Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial.

BACKGROUND: Most patients with glioblastoma are older than 60 years, but treatment guidelines are based on trials in patients aged only up to 70 years. We did a randomised trial to assess the optimum palliative treatment in patients aged 60 years and older with glioblastoma. METHODS: Patients with newly diagnosed glioblastoma were recruited from Austria, Denmark, France, Norway, Sweden, Switzerland, and Turkey. They were assigned by a computer-generated randomisation schedule, stratified by centre, to receive temozolomide (200 mg/m(2) on days 1-5 of every 28 days for up to six cycles), hypofractionated radiotherapy (34·0 Gy administered in 3·4 Gy fractions over 2 weeks), or standard radiotherapy (60·0 Gy administered in 2·0 Gy fractions over 6 weeks). Patients and study staff were aware of treatment assignment. The primary endpoint was overall survival. Analyses were done by intention to treat. This trial is registered, number ISRCTN81470623. FINDINGS: 342 patients were enrolled, of whom 291 were randomised across three treatment groups (temozolomide n=93, hypofractionated radiotherapy n=98, standard radiotherapy n=100) and 51 of whom were randomised across only two groups (temozolomide n=26, hypofractionated radiotherapy n=25). In the three-group randomisation, in comparison with standard radiotherapy, median overall survival was significantly longer with temozolomide (8·3 months [95% CI 7·1-9·5; n=93] vs 6·0 months [95% CI 5·1-6·8; n=100], hazard ratio [HR] 0·70; 95% CI 0·52-0·93, p=0·01), but not with hypofractionated radiotherapy (7·5 months [6·5-8·6; n=98], HR 0·85 [0·64-1·12], p=0·24). For all patients who received temozolomide or hypofractionated radiotherapy (n=242) overall survival was similar (8·4 months [7·3-9·4; n=119] vs 7·4 months [6·4-8·4; n=123]; HR 0·82, 95% CI 0·63-1·06; p=0·12). For age older than 70 years, survival was better with temozolomide and with hypofractionated radiotherapy than with standard radiotherapy (HR for temozolomide vs standard radiotherapy 0·35 [0·21-0·56], p<0·0001; HR for hypofractionated vs standard radiotherapy 0·59 [95% CI 0·37-0·93], p=0·02). Patients treated with temozolomide who had tumour MGMT promoter methylation had significantly longer survival than those without MGMT promoter methylation (9·7 months [95% CI 8·0-11·4] vs 6·8 months [5·9-7·7]; HR 0·56 [95% CI 0·34-0·93], p=0·02), but no difference was noted between those with methylated and unmethylated MGMT promoter treated with radiotherapy (HR 0·97 [95% CI 0·69-1·38]; p=0·81). As expected, the most common grade 3-4 adverse events in the temozolomide group were neutropenia (n=12) and thrombocytopenia (n=18). Grade 3-5 infections in all randomisation groups were reported in 18 patients. Two patients had fatal infections (one in the temozolomide group and one in the standard radiotherapy group) and one in the temozolomide group with grade 2 thrombocytopenia died from complications after surgery for a gastrointestinal bleed. INTERPRETATION: Standard radiotherapy was associated with poor outcomes, especially in patients older than 70 years. Both temozolomide and hypofractionated radiotherapy should be considered as standard treatment options in elderly patients with glioblastoma. MGMT promoter methylation status might be a useful predictive marker for benefit from temozolomide. FUNDING: Merck, Lion's Cancer Research Foundation, University of Umeå, and the Swedish Cancer Society.

Older Iowans: May 2006

Demographic profile for a given year on older Iowans compiled from Census statistics.

Older Iowans: 2007

Demographic profile for a given year on older Iowans compiled from Census statistics.

Older Iowans: 2008

Demographic profile for a given year on older Iowans compiled from Census statistics.

Older Iowans: 2009

Demographic profile for a given year on older Iowans compiled from Census statistics.

Older Iowans: 2010

Demographic profile for a given year on older Iowans compiled from Census statistics.

Older Iowans: 2011

Demographic profile for a given year on older Iowans compiled from Census statistics.

Older Iowans: 2012

Demographic profile for a given year on older Iowans compiled from Census statistics.

Older Iowans: 2013

Demographic profile for a given year on older Iowans compiled from Census statistics.

Older Iowans: 2014

Demographic profile for a given year on older Iowans compiled from Census statistics.

Older Iowans: 2015

Demographic profile for a given year on older Iowans compiled from Census statistics.

A comparison of the dental status and treatment needs of older adults with and without chronic mental illness in Sevilla, Spain

Objectives: To study the dental status and treatment needs of institutionalized older adults with chronic mental illness compared to a non-psychiatric control sample. Study Design: The sample size was 100, in which 50 were psychogeriatric patients (study group; SG) classified according to DSM-IV, with a mean age of 69.6 ± 6.7 years, and 50 non-psychiatric patients (control group; CG), with a mean age of 68.3 ± 6.9 years. Clinical oral health examinations were conducted and caries were recorded clinically using the Decayed, Missing and Filled Teeth Index (DMFT). Results were analyzed statistically using the Student"s t-test or analysis of variance. Results: Caries prevalence was 58% and 62% in SG and CG, respectively. DMFT index was 28.3 ± 6.6 in SG and 21.4 ± 6.07 in CG (p < 0.01). Mean number of decayed teeth was higher in SG (3.1) compared to CG (1.8) (p=0.047). Mean number of missing teeth were 25.2 and 16.4 in SG and CG respectively (p<0.05). DMFT scores were higher in SG in all the age groups (p < 0.01). Mean number of teeth per person needing treatment was 3.4 in SG and 1.9 in CG (p= 0.037). The need for restorative dental care was significantly lower in the SG (0.8 teeth per person) than in the CG (1.7 teeth per person) (p = 0.043). Conclusions: Institutionalized psychiatric patients have significantly worse dental status and more dental treatment needs than non-psychiatric patients.

Impact of Left-Turn Phasing on Older and Younger Drivers at High-Speed Signalized Intersections, 2004

Several recent studies have demonstrated differences in safety between different types of left-turn phasing—protected, permitted, and protected/permitted phasing. The issue in question is whether older and younger drivers are more affected by a particular type of left-turn phasing at high-speed signalized intersections and whether they are more likely to contribute to a left-turn related crash under a specific type of left-turn phasing. This study evaluated the impact of different types of left-turn phasing on older and younger drivers at high-speed signalized intersections in Iowa. High-speed signalized intersections were of interest since oncoming speeds and appropriate gaps may be more difficult to judge for older drivers and those with less experience. A total of 101 intersections from various urban locations in Iowa with at least one intersecting roadway with a posted speed limit of 45 mph or higher were evaluated. Left-turn related crashes from 2001 to 2003 were evaluated. Left-turn crash rate and severity for young drivers (14- to 24-year-old), middle-age drivers (25- to 64-year-old), and older drivers (65 years and older) were calculated. Poisson regression was used to analyze left-turn crash rates by age group and type of phasing. Overall, left-turn crash rates indicated that protected phasing is much safer than protected/permitted and permitted phasing. Protected/permitted phasing had the highest left-turn crash rates overall.

Metabolic syndrome and the risk of cardiovascular disease in older adults.

OBJECTIVES: The purpose of this study was to assess whether metabolic syndrome (MetSyn) predicts a higher risk for cardiovascular events in older adults. BACKGROUND: The importance of MetSyn as a risk factor has not previously focused on older adults and deserves further study. METHODS: We studied the impact of MetSyn (38% prevalence) on outcomes in 3,035 participants in the Health, Aging, and Body Composition (Health ABC) study (51% women, 42% black, ages 70 to 79 years). RESULTS: During a 6-year follow-up, there were 434 deaths overall, 472 coronary events (CE), 213 myocardial infarctions (MI), and 231 heart failure (HF) hospital stays; 59% of the subjects had at least one hospital stay. Coronary events, MI, HF, and overall hospital stays occurred significantly more in subjects with MetSyn (19.9% vs. 12.9% for CE, 9.1% vs. 5.7% for MI, 10.0% vs. 6.1% for HF, and 63.1% vs. 56.1% for overall hospital stay; all p < 0.001). No significant differences in overall mortality was seen; however, there was a trend toward higher cardiovascular mortality (5.1% vs. 3.8%, p = 0.067) and coronary mortality (4.5% vs. 3.2%, p = 0.051) in patients with MetSyn. After adjusting for baseline characteristics, patients with MetSyn were at a significantly higher risk for CE (hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.28 to 1.91), MI (HR 1.51, 95% CI 1.12 to 2.05), and HF hospital stay (HR 1.49, 95% CI 1.10 to 2.00). Women and whites with MetSyn had a higher coronary mortality rate. The CE rate was higher among subjects with diabetes and with MetSyn; those with both had the highest risk. CONCLUSIONS: Overall, subjects over 70 years are at high risk for cardiovascular events; MetSyn in this group is associated with a significantly greater risk.

Cannabis and tobacco co-consumptions: can cannabis consumers quit cigarette smoking?

Purpose: To assess the relation between cannabis and tobacco consumption among adolescents in Switzerland and whether cannabis and tobacco co-users can quit cigarette smoking. Methods: Based on individual interviews and focus groups, 22 youths aged 15-20 discussed cannabis consumption behaviours. Twenty (14 males) were cannabis consumers - of which 18 also smoked tobacco and 2 quit tobacco smoking - and 2 were former cannabis consumers (both females and daily smokers). Data were transcribed verbatim and analyzed using Atlas.ti qualitative analysis software. Results: Among the co-consumers, 9 started with tobacco, 7 with cannabis, and 2 with both. The main consumption mode among all cannabis consumers is joints, while other ways of consuming such as food preparations and water pipes are rare and experimental. Joints always mix cannabis with tobacco for 3 reasons: to burn correctly, pure cannabis is too strong, and smoking cannabis alone is too expensive. Two cannabis consumers - one former tobacco smoker and one occasional tobacco smoker - consider rolling tobacco less addictive than cigarette tobacco alone, and hence use it in their joints. Overall cannabis is considered 'natural' and less harmful to health than tobacco. Thus, many users describe their wish, in the longer term, to quit tobacco consumption without excluding occasional cannabis consumption. Nonetheless, all coconsumers declare that they smoke cigarettes as a substitute for cannabis: For example, "If I don't have a joint, I need fags; if I don't have fags, I need joints; and if I don't have anything, I go crazy!" or "About 20 minutes after smoking a joint we feel like smoking something again, because in the joint there is pure tobacco without a filter as in cigarettes, and that creates a crazy dependency!". Finally, all co-consumers state that the consumption of one of the substances increases when trying to diminish the other: "A few months ago I stopped smoking joints for a month. Well I was smoking more than a pack [of cigarettes] a day." Similarly, the 2 former cannabis consumers increased their cigarette use since quitting cannabis. Conclusions: The majority of cannabis users co-consume tobacco as a way of compensating for one substance or the other. Using tobacco within joints implies that there is a risk that even occasional joints can revive nicotine addiction. Consequently, health professionals wishing to help adolescents in substance use cessation and prevention efforts should consider both substances in a global perspective. Sources of Support: Dept. of Public Health of the canton of Vaud.