In 2020, about 600 000 people aged 65 years and older were diagnosed with a haematological malignancy worldwide, and this number will increase to almost 1 million by 2040, with the largest growth taking place in regions with less developed economies. Health-care systems globally are ill-prepared to face this impending increase in the burden of haematological malignancies among older people, and geriatric oncology and haematology are not properly developed in most low-income and middle-income countries, as well as in many community settings in high-income countries. Here, we provide an overview of the status of geriatric haematology in resource-limited settings, with a focus on health-care systems, educational activities, availability of resource-stratified guidelines, development of clinical programmes, and ongoing research initiatives. We also provide recommendations for the future development of geriatric haematology globally, focusing on the creation of educational activities for health-care providers, fostering research initiatives, improving the inclusion of principles of geriatric care into everyday clinical practice, and building strong international and local partnerships among organisations.
Accumulated evidence indicates that patients with lung cancer are a vulnerable population throughout the pandemic. Limited information is available in Latin America regarding the impact of the pandemic on medical care. The goal of this study was to describe the clinical and social effect of COVID-19 on patients with thoracic cancer and to ascertain outcomes in those with a confirmed diagnosis.
Mexico is an upper-middle income country located in North America, with an increasing life expectancy and a growing population of older adults.Due to population ageing and lifestyle changes, the number of cancer cases amongst older individuals is expected to increase in the upcoming decades, representing a challenge to the healthcare system.The challenges for implementing geriatric oncology care in Mexico include a fragmented healthcare system, as well as the lack of geriatric training amongst healthcare professionals.In this mini-review, we present an overview of the epidemiology of cancer amongst older adults in Mexico, the Mexican healthcare system and ongoing initiatives for the development of geriatric oncology programmes in the country.In addition, we highlight the priorities for future developments in the field of cancer and ageing in Mexico, with a focus on the various stakeholders involved.
267 Background: Immunotherapy has revolutionized cancer treatment, but immune-related side effects can significantly impact patients' quality of life and treatment outcomes. Physical activity and exercise have been shown to be beneficial in managing these adverse events. This study aims to investigate the effects of a low-cost and accessible remote physical activity program on quality of life and immune-related side effects in patients undergoing immunotherapy for solid tumors. Methods: Patients with cancer who were undergoing immunotherapy, either as monotherapy or in combination with other treatments, were enrolled in the study. Recruitment took place within a network of cancer practices in Brazil. Eligible patients were offered participation in a 12-week supervised and remote physical activity program, which encompassed resistance exercise, aerobic exercise, and mobility exercises. Assessment of patients was conducted at two time points: baseline and a 3-month follow-up. The FACT-ICM, ESAS, and BFI scales were utilized to measure various aspects of patient well-being. Descriptive statistics were employed to summarize the data, and ANOVA-RM was employed to examine changes in these measures over time. Results: The study enrolled 38 patients receiving immunotherapy, with a high adherence rate of 87.5% to the remote physical activity program. The most prevalent cancer types were breast (26.3%), kidney (24.3%), and lung cancer (13.2%), with 68.4% of patients diagnosed with metastatic disease. Baseline assessment revealed common issues such as short-term treatment reactions (71.1%), fatigue (65.8%), and weakness (52.6%), which significantly improved at the 3-month follow-up (P<0.01). Notably, symptoms assessed through ESAS have significantly decreased over time: pain (21.1% vs 2.6%), fatigue (47.4% vs 16.1%), anxiety (36.8% vs 3.2%), depression (21.1% vs 3.2%), P=0.01. Overall, the mean score of quality of life (M T1 =87.1 vs M T2 =97.4, P=0.001) and fatigue (M T1 =21.5 vs M T2 =8.0, P=0.001) also showed an improvement over time. Conclusions: These findings demonstrate the potential benefits of a remote physical activity program in reducing immune-related side effects and enhancing quality of life in a Brazilian population. This study contributes to the limited existing literature on this subject. The remote aspect of the program can improve patient adherence and reduce costs. Further randomized controlled trials are needed to validate and build upon these promising results, enabling more comprehensive interventions for this patient population.
The use of geriatric assessment (GA) by oncology specialists in Mexico is low.We aimed to explore factors associated with the evaluation of individual GA domains by Mexican oncology specialists.We performed an exploratory analysis of a sequential explanatory mixed-methods study consisting of an online cross-sectional survey of Mexican oncology specialists and follow-up interviews on the use of GA in cancer care.For each GA domain, we performed multivariable logistic regression analyses with the frequency of evaluation of the domains as the dependent variable (dichotomised as never/rarely/sometimes versus most of the time/always).A p-value <0.05 was considered significant.Qualitative data from the interviews were analysed inductively.Of 196 respondents, 62% were male, 50% were surgical oncologists, 51% took care of >10 patients per day and 61.7% had access to a geriatrician.Self-perceived confidence in managing common geriatric conditions was associated with the evaluation of specific GA domains.For instance, selfperceived confidence in managing dementia (OR 2.72; 95% CI 1.42-5.51,p = 0.008) was associated with cognition evaluation, while for evaluation of falls, self-perceived confidence in evaluation of falls (OR 6.31;, p < 0.001) was significantly associated.Follow-up interviews showed quality and appropriateness of evaluations may not be ideal: in many cases, physicians do not use guideline-recommended tools.For example, evaluation of cognition is commonly performed through non-validated methods which may miss the detection of patients with an impairment in this domain, partly due to limitations in knowledge and time to use recommended tools.In conclusion, selfperceived confidence in evaluating and managing common situations in older adults was associated with the evaluation of GA domains as part of everyday practice in a sample of oncology specialists in Mexico.This analysis supports the use of educational interventions to boost knowledge and confidence regarding the proper use of validated GA tools among oncology specialists.