Identification of clinical parameters predictive of one-year survival using two geriatric tools in clinically fit older patients with hematological malignancies: Major impact of cognition

Abstract

Little is known about the reliability of G8 screening tool and the prognostic value of clinical parameters within the Comprehensive Geriatric Assessment (CGA) in clinically fit older patients with haematological malignancies. This study was performed to assess the reliability of G8 as a screening tool and to determine the predictive value of CGA items in terms of one-year overall survival (OS). G8 and CGA were proposed to 107 consecutive patients (65-89yrs) with haematological malignancies that were judged clinically fit to receive chemotherapy. Ninety patients were evaluable with both scales; 72% and 80% were defined as "vulnerable" when evaluated with G8 (≤14.5) or CGA (≥2 impairments) respectively. The area under ROC-curve of G8 compared to CGA was 0.749 ± 0.051. Neither G8 nor CGA total score were predictive of one-year OS. However, age (HR=1.09, 95%CI: 1.009-1.185; p=0.029), diagnosis (HR=5.99, 95%CI: 2.322-15.428; p<0.001) and cognitive status (HR=3.50, 95%CI: 1.132-10.849; p=0.030) were predictive of OS. We conclude that in our selected haematological patients 1) the G8 score does not help selecting patients for CGA 2) the G8 and CGA total score do not predict OS 3) in addition to the age and disease itself, cognitive impairment appears to be a powerful prognostic factor.

Prevalence of Cognitive Impairment and Association With Survival Among Older Patients With Hematologic Cancers

“…37 Dementia detected as part of a geriatric evaluation was associated with poor survival among German patients with chronic lymphocytic leukemia (n = 97), 20 and cognitive impairment was predictive of mortality among 107 ostensibly clinically fit older Belgian patients with different blood cancers (hazard ratio, 3.26; 95% CI, 1.04-10.19). 19 In the United States, Klepin and colleagues 21 found that inpatients with acute myelogenous leukemia with impaired cognition had worse overall survival (n = 74).…”

The G8 screening tool enhances prognostic value to ECOG performance status in elderly cancer patients: A retrospective, single institutional study

“…In several previous studies that analyzed the association between the G8 score and OS, the cut-off value of G8 was set as 14 points [6, 12, 13, 21]. Kenis et al reported that patients with a G8 score of ≤14 significantly survived less than patients with a score of >14 in 937 elderly patients with various types of cancer [6].…”

What is known and unknown about chemotherapy‐related cognitive impairment in patients with haematological malignancies and areas of needed research

“…A longitudinal study of haematological malignancy survivors found that those with any cognitive impairment had a one-year overall survival of 63% compared to 83% for those with no cognitive impairment (hazard ratio 3.2 85% confidence interval 1.04-10.19) (Dubruille et al 2015). However, the independent value of these findings needs to be confirmed in studies that control for confounding variables including comorbidities.…”

“…Haematological malignancies are usually systemic, and often treated with chemotherapeutic agents that have been implicated in CRCI in solid tumours. The growing literature in this area suggests that cognition is an important predictor of survival in patients with haematological malignancies (Dubruille et al, 2015) and therefore, understanding factors that lead to CRCI in haematological malignancies warrants attention.…”