Geriatric assessment factors are associated with mortality after hospitalization in older adults with cancer

Jonna, Sushma; Chiang, Leslie; Liu, Jing‐Xia; Carroll, Maria; Flood, Kellie L.; Wildes, Tanya M.

doi:10.1007/s00520-016-3334-8

Cited by 18 publications

(22 citation statements)

References 38 publications

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“…15,18,44 In accordance with our first analyses, most studies have focused on the most prognostic individual GA components to improve the identification of patients with an increased mortality risk for appropriate interventions. 15,18,44 In accordance with our first analyses, most studies have focused on the most prognostic individual GA components to improve the identification of patients with an increased mortality risk for appropriate interventions.…”

Section: Discussionmentioning

confidence: 62%

“…Several studies have evaluated the association between GA and mortality in patients with cancer for different purposes. 15,18,44 In accordance with our first analyses, most studies have focused on the most prognostic individual GA components to improve the identification of patients with an increased mortality risk for appropriate interventions. From these analyses, it can be concluded that GA has some prognostic value, but because of inconsistent results, no specific recommendations can be made to guide treatment decision making.…”

Section: Discussionmentioning

confidence: 62%

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The added value of geriatric screening and assessment for predicting overall survival in older patients with cancer

Kenis

Baitar

Decoster

et al. 2018

Cancer

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BACKGROUND:The aim of this study was to determine and compare the added prognostic value of screening tools, geriatric assessment (GA) components, and GA summaries to clinical information for overall survival (OS) in older patients with cancer. METHODS: A screening and a 10-item GA were systematically performed in patients ≥70 years old with cancer. Cox regression analyses were conducted to evaluate the added prognostic value for OS of screening tools, GA, and GA summaries to clinical information (age, stage, and tumor type) in 2 cohorts (A and B). Cox models were compared on the basis of the Akaike information criterion and the concordance probability estimate. The 2 cohorts for the analyses were similar but independent. RESULTS: A complete case analysis was available for 763 patients (median age, 76 years) in cohort A and for 402 patients (median age, 77 years) in cohort B. In both cohorts, most individual GA components were independent prognostic factors for OS. Nutritional status (assessed with the Mini Nutritional Assessment Short Form) and functional status (assessed with the Instrumental Activities of Daily Living) consistently displayed a strong capacity to predict OS. Less consistent results were found for screening tools. GA summaries performed the best in comparison with the screening tools and the individual GA components. CONCLUSIONS: Most individual GA components, especially nutritional status and functional status, are prognostic factors for OS in older patients with cancer. GA summaries provide more prognostic information than individual GA components but only moderately improve the prognostic baseline model with clinical information.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 62%

The added value of geriatric screening and assessment for predicting overall survival in older patients with cancer

Kenis

Baitar

Decoster

et al. 2018

Cancer

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“…Dependency, impaired mobility, comorbidities and cognitive impairment are known to have a negative effect on the overall mortality of older patients with cancer, but not on cancer mortality 9,10,12,13,24–26 . This study is therefore the first to highlight an association with cancer death.…”

Section: Discussionmentioning

confidence: 69%

Cancer mortality and competing causes of death in older adults with cancer: A prospective, multicentre cohort study (ELCAPA‐19)

Assouan,

Paillaud,

Caillet

et al. 2023

Cancer Medicine

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BackgroundIn older patients with cancer, comorbidities compete with cancer for cause of death. The objectives were to evaluate cancer mortality and factors associated, according to metastatic status.MethodsBetween 2007 and 2014, patients with cancer aged ≥70 referred for pre‐therapeutic geriatric assessment (GA) were included through the ELCAPA prospective cohort study. The underlying cause of death was defined according to the International Classification of Diseases, 10th Revision. The World Health Organisation definition was used to categorise the cause of death as cancer versus another disease (e.g. cardiovascular disease, infectious disease, etc.) Competing risk models were used.ResultsMean (SD) age of the 1445 included patients was 80.2 (5.8) and 48% were women. Most common tumour sites were colorectal (19%), breast (17%) and urinary (15%); 773 patients (49%) had metastases. After a 34‐month median follow‐up, 706 cancer deaths were observed among 843 deaths. The 6‐month and 3‐year cancer mortality rates (95% CI) were 12% (9–15) and 34% (29–38) for non‐metastatic patients and 43% (39–47) and 79% (75–82) for metastatic patients, respectively. Dependency in activities of daily living and comorbidities were associated with 6‐month and 3‐year cancer mortality in non‐metastatic (adjusted subhazard ratio [aSHR] = 1.68 [0.99–2.85] and 1.69 [1.16–2.45]; and 1.98 [1.08–3.63] and 3.38 [1.47–7.76], respectively) and metastatic patients (aSHR = 2.81 [2.01–3.93] and 2.95 [2.14–4.07]; and 1.63 [1.18–2.25] and 2.06 [1.39–3.05], respectively). Impaired Timed‐Get‐Up‐and‐Go test was associated with 6‐month and 3‐year cancer mortality in metastatic patients (aSHR = 1.5 [1.06–2.12] and 1.38 [1.06–1.81], respectively). Obesity was negatively associated with 3‐year cancer death in non‐metastatic (aSHR = 0.53 [0.29–0.97]) and metastatic patients (aSHR = 0.71 [0.51–1.00]).ConclusionsThe majority of older adults with cancer referred for pre‐therapeutic GA die from cancer. Geriatric parameters are independently associated with cancer mortality and should be considered for prognosis assessment, decision‐making and care.

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“…The data in the literature show that elderly cancer patients more frequently may have the following problems: increased risk of therapy toxicity, risk of hospitalization, total dependence on the caregiver, reduced motivation for treatment, and difficulty in reaching the treatment center [24]. However, tolerability to active cancer improves for elderly patients by integrating early supportive care.…”

Section: Discussionmentioning

confidence: 99%

Integration between Geriatric Oncology and Palliative Care: A Single Center Experience for Hospitalized Older Patients with Cancer

Liguigli¹,

Cengarle²,

Rimanti³

et al. 2023

OBM Geriatr

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Comprehensive Geriatric Assessment (CGA) is utilized to plan social and health care of the elderly and to complete the diagnostic-therapeutic choice of oncologist also considering early integration with palliative care. Cancer patients (pts) hospitalized aged ≥70 years were screened by the G8 questionnaire to define if necessary CGA. CGA identified: fit, unfit and frail pts. We screened 95 pts by G8 and 93 (98%) were at risk. Pts at risk, evaluated by CGA resulted: 3 fit, 45 unfit and 45 frail. 3 fit pts received standard medical or surgical therapy. 41 unfit pts (91%) received personalized care and 4 pts got worse quickly and died. The median age was 76 and median score IADL/ADL (Instrumental/Activities Daily Living) was 5. Malnutrition was present in 31% and MMSE (Mini-Mental State Examination) was normal in 62%. Among these 45 pts, 32 died with a median survival of 120 days: 14 at home, 13 in hospice and 5 during hospitalization. Among 45 frail pts, 3 received personalized care and 42 received the Best Supportive Care. The median age was 81 and the median score IADL/ADL was 2. Malnutrition was present in 55%, and MMSE was normal in 22%. Among these 45 pts 40 died with a median survival of 36 days: 12 at home, 24 in hospice, and 4 during hospitalization. Unfit pts have a better functional, cognitive and nutritional status than frail pts. Early integration between geriatric oncology and palliative care represents the possibility of create a personalized care pathway especially for frail pts.

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Geriatric assessment factors are associated with mortality after hospitalization in older adults with cancer

Cited by 18 publications

References 38 publications

The added value of geriatric screening and assessment for predicting overall survival in older patients with cancer

The added value of geriatric screening and assessment for predicting overall survival in older patients with cancer

Cancer mortality and competing causes of death in older adults with cancer: A prospective, multicentre cohort study (ELCAPA‐19)

Integration between Geriatric Oncology and Palliative Care: A Single Center Experience for Hospitalized Older Patients with Cancer

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