Importance:Geriatric syndromes are common in hospitalized older adults and complicate acute care; however, their overall prevalence and cumulative burden remain poorly understood, especially in resource-limited settings. Objectives:To measure the prevalence of geriatric syndromes upon hospital admission and examine the independent association between the number of geriatric syndromes and 90-day mortality. Design, Setting, and Participants:This cohort study used data from the Creating a Hospital Assessment Network in Geriatrics (CHANGE) study, a multicenter, prospective cohort of 43 hospitals, including 38 in Brazil, 1 in Angola, 1 in Chile, 2 in Colombia, and 1 in Portugal. Consecutive patients aged 65 years or older admitted under geriatric teams between June 1, 2022, and December 31, 2023, were enrolled within 48 hours; patients with terminally illness were excluded. Data were analyzed from February 1 to November 23, 2025. Exposure:A standardized comprehensive geriatric assessment captured 14 geriatric syndromes: loneliness, dementia, depressive symptoms, sensory impairment, disability, immobility, incontinence, falls, frailty, malnutrition, pressure ulcers, polypharmacy, potentially inappropriate medications, and delirium. The exposure of interest was the within-patient count of syndromes. Main Outcomes and Measures:The primary outcome was 90-day all-cause mortality, ascertained by masked telephone follow-up with verification in medical records or public registries. Prespecified mixed-effects Cox proportional hazards regression were performed. Results:The study included 2556 participants (mean [SD] age, 79 [9] years, 1437 female [56.2%]). The median number of geriatric syndromes was 5 (IQR, 3-8). The highest prevalence rates for syndromes were 70.8% (95% CI, 69.1%-72.6%) for disability, 61.7% (95% CI, 59.8%-63.6%) for polypharmacy, 58.2% (95% CI, 56.3%-60.1%) for frailty, and 54.7% (95% CI, 52.8%-56.7%) for sensory impairment. Across categories, the mortality rate rose from 8.4% (95% CI, 6.2%-11.4%) for 0 to 2 syndromes to 12.7% (95% CI, 10.1%-15.7%) for 3 to 4 syndromes, 25.4% (95% CI, 22.2%-29.1%) for 5 to 6 syndromes, 30.4% (95% CI, 26.7%-34.5%) for 7 to 8 syndromes, 39.5% (95% CI, 34.4%-44.8%) for 9 to 10 syndromes, and 47.0% (95% CI, 36.4%-57.9%) for 11 or more syndromes. After adjusting for confounders, each additional geriatric syndrome was associated with an increased risk of mortality (hazard ratio, 1.22 [95% CI, 1.15-1.30), which became increasingly pronounced in older age groups. Conclusions and Relevance:This cohort study found that hospitalized older adults had a median of 5 geriatric syndromes, which were independently and incrementally associated with 90-day mortality. Multidomain assessments should be integrated into standard hospital care to identify and address vulnerabilities that commonly affect older adults with acute illness.
Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse event without effective treatment, just recommended dose reduction, interruption, or modification of the chemotherapy regimen. We conducted a randomized controlled study to evaluate the therapeutic effects of acupuncture. Sixty patients with stage I, II, and III breast cancer who developed CIPN due to neoadjuvant or adjuvant paclitaxel were randomized 1:1 to receive true vs sham acupuncture once per week for 8 weeks. The primary outcome was the response to Neuropathic Pain Symptom Inventory (NPSI), and the secondary outcomes were Visual Analog Scale (VAS) and Functional Assessment of Cancer Therapy-Taxane Version 4 (FACT-taxane) quality of life scale. The questionnaires were administered during weeks 1, 4, 6, and 8 (in person) and week 12 (by telephone). For the primary outcome, there were statistically significant differences at week 8 favoring the true acupuncture group for the subscales pressure pain (mean 0.11 vs 0.33; p = 0.01), paroxysmal pain (mean 0.13 vs 0.30; p = 0.037), paresthesia/dysesthesia (mean 0.21 vs 0.43; p = 0.007) and the total score (mean 0.14 vs 0.33; p = 0.02). Regarding secondary outcomes on the VAS scale, there was statistically significant difference favoring the true acupuncture group at visit 8 (mean 3.0 vs 6.0; p = 0.001), but without differences in FACT-taxane, either total score or subscales. There were no differences in any of the outcomes at week 12. CIPN-related symptoms in patients with breast cancer who received paclitaxel were reduced by true acupuncture compared with sham acupuncture in the eighth week (ClinicalTrials.gov ID NCT04461977).
e14104 Background: Medulloblastoma (MB) is a malignant embryonal neoplasm of the central nervous system (CNS) that is more common in children and rare in adults—a setting in which there is limited clinical evidence to guide treatment and prognostication. Report of an adult MB cohort treated exclusively at our institution focusing on therapies performed and oncological outcomes in the long term. Methods: This is an observational retrospective cohort study including patients aged 17 years or older with a histological diagnosis of MB. Survival curves were estimated using the Kaplan–Meier method and compared using the log-rank test. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models. Variables with clinical relevance were evaluated in univariable analyses to explore their association with OS and PFS. Level of significance was defined as a two-sided (alpha = 0.05). All statistical analyses were performed using R software (survival package). Results: From 2008 to 2025, 72 patients were included in the analysis. Median time of follow-up is 169,57 months. Forty-nine male and 23 female; median age at diagnosis 28 years. All patients underwent surgery; gross total resection in 52 patients (73,2%). Histological subtypes were nodular/desmoplastic found in 31 patients (43.1%); 55 patients (82,1%) were staged as Chang score M0. Sixty-one patients received any adjuvant therapy (84,7%), radiotherapy with concomitant vincristine in 35 patients (58.3%) and radiotherapy alone in 22 patients (37.2%). Forty-one patients (67.2%) received adjuvant chemotherapy using three-drug regimens. Recurrence was diagnosed in 27 patients (37,5%), with a median time from diagnosis to recurrence of 41 months, and 19 patients received salvage therapy. Median overall survival was 157 months for the whole cohort (95% CI: 98,9 – NA), and median progression-free survival 96 months (95% CI: 63 – NA). Variables associated with worse prognosis included absence of adjuvant therapy (HR 12.97; 95% CI: 5.44–30.91; p:7x10-9) and recurrence (HR 7.59; 95% CI: 3.29–17,54; p: 2×10−6). Variables correlated with improved OS included: concomitant vincristine and radiotherapy (HR 0,4; 95% CI: 0,16 - 1; p: 0,05), and use of adjuvant chemotherapy (HR 0,3; 95% CI: 0,14-0,63; p: 0,001). Gross total resection (GTR) was not associated with improved OS (HR 0.76; 95% CI: 0.34–1.7; p: 0,5). Conclusions: This work represents the largest single-center cohort reported of adult medulloblastoma. This study highlights the importance of employment of adjuvant therapy following initial surgery and underlines the favorable prognosis in the adult MB patients.
e13629 Background: Patients with head and neck cancer (HNC) may be particularly vulnerable to Financial Toxicity (FT) due to intensive multimodal treatments, new high cost technologies, prolonged recovery, and impaired return to work. We conducted a systematic review and meta-analysis to quantify FT in HNC patients and to examine associated factors across healthcare settings. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Searches were performed in MEDLINE/PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, and LILACS through June 4, 2025. Eligible studies assessing FT in adult patients with HNC using validated patient-reported outcome measures were included. Random-effects meta-analyses were conducted using RStudio software to estimate pooled FT levels, with subgroup analyses. Results: Thirteen studies were included in the systematic review, of which nine were eligible for meta-analysis, comprising a total of 833 patients. Financial toxicity (FT) was most commonly assessed using the FACIT-COST instrument, and 10 of the 13 studies were conducted in High-income countries. The oropharynx was the most frequently reported subsite. The pooled mean COST score was 21.12 (95% CI, 17.78–24.47), which, although classified as mild, indicates a clinically meaningful financial burden. FT may show partial recovery over time and varied across economic and demographic contexts: patients aged < 60 years had worse toxicity (COST 17.93) than older patients, and those from upper-middle and low-income countries experienced greater toxicity (COST 16.03) compared with patients from high-income settings. No consistent differences were observed by sex. Conclusions: FT in HNC is a dynamic and context-dependent phenomenon shaped by individual characteristics and structural conditions. Further studies are needed to clarify the role of gender in FT. Analyses stratified by tumor subsite and type of treatment would be particularly valuable, given the heterogeneity of treatment pathways and functional outcomes across HNC subsites. Longitudinal and context-sensitive FT assessment is essential to inform equitable cancer care and prevent financial burden from undermining treatment benefits.
