Comparison of mood disorder screening scales in geriatric oncology: THYMOG study results

Abstract Background: Early and systematic depression screening is recommended for older patients with cancer. The objective of this study is to evaluate the performance of three different mood disorder screening scales for detection of Major Depressive Disorder (MDD) in older patients with cancer. Methods: A prospective multicentric study was conducted in patients with cancer over 70 years of age, comparing three self-administered questionnaires: the 15-item Geriatric Depression Scale (GDS-15), the Hospital Anxiety and Depression Scale - Depression (HADS-D) and the Distress Thermometer (DT). Three weeks after initial assessment, in case of score above the standard cut-off, a reassessment of the patient’s mood was performed by the primary care physician, using the DSM-V MDD diagnostic criteria and the DT. Potential differences between an abnormal mood screening test and a confirmed MDD was assessed using variance analysis for each screening scale. Results: 93 patients with an average age of 81 years [70 - 95 years] were included. 66 patients had at least one abnormal score on one of the screening scales. A MDD was confirmed for 10 of the 36 reassessed patients (28%). Abnormal screening by the GDS-15 (p=0.021), the HADS-D (p=0.018) and the DT (p=0.045) was significantly associated with MDD diagnosis. Conclusions: The three screening scales enabled detection of MDD in older patients with cancer. Among the tested scales, the HADS-D could perform best in detecting MDD. However, these screening scales may not be sufficiently reliable for MDD screening in this population. Further studies are needed to confirm the results.

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A comparison of anticholinergic burden in older patients with and without cancer

Future Oncology ◽

10.2217/fon-2021-0469 ◽

2021 ◽

Author(s):

Ayse Irem Yasin ◽

Atakan Topcu ◽

Meysere Nur Akuc ◽

Hacı Mehmet Türk ◽

Pinar Soysal

Keyword(s):

Older Patients ◽

Nutritional Assessment ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Mini Nutritional Assessment ◽

Patients With Cancer ◽

Cancer Management ◽

Rational Drug ◽

Geriatric Clinic ◽

Anticholinergic Burden

Aim: To compare anticholinergic burden (ACB) in older patients with and without cancer and evaluate the effects of ACB on geriatric syndromes. Methods: A total of 291 patients from the geriatric clinic and 301 patients from the oncology clinic were evaluated. ACB <2 was categorized as low ACB and ACB ≥2 was categorized as high ACB. A comprehensive geriatric assessment was performed on patients from the geriatric clinic. Results: ACB scores were significantly higher in patients without cancer compared with those with cancer (p < 0.005). Number of falls and Geriatric Depression Scale 15 scores were higher and Mini-Nutritional Assessment and Barthel/Lawton activities of daily living scores were lower in geriatric patients with high ACB scores compared with those with low ACB scores (p < 0.005). Conclusion: It is crucial to understand the potential effects of ACB for rational drug use and optimum cancer management in older patients with cancer.

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Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology

Journal of Clinical Oncology ◽

10.1200/jco.2018.78.8687 ◽

2018 ◽

Vol 36 (22) ◽

pp. 2326-2347 ◽

Cited By ~ 267

Author(s):

Supriya G. Mohile ◽

William Dale ◽

Mark R. Somerfield ◽

Mara A. Schonberg ◽

Cynthia M. Boyd ◽

...

Keyword(s):

Older Patients ◽

Geriatric Depression Scale ◽

Geriatric Oncology ◽

Depression Scale ◽

Treatment Decision ◽

Eligibility Criteria ◽

Aging Research ◽

Additional Information ◽

Treatment Decision Making ◽

Cancer Management

Purpose To provide guidance regarding the practical assessment and management of vulnerabilities in older patients undergoing chemotherapy. Methods An Expert Panel was convened to develop clinical practice guideline recommendations based on a systematic review of the medical literature. Results A total of 68 studies met eligibility criteria and form the evidentiary basis for the recommendations. Recommendations In patients ≥ 65 years receiving chemotherapy, geriatric assessment (GA) should be used to identify vulnerabilities that are not routinely captured in oncology assessments. Evidence supports, at a minimum, assessment of function, comorbidity, falls, depression, cognition, and nutrition. The Panel recommends instrumental activities of daily living to assess for function, a thorough history or validated tool to assess comorbidity, a single question for falls, the Geriatric Depression Scale to screen for depression, the Mini-Cog or the Blessed Orientation-Memory-Concentration test to screen for cognitive impairment, and an assessment of unintentional weight loss to evaluate nutrition. Either the CARG (Cancer and Aging Research Group) or CRASH (Chemotherapy Risk Assessment Scale for High-Age Patients) tools are recommended to obtain estimates of chemotherapy toxicity risk; the Geriatric-8 or Vulnerable Elders Survey-13 can help to predict mortality. Clinicians should use a validated tool listed at ePrognosis to estimate noncancer-based life expectancy ≥ 4 years. GA results should be applied to develop an integrated and individualized plan that informs cancer management and to identify nononcologic problems amenable to intervention. Collaborating with caregivers is essential to implementing GA-guided interventions. The Panel suggests that clinicians take into account GA results when recommending chemotherapy and that the information be provided to patients and caregivers to guide treatment decision making. Clinicians should implement targeted, GA-guided interventions to manage nononcologic problems. Additional information is available at www.asco.org/supportive-care-guidelines .

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Diagnostic Performance of the 4‐Item Geriatric Depression Scale for Depression Screening in Older Patients with Cancer: The ELCAPA Cohort Study

The Oncologist ◽

10.1002/onco.13746 ◽

2021 ◽

Author(s):

Charlotte Lafont ◽

Anne Chah Wakilian ◽

Cédric Lemogne ◽

Clément Gouraud ◽

Virginie Fossey‐Diaz ◽

...

Keyword(s):

Cohort Study ◽

Older Patients ◽

Diagnostic Performance ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Depression Screening ◽

Geriatric Depression ◽

Patients With Cancer

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Drug-drug interactions in older patients with cancer: a report from the 15th Conference of the International Society of Geriatric Oncology, Prague, Czech Republic, November 2015

ecancermedicalscience ◽

10.3332/ecancer.2016.611 ◽

2016 ◽

Vol 10 ◽

Cited By ~ 3

Author(s):

Rob Stepney ◽

Stuart M Lichtman ◽

Romano Danesi

Keyword(s):

Czech Republic ◽

Drug Interactions ◽

International Society ◽

Older Patients ◽

Geriatric Oncology ◽

Patients With Cancer

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Latent Profile Analyses of Depressive Symptoms in Younger and Older Oncology Patients

Assessment ◽

10.1177/1073191118784653 ◽

2018 ◽

Vol 27 (7) ◽

pp. 1383-1398 ◽

Cited By ~ 3

Author(s):

Rebecca M. Saracino ◽

Heining Cham ◽

Barry Rosenfeld ◽

Christian J. Nelson

Keyword(s):

Depressive Symptoms ◽

Older Patients ◽

Latent Profile Analysis ◽

Latent Class ◽

Profile Analysis ◽

Depression Scale ◽

Epidemiological Studies ◽

Class Differences ◽

Patients With Cancer ◽

Latent Profile

The aging of America will include a significant increase in the number of older patients with cancer, many of whom will experience significant depressive symptoms. Although geriatric depression is a well-studied construct, its symptom presentation in the context of cancer is less clear. Latent profile analysis was conducted on depressive symptoms in younger (40-64 years) and older (≥65 years) patients with cancer ( N = 636). The sample was clinically heterogeneous (i.e., included all stages, dominated by advanced stage disease). Participants completed questionnaires including the Center for Epidemiological Studies Depression Scale, which was used for the latent profile analysis. A four-class pattern was supported for each age group. However, the four-class pattern was significantly different between the younger and older groups in terms of the item means within each corresponding latent class; differences were primarily driven by severity such that across classes, older adults endorsed milder symptoms. An unexpected measurement issue was uncovered regarding reverse-coded items, suggesting that they may generate unreliable scores on the Center for Epidemiological Studies Depression Scale for a significant subset of patients. The results indicate that cancer clinicians can expect to see depressive symptoms along a continuum of severity for patients of any age, with less severe symptoms among older patients.

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What Every Oncologist Should Know About Geriatric Assessment for Older Patients With Cancer: Young International Society of Geriatric Oncology Position Paper

Journal of Oncology Practice ◽

10.1200/jop.2017.026435 ◽

2018 ◽

Vol 14 (2) ◽

pp. 85-94 ◽

Cited By ~ 30

Author(s):

Kah Poh Loh ◽

Enrique Soto-Perez-de-Celis ◽

Tina Hsu ◽

Nienke A. de Glas ◽

Nicolò Matteo Luca Battisti ◽

...

Keyword(s):

Geriatric Assessment ◽

Older Patients ◽

Geriatric Oncology ◽

Treatment Decisions ◽

Position Paper ◽

Illustrative Case ◽

Newly Diagnosed ◽

Patients With Cancer ◽

Detailed Evaluation ◽

Oncology Practice

Aging is a heterogeneous process. Most newly diagnosed cancers occur in older adults, and it is important to understand a patient’s underlying health status when making treatment decisions. A geriatric assessment provides a detailed evaluation of medical, psychosocial, and functional problems in older patients with cancer. Specifically, it can identify areas of vulnerability, predict survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice; however, the uptake is hampered by limitations in both time and resources, as well as by a lack of expert interpretation. In this review, we describe the utility of geriatric assessment by using an illustrative case and provide a practical approach to geriatric assessment in oncology.

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Performance of Four Frailty Classifications in Older Patients With Cancer: Prospective Elderly Cancer Patients Cohort Study

Journal of Clinical Oncology ◽

10.1200/jco.2016.69.3143 ◽

2017 ◽

Vol 35 (7) ◽

pp. 766-777 ◽

Cited By ~ 45

Author(s):

Emilie Ferrat ◽

Elena Paillaud ◽

Philippe Caillet ◽

Marie Laurent ◽

Christophe Tournigand ◽

...

Keyword(s):

Older Patients ◽

Latent Class ◽

Geriatric Oncology ◽

Predictive Performance ◽

Hematologic Malignancies ◽

Teaching Hospitals ◽

Cancer Treatments ◽

Elderly Cancer Patients ◽

Patients With Cancer ◽

Κ Statistic

Purpose Frailty classifications of older patients with cancer have been developed to assist physicians in selecting cancer treatments and geriatric interventions. They have not been compared, and their performance in predicting outcomes has not been assessed. Our objectives were to assess agreement among four classifications and to compare their predictive performance in a large cohort of in- and outpatients with various cancers. Patients and Methods We prospectively included 1,021 patients age 70 years or older who had solid or hematologic malignancies and underwent a geriatric assessment in one of two French teaching hospitals between 2007 and 2012. Among them, 763 were assessed using four classifications: Balducci, International Society of Geriatric Oncology (SIOG) 1, SIOG2, and a latent class typology. Agreement was assessed using the κ statistic. Outcomes were 1-year mortality and 6-month unscheduled admissions. Results All four classifications had good discrimination for 1-year mortality (C-index ≥ 0.70); discrimination was best with SIOG1. For 6-month unscheduled admissions, discrimination was good with all four classifications (C-index ≥ 0.70). For classification into three (fit, vulnerable, or frail) or two categories (fit v vulnerable or frail and fit or vulnerable v frail), agreement among the four classifications ranged from very poor (κ ≤ 0.20) to good (0.60 < κ ≤ 0.80). Agreement was best between SIOG1 and the latent class typology and between SIOG1 and Balducci. Conclusion These four frailty classifications have good prognostic performance among older in- and outpatients with various cancers. They may prove useful in decision making about cancer treatments and geriatric interventions and/or in stratifying older patients with cancer in clinical trials.

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International Society of Geriatric Oncology Consensus on Geriatric Assessment in Older Patients With Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2013.54.8347 ◽

2014 ◽

Vol 32 (24) ◽

pp. 2595-2603 ◽

Cited By ~ 711

Author(s):

Hans Wildiers ◽

Pieter Heeren ◽

Martine Puts ◽

Eva Topinkova ◽

Maryska L.G. Janssen-Heijnen ◽

...

Keyword(s):

Geriatric Assessment ◽

International Society ◽

Older Patients ◽

Clinical Care ◽

Geriatric Oncology ◽

Evidence Base ◽

Patients With Cancer ◽

Consensus Statements ◽

Oncology Treatment ◽

Oncology Practice

Purpose To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. Methods SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment–related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. Results GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. Conclusion There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base.

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