The public defence will be held as a video conference over Zoom.
The defence will follow regular procedure as far as possible, hence it will be open to the public and the audience can ask ex auditorio questions when invited to do so.
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Due to copyright reasons, an electronic copy of the thesis must be ordered from the faculty. In order for the faculty to have time to process the order, it must be received by the faculty no later than 2 days prior to the public defence. Orders received later than 2 days before the defence will not be processed. Inquiries regarding the thesis after the public defence must be addressed to the candidate.
Digital Trial Lecture - time and place
Adjudication committee
- First opponent: Professor Alfonso J. Cruz-Jentoft, Universidad Europea, Madrid, Spain
- Second opponent: Senior Consultant Lene Annette Sand Strömgren, Bispebjerg Hospital, Copenhagen, Denmark
- Third member and chair of the evaluation committee: Associate Professor Mads Nikolaj Holten Andersen, Institute of Clinical Medicine, University of Oslo
Chair of defence
Associate Professor Øistein Hovde, Institute of Clinical Medicine, University of Oslo
Principal Supervisor
Professor II Marit Slaaen, Institute of Clinical Medicine, University of Oslo
Summary
Patients aged 70 or older represent about half of all cancer patients. Aging is a highly individual process, and older patients with cancer have a considerable variation in health status. Older patients with cancer are, in general, more vulnerable than their younger counterparts. They more frequently have complex medical problems, such as comorbidities, physical and cognitive impairments, muscle loss, and a low-grade, chronic inflammation compared to younger patients. The heterogeneous health status of older adults of similar age is also followed by a corresponding heterogeneity in tolerance of cancer treatment. A geriatric assessment (GA) is often used to identify frailty and includes a systematic evaluation of several vulnerability measures, such as comorbidities, cognitive and physical function, nutritional status, and symptoms of depression
The overarching aim of this study was to generate knowledge on vulnerability measures in older patients with cancer, their potential impact on prognosis and the trajectory of the disease and treatment.
The 4 studies in the present thesis are based on data from a prospective, observational multicenter study addressing patients aged 70 or more with cancer referred to systemic cancer treatment. A total of 307 patients were included in the main study. Baseline assessments included a modified GA, blood sampling, clinical and demographic data, and patient reported Quality of life (QoL), measured using European Organisation for Research and Treatment of Cancer Core Quality-of-life Questionnaire (done at baseline, 2, 4, 6, and 12 months). Routinely taken CT scans done within a predefined time window from inclusion were also collected and analyzed.
The general statistical approach was to use descriptive statistics to describe our patient populations, bivariate and multiple regression models were estimated to assess association between vulnerability measures and outcomes.
We found a highly significant association between GPS=2 and frailty and observed an increasing proportion of frail patients with increasing GPS score. We also found that patients with GPS=2 and CRP>27 mg/l exhibited poorer muscle measures compared to patients with lower levels. No associations between frailty and muscle mass were found. In the third paper, we found higher GDS- scores and poorer TUG to be 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. In paper 4 we found a malnutrition prevalence of 33.8%, and that the malnourished group had poorer ECOG status, more aggressive cancers, and more often received non-curative treatment. They also had the highest level of inflammation according to CRP and GPS scores, and the poorest geriatric profile. Furthermore, they reported the worst scores for all EORTC QLQ-C30 function and symptom scores.
Our studies show that there are many ways to identify vulnerabilities in older adults with cancer, and that these vulnerability measures can affect prognosis, and symptom burden. Vulnerability measures should be systematically assessed both before and during treatment.
Additional information
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