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

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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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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Cancer Surgery in the Elderly

The Scientific World JOURNAL ◽

10.1100/2012/303852 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 18

Author(s):

Gopal C. Kowdley ◽

Nishant Merchant ◽

James P. Richardson ◽

Justin Somerville ◽

Myriam Gorospe ◽

...

Keyword(s):

Decision Making ◽

Elderly Patients ◽

The Elderly ◽

Cancer Surgery ◽

Decision Making Process ◽

Benefit Ratio ◽

Patients With Cancer ◽

The World ◽

Surgery In The Elderly ◽

Surgical Treatments

The proportions both of elderly patients in the world and of elderly patients with cancer are both increasing. In the evaluation of these patients, physiologic age, and not chronologic age, should be carefully considered in the decision-making process prior to both cancer screening and cancer treatment in an effort to avoid ageism. Many tools exist to help the practitioner determine the physiologic age of the patient, which allows for more appropriate and more individualized risk stratification, both in the pre- and postoperative periods as patients are evaluated for surgical treatments and monitored for surgical complications, respectively. During and after operations in the oncogeriatric populations, physiologic changes occuring that accompany aging include impaired stress response, increased senescence, and decreased immunity, all three of which impact the risk/benefit ratio associated with cancer surgery in the elderly.

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

Journal of Clinical Oncology ◽

10.1200/jco.2010.31.0664 ◽

2011 ◽

Vol 29 (27) ◽

pp. 3636-3642 ◽

Cited By ~ 243

Author(s):

Philippe Caillet ◽

Florence Canoui-Poitrine ◽

Johanna Vouriot ◽

Muriel Berle ◽

Nicoleta Reinald ◽

...

Keyword(s):

Multivariate Analysis ◽

Elderly Patients ◽

Cancer Treatment ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Group Performance ◽

Univariate Analysis ◽

Patients With Cancer ◽

Treatment Changes ◽

The Mean

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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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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