Impact of the comprehensive geriatric assessment on treatment decision in geriatric oncology.

Abstract

Background: The comprehensive geriatric assessment (CGA) is the gold standard in geriatric oncology to identify patients at high risk of adverse outcomes and optimize cancer and overall management. Many studies have demonstrated that CGA could modify oncologic treatment decision. However, there is little knowledge on which domains of the CGA are associated with this change. Moreover, the impact of frailty and physical performance on change in cancer treatment plan has been rarely assessed.Methods: This is a cross-sectional study of older patients with solid or hematologic cancer referred by oncologists for a geriatric evaluation before cancer treatment. A comprehensive geriatric assessment was performed by a multidisciplinary team to provide guidance for treatment decision. We performed a multivariate analysis to identify CGA domains associated with change in cancer treatment plan. Results: 418 patients, mean age 82.8 ± 5.5, were included between October 2011 and January 2016, and 384 of them were referred with an initial cancer treatment plan. This initial cancer treatment plan was changed in 64 patients (16.7 %). In multivariate analysis, CGA domains associated with change in cancer treatment plan were cognitive impairment according to the MMSE score (p=0.020), malnutrition according to the MNA score (p=0.023), and low physical performance according to the Short Physical Performance Battery (p=0.010). Conclusion: Cognition, malnutrition and low physical performance are significantly associated with change in cancer treatment plan in older adults with cancer. More studies are needed to evaluate their association with survival, treatment toxicity and quality of life. The role of physical performance should be specifically explored.

Comprehensive geriatric assessment: Valuation and patient preferences in older Japanese adults with cancer

“…Previous studies have compared the patient characteristics of those with and without a change in treatment decision after a geriatric evaluation. [28][29][30] These studies showed that more impairments in geriatric domains were reported in patients whose treatment decision was modified after evaluation. As pre-frail and frail patients often have multiple geriatric problems, it is high yield to target these patients for a CGA, not only for treatment decision-making, but also for geriatric interventions.…”

“…We showed that treatment decisions were more frequently altered in patients who were pre‐frail and frail as compared with fit patients. Previous studies have compared the patient characteristics of those with and without a change in treatment decision after a geriatric evaluation 28–30 . These studies showed that more impairments in geriatric domains were reported in patients whose treatment decision was modified after evaluation.…”

Risk factors for non‐gastric‐cancer‐related death after gastrectomy in elderly patients

“…Individual risk factors for NGCaS and NGCaS by number of positive risk factors have to be validated in prospective studies with a large number of patients. Second, the analysis of risk factors for NGCaS after gastrectomy used factors from preoperative examinations usually performed before gastrectomy, such as past history, blood tests, and imaging studies, but did not include items from the detailed functional assessment of elderly patients, such as a comprehensive geriatric assessment 33–35 . Third, in this study, we cannot determine whether the patients who were found to be at high risk for non‐gastric‐cancer‐related death were originally a group of patients with a short life expectancy or whether the surgery had a negative impact on their prognosis.…”

“…[29][30][31] This indicates that it is difficult to predict the postoperative life expectancy of postoperative gastric cancer and imaging studies, but did not include items from the detailed functional assessment of elderly patients, such as a comprehensive geriatric assessment. [33][34][35] Third, in this study, we cannot determine whether the patients who were found to be at high risk for non-gastric-cancerrelated death were originally a group of patients with a short life expectancy or whether the surgery had a negative impact on their prognosis.…”

Critical Appraisal of the Concept Frailty: Rating of Frailty in Elderly People has Weak Scientific Basis and should not be Used for Managing Individual Patients

“…A current review of CGA showed that there is very great variation regarding which domains are used in CGA and which specific methods are used in each domain [23]. CGA is often carried out using rating scales in various domains [24]. Another proposal is a standardised multidimensional geriatric assessment, based on a menu of rating scales, summarised in a collective risk score for negative health outcomes [25].…”