Doğan Akagündüz, Diğdem; Türker, Perim Fatma; Akagündüz, Baran

Objectives: This study aimed to evaluate the effects of high-protein oral nutritional supplements (ONS) on nutritional status, physical function, and quality of life in older gastric cancer patients undergoing neoadjuvant chemotherapy (NAC). Methods: A prospective, randomized controlled trial was conducted between February 2023 and February 2024, including 46 patients aged 65 or older with newly diagnosed, locally advanced gastric cancer. Participants were randomized into two groups: an intervention group receiving high-protein ONS in addition to standard nutrition care, and a control group receiving only standard nutrition care. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), physical function was evaluated through handgrip strength, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) scales, and health-related quality of life was measured using the EORTC QLQ-C30. Bioelectrical impedance was used to analyze body composition. Results: Among the 46 patients (23 in each group), baseline characteristics were similar between the groups (p > 0.05). The ONS group showed significantly higher energy and protein intake than the control group (p < 0.05). MNA scores improved significantly in the ONS group after 8 weeks (p < 0.001), with a reduction in malnutrition risk to 4.3%, compared to 17.4% in the control group (p = 0.003). ADL and IADL scores remained stable in both groups, and both groups reduced functions and increased symptoms of HRQL over 8 weeks. Emotional functioning scores significantly declined in both groups over the 8-week period (ONS group: from 91.7 [16.67] to 83.3 [8.33], p = 0.001; non-ONS group: from 91.7 [8.33] to 83.3 [16.67], p = 0.011). Fatigue levels also increased markedly in both groups (ONS: from 11.1 [11.11] to 49.3 ± 17.02; non-ONS: from 22.2 [11.11] to 44.4 [22.22], p < 0.001). Additionally, constipation symptoms worsened significantly in the non-ONS group by week 8 (p = 0.008). Conclusions: High-protein ONS improved nutritional status and reduced malnutrition risk in older gastric cancer patients undergoing NAC. Further research is needed to assess the long-term effects of ONS on physical function and quality of life. Trial registration: Registered under ClinicalTrials.gov Identifier no. NCT06645912.

Guven, Deniz Can; Erul, Enes; Kaygusuz, Yunus; Akagunduz, Baran; Kilickap, Saadettin; De Luca, Raffaele; Rizzo, Alessandro

Purpose: Immune checkpoint inhibitors (ICIs) are related to various immune-related adverse events (irAEs). However, the knowledge is limited with rare irAEs like hearing loss. Therefore, we evaluated the characteristics, presentation, and treatment of ICI-related hearing loss by reviewing the individual patient data from the previous studies. Methods: We conducted a systematic search of the Web of Science, PubMed, and Embase databases for studies published until 17 November 2022. The selected MeSH search terms were “hearing loss” OR “hearing impairment” OR “ototoxicity” OR “vestibular toxicity” OR “audiovestibular toxicity” AND “immune checkpoint inhibitor” OR “immunotherapy.” Results: A total of 38 patients were included. Melanoma was the most frequent diagnosis (73.7%). The median time from ICI initiation to hearing loss development was 3 months. The hearing impairment was secondary to bilateral sensorineural hearing loss (SNHL) in 24 (68.6%) patients, and at least one other irAE accompanied the hearing loss in 24 patients. Hearing loss significantly improved in 45.7% of the patients. The overall response rate and disease control rate were 67.6% and 85.3%, respectively. Conclusion: We observed that most cases of ICI-related hearing loss were reversible, observed in patients with melanoma, accompanied by other irAEs, and associated with a high response rate to ICIs. With the expanded use of ICIs in the earlier treatment lines and adjuvant settings, the number of survivors with ICI-related hearing loss is expected to increase. Further research is needed to define the true prevalence of ICI-related hearing loss, optimal diagnosis, and management.

Akagunduz, Baran; Altın, Zeynep; Atcı, Muhammed Mustafa; Ozer, Muhammet; Güven, Deniz Can; Çil, İbrahim; Özçiçek, Fatih; Demirtaş, Levent; Duzgun, Eren; Gunderci, Azad

Background: Older cancer patients are more likely to present with functional dependency, multiple comorbidities, polypharmacy, malnutrition, and cognitive dysfunction than their younger counterparts which increases the risk of elder abuse. Herein, in this single-institution observational study, we aimed to determine the frequency and risk factors of abuse in cancer patients aged 70 and above. Methods: A total of 217 cancer patients aged ≥ 70 years who applied to the medical oncology outpatient clinic between June 2020 and January 2021 were included in this study. Informed consent was obtained before data collection. The Hwalek-Sengstock Elder Abuse Screening Test (H–S/EAST) was used to evaluate elder abuse. Sociodemographic characteristics and clinical measurements were collected. Results: The mean age was 75.5, and 59.4% were male. The prevalence of abuse risk in older patients with cancer was 39.2%. In the multivariate logistic regression model, applying to the outpatient clinic for treatment (OR: 3.369, 95% CI: 1.455–7.802, p = 0.005), living in urban (OR: 5.787, 95% CI: 2.377–14.090, p < 0.001), history of falls (OR: 4.587, 95% CI: 1.789–11.762, p = 0.002), and being depressed according to the Geriatric Depression Scale-15 (GDS-15) score (OR: 10.788, 95% CI: 4.491–25.914, p < 0.001) were associated with an increased risk of elder abuse. Primary/junior education level and high school/university education level were protective against elder abuse risk compared to being illiterate (OR: 0.073, 95% CI: 0.025–0.210 and OR: 0.213, 95% CI: 0.056–0.806, respectively). Conclusion: Cancer patients aged ≥ 70 years had a high risk of elder abuse. Elder abuse should be screened in patients with cancer, and the effects of this phenomenon on cancer care should be investigated in larger studies.