All Publications

  • Common cancers among the aging population: What NPs need to know. The Nurse practitioner McMillan, S., Kim, S. J., Yulico, H., Li, R., Allison, M., Bascombe, D., Lin, X., Grodzicki, B. K. 2025; 50 (6): 39-47

    Abstract

    The incidence rates for cancer increase from fewer than 25 cases per 100,000 people among those younger than age 20 years to about 350 per 100,000 among those ages 45 to 49 years and to more than 1,000 per 100,000 among those age 60 years and older. This article explores current screening guidelines for the most common cancers in the US among older adults - breast, lung and bronchus, colorectal, and prostate, with a focus on older adults. Other oncologic-focused special considerations for older adults are also addressed.

    View details for DOI 10.1097/01.NPR.0000000000000321

    View details for PubMedID 40420349

  • Telemedicine in geriatric oncology is here to stay. Frontiers in medicine Alexander, K., Tin, A. L., McMillan, S., Amirnia, F., Yulico, H., Sun, S., Korc Grodzicki, B. 2024; 11: 1439975

    Abstract

    Advancing age is the most important risk factor for cancer. Collaborations with medical and surgical-oncology divisions, and supportive services are required to assist older adults with cancer through their assessment and treatment trajectories. This often requires numerous clinical encounters which can increase treatment burden on the patient and caregivers. One solution that may lighten this load is the use of telemedicine.At Memorial Sloan Kettering, the Cancer and Aging Interdisciplinary Team (CAIT) clinic risk stratifies and optimizes older adults planned for medical cancer treatment. We analyzed patients seen in the CAIT clinic between May 2021 and December 2023, focusing on their utilization of telemedicine, and on the differences in characteristics of the visits and the results of the Geriatric Assessment based on visit type.Of the 288 patients (age range 67-100) evaluated, the majority (77%) chose telemedicine visits. Older age, lower educational status, living in New York City, abnormal cognitive screen, impaired performance measures, IADL dependency and having poor social support were all associated with choosing an in-person visit as opposed to telemedicine.Older patients with cancer frequently choose and can complete telemedicine visits. Efforts should be directed to develop an infrastructure for remote engagement, improving reach into rural and underserved areas, decreasing the burden generated by multiple appointments.

    View details for DOI 10.3389/fmed.2024.1439975

    View details for PubMedID 39411189

    View details for PubMedCentralID PMC11473358

  • Association of frailty with 90-day postoperative mortality & geriatric comanagement among older adults with cancer. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology McMillan, S., Kim, S. J., Tin, A. L., Downey, R. J., Vickers, A. J., Korc-Grodzicki, B., Shahrokni, A. 2022; 48 (4): 903-908

    Abstract

    Geriatric medical comanagement of older surgical patients with cancer is associated with lower 90-day postoperative mortality. Here, we investigate the hypothesis that this association varies on the basis of the degree of a patient's frailty.Frailty was assessed using the Memorial Sloan Kettering Frailty Index. Our hypothesis was evaluated using two approaches, both adjusted for age, sex, American Society of Anesthesiologists Physical Status, preoperative albumin, operating room duration, and estimated blood loss. A logistic regression was performed with 90-day mortality as the outcome and geriatric comanagement, continuous Memorial Sloan Kettering Frailty Index, and an interaction term between these two variables as the primary predictors. We then categorized frailty into four levels and, within each level, performed logistic regression with geriatric comanagement as the primary predictor and 90-day mortality as the outcome. Finally, we extracted the effect size and used a meta-analytic approach to test for heterogeneity.Of 1687 patients aged ≥75 years who underwent elective cancer surgery with a length of stay of ≥1 day, 931 (55%) received comanagement; 31 patients (3.3%) who received comanagement died within 90 days, compared with 72 (9.5%) who did not. Ninety-day mortality was not statistically significantly different by degree of frailty in either analysis (interaction P = 0.4; test of heterogeneity P = 0.8).Geriatric comanagement is valuable for all older surgical patients, not just the frail, and should be provided to as large a portion of the older surgical population as possible. Further research should examine predictors of response to geriatric comanagement.

    View details for DOI 10.1016/j.ejso.2021.10.019

    View details for PubMedID 34756761

    View details for PubMedCentralID PMC8995331

  • Association of Geriatric Comanagement and 90-Day Postoperative Mortality Among Patients Aged 75 Years and Older With Cancer. JAMA network open Shahrokni, A., Tin, A. L., Sarraf, S., Alexander, K., Sun, S., Kim, S. J., McMillan, S., Yulico, H., Amirnia, F., Downey, R. J., Vickers, A. J., Korc-Grodzicki, B. 2020; 3 (8): e209265

    Abstract

    Collaboration between geriatricians and surgeons in the perioperative treatment of older patients has been associated with improved outcomes in several nononcologic specialties. Similar associations may be possible among older patients with cancer.To investigate the associations of geriatric comanagement of care for older patients undergoing cancer-related surgical treatment with 90-day postoperative mortality, rate of adverse surgical events, and postoperative use of inpatient supportive care services.This retrospective cohort study assessed outcomes of patients who received geriatric comanaged care vs those who did not using multivariable logistic regression analysis, with 90-day mortality as the outcome and geriatric comanagement of care as the main variable, with adjustment for age, sex, American Society of Anesthesiology score, Memorial Sloan Kettering Frailty Index score, preoperative albumin level, operative time, and estimated blood loss. A similar model was used to assess the association of geriatric comanagement with adverse surgical events, defined as any major complication, readmission, or emergency department visit within 30 days. Patients aged 75 years and older who underwent an elective surgical procedure with a hospital stay of at least 1 day at a single tertiary-care cancer center between February 2015 and February 2018 were included. Data were analyzed from January to July 2019.Postoperative care comanaged by the geriatrics service and surgical service (geriatric comanagement group) vs by the surgical service only (surgical service group).90-day mortality, adverse surgical events, and use of supportive care services.Of 1892 patients included, 1020 (53.9%) received geriatric comanagement of care; these patients, compared with those who received care managed by the surgery service only, were older (mean [SD] age, 81 [4] years vs 80 [4] years; P < .001), had longer operative time (mean [SD], 203 [146] minutes vs 138 [112] minutes; P < .001), and longer length of stay (median [interquartile range], 5 [3-8] days vs 4 [2-7] days; P < .001). There were no differences in the proportions of men (488 [47.8%] men vs 450 [51.6%] men; P = .11). Adverse surgical events were not significantly different between groups (odds ratio, 0.93 [95% CI, 0.73-1.18]; P = .54). However, the adjusted probability of death within 90 days after surgical treatment was 4.3% for the geriatric comanagement group vs 8.9% for the surgical service group (difference, 4.6% [95% CI, 2.3%-6.9%]; P < .001). Additionally, compared with patients who received postoperative care management from the surgery service only, a higher proportion of patients in the geriatric comanagement group received inpatient supportive care services, including physical therapy (555 patients [63.6%] vs 820 patients [80.4%]; P < .001), occupational therapy (220 patients [25.2%] vs 385 patients [37.7%]; P < .001), speech and swallow rehabilitation (42 patients [4.8%] vs 86 patients [8.4%]; P = .002), and nutrition services (637 patients [73.1%] vs 803 patients [78.7%]; P = .004).This cohort study found that geriatric comanagement was associated with significantly lower 90-day postoperative mortality among older patients with cancer. These findings suggest that such patients may benefit from geriatric comanagement, which could improve their ability to survive adverse postoperative events.

    View details for DOI 10.1001/jamanetworkopen.2020.9265

    View details for PubMedID 32822490

    View details for PubMedCentralID PMC7439108