THEODORA KARNAKIS
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
20 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 20
bookPart O câncer no envelhecimento(2015) KANAJI, Ana Lumi; JR, Luiz Antonio Gil; KARNAKIS, Theodora; HOFF, Paulo Marcelo Gehm- Older Adult Patients(2022) DESIDERI, I.; KARNAKIS, T.; BRAIN, E.Ageing is the most important risk factor for developing cancer. Breast cancer is not an exception to the rule, with a median age of 62 years at diagnosis, depending on the age distribution of the population at risk. In western countries, 40–50% of patients are being diagnosed at age 70 or older. Given the competing risks on mortality with multi-morbidities, a screening tool for frailty is recognized as the gateway to any treatment decision-making in patients aged 70 and older, for personalizing treatment. Indeed, treatment choice requires careful assessment of the benefit–risk ratio and guidance according to a general health status assessment, to avoid jeopardizing functional status and quality of life. This concept applies to any specific local or systemic treatment, showing the need for constant adjustment according to the degree of frailty reversibility. Hypofractionated schedules and partial breast irradiation are approaches increasing attractivity of radiation therapy strategies for older patients to avoid multiple burdensome transportations, while improving selection of cases for which chemotherapy is required, both in adjuvant and metastatic settings, is the main challenge for systemic treatments.
- International Society of Geriatric Oncology Consensus on Geriatric Assessment in Older Patients With Cancer(2014) WILDIERS, Hans; HEEREN, Pieter; PUTS, Martine; TOPINKOVA, Eva; JANSSEN-HEIJNEN, Maryska L. G.; EXTERMANN, Martine; FALANDRY, Claire; ARTZ, Andrew; BRAIN, Etienne; COLLOCA, Giuseppe; FLAMAING, Johan; KARNAKIS, Theodora; KENIS, Cindy; AUDISIO, Riccardo A.; MOHILE, Supriya; REPETTO, Lazzaro; LEEUWEN, Barbara Van; MILISEN, Koen; HURRIA, ArtiPurpose To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. Methods SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment-related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. Results GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. Conclusion There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base. (C) 2014 by American Society of Clinical Oncology
- Ten years of a geriatric oncology service at a public university cancer centre in Brazil(2023) KARNAKIS, Theodora; KANAJI, Ana L.; GATTAS-VERNAGLIA, Isabella F.; ADRIAZOLA, Izabela; RAMOS, Paola; LIMA, Maria Eduarda P. L. S.; ALMEIDA, Olga L. S.; JACOB-FILHO, Wilson; FERRIOLLI, EduardoThe implementation of a geriatric oncology service is challenging in both high-income and low-and-middle-income countries. The Octavio Frias de Oliveira Institute of Cancer of Sao Paulo (ICESP) is a tertiary healthcare complex of the Clinics Hospital of the Uni-versity of Sao Paulo Medical School and is considered a model of excellence in oncology in Latin America. The objective of this manuscript is to describe 10 years of the geriatric oncology service at ICESP and the challenges for its implementation. We performed a narrative description of the ICESP's geriatric oncology service and a general retrospective descriptive analysis of data collected from routine structured medical records of patients referred to the service from 2011 to 2021. This article highlights the different settings in which the service operates (outpatient, pre-operative and hospital follow-up). In this period, 1,700 patients were assessed for preoperative evaluation (median age 83.9, SD 4.95), 468 patients were evaluated for therapeutic decision (median age 79.4, SD 7.38), 968 in general geriatric oncology care outpatient clinics from 2012 to 2021 (median age 78.7, SD 7.91) and 1,391 inpatient evaluations. In the past 10 years, our geriatric oncol-ogy team has grown exponentially and changed its characteristics in order to adjust them to the hospital demands, raising awareness among the oncology teams about the benefit of using geriatric assessment and promoting multidisciplinary discussions.
conferenceObject Potentially Inappropriate Medications in aged hospitalized in a cancer hospital(2018) GIL- JR., L. A.; HIRAMA, S. C.; KARNAKIS, T.; KANAJI, A. L.; SIQUEIRA, R.; PASSARELLI, C.; JACOB-FILHO, W.bookPart Particularidades da doença oncológica no idoso(2013) KARNAKIS, Theodora- The Impact of Frailty on the Relationship between Life-Space Mobility and Quality of Life in Older Adults During the COVID-19 Pandemic(2021) SARAIVA, M. D.; APOLINARIO, D.; AVELINO-SILVA, T. J.; TAVARES, C. De Assis Moura; GATTAS-VERNAGLIA, I. F.; FERNANDES, C. Marques; RABELO, L. M.; YAMAGUTI, S. Tavares Fernandes; KARNAKIS, T.; KALIL-FILHO, R.; JACOB-FILHO, W.; ALIBERTI, Marlon Juliano RomeroBackground The COVID-19 pandemic has led to abrupt restrictions of lile-space mobility. The impact of shelter-in-place orders on older adults' health and well-being is still unclear. Objective To investigate the relationship between life-space mobility and quality of life (QoL) in older adults with and without frailty during the COVID-19 pandemic. Design Multicenter prospective cohort study based on structured telephone interviews. Setting Four geriatric outpatient clinics in the metropolitan area of Sao Paulo, Brazil. Participants 557 community-dwelling adults aged 60 years and older. Measurements The Life-Space Assessment was used to measure community mobility before and during the COVID-19 pandemic, and a previously validated decrease of >= 5 points defined restricted life-space mobility. Frailty was assessed through the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale. The impact of shelter-in-place orders on QoL was evaluated with the question << How is the COVID-19 pandemic affecting your QoL?>>, to which participants could respond << not at all >>, << to some extent >>, or << to a great extent >>. We used ordinal logistic regressions to investigate the relationship between restricted life-space mobility and impact on QoL, adjusting our analyses for demographics, frailty, comorbidities, cognition, functionality, loneliness, depression, and anxiety. We explored whether frailty modified the association between life-space mobility and impact on QoL. Results Participants were on average 80 +/- 8 years old, 65% were women, and 33% were frail. The COVID-19 quarantine led to a restriction of community mobility in 79% of participants and affected the QoL for 77% of participants. We found that restricted life-space mobility was associated with impact on QoL in older adults during the pandemic, although frailty modified the magnitude of the association (P-value for interaction=0.03). Frail participants who experienced restricted life-space mobility had twice the odds of reporting an impact on QoL when compared with non-frail individuals, with respective adjusted odds ratios of 4.20 (95% CI=2.36-7.50) and 2.18 (95% CI=1.33-3.58). Conclusion Older adults experienced substantial decreases in life-space mobility during the COVID-19 pandemic, and this unexpected change impacted their QoL. Providers should be particularly watchful for the consequences of abrupt life-space restrictions on frail individuals.
- Impact of the COVID-19 pandemic on the life-space mobility of older adults with cancer(2021) GATTAS-VERNAGLIA, Isabella Figaro; RAMOS, Paola Teruya; PERINI, Maria Laura Lazaretti; HIGA, Camila Suemi; APOLINARIO, Daniel; ALIBERTI, Marlon Juliano Romero; KANAJI, Ana Lumi; ADRIAZOLA, Izabela Ono; SARAIVA, Marcos Daniel; AVELINO-SILVA, Thiago Junqueira; TAVARES, Caio de Assis Moura; JACOB-FILHO, Wilson; KARNAKIS, Theodora
- Priorities for the global advancement of care for older adults with cancer: an update of the International Society of Geriatric Oncology Priorities Initiative(2021) EXTERMANN, Martine; BRAIN, Etienne; CANIN, Beverly; CHERIAN, Meena Nathan; CHEUNG, Kwok-Leung; GLAS, Nienke de; DEVI, Beena; HAMAKER, Marije; KANESVARAN, Ravindran; KARNAKIS, Theodora; KENIS, Cindy; MUSOLINO, Najia; O'DONOVAN, Anita; SOTO-PEREZ-DE-CELIS, Enrique; STEER, Christopher; WILDIERS, HansIn 2011, the International Society of Geriatric Oncology (SIOG) published the SIOG 10 Priorities Initiative, which defined top priorities for the improvement of the care of older adults with cancer worldwide.' Substantial scientific, clinical, and educational progress has been made in line with these priorities and international health policy developments have occurred, such as the shift of emphasis by WHO from communicable to non-communicable diseases and the adoption by the UN of its Sustainable Development Goals 2030. Therefore, SIOG has updated its priority list. The present document addresses four priority domains: education, clinical practice, research, and strengthening collaborations and partnerships. In this Policy Review, we reflect on how these priorities would apply in different economic settings, namely in high-income countries versus low-income and middle-income countries. SIOG hopes that it will offer guidance for international and national endeavours to provide adequate universal health coverage for older adults with cancer, who represent a major and rapidly growing group in global epidemiology.
bookPart Cuidados em pacientes idosos(2014) BRITO, Christina May Moran de; GIL, Luiz Antonio Jr.; KARNAKIS, Theodora; JACOB, Wilson Filho