Comprehensive Geriatric Assessment in the Decision-Making Process in Elderly Patients With Cancer: ELCAPA Study

Purpose To identify Comprehensive Geriatric Assessment (CGA) components independently associated with changes in planned cancer treatment. Patients and Methods We prospectively included 375 consecutive elderly patients with cancer (ELCAPA01 study) assessed by geriatricians using the CGA. Multivariate analysis was used to identify factors associated with changes in the cancer treatment (intensification, decrease, or delayed > 2 weeks). Change was defined as a difference between the initial treatment proposal and the final treatment selected in a multidisciplinary meeting. Results Mean age was 79.6 years (standard deviation [SD], 5.6 years), and 197 (52.5%) were women. The most common tumor location was the digestive system (58.7%). The mean number of comorbidities was 4.2 (SD, 2.7) per patient, and the mean Cumulative Illness Rating Scale for Geriatrics score was 11.8 (SD, 5.3). After the CGA, the initial cancer treatment plan was modified for 78 (20.8%) of 375 patients (95% CI, 16.8 to 25.3), usually to decrease treatment intensity (63 [80.8%] of 78 patients). By univariate analysis, cancer treatment changes were associated with Eastern Cooperative Oncology Group performance status ≥ 2 (73.3% in the group with changes v 41.1% in the in the group without changes; P < .001), dependency for one or more activities of daily living (ADL; 59.0% v 24.2%; P < .001), malnutrition (81.8% v 51.2%; P < .001), cognitive impairment (38.5% v 24.9%; P = .023), depression (52.6% v 21.7%; P < .001), and greater number of comorbidities (mean, 4.8 [SD, 2.9] v 4.0 [SD, 2.6]; P = .02). By multivariate analysis, factors independently associated with cancer treatment changes were a lower ADL score (odds ratio [OR], 1.25 per 0.5-point decrease; CI, 1.04 to 1.49; P = .016) and malnutrition (OR, 2.99; CI, 1.36 to 6.58; P = .007). Conclusion Functional status assessed by the ADL score and malnutrition were independently associated with changes in cancer treatment.

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Analysis of Prognostic Factors of Comprehensive Geriatric Assessment and Development of a Clinical Scoring System in Elderly Asian Patients With Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2010.32.0796 ◽

2011 ◽

Vol 29 (27) ◽

pp. 3620-3627 ◽

Cited By ~ 120

Author(s):

Ravindran Kanesvaran ◽

Huihua Li ◽

Khai-Nee Koo ◽

Donald Poon

Keyword(s):

Prognostic Factors ◽

Elderly Patients ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Scoring System ◽

Group Performance ◽

Eastern Cooperative Oncology Group ◽

Disease Stage ◽

Patients With Cancer ◽

The Impact

Purpose To determine the impact of each comprehensive geriatric assessment (CGA) domain on overall survival (OS) and develop a prognostic scoring system for elderly patients with cancer. Patients and Methods A retrospective analysis of CGA data collected from 249 consecutive patients with cancer who attended the outpatient geriatric oncology clinic at the National Cancer Center Singapore age 70 years or older was performed. Univariate and multivariate analyses were performed using Cox proportional hazards method to identify significant prognostic factors within the CGA. A simple nomogram to predict OS was developed using regression coefficients from the multivariate model. Concordance between predicted and observed response of the individual patient score was evaluated by means of Harrell's c-index. Calibration was performed using simulated data via bootstrap. Results Median age of the patients was 77 years (range, 70 to 94 years). In our model, age (hazard ratio [HR], 1.04; 95% CI, 1.01 to 1.07), abnormal albumin level (HR, 1.97; 95% CI, 1.23 to 3.15), poor Eastern Cooperative Oncology Group performance status (≥ 2 v < 2: HR, 1.77; 95% CI, 1.15 to 2.72), abnormal geriatric depression scale status (HR, 1.81; 95% CI, 1.29 to 2.56), high malnutrition risk (high v low risk: HR, 1.84; 95% CI, 1.17 to 2.87), and advanced disease stage (late v early: HR, 1.71; 95% CI, 0.98 to 2.95) were independent predictors of survival. Conclusion Results confirm the importance of the CGA in assessment of elderly patients with cancer. The development of this nomogram incorporating these prognostic factors helps predict OS of patients, for further intervention.

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Faculty Opinions recommendation of Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13428956.793494172 ◽

2014 ◽

Author(s):

Thomas Flaig

Keyword(s):

Decision Making ◽

Elderly Patients ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Decision Making Process ◽

Patients With Cancer

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P31 The impact of a Comprehensive Geriatric Assessment (CGA) on medical oncology treatment decisions for elderly patients with cancer

Critical Reviews in Oncology/Hematology ◽

10.1016/s1040-8428(09)70069-1 ◽

2009 ◽

Vol 72 (1) ◽

pp. S29-S30

Author(s):

A.M. Horgan ◽

N.B. Leighl ◽

S.M.H. Alibhai

Keyword(s):

Elderly Patients ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Medical Oncology ◽

Treatment Decisions ◽

Patients With Cancer ◽

Oncology Treatment ◽

The Impact

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Alterations in comprehensive geriatric assessment decrease survival of elderly patients with cancer

European Journal of Cancer ◽

10.1016/j.ejca.2017.11.013 ◽

2018 ◽

Vol 90 ◽

pp. 10-18 ◽

Cited By ~ 15

Author(s):

M. Frasca ◽

P. Soubeyran ◽

C. Bellera ◽

M. Rainfray ◽

K. Leffondre ◽

...

Keyword(s):

Elderly Patients ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Patients With Cancer

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

10.21203/rs.2.12137/v1 ◽

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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Prediction of major surgical complications by comprehensive geriatric assessment in elderly patients with gynecologic cancers: A prospective cohort study.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20530 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20530-e20530

Author(s):

Jae Weon Kim ◽

Dong-Hoon Suh ◽

Mi-Kyung Kim ◽

Hee-Seung Kim ◽

Hyun Hoon Chung ◽

...

Keyword(s):

Postoperative Complications ◽

Elderly Patients ◽

Postoperative Complication ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Univariate Analysis ◽

Gynecologic Cancer ◽

Postoperative Mortality ◽

Gynecologic Cancers ◽

Related Mortality

e20530 Background: To evaluate the ability of a preoperative comprehensive geriatric assessment (CGA) to predict the risk of postoperative complications in elderly patients who underwent primary surgery for gynecologic cancers. Methods: Sixty consecutive patients (26 ovarian, 16 cervical, 7 endometrial, 5 uterine sarcoma, 4 vulvar, and 2 metastatic cancers) older than 70 years scheduled to take surgery electively for gynecologic cancer were preoperatively assessed by CGA. Every category of CGA was evaluated for in-hospital postoperative complications and mortality within 30 days of surgery. Major complication included any complication of 2 or higher grade according to Memorial Sloan-Kettering Surgical Complication Criteria 12/99. Results: Mean age was 73.6±3.5 years (range 70-85). Overall postoperative complication rate was 30.0% (18/60) including 9 (15.0%) major and 8 (13.3%) multiple complications. Mean hospital stay was 18.4±13.3 days (range 3-81), during which in-hospital mortality was 2 (3.3%). Univariate analysis revealed that dependent instrumental activity of daily living (IADL) was associated with any postoperative complication (p=0.023), especially for multiple complications (p=0.019). However, poor performance status (PS) was associated only with major and multiple complications (p=0.021 and p=0.014, respectively). Multiple regression analysis revealed that dependent IADL was the independent risk factor for any postoperative complication (relative risk [RR] 8.0, 95% confidence interval [CI] 1.1-59.8, p = 0.042). Notably, poor PS was significantly associated with postoperative mortality (p = 0.006), however, dependent IADL with a marginal significance (p = 0.059). Conclusions: IADL and PS were useful to predict postoperative complications and related mortality in elderly patients with gynecologic cancers. Postoperative complications and related mortality can be prevented by identifying the elderly patients with gynecologic cancers who showed dependent IADL and poor PS in CGA.

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Comprehensive geriatric assessment and management for Canadian elders with Cancer: The 5C study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12011 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12011-12011

Author(s):

Martine Puts ◽

Naser Alqurini ◽

Fay Strohschein ◽

Johanne Monette ◽

Doreen Wan-Chow-Wah ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Data Collection ◽

Cancer Treatment ◽

Functional Status ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Primary Outcome ◽

Group Performance

12011 Background: Comprehensive Geriatric Assessment (CGA) is recommended by ASCO for older adults with cancer undergoing chemotherapy to identify issues that can interfere with treatment delivery and optimize functional status and quality of life. However, few randomized controlled trials have been completed so far. Our objective is to evaluate the effectiveness of CGA on improving quality of life for older adults receiving cancer treatment. Methods: Eligible patients were aged 70+, diagnosed with a solid tumour, lymphoma or myeloma, referred for first/second line chemotherapy, speaking English/French, and with an Eastern Collaborative Oncology Group Performance Status 0–2. The CGA was done by a nurse and geriatrician followed by monthly phone calls by the study nurse for 6 months. Patients were randomly assigned (1:1) to receive either the intervention (CGA plus follow-up by geriatric trained team in addition to usual oncology care) or usual care alone. All participants received a monthly healthy aging booklet for attention control. Randomization was stratified by center and treatment intent (curative/adjuvant versus palliative). Our primary outcome was health-related quality of life (HRQOL) assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 global health scale (items 29 and 30). Secondary outcomes include functional status (Instrumental Activities of Daily Living). Outcome data collection was completed monthly for the first 6 months, then at 9 and 12 months. For the primary outcome we used a pattern mixture model using an intent-to-treat approach (at 0, 3, and 6 months). The last data collection took place March 8 2021. Results: From May 2017 to March 2020, 351 participants from 8 hospitals across Canada were enrolled. All patients were seen on or after day 1 of treatment for the intervention per patient request. Patient characteristics at baseline were similar in both arms. The average age was 75.7 (SD = 4.8), 60.4% was male and 54.3% had treatment with palliative intent. Change in HRQOL scores did not differ by arm (p =.80). Neither group exceeded the MCID of 10 points. There was also no difference in IADL between the groups (p = 0.82). Conclusion: CGA was not effective in improving quality of life for older adults receiving cancer treatment in this study. CGA may need to be performed prior to treatment initiation to achieve benefits. Clinical trial information: NCT03154671.

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

10.21203/rs.2.12137/v2 ◽

2020 ◽

Author(s):

Sandrine Sourdet ◽

Delphine Brechemier ◽

Zara Steinmeyer ◽

Stephane Gerard ◽

Laurent Balardy

Keyword(s):

Multivariate Analysis ◽

Cancer Treatment ◽

Physical Performance ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Treatment Plan ◽

Geriatric Oncology ◽

Treatment Decision ◽

Adverse Outcomes ◽

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 performance 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 provide guidance for treatment decision. We performed a multivariate analysis to identify CGA domains associated with change in cancer treatment plan. Results: 418 patients, mean age 82.8 ± 5.5, were included between October 2011 and January 2016, and 384 of them were referred with an initial cancer treatment plan. This initial cancer treatment plan was changed in 64 patients (16.7 %). In multivariate analysis, CGA domains associated with change in cancer treatment plan were cognitive impairment according to the MMSE score (p=0.020), malnutrition according to the MNA score (p=0.023), and low physical performance according to the Short Physical Performance Battery (p=0.010). Conclusion: Cognition, malnutrition and low physical performance are significantly associated with change in cancer treatment plan 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 performance should be specifically explored.

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Detecting Disabilities in Older Patients With Cancer: Comparison Between Comprehensive Geriatric Assessment and Vulnerable Elders Survey-13

Journal of Clinical Oncology ◽

10.1200/jco.2009.25.9978 ◽

2010 ◽

Vol 28 (12) ◽

pp. 2046-2050 ◽

Cited By ~ 131

Author(s):

Andrea Luciani ◽

Gilda Ascione ◽

Cecilia Bertuzzi ◽

Desirè Marussi ◽

Carla Codecà ◽

...

Keyword(s):

Elderly Patients ◽

Activities Of Daily Living ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Daily Living ◽

Older Patients ◽

Reliability And Validity ◽

Patients With Cancer ◽

Age Related ◽

Time Required

PurposeComprehensive geriatric assessment (CGA) is a multidimensional method used by geriatricians and oncologists to detect and evaluate multiple age-related problems and to plan and coordinate interventions. Because its main drawback is the time required, efforts have been made to evaluate screening instruments suitable for preliminarily assessing elderly patients. The main aim of this study was to establish the accuracy of the Vulnerable Elders Survey-13 (VES-13) in predicting the presence of abnormalities revealed by CGA.Patients and MethodsPatients age ≥ 70 years with a histologically or cytologically confirmed diagnosis of a solid or hematologic tumor underwent both CGA and a VES-13 assessment, and the reliability and validity of VES-13 were analyzed.ResultsFifty-three percent of the 419 elderly patients with cancer (mean age, 76.8 years) were vulnerable on VES-13; the rates of disabilities on CGA and activities of daily living (ADLs)/instrumental activities of daily living (IADLs) scales were 30% and 25%, respectively. The sensitivity and specificity of VES-13 were 87% and 62%, respectively, versus CGA and 90% and 70%, respectively, versus ADL/IADL scales.ConclusionsOn the basis of our data, VES-13 is highly predictive of impaired functional status and can thus be considered a useful preliminary means of assessing older patients with cancer before undertaking a full CGA.

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