Clinical judgment versus geriatric assessment for frailty in older patients with cancer

Walree, Inez Charlotte van; Scheepers, Ellen R M; Bos, Frederiek van den; Huis‐Tanja, Lieke H. van; Emmelot-Vonk, Mariëlle H.; Hamaker, Marije E.

doi:10.1016/j.jgo.2020.05.011

Cited by 20 publications

(17 citation statements)

References 25 publications

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“…The prevalence of frailty in our cohort aligns with other studies. High prevalence of prefrailty and frailty (69% of 125 patients, defined by Fried phenotype for frailty 15 ) was found in older candidates for surgery in a single thoracic clinic 27 . Interestingly, they found that the Eastern Cooperative Oncology Group (ECOG) score and frailty status were not strongly correlated, which further emphasizes the limitations of relying solely on the ECOG performance scale for treatment decisions and risk assessment 27 .…”

Section: Discussionmentioning

confidence: 99%

“…High prevalence of prefrailty and frailty (69% of 125 patients, defined by Fried phenotype for frailty 15 ) was found in older candidates for surgery in a single thoracic clinic 27 . Interestingly, they found that the Eastern Cooperative Oncology Group (ECOG) score and frailty status were not strongly correlated, which further emphasizes the limitations of relying solely on the ECOG performance scale for treatment decisions and risk assessment 27 . Another example supporting the importance of rigorously assessing and identifying varying degrees of frailty typically undetected by nongeriatric teams is a study by Ferguson et al 28 showing that surgeons and trainees consider clinical judgment based on physical appearance and behavior (the “eyeball test”) more important than clinical factors.…”

Section: Discussionmentioning

confidence: 99%

“…27 Interestingly, they found that the Eastern Cooperative Oncology Group (ECOG) score and frailty status were not strongly correlated, which further emphasizes the limitations of relying solely on the ECOG performance scale for treatment decisions and risk assessment. 27 Another example supporting the importance of rigorously assessing and identifying varying degrees of frailty typically undetected by nongeriatric teams is a study by Ferguson et al 28 showing that surgeons and trainees consider clinical judgment based on physical appearance and behavior (the "eyeball test") more important than clinical factors. Conducting a CGA in older patients allows clinical, psychosocial, and physical factors to be addressed perioperatively, while assuring that validated geriatric tools, incorporated into the surgical assessment, are used to guide surgical decisions rather than "eyeballing" the patient.…”

Section: Discussionmentioning

confidence: 99%

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Thoracic surgery with geriatric assessment and collaboration can prepare frail older adults for lung cancer surgery

Cooper

Gong

Dezube

et al. 2022

Journal of Surgical Oncology

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Background and Objectives: We assessed frailty, measured by a comprehensive geriatric assessment-based frailty index (FI-CGA), and its association with postoperative outcomes among older thoracic surgical patients.Methods: Patients aged ≥65 years evaluated in the geriatric-thoracic clinic between June 2016 through May 2020 who underwent lung surgery were included. Frailty was defined as FI-CGA > 0.2, and "occult frailty", a level not often recognized by surgical teams, as 0.2 < FI-CGA < 0.4. A qualitative analysis of geriatric interventions was performed.Results: Seventy-three patients were included, of which 45 (62%) were nonfrail and 28 (38%) were frail. "Occult frailty" was present in 23/28 (82%). Sixty-one (84%) had lung malignancy. Geriatric interventions included delirium management, geriatricspecific pain and bowel regimens, and frailty optimization. More sublobar resections versus lobectomies (61% vs. 25%) were performed among frail patients. Frailty was not significantly associated with overall complications (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 0.88-6.44; p = 0.087), major complications (OR: 2.33; 95% CI: 0.48-12.69; p = 0.293), discharge disposition (OR: 2.8; 95% CI: 0.71-11.95; p = 0.141), or longer hospital stay (1.3 more days; p = 0.18). Conclusion:Frailty and "occult frailty" are prevalent in patients undergoing lung surgery. However, with integrated geriatric management, these patients can safely undergo surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Thoracic surgery with geriatric assessment and collaboration can prepare frail older adults for lung cancer surgery

Cooper

Gong

Dezube

et al. 2022

Journal of Surgical Oncology

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“…Frailty can be subtle and may remain undetected in self-assessment and clinical judgment by the treating oncologist [38][39][40]. There is often a poor association between the cancer specialist's clinical judgment and frailty found through geriatric assessment [41]. Furthermore, there is also considerable assessor variability between physicians, in the clinical judgment of frailty in older patients with cancer [40].…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Geriatric Oncology Screening and Geriatric Assessment in Older Patients with Solid Cancers: Protocol for a Danish prospective cohort study (PROGNOSIS-G8)

Ditzel

Giger

Lund

et al. 2021

Journal of Geriatric Oncology

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Introduction: Older patients with cancer constitute a heterogeneous group with varying degrees of frailty; therefore, geriatric assessment with initial geriatric oncology screening is recommended. The Geriatric 8 (G8) and the modified Geriatric 8 (mG8) are promising screening tools with high accuracy and an association with survival. However, evidence is sparse regarding patient-centered outcomes. This protocol describes a study, which aims to address the predictive and prognostic value of the G8 and mG8, with quality of life (QoL) as the primary outcome. Materials and methods: In this single-center prospective cohort study, patients, age ≥70 years with solid malignancies, will be screened with the G8 and mG8 prior to receiving 1st line antineoplastic treatment. Patients will contribute medical record data including; cancer type, Charlson comorbidity index score, performance status, and treatment intent, type, and dosage, at baseline. Patients will complete QoL questionnaires (EORTC QLQ-C30 and ELD-14) at baseline, 3, 6, 9, and 12-months follow-up. Two functional measurements (the 30-s chair stand test and the handgrip strength test) will be conducted at baseline to assess the added predictive and prognostic value. At 12 months follow-up, initially administered treatment and treatment adherence will be recorded and assessed with generalized linear models, while overall survival and cancer-specific survival will be assessed using survival analysis models with time-varying covariates. The relationship between frailty (G8 ≤ 14, mG8 ≥ 6) and QoL within 12 months will be examined using mixed regression models. Discussion: Geriatric oncology screening may identify a subgroup of older patients with frailty, at risk of experiencing diminishing QoL and poor treatment adherence. With the proposed screening program, patients who require treatment modification and additional support to maintain their QoL may be identified. It is our hope, that these insights may facilitate the formation of national guidelines for the treatment of older patients with cancer.

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“…Due to favourable survival in patients with untreated localized disease, active treatment is considered beneficial only in patients with a life expectancy of at least 10 years [ 3 ]. The majority of comorbid, elderly patients will die from competing causes and the impact of their tumours’ characteristics on their 10-year overall survival is unclear [ 4 ], which necessitates the prediction of life expectancy in patients with PCa as a part of clinical practice [ 5 , 6 , 7 , 8 ]. Simultaneously, stratifying survival in patients treated with curative intent remains challenging due to favourable prognoses and extensive censoring in observational studies, leaving the definition of the patient at risk of early death yet to be specified.…”

Section: Introductionmentioning

confidence: 99%

The Clinical Utility of Systemic Immune-Inflammation Index Supporting Charlson Comorbidity Index and CAPRA-S Score in Determining Survival after Radical Prostatectomy—A Single Centre Study

Zapała

Garbas

Lewandowski

et al. 2022

Cancers

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The selection of candidates for the curative treatment of PCa requires a careful assessment of life expectancy. Recently, blood-count inflammatory markers have been introduced as prognosticators of oncological and non-oncological outcomes in different settings. This retrospective, monocentric study included 421 patients treated with radical prostatectomy (RP) for nonmetastatic PCa and aimed at determining the utility of a preoperative SII (neutrophil count × platelet count/lymphocyte count) in predicting survival after RP. Patients with high SIIs (≥900) presented significantly shorter survival (p = 0.02) and high SIIs constituted an independent predictor of overall survival [HR 2.54 (95%CI 1.24–5.21); p = 0.01] when adjusted for high (≥6) age-adjusted CCI (ACCI) [HR 2.75 (95%CI 1.27–5.95); p = 0.01] and high (≥6) CAPRA-S [HR 2.65 (95%CI 1.32–5.31); p = 0.006]. Patients with high scores (ACCI and/or CAPRA-S) and high SIIs were at the highest risk of death (p < 0.0001) with approximately a one-year survival loss during the first seven years after surgery. In subgroup of high CAPRA-S (≥6), patients with high ACCIs and high SIIs were at the highest risk of death (p <0.0001). Our study introduces the SII as a straightforward marker of mortality after RP that can be helpful in pre- and postoperative decision-making.

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Clinical judgment versus geriatric assessment for frailty in older patients with cancer

Cited by 20 publications

References 25 publications

Thoracic surgery with geriatric assessment and collaboration can prepare frail older adults for lung cancer surgery

Thoracic surgery with geriatric assessment and collaboration can prepare frail older adults for lung cancer surgery

Predictive Value of Geriatric Oncology Screening and Geriatric Assessment in Older Patients with Solid Cancers: Protocol for a Danish prospective cohort study (PROGNOSIS-G8)

The Clinical Utility of Systemic Immune-Inflammation Index Supporting Charlson Comorbidity Index and CAPRA-S Score in Determining Survival after Radical Prostatectomy—A Single Centre Study

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