G-8 Geriatric Screening Tool Independently Predicts Progression-Free Survival in Older Ovarian Cancer Patients Irrespective of Maximal Surgical Effort: Results of a Retrospective Cohort Study

<b><i>Background:</i></b> We evaluated the prognostic impact of various global health assessment tools in patients older than 60 years with ovarian cancer (OC). <b><i>Methods:</i></b> G-8 geriatric screening tool (G-8 score), Lee Schonberg prognostic index, Eastern Cooperative Oncology Group (ECOG) performance status, and Charlson Comorbidity Index (CCI) were determined retrospectively in a consecutive cohort of elderly patients with OC. Univariate and multivariate Cox regression analyses and Kaplan-Meier method were performed to analyze the impact of the preoperative global health status on survival. <b><i>Results:</i></b> 116 patients entered the study. In multivariate analysis adjusted for clinical-pathological factors, only the G-8 score retained significance as a prognostic parameter of progression-free survival (PFS) (hazard ratio [HR]: 1.970; 95% confidence interval [CI] [1.056–3.677]; <i>p</i> = 0.033). Fifty-six patients were classified as G-8-nonfrail with an increased PFS compared to 50 G-8-frail patients (53.4% vs. 16.7%; <i>p</i> = 0.010). A higher CCI was associated with decreased PFS (45.1% vs. 22.2%; <i>p</i> = 0.012), but it did not influence the risk of recurrences or death (<i>p</i> = 0.360; <i>p</i> = 0.111). The Lee Schonberg prognostic index, the ECOG, and age were not associated with survival. <b><i>Conclusions:</i></b> The G-8 score independently predicted PFS in elderly OC patients regardless of maximal surgical effort. Thus, it could be useful to assess surgical treatment based on frailty rather than age alone.

The 4Ms of Age-Friendly Care: Successful Infusion into Electronic Medical Records Leads to Improved Care

Electronic Medical Records (EMR) and Health Information Technology (HIT) have changed the daily operations of the healthcare industry. For primary care systems/clinics, it has meant the purchase and tailoring of systems to fit specific needs of users and patients. As one of the HRSA funded Geriatric Workforce Enhancement recipients, the AR Geriatric Education Collaborative (AGEC) worked with a rural federally qualified healthcare clinic system for over a year to help them become IHI certified in Age-Friendly Care and the EMR has been a critical link. The system was crucial in identifying compliancy to the clinical Merit-based Incentive Payment System (MIPS) measures which helped identify the areas where most improvement was needed. Included in the process was a new geriatric screening tab in the EMR system. This tab contains 8 screenings including: depression, anxiety, alcohol use, prescription opioid use and recreational drug use, mentation, medication and mobility. This is in addition to asking “what matters” so that all four of the 4M’s age friendly framework components were included. Clinicians are successfully using the systems and improvements in outcomes are beginning to be noted. The outcome MIPS measures are obtained quarterly from an EMR report and data is shared with the staff and new quality improvement projects are developed using PDSA (plan, do, study, act) cycles based on the outcomes of the data. Next steps with the EMR will be the development of flags that will notify the clinicians when a screening is needed.