Challenges in Geriatric Oncology-A Surgeon's Perspective.

As our global population ages, we will see more cancer diagnoses in older adults. Surgery is an important treatment modality for solid tumours, forming the majority of all cancers. However, the management of older adults with cancer can be more complex compared to their younger counterparts. This narrative review will outline the current challenges facing older adults with cancer and potential solutions. The challenges facing older adults with cancer are complex and include lack of high-level clinical trials targeting older adults and selection of the right patient for surgery. This may be standard surgical treatment, minimally invasive surgery or alternative therapies (no surgery) which can be local or systemic. The next challenge is to identify the individual patient's vulnerabilities to allow them to be maximally optimised for treatment. Prehabilitation has been shown to be of benefit in some cancer settings but uniform guidance across all surgical specialties is required. Greater awareness of geriatric conditions amongst surgical oncologists and integration of geriatric assessment into a surgical clinic are potential solutions. Enhanced recovery programmes tailored to older adults could reduce postoperative functional decline. Ultimately, the greatest challenge an older adult with cancer may face is the mindset of their treating clinicians-a shared care approach between surgical oncologists and geriatricians is required.

BQ323636.1, a Novel Splice Variant to NCOR2, as a Predictor for Tamoxifen-Resistant Breast Cancer.

Purpose: Adjuvant tamoxifen treatment revolutionized the management of estrogen receptor (ER)-positive breast cancers to prevent cancer recurrence; however, drug resistance compromises its clinical efficacy. The mechanisms underlying tamoxifen resistance are not fully understood, and no robust biomarker is available to reliably predict those who will be resistant. Here, we study BQ323636.1, a novel splice variant of the NCOR2 gene, and evaluate its efficacy in predicting tamoxifen resistance in patients with breast cancer.Experimental Design: A monoclonal anti-BQ323636.1 antibody that specifically recognizes the unique epitope of this splice variant was generated for in vitro mechanistic studies and for in vivo analysis by immunohistochemistry on tissue microarrays of two independent cohorts of 358 patients with more than 10 years clinical follow-up data, who had ER-positive primary breast cancer and received adjuvant tamoxifen treatment. An orthotopic mouse model was also used.Results: Overexpression of BQ323636.1 conferred resistance to tamoxifen in both in vitro and in an orthotopic mouse model. Mechanistically, coimmunoprecipitation showed BQ323636.1 could bind to NCOR2 and inhibit the formation of corepressor complex for the suppression of ER signaling. Nuclear BQ3232636.1 overexpression in patients samples was significantly associated with tamoxifen resistance (P = 1.79 × 10-6, sensitivity 52.9%, specificity 72.0%). In tamoxifen-treated patients, nuclear BQ323636.1 overexpression was significantly correlated with cancer metastasis and disease relapse. Nuclear BQ323636.1 was also significantly associated with poorer overall survival (P = 1.13 × 10-4) and disease-specific survival (P = 4.02 × 10-5).Conclusions: These findings demonstrate that BQ323636.1 can be a reliable biomarker to predict tamoxifen resistance in patients with ER-positive breast cancer. Clin Cancer Res; 24(15); 3681-91. ©2018 AACRSee related commentary by Jordan, p. 3480.

Tumour boards in geriatric oncology.

Multidisciplinary tumour board is an integral part of cancer treatment planning. Although no definite survival benefits have yet been shown by mostly observational studies, other benefits of multidisciplinary tumour board have been identified. Traditionally the multidisciplinary tumour board involves participation of treating clinicians-medical, radiation and surgical oncologists. They tend to focus on the cancer alone. There is an increasing awareness that the treatment goal for cancer in older adults is not primarily on prolonging survival, with functional preservation and quality of life being particularly important for this population. The use of Comprehensive Geriatric Assessment and the input of the geriatrician in informing the oncologists regarding treatment decision have increasingly been shown to be beneficial. The integration of the geriatrician into the multidisciplinary tumour board should be urgently explored.

Effects of nutrient enrichment derived from fish farming activities on macroinvertebrate assemblages in a subtropical region of Hong Kong.

To study the correlation between nutrient enrichment derived from fish farming activities and changes in macrobenthic assemblages, a one-year field study was conducted in Kau Sai Bay marine fish culture zone of Hong Kong. Bimonthly sediment samples were collected at six stations: two at the fish cages, two near the boundary of the fish culture area, and two reference sites further away from the culture area. Sediment physico-chemical characteristics in terms of silt/clay fraction, moisture content, total organic carbon (TOC), total Kjeldahl nitrogen (TKN) and total phosphorus (TP) were analyzed. The macrobenthos (>0.5 mm) present in the sediment were sorted, identified and enumerated. On average, TOC, TKN and TP levels at the fish cage stations were 82.8%, 128.5% and 1315.7% higher than those at the reference stations, respectively. As a result, the N:P molar ratio was greatly reduced from 8.75 at the reference stations to 1.83 at the fish cage stations. Univariate and multivariate analyses revealed that diversity of macrofauna was significantly reduced and community structure differed at the fish cage stations relative to the reference sites. The intermediary stations near the fish culture area showed a transitional state of disturbance. Faunal diversity was negatively correlated with nutrient level, reflecting the adverse impacts of nutrient enrichment derived from fish farming activities on the benthic assemblages. Whilst in subtropical Asia-Pacific trash fish is the major feed for fish culture resulting in a higher nutrient loading and nutrient ratio accumulated in the sediment beneath the fish rafts, the effects of nutrient enrichment on macrobenthic assemblages are comparable to that in temperate waters owing to relatively high sediment metabolism rate and smaller fish culture scale in Hong Kong.