Association Between Chronologic Age and Geriatric Assessment–Identified Impairments: Findings From the CARE Registry

Abstract

Background: The NCCN Guidelines for Older Adult Oncology recommend that, when possible, older adults with cancer undergo a geriatric assessment (GA) to provide a comprehensive health appraisal to guide interventions and appropriate treatment selection. However, the association of age with GA-identified impairments (GA impairments) remains understudied and the appropriate age cutoff for using the GA remains unknown. Patients and Methods: We designed a cross-sectional study using the Cancer and Aging Resilience Evaluation (CARE) registry of older adults with cancer. We included adults aged ≥60 years diagnosed with gastrointestinal malignancy who underwent a patient-reported GA prior to their initial consultation at the gastrointestinal oncology clinic. We noted the presence of GA impairments and frailty using Rockwood’s deficit accumulation approach. We studied the relation between chronologic age and GA impairments/frailty using Spearman rank correlation and chi-square tests of trend. Results: We identified 455 eligible older adults aged ≥60 years with gastrointestinal malignancies; the median age was 68 years (range, 64–74 years) and colorectal (33%) and pancreatic (24%) cancers were the most common cancer type. The correlation between chronologic age and number of geriatric impairments was weak and did not reach statistical significance (Spearman ρ, 0.07; P=.16). Furthermore, the prevalence of domain-specific impairments or frailty was comparable across the 3 age groups (60–64 years, 65–74 years, ≥75 years) with the exception of comorbidity burden. Notably, 61% of patients aged 60 to 64 years had ≥2 GA impairments and 35% had evidence of frailty, which was comparable to patients aged 65 to 74 years (66% and 36%, respectively) and ≥75 years (70% and 40%, respectively). Conclusions: Using chronologic age alone to identify which patients may benefit from GA is problematic. Future studies should identify screening tools that may identify patients at high risk of frailty and GA impairments.

Racial disparities in frailty and geriatric assessment impairments in older adults with cancer in the Deep South: Results from the CARE Registry

“…We used domain-specific cutoffs to define geriatric assessment impairments in accordance with prior literature (see Supporting Table 1). 13,[25][26][27]…”

How frail is frail in oncology studies? A scoping review

“…Fifteen studies were speci cally conducted in the medical oncology setting, 19,20,23,24,[26][27][28][29][33][34][35]38,43,51,54 eight studies in surgical oncology, 41,42,45,49,52,53,55,56 and the remainder were either mixed or not speci ed. 17,18,22,25,[30][31][32]36,37,39,40,44,[46][47][48]50,57,58 Fourteen studies included a range of cancers and the rest focused on individual cancer types.…”

“…17,18,22,25,[30][31][32]36,37,39,40,44,[46][47][48]50,57,58 Fourteen studies included a range of cancers and the rest focused on individual cancer types. 20,[22][23][24][25]30,32,36,39,40,44,46,47,50,57,58 There were 10 studies of breast cancer, [17][18][19][26][27][28][29]33,37,56 of which six studies were different secondary analyses of the same prospective clinical trial. 19,26,27,33 Similarly, two 34,51 of the ve lung cancer studies utilised the same retrospective database, 34,35,…”

“…19,26,27,33 Similarly, two 34,51 of the ve lung cancer studies utilised the same retrospective database, 34,35,48,49,51 as did three [53][54][55] of four studies of gynaecological cancers, 45,[53][54][55] and both studies of pancreatic cancer. 30,31 Four studies evaluated gastrointestinal cancers, 23,38,41,42 and one was speci cally evaluated participants with meningiomas. 52 INSERT FIGURE 1 INSERT TABLE 1 Frailty Index Categories In 22 studies (55%) an FI ≥ 0.35 was used to categorise people as frail and an FI between 0.20 and 0.35 categorised people as prefrail.…”

“…52 INSERT FIGURE 1 INSERT TABLE 1 Frailty Index Categories In 22 studies (55%) an FI ≥ 0.35 was used to categorise people as frail and an FI between 0.20 and 0.35 categorised people as prefrail. [17][18][19][20][22][23][24][25][26][27][28][29][31][32][33][34][35][36][37][38]57,58 Thirteen of the 22 studies referenced one of three oncology studies as rationale for their FI categorisation. 20,25,33 20 published four years later, referenced Sheppard et al and reported that frailty predicted an increased likelihood of hospitalisation and treatment discontinuation in older adults commencing chemotherapy.…”