Tania Kalsi - Academia.edu (original) (raw)
Papers by Tania Kalsi
If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.
ecancermedicalscience
The ageing population poses new challenges globally. Cancer care for older patients is one of the... more The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area. Older cancer patients are at a higher risk of both under-and over-treatment. Therefore, the assessment of a patient's biological age and effective organ functional reserve becomes paramount. This may then guide treatment decisions by better estimating a prognosis and the risk-to-benefit ratio of a given therapy to anticipate and mitigate against potential toxicities/difficulties. Moreover, older cancer patients are often affected by geriatric syndromes and other issues that impact their overall health, function and quality of life. Comprehensive geriatric assessments offer an opportunity to identify and address health problems which may then optimise one's fitness and well-being. Whilst it is widely accepted that older cancer patients may benefit from such an approach, resources are often scarce, and access to dedicated services and research remains limited to specific Review
Journal of Geriatric Oncology
World Journal of Clinical Oncology
Harari D led design of survey with the United Kingdom Geriatric Oncology Expert Reference Group c... more Harari D led design of survey with the United Kingdom Geriatric Oncology Expert Reference Group contributing to iterations; Kalsi T led survey distribution and analysis of survey; Kalsi T and Harari D writing of manuscript.
Journal of Geriatric Oncology
European Geriatric Medicine
Cancer Treatment Reviews, 2016
If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.
European Journal of Cancer
British Journal of Cancer
Background:Significant toxicity in chemotherapy trials is usually defined as grade ⩾3. In clinica... more Background:Significant toxicity in chemotherapy trials is usually defined as grade ⩾3. In clinical practice, however, multiple lower grade toxicities are often considered meaningful. The purpose of this observational cohort study was to identify which level of toxicity triggers treatment modification and early discontinuation of chemotherapy in older people.Methods:Patients aged 65+ were recruited in a central London hospital. A total of 108 patients were recruited at the start of new chemotherapy treatment between October 2010 and July 2012.Results:Mean age was 72.1±5 years, median 72 and range 65-86 years. Of the patients, 50.9% (55) were male with gastrointestinal (49), gynaecological (18), lung (15) and other cancers (26). Chemotherapy was palliative in 59.3% (64/108), curative/ neoadjuvant/adjuvant in the others. Mean number of cycles completed was 4.2±3. Treatment modifications due to toxicity occurred in 60 (55.6%) patients, 35% (21/60) of whom had no greater than grade 2 tox...
British Journal of Cancer
Background:Outcomes for older people with cancer are poorer in the United Kingdom compared with t... more Background:Outcomes for older people with cancer are poorer in the United Kingdom compared with that in other countries. Despite this, the UK oncology curricula do not have dedicated geriatric oncology learning objectives. This cross-sectional study of UK medical oncology trainees investigates the training, confidence level and attitudes towards treating older people with cancer.Methods:A web-based survey link was sent to the delegates of a national medical oncology trainee meeting. Responses were collected in October 2011.Results:The response rate was 93% (64 out of 69). The mean age of the respondents was 32.3 years (range 27-42 years) and 64.1% were female. A total of 66.1% of the respondents reported never receiving training on the particular needs of older people with cancer, 19.4% reported to have received this training only once. Only 27.1% of the trainees were confident in assessing risk to make treatment recommendations for older patients compared with 81.4% being confident...
Age and Ageing
Abstract Background: With a growing number of older people undergoing cancer treatment, identifyi... more Abstract Background: With a growing number of older people undergoing cancer treatment, identifying their wider needs is becoming increasingly important. CGA screening in non-UK studies have identified broader issues, but tools are too lengthy to implement in the busy NHS oncology clinic setting. We evaluated a briefer self-reporting CGA screening questionnaire (CGA-GOLD) which included evidence-based measures and a validated quality of life tool (EORTC-QLQ-C30). Method: Participants completed the CGA-GOLD questionnaire in the POPS-GOLD (Geriatric Oncology Liaison Development) pilot project (LREC 11/LO/0695). Two clinicians (geriatrics specialist registrar (SPR) and clinical nurse specialist (CNS)) reviewed CGA-GOLD responses. Patients deemed with ‘no significant CGA needs’ received no input, ‘possible need’ received a telephone call to clarify, and ‘definite need’ were invited for an in-depth CGA assessment and management plan. We assessed questionnaire validity and reliability in ...
BMJ Case Reports, 2011
Summary A 29-year-old lady presented with an increasingly swollen tongue 3 days after commencing ... more Summary A 29-year-old lady presented with an increasingly swollen tongue 3 days after commencing oseltamivir (Tamiflu) for flu-like symptoms. Once identified as the cause, her symptoms rapidly improved with antihistamines and discontinuing the Tamiflu. The ...
Journal of Geriatric Oncology, 2012
Journal of Geriatric Oncology, 2013
Journal of Geriatric Oncology, 2013
ABSTRACT Introduction: There is increasing interest in identifying frailty in older people with c... more ABSTRACT Introduction: There is increasing interest in identifying frailty in older people with cancer to aid treatment decision-making. Frailty has been described as a model of deficit accumulation (eg. a frailty index as described by Rockwood1 or “the Balducci criteria”2) and as a phenotype (eg. Fried3). Whether different frailty diagnostic criteria agree on who is fit or frail in the chemotherapy setting has yet to be explored. Objective: The purpose of this study was to compare 2 frailty diagnostic criteria (the Balducci criteria and a frailty index) in identifying who is fit and who is frail in an already clinically selected “fit” cohort of older people undergoing chemotherapy. Method: A prospective observational cohort study in a London teaching hospital recruited 516 cancer patients aged 65+. The overall aim was to identify the comprehensive geriatric assessment (CGA) needs of older people with cancer using a self-reporting CGA screening questionnaire. Patients receiving all types of treatment modalities were recruited. This report is a subgroup analysis of those recruited prior to chemotherapy treatment (n=108). Participants were retrospectively defined as "fit" or "frail" using the Balducci criteria and a frailty index. The Balducci criteria defined frail as: age 85+ &/or functional deficit (≥1 ADL dependency) &/or serious comorbidity (serious cardiovascular, respiratory or cerebrovascular disease or 3+ comorbidities) &/or presence of any geriatric syndrome. The frailty index was derived from 43 items from the CGA screening questionnaire using methodology as described by Rockwood1. Frailty index scored from 0-1, with the validated cut-off of "frail" at ≥0.25. As frailty categorisation was assigned retrospectively, included patients were deemed to have been judged fit for chemotherapy by usual clinical practice. Agreement between the two methods regarding “fit or frail” was tested with the kappa statistic. Results: Mean age was 72.1 +/- 5 years, range 65-86, 50.9% (55) male. Full data was available for 106: two patients did not complete the screening questionnaire to derive the frailty index. The mean frailty index score was 0.21 +/- 0.16, range 0-0.67. The frailty index classified 33.0% (35/106) as frail compared with 72.6% (77/106) by the Balducci criteria. There was poor agreement in who was fit or frail between the 2 diagnostic criteria (kappa=0.25). Conclusion: In this clinically selected “fit” cohort of older people receiving chemotherapy, the Balducci criteria classified the majority as frail; those already identified by the frailty index but also many more. Best practice guidelines are emerging (including from SIOG) suggesting that frail patients should receive adapted treatment4 or palliation alone5. The use of Balducci criteria to define frailty may risk under-treatment of older people with cancer.
British Medical Journal, 2011
If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.
ecancermedicalscience
The ageing population poses new challenges globally. Cancer care for older patients is one of the... more The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area. Older cancer patients are at a higher risk of both under-and over-treatment. Therefore, the assessment of a patient's biological age and effective organ functional reserve becomes paramount. This may then guide treatment decisions by better estimating a prognosis and the risk-to-benefit ratio of a given therapy to anticipate and mitigate against potential toxicities/difficulties. Moreover, older cancer patients are often affected by geriatric syndromes and other issues that impact their overall health, function and quality of life. Comprehensive geriatric assessments offer an opportunity to identify and address health problems which may then optimise one's fitness and well-being. Whilst it is widely accepted that older cancer patients may benefit from such an approach, resources are often scarce, and access to dedicated services and research remains limited to specific Review
Journal of Geriatric Oncology
World Journal of Clinical Oncology
Harari D led design of survey with the United Kingdom Geriatric Oncology Expert Reference Group c... more Harari D led design of survey with the United Kingdom Geriatric Oncology Expert Reference Group contributing to iterations; Kalsi T led survey distribution and analysis of survey; Kalsi T and Harari D writing of manuscript.
Journal of Geriatric Oncology
European Geriatric Medicine
Cancer Treatment Reviews, 2016
If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.
European Journal of Cancer
British Journal of Cancer
Background:Significant toxicity in chemotherapy trials is usually defined as grade ⩾3. In clinica... more Background:Significant toxicity in chemotherapy trials is usually defined as grade ⩾3. In clinical practice, however, multiple lower grade toxicities are often considered meaningful. The purpose of this observational cohort study was to identify which level of toxicity triggers treatment modification and early discontinuation of chemotherapy in older people.Methods:Patients aged 65+ were recruited in a central London hospital. A total of 108 patients were recruited at the start of new chemotherapy treatment between October 2010 and July 2012.Results:Mean age was 72.1±5 years, median 72 and range 65-86 years. Of the patients, 50.9% (55) were male with gastrointestinal (49), gynaecological (18), lung (15) and other cancers (26). Chemotherapy was palliative in 59.3% (64/108), curative/ neoadjuvant/adjuvant in the others. Mean number of cycles completed was 4.2±3. Treatment modifications due to toxicity occurred in 60 (55.6%) patients, 35% (21/60) of whom had no greater than grade 2 tox...
British Journal of Cancer
Background:Outcomes for older people with cancer are poorer in the United Kingdom compared with t... more Background:Outcomes for older people with cancer are poorer in the United Kingdom compared with that in other countries. Despite this, the UK oncology curricula do not have dedicated geriatric oncology learning objectives. This cross-sectional study of UK medical oncology trainees investigates the training, confidence level and attitudes towards treating older people with cancer.Methods:A web-based survey link was sent to the delegates of a national medical oncology trainee meeting. Responses were collected in October 2011.Results:The response rate was 93% (64 out of 69). The mean age of the respondents was 32.3 years (range 27-42 years) and 64.1% were female. A total of 66.1% of the respondents reported never receiving training on the particular needs of older people with cancer, 19.4% reported to have received this training only once. Only 27.1% of the trainees were confident in assessing risk to make treatment recommendations for older patients compared with 81.4% being confident...
Age and Ageing
Abstract Background: With a growing number of older people undergoing cancer treatment, identifyi... more Abstract Background: With a growing number of older people undergoing cancer treatment, identifying their wider needs is becoming increasingly important. CGA screening in non-UK studies have identified broader issues, but tools are too lengthy to implement in the busy NHS oncology clinic setting. We evaluated a briefer self-reporting CGA screening questionnaire (CGA-GOLD) which included evidence-based measures and a validated quality of life tool (EORTC-QLQ-C30). Method: Participants completed the CGA-GOLD questionnaire in the POPS-GOLD (Geriatric Oncology Liaison Development) pilot project (LREC 11/LO/0695). Two clinicians (geriatrics specialist registrar (SPR) and clinical nurse specialist (CNS)) reviewed CGA-GOLD responses. Patients deemed with ‘no significant CGA needs’ received no input, ‘possible need’ received a telephone call to clarify, and ‘definite need’ were invited for an in-depth CGA assessment and management plan. We assessed questionnaire validity and reliability in ...
BMJ Case Reports, 2011
Summary A 29-year-old lady presented with an increasingly swollen tongue 3 days after commencing ... more Summary A 29-year-old lady presented with an increasingly swollen tongue 3 days after commencing oseltamivir (Tamiflu) for flu-like symptoms. Once identified as the cause, her symptoms rapidly improved with antihistamines and discontinuing the Tamiflu. The ...
Journal of Geriatric Oncology, 2012
Journal of Geriatric Oncology, 2013
Journal of Geriatric Oncology, 2013
ABSTRACT Introduction: There is increasing interest in identifying frailty in older people with c... more ABSTRACT Introduction: There is increasing interest in identifying frailty in older people with cancer to aid treatment decision-making. Frailty has been described as a model of deficit accumulation (eg. a frailty index as described by Rockwood1 or “the Balducci criteria”2) and as a phenotype (eg. Fried3). Whether different frailty diagnostic criteria agree on who is fit or frail in the chemotherapy setting has yet to be explored. Objective: The purpose of this study was to compare 2 frailty diagnostic criteria (the Balducci criteria and a frailty index) in identifying who is fit and who is frail in an already clinically selected “fit” cohort of older people undergoing chemotherapy. Method: A prospective observational cohort study in a London teaching hospital recruited 516 cancer patients aged 65+. The overall aim was to identify the comprehensive geriatric assessment (CGA) needs of older people with cancer using a self-reporting CGA screening questionnaire. Patients receiving all types of treatment modalities were recruited. This report is a subgroup analysis of those recruited prior to chemotherapy treatment (n=108). Participants were retrospectively defined as "fit" or "frail" using the Balducci criteria and a frailty index. The Balducci criteria defined frail as: age 85+ &/or functional deficit (≥1 ADL dependency) &/or serious comorbidity (serious cardiovascular, respiratory or cerebrovascular disease or 3+ comorbidities) &/or presence of any geriatric syndrome. The frailty index was derived from 43 items from the CGA screening questionnaire using methodology as described by Rockwood1. Frailty index scored from 0-1, with the validated cut-off of "frail" at ≥0.25. As frailty categorisation was assigned retrospectively, included patients were deemed to have been judged fit for chemotherapy by usual clinical practice. Agreement between the two methods regarding “fit or frail” was tested with the kappa statistic. Results: Mean age was 72.1 +/- 5 years, range 65-86, 50.9% (55) male. Full data was available for 106: two patients did not complete the screening questionnaire to derive the frailty index. The mean frailty index score was 0.21 +/- 0.16, range 0-0.67. The frailty index classified 33.0% (35/106) as frail compared with 72.6% (77/106) by the Balducci criteria. There was poor agreement in who was fit or frail between the 2 diagnostic criteria (kappa=0.25). Conclusion: In this clinically selected “fit” cohort of older people receiving chemotherapy, the Balducci criteria classified the majority as frail; those already identified by the frailty index but also many more. Best practice guidelines are emerging (including from SIOG) suggesting that frail patients should receive adapted treatment4 or palliation alone5. The use of Balducci criteria to define frailty may risk under-treatment of older people with cancer.
British Medical Journal, 2011