01 / DEVELOPMENT OF MINI-COMPREHENSIVE GERIATRIC ASSESSMENT FOR THE ELDERLY CANCER PATIENTS BASED ON RELATIONSHIPS BETWEEN COMPREHENSIVE GERIATRIC ASSESSMENT ITEMS AND PERFORMANCE STATUS

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.

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An exploratory analysis of comprehensive geriatric assessment results and overall survival in 233 consecutive elderly cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.9504 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 9504-9504

Author(s):

D. Poon ◽

H. H. Lee ◽

L. L. Chan ◽

R. Yap ◽

W. H. Koo

Keyword(s):

Overall Survival ◽

Cancer Patients ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Advanced Disease ◽

Performance Status ◽

Geriatric Syndrome ◽

Cancer Type ◽

Elderly Cancer Patients ◽

Poor Cognition

9504 Background: Performance status (PS) is the main clinical parameter used by most oncologists to assess the ability of elderly cancer patients to tolerate chemotherapy and estimate prognosis. The results of comprehensive geriatric assessment (CGA) for elderly cancer patients were analyzed to investigate the impact of each CGA functional, physical, cognitive, and affective domain on overall survival in relation to performance status. Methods: CGA was used for 233 consecutive elderly cancer patients aged 70 and above. CGA tools included the Katz index of daily activities independence (ADL), instrumental activities of daily living (IADL), mini-mental state examination (MMSE), geriatric depression scale (GDS), Charlson comorbidity risk index, get up and go test, and mini-nutritional assessment. Geriatric syndrome is defined as any high risk of falls, depression, dementia, increased functional dependence, or malnutrition. Eastern Cooperative Oncology Group (ECOG) scale was used to grade PS. Cancer type and stage were also analyzed. Log rank test was used to compare overall survival and hazard ratio (HR) derived using Cox regression method. Univariate and multivariate analyses were done to assess impact of ECOG status, presence of geriatric syndrome, stage of disease and cancer type on overall survival. Results: All 233 patients were included in the analysis, median age 77 (70 - 93), all had solid tumors and predominant tumors comprising 79% of diagnoses were colorectal, lung and breast, 50% had advanced metastatic disease. ECOG grades 2,3,4 (HR 0.28, 95% CI 0.14 - 0.55), dependent IADL status (HR 0.30, 95% CI 0.11 - 0.83), presence of geriatric syndrome (HR 0.42 95% CI 0.26 - 0.69), poor cognition (HR 0.53 95% CI 0.36 - 0.77), or advanced disease (HR 0.30 95% CI 0.14 - 0.65) was associated with inferior overall survival in univariate analysis. Only poor ECOG status, presence of a geriatric syndrome and advanced disease predicted adversely for overall survival in multivariate analysis. Poor cognition (MMSE score <24) in those with borderline ECOG 2 status was associated with poorer survival (HR 0.38 95% CI 0.33 - 0.90). Conclusions: Utility of CGA will improve the assessment of the elderly cancer patient. No significant financial relationships to disclose.

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

Journal of Clinical Oncology ◽

10.1200/jco.20.2.494 ◽

2002 ◽

Vol 20 (2) ◽

pp. 494-502 ◽

Cited By ~ 337

Author(s):

L. Repetto

Keyword(s):

Cancer Patients ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Group Performance ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Geriatric Oncology ◽

Oncology Group ◽

Elderly Cancer Patients

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Glioblastoma: approach to treat elderly patients

Einstein (São Paulo) ◽

10.1590/s1679-45082012000400021 ◽

2012 ◽

Vol 10 (4) ◽

pp. 512-518 ◽

Cited By ~ 3

Author(s):

Luciola de Barros Pontes ◽

Theodora Karnakis ◽

Suzana Maria Fleury Malheiros ◽

Eduardo Weltman ◽

Reynaldo André Brandt ◽

...

Keyword(s):

Elderly Patients ◽

Cancer Patients ◽

Geriatric Assessment ◽

Local Control ◽

Comprehensive Geriatric Assessment ◽

Performance Status ◽

Tumor Resection ◽

Total Resection ◽

Elderly Cancer Patients ◽

Therapeutic Modalities

Treating elderly cancer patients is a challenge for oncologists, especially considering the several therapeutic modalities in glioblastoma. Extensive tumor resection offers the best chance of local control. Adequate radiotherapy should always be given to elderly patients if they have undergone gross total resection and have maintained a good performance status. Rather than being ruled out, chemotherapy should be considered, and temozolomide is the chosen drug. A comprehensive geriatric assessment is a valuable tool to help guiding treatment decisions in elderly patients with glioblastoma.

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A prospective study of the impact of chemotherapy-related toxicities on the quality of life in elderly patients with cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e23013 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e23013-e23013

Author(s):

Sanketh Kotne ◽

Bharadwaj Ponnada ◽

Arun Philip ◽

Pavithran Keechilat

Keyword(s):

Quality Of Life ◽

Elderly Patients ◽

Cancer Patients ◽

Geriatric Assessment ◽

Mental Status ◽

Comprehensive Geriatric Assessment ◽

The Elderly ◽

Assessment Tools ◽

Elderly Cancer Patients

e23013 Background: Treatment of cancer in elderly is challenging. Majority of the elderly cancer patients are offered chemotherapy based on their performance scale and geriatric assessment tools are not routinely employed in clinical practice as they are time consuming and cumbersome. Aim: The primary objective was to estimate the incidence of chemotherapy related adverse events in newly diagnosed elderly cancer patients above 65 years of age treated at a tertiary cancer institute in southern India. The secondary objective was to predict and assess the factors associated with chemotherapy related toxicities in the elderly patients using the Cancer and Aging Research Group's (CARG) scoring tool and to study the quality of life and to assess the nutritional status and the mental status in elderly cancer patients above 65 years of age. Methods: A prospective cross-sectional study was done among 179 patients with age ≥ 65 years, a solid organ cancer (any type or stage) from February 2017 to August 2018. Prechemotherapy comprehensive geriatric assessment (CGA) with Older People’s Quality of Life Questionnaire (OPQOL-35), Mini Nutritional assessment (MNA) and Folstein’s Mini Mental status examination (MMSE) was done at baseline, 2 months and 6 months. CARG tool was used to predict the risk of chemotherapy toxicity with the standard and modified dose. Results: The mean age was 68.53 years. Majority of the patients had breast cancer 29.60%. The proportion of lung cancer, prostate cancer, stomach cancer, colorectal and ovarian cancers were 21.80%,10.60%, 9.50%, 14.5% and 7.30% respectively. Other cancers were seen in 5 patients (2.79%). 40 (22.30%) patients had received anthracycline based chemotherapy. 143 (79.90%) had received standard dosing chemotherapy.118 (65.90%) & 125 (69.80%) out of 179 patients had developed hematological toxicities and non- hematological toxicities respectively. According to the ROC curve for the CARG tool risk of toxicity with standard & modified dosing and hematological & non- hematological toxicities, the accuracy of the test is 60.89% indicating its poor predictive validity. There is a decline in the CGA at 2 months follow-up, but there was an improvement after assessment at 6 months. Conclusions: Comprehensive geriatric assessment at base line is required to adequately analyse patient’s risk of chemotherapy related toxicities. In our study, the patients have tolerated the chemotherapy well in spite of receiving standard dosing.

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