scholarly journals The Brief Gah Scale (Geriatric Assessment in Hematology) Correlates Well with a Comprehensive Geriatric Assessment in Patients with Hematologic Malignancies

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4753-4753
Author(s):  
Raul Cordoba ◽  
Ana-Isabel Hormigo ◽  
Javier Martinez-Peromingo ◽  
Maria Jarana ◽  
Marta Perez-Albacete ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Geriatric Assessment ◽  
Roc Curve ◽  
Comprehensive Geriatric Assessment ◽  
Conflicts Of Interest ◽  
Performance Status ◽  
Geriatric Oncology ◽  
Well Being ◽  
Hematologic Malignancies ◽  
Frail Patients

Abstract Introduction The comprehensive geriatric assessment (CGA) in older patients with cancer is the gold standard to identify robust, frail or poor prognosis patients according Balducci classification. In Spain, a new proposal of a specific Geriatric Assessment in Hematology (GAH) scale has been designed and validated in patients with hematologic malignancies such as MDS/AML, multiple myeloma and CLL. The GAH scale has not been explored in patients with lymphoma. In this study, we have analyzed the utility of using the GAH scales in patients with hematologic malignancies, mostly lymphoma patients. Patients and methods. From March 2016 and September 2017, patients with hematologic malignancies were prospectively referred to the Geriatric Oncology clinic after a frailty screening test using G8 scale and with score <14 points. All patients were assessed with CIRS-G and GAH scales performed by the oncology nurses and a comprehensive geriatric assessment performed by the geriatrician. Results Of the 96 patients referred aged 70 years or over, 41 were males (42.7%) and 55 females (57.3%), the median age was 79 years (range, 70-89), and with the diagnosis of lymphoma in 53 patients (55.2%), multiple myeloma in 23 patients (24.0%), CLL in 13 patients (13.6%), MDS/AML in 5 patients (5.2%) and CML in 2 patients (2.0%). Seventy-five patients (78.1%) had good performance status with ECOG score 0-1. Regarding frailty, 20 patients (20.8%) had a score of 15 points or over at G8 scale and 76 patients (79.2%) were identified as frail because of a score of 14 points or below. Regarding comorbidities, the median CIRS-G score was 9 (range, 4-20). After the GAH scale assessment, the median number of domains affected in robust patients was 2 (1-4) and in frail patients was 4 (3-5) (p=0.0001). In the ROC curve, with an AUC of 0.7595 and a likelyhood ratio of 9, the cut-off in this series was 2 domains with impairment, with a sentivity of 13.79% and a specificity of 92.5% (p= 0.0003). Using a correlation factor for each domain, the mean score at GAH scale in robust patients was 26 points and in frail patients was 42.5 points (p=0.0038). In the ROC curve, with an area under the curve of 0.7026 and a likelihood ratio of 2.04, the cut-off value to identify robust vs frail patients was 33 points in the GAH scale, with a sensitivity of 77.5% and a specificity of 62.07% (p=0.0043). Analyzing the eight domains explored in the GAH scale, robust patients according CGA had less risk of polypharmacy of 31.25% vs 81.48% in frail patients (OR 0.1033, 95% CI 0.0472-0.2541) (p<0.0001), less gate speed/FAC impairment of 16.66% vs 81.48% (OR 0.04545, 95% CI 0.0183-0.1313) (p<0.0001), less ADL impairment 37.5% vs 85.19% (OR 0.1043, 95% CI 0.0398-0.2684) (p<0.0001), less mood impairment in 4.17% vs 40.74% in frail patients (OR 0.06324, 95% CI 0.01421-0.2498) (p<0.0001), less mental health impairments in 2.08% vs 22.22% in frail patients (OR 0.0744, 95% CI 0.0068-0.4531) (p=0.0023), less comorbidities in 2.08% vs 42.59% (OR 0.0286, 95% CI 0.0027-0.1817) (p<0.0001), less malnutrition in 10.42% vs 37.04% (OR 0.1977, 95% CI 0.0759-0.5495) (p=0.0024), and less poor self-reported well-being in 6.25% vs 66.67% (OR 0.0333, 95% CI 0.0101-0.1187) (p<0.0001). The median overall survival for patients with 3 or less domains impaired was not reached vs 90.77 months in those patients with 4-8 domains impaired (Log-rank test, p=0.0003), with HR (Log-rank) of 0.11 (95% CI, 0.04474-0.2846). Mean G8 score were similar between robust (11.68) and frail (11.04) patients (p=n.s.) among all patients with score below 14 points. Robust patients had less comorbidities according to CIRS-G scale, with a median of 9 vs 11 points (p=0.0001). There was correlation between CIRS-G and ECOG with G8 score, not found in previous studies. There is a correlation between the brief comorbidity assessment in the GAH scale with CIRS-G score. Among patients identified as not having comorbidities, the median CIRS-G score was 9 vs 13.5 among patients with comorbidities according the GAH scale (p<0.0001). Conclusions. The GAH scale is a valid tool for patients with hematologic malignancies, including patients with lymphoma, in order to classify patients according frailty phenotype. All domains explored in GAH scale were impaired with higher frequency in frail patients. Robust patients had less comorbidities and better performance status. The brief comorbidities assessment in the GAH scale correlates well with the CIRS-G. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

scholarly journals Comprehensive Geriatric Assessment in Consecutive Newly-Diagnosed Elderly Multiple Myeloma Patients in China: A Multicentered, Prospective, Non-Interventional Study

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5493-5493
Author(s):  
Yuan Yao ◽  
Dehui Zou ◽  
Aijun Liao ◽  
Xiaoxia Chu ◽  
Wei Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Myeloma ◽  
Clinical Trials ◽  
Cognitive Impairment ◽  
Geriatric Assessment ◽  
Real World ◽  
Comprehensive Geriatric Assessment ◽  
Newly Diagnosed ◽  
Frail Patients

Background: Multiple Myeloma (MM) is a disease of the elderly, whose prognoses are highly heterogeneous. Hence International Myeloma Working Group (IMWG) proposed geriatric assessment (GA) in 2015, including daily activity and comorbidity status, to better discriminate between fit and frail patients (Palumbo et al, 2015). However, IMWG recruited patients from clinical trials instead of real world practices. Therefore we studied GA in elderly MM patients consecutively in China, along with other perspectives which are known to be problematic in elderly population that were previously left unnoticed, such as nutrition status, risk of cognitive impairment, risk of depression, and quality of life. Aim: Our study centers on the feasibility to perform a more comprehensive geriatric assessment (cGA) in elderly MM patients, current cGA status in elderly MM patients in China, and the cGA difference between Chinese patients and patients in the IMWG study. Method: From August 2017 to April 2019, we continuously recruited 336 newly diagnosed elderly (age ≥ 65) MM patients from 21 centers in China. cGA was performed at diagnosis, after treatment cycle 1, after cycle 4, and 1 year after treatment. cGA includes physical conditions (ECOG), activities of daily living (ADL), instrumental ADL (IADL), mini-nutritional assessment (MNA-SF), geriatric depression scale (GDS), mini-mental state examination (MMSE), quality of life (SF-36) and Charlson comorbidity index (CCI). Staging was assessed at baseline (International Staging System (ISS) & Revised ISS) and hematological responses were evaluated along with each cGA timepoint. Results: We pool-analyzed data of 336 newly-diagnosed elderly MM patients. The median age was 70 (range 65-88) and 25.5% of patients were older than 75 years. 336 (100%) patients were able to complete cGA, and median assessment time was 40 minutes (range 20-70). Upon diagnosis, only 34% and 37.5% of patients had full ADL and IADL respectively. 38.5% of patients had moderate to high risk of depression (GDS ≥ 6). 13.2% of patients were malnourished (MNA-SF ≤ 7), while 46.3% of patients were at risk of malnutrition (8 ≤ MNA-SF ≤ 11). 41% of patients had at least one comorbidity (CCI ≥ 1). 45.7% of patients had moderate to intermediate risk of cognitive impairment (MMSE ≤ 26). Grouping by IMWG-GA index, our study identified 59.9% patients in frail group (vs 39% in IMWG study), 15.8% in intermediate (vs 31% in IMWG) and 24.3% in fit (vs 30% in IMWG). 69% of patients received proteasome inhibitor-containing regimens and 20.7% of patients received lenalidomide-containing regimens. Best hematological responses in fit and intermediate groups were better than responses in frail group (≥ PR rate: 88.5% in fit, 94.4% in intermediate vs 77.5% in frail). Median follow up time was 10 months. To date, 215 (64%) patients have finished the cGA after cycle 1; 164 (48.8%) patients have finished the cGA after cycle 4; 91 (27.1%) patients has finished all 4 planned cGA and improvements in cGA were observed in the majority of these patients. Conclusion: Our study showed significant CGA heterogeneity in elderly MM patients. Even in the IMWG-GA "fit" group, nutrition, depression and cognitive impairment remain problems. Frail patients took up a larger proportion in Chinese elderly MM patients compared to IMWG study. Our study strongly justifies the necessity for cGA in elderly patients with MM, more so in the real world MM patients than in the clinical trials. Disclosures No relevant conflicts of interest to declare.

Comprehensive Geriatric Assessment Adds Information to Eastern Cooperative Oncology Group Performance Status in Elderly Cancer Patients: An Italian Group for Geriatric Oncology Study

2002 ◽  
Vol 20 (2) ◽  
pp. 494-502 ◽  
Author(s):  
Lazzaro Repetto ◽  
Lucia Fratino ◽  
Riccardo A. Audisio ◽  
Antonella Venturino ◽  
Walter Gianni ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Daily Living ◽  
Group Performance ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Geriatric Oncology ◽  
Oncology Group ◽  
Elderly Cancer Patients

PURPOSE: To appraise the performance of Comprehensive Geriatric Assessment (CGA) in elderly cancer patients (≥ 65 years) and to evaluate whether it could add further information with respect to the Eastern Cooperative Oncology Group performance status (PS). PATIENTS AND METHODS: We studied 363 elderly cancer patients (195 males, 168 females; median age, 72 years) with solid (n = 271) or hematologic (n = 92) tumors. In addition to PS, their physical function was assessed by means of the activity of daily living (ADL) and instrumental activities of daily living (IADL) scales. Comorbidities were categorized according to Satariano’s index. The association between PS, comorbidity, and the items of the CGA was assessed by means of logistic regression analysis. RESULTS: These 363 elderly cancer patients had a good functional and mental status: 74% had a good PS (ie, lower than 2), 86% were ADL-independent, and 52% were IADL-independent. Forty-one percent of patients had one or more comorbid conditions. Of the patients with a good PS, 13.0% had two or more comorbidities; 9.3% and 37.7% had ADL or IADL limitations, respectively. By multivariate analysis, elderly cancer patients who were ADL-dependent or IADL-dependent had a nearly two-fold higher probability of having an elevated Satariano’s index than independent patients. A strong association emerged between PS and CGA, with a nearly five-fold increased probability of having a poor PS (ie, ≥ 2) recorded in patients dependent for ADL or IADL. CONCLUSION: The CGA adds substantial information on the functional assessment of elderly cancer patients, including patients with a good PS. The role of PS as unique marker of functional status needs to be reappraised among elderly cancer patients.

The ability of physical performance test and Karnofsky performance status to identify elderly cancer patients requiring a comprehensive geriatric assessment: A comparative study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20534-e20534
Author(s):  
Najib Antoine Nassani ◽  
Sassine Ghanem ◽  
Elie Kassouf ◽  
Lana El Osta ◽  
Fadi El Karak ◽  
...  
Keyword(s):  
Physical Performance ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Performance Test ◽  
Screening Tool ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Geriatric Oncology ◽  
Physical Performance Test ◽  
Sleeping Problems

e20534 Background: The role of Physical Performance Test (PPT) as a screening tool for patients in geriatric oncology requiring a Comprehensive Geriatric Assessment (CGA) has not been studied so far. We undergo this study to assess PPT as a screening tool in comparison with Karnofsky Performance Status (KPS) and CGA. Methods: One hundred patients, aged ≥ 70 and diagnosed with cancer participated in our study. Inclusion criteria were knowledge of Arabic, French or English and absence of significant cognitive impairment. Exclusion criteria were: KPS<60% or severe medical condition. ROC curves were used to compare PPT and KPS in identifying ≥ 2 impairments on CGA. Results: Median age was 76 years (70 – 89). Most frequent malignancies were: Lung (19%), colo-rectum (16%), and breast (15%). Stage IV was present in half of patients. Patients were at increased risk of malnutrition (46%) and malnourished (15%), had moderate to severe pain uncontrolled by medication (41%), were at risk of falls (42%), were suffering from frequent sleeping problems (43%), had vision (56%) and hearing (36%) impairment, have had urinary incontinence within one year (21%). All had social support in case of emergency. Cardiovascular (67%), diabetes mellitus (30%) and pulmonary (26%) were the most frequent comorbidities. A remarkable prevalence of geriatric problems was noted with 69% having ≥ 2 impairments on CGA. A good correlation existed between KPS and PPT r = 0.68 (p<.0001). PPT (Se=65%, Sp=84%, PPV=90%, NPV=52%, cut-off ≤24) was equivalent to KPS (Se=65%, Sp=81%, PPV=88%, NPV=51%, cut-off ≤80%) in identifying ≥ 2 impairments on CGA. Conclusions: Patients aged ≥ 70, diagnosed with cancer and having a KPS ≤ 80% or a PPT ≤ 24 must be referred to specialists in geriatric oncology or to geriatricians for a thorough assessment.

Hypoxia Induces Up-Regulation Of P-Glycoprotein and Promotes Resistance To Carfilzomib In Multiple Myeloma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4907-4907
Author(s):  
Joseph Abraham ◽  
Salama N Noha ◽  
Abdel Kareem Azab
Keyword(s):  
Multiple Myeloma ◽  
Drug Resistance ◽  
Plasma Cells ◽  
Conflicts Of Interest ◽  
Tumor Hypoxia ◽  
Hematologic Malignancies ◽  
Multi Drug Resistance ◽  
Resistance Proteins ◽  
Hypoxic Conditions ◽  
Bm Niche

Abstract Introduction Multiple myeloma (MM) is a malignant neoplastic cancer of plasma cells that involves the bone marrow. Generally, patients will respond to treatment initially, but they later become resistant to therapy, and this is ultimately due to a change in the biology of the tumor. Multi-drug-resistance transporter proteins were shown to play a role in drug resistance in MM patients; P-glyco-protein (P-gp) is the most studied of the multi-drug resistance proteins, and it becomes up-regulated in response to many chemotheries. Hypoxia was shown to develop in the BM niche during progression of MM and to play a major role in the dissemination of MM cells to the new BM niches. Tumor-hypoxia was shown todevelop many kinds of solid tumors and hematologic malignancies. Specifically, hypoxia was shown to develop in the BM niche during progression of MM and to play a major role in the dissemination of MM cells to the new BM niches. In this study, we examinned the effect of hypoxia on the expression and activity of P-gp in MM and its contributing to drug resistance to therapies used in MM. Methods and Results We tested the effect of hypoxia on the activity of P-gp in MM lines. We incubated MM cells under hypoxic and normoxic conditions, and we tested their ability to pump out Rhodamine (Rh) by measuring Rh content in the cells by fluorescent reader. First, we optimized the concentration of Rh and the time of incubation with the cells. We found that at all concentrations tested (0.1, 0.5, 1, 5 and 10 ug/ml) and at all incubation time of cells with Rh with MM cells (0.25, 0.5, 1, 2, 4, 6, 8 and 24hrs) , hypoxia increased the efflux of Rh. The most significant efflux was achieved when incubating the cells for 1hr with Rh 1ug/ml. We found that hypoxia increased the efflux of Rh in all MM cell lines tested. Incubation of RPMI cells under hypoxic for 24hrs and 48hrs decreased the Rh content of the cells by about 40% and 65%, respectively. Carfilzomib was previously reported to be a substrate of P-gp, we tested the effect of carfilzomib on the efflux of Rd in the MM cells. Hypoxic and normoxic MM cells were treated for 5hrs with carfilzomib (5 nM) and then incubated for 1hrs with Rh (1ug/ml). We tested the Rh content of the cells by fluorescent reader and found that carfilzomib competed with Rh on the P-gp and decreased the efflux of Rh induced by hypoxic. We tested the effect of carfilzomib on induction of P-gp in hypoxic and normoxic MM cells by treating RPMI cells with a low dose of carfilzomib (0.25nM) for 48hrs under hypoxic or normoxic conditions, and tested the cells ability to efflux Rh. We found that carfilzomib increased P-gp expression and induced efflux of about 30% of the Rh in non-treated normoxic cells.  Hypoxia induced efflux of about 65% of normoxic cells, but no effect was observed with the treatment of carfilzomib. Furthermore, we tested the hypoxia-induced P-gp expression in MM on the sensitivity of MM cells to carfilzomib. We incubated MM cells for 24hrs in hypoxic and normoxic conditions, and cells were treated with carfilzomib (0 or 5nM) for additional 24hrs. We found that while carfilzomib induced the death of about 40% of the cells under normoxic condition, it had no significant effect on the survival of MM cell under hypoxic conditions. Conclusion Hypoxia induced a significant up-regulation of P-gp in MM cells, and increased MM drug resistance to carfilzomib. These results provide mechanistic evidence for drug resistance to carfilzomib in MM, and suggest hypoxia as a novel therapeutic to prevent upregulation of P-gp and drug resistance. Disclosures: No relevant conflicts of interest to declare.

Is docetaxel-prednisone (DP) feasible in frail elderly (age 75 or older) patients with castration-resistant metastatic prostate cancer (CRMPC)? GERICO10-GETUG P03 trial: A trial from elderly and genitourinary oncology UNICANCER groups.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 93-93
Author(s):  
Loic Mourey ◽  
Emmanuel Sevin ◽  
Igor Latorzeff ◽  
Nadine Houede ◽  
Jérome Meunier ◽  
...  
Keyword(s):  
Geriatric Assessment ◽  
Phase Ii ◽  
Comprehensive Geriatric Assessment ◽  
A Priori ◽  
Haematological Toxicity ◽  
Geriatric Oncology ◽  
Pregnane X Receptor ◽  
Elderly Age ◽  
Pharmacogenetic Study ◽  
Randomized Phase Ii

93 Background: Standard treatment of CRMPC is DP 75 mg/m² every 3 weeks since a symptomatic and overall survival benefit was demonstrated. Little is known about feasibility of DP in unselected elderly patients (day to day practice). Methods: Randomized phase II study evaluating prospectively the feasibility of DP administered every 3 weeks (60 mg / m² C1 then 70 mg / m² for subsequent cycles) or weekly (35mg/m² D1D8 with Day 1 = Day 21) in patients ≥75 years old, evaluated by comprehensive geriatric assessment, belonging to group 2 “vulnerable” or to group 3 “frail” of the classification proposed by the International Society of Geriatric Oncology (SIOG). Feasibility is defined as the possibility for a patient to receive 6 cycles of chemotherapy without fulfilling the criteria for withdrawal from study defined “a priori” by GERICO group: - stop or delay chemotherapy > 2 weeks - necessity to reduce chemotherapy dose > 25% - febrile neutropenia or NCI CTC grade III non-haematological toxicity (except alopecia) - loss of autonomy ( Activity of Daily Living (ADL) decrease≥2 points) →geriatric criterion It is a double randomized phase II based on a Simon’s optimum two stage design for each strata defined according to the SIOG criteria (α = 5%, 1-β = 90 %, p0 = 0.70 and p1 = 0.90). A pharmacokinetic / pharmacodynamic study (method of population pharmacokinetics) and pharmacogenetic study of PXR (pregnane X receptor) CYP3A4 and CYP3A5) are planed. Results: 25 centers participate to the study (23 opened). 10 centers have included 22 patients (16 “vulnerable” and 6 “frail”) from December 2010 until now. Conclusions: The results of this study will support the prescription of chemotherapy and its modalities, in patients aged 75 and over, classified as “vulnerable” or “frail” according to SIOG criteria, after comprehensive geriatric assessment.

Comprehensive geriatric assessment and comorbidities predict survival in geriatric oncology

2016 ◽  
Vol 71 (4) ◽  
pp. 206-213 ◽  
Author(s):  
Nathalie Denewet ◽  
Sandra De Breucker ◽  
Sylvie Luce ◽  
Bernard Kennes ◽  
Sandra Higuet ◽  
...  
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Geriatric Oncology

scholarly journals Impact of the comprehensive geriatric assessment on treatment decision in geriatric oncology

2019 ◽  
Author(s):  
Sandrine Sourdet ◽  
Delphine Brechemier ◽  
Zara Steinmeyer ◽  
Stephane Gerard ◽  
Laurent Balardy
Keyword(s):  
Multivariate Analysis ◽  
Cancer Treatment ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Treatment Plan ◽  
Geriatric Oncology ◽  
Treatment Decision ◽  
Adverse Outcomes ◽  
Physical Performances ◽  
The Impact

Abstract Background The comprehensive geriatric assessment (CGA) is the gold standard in geriatric oncology to identify patients at high risk of adverse outcomes and optimize cancer and overall management. Many studies have demonstrated that CGA could modify oncologic treatment decision. However, there is little knowledge on which domains of the CGA are associated with this change. Moreover, the impact of frailty and physical performances on cancer treatment changes have been rarely assessed. Methods This is a cross-sectional study of older patients with solid or hematologic cancer referred by oncologists for a geriatric evaluation before cancer treatment. A comprehensive geriatric assessment was performed by a multidisciplinary team to decide if the initial cancer treatment plan was appropriate or not. We performed a multivariate analysis to identify CGA domains associated with the risk to judge the treatment inappropriate. Results 418 patients, mean age 82.8 ± 5.5, were included between 2011 and 2015. The initial cancer treatment plan was judged inappropriate in 56 patients (14.6%). In multivariate analysis, the treatment was judged inappropriate in patients with cognitive impairment (p=0.006), malnutrition (p=0.011), and low physical performances according to the Short Physical Performance Battery (p=0.001). Conclusion Cognition, malnutrition and low physical performances significantly affects cancer treatment decision in older adults with cancer. More studies are needed to evaluate their association with survival, treatment toxicity and quality of life. The role of physical performances should be specifically explored.

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