Development and temporal validation of a practical prognostic scoring system (ONCOGERIATRIC INDEX -OGI) based on the comprehensive geriatric assessment to predict early death in elderly cancer patients: A 892 patients cohort study.

e21537 Background: Components of the comprehensive geriatric assessment (CGA) correlate with risk of early mortality in elderly cancer patients (ECP). However, its complexity and the time required for its administration. The aim of this study was to determine the impact of each CGA domain on overall survival(OS) and to first step for the development of a prognostic scoring system to stratify ECP. Methods: a prospective cohort study. Participants with a recent diagnosis of cancer were from eight hospitals and one cancer center in Brazil and were recruited during their first medical appointment at the outpatient oncologic clinic. A basal CGA was done before the care decision (ADL, Charlson Comorbidity Index- CCI, Karnofsky Performance status – KPS, GDS15, IPAQ, MMSE, MNA, MNA-SF, PS, PPS, Polipharmacy, QLQc30, TUG). During the follow up of six months, information about the treatments performed and early death was collected. OS was estimated using the Kaplan–Meier method, and survival curves were compared using the Log rank test for categorical variables. A multivariate Cox proportional hazards model was used to select early death risk factors. A clinical score considering the number of risk variables was created. Results: From 2015-2016, 608 ECP, mean age 71.9 (SD ±7.4; range 60-96), 50.7% male, were enrolled. 100 (16.4%) ECP died in less than six months of follow-up. In our multivariate model, controlled by age, site of cancer and cancer stage, the remaining significant risk factors were malnutrition/nonutrition determined by MNA (HR 3.3, 95%CI 1.81-5.99, p < 0.001), KPS < 50% (HR 2.44, CI 1.56-3.81, p < 0.001) and CCI > 2 (HR 1.6, CI 1.09-2.52, p = 0.018). The risk for early death according to the number of risk variables: three (HR 12.99, CI 5.69-29.60, p < 0.001), two (HR 5.65, CI 2.61-12.24, p < 0.001) or one (HR 2.7, CI 1.28-5.87, p = 0.009). Conclusions: a practical clinical score using three instruments of the CGA (MNA, KPS and CCI) can predict independent the risk for an early death in ECP. The development of a practical system for risk scoring, incorporating few clinical prognostic factors, helps to stratify patients into risk groups and to plan a personalized care.

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PREDICTIVE POWER OF COMPREHENSIVE GERIATRIC ASSESSMENT QUESTIONNAIRES TO ESTIMATE THE RISK OF EARLY DEATH IN ELDERLY CANCER PATIENTS USING MACHINE LEARNING

Journal of Geriatric Oncology ◽

10.1016/s1879-4068(19)31142-7 ◽

2019 ◽

Vol 10 (6) ◽

pp. S14

Author(s):

G.R. Sena ◽

T.P. Lima ◽

M.G. Mello ◽

J.T. Lima ◽

L.S. Thuler

Keyword(s):

Machine Learning ◽

Cancer Patients ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Predictive Power ◽

Early Death ◽

Elderly Cancer Patients

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Basal physical inactivity as an independent risk factor for early death in elderly cancer patients: A prospective Brazilian cohort study with 608 patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e21534 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e21534-e21534

Author(s):

Jurema Telles O Lima ◽

Maria Julia Gonçalves Mello ◽

Anke Bergmann ◽

Mirella Rebello Bezerra ◽

Zilda Cavalcanti ◽

...

Keyword(s):

Physical Activity ◽

Cohort Study ◽

Cancer Patients ◽

Geriatric Assessment ◽

Physical Inactivity ◽

Early Death ◽

Premature Death ◽

Elderly Cancer Patients ◽

Low Middle Income Countries ◽

Physically Inactive

e21534 Background:With the aging of the population, cancer in the elderly people is becoming an increasingly common and complex health problem, particularly in low-middle-income countries, where physical inactivity and obesity have also been challenging and correlated with cancer and aging. The aim of this study is to determine whether the baseline physical inactivity per International Physical Activity Questionnaire(IPAQ) is an independent factor of premature death in the first six months.Methods: prospective cohort study of elderly patients (≥ 60 years). Participants with a recent diagnosis of cancer were from eight community hospitals and one cancer center in Northeast Brazil and were recruited during their first medical appointment at the outpatient oncologic clinic. Sociodemographic and clinical variables were determined and baseline comprehensive geriatric assessment (CGA) was conducted including IPAQ and Time Up and Go test. Data were analyzed using multivariate Cox proportional hazards models, overall survival was estimated using the Kaplan–Meier method and survival curves were compared using the Log rank test. Results:From 2015-2016, 608 patients, mean age 71.9 (SD ±7.4; range 60-96), 50.7% male, were enrolled. Main diagnoses were prostate cancer (29.1%), digestive system cancer (25.5%) and breast cancer (16.0%). 40.3% were considered obese/overweight (BMI ≥ 27). 42.1% were considered physically inactive per IPAQ. The mean of the Time Up and Go test on the physically inactive group by IPAQ was of 13.11s (SD ± 6.5), and of 22.72s (SD± 16.7) on the physically active one. After adjustment for age, site of cancer and cancer stage, the multivariate regression Cox model showed that being physically inactive is an independent predictor for early death (HR = 2.35, 95% CI: 1.50‒ 3.66, p < 0.001).Conclusions:Physical inactivity at admission was identified as a significant predictor of risk for premature death in elderly cancer patients. The evaluation of the physical activity should be incorporated into regular geriatric assessment of elderly cancer patients.

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The comprehensive geriatric assessment in malignancies and prognostic factors: Description of a prospective cohort of 889 Brazilian elderly cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e23035 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e23035-e23035

Author(s):

Jurema Telles O Lima ◽

Raissa Viana ◽

Mirella Rebello ◽

Maria Julia Gonçalves Mello ◽

Letícia telles Sales ◽

...

Keyword(s):

Clinical Practice ◽

Cancer Patients ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Prospective Cohort ◽

Early Death ◽

Northeastern Brazil ◽

World Health ◽

Elderly Cancer Patients ◽

Risk Of Death

e23035 Background: According to the World Health Organization (WHO), the definition of "elderly" varies according to the degree of development of the country. In Low and Medium Development Countries (LMDC), a person aged 60 or older is considered elder, opposed to developed countries (65 or older). It is in LMDC that is occurring the largest relative increase in the incidence of cancer, specially those related to aging. The Comprehensive Geriatric Assessment (CGA) is still underutilized in oncological clinical practice, especially in LMDC. Objectives: To determine predictive factors for the occurrence of early death (in the first six months of surveillance) and to perform the development and temporal validation of a practical prognostic score based on the CGA to predict early death (up to 180 days) in elderly cancer patients. Methods: A prospective cohort enrolled elderly patients ≥ 60 years with a recent cancer diagnosis admitted between 2015-2017. The CGA performed at the time of admission included the following instruments: CCI; KPS; MMSE; TUG test; IPAQ; ADL; MNA; MNA-SF; GDS15; PPS and Polypharmacy. The studied outcome was early death, defined as the one that occurred within the first six months after the diagnosis. Survival analysis (Kaplan-Meier) and Cox proportional hazard regression was performed. Results: 889 patients were included in the study, performed at a referral center in cancer of a teaching hospital in Northeastern Brazil. The independent risk factors for death identified by CGA were: Mini exam of mental state (MMSE) as a continuous variable (HR 1.04 95% CI 1.00-1.07), Geriatric depression scale (GDS-15) ≥ 10 (HR 1 , 50 IC95% 1.10-2.07), Karnofsky Functional Performance Scale (KPS) < 50 (HR 1.57 IC95% 1.02-2.42), Katz Index ≤4 (HR 2.58 IC95% 1.68-3.97) and the Mininutrition assessment (MAN-SF) < 12 (HR 2.96 IC95% 2.00-4.39), with higher risk for early death amongst patients with abnormalities detected by the scales performed at admission (log rank < 0.001). Conclusions: Comprehensive geriatric assessment is an important tool to identify fragility in elderly cancer patients. Some of its scales should be incorporated into clinical practice, as they are simple and significant prognostic markers and identify patients with a higher risk of death in the first twelve months.

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