Siri Rostoft

• Hamaker ME, Rostoft S. Geriatric assessment in older patients with cancer: a new standard of care.

  Lancet. 2021 Nov 20;398(10314):1853-1855. doi: 10.1016/S0140-6736(21)01998-X.
• Saur NM, Davis B, Montroni I, Shahrokni A, Rostoft S, Russell M, Mohile SG, Suwanabol PA, Lightner A, Poylin V, Paquette IM, Feingold DL. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Perioperative Evaluation and Management of Frailty Among Older Adults Undergoing Colorectal Surgery. Dis Colon Rectum. 2022 Jan 5. doi: 10.1097/DCR.0000000000002410.
• Rostoft S, O'Donovan A, Soubeyran P, Alibhai SMH, Hamaker ME. Geriatric Assessment and Management in Oncology. J Clin Oncol. 2021 Jul 1;39(19):2058-2067. doi: 10.1200/JCO.21.00089.
• Hamaker ME, Wildes TM, Rostoft S. Time to Stop Saying Geriatric Assessment Is Too Time Consuming. J Clin Oncol. 2017 Sep 1;35(25):2871-2874. doi: 10.1200/JCO.2017.72.8170. 
• Kristjansson SR, Nesbakken A, Jordhøy MS, Skovlund E, Audisio RA, Johannessen HO, Bakka A, Wyller TB. Comprehensive Geriatric Assessment can predict Complications in Elderly Patients after Elective Surgery for Colorectal Cancer: A Prospective Observational Cohort Study. Crit Rev Oncol/Hematol 2010, 76(3): 208-17  
• Rostoft S, Hamaker ME. Basic geriatric principles for colorectal surgeons: how to optimize assessment and care of the elderly in the perioperative period. Eur J Surg Oncol. 2019 Jul 26. pii: S0748-7983(19)30585-2. doi: 10.1016/j.ejso.2019.07.027.
• Hamaker ME, van Huis-Tanja LH, Rostoft S. Optimizing the geriatrician's contribution to cancer care for older patients. J Geriatr Oncol. 2019 Jul 5. pii: S1879-4068(19)30126-2. doi: 10.1016/j.jgo.2019.06.018.
• Rostoft S, van den Bos F, Pedersen R, Hamaker ME. Shared decision-making in older patients with cancer - What does the patient want? J Geriatr Oncol. 2020 Aug 21:S1879-4068(20)30400-8. doi: 10.1016/j.jgo.2020.08.001. Epub ahead of print. PMID: 32839118.
• Hamaker ME, van den Bos F, Rostoft S. Frailty and palliative care. BMJ Support Palliat Care. 2020 Sep;10(3):262-264. doi: 10.1136/bmjspcare-2020-002253. Epub 2020 Jul 24. PMID: 32709709.
• Berg AS, Rostoft S. Frailty indicators in older cancer patients. Tidsskr Nor Laegeforen. 2019 Dec 3;139(18). Norwegian, English. doi: 10.4045/tidsskr.18.0337. PMID: 31823589.
• N Ommundsen, TB. Wyller, A Nesbakken, MS Jordhøy, A Bakka, E Skovlund and S Rostoft. Preoperative geriatric assessment and tailored interventions in frail older patients with colorectal cancer. A randomised controlled trial. Colorectal Dis. 2018 Jan;20(1):16-25
• Rønning B, Wyller TB, Jordhøy MS, Nesbakken A, Bakka A, Seljeflot I, Kristjansson SR. Frailty indicators and functional status in older patients after colorectal cancer surgery. J Geriatr Oncol (2014), 5(1): 26–32
• Ommundsen N, Wyller TB, Nesbakken A, Jordhøy MS, Bakka A, Skovlund E and Rostoft S. Frailty is an independent  predictor of survival in older patients with colorectal cancer. Oncologist. 2014 Dec;19(12):1268-75. doi: 10.1634/theoncologist.2014-0237.
• Kristjansson SR, Jordhøy MS, Nesbakken A, Skovlund E, Bakka A, Johannessen HO, Wyller TB. Which elements of a comprehensive geriatric assessment (CGA) predict post- operative complications and early mortality after colorectal cancer surgery? J Geriatr Oncol 2010, 1(2):57-65

• Røyset, Inga Marie; Saltvedt, Ingvild Tina; Sollid, May Ingvild Volungholen; Kirkevold, Øyvind; Grønberg, Bjørn Henning & Eriksen, Guro Falk [Vis alle 9 forfattere av denne artikkelen] (2026). Primary care implementation of a cross-sector geriatric assessment with management intervention for older patients undergoing radiotherapy. European Journal of Oncology Nursing. ISSN 1462-3889. 84, s. 103314–103314. doi: 10.1016/j.ejon.2026.103314. Fulltekst i vitenarkiv
• Tjugum, Heidi Marie; Rostoft, Siri; Benth, Jurate Saltyte; Sollid, May Ingvild Volungholen; Eriksen, Guro Falk & Borza, Tom [Vis alle 13 forfattere av denne artikkelen] (2026). Functional trajectories and associated factors in older adults with cancer after radiotherapy. Journal of Geriatric Oncology. ISSN 1879-4068. 18(1). doi: 10.1016/j.jgo.2026.103410. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Functional ability is vital for independent living. In this study, we explored functional trajectories of instrumental activities of daily living (IADL) and participation in working- or leisure activities (role function) in older adults undergoing radiotherapy (RT) and aimed to identify individuals at risk of functional decline. Materials and methods: Patients were ≥ 65 years and received RT with curative or palliative intent. IADL was assessed by Nottingham Extended Activities of Daily Living (NEADL) scale at start and end of RT, and at 2, 8, and 16 weeks after treatment. Simultaneously, patients reported role function and symptoms using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (QLQ-C30). Data were analysed by growth mixture modelling and linear mixed models. Results: We included 258 patients, mean age 73.5 years, 129 (50%) were female, and 232 (89.9%) had an Eastern Cooperative Oncology Group performances status scale (PS) of 0-1. For both NEADL and the role function scale of the QLQ-C30, four groups with distinct trajectories were identified. The group with the poorest baseline scores showed a clinically significant decline. Patients in this group were older, had more geriatric impairments, poorer PS and received palliative RT. Fatigue, pain and loss of appetite were associated with poorer NEADL and role function scores during and after RT. Discussion: Although most patients preserved their IADL and role function during RT treatment, patients with poor IADL and role function at the start of RT were at risk of further functional decline. This knowledge should be incorporated into treatment decision-makings. Geriatric impairments and symptom burden are important targets for supportive measures and should be identified and assessed both before and during treatment.

• Lia, Kjersti; Galleberg, Renate Berget; Rostoft, Siri; Jørgensen, Rasmus R.K.; Smeland, Knut Bjøro & Hjermstad, Marianne Jensen [Vis alle 13 forfattere av denne artikkelen] (2026). Self-reported late effects, daily functioning, and health-related quality of life in older Hodgkin lymphoma survivors – a national population-based cross-sectional survey. Leukemia and Lymphoma. ISSN 1042-8194. 67(5), s. 1125–1135. doi: 10.1080/10428194.2026.2633180. Fulltekst i vitenarkiv Vis sammendrag

  In a Norwegian national cross-sectional survey, we assessed the burden of selected late effects (LEs) by a 95-item questionnaire in tumor-free Hodgkin lymphoma survivors (HLSs) diagnosed at age ≥60 years. Responses were compared to age- and sex-matched controls. A total of 290 older HLSs diagnosed 2000–2021 received the questionnaire, 193 (67%) were included. Median age at survey was 76 years (range 63–92) and median time since diagnosis 7 years (2–23). Compared to controls, HLSs reported significantly higher rates of heart failure (10% vs. 6%), atrial fibrillation (19% vs. 14%), memory problems (48% vs. 37%), other cognitive difficulties (34% vs. 17%) and chronic fatigue (29% vs. 13%). HLSs scored lower on physical and mental health-related quality of life (HRQoL) and more often reported needing help with basic (P-ADL) and instrumental activities of daily living (I-ADL). However, differences were small, only for fatigue and dependence in I-ADL did the difference reach moderate statistical effect size.

• Skyrud, Katrine Damgaard; Rostoft, Siri & Syse, Astri (2025). Institutionalization and home health care after acute hospitalizations of older persons in Norway. BMC Health Services Research. 26(1). doi: 10.1186/s12913-025-13851-x. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Population ageing and strained public resources challenge the future provision of health and care services. We assess the uptake of formal health-related care services (FCS), either home health care (HHC) or short- or long-term institutional care (IC), before and after an acute hospital admission in a full-population sample of older persons. Methods Multinominal logistic population average regression models were applied to Norwegian registry data on older persons (aged 75+) in 2021 ( N  = 68,803) at hospital discharge following admission for select diagnoses ( N  = 94,748) to examine how functional status (for FCS users) and comorbidities (for non-FCS users), acute hospital admissions and sociodemographic characteristics are associated with HHC and IC uptake within 4 weeks and at 6 months post-discharge. Results Altogether, 53% of the sample were already recipients of FCS at the time of the acute event, 43% in HHC and 10% in IC. Overall, the shares increased to 33% for IC and decreased to 29% for HHC 4 weeks post-discharge. At 6 months, the respective shares were 14 and 35%. Among HHC recipients at hospital admission, 44% transitioned to IC within 4 weeks. At 6 months, the share had declined to 21%. Multivariate models showed that transitions into and within FCS were associated with older age, female sex, comorbidities/functional status and living alone. Trauma, cerebrovascular and geriatric conditions were substantially associated with subsequent FCS uptake, and especially IC. Short-term IC transitions were more common among HHC-users than non-HHC-users. In terms of moderating factors, larger differences were observed by living situation as opposed to sex and functional status/comorbidity. Conclusions Irrespective of prior FCS uptake, acute hospital admissions are associated with subsequent FCS uptake, especially for trauma, cerebrovascular and geriatric conditions. Minor variations across sociodemographic characteristics suggest need-based, equitable service provision. The mode (HHC vs IC) and temporality of FCS uptake warrants further research to identify policy measures that may improve care trajectories to ensure sustainable, safe, and high-quality care and rehabilitation following acute hospitalizations of older individuals. Clinical practice and future research should include hospital frailty measures to improve predictions of future FCS needs, particularly for persons unknown to the FCS system pre-hospitalization.

• Baldini, C.; Mislang, A. R.A.; Cheung, K. L.; Pilleron, S.; Wildiers, H. & Rostoft, Siri [Vis alle 24 forfattere av denne artikkelen] (2025). The ESMO/SIOG Cancer in the Elderly Working Group pragmatic strategies for clinical trial designs and endpoints in older adults with cancer. ESMO Open. doi: 10.1016/j.esmoop.2025.105940. Fulltekst i vitenarkiv Vis sammendrag

  Background Despite cancer affecting mostly older people, patients aged 70 years or older are under-represented in contemporary trials even in the absence of age restrictions. Moreover, trials dedicated to older adults with cancer, including geriatric assessment and management, are limited because of either clinician, patient, or sponsor bias. This article outlines pragmatic strategies to improve trial design and endpoints to facilitate participation of older adults with cancer in clinical trials. Methods The joint European Society for Medical Oncology (ESMO) and International Society of Geriatric Oncology (SIOG) Cancer in the Elderly Working Group assembled a group of international experts to propose strategies for clinical trial designs and endpoints in older adults with cancer. Expert panel discussions based on review of the evidence were held to reach a consensus. Results Several obstacles to trial participation such as system barriers (e.g. strict eligibility criteria, poor design, time-consuming procedures) and clinician and individual barriers (e.g. age bias, toxicity concerns, patient preferences, caregiver influences, digital divide) have been identified. Strategies to improve trial accrual and retention include streamlining recruitment, enhancing patient support, leveraging digital tools, and engaging caregivers and patient advocates. Conclusions We recommend investing in geriatric oncology clinical trial designs that incorporate traditional survival endpoints, as well as prioritise outcome measures affecting quality of life and function in line with the patient goals and preferences.

• Gardner, Raymond; Canin, Beverly; Loh, Kah Poh; O'Shea, Chuck; Puts, Martine & Rostoft, Siri [Vis alle 18 forfattere av denne artikkelen] (2025). Will evidence-based patient-centred care meet the future inter-generational needs of older adults with cancer? A diverse perspective. Journal of Geriatric Oncology. ISSN 1879-4068. 16(5). doi: 10.1016/j.jgo.2025.102241. Fulltekst i vitenarkiv
• Gilbert, A.; Rostoft, Siri; Vendrely, V.; Muirhead, R.; Pearce, J. & Lièvre, A. [Vis alle 7 forfattere av denne artikkelen] (2025). Treatment of anal cancer in older patients and patients with frailty. ESMO Gastrointestinal Oncology. s. 100155–100155. doi: 10.1016/j.esmogo.2025.100155. Fulltekst i vitenarkiv
• Eochagain, Colm Mac; Neuendorff, Nina Rosa; Gente, Karolina; Leipe, Jan; Verhaert, Marthe & Sam, Christine [Vis alle 15 forfattere av denne artikkelen] (2025). Management of immune checkpoint inhibitor-associated toxicities in older adults with cancer: recommendations from the International Society of Geriatric Oncology (SIOG). The Lancet Oncology. ISSN 1470-2045. 26(2), s. e90–e102. doi: 10.1016/S1470-2045(24)00404-2. Fulltekst i vitenarkiv
• Bakken, Inger Johanne Landsjøåsen; Heyeraas, Thomas Nordbø; Døhl, Øystein; Rostoft, Siri; Ariansen, Inger Kristine Holtermann & Burrell, Lisa Victoria (2025). Diagnoses among long-term care recipients in Norway: a nation-wide registry study on prevalence and data completeness. Scandinavian Journal of Public Health. ISSN 1403-4948. s. 1–7. doi: 10.1177/14034948251339873. Fulltekst i vitenarkiv Vis sammendrag

  Background and aims: The Norwegian Registry for Primary Health Care (NRPHC) is a mandatory register for all publicly funded primary healthcare services in Norway, including long-term care (LTC) services. The registry holds information on diagnoses for recipients of LTC services, but little is known regarding data quality and completeness. Methods: The study population consisted of all LTC recipients in Norway in 2023 (N=393,446). We investigated the proportion registered with any diagnosis in NRPHC LTC data. We compared diagnoses reported by LTC providers with diagnoses reported by general practitioners and by specialist health services. Additionally, we investigated the distribution of diagnoses by type of LTC provided. Diagnoses presumed common among recipients of LTC were investigated (diabetes, cardiovascular diseases, chronic obstructive lung diseases, cancer, mental disorders/substance use disorders, dementia, intellectual disability and hip fracture). Results: Diagnoses were reported by LTC providers for 51.4% of LTC recipients. Diagnoses were more often reported for users with more complex services (long-term institutional stay: 85.5%; assistive technology: 30.5%). Including data from general practitioners and specialist health services increased prevalence estimates compared with using NRPHC LTC data alone (dementia: 14.2% vs 8.2%; chronic obstructive lung diseases: 12.7% vs. 4.1%). Based on all available data, the prevalence of reported dementia among recipients of long-term institutional stay was 58.7%. The prevalence of reported substance use disorders among recipients of home-based services was 13.4%. Conclusions: Data on diagnoses reported by LTC providers to the NRPHC are insufficient and should be supplemented with data from other sources.

• Romøren, Maria; Hermansen, Karin Berg; Sævareid, Trygve Johannes Lereim; Brøderud, Linn Benita; Westbye, Siri Færden & Wahl, Astrid Klopstad [Vis alle 10 forfattere av denne artikkelen] (2024). Implementation of advance care planning in the routine care for acutely admitted patients in geriatric units: protocol for a cluster randomized controlled trial. BMC Health Services Research. 24. doi: 10.1186/s12913-024-10666-0. Fulltekst i vitenarkiv Vis sammendrag

  Background Acutely ill and frail older adults and their next of kin are often poorly involved in treatment and care decisions. This may lead to either over- or undertreatment and unnecessary burdens. The aim of this project is to improve user involvement and health services for frail older adults living at home, and their relatives, by implementing advance care planning (ACP) in selected hospital wards, and to evaluate the clinical and the implementation interventions. Methods This is a cluster randomized trial with 12 hospital units. The intervention arm receives implementation support for 18 months; control units receive the same support afterwards. The ACP intervention consists of 1. Clinical intervention: ACP; 2. Implementation interventions: Implementation team, ACP coordinator, network meetings, training and supervision for health care personnel, documentation tools and other resources, and fidelity measurements with tailored feedback; 3. Implementation strategies: leadership commitment, whole ward approach and responsive evaluation. Fidelity will be measured three times in the intervention arm and twice in the control arm. Here, the primary outcome is the difference in fidelity changes between the arms. We will also include 420 geriatric patients with one close relative and an attending clinician in a triadic sub-study. Here, the primary outcomes are quality of communication and decision-making when approaching the end of life as perceived by patients and next of kin, and congruence between the patient’s preferences for information and involvement and the clinician’s perceptions of the same. For patients we will also collect clinical data and health register data. Additionally, all clinical staff in both arms will be invited to answer a questionnaire before and during the implementation period. To explore barriers and facilitators and further explore the significance of ACP, qualitative interviews will be performed in the intervention units with patients, next of kin, health care personnel and implementation teams, and with other stakeholders up to national level. Lastly, we will evaluate resource utilization, costs and health outcomes in a cost-effectiveness analysis. Discussion The project may contribute to improved implementation of ACP as well as valuable knowledge and methodological developments in the scientific fields of ACP, health service research and implementation science.

• Seghers, P.A.L.; Rostoft, Siri; O’Hanlon, Shane; O’Donovan, Anita; Schulkes, Karlijn & Montroni, Isacco [Vis alle 10 forfattere av denne artikkelen] (2024). How to incorporate chronic health conditions in oncologic decision-making and care for older patients with cancer? A survey among healthcare professionals. European Geriatric Medicine. ISSN 1878-7649. doi: 10.1007/s41999-023-00919-2. Fulltekst i vitenarkiv Vis sammendrag

  Purpose A substantial proportion of patients with cancer are older and experience multimorbidity. As the population is ageing, the management of older patients with multimorbidity including cancer will represent a significant challenge to current clinical practice. Methods This study aimed to (1) identify which chronic health conditions may cause change in oncologic decision-making and care in older patients and (2) provide guidance on how to incorporate these in decision-making and care provision of older patients with cancer. Based on a scoping literature review, an initial list of prevalent morbidities was developed. A subsequent survey among healthcare providers involved in the care for older patients with cancer assessed which chronic health conditions were relevant and why. Results A list of 53 chronic health conditions was developed, of which 34 were considered likely or very likely to influence decision-making or care according to the 39 healthcare professionals who responded. These conditions were further categorized into five patient profiles. From these conditions, five patient profiles were developed, namely, (1) a somatic profile consisting of cardiovascular, metabolic, and pulmonary disease, (2) a functional profile, including conditions that cause disability, dependency or a high caregiver burden, (3) a psychosocial profile, including cognitive impairment, (4) a nutritional profile also including digestive system diseases, and finally, (5) a concurrent cancer profile. All profiles were considered likely to impact decision-making with differences between treatment modalities. The impact on the care trajectory was generally considered less significant, except for patients with care dependency and psychosocial health problems. Conclusions Chronic health conditions have various ways of influencing oncologic decision-making and the care trajectory in older adults with cancer. Understanding why specific chronic health conditions may impact the oncologic care trajectory can aid clinicians in the management of older patients with multimorbidity, including cancer.

• Ihle-Hansen, Hege Beate; Pedersen, Reidar; Westbye, Siri Færden; Sævareid, Trygve Johannes Lereim; Brøderud, Linn Benita & Larsen, Marie Hamilton [Vis alle 9 forfattere av denne artikkelen] (2024). Patient preferences in geriatric wards, a survey of health care professionals’ practice, experience and attitudes. European Geriatric Medicine. ISSN 1878-7649. 15, s. 153–158. doi: 10.1007/s41999-023-00922-7. Fulltekst i vitenarkiv Vis sammendrag

  Purpose We aimed to identify whether health care professionals (HCP) examine their patient and next-of-kin preferences, and to study whether medical decisions follow these preferences. Method A cross-sectional web-based survey was conducted with multidisciplinary HCP from 12 geriatric wards in the South-Eastern Norway Regional Health Authority. Results Of the 289 HCPs responding (response rate 61%), mean age 37.8 years (SD 11.3), 235 (81.3%) women, 12.4 (SD 9.6) years of experience and 67 (23.2%) medical doctors, only half report clarifying patients’ preferences. The majority reported that they did not inform, involve and treat in line with such preferences. However, 53% believe that HCP, patients and next-of-kin should make clinical decisions together. Discussion Our findings indicate a lack of engagement in conversation and inclusion of patient preferences when providing health interventions in geriatric wards. Measures for change of culture are needed.

• Sletten, Reidun; Christiansen, Ola B.; Oldervoll, Line Merethe; Åstrøm, Lennart; Skjellegrind, Håvard Kjesbu & Benth, Jurate Saltyte [Vis alle 13 forfattere av denne artikkelen] (2024). The association between age and long-term quality of life after curative treatment for prostate cancer: a cross-sectional study. Scandinavian Journal of Urology. ISSN 2168-1805. 59, s. 31–38. doi: 10.2340/sju.v59.18616. Fulltekst i vitenarkiv Vis sammendrag

  Objective: We aimed to investigate the associations between age at radical prostate cancer treatment and long-term global quality of life (QoL), physical function (PF), and treatment-related side effects. Material and Methods: This single-center, cross-sectional study included men treated for localized prostate cancer with robotic-assisted radical prostatectomy (RARP) or external beam radiotherapy (EBRT) in 2014–2018. Global QoL and PF were assessed by the European Organisation of Research and Treatment in Cancer Quality of life Questionnaire-C30 (QLQ-C30), side effects by the Expanded Prostate Cancer Index Composite (EPIC-26). Adjusted linear regression models were estimated to assess associations between age (continuous variable) at treatment and outcomes. QLQ-C30 scores were compared to normative data after dividing the cohort in two groups, <70 years and ≥70 years at treatment. Results: Of 654 men included, 516 (79%) had undergone RARP, and 138 (21%) had undergone EBRT combined with androgen deprivation therapy for 93%. Mean time since treatment was 57 months. Median age at treatment was 68 (min–max 44–84) years. We found no statistically significant independent association between age at treatment and global QoL, PF or side effects, except for sexual function (regression coefficient [RC] −0.77; p < 0.001) and hormonal/vitality (RC 0.30; p = 0.006) function. Mean QLQ-C30 scores were slightly poorer than age-adjusted normative scores, for men <70 years (n = 411) as well as for men ≥70 years (n = 243) at treatment, but the differences were not beyond clinical significance. Conclusions: In this cohort of prostate cancer survivors, age at treatment had little impact on long-term QoL and function. Due to the cross-sectional design, short term impact or variation over time cannot be ruled out.

• Loh, K.P.; Liposits, G.; Arora, S.P.; Neuendorff, N.R.; Gomes, F. & Krok-Schoen, J.L. [Vis alle 18 forfattere av denne artikkelen] (2024). Adequate assessment yields appropriate care—the role of geriatric assessment and management in older adults with cancer: a position paper from the ESMO/SIOG Cancer in the Elderly Working Group. ESMO Open. 9(8). doi: 10.1016/j.esmoop.2024.103657. Fulltekst i vitenarkiv Vis sammendrag

  With the aging population, older adults constitute a growing proportion of the new cancer cases. Given the heterogeneous health status among older adults and their susceptibility to aging-related vulnerabilities, understanding their diversity and its implications becomes increasingly crucial for prognostication and guiding diagnostics, treatment decisions, and follow-up, as well as informing supportive care interventions. Geriatric assessment and management (GAM) refers to the comprehensive evaluation of an older individual’s health status with subsequent management plans focusing on both oncologic and non-oncologic interventions. In 2019, the European Society for Medical Oncology (ESMO) and the International Society of Geriatric Oncology (SIOG) established the ESMO/SIOG Cancer in the Elderly Working Group. This position paper reflects the recommendations of the working group. Our paper summarizes the existing evidence with a focus on recent key trials and based on this, we propose several recommendations and future directions.

• Sletten, Reidun; Jordhøy, Marit Slaaen; Oldervoll, Line Merethe; Skjellegrind, Håvard Kjesbu; Benth, Jurate Saltyte & Åstrøm, Lennart [Vis alle 13 forfattere av denne artikkelen] (2024). Physical Performance and Activity in Older Prostate Cancer Survivors in Comparison with Population-based Matched Controls. European Urology Open Science. ISSN 2666-1691. 71, s. 87–95. doi: 10.1016/j.euros.2024.11.005. Fulltekst i vitenarkiv Vis sammendrag

  Background and objective: Whether radical prostate cancer treatment affects long-term physical performance and physical activity in older men is not known. We aimed to compare physical performance and self-reported physical activity between relapse-free older prostate cancer survivors and population-based controls. Methods: A single-centre, cross-sectional study including 109 men aged ≥70 yr receiving robotic-assisted radical prostatectomy (61.5%) or external beam radiotherapy (38.5%) between 2014 and 2018 was conducted. Population-based matched (age, gender, and education) controls (n = 327) were drawn from the Trøndelag Health Study. The primary (the Short Physical Performance Battery [SPPB] summary score) and secondary (gait speed, grip strength, one-legged balance, and the self-reported Physical Activity Index) outcomes were compared between survivors and controls by adjusted linear mixed models. Key findings and limitations: The SPPB score, gait speed, and Physical Activity Index did not differ between survivors (mean age 78.3 yr, mean time since treatment 52.9 mo) and controls (mean age 78.2 yr). Survivors had slightly poorer grip strength (regression coefficient [RC] –5.81, p < 0.001, 95% confidence interval [CI] –7.46; –4.17) and one-legged balance (RC –4.36, p < 0.001, 95% CI –6.72; –2.00; adjusted models), but the clinical significance is uncertain. Small sample size and potential selection of the fittest survivors are limitations that may reduce the generalisability of our findings. Conclusions and clinical implications: 3 to 8 yr after radical prostate cancer treatment, older men’s overall physical performance and physical activity level were comparable with those of matched controls. This suggests that the treatment had little impact on functional status. Patient summary: In this study, we investigated physical function in older men several years after they had undergone curatively intended treatment for prostate cancer in comparison with men in a general population of the same age and education. We found that physical function was similar, except slightly poorer grip strength and balance on one leg in men treated for prostate cancer. We conclude that the overall physical function was comparable with that of the general population and believe that this indicates that prostate cancer treatment was well tolerated despite older age.

• Jordhøy, Marit Slaaen; Røyset, Inga Marie; Saltvedt, Ingvild Tina; Grønberg, Bjørn Henning; Halsteinli, Vidar & Døhl, Øystein [Vis alle 18 forfattere av denne artikkelen] (2024). Geriatric assessment with management for older patients with cancer receiving radiotherapy: a cluster-randomised controlled pilot study. BMC Medicine. 22(1). doi: 10.1186/s12916-024-03446-4. Fulltekst i vitenarkiv Vis sammendrag

  Background Geriatric assessment and management (GAM) improve outcomes in older patients with cancer treated with surgery or chemotherapy. It is unclear whether GAM may provide better function and quality of life (QoL), or be cost-effective, in a radiotherapy (RT) setting. Methods In this Norwegian cluster-randomised controlled pilot study, we assessed the impact of a GAM intervention involving specialist and primary health services. It was initiated in-hospital at the start of RT by assessing somatic and mental health, function, and social situation, followed by individually adapted management plans and systematic follow-up in the municipalities until 8 weeks after the end of RT, managed by municipal nurses as patients’ care coordinators. Thirty-two municipal/city districts were 1:1 randomised to intervention or conventional care. Patients with cancer ≥ 65 years, referred for RT, were enrolled irrespective of cancer type, treatment intent, and frailty status, and followed the allocation of their residential district. The primary outcome was physical function measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (QLQ-C30). Secondary outcomes were overall quality of life (QoL), physical performance, use and costs of health services. Analyses followed the intention-to-treat principle. Study registration at ClinicalTrials.gov ID NCT03881137. Results We included 178 patients, 89 in each group with comparable age (mean 74.1), sex (female 38.2%), and Edmonton Frail Scale scores (mean 3.4 [scale 0–17], scores 0–3 [fit] in 57%). More intervention patients received curative RT (76.4 vs 61.8%), had higher irradiation doses (mean 54.1 vs 45.5 Gy), and longer lasting RT (mean 4.4 vs 3.6 weeks). The primary outcome was completed by 91% (intervention) vs 88% (control) of patients. No significant differences between groups on predefined outcomes were observed. GAM costs represented 3% of health service costs for the intervention group during the study period. Conclusions In this heterogeneous cohort of older patients receiving RT, the majority was fit. We found no impact of the intervention on patient-centred outcomes or the cost of health services. Targeting a more homogeneous group of only pre-frail and frail patients is strongly recommended in future studies needed to clarify the role and organisation of GAM in RT settings.

• Sletten, Reidun; Jordhøy, Marit Slaaen; Oldervoll, Line Merethe; Skjellegrind, Håvard Kjesbu; Benth, Jurate Saltyte & Åstrøm, Lennart [Vis alle 13 forfattere av denne artikkelen] (2024). Self-reported health, function, and use of health care services in older prostate cancer survivors compared to matched controls: a cross-sectional study. Journal of cancer survivorship. ISSN 1932-2259. doi: 10.1007/s11764-024-01670-8. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Information about outcomes of particular relevance to older prostate cancer survivors is limited. This study aimed to compare health, activities of daily living (ADL), and use of health care services between survivors and matched controls. Methods: A single-centre study on men treated for prostate cancer with curative intent at the age ≥ 70 years 2 to 7 years earlier. Controls matched on age and education were drawn (1:3) from the Trøndelag Health Study (HUNT) in Norway. Self-reported general health, independence in ADL and instrumental activities of daily living (IADL), hospital admissions and emergency room visits were compared by estimating non-adjusted and adjusted (age, education, comorbidity, cohabitant status and pack years of smoking) regression models. Results: The majority of both survivors (N = 233) and controls (N = 699) reported good (58.7% vs. 62.7%) or very good (11.2% vs. 6.8%) health and independence in ADL (95.6% vs. 96.3%) and IADL (82.7% vs. 81.9%). Hospital admission was reported by 17.3% vs. 18.2% and emergency room visit by 23.6% vs. 26.7%. Regression models showed no significant differences between survivors and controls. Conclusions: Older prostate cancer survivors reported similar health, independence in ADL and use of emergency room and hospital admissions as matched controls. Implications for Cancer Survivors: This study shows that survivors after curatively intended treatment of prostate cancer have as good health as matched controls, indicating that many patients tolerate such treatment well despite being of old age and that current practice for selection of patients offered such treatment is appropriate.

• Skaar, Elisabeth; Rostoft, Siri; Cruz-Jentoft, Alfonso; Jackson, Thomas; Bleie, Øyvind & Packer, Erik [Vis alle 8 forfattere av denne artikkelen] (2024). 'If you've lost your personality, there's no point in changing the valve'-a qualitative study of older adults' attitudes towards treatment of aortic stenosis with comorbid dementia. BMJ Open. 14(11). doi: 10.1136/bmjopen-2024-086674. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Due to prognostic uncertainty and limited decision-making capacity, the choice to perform transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS) and comorbid dementia is challenging. This study explores older adults’ perspectives on complex decision-making preceding TAVI in the hypothetical setting of comorbid dementia. Design Qualitative study entailing semistructured interviews. Analysis was by systematic text condensation. The interview guide addressed their attitudes regarding treatment dilemmas before TAVI in patients living with dementia. Setting Patients were recruited from the TAVI outpatient clinic at a university hospital performing TAVI. Participants A purposive sample of 10 older adults (5 women) with AS and without dementia (range 77–94 years), where 8/10 had undergone TAVI were included. Results Three main challenges were identified: (1) Risk assessment. Participants found it hard to compare the burden of aortic stenosis vs dementia. They acknowledged the dilemma of implanting a new heart valve to achieve symptom relief while risking severe dementia in the future due to prolonged life span. (2) Autonomous capacity. A profound uncertainty was described regarding who should participate in decision-making if the person was incapacitated due to dementia. (3) Customised information. Participants advocated for thorough information describing facts and uncertainty, aiming to protect and support the person living with dementia. Conclusion Older adults with severe aortic stenosis find it hard relating to dilemmas arising from providing TAVI in patients living with dementia. There is a need for tailor-made information to support autonomy and decision-making under uncertainty.

• Burrell, Lisa Victoria; Døhl, Øystein; Rostoft, Siri; Berggaard, Nina; Antonova, Iryna & Bakken, Inger Johanne Landsjøåsen (2024). Disability level and use of long-term care services in Norway: a nationwide registry study. Scandinavian Journal of Public Health. ISSN 1403-4948. s. 1–8. doi: 10.1177/14034948241251914. Fulltekst i vitenarkiv
• Ihle-Hansen, Hege Beate; Ihle-Hansen, Håkon; Rostoft, Siri; Munkhaugen, John; Westbye, Siri Færden & Romøren, Maria [Vis alle 13 forfattere av denne artikkelen] (2024). Forhåndssamtaler om siste livsfase. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(13). doi: 10.4045/tidsskr.24.0105. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Det foreligger nye nasjonale faglige råd om forhåndssamtaler om siste livsfase. Trygghet i kommunikasjon er viktig for implementering. Formålet med denne studien var å kartlegge helsepersonells selvopplevde trygghet i kommunikasjon om fremtidig helsehjelp og pasientens ønsker i livets sluttfase. Materiale og metode: Helsepersonell ved tolv geriatriske enheter i Helse Sør-Øst besvarte en nettbasert spørreundersøkelse høsten 2022. De fire svaralternativene for selvrapportert trygghet – «lite trygg», «nokså trygg», «meget trygg» og «svært trygg» – er slått sammen til to kategorier: «begrenset trygghet» («lite trygg» og «nokså trygg») og «høy trygghet» («meget trygg» og «svært trygg»). Resultater: Vi fikk svar fra 289 av 470 (61,5 %) av de inviterte, med en gjennomsnittsalder på 37,8 ± 11,3 år, hvorav 217 av 289 (75 %) hadde mer enn fem års yrkeserfaring. Blant legene rapporterte 15 av 67 (22 %) begrenset trygghet i kommunikasjon om «fremtidig forverring av pasientens helsetilstand», 20 av 67 (30 %) om «livsforlengende behandling» og 13 av 67 (19 %) om «ønsker for livets sluttfase». For annet helsepersonell var tilsvarende responser 119 av 222 (54 %), 140 av 222 (63 %) og 109 av 222 (49 %). Fortolkning: Egenvurdert trygghet i kommunikasjon om fremtidig forverring, fremtidig helsehjelp og pasientens egne ønsker i livets sluttfase varierer, og er begrenset blant mye helsepersonell i geriatriske enheter. Det synes nødvendig med tiltak for å øke tryggheten i kommunikasjon og implementering av forhåndssamtaler i helsetjenesten. Hovedfunn: Blant leger oppga 20 av 67 (30 %) begrenset trygghet i kommunikasjon om «fremtidig helsehjelp», mens av annet helsepersonell svarte 140 av 222 (63 %) det samme. For kommunikasjon om «ønsker for livets siste fase» fant vi at 13 av 67 (19 %) av legene og 109 av 222 (49 %) av annet helsepersonell oppga begrenset trygghet.

• Seghers, Seghers Nelleke; Hamaker, Marije E.; O'Hanlon, Shane; Portielje, Johanneke E.A.; Wildiers, Hans & Soubeyran, Pierre [Vis alle 8 forfattere av denne artikkelen] (2023). Self-reported electronic symptom monitoring in older patients with multimorbidity treated for cancer: Development of a core dataset based on expert consensus, literature review, and quality of life questionnaires. Journal of Geriatric Oncology. ISSN 1879-4068. 15(1). doi: 10.1016/j.jgo.2023.101643. Fulltekst i vitenarkiv Vis sammendrag

  Introduction In cancer care, symptom monitoring during treatment results in improved clinical outcomes such as improved quality of life, longer survival, and fewer hospital admissions. However, as the majority of patients with cancer are older and have multimorbidity, they may benefit from monitoring of additional symptoms. The aim of this study was to identify a core set of symptoms to monitor in older patients with multimorbidity treated for cancer, including symptoms caused by treatment side effects, destabilization of comorbidities, and functional decline. Materials and Methods During a scoping literature search, 17 quality of life questionnaires were used to select 53 possible symptoms to monitor. An expert panel of cancer and geriatrics specialists was asked to participate in multiple online surveys to indicate whether these symptoms were not relevant to monitor, only relevant to monitor in a specific patient group, or relevant to monitor in all patients. In a subsequent round the list was reduced and the panel indicated how frequently these symptoms should be monitored during cancer treatment and after cancer treatment completion. Finally, a digital consensus meeting was organised to decide when symptoms had to trigger a recommendation to the patient to get in touch with their medical team. Results In total, 30 healthcare professionals participated in the online surveys. After two rounds, a dataset of 19 symptoms related to cancer, cancer treatment, functional decline, and destabilization of comorbidities was agreed upon for monitoring. Five symptoms were selected for daily monitoring during treatment, seven for weekly, and seven for monthly. After treatment completion, the panel agreed upon less frequent reporting. Additionally, nine symptoms to be monitored only in patients with specific cancer types or treatment types were chosen, such as “cough up blood” in lung cancer. Discussion This study is the first to identify a core set of symptoms to monitor in older patients with multimorbidity treated for cancer. Future research is needed to investigate whether the monitoring of these symptoms is feasible and improves clinical outcomes in older patients with multimorbidity treated for cancer.

• Hamaker, Marije; Gijzel, Sanne; Rostoft, Siri & Bos, Frederiek van den (2023). Intrinsic capacity and resilience: Taking frailty to the next level. Journal of Geriatric Oncology. ISSN 1879-4068. 14(2). doi: 10.1016/j.jgo.2022.101421. Fulltekst i vitenarkiv
• Seghers, P.A.L.; Alibhai, Shabbir M. H.; Battisti, Nicolò Matteo Luca; Kanesvaran, Ravindran; Extermann, Martine & O’Donovan, Anita [Vis alle 18 forfattere av denne artikkelen] (2023). Geriatric assessment for older people with cancer: policy recommendations. Global Health Research and Policy. 8(1). doi: 10.1186/s41256-023-00323-0. Fulltekst i vitenarkiv Vis sammendrag

  Most cancers occur in older people and the burden in this age group is increasing. Over the past two decades the evidence on how best to treat this population has increased rapidly. However, implementation of new best practices has been slow and needs involvement of policymakers. This perspective paper explains why older people with cancer have different needs than the wider population. An overview is given of the recommended approach for older people with cancer and its benefits on clinical outcomes and cost-effectiveness. In older patients, the geriatric assessment (GA) is the gold standard to measure level of fitness and to determine treatment tolerability. The GA, with multiple domains of physical health, functional status, psychological health and socio-environmental factors, prevents initiation of inappropriate oncologic treatment and recommends geriatric interventions to optimize the patient’s general health and thus resilience for receiving treatments. Multiple studies have proven its benefits such as reduced toxicity, better quality of life, better patient-centred communication and lower healthcare use. Although GA might require investment of time and resources, this is relatively small compared to the improved outcomes, possible cost-savings and compared to the large cost of oncologic treatments as a whole.

• Montroni, Isacco; Ugolini, Giampaolo; Saur, Nicole M.; Rostoft, Siri; Spinelli, Antonino & Leeuwen, Barbara L. Van [Vis alle 17 forfattere av denne artikkelen] (2023). Predicting Functional Recovery and Quality of Life in Older Patients Undergoing Colorectal Cancer Surgery: Real-World Data From the International GOSAFE Study. Journal of Clinical Oncology. ISSN 0732-183X. 41(34), s. 5247–5262. doi: 10.1200/JCO.22.02195. Fulltekst i vitenarkiv
• Seghers, P.A.L. Nelleke; Rostoft, Siri; O'Hanlon, Shane; Degol, Lien; Kenis, Cindy & Wildiers, Hans [Vis alle 8 forfattere av denne artikkelen] (2023). A care pathway for older patients with multimorbidity including cancer – Design of the GERONTE pathway. Journal of Geriatric Oncology. ISSN 1879-4068. doi: 10.1016/j.jgo.2023.101654. Fulltekst i vitenarkiv
• Seghers, P.A.L. (Nelleke); Rostoft, Siri; O'Hanlon, Shane; O'Sullivan, Bridget; Portielje, Johanneke E.A. & Wildiers, Hans [Vis alle 8 forfattere av denne artikkelen] (2023). Challenges of caring for older patients with multimorbidity including cancer. Journal of Geriatric Oncology. ISSN 1879-4068. 14(7). doi: 10.1016/j.jgo.2023.101588. Fulltekst i vitenarkiv Vis sammendrag

  Introduction As the population is ageing, the number of older patients with multimorbidity including cancer continues to increase. To improve care for these patients, the European Union-funded project “Streamlined Geriatric and Oncological evaluation based on IC Technology” (GERONTE) was initiated to develop a new, patient-centred, holistic care pathway. The aim of this paper is to analyse what challenges are encountered in everyday clinical practice according to patients, their informal caregivers, and healthcare professionals as a starting point for the development of the care pathway. Materials and Methods An expert panel of cancer and geriatrics specialists participated in an online survey to answer what challenges they experience in caring for older patients with multimorbidity including cancer and what treatment outcomes could be improved. Furthermore, in-depth interviews with older patients and their informal caregivers were organised to assess what challenges they experience. Results Healthcare professionals (n = 36) most frequently mentioned the challenge of choosing the best treatment in light of the lack of evidence in this population and how to handle interactions between the (cancer) treatment and multimorbidities. Twelve patients and caregivers participated, and they most frequently mentioned challenges related to treatment outcomes, such as how to deal with symptoms of disease or treatment and how to maintain quality of life. From the challenges, five main themes emerged that should be taken into account when developing a new care pathway for older patients with multimorbidity including cancer. Two themes focus on decision making aspects such as personalized treatment recommendations and inclusion of non-oncologic information, two focus on patient support and monitoring to maintain quality of life and functioning, and one overarching theme addresses care coordination to prevent fragmentation of care. Discussion In conclusion, the management of older patients with multimorbidity including cancer is complex and although progress has been made on improving aspects of their care, challenges remain and patients are at risk of receiving inappropriate, unnecessary, and potentially harmful treatment. A patient-centred care pathway that integrates solutions to the five main themes and that moves away from a single-disease centred approach is needed.

• Galvin, Angéline; Soubeyran, Pierre; Brain, Etienne; Cheung, Kwok-Leung; Hamaker, Marije E. & Kanesvaran, Ravindran [Vis alle 14 forfattere av denne artikkelen] (2023). Assessing patient-reported outcomes (PROs) and patient-related outcomes in randomized cancer clinical trials for older adults: Results of DATECAN-ELDERLY initiative. Journal of Geriatric Oncology. ISSN 1879-4068. doi: 10.1016/j.jgo.2023.101611. Fulltekst i vitenarkiv Vis sammendrag

  As older adults with cancer are underrepresented in randomized clinical trials (RCT), there is limited evidence on which to rely for treatment decisions for this population. Commonly used RCT endpoints for the assessment of treatment efficacy are more often tumor-centered (e.g., progression-free survival). These endpoints may not be as relevant for the older patients who present more often with comorbidities, non–cancer-related deaths, and treatment toxicity. Moreover, their expectation and preferences are likely to differ from younger adults. The DATECAN-ELDERLY initiative combines a broad expertise, in geriatric oncology and clinical research, with interest in cancer RCT that include older patients with cancer. In order to guide researchers and clinicians coordinating cancer RCT involving older patients with cancer, the experts reviewed the literature on relevant domains to assess using patient-reported outcomes (PRO) and patient-related outcomes, as well as available tools related to these domains. Domains considered relevant by the panel of experts when assessing treatment efficacy in RCT for older patients with cancer included functional autonomy, cognition, depression and nutrition. These were based on published guidelines from international societies and from regulatory authorities as well as minimum datasets recommended to collect in RCT including older adults with cancer. In addition, health-related quality of life, patients' symptoms, and satisfaction were also considered by the panel. With regards to tools for the assessment of these domains, we highlighted that each tool has its own strengths and limitations, and very few had been validated in older adults with cancer. Further studies are thus needed to validate these tools in this specific population and define the minimum clinically important difference to use when developing RCTs in this population. The selection of the most relevant tool should thus be guided by the RCT research question, together with the specific properties of the tool.

• Rostoft, Siri; Thomas, Michael; Jordhøy, Marit Slaaen; Møller, Bjørn; Nesbakken, Arild & Syse, Astri (2023). Hospital use and cancer treatment by age and socioeconomic status in the last year of life: A Norwegian population-based study of patients dying of cancer. Journal of Geriatric Oncology. ISSN 1879-4068. 15(2). doi: 10.1016/j.jgo.2023.101683. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Cancer is the leading cause of death in Norway. In this nationwide study we describe the number and causes of hospital admissions and treatment in the final year of life for patients who died of cancer, as well as the associations to age and socioeconomic status (SES). Materials and Methods From nationwide registries covering 2010–2014, we identified all patients who were diagnosed with cancer 12–60 months before death and had cancer as their reported cause of death. We examined the number of overnight hospital stays, causes of admission, and treatment (chemotherapy, radiotherapy, surgical procedures) offered during the last year of life by individual (age, sex, comorbidity), cancer (type, stage, months since diagnosis), and socioeconomic variables (co-residential status, income, education). Results The analytical sample included 17,669 patients; 8,247 (47%) were female, mean age was 71.7 years (standard deviation 13.7). At diagnosis, 31% had metastatic disease, while 29% had an intermediate or high comorbidity burden. Altogether, 94% were hospitalized during their final year, 82% at least twice, and 33% six times or more. Patients spent a median of 23 days in hospital (interquartile range 11–41), and altogether 38% died there. Younger age, bladder and ovarian cancer, not living alone, and higher income were associated with having ≥6 hospitalizations. Cancer-related diagnoses were the main causes of hospitalizations (65%), followed by infections (11%). Around 51% had ≥1 chemotherapy episode, with large variations according to patient age and SES; patients who were younger, did not live alone, had high education, and high income received more chemotherapy. Radiotherapy was received by 15% and declined with age, and the variation according to SES characteristics was minor. Of the 12,940 patients with a cancer type where surgery is a main treatment modality, only 835 (6%) underwent surgical procedures for their primary tumor in the last year of life. Discussion Most patients who die of cancer are hospitalized multiple times during the last year of life. Hospitalizations and treatment decline with advancing age. Living alone and having low income is associated with fewer hospitalizations and less chemotherapy treatment. Whether this indicates over- or undertreatment across various groups warrants further exploration.

• Rostoft, Siri; Seghers, Nelleke & Hamaker, Marije E. (2023). Achieving harmony in oncological geriatric assessment – Should we agree on a best set of tools? Journal of Geriatric Oncology. ISSN 1879-4068. doi: 10.1016/j.jgo.2023.101473. Fulltekst i vitenarkiv
• Røyset, Inga Marie; Eriksen, Guro Falk; Benth, Jurate Saltyte; Saltvedt, Ingvild Tina; Grønberg, Bjørn Henning & Rostoft, Siri [Vis alle 9 forfattere av denne artikkelen] (2023). Edmonton Frail Scale predicts mortality in older patients with cancer undergoing radiotherapy-A prospective observational study. PLOS ONE. 18(3). doi: 10.1371/journal.pone.0283507. Fulltekst i vitenarkiv Vis sammendrag

  Background: Several screening tools are developed to identify frailty in the increasing number of older patients with cancer. Edmonton Frail Scale (EFS) performs well in geriatric settings but is less studied in oncology. We aimed to investigate if EFS score (continuous and categorical) predicts survival in patients referred for radiotherapy, and to assess the concurrent validity of EFS compared with a modified geriatric assessment (mGA). Methods: Prospective observational, single-center study including patients ≥65 years, referred for curative or palliative radiotherapy for confirmed cancer. Patients underwent mGA (assessment of cognition, mobility, falls, comorbidity, polypharmacy, depression, nutrition, and activities of daily living) and screening with EFS prior to radiotherapy. The predictive value of EFS score of two-year overall survival (OS) was assessed by Kaplan-Meier plots and compared by log-rank test. Cox proportional hazards regression model was estimated to adjust the associations for major cancer-related factors. Concurrent validity of EFS in relation to mGA was estimated by Spearman`s correlation coefficient and ordinal regression. Sensitivity and specificity for different cut-offs was assessed. Results: Patients' (n = 301) mean age was 73.6 (SD 6.3) years, 159 (52.8%) were men, 54% received curative-intent treatment, breast cancer (32%) was the most prevalent diagnosis. According to EFS≥6, 101 (33.7%) were classified as frail. EFS score was predictive of OS [hazard ratio (HR) 1.20 (95% confidence interval (CI) 1.10-1.30)], as was increasing severity assessed by categorical EFS (p<0.001). There was a strong correlation between EFS score and number of geriatric impairments (Spearman`s correlation coefficient 0.77). EFS cut-off ≥6 had a sensitivity of 0.97 and specificity of 0.57 for identifying patients with minimum two geriatric impairments. Conclusion: EFS predicts mortality in older patients with cancer receiving radiotherapy, and it is a quick (<5 minutes) and sensitive screening tool to identify patients who may benefit from a geriatric assessment. Copyright: © 2023 Røyset et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

• Westbye, Siri Færden; Rostoft, Siri; Romøren, Maria; Thoresen, Lisbeth; Wahl, Astrid Klopstad & Pedersen, Reidar (2023). Barriers and facilitators to implementing advance care planning in naïve contexts - where to look when plowing new terrain? BMC Geriatrics. 23(1). doi: 10.1186/s12877-023-04060-4. Fulltekst i vitenarkiv Vis sammendrag

  Background Advance care planning (ACP) is a way of applying modern medicine to the principle of patient autonomy and ensuring that patients receive medical care that is consistent with their values, goals and preferences. Robust evidence supports the benefits of ACP, but it remains an underutilized resource in most countries. This paper goes from the naïve point of view, and seeks to identify the barriers and facilitators to implementation in unfamiliarized contexts and in a whole system approach involving the clinical, institutional and policy level to improve the implementation of ACP. Methods Qualitative interviews were chosen to enable an explorative, flexible design. Qualitative interviews were conducted with 40 health care professionals and chief physicians in hospitals and in municipalities. The thematic analysis was done following Braun and Clarke’s strategy for thematic analysis. Results The main reported barriers were the lack of time and space, a lack of culture and leadership legitimizing ACP, lack of common communication systems, and unclear responsibility about who should initiate, resulting in missed opportunities and overtreatment. Policy development, public and professional education, and standardization of documentation were reported as key to facilitate ACP and build trust across the health care system. Conclusions Progressively changing the education of health professionals and the clinical culture are major efforts that need to be tackled to implement ACP in unfamiliarized contexts, particularly in contexts where patient's wishes are not legally binding. This will need to be tackled through rectifying the misconception that ACP is only about death, and providing practical training for health professionals, as well as developing policies and legislation on how to include patients and caregivers in the planning of care.

• Hamaker, Marije; Lund, Cecilia; Molder, Marthe te; Soubeyran, Pierre; Wildiers, Hans & Huis, Lieke van [Vis alle 7 forfattere av denne artikkelen] (2022). Geriatric assessment in the management of older patients with cancer – A systematic review (update). Journal of Geriatric Oncology. ISSN 1879-4068. 13(6), s. 761–777. doi: 10.1016/j.jgo.2022.04.008. Fulltekst i vitenarkiv Vis sammendrag

  Aim The aim of this systematic review is to summarize all available data on the effect of a geriatric assessment in older patients with cancer, for oncologic treatment decisions, the implementation of non-oncologic interventions, patient-doctor communication, and treatment outcome. Additionally, we examined the impact of the type of assessment used. Methods Systematic Medline and Embase search for studies on the effect of a geriatric assessment on oncologic treatment decisions, non-oncologic interventions, communication, and outcome. Results Sixty-five publications from 61 studies were included. After a geriatric assessment, the oncologic treatment plan was altered in a median of 31% of patients (range 7–56%), with highest change rates in studies using a multidisciplinary team evaluation. Non-oncologic interventions were recommended in over 70% of patients, provided that an intervention plan or specific expertise was in place. A geriatric assessment led to more goals-of-care discussions and improved communication. The geriatric assessment also led to lower toxicity/complication rates (most strongly if the assessment outcomes were considered during decision making), improved likelihood of treatment completion, and improved physical functioning and quality of life in the majority of included studies. Conclusion A geriatric assessment can change oncologic treatment plans, leads to non-oncologic interventions, and improve communication about care planning and ageing-related issues. It can decrease toxicity/complications and improve treatment completion and patient-centred outcomes. If multidisciplinary or geriatric input is not available, having a pre-defined non-oncologic intervention plan is important. To maximize the effect on outcomes, the result of the geriatric assessment should be incorporated into oncologic decision-making.

• Seghers, Petronella A. L.; Wiersma, Anke; Festen, Suzanne; Stegmann, Mariken E.; Soubeyran, Pierre & Rostoft, Siri [Vis alle 9 forfattere av denne artikkelen] (2022). Patient Preferences for Treatment Outcomes in Oncology with a Focus on the Older Patient—A Systematic Review. Cancers. 14(5), s. 1–16. doi: 10.3390/cancers14051147. Fulltekst i vitenarkiv Vis sammendrag

  For physicians, it is important to know which treatment outcomes are prioritized overall by older patients with cancer, since this will help them to tailor the amount of information and treatment recommendations. Older patients might prioritize other outcomes than younger patients. Our objective is to summarize which outcomes matter most to older patients with cancer. A systematic review was conducted, in which we searched Embase and Medline on 22 December 2020. Studies were eligible if they reported some form of prioritization of outcome categories relative to each other in patients with all types of cancer and if they included at least three outcome categories. Subsequently, for each study, the highest or second-highest outcome category was identified and presented in relation to the number of studies that included that outcome category. An adapted Newcastle–Ottawa Scale was used to assess the risk of bias. In total, 4374 patients were asked for their priorities in 28 studies that were included. Only six of these studies had a population with a median age above 70. Of all the studies, 79% identified quality of life as the highest or second-highest priority, followed by overall survival (67%), progression- and disease-free survival (56%), absence of severe or persistent treatment side effects (54%), and treatment response (50%). Absence of transient short-term side effects was prioritized in 16%. The studies were heterogeneous considering age, cancer type, and treatment settings. Overall, quality of life, overall survival, progression- and disease-free survival, and severe and persistent side effects of treatment are the outcomes that receive the highest priority on a group level when patients with cancer need to make trade-offs in oncologic treatment decisions.

• Munthe-Kaas, Ragnhild; Aam, Stina; Saltvedt, Ingvild; Wyller, Torgeir Bruun; Pendlebury, Sarah T. & Lydersen, Stian [Vis alle 10 forfattere av denne artikkelen] (2022). Is Frailty Index a better predictor than pre-stroke modified Rankin Scale for neurocognitive outcomes 3-months post-stroke? BMC Geriatrics. 22(1). doi: 10.1186/s12877-022-02840-y. Fulltekst i vitenarkiv Vis sammendrag

  Background The prognostic value of frailty measures for post-stroke neurocognitive disorder (NCD) remains to be evaluated. Aims The aim of this study was to compare the predictive value of pre-stroke FI with pre-stroke modified Rankin Scale (mRS) for post-stroke cognitive impairment. Further, we explored the added value of including FI in prediction models for cognitive prognosis post-stroke. Methods We generated a 36-item Frailty Index (FI), based on the Rockwood FI, to measure frailty based on pre-stroke medical conditions recorded in the Nor-COAST multicentre prospective study baseline assessments. Consecutive participants with a FI score and completed cognitive test battery at three months were included. We generated Odds Ratio (OR) with NCD as the dependent variable. The predictors of primary interest were pre-stroke frailty and mRS. We also measured the predictive values of mRS and FI by the area (AUC) under the receiver operating characteristic curve. Results 598 participants (43.0% women, mean/SD age = 71.6/11.9, mean/SD education = 12.5/3.8, mean/SD pre-stroke mRS = 0.8/1.0, mean/SD GDS pre-stroke = 1.4/0.8, mean/SD NIHSS day 1 3/4), had a FI mean/SD score = 0.14/0.10. The logistic regression analyses showed that FI (OR 3.09), as well as the mRS (OR 2.21), were strong predictors of major NCD. When FI and mRS were entered as predictors simultaneously, the OR for mRS decreased relatively more than that for FI. AUC for NCD post-stroke was higher for FI than for mRS, both for major NCD (0.762 vs 0.677) and for any NCD (0.681 vs 0.638). Conclusions FI is a stronger predictor of post-stroke NCD than pre-stroke mRS and could be a part of the prediction models for cognitive prognosis post-stroke.

• Eriksen, Guro Falk; Benth, Jurate Saltyte; Grønberg, Bjørn Henning; Rostoft, Siri; Kirkhus, Lene & Kirkevold, Øyvind [Vis alle 10 forfattere av denne artikkelen] (2022). Geriatric impairments are associated with reduced quality of life and physical function in older patients with cancer receiving radiotherapy - A prospective observational study. Journal of Geriatric Oncology. ISSN 1879-4068. 14(1), s. 1–11. doi: 10.1016/j.jgo.2022.09.008. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Quality of life (QoL) and function are important outcomes for older adults with cancer. We aimed to assess differences in trends in patient-reported outcomes (PROs) during radiotherapy (RT) between (1) groups with curative or palliative treatment intent and (2) groups defined according to the number of geriatric impairments. Materials and methods: A prospective observational study including patients aged ≥65 years receiving curative or palliative RT was conducted. Geriatric assessment (GA) was performed before RT, and cut-offs for impairments within each domain were defined. Patients were grouped according to the number of geriatric impairments: 0, 1, 2, 3, and ≥ 4. Our primary outcomes, global QoL and physical function (PF), were assessed by The European Organisation for Research and Treatment of Cancer Quality-of-Life Core Questionnaire (EORTC) (QLQ-C30) at baseline, RT completion, and two, eight, and sixteen weeks later. Differences in trends in outcomes between the groups were assessed by linear mixed models. Results: 301 patients were enrolled, mean age was 73.6 years, 53.8% received curative RT. Patients receiving palliative RT reported significantly worse global QoL and PF compared to the curative group. The prevalence of 0, 1, 2, 3 and ≥ 4 geriatric impairments was 16.6%, 22.7%, 16.9%, 16.3% and 27.5%, respectively. Global QoL and PF gradually decreased with an increasing number of impairments. These group differences remained stable from baseline throughout follow-up without any clinically significant changes for any of the outcomes. Discussion: Increasing number of geriatric impairments had a profound negative impact on global QoL and PF, but no further decline was observed for any group or outcome, indicating that RT was mainly well tolerated. Thus, geriatric impairments per se should not be reasons for withholding RT. GA is key to identifying vulnerable patients in need of supportive measures, which may have the potential to improve treatment tolerance. Registered at clinicaltrials.gov (NCT03071640). Keywords: Frailty; Geriatric assessment; Geriatric impairment; Geriatric oncology; Patient-reported outcome (PRO); Physical function; Quality of life; Radiotherapy. Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Montroni, Isacco; Ugolini, Giampaolo; Saur, Nicole M.; Rostoft, Siri; Spinelli, Antonino & Leeuwen, Barbara L. Van [Vis alle 17 forfattere av denne artikkelen] (2022). Quality of Life in Older Adults After Major Cancer Surgery: The GOSAFE International Study. Journal of the National Cancer Institute. ISSN 0027-8874. 114(7), s. 969–978. doi: 10.1093/jnci/djac071. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Accurate quality of life (QoL) data and functional results after cancer surgery are lacking for older patients. The international, multicenter Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery (GOSAFE) Study compares QoL before and after surgery and identifies predictors of decline in QoL. Methods GOSAFE prospectively collected data before and after major elective cancer surgery on older adults (≥70 years). Frailty assessment was performed and postoperative outcomes recorded (30, 90, and 180 days postoperatively) together with QoL data by means of the three-level version of the EuroQol five-dimensional questionnaire (EQ-5D-3L), including 2 components: an index (range = 0-1) generated by 5 domains (mobility, self-care, ability to perform the usual activities, pain or discomfort, anxiety or depression) and a visual analog scale. Results Data from 26 centers were collected (February 2017-March 2019). Complete data were available for 942/1005 consecutive patients (94.0%): 492 male (52.2%), median age 78 years (range = 70-95 years), and primary tumor was colorectal in 67.8%. A total 61.2% of all surgeries were via a minimally invasive approach. The 30-, 90-, and 180-day mortality was 3.7%, 6.3%, and 9%, respectively. At 30 and 180 days, postoperative morbidity was 39.2% and 52.4%, respectively, and Clavien-Dindo III-IV complications were 13.5% and 18.7%, respectively. The mean EQ-5D-3L index was similar before vs 3 months but improved at 6 months (0.79 vs 0.82; P &amp;lt; .001). Domains showing improvement were pain and anxiety or depression. A Flemish Triage Risk Screening Tool score greater than or equal to 2 (odds ratio [OR] = 1.58, 95% confidence interval [CI] = 1.13 to 2.21, P = .007), palliative surgery (OR = 2.14, 95% CI = 1.01 to 4.52, P = .046), postoperative complications (OR = 1.95, 95% CI = 1.19 to 3.18, P = .007) correlated with worsening QoL. Conclusions GOSAFE shows that older adults’ preoperative QoL is preserved 3 months after cancer surgery, independent of their age. Frailty screening tools, patient-reported outcomes, and goals-of-care discussions can guide decisions to pursue surgery and direct patients’ expectations.

• Eriksen, Guro Falk; Benth, Jurate Saltyte; Grønberg, Bjørn Henning; Rostoft, Siri; Kirkevold, Øyvind & Bergh, Sverre [Vis alle 9 forfattere av denne artikkelen] (2022). Cognitive Trajectories in Older Patients with Cancer Undergoing Radiotherapy—A Prospective Observational Study. Current Oncology. ISSN 1198-0052. 29(7), s. 5164–5178. doi: 10.3390/curroncol29070409. Fulltekst i vitenarkiv Vis sammendrag

  Cognitive function can be affected by cancer and/or its treatment, and older patients are at a particular risk. In a prospective observational study including patients ≥65 years referred for radiotherapy (RT), we aimed to investigate the association between patient- and cancer-related factors and cognitive function, as evaluated by the Montreal Cognitive Assessment (MoCA), and sought to identify groups with distinct MoCA trajectories. The MoCA was performed at baseline (T0), RT completion (T1), and 8 (T2) and 16 (T3) weeks later, with scores ranging between 0 and 30 and higher scores indicating better function. Linear regression and growth mixture models were estimated to assess associations and to identify groups with distinct MoCA trajectories, respectively. Among 298 patients with a mean age of 73.6 years (SD 6.3), the baseline mean MoCA score was 24.0 (SD 3.7). Compared to Norwegian norm data, 37.9% had cognitive impairment. Compromised cognition was independently associated with older age, lower education, and physical impairments. Four groups with distinct trajectories were identified: the very poor (6.4%), poor (8.1%), fair (37.9%), and good (47.7%) groups. The MoCA trajectories were mainly stable. We conclude that cognitive impairment was frequent but, for most patients, was not affected by RT. For older patients with cancer, and in particular for those with physical impairments, we recommend an assessment of cognitive function. Keywords: Montreal Cognitive Assessment; cancer-related cognitive impairment; geriatric oncology; cognitive function; physical impairment; frailty

• Rostoft, Siri; Thomas, Michael; Jordhøy, Marit Slaaen; Møller, Bjørn & Syse, Astri (2022). The effect of age on specialized palliative care use in the last year of life for patients who die of cancer: A nationwide study from Norway. Journal of Geriatric Oncology. ISSN 1879-4068. 13(8), s. 1103–1110. doi: 10.1016/j.jgo.2022.08.002. Fulltekst i vitenarkiv Vis sammendrag

  Specialized palliative care (SPC) is beneficial towards end of life because of its holistic approach to improve quality of life and comfort of patients and their families. Few studies have described how patient age, sex, comorbidities, and socioeconomic status (SES) are associated with SPC use in nonselective populations who die of cancer. This study aimed to evaluate the use of SPC in the year preceding death by all Norwegian individuals with a recent cancer diagnosis who died of cancer.

• Seghers, Petronella A. L.; Kregting, Jolina A.; Huis-Tanja, Lieke H. van; Soubeyran, Pierre; O’hanlon, Shane & Rostoft, Siri [Vis alle 8 forfattere av denne artikkelen] (2022). What Defines Quality of Life for Older Patients Diagnosed with Cancer? A Qualitative Study. Cancers. 14(5), s. 1–12. doi: 10.3390/cancers14051123. Fulltekst i vitenarkiv Vis sammendrag

  The treatment of cancer can have a significant impact on quality of life in older patients and this needs to be taken into account in decision making. However, quality of life can consist of many different components with varying importance between individuals. We set out to assess how older patients with cancer define quality of life and the components that are most significant to them. This was a single-centre, qualitative interview study. Patients aged 70 years or older with cancer were asked to answer open-ended questions: What makes life worthwhile? What does quality of life mean to you? What could affect your quality of life? Subsequently, they were asked to choose the five most important determinants of quality of life from a predefined list: cognition, contact with family or with community, independence, staying in your own home, helping others, having enough energy, emotional well-being, life satisfaction, religion and leisure activities. Afterwards, answers to the open-ended questions were independently categorized by two authors. The proportion of patients mentioning each category in the open-ended questions were compared to the predefined questions. Overall, 63 patients (median age 76 years) were included. When asked, “What makes life worthwhile?”, patients identified social functioning (86%) most frequently. Moreover, to define quality of life, patients most frequently mentioned categories in the domains of physical functioning (70%) and physical health (48%). Maintaining cognition was mentioned in 17% of the open-ended questions and it was the most commonly chosen option from the list of determinants (72% of respondents). In conclusion, physical functioning, social functioning, physical health and cognition are important components in quality of life. When discussing treatment options, the impact of treatment on these aspects should be taken into consideration.

• Isaksen, Kathrine Thuestad; Mastroianni, Maria Adele; Rinde, Marit; Rusten, Leiv Sindre; Barzenje, Dlawer Abdulla & Ramslien, Lloyd Frode [Vis alle 13 forfattere av denne artikkelen] (2021). A simplified frailty score predicts survival and can aid treatment-intensity decisions in older patients with DLBCL. Blood Advances. ISSN 2473-9529. 5(22), s. 4771–4782. doi: 10.1182/bloodadvances.2021004777. Fulltekst i vitenarkiv Vis sammendrag

  Diffuse large B-cell lymphoma (DLBCL) patients have a median age of 70 years. Yet, empirical knowledge on treatment for older patients is limited as they are frequently excluded from clinical trials. We aimed to construct a simplified frailty score and examine survival and treatment-related mortality (TRM) according to frailty status and treatment intensity in an older, real-world DLBCL population. All patients ≥70 years diagnosed with DLBCL 2006-2016 in south-eastern Norway (n=784) were included retrospectively, and divided into a training (n=522) and validation cohort (n=262). We constructed and validated a frailty score based on geriatric assessment variables, and examined survival and TRM according to frailty status and treatment. The frailty score identified three frailty groups with distinct survival and TRM, independent of established prognostic factors (2-year overall survival (OS) fit 82%, unfit 47%, frail 14%, P80%) was associated with better survival than attenuated R-CHOP (2-year OS 86% vs 70%, P=0.012), also in adjusted analysis. For unfit and frail patients, full-dose R-CHOP was not superior to attenuated R-CHOP, while an anthracycline-free regimen was associated with poorer survival in adjusted analyses. A simplified frailty score identified unfit and frail patients with higher risk of death and TRM, which can aid treatment intensity decisions in older DLBCL patients. In this study, fit patients benefit from full-dose R-CHOP, while unfit and frail patients have no benefit of full-dose R-CHOP over R-miniCHOP. An online calculator for assessment of the frailty score is available at https://wide.shinyapps.io/app-frailty/

• Eriksen, Guro Falk; Benth, Jurate Saltyte; Grønberg, Bjørn Henning; Rostoft, Siri; Kirkhus, Lene & Kirkevold, Øyvind [Vis alle 8 forfattere av denne artikkelen] (2021). Geriatric impairments are prevalent and predictive of survival in older patients with cancer receiving radiotherapy: a prospective observational study. Acta Oncologica. ISSN 0284-186X. 61(4), s. 393–402. doi: 10.1080/0284186X.2021.2009561. Fulltekst i vitenarkiv Vis sammendrag

  Background: A systematic assessment of problems that are frequent in older age (geriatric assessment [GA]) provides prognostic information for patients undergoing cancer surgery and systemic cancer treatment. We aimed to investigate the prevalence of geriatric impairments and their impact on survival in older patients with cancer receiving radiotherapy (RT). Material and methods: A single-centre prospective observational study was conducted including patients ≥65 years referred for curative or palliative RT. Prior to RT, we performed a modified GA (mGA) assessing comorbidities, medications, nutritional status basic- and instrumental activities of daily living (IADL) mobility, falls, cognition and depressive symptoms. Impairments in each mGA domain were defined. Overall survival (OS) was presented by Kaplan Meier plots for groups defined according to the number of impairments, and compared by log-rank test. The association between mGA domains and OS was assessed by Cox proportional hazard regression analysis. Results: Between February 2017 and July 2018, 301 patients were included, 142 (47.2%) were women. Mean age was 73.6 (SD 6.3) years, 162 (53.8%) received curative RT. During the median observation time of 24.2 months (min 0.3, max 25.9), 123 (40.9%) patients died. In the overall cohort, 49 (16.3%) patients had no geriatric impairment, 81 (26.9%) had four or more. OS significantly decreased with an increasing number of impairments (p < .01). Nutritional status (HR 0.90, 95% CI [0.81; 0.99], p = .038) and IADL function (HR 0.98, 95% CI [0.95; 1.00], p = .027) were independent predictors of OS. Conclusion: Geriatric impairments were frequent among older patients with cancer receiving RT and nutritional status and IADL function predicted OS. Targeted interventions to remediate modifiable impairments may have the potential to improve OS.Til

• Krogseth, Maria; Rostoft, Siri; Benth, Jurate Saltyte; Selbæk, Geir & Wyller, Torgeir Bruun (2021). Skrøpelighet blant eldre pasienter med hjemmesykepleie. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(4), s. 1–10. doi: 10.4045/tidsskr.20.0688. Fulltekst i vitenarkiv Vis sammendrag

  BAKGRUNN: Det er et politisk ønske at eldre personer med hjelpebehov skal kunne bo hjemme så lenge som mulig og motta helsetjenester utenfor institusjon. Denne gruppens grad av skrøpelighet samt risiko for akuttinnleggelser og død, er lite studert. Hensikten med prosjektet var å studere dette gjennom to år i en middelsstor norsk kommune. MATERIALE OG METODE: Et utvalg pasienter i Sandefjord kommune, 65 år eller eldre, med ukentlig offentlig hjemmesykepleie ble inkludert. Pasientene gjennomgikk en geriatrisk vurdering i eget hjem hvert halvår i to år. Grad av skrøpelighet ble beregnet ved hjelp av Skrøpelighetsindeks (Frailty Index). Forekomst av dødsfall og akutte sykehusinnleggelser ble registrert i to år. RESULTATER: Av 271 forespurte pasienter ble 210 inkludert. 160 pasienter (76 %) ble klassifisert som moderat eller alvorlig skrøpelige. I løpet av observasjonsperioden ble det registrert 307 akuttinnleggelser med til sammen 1 235 liggedøgn i sykehus. Sammenliknet med pasienter med alvorlig skrøpelighet var pasienter med mild skrøpelighet sjeldnere innlagt på sykehus (hasardratio (HR) 0,33; 95 % konfidensintervall (KI) 0,19–0,60). 63 (30 %) av deltakerne døde i løpet av to års observasjonstid. Dødeligheten var høyest blant pasienter med alvorlig skrøpelighet. Ved justert Cox-regresjon var økende alder assosiert med økt risiko for død, men ikke med akuttinnleggelser. FORTOLKNING: Eldre pasienter som mottar hjemmesykepleie, har høy grad av skrøpelighet, og grad av skrøpelighet er assosiert med risiko for sykehusinnleggelser og død.

• Hamaker, Marije Emilie; Walree, Inez Charlotte van; Seghers, Petronella A.L. (Nelleke); Bos, Frederiek van den; Soubeyran, Pierre & O'Hanlon, Shane [Vis alle 7 forfattere av denne artikkelen] (2021). Information needs of older patients newly diagnosed with cancer. Journal of Geriatric Oncology. ISSN 1879-4068. doi: 10.1016/j.jgo.2021.09.011. Fulltekst i vitenarkiv Vis sammendrag

  Background Understanding what information patients want and need is an important step in optimizing care. Therefore, we set out to collect all available evidence about the information that is most important to older patients with a new cancer diagnosis and whether or not these information needs are sufficiently addressed. Method A systematic literature review of Embase and Medline. Results We included eighteen studies addressing the importance of a range of information topics and studies addressing the sufficiency of information provided. On a scale from 1 to 10, patients ranked information about prognosis and the chance of cure as the most important category (median ranking 10, interquartile range (IQR) 8–10), followed by information on cancer itself (median 9, IQR 5.5–9), and treatment options (median 8, IQR 8–9). Information on side-effects of treatment (median 7, IQR 6–8), and practicalities (median 6, IQR 5–7.5) were also considered important. Patients rated information about the practicalities of treatment as the most insufficiently addressed (median 9.5), followed by self-care at home (median 9), and information about prognosis and side-effects (median 8 for both). Conclusion This systematic review demonstrates that information provision about the cancer itself and about treatment options is generally satisfactory to patients, while information about prognosis, practicalities of treatment and self-care at home could be improved. However, there is significant heterogeneity among older patients regarding which information is most important to them, thus requiring an ongoing dialogue between patients and health care providers about which information is most needed at any given time.

• Røyset, Inga; Saltvedt, Ingvild; Rostoft, Siri; Grønberg, Bjørn Henning; Kirkevold, Øyvind & Oldervoll, Line [Vis alle 17 forfattere av denne artikkelen] (2021). Geriatric assessment with management for older patients with cancer receiving radiotherapy. Protocol of a Norwegian cluster-randomised controlled pilot study. Journal of Geriatric Oncology. ISSN 1879-4068. 13(3). doi: 10.1016/j.jgo.2021.11.001. Fulltekst i vitenarkiv Vis sammendrag

  About 50% of patients with cancer are expected to need radiotherapy (RT), and the majority of these are older. To improve outcomes for older patients with cancer, geriatric assessment (GA) with management (GAM) is highly recommended. Evidence for its benefits is still scarce, in particular for patients receiving RT. We report the protocol of a cluster-randomised pilot study designed to test the effect, feasibility and health economic impact of a GAM intervention for patients ≥65 years, referred for palliative or curative RT. The randomising units are municipalities and city districts. The intervention is municipality-based and carried out in collaboration between hospital and municipal health services from the start of RT to eight weeks after the end of RT. Its main constituents are an initial GA followed by measures adapted to individual patients' impairments and needs, systematic symptom assessments and regular follow-up by municipal cancer nurses, appointed to coordinate the patient's care. Follow-up includes at least one weekly phone call, and a house call four weeks after the end of RT. All patients receive an individually adapted physical exercise program and nutritional counselling. Detailed guidelines for management of patients' impairments are provided. Patients allocated to the intervention group will be compared to controls receiving standard care. The primary outcome is physical function assessed by the European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire C-30. Secondary outcomes are global quality of life, objectively tested physical performance and use of health care services. Economic evaluation will be based on a comparison of costs and effects (measured by the main outcome measures). Feasibility will be assessed with mixed methodology, based on log notes and questionnaires filled in by the municipal nurses and interviews with patients and nurses. The study is carried out at two Norwegian RT centres. It was opened in May 2019. Follow-up will proceed until June 2022. Statistical analyses will start by the end of 2021. We expect the trial to provide important new knowledge about the effect, feasibility and costs of a GAM intervention for older patients receiving RT.

• Sprangers, Ben; Veen, Annelien Van der; Hamaker, Marije E.; Rostoft, Siri; Latcha, Sheron & Lichtman, Stuart M [Vis alle 8 forfattere av denne artikkelen] (2021). Initiation and termination of dialysis in older patients with advanced cancer: providing guidance in a complicated situation. The Lancet Healthy Longevity. doi: 10.1016/S2666-7568(20)30060-X. Fulltekst i vitenarkiv Vis sammendrag

  Cancer and chronic kidney disease prevalence both increase with age. As a consequence, physicians are more frequently encountering older people with cancer who need dialysis, or patients on dialysis diagnosed with cancer. Decisions in this context are particularly complex and multifaceted. In this Review, we aim to provide an overview of the key points to address when making a treatment strategy in these patients. We provide information on what happens if dialysis is not started or is stopped, and how physicians should deal with such patients. Informed decisions about dialysis require a personalised care plan that considers the prognosis and treatment options for each condition while also respecting patient preferences. The concept of prognosis should include quality-of-life considerations, functional status, and burden of care. Close collaboration between oncologists, nephrologists, and geriatricians is crucial to making optimal treatment decisions, and several tools are available for estimating cancer prognosis, prognosis of renal disease, and general age-related prognosis. Emerging evidence shows that these geriatric assessment tools, which measure degrees of frailty, are useful in patients with chronic kidney disease. In this Review, we try to hand tools to practising physicians, to guide decision making regarding the initiation and termination of dialysis in patients with advanced cancer.

• Rostoft, Siri; O'Donovan, Anita; Soubeyran, Pierre; Alibhai, Shabbir M H & Hamaker, Marije E. (2021). Geriatric Assessment and Management in Cancer. Journal of Clinical Oncology. ISSN 0732-183X. 39(19), s. 2058–2067. doi: 10.1200/JCO.21.00089. Fulltekst i vitenarkiv Vis sammendrag

  As the majority of patients with cancer are older than 65 years, most medical, surgical, and radiation oncologists treat a large number of older adults in their clinical practice. Older adults are a heterogeneous group of patients, in terms of physiologic reserves, comorbidity, and geriatric conditions such as cognitive impairment and disability. Comorbidities become increasingly common as people age, as does frailty (limited physiologic reserves that increase the risk of negative outcomes).1 Neither chronological age alone nor performance status does justice to characterizing this heterogeneity. Furthermore, since older patients are under-represented in clinical cancer trials, especially if they are frail with comorbidity or functional dependency, traditional treatment algorithms may not be applicable.2,3 As a result, treatment decisions in older adults with cancer are not straightforward.

• Rostoft, Siri; Bos, Frederiek van den; Pedersen, Reidar & Hamaker, Marije E. (2020). Shared decision-making in older patients with cancer - What does the patient want? Journal of Geriatric Oncology. ISSN 1879-4068. 15:e0235393(4). doi: 10.1016/j.jgo.2020.08.001. Fulltekst i vitenarkiv Vis sammendrag

  Shared decision-making in cancer care, where we move away from the paternalistic “the doctor knows best” attitude to involving the patient in decisions regarding her or his health, is now universally accepted in western societies. However, in many situations this is easier said than done. For instance, if the interaction with the patient is not performed in a skillful manner, shared decision-making can make the patient feel unsafe – shouldn't the specialist know how to treat a serious disease such as cancer? Why would the doctor ask the patient about this? In other cases, what the patient wants in unrealistic, for example a severely frail patient aged 85 years with more than one life-limiting comorbidity who is diagnosed with an advanced cancer and has a goal of living to be at least 100 years. And what does a patient with advanced dementia want in the context of a cancer disease? In this perspectives piece, we will describe different scenarios that may arise within geriatric oncology and shared decision-making, make recommendations about how to handle such situations, and provide some food for thought.

• Harneshaug, Magnus; Benth, Jurate Saltyte; Kirkhus, Lene; Gronberg, Bjorn Henning; Bergh, Sverre & Rostoft, Siri [Vis alle 7 forfattere av denne artikkelen] (2020). CT Derived Muscle Measures, Inflammation, and Frailty in a Cohort of Older Cancer Patients. In Vivo. ISSN 0258-851X. 34(6), s. 3565–3572. doi: 10.21873/invivo.12200. Fulltekst i vitenarkiv Vis sammendrag

  Background/aim: Muscle loss, inflammation, and frailty are prevalent among older cancer patients. We aimed to evaluate whether inflammatory markers could identify muscle loss, and if muscle measures differed between frail and non-frail patients. Patients and methods: A total of 115 patients ≥70 years old with solid tumors were included. Inflammation was measured using the Glasgow Prognostic Score (GPS), which is based on C-reactive protein (CRP) and albumin levels, and CRP alone. Frailty was evaluated using a modified geriatric assessment (mGA) of eight domains affecting older patients' health status. Computed tomography-derived muscle measures were collected at the level of the third lumbar vertebra. Results: Patients with GPS=2 and CRP>27 mg/l exhibited poorer muscle measures compared to patients with lower levels. No associations between mGA-based frailty and muscle mass were found. Conclusion: Inflammation has detrimental effects on muscle mass. However, GPS or CRP alone cannot be used to identify muscle loss, and muscle measures were not associated with frailty in this series.

• Rostoft, Siri & Leeuwen, Barbara van (2020). Frailty assessment tools and geriatric assessment in older patients with hepatobiliary and pancreatic malignancies. European Journal of Surgical Oncology. ISSN 0748-7983. doi: 10.1016/j.ejso.2020.08.024. Fulltekst i vitenarkiv Vis sammendrag

  Background The majority of patients with hepatobiliary and pancreatic (HBP) malignancies are older than 65 years. Due to the heterogeneity of this older population, decisions regarding surgical treatment cannot rely solely on treatment guidelines, but have to take into account patient frailty, geriatric impairments and resilience as well as patient preferences. In the few studies of older patients with HBP malignancies that have included a preoperative geriatric assessment (GA), frailty and elements from the GA such as reduced functional status have emerged as powerful predictors of postoperative morbidity and mortality, length of stay, type of treatment received and survival. A GA is a systematic evaluation of functional status, comorbidities, polypharmacy, cognition, nutritional status, emotional status, and social support. Materials and methods A Pubmed search identifying clinical studies investigating the association between frailty, GA and outcomes in patients with HBP malignancies. Results A total of 20 studies were included in this review. For HBP malignancies, the evidence linking frailty and GA variables to negative outcomes is limited, but generally shows that frailty, functional dependency, comorbidity, and sarcopenia predict postoperative complications and survival. Conclusion Although scarcely investigated, frailty and elements from a GA seem to be associated with negative short- and long-term treatment outcomes in older patients with HBP malignancies. Future studies should investigate the impact of geriatric interventions and prehabilitation on outcomes.

• Hamaker, M.E.; Bos, Frederiek Van Den & Rostoft, Siri (2020). Frailty and palliative care. BMJ Supportive & Palliative Care. ISSN 2045-435X. 10(3), s. 262–264. doi: 10.1136/bmjspcare-2020-002253. Fulltekst i vitenarkiv
• Kirkhus, Lene; Benth, Jurate Saltyte; Grønberg, Bjørn Henning; Hjermstad, Marianne Jensen; Rostoft, Siri & Harneshaug, Magnus [Vis alle 9 forfattere av denne artikkelen] (2019). Frailty identified by geriatric assessment is associated with poor functioning, high symptom burden and increased risk of physical decline in older cancer patients: Prospective observational study. Palliative Medicine. ISSN 0269-2163. 33(3), s. 312–322. doi: 10.1177/0269216319825972. Fulltekst i vitenarkiv Vis sammendrag

  Background: Maintaining quality of life including physical functioning is highly prioritized among older cancer patients. Geriatric assessment is a recommended approach to identify patients with increased vulnerability to stressors (frailty). How frailty affects quality of life and physical functioning in older cancer patients has scarcely been investigated. Aim: Focusing on physical functioning and global quality of life, we investigated whether frailty identified by a geriatric assessment was associated with higher risk of quality-of-life deterioration during cancer treatment and follow-up. Design: Prospective, observational study. Patients were classified as frail or non-frail by a modified geriatric assessment. Quality of life was measured using the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire at inclusion, 2, 4, 6 and 12 months. Setting: Eight Norwegian outpatient cancer clinics. Participants: Patients ⩾70 years with solid tumours referred for palliative or curative systemic medical cancer treatment. Results: Among 288 patients included, 140 (49%) were frail and 148 (51%) non-frail. Frail patients consistently reported poorer scores on all functioning and symptom scales. Independent of age, gender and major cancer-related factors, frail patients had significantly poorer physical functioning and global quality of life during follow-up, and opposed to non-frail patients they had both a clinically and statistically significant decline in physical functioning from baseline until 12 months. Conclusions: Geriatric assessment identifies frail patients with increased risk of physical decline, poor functioning and high symptom burden during and following cancer treatment. Frail patients should therefore receive early supportive or palliative care.

• Montroni, Isacco; Rostoft, Siri; Spinelli, Antonino; Leeuwen, Barbara L. van; Ercolani, Giorgio & Saur, Nicole M. [Vis alle 14 forfattere av denne artikkelen] (2019). GOSAFE - Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery: early analysis on 977 patients. Journal of Geriatric Oncology. ISSN 1879-4068. s. 1–12. doi: 10.1016/j.jgo.2019.06.017. Fulltekst i vitenarkiv
• Berg, Arne Stenrud & Rostoft, Siri (2019). Sårbarhetsfaktorer hos eldre med kreft. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 139(18). doi: 10.4045/tidsskr.18.0337. Fulltekst i vitenarkiv
• Hamaker, Marije E; Huis-Tanja, Lieke H van & Rostoft, Siri (2019). Optimizing the geriatrician's contribution to cancer care for older patients. Journal of Geriatric Oncology. ISSN 1879-4068. doi: 10.1016/j.jgo.2019.06.018. Fulltekst i vitenarkiv Vis sammendrag

  Cancer specialists and geriatricians can struggle to find the best form for their collaboration within geriatric oncology and do not always benefit optimally from the experience and knowledge the other has to offer. To optimize the yield of a geriatric consultation for older patients with cancer, the geriatrician needs to know the specific purpose of the consultation, the expected disease trajectory, and some information on the potential benefits and risks of treatment options including best supportive care only. The geriatrician should subsequently focus primarily on the patient, their preferences and priorities with regards to oncologic and non-oncologic outcomes and assess their overall health status through a geriatric assessment that includes at minimum comorbidities, medication review, basic and instrument activities of daily living, mobility, falls, nutritional status, cognition, mood and social support. Reporting back to the cancer specialist should be concise, objective whenever possible and to the point. Within the multidisciplinary team, the geriatrician can contribute with information on health status and reserves, remaining life-expectancy and toxicity risks, and by creating awareness of the limitations of evidence regarding the older population. This will help in reaching a well-tailored treatment decision that balances cancer-related and patient-centred outcome measures and fits within the patient's own preferences for treatment.

• Kirkhus, Lene; Harneshaug, Magnus; Benth, Jurate Saltyte; Grønberg, Bjørn Henning; Rostoft, Siri & Bergh, Sverre [Vis alle 13 forfattere av denne artikkelen] (2019). Modifiable factors affecting older patients' quality of life and physical function during cancer treatment. Journal of Geriatric Oncology. ISSN 1879-4068. 10(6), s. 904–912. doi: 10.1016/j.jgo.2019.08.001. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: Maintaining physical function and quality of life (QoL) are prioritized outcomes among older adults. We aimed to identify potentially modifiable factors affecting older patients' physical function and QoL during cancer treatment. METHODS: Prospective, multicenter study of 307 patients with cancer ≥70 years, referred for systemic treatment. Pre-treatment, a modified geriatric assessment (mGA) was performed, including registration of comorbidities, medications, nutritional status, cognitive function, depressive symptoms (Geriatric Depression Scale-15 [GDS]), and mobility (Timed Up and Go [TUG]). Patient-reported physical function (PF)-, global QoL-, and symptom scores were assessed at baseline, two, four, and six months by the EORTC Quality of Life Core Questionnaire-C30. The impact of mGA components and symptoms on patients' PF and global QoL scores during six months was investigated by linear mixed models. To identify groups following distinct PF trajectories, a growth mixture model was estimated. RESULTS: 288 patients were eligible, mean age was 76.9 years, 68% received palliative treatment. Higher GDS-scores and poorer TUG were independently associated with an overall level of poorer PF and global QoL throughout follow-up, as were more pain, dyspnea, and appetite loss, and sleep disturbance. Three groups with distinct PF trajectories were identified: a poor group exhibiting a non-linear statistically (p < .001) and clinically significant decline (≥10 points), an intermediate group with a statistically (p = .003), but not clinically significant linear decline, and a good group with a stable trajectory. Higher GDS-scores and poorer TUG, more pre-treatment pain and dyspnea were associated with higher odds of belonging to the poor compared to the good PF group. CONCLUSION: Depressive symptoms, reduced mobility, and more physical symptoms increased the risk of decrements in older patients' PF and global QoL scores during cancer treatment, and represent potential targets for interventions aiming at improving these outcomes.

• DuMontier, Clark; Sedrak, Mina S.; Soo, Wee Kheng; Kenis, Cindy; Williams, Grant R. & Haase, Kristen [Vis alle 12 forfattere av denne artikkelen] (2019). Arti Hurria and the progress in integrating the geriatric assessment into oncology: Young international society of geriatric oncology review paper. Journal of Geriatric Oncology. ISSN 1879-4068. s. 1–10. doi: 10.1016/j.jgo.2019.08.005. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Until recently, the progress in the diagnosis and management of cancer has not been matched by similar progress in the assessment of the increasing numbers of older and more complex patients with cancer. Dr. Arti Hurria identified this gap at the outset of her career, which she dedicated toward studying the geriatric assessment (GA) as an improvement over traditional methods used in oncology to assess vulnerability in older patients with cancer. This review documents the progress of the GA and its integration into oncology. First, we detail the GA's origins in the field of geriatrics. Next, we chronicle the early rise of geriatric oncology, highlighting the calls of early thought-leaders to meet the demands of the rapidly aging cancer population. We describe Dr. Hurria's early efforts toward meeting these calls though the implementation of the GA in oncology research. We then summarize some of the seminal studies constituting the evidence base supporting GA's implementation. Finally, we lay out the evolution of cancer-focused guidelines recommending the GA, concluding with future needs to advance the next steps toward more widespread implementation in routine cancer care. Throughout, we describe Dr. Hurria's vision and its execution in driving progress of the GA in oncology, from her fellowship training to her co-authored guidelines recommending GA for all older adults with cancer-published in the year of her untimely death.

• Rostoft, Siri & Hamaker, Marije E (2019). Basic geriatric principles for colorectal surgeons: How to optimize assessment and care of the elderly in the perioperative period. European Journal of Surgical Oncology. ISSN 0748-7983. s. 1–6. doi: 10.1016/j.ejso.2019.07.027. Fulltekst i vitenarkiv Vis sammendrag

  Background The majority of patients with colorectal cancer are older. For surgeons dealing with older patients, it is important to recognize patients that are frail and have an increased risk of complications and mortality. In this review, we will go through pre-treatment assessment, peri-operative management, as well as discharge planning and rehabilitation. Methods This review is based on searching the literature for studies regarding colorectal cancer, frailty, cognition, patient preferences and geriatric assessment as well as the academic and clinical experience of the authors. Results In the pre-treatment assessment, surgeons need to consider capacity to consent, patient preferences, frailty and life-expectancy, risk of complications, and whether the patient can be optimized before surgery. Then, the patient and treatment options should be discussed at a multidisciplinary team meeting. When the patient is admitted for surgery, discharge planning should start immediately, and if complications such as delirium or falls occur, the patient should be co-managed with geriatric services. Conclusion Frail older adults with colorectal cancer need a tailored approach from pre-treatment assessment until discharge after surgery, and co-management with a geriatrician is recommended. If this is not possible, surgeons treating frail older patients may improve care by adapting some geriatric principles.

• Montroni, Isacco; Ugolini, Giampaolo; Saur, Nicole M.; Spinelli, Antonino; Rostoft, Siri & Millan, Monica [Vis alle 28 forfattere av denne artikkelen] (2018). Personalized management of elderly patients with rectal cancer: Expert recommendations of the European Society of Surgical Oncology, European Society of Coloproctology, International Society of Geriatric Oncology, and American College of Surgeons Commission on Cancer. European Journal of Surgical Oncology. ISSN 0748-7983. 44, s. 1685–1702. doi: 10.1016/j.ejso.2018.08.003. Fulltekst i vitenarkiv
• Harneshaug, Magnus; Kirkhus, Lene; Benth, Jurate Saltyte; Grønberg, Bjørn Henning; Bergh, Sverre & Whist, Jon Elling [Vis alle 8 forfattere av denne artikkelen] (2018). Screening for frailty among older patients with cancer using blood biomarkers of inflammation. Journal of Geriatric Oncology. ISSN 1879-4068. 10(2). doi: 10.1016/j.jgo.2018.07.003. Fulltekst i vitenarkiv Vis sammendrag

  As frailty is associated with inflammation, biomarkers of inflammation may represent objective measures that could facilitate the identification of frailty. Glasgow prognostic score (GPS), combines C-reactive protein (CRP) and albumin, and isscored from 0-2 points. Higher score indicates a higher degree of inflammation.Objectives: To investigate whether (1)GPS is associated with frailty,(2)GPS could be used to screen for frailty, (3) IL-6 and TNF-α add to the accuracy of GPS as a screening tool, and(4)GPS adds prognostic information in frail older cancer patients.Methods:Prospective, observational study of 255 patients ≥ 70 years with solid malignant tumours referred for medical cancer treatment.At baseline, frail patients were identified by a modified Geriatric Assessment (mGA), andblood samples were collected. Results: Mean age was 76.7years, 49.8% were frail, and 56.1% had distant metastases. The proportion of frail patients increased with higher GPS (GPSzero: 43.2%, GPSone:52.7%, GPStwo: 94.7%). GPStwowas significantly associated with frailty (OR 18.5), independent of cancer type, stage, BMI and the use of anti-inflammatory drugs. The specificity of GPS was high (99%), but the sensitivity waslow (14%). Frail patients with GPStwohad poorer survival than patients with GPS zero-one. TNF-α and IL-6 did not improve the accuracy of GPS when screening for frailty.Conclusion: Frailty and GPStwoarestrongly associated,and GPStwois a significant prognostic factor in frail, older cancer patients. The inflammatory biomarkers investigated are not suitable screening tools for frailty.

• Paillaud, Éléna; Soubeyran, Pierre; Caillet, Philippe; Cudennec, Tristan; Brain, Étienne G.C. & Terret, Catherine [Vis alle 15 forfattere av denne artikkelen] (2018). Multidisciplinary development of the Geriatric Core Dataset for clinical research in older patients with cancer: A French initiative with international survey. European Journal of Cancer. ISSN 0959-8049. 103, s. 61–68. doi: 10.1016/j.ejca.2018.07.137. Fulltekst i vitenarkiv
• Allum, William; Lordick, Florian; Alsina, Melissa; Andritsch, Elisabeth; Ba-Ssalamah, Ahmed & Beishon, Marc [Vis alle 26 forfattere av denne artikkelen] (2018). ECCO essential requirements for quality cancer care: Oesophageal and gastric cancer. Critical Reviews in Oncology/Hematology. ISSN 1040-8428. 122, s. 179–193. doi: 10.1016/j.critrevonc.2017.12.019. Fulltekst i vitenarkiv
• Ommundsen, Nina; Nesbakken, Arild; Wyller, Torgeir Bruun; Skovlund, Eva; Bakka, Arne Olav & Jordhøy, Marit Slaaen [Vis alle 7 forfattere av denne artikkelen] (2018). Post-discharge complications in frail older patients after surgery for colorectal cancer. European Journal of Surgical Oncology. ISSN 0748-7983. 44(10), s. 1542–1547. doi: 10.1016/j.ejso.2018.06.024. Fulltekst i vitenarkiv Vis sammendrag

  Background The incidence of postoperative complications after colorectal cancer surgery varies between publications. Complications occurring after discharge from hospital are often not reported. The aims of this study were to investigate the proportion of frail older colorectal cancer patients who developed complications only after discharge, the severity of post-discharge complications, and the time point at which the most frequent complications occurred. Methods Patients were included if they were 65 years and older, screened positively for frailty and were scheduled for colorectal cancer surgery. Included patients were followed prospectively both in hospital and after discharge for 30 days after surgery, and complications were graded according to the Clavien-Dindo classification. Results We included 114 patients. Median age was 79 years. Twenty-two patients (19%) were discharged without complications, but developed complications after discharge. These patients had shorter length of stay (6.5 versus 10 days), were more often discharged to their own home without assistance, and had higher 5-year survival (76% vs 54%) than patients who developed complications in hospital. Post-discharge complications were most frequently grade II. The most common types of complications that occurred late in the postoperative course were urinary tract infections and superficial surgical site infections. Conclusions Complications after colorectal cancer surgery in frail older patients frequently arise after discharge from hospital. Doctors should be aware of this and inform their patients. This is increasingly important as length of stay after surgery decreases. When complications are used as a quality measure, it should be clear whether only in-hospital complications are registered.

• Ommundsen, Nina; Wyller, Torgeir Bruun; Nesbakken, Arild; Bakka, Arne Olav; Jordhøy, Marit Slaaen & Skovlund, Eva [Vis alle 7 forfattere av denne artikkelen] (2018). Preoperative geriatric assessment and tailored interventions in frail older patients with colorectal cancer: a randomized controlled trial. Colorectal Disease. ISSN 1462-8910. 20(1), s. 16–25. doi: 10.1111/codi.13785. Fulltekst i vitenarkiv
• Rostoft, Siri (2017). Integration of geriatric assessment in the care of patients with gastrointestinal malignancies. Visceral Medicine. ISSN 2297-4725. 33(4), s. 275–280. doi: 10.1159/000475452. Fulltekst i vitenarkiv
• Rostoft, Siri & Audisio, Riccardo A. (2017). Recent advances in cancer surgery in older patients. F1000. 6:1242, s. 1–8. doi: 10.12688/f1000research.10683.1. Fulltekst i vitenarkiv
• Kirkhus, Lene; Benth, Jurate Saltyte; Kristjansson, Siri Rostoft; Grønberg, Bjørn Henning; Hjermstad, Marianne Jensen & Selbæk, Geir [Vis alle 9 forfattere av denne artikkelen] (2017). Geriatric assessment is superior to oncologists’ clinical judgement in identifying frailty. British Journal of Cancer. ISSN 0007-0920. 117(4), s. 470–477. doi: 10.1038/bjc.2017.202. Fulltekst i vitenarkiv Vis sammendrag

  Background: Frailty is a syndrome associated with increased vulnerability and an important predictor of outcomes in older cancer patients. Systematic assessments to identify frailty are seldom applied, and oncologists’ ability to identify frailty is scarcely investigated. Methods: We compared oncologists’ classification of frailty (onc-frail) based on clinical judgement with a modified geriatric assessment (mGA), and investigated associations between frailty and overall survival. Patients X70 years referred for medical cancer treatment were eligible. mGA-frailty was defined as impairment in at least one of the following: daily activities, comorbidity, polypharmacy, physical function or at least one geriatric syndrome (cognitive impairment, depression, malnutrition, falls). Results: Three hundred and seven patients were enroled, 288 (94%) completed the mGA, 286 (93%) were rated by oncologists. Median age was 77 years, 56% had metastases, 85% performance status (PS) 0–1. Overall, 104/286 (36%) were onc-frail and 140/288 (49%) mGA-frail, the agreement was fair (kappa value 0.30 (95% CI 0.19; 0.41)), and 67 mGA-frail patients who frequently had localised disease, good PS and received curative treatment, were missed by the oncologists. Only mGA-frailty was independently prognostic for survival (HR 1.61, 95% CI 1.14; 2.27; P¼0.007). Conclusions: Systematic assessment of geriatric domains is needed to aid oncologists in identifying frail patients with poor survival.

• Rønning, Benedicte; Wyller, Torgeir Bruun; Nesbakken, Arild; Skovlund, Eva; Jordhøy, Marit Slaaen & Bakka, Arne Olav [Vis alle 7 forfattere av denne artikkelen] (2016). Quality of life in older and frail patients after surgery for colorectal cancer-A follow-up study. Journal of Geriatric Oncology. ISSN 1879-4068. 7(3), s. 195–200. doi: 10.1016/j.jgo.2016.03.002. Fulltekst i vitenarkiv Vis sammendrag

  Objective The incidence of colorectal cancer is increasing, mainly due to the aging of the population. Frailty, describing a state of increased vulnerability, is common in older patients, but frailty and high age are not necessarily contraindications to surgical treatment. However, limited data describing long-term outcomes after surgery in this patient group exist. In this clinical follow-up study, we aimed to examine long-term health-related quality of life in older surgical patients with colorectal cancer. Materials and Methods Patients were recruited from a prospective multicenter study investigating frailty as a predictor of postoperative complications after surgery for colorectal cancer. A preoperative geriatric assessment was performed, and patients were classified as frail or non-frail. Patients responded to version 3.0 of The European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire-C30 before surgery, 3 months postoperatively and at a long-term follow-up 16–28 months (median 22 months) after surgery. One-way repeated-measures analyses of variance were performed to examine changes in scores over time. Results 180 patients with a mean age of 80 years were included at baseline, 138 at 3 months postoperatively, and 84 patients (69% of survivors) at long-term follow-up. A significant improvement in quality of life-scores was present 3 months after surgery, also in the subgroup of frail patients. At long-term follow-up, scores decreased, but to values above baseline. Conclusion Health-related quality of life may be improved in older patients after surgery for colorectal cancer, even in patients who are classified as frail preoperatively.

• Kirkhus, Lene; Jordhøy, Marit; Benth, Jurate Saltyte; Kristjansson, Siri Rostoft; Selbæk, Geir & Hjermstad, Marianne Jensen [Vis alle 7 forfattere av denne artikkelen] (2016). Comparing comorbidity scales: Attending physician score versus the Cumulative Illness Rating Scale for Geriatrics. Journal of Geriatric Oncology. ISSN 1879-4068. 7(2), s. 90–98. doi: 10.1016/j.jgo.2015.12.003. Fulltekst i vitenarkiv
• Parks, Ruth Mary; Kristjansson, Siri Rostoft; Ommundsen, Nina & Cheung, Kwok-Leung (2015). Peri-operative management of older adults with cancer—The roles of the surgeon and geriatrician. Cancers. 7(3), s. 1605–1621. doi: 10.3390/cancers7030853. Fulltekst i vitenarkiv
• Decoster, L; Puyvelde, K* Van; Mohile, S*; Wedding, Ulrich; Basso, U* & Colloca, G [Vis alle 18 forfattere av denne artikkelen] (2015). Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations. Annals of Oncology. ISSN 0923-7534. 26(2), s. 288–300. doi: 10.1093/annonc/mdu210. Fulltekst i vitenarkiv
• Papamichael, Demetris; Audisio, Riccardo Alberto; Glimelius, Bengt; Gramont, Aimery de; Glynne-Jones, Rob George T. & Haller, Daniel George [Vis alle 17 forfattere av denne artikkelen] (2015). Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013. Annals of Oncology. ISSN 0923-7534. 26(3), s. 463–476. doi: 10.1093/annonc/mdu253. Fulltekst i vitenarkiv
• Ommundsen, Nina; Wyller, Torgeir Bruun; Nesbakken, Arild; Jordhøy, Marit; Bakka, Arne Olav & Skovlund, Eva [Vis alle 7 forfattere av denne artikkelen] (2014). Frailty is an independent predictor of survival in older patients with colorectal cancer. The Oncologist. ISSN 1083-7159. 19(12), s. 1268–1275. doi: 10.1634/theoncologist.2014-0237. Fulltekst i vitenarkiv Vis sammendrag

  Background. Colorectal cancer (CRC) is prevalent in the older population. Geriatric assessment (GA) has previously been found to predict treatment tolerance and postoperative complications in older cancer patients. The aim of this study was to explore whether GA also predicts 1-year and 5-year survival after CRC surgery in older patients and to compare the predictive power of GA with that of established prognostic factors such as TNM classification of malignant tumors (TNM) stage and age. Materials and Methods. A cohort of 178 CRC patients aged 70 and older were followed prospectively. All patients went through elective surgery, and GA was performed presurgery. The GA resulted in patients being divided into two groups: frail or nonfrail. All patients were followed for 5 years or until death. Data were analyzed by Kaplan-Meier plots and the Cox proportional hazards model. Results. Seventy-six patients (43%) were frail, and one hundred and two (57%) were nonfrail. Twenty-three patients (13%) died during the first year after surgery. One-year survival was 80% in the frail group and 92% in the nonfrail group. Five-year survival was significantly lower in frail (24%) than nonfrail patients (66%), and this difference was apparent both within the stratums of TNM stages 0–II and TNM stage III. In multivariable analysis adjusting for TNM stage, age, and sex, frailty was an independent prognostic factor for survival. Conclusion. A GA-based frailty assessment predicts 1-year and 5-year survival in older patients after surgery for CRC. In localized and regional disease, the impact of frailty upon 5-year survival is comparable with that of TNM stage.

• Rønning, Benedicte; Wyller, Torgeir Bruun; Jordhøy, Marit Slaaen; Nesbakken, Arild; Bakka, Arne Olav & Seljeflot, Ingebjørg [Vis alle 7 forfattere av denne artikkelen] (2014). Frailty indicators and functional status in older patients after colorectal cancer surgery. Journal of Geriatric Oncology. ISSN 1879-4068. 5(1), s. 26–32. doi: 10.1016/j.jgo.2013.08.001. Fulltekst i vitenarkiv
• Kristjansson, Siri Rostoft; Rønning, Benedicte; Hurria, Arti; Skovlund, Eva; Jordhøy, Marit Slaaen & Nesbakken, Arild [Vis alle 7 forfattere av denne artikkelen] (2012). A comparison of two pre-operative frailty measures in older surgical cancer patients. Journal of Geriatric Oncology. ISSN 1879-4068. 3(1), s. 1–7. doi: 10.1016/j.jgo.2011.09.002. Fulltekst i vitenarkiv
• Kristjansson, Siri Rostoft; Spies, Claudia; Veering, Bernadette T.H.; Silverstein, Jeffrey H.; Vigano, Antonio A.L. & Mercadante, Sebastiano [Vis alle 13 forfattere av denne artikkelen] (2012). Perioperative care of the elderly oncology patient: A report from the SIOG task force on the perioperative care of older patients with cancer. Journal of Geriatric Oncology. ISSN 1879-4068. 3(2), s. 147–162. doi: 10.1016/j.jgo.2012.01.003. Fulltekst i vitenarkiv
• Kristjansson, Siri Rostoft; Nesbakken, Arild; Jordhøy, Marit S; Skovlund, Eva; Audisio, Riccardo A. & Johannessen, Hans Olaf [Vis alle 8 forfattere av denne artikkelen] (2010). Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: A prospective observational cohort study. Critical Reviews in Oncology/Hematology. ISSN 1040-8428. 76(3), s. 208–217. doi: 10.1016/j.critrevonc.2009.11.002. Fulltekst i vitenarkiv
• Kristjansson, Siri Rostoft; Jordhøy, Marit S; Nesbakken, Arild; Skovlund, Eva; Bakka, Arne Olav & Johannessen, Hans Olaf [Vis alle 7 forfattere av denne artikkelen] (2010). Which elements of a comprehensive geriatric assessment (CGA) predict post-operative complications and early mortality after colorectal cancer surgery? Journal of Geriatric Oncology. ISSN 1879-4068. 1(2), s. 57–65. doi: 10.1016/j.jgo.2010.06.001. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Glas, Nienke de; Rostoft, Siri; Schaufel, Margrethe Aase; aasen, stine voll & Guldhav, Kristin Vassbotn (2025). Oppstartsseminar IMPACT-study. Fulltekst i vitenarkiv Vis sammendrag

  Oppstartsseminar til å presentere IMPACT-studien i Helse Førde

• Glas, Nienke de & Rostoft, Siri (2025). Implementering av pasient-tilpasset kreftbehandling hos eldre pasienter – IMPACT-studien. Onkonytt. ISSN 1503-7886. Fulltekst i vitenarkiv
• Gómez-Moreno, Carolina; Russo, Chiara; Parala-Metz, Armida; Beauplet, Bérengère; Pillai, Anupa & Kumar, Anand [Vis alle 9 forfattere av denne artikkelen] (2025). Do we need geriatricians in geriatric oncology? A SIOG geriatricians position statement. Journal of Geriatric Oncology. ISSN 1879-4068. doi: 10.1016/j.jgo.2025.102831. Fulltekst i vitenarkiv
• Sletten, Reidun; Jordhøy, Marit Slaaen; Oldervoll, Line Merethe; Skjellegrind, Håvard Kjesbu; Benth, Jurate Saltyte & Åstrøm, Lennart [Vis alle 13 forfattere av denne artikkelen] (2025). Corrigendum to “Physical Performance and Activity in Older Prostate Cancer Survivors in Comparison with Population-based Matched Controls” [Eur. Urol. Open Sci. 71 (2025) 85–95](S2666168324014277)(10.1016/j.euros.2024.11.005). European Urology Open Science. ISSN 2666-1691. 77, s. 79–82. doi: 10.1016/j.euros.2025.05.005. Fulltekst i vitenarkiv
• Ihle-Hansen, Håkon; Rostoft, Siri; Bakken, Marit Stordal; Hamre, Kristin Mork; Seredkina, Natalya & Egstad, Elisabeth (2025). Skåringsverktøy for vurdering av skrøpelighet. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(7), s. 594–595. doi: 10.4045/tidsskr.25.0249. Fulltekst i vitenarkiv
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• Burrell, Lisa Victoria; Bakken, Inger Johanne Landsjøåsen; Døhl, Øystein; Rostoft, Siri; Berggaard, Nina & Antonova, Iryna [Vis alle 8 forfattere av denne artikkelen] (2024). Data completeness & -quality in The Norwegian Registry of Primary Health Care (LTC). Fulltekst i vitenarkiv
• Hamaker, Marije E.; Wildiers, Hans; Ardito, Vittoria; Arsandaux, Julie; Barthod-Malat, Aurore & Davies, Paul [Vis alle 22 forfattere av denne artikkelen] (2024). Study protocol for two stepped-wedge interventional trials evaluating the effects of holistic information technology-based patient-oriented management in older multimorbid patients with cancer: The GERONTE trials. Journal of Geriatric Oncology. ISSN 1879-4068. 15(4). doi: 10.1016/j.jgo.2024.101761. Fulltekst i vitenarkiv
• Syse, Astri; Kravdal, Øystein; Rostoft, Siri; Thomas, Michael & Hart, Rannveig Kaldager (2024). Illness in Marital or Cohabiting Partners: Implications for Welfare Uptake and Labor Market Efforts. Fulltekst i vitenarkiv
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• Burrell, Lisa Victoria; Døhl, Øystein; Rostoft, Siri; Berggaard, Nina; Antonova, Iryna & Bakken, Inger Johanne Landsjøåsen (2023). KPR Helse- og omsorgsdata: Nye delmål og samlemål for funksjon. Fulltekst i vitenarkiv
• Nortvedt, Per; Røise, Olav; Rostoft, Siri & Pedersen, Reidar (2022). Man bryr seg mindre jo mer man gjør det. 142(18), s. 1538–1538. doi: 10.4045/tidsskr.22.0667. Fulltekst i vitenarkiv
• Saur, Nicole M.; Davis, Bradley R.; Montroni, Isacco; Shahrokni, Armin; Rostoft, Siri & Russell, Marcia M. [Vis alle 12 forfattere av denne artikkelen] (2022). The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Perioperative Evaluation and Management of Frailty Among Older Adults Undergoing Colorectal Surgery. Diseases of the Colon & Rectum. ISSN 0012-3706. 65(4), s. 473–488. doi: 10.1097/DCR.0000000000002410. Fulltekst i vitenarkiv
• Røyset, Inga Marie; Benth, Jurate Saltyte; Eriksen, Guro Falk; Saltvedt, Ingvild; Grønberg, Bjørn Henning & Rostoft, Siri [Vis alle 8 forfattere av denne artikkelen] (2021). Edmonton Frail Scale predicts mortality in older patients with cancer undergoing radiotherapy - a prospective observational study. Fulltekst i vitenarkiv
• Kirkhus, Lene; Saltyte-Benth, Jurate; Grønberg, Bjørn Henning; Hjermstad, Marianne Jensen; Rostoft, Siri & Harneshaug, Magnus [Vis alle 9 forfattere av denne artikkelen] (2020). Reply to the letter to the editor ‘Geriatric-oncology and palliative care: cautionary on using geriatric assessment as a sole basis to limit care’. Palliative Medicine. ISSN 0269-2163. 34(2), s. 255–256. doi: 10.1177/0269216319888987. Fulltekst i vitenarkiv
• Mellingsæter, Marte; Pedersen, Reidar; Rostoft, Siri & Ahmed, Marc (2020). Kan vi forberede oss på døden? Fulltekst i vitenarkiv
• Kirkhus, Lene; Benth, Jurate Saltyte; Grønberg, Bjørn Henning; Hjermstad, Marianne Jensen; Rostoft, Siri & Harneshaug, Magnus [Vis alle 9 forfattere av denne artikkelen] (2019). Reply to the letter to the editor 'Geriatric-oncology and palliative care: cautionary on using geriatric assessment as a sole basis to limit care'. Palliative Medicine. ISSN 0269-2163. doi: 10.1177/0269216319888987. Fulltekst i vitenarkiv
• Mohile, Supriya Gupta; Dale, William & Rostoft, Siri (2019). Special issue to honor and remember Dr. Arti Hurria: Call for papers for the Journal of Geriatric Oncology. Journal of Geriatric Oncology. ISSN 1879-4068. doi: 10.1016/j.jgo.2019.01.014. Fulltekst i vitenarkiv
• Ommundsen, Nina; Wyller, Torgeir Bruun; Nesbakken, Arild; Bakka, Arne Olav; Jordhøy, Marit Slaaen & Skovlund, Eva [Vis alle 7 forfattere av denne artikkelen] (2018). Reply to Lawday et al. Colorectal Disease. ISSN 1462-8910. 20(4), s. 350–351. doi: 10.1111/codi.14059. Fulltekst i vitenarkiv
• Hamaker, Marije; Wildes, Tanya Petka & Rostoft, Siri (2017). Time to stop saying geriatric assessment is too time-consuming. Journal of Clinical Oncology. ISSN 0732-183X. 35(25), s. 2871–2874. doi: 10.1200/JCO.2017.72.8170. Fulltekst i vitenarkiv Vis sammendrag

  Aging makes us increasingly unique. A group of older patients with cancer of identical chronologic age will demonstrate great heterogeneity with regard to vitality, comorbidity, functional status, physiologic reserves, and psychosocial functioning.1,2 Thus, age alone is an insufficient surrogate for biologic aging. Similarly, commonly used unidimensional measures, such as performance status or the American Society of Anesthesiologists classification, cannot fully do justice to this heterogeneity.3 Despite accumulating evidence regarding the value of geriatric assessment (GA) to encompass the diversity of older patients, it seems almost requisite in literature and presentations on GA in cancer care to state that it is too time consuming to implement in daily oncology practice.4-7 In our opinion, this complaint is ill founded and should be retired. [...]

• Rostoft, Siri & Skaar, Elisabeth (2016). Er pasienten min skrøpelig? Indremedisineren. ISSN 1891-1617. Fulltekst i vitenarkiv
• Kristjansson, Siri Rostoft (2013). Definition of aging and functional decline. European Journal of Cancer. ISSN 0959-8049. 49, s. S82–S82. Fulltekst i vitenarkiv
• Kirkhus, Lene; Kristjansson, Siri Rostoft; Selbæk, Geir; Hjermstad, Marianne Jensen; Aass, Nina Kathrine & Bye, Asta [Vis alle 8 forfattere av denne artikkelen] (2013). Cancer in the elderly: prevalence and impact of age related symptoms on quality of life, treatment tolerance and survival. Fulltekst i vitenarkiv

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