To assess the feasibility of a therapeutic radiographer completing the brief geriatric assessment in lung cancer patients during routine radiotherapy practice

122 Background: The incidence of cancer in patients older than 65 is nearly tenfold higher than in their younger counterparts. Comprehensive geriatric assessment (CGA) is recommended for cancer patients > 65 years, as it can more reliably assess underlying function and predict tolerance to anticancer therapy. We reviewed data for patients with lung cancer and hematologic malignancies who completed comprehensive geriatric assessment by the Senior Oncology Section within the Levine Cancer Institute. Methods: From 2015 to 2019 Levine Cancer Institute (LCI) providers performed 96 CGAs in lung cancer patients and 58 in patients with hematologic malignancy, many of the latter being evaluated for bone marrow transplantation. Data was incorporated into an LCI Senior Oncology Clinic Database using the REDCap secure web application, allowing both quantitative and qualitative data analysis. Results: Median ages were 80 in lung cancer and 67 in hematologic malignancy. The lung cancer patients had a slower gait than patients with hematologic malignancy (0.8 m/s versus 1.3 m/s). Lung cancer patients also had a longer median timed up and go (TUG) test of 13 seconds, versus 8 seconds in hematologic malignancy. Considerably more lung cancer patients had experienced a fall within the preceding six months (32 (33%) versus 9 (16%)). The median Cumulative Illness Rating Scale-Geriatric (CIRS-G) total score was significantly higher in lung than in hematologic malignancy (14 versus 8), indicating a higher degree of comorbid illness. Cognitive functioning was comparable between the two groups, with median Montreal Cognitive Assessment (MoCA) scores of 25 in lung and 26 in hematologic malignancy. Conclusions: Lung cancer patients undergoing CGA had more comorbid illnesses, slower gait speed and timed up and go, and more falls in the preceding 6 months than hematologic malignancy patients. Overall cognitive functioning was not significantly different between the two groups. These findings highlight the importance of comprehensive geriatric assessment in elderly lung cancer patients. [Table: see text]

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Impact of age and frailty markers on overall survival among hospitalized patients with lung cancer treated with immunotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e21151 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e21151-e21151

Author(s):

Eric Olson ◽

Gregory Russell ◽

Jeffrey Lantz ◽

Nathan Roberts ◽

Andy Shipe Dothard ◽

...

Keyword(s):

Lung Cancer ◽

At Risk ◽

Overall Survival ◽

High Risk ◽

Cancer Patients ◽

Geriatric Assessment ◽

Hospitalized Patients ◽

Advanced Lung Cancer ◽

Lung Cancer Patients ◽

Risk Patients

e21151 Background: Although predictive of chemotherapy toxicity, geriatric assessment measures are not systematically collected in clinical practice and may or may not be predictive for immune-related adverse events. Furthermore, hospitalization during immune checkpoint inhibitor (ICI) treatment for advanced lung cancer has variable prognostic significance. This study aimed to evaluate whether age and documented patient characteristics mapped to geriatric assessment domains (frailty markers, FM) predict survival in this setting. Methods: A single-center retrospective cohort of advanced stage lung cancer patients who received >1 dose of an ICI from 6/1/18 to 2/1/20, were later hospitalized, and received ≥ 1 dose of systemic corticosteroids (n=97) was analyzed. Chart review ascertained documentation of any of the following FMs prior to ICI initiation: inability to walk one block, unintentional weight loss, decreased social activities, recent falls, need for assistance with medications, visual or hearing impairments, living alone, and concern regarding social support. Patients were stratified according to age and three FM categories (0 FM [low risk], ≥1 FMs [at risk], and ≥2 FMs [high risk]). Overall survival (OS) analysis was calculated from first dose of ICI to date of death or last follow-up. Cox’s proportional hazards models were used to assess the relationship between FMs and age on OS; hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Results: Analysis of < 75 and ≥ 75 yo revealed a median OS of 15.1 and 5.4 months respectively (HR 2.76, CI 1.62-4.72). Controlled for performance status (PS), older age (≥75 yo) was associated with a higher risk of death (HR 2.39, CI 1.32-4.31). FMs were associated with higher mortality, adjusted for PS and age (at risk patients HR 1.81, CI 1.03-3.16; high risk patients HR 2.02, CI 1.07-3.78). PS prior to starting ICI was not associated with OS. Conclusions: Age ≥ 75 yo is associated with short survival among lung cancer patients hospitalized while receiving ICI. Pre-treatment FMs documented as part of usual care were associated with worse OS, even after controlling for PS and age. This study shows promise for use of machine learning algorithms to stratify risk in hospitalized patients undergoing treatment for lung cancer with ICIs. These data would allow providers to better target serious illness conversations and end-of-life resources.[Table: see text]

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Comprehensive Geriatric Assessment (CGA) of elderly lung cancer patients: A single-center experience

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2011.12.005 ◽

2012 ◽

Vol 3 (2) ◽

pp. 98-103 ◽

Cited By ~ 32

Author(s):

Regina Gironés ◽

Dolores Torregrosa ◽

Inma Maestu ◽

José Gómez-Codina ◽

Jose M. Tenias ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Patients ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Single Center ◽

Lung Cancer Patients ◽

Single Center Experience

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Protocol for a multi-site, cluster‐randomized, phase III, comparative clinical trial of geriatric assessment of older patients with non‐small‐cell lung cancer: the ENSURE-GA study

BMC Geriatrics ◽

10.1186/s12877-021-02028-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yukari Tsubata ◽

Shun Shinomiya ◽

Koji Inoue ◽

Nobuhisa Ishikawa ◽

Ryota Saito ◽

...

Keyword(s):

Lung Cancer ◽

Clinical Trial ◽

Patient Satisfaction ◽

Cancer Patients ◽

Geriatric Assessment ◽

Older Patients ◽

Phase Iii ◽

Comparative Clinical Trial ◽

Lung Cancer Patients ◽

Cluster Randomized

Abstract Background In Japan, approximately half of all lung cancer patients are aged > 75 years, and the proportion of older patients is increasing. In older patients, it is necessary to consider comorbidities and concomitant drug use to ensure optimal cancer treatment; however, geriatric assessment (GA) is not widely performed. We plan to conduct a study (ENSURE-GA) of GA in older lung cancer patients to determine whether GA with intervention improves patient satisfaction with their treatment. Methods The study will be a phase III comparative clinical trial with a cluster-randomized design, and it will be conducted at 81 sites distributed throughout Japan. Approximately 1000 lung cancer patients aged ≥ 75 years will be enrolled in the study. All participants will undergo a standardized GA before starting treatment (using an iPad). At the intervention sites, the GA results and intervention method recommended on the basis of the GA results will be returned as an instant report to guide the physician’s choice of intervention. At the control sites, the physician will decide on interventions based on standard practice. All participants will complete a patient satisfaction survey before treatment initiation (after the GA) and 3 months later. Discussion The purpose of the ENSURE-GA study is to evaluate whether GA with interventions improves patient satisfaction with treatment outcomes. The study may lead to the increased use of GA and improved treatment of cancer in older adults. The results will also be used to prepare guidelines for treating older cancer patients and will provide a foundation for the development of a standardized geriatric oncology system. Trial registration The study has been registered in the University Hospital Medical Information Network database (no. UMIN000037590). The registration date is August 4, 2019, and the protocol version is 2.0. (https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000042853.)

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