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Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
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A decreasing function describes a relationship where the output consistently declines as the input increases. This means that for any two input values, if one is greater than the other, the corresponding output is smaller. Mathematically, a function f is decreasing on an interval I if for every x1 < x2​ in I, f (x1) > f (x2). This type of behavior is visually identified on a graph that slopes downward from left to right.The nature of a function can be analyzed by calculating...
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As individuals age, their body's physiology evolves, affecting drug pharmacokinetics. The most apparent changes occur in the gastrointestinal tract, where an increase in gastric pH, a delay in gastric emptying, and a reduction in gastrointestinal motility are observed. Remarkably, these changes do not substantially modify the absorption of orally administered drugs, particularly those absorbed via passive diffusion.Transdermal drug delivery emerges as a highly viable method for older adults due...
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Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are...
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Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...
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Decrease in 30-day and one-year mortality over time in patients aged ≥75 years with stage I-III colon cancer: A

A J Breugom1, E Bastiaannet2, J W T Dekker3

  • 1Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.

European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
|September 29, 2018
PubMed
Summary

Mortality rates for older patients with stage I-III colon cancer decreased slightly over time. However, both 30-day and one-year mortality remain high, requiring focused improvement strategies for this vulnerable group.

Keywords:
Colorectal cancerElderlyStage I–IIITime trends

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Area of Science:

  • Oncology
  • Surgical Outcomes
  • Public Health

Background:

  • Monitoring cancer mortality trends is crucial for evaluating healthcare effectiveness.
  • Postoperative mortality in colorectal cancer patients can extend beyond 30 days to one year.
  • This study addresses the need to understand temporal changes in colorectal cancer mortality.

Purpose of the Study:

  • To assess temporal trends in 30-day and one-year mortality for stage I-III colorectal cancer patients.
  • To investigate these trends based on tumor location (colon vs. rectum) and age groups.
  • To identify potential areas for improving patient outcomes in colorectal cancer care.

Main Methods:

  • Nationwide observational study using the Netherlands Cancer Registry.
  • Inclusion of surgically treated patients diagnosed with stage I-III colorectal cancer between 2009 and 2013.
  • Analysis of 30-day and one-year mortality trends using logistic regression, stratified by tumor site and age (<75 and ≥75 years).

Main Results:

  • A total of 41,186 patients were analyzed.
  • For patients aged ≥75 with colon cancer, 30-day mortality decreased from 8.3% to 6.2% (p=0.011) and one-year mortality from 18.5% to 15.0% (p=0.007) between 2009 and 2013.
  • No significant temporal mortality changes were observed for younger colon cancer patients or any age group with rectal cancer.

Conclusions:

  • Mortality rates show a decreasing trend over time for older patients with stage I-III colon cancer.
  • Despite the decrease, 30-day and one-year mortality remain high in elderly colorectal cancer patients.
  • Further interventions are necessary to improve outcomes for older colorectal cancer patient subgroups.