Impact of comprehensive geriatric assessment on quality of life, overall survival, and unplanned admission in patients with non-small cell lung cancer treated with stereotactic body radiotherapy

Jeppesen, Stefan Starup; Matzen, Louise Hauge; Brink, Carsten; Bliucukiene, Rasa; Kasch, Søren; Schytte, Tine; Kristiansen, Charlotte; Hansen, Otto

doi:10.1016/j.jgo.2018.05.009

Cited by 25 publications

(15 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Since comorbidity influences OS, but not LCSS, it seems relevant to optimize the comorbid condition of the patients to improve survival. In a recent randomized pilot study, an attempt to improve outcome after SBRT for patients with early stage NSCLC, a comprehensive geriatric assessment (CGA) including interventions and follow-up at a Department of Geriatric Medicine was performed [18]. The study found that more patients died within the first year after SBRT in the group without a CGA performed, but the result was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Survival after stereotactic radiotherapy in patients with early-stage non-small cell lung cancer

et al. 2019

Self Cite

View full text Add to dashboard Cite

Introduction: Stereotactic radiotherapy (SBRT) is the treatment of choice for inoperable early stage non-small cell lung cancer (NSCLC). We report analyses of the influence of age on survival after SBRT. Methods and material: From 2005 to 2017, 544 previously un-irradiated patients with early stage NSCLC had SBRT. The data were analyzed in four age groups: A:-69 (176 pts), B: 70-74 (115 pts), C: 75-79 (131 pts) and D: 80 years or older (122 pts). Two SBRT dose regimes were used: 45 Gy/3F (N ¼ 103) and 66 Gy/3F (N ¼ 441). Results: All patients had a follow up (time to censoring, FU) of at least 16 months, the median FU being 48.0 months. The median age was 74.4 years. The overall survival (OS) was associated with age. The median OS was 50.7, 45.9, 45.4 and 33.0 months, and the 5-year OS was 45%, 32%, 33% and 18% in groups A, B, C and D, respectively. No difference was found between groups B and C, while OS in group A was significantly better than remaining groups, and the OS in group D significantly poorer. In multivariable analyses, OS was heavily influenced by age, Charlson's comorbidity index (CCI) and performance status (PS). For lung cancer-specific survival (LCSS), only increasing tumor diameter and PS were associated with poor survival. Conclusions: The OS was influenced by age, but the study suggests that a cut point of 75 year is inappropriate in evaluating the effect of old age on survival.

show abstract

Section: Discussionmentioning

confidence: 99%

Survival after stereotactic radiotherapy in patients with early-stage non-small cell lung cancer

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…This study presents prospectively collected long-term 4-year overall survival data from a single institutional randomized study performed in 2015-2016. The primary aim of the randomized study was to investigate the impact of CGA and interventions as needed on quality of life (QoL), and it was reported in a peer-reviewed and published paper [19]. The standard arm of the randomized study was SBRT without CGA, and the intervention arm was SBRT with CGA.…”

Section: Methodsmentioning

confidence: 99%

Combination of the G-8 Screening Tool and Hand-Grip Strength to Predict Long-Term Overall Survival in Non-Small Cell Lung Cancer Patients Undergoing Stereotactic Body Radiotherapy

Bentsen

Hansen

Ryg

et al. 2021

Cancers

Self Cite

View full text Add to dashboard Cite

The Geriatric 8 (G-8) is a known predictor of overall survival (OS) in older cancer patients, but is mainly based on nutritional aspects. This study aimed to assess if the G-8 combined with a hand-grip strength test (HGST) in patients with NSCLC treated with stereotactic body radiotherapy can predict long-term OS better than the G-8 alone. A total of 46 SBRT-treated patients with NSCLC of stage T1-T2N0M0 were included. Patients were divided into three groups: fit (normal G-8 and HGST), vulnerable (abnormal G-8 or HGST), or frail (abnormal G-8 and HGST). Statistically significant differences were found in 4-year OS between the fit, vulnerable, and frail groups (70% vs. 46% vs. 25%, p = 0.04), as well as between the normal and abnormal G-8 groups (69% vs. 39%, p = 0.02). In a multivariable analysis of OS, being vulnerable with a hazard ratio (HR) of 2.03 or frail with an HR of 3.80 indicated poorer OS, but this did not reach statistical significance. This study suggests that there might be a benefit of adding a physical test to the G-8 for more precisely predicting overall survival in SBRT-treated patients with localized NSCLC. However, this should be confirmed in a larger study population.

show abstract

“…Multiple studies show that SBRT has no negative impact on QOL (Table 4) (20,26,34,36,(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85)(86)(87) despite mostly using the more sensitive EORTC assessment (vs. the SF-36). The minimal impact on QOL is seen despite many PS2 patients and most being deemed medically inoperable.…”

Section: Long-term Qolmentioning

confidence: 99%

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 4: systematic review of evidence involving SBRT and ablation

Park¹,

Detterbeck²,

Madoff³

et al. 2022

J Thorac Dis

View full text Add to dashboard Cite

Background: Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options [lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation],weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making.Methods: A PubMed systematic review from 2000-2021 of outcomes after SBRT or thermal ablation vs. resection is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved.Results: Short-term outcomes are meaningfully better after SBRT than resection. SBRT doesn't affect quality-of-life (QOL), on average pulmonary function is not altered, but a minority of patients may experience gradual late toxicity. Adjusted non-randomized comparisons demonstrate a clinically relevant detriment in long-term outcomes after SBRT vs. surgery. The short-term benefits of SBRT over surgery are accentuated with increasing age and compromised patients, but the long-term detriment remains. Ablation is associated with a higher rate of complications than SBRT, but there is little intermediate-term impact on quality-of-life or pulmonary function tests. Adjusted comparisons show a meaningful detriment in long-term outcomes after ablation vs. surgery; there is less difference between ablation and SBRT.Conclusions: A systematic, comprehensive summary of evidence regarding Stereotactic Body Radiotherapy or thermal ablation vs. resection with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making.

show abstract

Impact of comprehensive geriatric assessment on quality of life, overall survival, and unplanned admission in patients with non-small cell lung cancer treated with stereotactic body radiotherapy

Cited by 25 publications

References 40 publications

Survival after stereotactic radiotherapy in patients with early-stage non-small cell lung cancer

Survival after stereotactic radiotherapy in patients with early-stage non-small cell lung cancer

Combination of the G-8 Screening Tool and Hand-Grip Strength to Predict Long-Term Overall Survival in Non-Small Cell Lung Cancer Patients Undergoing Stereotactic Body Radiotherapy

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 4: systematic review of evidence involving SBRT and ablation

Contact Info

Product

Resources

About