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

Caillet, Philippe; Canouï‐Poitrine, Florence; Vouriot, Johanna; Berle, M.; Reinald, Nicoleta; Krypciak, Sébastien; Bastuji‐Garin, Sylvie; Culine, Stéphane; Paillaud, Éléna

doi:10.1200/jco.2010.31.0664

Cited by 378 publications

(255 citation statements)

References 44 publications

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“…A systematic assessment aids in staging the aging, thereby discriminating between fit and relatively vulnerable patients (44), and it reveals deficits that are not routinely captured in standard history and examination (8). A multidisciplinary discussion on the basis of the results of a GA can lead to adjustments of initial treatment proposals in elderly patients in the oncology department by either increasing or decreasing the treatment intensity (45,46).…”

Section: Discussionmentioning

confidence: 99%

“…Concrete information on impaired domains that could compromise dialysis treatment may facilitate shared decision making with the patient and relatives. In addition, it may reveal treatable conditions that would otherwise be overlooked (4,48), thereby forming a starting point for (preventive) interventions to optimize quality of life, such as physical and ADL impairments and social problems (45,49). Finally, the information derived from a GA may help to estimate adverse outcomes of surgical interventions (50) and other complex interventions (51).…”

Section: Discussionmentioning

confidence: 99%

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The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

Loon

Wouters²,

Boereboom

et al. 2016

CJASN

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Background and objectives With aging of the general population, patients who enter dialysis therapy will more frequently have geriatric impairments and a considerable comorbidity burden. The most vulnerable among these patients might benefit from conservative therapy. Whether assessment of geriatric impairments would contribute to the decision-making process of dialysis initiation is unknown.Design, setting, participants, & measurements A systematic Medline and Embase search was performed on December 1, 2015 to identify studies assessing the association between risk of mortality or hospitalization and one or more geriatric impairments at the start of dialysis therapy, including impairment of cognitive function, mood, performance status or (instrumental) activities of daily living, mobility (including falls), social environment, or nutritional status.Results Twenty-seven studies were identified that assessed one or more geriatric impairments with respect to prognosis. The quality of most studies was moderate. Only seven studies carried out an analysis of elderly patients ($70 years old). Malnutrition and frailty were systematically assessed, and their relation with mortality was clear. In addition, cognitive impairment and functional outcomes at the initiation of dialysis were related to an increased mortality in most studies. However, not all studies applied systematic assessment tools, thereby potentially missing relevant impairment. None of the studies applied a geriatric assessment across multiple domains.Conclusions Geriatric impairment across multiple domains at dialysis initiation is related to poor outcome. However, information in the elderly is sparse, and a systematic approach of multiple domains with respect to poor outcome has not been performed. Because a geriatric assessment has proved useful in predicting outcome in other medical fields, its potential role in the ESRD population should be the subject of future research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

Loon

Wouters²,

Boereboom

et al. 2016

CJASN

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“…To assess the profile of each individual patient, a multidimensional geriatric assessment (GA) [2,3].The GA produces an inventory of health problems and an assessment of physical, psychosocial, and functional capabilities [4].The GA has proved useful for characterizing health and functional impairments potentially associated with oncological outcomes [2,[5][6][7]. Nevertheless, it requires considerable time and human resources and is actually not required in all patients [6].…”

Section: Introductionmentioning

confidence: 99%

Optimizing the G8 Screening Tool for Older Patients With Cancer: Diagnostic Performance and Validation of a Six-Item Version

Martínez-Tapia¹,

Canouï‐Poitrine

Bastuji‐Garin³

et al. 2016

The Oncologist

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Background. A multidimensional geriatric assessment (GA) is recommended in older cancer patients to inventory health problems and tailor treatment decisions accordingly but requires considerable time and human resources. The G8 is among the most sensitive screening tools for selecting patients warranting a full GA but has limited specificity. We sought to develop and validate an optimized version of the G8. Patients and Methods. We used a prospective cohort of cancer patients aged $70 years referred to geriatricians for GA (2007)(2008)(2009)(2010)(2011)(2012): n 5 729 [training set]; 2012-2014: n 5 414 [validation set]). Abnormal GA was defined as at least one impaired domain across seven validated tests. Multiple correspondence analysis, multivariate logistic regression, and bootstrapped internal validation were performed sequentially.Results. The final model included six independent predictors for abnormal GA: weight loss, cognition/mood, performance

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“…CGA is also used to identify patients at increased risk of adverse outcomes and guide management (21). In previous studies, the CGA tool and the frailty index for geriatric cancer patients were shown to provide valuable information through the prediction of complications from chemotherapy and tolerance to treatment (22,23).…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of chemotherapy for geriatric patients with advanced or recurrent gastric cancer

Kawaguchi

Komatsu

Ichikawa

et al. 2014

Molecular and Clinical Oncology

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Abstract. Recent clinical trials, such as JCOG9912 and SPIRITS, excluded geriatric patients aged ≥75 years. The clinical significance of intensive chemotherapy for geriatric patients with advanced or recurrent gastric cancer remains unclear. Between 2002 and 2010, 54 consecutive advanced or recurrent gastric cancer patients aged ≥75 years were enrolled in this study. We analyzed the predictors of chemotherapy administration and evaluated the survival benefit of chemotherapy for geriatric patients with advanced or recurrent gastric cancer.

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

Abstract: Functional status assessed by the ADL score and malnutrition were independently associated with changes in cancer treatment.

Cited by 378 publications

References 44 publications

The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

Optimizing the G8 Screening Tool for Older Patients With Cancer: Diagnostic Performance and Validation of a Six-Item Version

Clinical significance of chemotherapy for geriatric patients with advanced or recurrent gastric cancer

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