Excess mortality in Europe coincides with peaks of COVID-19, influenza and respiratory syncytial virus (RSV), November 2023 to February 2024.

Since the end of November 2023, the European Mortality Monitoring Network (EuroMOMO) has observed excess mortality in Europe. During weeks 48 2023-6 2024, preliminary results show a substantially increased rate of 95.3 (95% CI:  91.7-98.9) excess all-cause deaths per 100,000 person-years for all ages. This excess mortality is seen in adults aged 45 years and older, and coincides with widespread presence of COVID-19, influenza and respiratory syncytial virus (RSV) observed in many European countries during the 2023/24 winter season.

Distress in older patients with cancer.

PURPOSE: To determine the predictors of distress in older patients with cancer. PATIENTS AND METHODS: Patients age >or= 65 years with a solid tumor or lymphoma completed a questionnaire that addressed these geriatric assessment domains: functional status, comorbidity, psychological state, nutritional status, and social support. Patients self-rated their level of distress on a scale of zero to 10 using a validated screening tool called the Distress Thermometer. The relationship between distress and geriatric assessment scores was examined. RESULTS: The geriatric assessment questionnaire was completed by 245 patients (mean age, 76 years; standard deviation [SD], 7 years; range, 65 to 95 years) with cancer (36% stage IV; 71% female). Of these, 87% also completed the Distress Thermometer, with 41% (n = 87) reporting a distress score of >or= 4 on a scale of zero to 10 (mean score, 3; SD, 3; range, zero to 10). Bivariate analyses demonstrated an association between higher distress (>or= 4) and poorer physical function, increased comorbid medical conditions, poor eyesight, inability to complete the questionnaire alone, and requiring more time to complete the questionnaire. In a multivariate regression model based on the significant bivariate findings, poorer physical function (increased need for assistance with instrumental activities of daily living [P = .015] and lower physical function score on the Medical Outcomes Survey [P = .018]) correlated significantly with a higher distress score. CONCLUSION: Significant distress was identified in 41% of older patients with cancer. Poorer physical function was the best predictor of distress. Further studies are needed to determine whether interventions that improve or assist with physical functioning can help to decrease distress in older adults with cancer.

Identifying vulnerable older adults with cancer: integrating geriatric assessment into oncology practice.

OBJECTIVES: To integrate the principles of geriatric assessment into the care of older patients with cancer in order to identify vulnerable older adults and develop interventions to optimize cancer treatment. DESIGN: A brief, comprehensive, self-administered questionnaire and intervention algorithm were developed consisting of measures of geriatric assessment that are brief, reliable, validated, and predictive of mortality and morbidity in older patients. SETTING: Academic tertiary care cancer center and community-based satellite practice. PARTICIPANTS: Patients aged 65 and older with cancer. MEASUREMENTS: The questionnaire solicits information about the patient's functional status, comorbidity, psychological status, nutritional status, and social support. A scoring algorithm for referral to a multidisciplinary team was developed. RESULTS: Two hundred forty-five of 250 patients completed the questionnaire (mean age 76, range 65-95). The majority of patients were women (71%), white (95%), married (52%), and retired (90%), with a variety of tumor types and stages. Most patients (78%) completed the questionnaire on their own and reported acceptance of questionnaire length (91%), no difficult questions (94%), no upsetting questions (96%), and no missing questions (89%). The mean time to completion was 15 minutes, with a median of 12.5 (standard deviation 10, range 2-60). Information from this questionnaire helped identify physical and psychological impairments, poor nutrition, lack of social support, and untreated comorbidities. Appropriate referrals to a multidisciplinary team were made. CONCLUSION: This brief, comprehensive, self-administered questionnaire is feasible for use in the outpatient oncology setting and helped identify the needs of geriatric oncology patients. Prospective trials are needed to determine the effectiveness of the interventions offered.