%) and the lower (28%) in people older than 62 years (P < 0.001). Conclusion: Prevalence of the seven CV health metrics was low in our population and just 1 in 10 met more than five ideal CV health metrics. Social initiatives and awareness policies from governments are mandatory to promote CV health. Further studies should address the impact of such CV metrics on several outcomes in European countries.

Research paper thumbnail of Sarcopenia (and sarcopenic obesity) in older patients with gynecological malignancies

Journal of Geriatric Oncology, Apr 1, 2021

Research paper thumbnail of International Society of Geriatric Oncology Consensus on Geriatric Assessment in Older Patients With Cancer

Journal of Clinical Oncology, Aug 20, 2014

To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatri... more To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. Methods SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment-related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. Results GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. Conclusion There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base.

Research paper thumbnail of Self-Assessed Health Status, Walking Speed and Mortality in Older Mexican-Americans

Gerontology, Nov 18, 2008

Research paper thumbnail of Cognitive performance is associated with left ventricular function in older chronic hemodialysis patients: result of a pilot study

Aging Clinical and Experimental Research, Dec 19, 2013

Cognitive impairment is a common finding in end-stage renal disease patients on chronic hemodialy... more Cognitive impairment is a common finding in end-stage renal disease patients on chronic hemodialysis, but data on the associated factors are still scanty. The present study evaluated the association between cognitive function and left ventricular systolic function in hemodialysis patients. We enrolled 72 patients admitted to the Hemodialysis Unit of the Catholic University, Rome. Cognitive performance was evaluated using the Mini Mental State Examination (MMSE); a cutoff of 24 was used to diagnose cognitive impairment. Left ventricular ejection fraction (LVEF) was assessed by echocardiography. Multivariable linear and logistic regressions were adopted to assess the adjusted association between cognitive performance and LVEF. Also, linear discriminant analysis was performed to ascertain the cutoff level of LVEF which best predicted cognitive impairment. Cognitive impairment was found in 37 (51 %) patients. According to linear regression, MMSE was independently associated with LVEF (B = 0.06; 95 % CI = 0.01-0.12; P = 0.040). Logistic regression confirmed the inverse association between LVEF and cognitive impairment (OR = 0.87; 95 % CI = 0.78-0.98; P = 0.022). In linear discriminant analysis, the LVEF cutoff level that best predicted cognitive impairment was ≤51 %. Cognitive impairment is a common finding in hemodialysis patients. Even mildly depressed LVEF is independently associated with cognitive impairment. This association and its potential therapeutic implications should be assessed in dedicated studies.

Research paper thumbnail of Onco-Geriatric Approach for the Management of Older Patients with Cancer

Journal of the American Medical Directors Association, Feb 1, 2011

Research paper thumbnail of Inappropriate Drugs in Elderly Patients with Severe Cognitive Impairment: Results from the Shelter Study

PLOS ONE, Oct 3, 2012

Background: It has been estimated that Nursing Home (NH) residents with impaired cognitive status... more Background: It has been estimated that Nursing Home (NH) residents with impaired cognitive status receive an average of seven to eight drugs daily. The aim of this study was to determine prevalence and factors associated with use of inappropriate drugs in elderly patients with severe cognitive impairment living in NH in Europe. Methods: Cross-sectional data from a sample of 1449 NH residents with severe cognitive impairment, participating in the Services and Health for Elderly in Long TERm care (SHELTER) study were analysed. Inappropriate drug use was defined as the use of drugs classified as rarely or never appropriate in patients with severe cognitive impairment based on the Holmes criteria published in 2008. Results: Mean age of participating residents was 84.268.9 years, 1087 (75.0%) were women. Inappropriate drug use was observed in 643 (44.9%) residents. Most commonly used inappropriate drugs were lipid-lowering agents (9.9%), antiplatelet agents (excluding Acetylsalicylic Acid-ASA-) (9.9%), acetylcholinesterase, inhibitors (7.2%) and antispasmodics (6.9%). Inappropriate drug use was directly associated with specific diseases including diabetes (OR 1.64; 95% CI 1.21-2.24), heart failure (OR 1.48; 95% CI 1.04-2.09), stroke (OR 1.43; 95% CI 1.06-1.93), and recent hospitalization (OR 1.69; 95% CI 1.20-2.39). An inverse relation was shown between inappropriate drug use and presence of a geriatrician in the facility (OR 0.55; 95% CI 0.39-0.77). Conclusion: Use of inappropriate drugs is common among older EU NH residents. Determinants of inappropriate drug use include comorbidities and recent hospitalization. Presence of a geriatrician in the facility staff is associated with a reduced rate of use of these medications.

Research paper thumbnail of Causes of deaths in long-term care and hospice care facilities during the first year of COVID-19 pandemic: a snapshot of Italy during 2020

Aging Clinical and Experimental Research

Background Older adults living in long-term care facilities (LTCF) have been severely affected by... more Background Older adults living in long-term care facilities (LTCF) have been severely affected by COVID-19. Hospice care (HC) facilities and palliative care are essential in treating patients dying from COVID-19. In Italy, little is known about the impact of COVID-19 on deaths in LTCF and the care provided in HC to COVID-19 patients. Aim To assess overall and case-specific mortality in 2020 in LTC and HC facilities in comparison to the previous five years (2015–2019). Methods We performed a descriptive study using data derived from the Italian national “Cause of Death” registry—managed by the Italian National Institute of Statistics—on deaths occurred in LTC and HC facilities during 2020 and the period 2015–2019. Results Number of deaths significantly increased in 2020 compared with 2015–2019 in LTCF (83,062 deaths vs. 59,200) and slightly decreased in hospices (38,788 vs. 39,652). COVID-19 caused 12.5% of deaths in LTCF and only 2% in hospices. Other than COVID-19, in 2020, cancer ...