RELATIONSHIP BETWEEN ONCOLOGIST CONFIDENCE ADDRESSING AGE-RELATED CONCERNS AND IMPLEMENTATION OF GERIATRIC ASSESSMENT IN COMMUNITY ONCOLOGY CLINICS: A UR NCORP STUDY

The incidence of hematologic malignancies (HMs) is highest in the seventh decade of life and coincides with increasing occult, age-related vulnerabilities. Identification of frailty is useful in prognostication and treatment decision-making for older adults with HMs. This real-world analysis describes 311 older adults with HMs evaluated in a multidisciplinary oncogeriatric clinic. The accumulation of geriatric conditions [1-unit increase, hazards ratio (HR) = 1.13, 95% CI 1.00–1.27, p = 0.04] and frailty assessed by the Rockwood Clinical Frailty Scale (CFS, mild/moderate/severe frailty vs. very fit/well, HR = 2.59, 95% CI 1.41–4.78, p = 0.002) were predictive of worse overall survival. In multivariate analysis, HM type [acute leukemia, HR = 3.84, 95% CI 1.60–9.22, p = 0.003; myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN)/bone marrow failure, HR = 2.65, 95% CI 1.10–6.35, p = 0.03], age (per 5-year increase, HR = 1.46, 95% CI 1.21–1.76, p < 0.001), hemoglobin (per 1 g/dl decrease, HR = 1.21, 95% CI 1.05–1.40, p = 0.009), deficit in activities of daily living (HR = 2.20, 95% CI 1.11–4.34, p = 0.02), and Mini Nutrition Assessment score (at-risk of malnutrition vs. normal, HR = 2.00, 95% CI 1.07–3.73, p = 0.03) were independently associated with risk of death. The most commonly prescribed geriatric interventions were in the domains of audiology (56%) and pharmacy (54%). The Rockwood CFS correlated with prescribed interventions in nutrition (p = 0.01) and physical function (p < 0.001) domains. Geriatric assessment with geriatric intervention can be practically integrated into the routine care of older adults with HMs.

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Chemotherapy Regimen in Nonagenarian Cancer Patients: A Bi-Institutional Experience

Chemotherapy ◽

10.1159/000441018 ◽

2015 ◽

Vol 61 (2) ◽

pp. 65-71 ◽

Cited By ~ 9

Author(s):

Romain Rivoirard ◽

Cyrus Chargari ◽

Sharif Kullab ◽

Jane-Chloé Trone ◽

Julien Langrand-Escure ◽

...

Keyword(s):

Elderly Patients ◽

Geriatric Assessment ◽

Locally Advanced ◽

Progression Free Survival ◽

Anticancer Therapy ◽

Public Health Issue ◽

Line Treatment ◽

First Line ◽

Age Related ◽

First Line Treatment

Background: The elderly population in Western countries is growing and constitutes a public health issue. Concomitantly, age-related diseases such as cancer increase. There are few data on the efficacy, tolerability and toxicity of specific anticancer therapy in the very elderly patients; therefore, their management is not standardized. Methods: In this bi-institutional study, we reviewed medical records of patients who received or continued specific anticancer therapy beyond the age of 90 years. Geriatric assessment was not reported for our patients. Twelve patients were enrolled. Their general health condition was good, and half of them were living in elderly institutions. Ten patients had a solid tumor and 2 were treated for hematological malignancies. Most were diagnosed with a locally advanced or metastatic disease, and the goal of treatment was curative for only 1 patient. Six patients received chemotherapy as first-line treatment, 4 patients received targeted therapy and 2 received concomitant chemoradiation. Four patients received a second-line treatment. Results: Despite a significant reduction in treatment posology in half of the patients, 8 acute grade 3/4 toxicities were reported and 2 patients died of treatment-related septic shock. Median duration of first-line treatment was 3.2 months, and progression-free survival ranged from 18 to 311 days. Overall survival ranged from 18 days to 11 years. Conclusion: Aging is a heterogeneous process, and management of elderly patients is a multidisciplinary approach. Geriatric assessment helps to identify older patients with a higher risk of morbidity/mortality and allows to assess the risks and benefits of specific anticancer therapy. The choice of treatment should be based primarily on the expected symptomatic benefit, and treatment should not compromise the quality of life.

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Geriatric assessment in older alloHCT recipients: association of functional and cognitive impairment with outcomes

Blood Advances ◽

10.1182/bloodadvances.2020001719 ◽

2020 ◽

Vol 4 (12) ◽

pp. 2810-2820 ◽

Cited By ~ 2

Author(s):

Rebecca L. Olin ◽

Caitrin Fretham ◽

Marcelo C. Pasquini ◽

Mukta Arora ◽

Vijaya R. Bhatt ◽

...

Keyword(s):

Cognitive Impairment ◽

Geriatric Assessment ◽

Older Patients ◽

Hematopoietic Cell Transplantation ◽

Hazard Ratio ◽

Hematopoietic Cell ◽

Cell Transplant ◽

Timed Up And Go ◽

Subdistribution Hazard ◽

Age Related

Abstract Use of allogeneic hematopoietic cell transplantation (alloHCT) is increasing in older patients with hematologic malignancies. Studies suggest that geriatric assessment (GA), incorporating functional measures such as instrumental activities of daily living (IADL), delineates subtle age-related impairments that enhance risk-stratification. The objective of this multi-institutional retrospective study was to evaluate the prognostic utility of GA metrics collected pre-alloHCT. Eligibility criteria included age ≥50 and pre-alloHCT GA inclusive of at least IADL. Beyond IADL, additional geriatric metrics were collected where available and included Medical Outcomes Study Physical Health score (MOS-PH), Timed Up and Go (TUG), and cognition by Blessed Orientation Memory Concentration (BOMC). Three hundred thirty subjects were included, with a median age of 63 (range 50 to 77). Impairments were frequent: 36% had at least 1 IADL impairment; 14% had TUG ≥13.5 seconds; and 17% had cognitive impairment (BOMC ≥ 7). Median MOS-PH score was 80. IADL and age were not significantly associated with nonrelapse mortality (NRM) or overall survival (OS). In multivariate analysis, only impaired cognition and Hematopoietic Cell Transplant-Comorbidity Index score ≥3 showed an independent association with 1-year NRM (subdistribution hazard ratio [SHR], 2.36; P = .01; and SHR, 2.19; P = .009, respectively). Cognitive impairment independently conferred inferior 1-year OS (hazard ratio, 1.94; P = .01). In a preplanned subgroup analysis in 224 patients aged ≥60 years, cognitive impairment remained the sole GA metric predictive of NRM (2-year NRM: SHR, 2.72; P = .007). These data suggest that cognitive impairment elevates risk of post-alloHCT NRM in older patients.

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Geriatric Assessment for Older Adults with Sickle Cell Disease: protocol for a prospective cohort pilot study

10.21203/rs.3.rs-28528/v2 ◽

2020 ◽

Author(s):

Charity I Oyedeji ◽

Katherine Hall ◽

Alison Luciano ◽

Miriam Morey ◽

John Joseph Strouse

Keyword(s):

Sickle Cell Disease ◽

Geriatric Assessment ◽

Sickle Cell ◽

Prospective Cohort ◽

Weight Status ◽

Functional Decline ◽

Psychological State ◽

Cell Disease ◽

Multiple Organs ◽

Age Related

Abstract Background: The life expectancy for people with sickle cell disease (SCD) has improved tremendously over the last 50 years. This population experiences hemolysis and vaso-occlusion in multiple organs that lead to complications such as cardiopulmonary disease, strokes, and avascular necrosis. These complications can limit mobility and aerobic endurance, similar to limitations that often occur in geriatric populations. These sickle-cell and age-related events lead to frequent hospitalization, which further increases the risk of functional decline. We have few tools to measure functional decline in people with SCD. The purpose of this paper is to describe a protocol to evaluate the feasibility of sickle cell disease geriatric assessment (SCD-GA).Methods/Design: We will enroll 40 adults with SCD (20 age 18-49 years and 20 age ≥ 50 years) in a prospective cohort study to assess the feasibility of SCD-GA. The SCD-GA includes validated measures from the oncology geriatric assessment enriched with additional physical and cognitive measures. The SCD-GA will be performed at the first study visit, 10 to 20 days after hospitalization, and at after 12-months (exit visit). With input from a multidisciplinary team of sickle cell specialists, geriatricians, and experts in physical function and physical activity, we selected assessments across 7 domains: functional status (11 measures), comorbid medical conditions (1 measure), psychological state (1 measure), social support (2 measures), weight status (2 measures), cognition (3 measures), and medications (1 measure). We will measure the proportion completing the assessment with feasibility as the primary outcome. Secondary outcomes include the proportion consenting and completing all study visits, duration of the assessment, acceptability, and adverse events.Discussion: We present the protocol and rationale for selection of the measures included in SCD-GA. We also outline the methods to determine feasibility and subsequently to optimize the SCD-GA in preparation for a larger multicenter validation study of the SCD-GA.

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ABOUT THE BASICS OF COMPREHENSIVE GERIATRIC ASSESSMENT

The Russian Archives of Internal Medicine ◽

10.20514/2226-6704-2019-9-4-245-252 ◽

2019 ◽

Vol 9 (4) ◽

pp. 245-252

Author(s):

L. M. Farkhutdinova

Keyword(s):

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Sinus Node ◽

Elderly Person ◽

The Body ◽

Stress Factors ◽

Lymphoid Tissues ◽

Age Related ◽

Increased Risk

The article covers the principles of comprehensive geriatric assessment — an interdisciplinary diagnostic procedure aimed at developing a plan of treatment, long-term monitoring and support of an elderly person. The components of a comprehensive geriatric assessment, including the determination of physical, functional, psychological and social status of the subject, are reflected. During the process of analyzing the patient’s physical status, the age-related features of the functioning of various organs and systems, knowledge of which is necessary for the development of a targeted geriatric care strategy, should be taken into account. Involution of the respiratory organs is characterized by a decrease in the respiratory surface, atrophic processes in the mucous and lymphoid tissues, and an increased risk of developing bronchoobstructive syndrome. Degenerative sclerotic changes in the cardiovascular system contribute to the development of circulatory failure, sinus node dysfunction, increased sensitivity to stress factors, orthostatic hypotension, etc. With age, the secretory function of the gastrointestinal tract decreases, and the functional ability of the liver is limited. Reducing the reserve capacity of the kidneys provokes the development of inflammatory processes and contributes to the dehydration of the body. In older people, the risk of developing diabetes, hypothyroidism and hyperparathyroidism increases. The growth of connective tissue in the blood-forming organs limits the functionality of the blood system. Age-related changes in the musculoskeletal system are characterized by a decrease in muscle mass and the development of osteoporosis. Drug therapy is also being analyzed, since polypharmacy in the elderly is associated with a particularly high risk of developing side effects of the drugs. Assessment of the functional status implies the determination of the self service ability and the degree of a person’s independence from the help of others by his/her ability to perform basic functions, activities in everyday life and instrumental activity. The psycho emotional status is judged by the emotional background of the patient and his/her cognitive functions. Social and household status is estimated by the living conditions of an elderly person. Based on the results of a comprehensive geriatric assessment, an individual management plan is drawn up, the implementation of which is possible with the combined efforts of the geriatrician and a team of medical specialists, relatives, and social workers.

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Comprehensive Geriatric Assessment as a Versatile Tool to Enhance the Care of the Older Person Diagnosed with Cancer

Geriatrics ◽

10.3390/geriatrics4020039 ◽

2019 ◽

Vol 4 (2) ◽

pp. 39 ◽

Cited By ~ 3

Author(s):

Janine Overcash ◽

Nikki Ford ◽

Elizabeth Kress ◽

Caitlin Ubbing ◽

Nicole Williams

Keyword(s):

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Administrative Support ◽

Geriatric Oncology ◽

Provider Communication ◽

Older Person ◽

Cancer Centers ◽

Community Oncology ◽

Versatile Tool ◽

Treatment Tolerance

The comprehensive geriatric assessment (CGA) is a versatile tool for the care of the older person diagnosed with cancer. The purpose of this article is to detail how a CGA can be tailored to Ambulatory Geriatric Oncology Programs (AGOPs) in academic cancer centers and to community oncology practices with varying levels of resources. The Society for International Oncology in Geriatrics (SIOG) recommends CGA as a foundation for treatment planning and decision-making for the older person receiving care for a malignancy. A CGA is often administered by a multidisciplinary team (MDT) composed of professionals who provide geriatric-focused cancer care. CGA can be used as a one-time consult for surgery, chemotherapy, or radiation therapy providers to predict treatment tolerance or as an ongoing part of patient care to manage malignant and non-malignant issues. Administrative support and proactive infrastructure planning to address scheduling, referrals, and provider communication are critical to the effectiveness of the CGA.

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Geriatric assessment tool to assist physicians in providing patients with quality care in rural community oncology setting.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.200 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 200-200

Author(s):

Mari Montesano ◽

Venus Fromwiller ◽

Shrida Sharma ◽

Candice Murphy ◽

Amrita Desai

Keyword(s):

Decision Making ◽

Geriatric Assessment ◽

Rural Community ◽

Assessment Tool ◽

Cancer Center ◽

Comprehensive Treatment ◽

Decision Making Process ◽

Geriatric Population ◽

Community Oncology ◽

Hematological Cancers

200 Background: Currently in the USA, 60% of all cancers and 70% of cancer mortality occur s i n people aged 65 and older. However, there are significant gaps in knowledge of oncology treatment outcomes in the geriatric population. The Cancer and Aging Research Group developed a Comprehensive Geriatric Assessment (CGA) tool in 2 007 to assess the abilities of older patients to make judgments and carry out daily activities. The assessment was created to help doctors recognize issues in the geriatric population and develop comprehensive treatment plans with the aim to improve outcomes in this age group. The purpose of the study was to assess whether the CGA tool would be useful in the physician’s decision-making process and in making appropriate and timely patient referrals in a rural community oncology setting. Methods: Newly diagnosed cancer patients with non-hematological cancers above 65 years of age seeking care at the Columbia Memorial Hospital -OHSU Knight Cancer Collaborative during May to August of 2019 were consented and asked to take the CGA survey. A summary of the patient’s responses with the scores and a list of recommendations was provided to the physician at the time of the initial consultation. Along with this summary, a single question survey was given to the physician in order to assess whether the feedback was helpful in their treatment planning. Results: Of the 49 new patients seen at the CMH-OHSU Knight Cancer Collaborative who qualified to participate in the study 22 (44.8%) completed the survey,18 (36.7%) did not complete the survey, 5 (10%) did not come in for their clinic appointment, and 5 others were disqualified from the survey for other reasons. The results indicate that the survey tool aided the clinician in the majority (95%) of the cases to make overall assessments of their patient’s health and helped make management decisions. The results showed that more referrals were made to physical therapy & primary care clinics in patients who took the survey as compared to the patients who did not take the survey [14% vs 5%]. Conclusions: We conclude that the oncologists at our cancer center found that the CARG assessment tool is beneficial for physicians in their decision-making process while assessing an elderly patient and helped them provide timely and more comprehensive treatment care plan.

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Integrating Comprehensive Geriatric Assessment Into HIV Care Systems in Indonesia: A Synthesis of Recent Evidence

Creative Nursing ◽

10.1891/1078-4535.26.1.9 ◽

2020 ◽

Vol 26 (1) ◽

pp. 9-16

Author(s):

Linlin Lindayani ◽

Irma Darmawati ◽

Heni Purnama ◽

Bhakti Permana

Keyword(s):

Health Care ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Health Care Professionals ◽

Hiv Care ◽

Geriatric Syndrome ◽

People Living With Hiv ◽

Age Related ◽

Care Systems ◽

Living With Hiv

Combination antiretroviral therapy (cART) has improved the health and life expectancy of people living with human immunodeficiency virus (HIV). Comorbidities and geriatric syndrome are more prevalent in patients with HIV than in the general population. As a result, people living with HIV may face unique characteristics and needs related to aging. Health-care systems need to prepare to encounter those issues that not only focus on virology suppression and cART management but also chronic non-AIDS comorbidities and geriatric syndrome. However, there are limited data on geriatric assessment among people living with HIV. The purpose of this article is to present findings of a literature search that integrate age-related issues in HIV care management for health-care professionals caring for people living with HIV in Indonesia to consider. Integrating comprehensive geriatric assessment (CGA) into HIV care is essential. However, some critical issues need to be considered prior to implementing CGA in HIV primary care, including social vulnerability, economic inequality, and aging-related stigma. Developing guidelines for implementing CGA in HIV primary clinics remains a priority. Studies of HIV in the aging population in Indonesia need to be conducted to understand the burden of geriatric syndrome.

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Perioperative comprehensive geriatric assessment: what do we need to know?

British Journal of Hospital Medicine ◽

10.12968/hmed.2019.80.5.258 ◽

2019 ◽

Vol 80 (5) ◽

pp. 258-262

Author(s):

Simon Trundle ◽

Mevan Gooneratne ◽

Andrew Rogerson ◽

Jugdeep Dhesi

Keyword(s):

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Preoperative Assessment ◽

Postoperative Outcomes ◽

Ageing Population ◽

Optimization Strategy ◽

Age Related ◽

Improved Outcomes ◽

Increased Risk ◽

Surgical Setting

As a consequence of an ageing population greater numbers of elderly patients are presenting for both elective and emergency surgery. These older patients typically present with an increased burden of age-related problems and multimorbidity, which is associated with an increased risk of adverse postoperative outcomes. Traditional preoperative assessment models are adept at discerning patients' suitability for anaesthesia and surgery, but there is minimal focus on improving postoperative outcomes. Comprehensive geriatric assessment is a multidisciplinary approach used both to assess existing ‘known’ pathology and to screen for previously undiagnosed issues across medical, functional, social and/or psychological domains. This diagnostic phase then leads to the development and implementation of an individualized ‘optimization’ strategy across these domains. There is emerging evidence that comprehensive geriatric assessment and optimization in the surgical setting leads to improved outcomes, and it is reasonable to conclude that it would benefit the patient's long-term health.

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