NCOG-16. RELEVANCE OF GERIATRIC ASSESSMENT FOR PRIMARY BRAIN TUMOR PATIENTS: IMPLICATIONS FOR RESEARCH AND CARE

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi155-vi155
Author(s):  
Heather Leeper ◽  
Anna Choi ◽  
Elizabeth Vera ◽  
Alvina Acquaye ◽  
Nicole Briceno ◽  
...  
Keyword(s):  
Geriatric Assessment ◽  
Older Patients ◽  
Performance Status ◽  
Age Groups ◽  
Symptom Burden ◽  
Tumor Grade ◽  
Primary Brain Tumor ◽  
Functional Impairments ◽  
Who Grade ◽  
Patient Reported

Abstract BACKGROUND The utility of geriatric assessment (GA) has been evaluated in older adults diagnosed with solid tumors other than primary brain tumors (PBT). We assessed several key GA domains in adults with PBT receiving tumor-directed treatment. METHODS Patient and disease characteristics and key GA domains within patient-reported outcomes (PROs) including symptom burden (MDASI-BT), Anxiety/ Depression (PROMIS-short forms) and general health status (EQ-5D-3L) were systematically and prospectively collected between 9/2016–8/2019 from adults diagnosed with PBT. Descriptive statistics and regression analyses were used to assess PROs. RESULTS Of 581 participants, 92 were 65 – 85 years old (median age = 70 years; “older”) and 489 were ≤ 64 years (median age = 46 years; “younger”). Tumor grade distribution in the older group was 74% WHO grade III/IV, 26% WHO grade I/II; tumor types included gliomas and meningiomas with no tissue diagnosis in 3 patients. Older patients were 49% less likely to receive chemotherapy and twice as likely to have KPS ≤ 80 (p=0.003, OR=0.51, OR=1.98). More older patients reported problems with mobility (57% vs 44%), self-care (38% vs 26%), and usual activities (64% vs 51%) than younger patients. Charlson Comorbidity Index mean scores were significantly higher in older patients (3.5 vs 0.6, p< 0.001). The top 3 most frequently reported moderate-to-severe symptoms were similar in older vs younger groups: fatigue (44% vs 41%), feeling drowsy (29% vs 30%) and difficulty remembering (28% vs 29%). Feeling distressed was the only symptom whose frequency differed between the age groups (11% older vs 27% younger, p=0.001). CONCLUSION Older PBT patients had lower performance status, more co-morbidities and increased functional impairments, affirming that GA is relevant. Symptom burden was similarly high in both age groups. These findings support conducting GA concurrently in future symptom intervention and therapeutic clinical trials for adults with PBT receiving tumor-directed treatment.

scholarly journals Relationship between symptom burden and health status: analysis of the MDASI-BT and EQ-5D

2017 ◽  
Vol 5 (1) ◽  
pp. 56-63 ◽  
Author(s):  
Elizabeth Vera ◽  
Alvina A Acquaye ◽  
Tito R Mendoza ◽  
Mark R Gilbert ◽  
Terri S Armstrong
Keyword(s):  
Health Status ◽  
Functional Limitations ◽  
Performance Status ◽  
Functional Limitation ◽  
Symptom Burden ◽  
Tumor Grade ◽  
Walking Activity ◽  
Patient Health ◽  
And Performance ◽  
Md Anderson

Abstract Background Patients with glioma are highly symptomatic and often have functional limitations from the time of diagnosis. Measuring health status may have value in determining impact of disease. This study provided a description of health status and utility scores in glioma patients throughout the illness trajectory using the EQ-5D (a functional measure of general health status). Furthermore, it evaluated the information provided by the MD Anderson Symptom Inventory-Brain Tumor (MDASI-BT; a measure of symptom burden and interference) in describing health-related quality of life as assessed by the EQ-5D. Methods Glioma patients completed the EQ-5D and MDASI-BT. Disease and clinical details were collected by medical record review. Linear regression evaluated whether MDASI-BT scores adequately predict patient health outcomes measured by the EQ-5D. Results The sample included 100 patients (65% male, 78% with a glioblastoma, median age 52 [range, 20–75], 56% in active treatment). Seventy-two percent of patients reported functional limitations in at least 1 area. Extreme cases reported inability to perform usual activities (8%) and significant anxiety/depression (5%). The MDASI-BT neurologic factor and activity-related interference (walking/activity/work) explained 52% of the variability in the EQ-5D in this patient population while adjusting for the effect of tumor grade, recurrence status, and performance status. Conclusions The majority of glioma patients reported at least 1 functional limitation on the EQ-5D. Over half of the variance in the EQ-5D was explained by the MDASI-BT, performance status, tumor grade, and recurrence status. The resultant model demonstrates the significant contribution of symptom burden on health status in glioma patients.

Survival until First Progression and Post First Progression Survival Equally Contribute to the Overall Survival of Myeloma Patients: Differences in Patients ≤65 Years of Age Compared to Patients >65 Years

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4030-4030
Author(s):  
Efstathios Kastritis ◽  
Evangelos Terpos ◽  
Maria Roussou ◽  
Maria Gavriatopoulou ◽  
Dimitra Gika ◽  
...  
Keyword(s):  
High Risk ◽  
Renal Impairment ◽  
Initial Phase ◽  
Older Patients ◽  
Performance Status ◽  
Age Groups ◽  
First Line ◽  
Younger Patients ◽  
First Line Therapy ◽  
Line Therapy

Abstract Abstract 4030 Age is a major prognostic factor for the outcome of patients with multiple myeloma (MM), due to more intensive treatment in younger vs. older patients, comorbidities and toxicity, resulting in early discontinuation of treatment in older patients or even differences in disease characteristics. It is believed that the longer survival of patients ≤65 years is, to a large extent, due to the receipt of more lines of therapy and thus they can have an extended survival even after relapse to first line therapy. In order to decipher these differences in the outcome of MM patients of different ages, we analyzed 438 consecutive, unselected patients who were treated in a single center (Department of Clinical Therapeutics, University of Athens School of Medicine) from April 1994 to April 2012, and compared the characteristics and outcome of patients ≤65 years (166 patients), which are usually treated with more intensive therapies (including HDT), to that of patients 66–75 years (154 patients) and >75 years of age (118 patients). Some of these patients were included in clinical trials; however, even patients who were ineligible because of poor performance status, renal impairment or comorbidities were also included, thus, being more representative of the general myeloma population. Differences in the characteristics of patients of different age groups are depicted in the table. Younger patients presented less often with ISS-3, severe anemia, renal impairment or impaired PS than older patients. However, there was no difference in the detection of high risk cytogenetics. Response was higher and deeper in younger patients. Early deaths, within 2 months from initiation of therapy, occurred more often in older patients. Median PFS was longer in younger patients. Similar proportion of patients who relapsed have received 2nd line therapy (p=0.365). Post relapse survival (PRS) was 31 months for patients ≤65 years, 20 months for patients 66–75 years and 15 months for patients >75 years (p<0.001). The difference of PRS between patients 66–75 years and patients >75 years was also significant (p=0.004). Median OS was 71 months for patients <65 years, 46 months for patients 66–75 years and 31.5 months for patients >75 years (p<0.001). Thus, it seems that the OS of patients in each age group is distributed almost equally between the initial phase of the disease and post first relapse/progression (see Table). PFS <12 months was observed in 10% of patients ≤65 years vs. 22.5% and 29% of patients 66–75 and >75 years (p=0.003). PRS for patients with a PFS<12 months was 8 months for those ≤65 years, 10 months and 6 months for patients 66–75 and >75 years. Median OS was significantly better for patients who achieved CR or VGPR (58 months) vs. patients who achieved a PR (39 months) (p<0.001). For patients <65 years who achieved a CR/VGPR median OS has not been reached (4-year OS was 79%), for patients 66–75 years was 52 months and 40 months for those >75 years (p<0.001). Among patients with a minimum follow up ≥10 years (76 patients), 5 (6.5%) remained without progression for ≥10 years (4 of them had received HDT). In order to adjust for imbalances in baseline characteristics and depth of response (CR/VGPR vs. PR), we performed a multivariate analysis in which ISS stage (p<0.001), novel agent-based first line therapy (p=0.01), CR/VGPR (p=0.005) and age ≤65 (p<0.001), but not 66–75 vs. >75 years (p=0.092) were independently associated with improved survival. In conclusion, our data indicate that the survival of MM patients is distributed almost equally between the initial phase i.e. before relapse to first line therapy, and to subsequent phases of their disease i.e. post relapse survival. This is observed across all age groups, but in patients ≤65 years the duration of first response is significantly longer, perhaps due to more intensive therapies and to less frequent early deaths. In this unselected series of patients, the 10-year free of progression rate was 6.5%. Table ≤65 years 66–75 years >75 years p-value Males 60% 43.5% 51% 0.015 ISS-1 21% 18% 9% 0.02 ISS-2 50% 46% 47% ISS-3 29% 37% 45% Hb <10 g/dl 40% 45% 53% 0.075 eGFR <60 ml/min 29% 45% 55% <0.001 Performance status ≥2 39% 55% 59% 0.001 High risk cytogenetics (n=194) 50% 48% 41% 0.5 Upfront novel agents 73.5% 63% 81% 0.023 CR 34% 27% 17% 0.005 >VGPR 56% 49% 34% 0.001 ≥PR 81% 79% 64% 0.003 Early deaths 2% 6% 12% 0.005 Median PFS (months) 34 19.5 15 0.001 Median PRS (months) 31 20 15 <0.001 Median OS (months) 71 46 31.5 <0.001 Disclosures: No relevant conflicts of interest to declare.

Patient-reported symptom burden and quality of life in advanced lung cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16570-e16570
Author(s):  
Shrividya Iyer ◽  
Alex Rider ◽  
Gavin Taylor-Stokes ◽  
Adam Roughley
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Performance Status ◽  
Symptom Burden ◽  
Shortness Of Breath ◽  
Patient Reported ◽  
And Performance ◽  
Loss Of Appetite ◽  
Nsclc Patients

e16570 Background: The main objective of our study was to assess patient reported symptom burden and impact on quality of life in advanced non small cell lung cancer (NSCLC) patients in the United States. Methods: Patients with advanced (stage IIIB/IV) NSCLC (N=450) were recruited with informed consent in a nationwide (US) lung cancer study from Oct-Dec 2011. Patient reported symptoms were assessed using the Lung Cancer Symptom Scale (LCSS) on a 0-100 visual analogue scale and included six symptoms: fatigue, appetite loss, shortness of breath, cough, pain and blood in sputum. An average symptom burden index was calculated. Quality of life was assessed using the Functional Assessment of Cancer Therapy- Lung (FACT-L).Higher scores indicate higher symptom severity on the LCSS and better quality of life on the FACT-L. Correlation between the total FACT-L score and LCSS symptom burden index was assessed. A multivariate regression analysis was performed with FACT-L total score as the dependent variable and LCSS symptom scores as predictors controlling for age, gender, stage and performance status. Results: Majority of the patients were male (59%), Caucasian (74%), smokers/ex-smokers (78%) with an average age of 64 years. Proportion of patients reporting each lung cancer symptom was: Fatigue (100%), loss of appetite (97%), shortness of breath (95%), cough (93%), pain (92%) and blood in sputum (63%). The average (SD) symptom burden index was 42.3 (21.5).The mean± SD severity scores on symptoms were: fatigue (53.2±24.7), loss of appetite (48.1±25.8), cough (48.4±29.9), shortness of breath (44.7± 27), pain (39.7± 28.1) and blood in sputum (18.4±23.6). The average (SD) FACT-L score was 71.7 (25.3). A significant negative correlation was found between the LCSS symptom burden index and FACT-L scores (ρ= -0.82; p<0.001). Loss of appetite (β=-0.204; p<0.001), cough (β= -0.145; p<0.01), pain (β=-0.265; p<0.001), shortness of breath (β = -0.145; p<0.01), age (β= 0.217; p<0.05) and performance status (β = 0.283; p<0.001) were found to be significant predictors of quality of life. Conclusions: Cough, pain, shortness of breath and loss of appetite contribute to symptom burden and have a significant negative impact on quality of life in advanced NSCLC patients.

Pre- and post-comprehensive geriatric assessment in older patients with hematological malignancy before allogeneic stem cell transplantation.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 212-212
Author(s):  
Daniel Ernest Haggstrom ◽  
Marielys Figueroa-Sierra ◽  
Thomas Gregory Knight ◽  
Raghava Induru ◽  
Kim DeRhodes ◽  
...  
Keyword(s):  
Stem Cell ◽  
Grip Strength ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Older Patients ◽  
Hematologic Malignancy ◽  
Psychological Status ◽  
Cell Transplant ◽  
Common Diagnosis ◽  
Patient Reported

212 Background: Comprehensive geriatric assessment (CGA) is a multi-dimensional evaluation which influences medical decisions and predicts toxicity in older cancer patients. CGA pre-allogeneic stem cell transplant patients (ASCT) and repeated post-transplant provides information about treatment and helps to determine which parameters may predict ASCT outcomes. Methods: This was a prospective observational study evaluating 17 older patients with hematologic malignancy with CGA between December 9, 2016 and April 3, 2018 within the Levine Cancer Institute Senior Oncology Clinic. Included were validated measures across domains of cognition, disability, frailty, function and psychologic status. Repeat CGA was performed on surviving patients at least 99 days after ASCT (avg 122 days). Results: Median age was 66 (range 60-75) and the most common diagnosis was AML. There was no notable difference in pre and post-CGA physical and neurocognitive parameters for ASCT survivors (n=8). Within the deceased group (n=9) there was a longer TUG, lower patient-reported KPS, poorer psychological status, grip strength, and social support. Conclusions: There was no notable difference in the physical and neurocognitive CGA parameters before and after ASCT. Although the sample is small, there were notable trends toward lower patient-rated KPS compared to physician-rated KPS, poorer ADL function, slower TUG, and weaker grip strength in those patients who did not survive. CGA may identify older patients with hematologic malignancy who are at risk for worse outcomes post-ASCT.[Table: see text]

scholarly journals Novel mHealth App to Deliver Geriatric Assessment-Driven Interventions for Older Adults With Cancer: Pilot Feasibility and Usability Study (Preprint)

2018 ◽  
Author(s):  
Kah Poh Loh ◽  
Erika Ramsdale ◽  
Eva Culakova ◽  
Jason H Mendler ◽  
Jane L Liesveld ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Geriatric Assessment ◽  
Older Patients ◽  
Symptom Burden ◽  
Mobile App ◽  
Care Utilization ◽  
Intervention Period ◽  
Patients With Cancer ◽  
System Usability Scale

BACKGROUND Older patients with cancer are at an increased risk of adverse outcomes. A geriatric assessment (GA) is a compilation of reliable and validated tools to assess domains that are predictors of morbidity and mortality, and it can be used to guide interventions. However, the implementation of GA and GA-driven interventions is low due to resource and time limitations. GA-driven interventions delivered through a mobile app may support the complex needs of older patients with cancer and their caregivers. OBJECTIVE We aimed to evaluate the feasibility and usability of a novel app (TouchStream) and to identify barriers to its use. As an exploratory aim, we gathered preliminary data on symptom burden, health care utilization, and satisfaction. METHODS In a single-site pilot study, we included patients aged ≥65 years undergoing treatment for systemic cancer and their caregivers. TouchStream consists of a mobile app and a Web portal. Patients underwent a GA at baseline with the study team (on paper), and the results were used to guide interventions delivered through the app. A tablet preloaded with the app was provided for use at home for 4 weeks. Feasibility metrics included usability (system usability scale of >68 is considered above average), recruitment, retention (number of subjects consented who completed postintervention assessments), and percentage of days subjects used the app. For the last 8 patients, we assessed their symptom burden (severity and interference with 17-items scored from 0-10 where a higher score indicates worse symptoms) using a clinical symptom inventory, health care utilization from the electronic medical records, and satisfaction (6 items scored on a 5-point Likert Scale for both patients and caregivers where a higher score indicates higher satisfaction) using a modified satisfaction survey. Barriers to use were elicited through interviews. RESULTS A total of 18 patients (mean age 76.8, range 68-87) and 13 caregivers (mean age 69.8, range 38-81) completed the baseline assessment. Recruitment and retention rates were 67% and 80%, respectively. The mean SUS score was 74.0 for patients and 72.2 for caregivers. Mean percentage of days the TouchStream app was used was 78.7%. Mean symptom severity and interference scores were 1.6 and 2.8 at preintervention, and 0.9 and 1.5 at postintervention, respectively. There was a total of 27 clinic calls during the intervention period and 15 during the postintervention period (week 5-8). One patient was hospitalized during the intervention period (week 1-4) and two patients during the postintervention period (week 5-8). Mean satisfaction scores of patients and caregivers with the mobile app were 20.4 and 23.4, respectively. Barriers fell into 3 themes: general experience, design, and functionality. CONCLUSIONS TouchStream is feasible and usable for older patients on cancer treatment and their caregivers. Future studies should evaluate the effects of the TouchStream on symptoms and health care utilization in a randomized fashion.

Adjuvant or Palliative Chemotherapy for Colorectal Cancer in Patients 70 Years or Older

1999 ◽  
Vol 17 (8) ◽  
pp. 2412-2412 ◽  
Author(s):  
R. A. Popescu ◽  
A. Norman ◽  
P. J. Ross ◽  
B. Parikh ◽  
D. Cunningham
Keyword(s):  
Colorectal Cancer ◽  
Elderly Patients ◽  
Older Patients ◽  
Palliative Chemotherapy ◽  
Performance Status ◽  
Age Groups ◽  
Response Rates ◽  
The Elderly ◽  
Younger Patients ◽  
Royal Marsden Hospital

PURPOSE: The surgical treatment of colorectal cancer (CRC) in elderly patients (age 70 years or older) has improved, but data on adjuvant and palliative chemotherapy tolerability and benefits in this growing population remain scarce. Elderly patients are underrepresented in clinical trials, and results for older patients are seldom reported separately. PATIENTS AND METHODS: Using a prospective database, we analyzed demographics, chemotherapy toxicity, response rates, failure-free survival (FFS), and overall survival (OS) of CRC patients receiving chemotherapy at the Royal Marsden Hospital. The cutoff age was 70 years. RESULTS: A total of 844 patients received first-line chemotherapy with various fluorouracil (5-FU)-containing regimens or raltitrexed for advanced disease, and 543 patients were administered adjuvant, protracted venous infusion 5-FU or bolus 5-FU/folinic acid (FA) chemotherapy. Of the 1,387 patients, 310 were 70 years or older. There was no difference in overall or severe (Common Toxicity Criteria III to IV) toxicity between the two age groups, with the exception of more frequent severe mucositis in older patients receiving adjuvant bolus 5-FU/FA. For patients receiving palliative chemotherapy, no difference in response rates (24% v 29%, P = .19) and median FFS (164 v 168 days) were detected when the elderly were compared with younger patients. Median OS was 292 days for the elderly group and 350 days for the younger patients (P = .04), and 1-year survival was 44% and 48%, respectively. The length of inpatient hospital stay was identical. CONCLUSION: Elderly patients with good performance status tolerated adjuvant and palliative chemotherapy for CRC as well as did younger patients and had similar benefits from palliative chemotherapy.

The relationship between symptom burden and perceived comorbidity in outpatients with common solid tumors.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6080-6080
Author(s):  
Christine Ritchie ◽  
Judith Manola ◽  
Elizabeth Kvale ◽  
Claire Frances Snyder ◽  
Michael Fisch
Keyword(s):  
Cancer Patients ◽  
Weighted Least Squares ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Symptom Burden ◽  
Health Problems ◽  
Comorbid Conditions ◽  
Factors Associated ◽  
Physical Scale ◽  
Patient Reported

6080 Background: Cancer patients have high symptom burden, but it is unclear whether comorbid conditions are associated with patient-reported symptom burden (the number and severity of symptoms). Methods: The Eastern Cooperative Oncology Group (ECOG) enrolled 3106 patients with invasive cancer of the breast, colon/rectum, prostate and lung, regardless of phase of care or stage of disease. At baseline, patients completed the M.D. Anderson Symptom Inventory (MDASI) and were also asked how bothered they were by difficulties related to health problems other than cancer. Symptom burden (SB) was defined as the number of symptoms scored 7 or higher on the 13-item MDASI physical scale. Variance-weighted least squares regression was used to identify factors associated with increasing levels of being bothered by comorbid conditions. Results: About 65% of patients were at least a little bothered by symptoms associated with comorbidities. There was a strong association between increased bother by comorbidities and increased SB (p<0.0001). Among those not bothered by difficulties related to comorbidities, ≥1 symptom was rated 7 or worse by 29% of patients, compared to 51% in patients bothered by difficulties related to comorbidities (Fisher’s exact p<0.0001). Except for hair loss, the severity of all symptoms was higher in those patients reporting bother due to other perceived comorbidities. Factors associated with increased bother include SB (p<0.0001), taking medications for diabetes (p<0.0001), impaired ECOG performance status (p=0.03), older age (p=0.004), and being perceived by the clinician as having higher degree of difficulty for providing care (p<0.0001). Conclusions: Symptom burden varies significantly according to the degree to which cancer patients perceive bother that they attribute to comorbid health problems. Perception of comorbidity is worth exploring as a stratification factor in symptom research and as an indicator for complexity in patient care.

Integrating geriatric assessment into routine gastrointestinal (GI) consultation: The Cancer and Aging Resilience Evaluation (CARE).

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 667-667 ◽  
Author(s):  
Grant Richard Williams ◽  
Kelly Kenzik ◽  
Mariel Parman ◽  
Gabrielle Betty Rocque ◽  
Andrew Michael McDonald ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Geriatric Assessment ◽  
Daily Living ◽  
Performance Status ◽  
Stage Iv ◽  
Routine Care ◽  
Aging Research ◽  
Patient Reported ◽  
Tumor Types

667 Background: Integrating Geriatric Assessment (GA) in the management of older adults with cancer is recommended, yet rarely practiced in routine oncologic care. In this report, we describe the feasibility of integrating the routine incorporation of GA in the management of older adults with GI malignancies and characterize GA impairments. Methods: CARE was adapted from the Cancer and Aging Research Group GA with modifications to create a completely patient-reported version. The CARE assesses self-reported functional status, physical function, nutrition, social support, anxiety/depression, cognitive function, comorbidities, and social activities. Patients ≥ 60yo referred for consultation to the GI Oncology clinic were asked to complete the CARE (paper/pencil) on their first visit. The completed CARE was collected during nurse triage and submitted to the clinical team prior to the physician encounter. Feasibility was defined as completion of the CARE by ≥ 80% of eligible patients during the initial consultation. Results: Between September 2017 and August 2018, 199 eligible new patients attended the GI Oncology Clinic, 192 (96.5%) were approached, and 181 (90.4%) completed the CARE. Most patients (79.6%) felt the length of time to complete was appropriate (median time of 10 minutes [IQR 10-15 minutes]). The mean age was 70y (range 60-96), 54.3% were male, and 75.1% were non-Hispanic white. Common tumor types included colon (27.8%), pancreatic (21.2%), and rectal (10.2%) cancer; predominately advanced stage diseases (stage III: 26.9%; stage IV: 40.0%). GA impairments were prevalent: 48.6% reported dependence in Instrumental Activities of Daily Living, 18.0% reported dependence in Activities of Daily Living, 22.5% reported ≥ 1 fall, 29.4% reported a performance status ≥ 2, 51.3% were limited in walking one block, 75.7% reported polypharmacy (≥ 4 medications), and 84.3% had ≥ 1 comorbidity. Conclusions: Performing a GA in the routine care of older adults with GI malignancies is feasible, and GA impairments are common among older adults with GI malignancies. A fully patient-reported GA such as the CARE may facilitate broader incorporation of GA in the routine clinic work flow.

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