The added value of geriatric screening and assessment for predicting overall survival in older patients with cancer

As the number of older patients with cancer is increasing, oncology disciplines are faced with the challenge of managing patients with multiple chronic conditions who have difficulty maintaining independence, who may have cognitive impairment, and who also may be more vulnerable to adverse outcomes. National and international societies have recommended that all older patients with cancer undergo geriatric assessment (GA) to detect unaddressed problems and introduce interventions to augment functional status to possibly improve patient survival. Several predictive models have been developed, and evidence has shown correlation between information obtained through GA and treatment-related complications. Comprehensive geriatric evaluations and effective interventions on the basis of GA may prove to be challenging for the oncologist because of the lack of the necessary skills, time constraints, and/or limited available resources. In this article, we describe how the Geriatrics Service at Memorial Sloan Kettering Cancer Center approaches an older patient with colon cancer from presentation to the end of life, show the importance of GA at the various stages of cancer treatment, and how predictive models are used to tailor the treatment. The patient’s needs and preferences are at the core of the decision-making process. Development of a plan of care should always include the patient’s preferences, but it is particularly important in the older patient with cancer because a disease-centered approach may neglect noncancer considerations. We will elaborate on the added value of co-management between the oncologist and a geriatric nurse practitioner and on the feasibility of adapting elements of this model into busy oncology practices.

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Overall survival in older patients with cancer

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-001516 ◽

2018 ◽

Vol 10 (1) ◽

pp. 25-35 ◽

Cited By ~ 7

Author(s):

Beatrice J Edwards ◽

Xiaotao Zhang ◽

Ming Sun ◽

Juhee Song ◽

Peter Khalil ◽

...

Keyword(s):

Older Adults ◽

Overall Survival ◽

Older Patients ◽

Eastern Cooperative Oncology Group ◽

Karnofsky Performance Scale ◽

Haematological Malignancies ◽

Patients With Cancer ◽

Number Of Patients ◽

Traditional Performance

ObjectivesA growing number of patients with cancer are older adults. We sought to identify the predictors for overall survival (OS) in older adults with solid tumour and haematological malignancies between January 2013 and December 2016.MethodsRetrospective cohort study. A comprehensive geriatric assessment was performed, with a median follow-up of 12.8 months. Analysis: univariate and multivariate Cox proportional hazards regression analysis.ResultsIn this study, among the 455 patients with last follow-up date or date of death, 152 (33.4%) died during the follow-up. The median follow-up is 12.8 months (range 0.2–51.1 months) and the median OS is 20.5 months (range 0.3–44.5 months). Among all older patients with cancer, predictors of OS included male gender, cancer stage, malnutrition, history of smoking, heavy alcohol use, frailty, weight loss, major depression, low body weight and nursing home residence. Traditional performance scores (Eastern Cooperative Oncology Group (ECOG) and Karnofsky Performance Scale (KPS)) were predictors of OS. Independent predictors included age >85 years and haematological malignancies. Among solid tumours (n=311) in addition to the above predictors, comorbidity, gait speed and vitamin D deficiency were associated with OS.ConclusionsWe identified specific geriatric factors associated with OS in older patients with cancer, and comparable in predictive ability to traditional performance scores such as KPS and ECOG. Prospective studies will be necessary to confirm our findings.

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Malnutrition and overall survival in older patients with cancer

Clinical Nutrition ◽

10.1016/j.clnu.2020.06.026 ◽

2020 ◽

Author(s):

Xiaotao Zhang ◽

Linda Pang ◽

Shreela V. Sharma ◽

Ruosha Li ◽

Alan G. Nyitray ◽

...

Keyword(s):

Overall Survival ◽

Older Patients ◽

Patients With Cancer

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Prognostic value of routine biomarkers in older patients with cancer: Pooled analysis of three prospective cohorts.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.11551 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 11551-11551

Author(s):

Elena Paillaud ◽

Pierre Soubeyran ◽

Nadia Oubaya ◽

Etienne Brain ◽

Marianne Fonck ◽

...

Keyword(s):

Overall Survival ◽

Older Patients ◽

Prognostic Value ◽

Prognostic Score ◽

Performance Status ◽

Glasgow Prognostic Score ◽

Pooled Analysis ◽

Clinical Model ◽

Patients With Cancer ◽

Net Reclassification Improvement

11551 Background: To assess prognostic value of routine biomarkers in older patients with cancer. Methods: A pooled analysis of three prospective multicentre cohorts, ELCAPA, PHRC Aquitaine and ONCODAGE was conducted. Patients aged 70 years or older, with cancer were included. Biomarkers collected were plasmatic C-reactive protein, albumin and a combined score: Glasgow Prognostic Score (GPS). The GPS comprised three categories (0: CRP≤10 mg/L, albumin≥35 g/L; 1: CRP≤10 mg/L and albumin < 35 g/L, or CRP > 10 mg/L and albumin≥35 g/L; 2: CRP > 10 mg/L and albumin < 35 g/L).The primary endpoint was overall survival at 12 months. Multivariable Cox models were used, adjusting for age, sex, localisation, metastatic status, performance status, frailty screening index, the G8. Discriminative properties were assessed using Harrell C index and NRI (Net Reclassification Improvement). Results: Overall 1800 patients were analyzed (ELCAPA: N = 543, PHRC Aquitaine: N = 253, ONCODAGE: N = 1004; mean age: 78.5±5.5 years; 61.7% of men; 37% metastatic; most frequent localisations: breast (34.9%) and colon-rectum (17.7%); 70.7% of patients screened at risk of frailty with G8). Overall survival was 71.1%. GPS was independently associated with death (among normal G8: GPS 1: Hazard Ratio (HR) = 4.48; 95% Confidence Interval (95% CI) = [2.03; 9.89], GPS 2: 11.64 [4.54; 29.81], among abnormal G8: GPS 1: 2.45 [1.79; 3.34], GPS 2: 3.97 [2.93; 5.37]. The addition of GPS to the clinical model (Harell C: 0.82 [0.80; 0.83]) improved discrimination (Harell C: 0.84 [0.82; 0.85], NRI: 11% [5; 19]). Conclusions: GPS could be used in older patients with cancer to help decision-making and prognosis assessment.

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