Patterns of care and survival in cancer patients with cognitive impairment

Robb, Claire; Boulware, David; Overcash, Janine; Extermann, Martine

doi:10.1016/j.critrevonc.2009.07.002

Cited by 76 publications

(59 citation statements)

References 20 publications

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“…This result is concordant with other studies that have demonstrated that older cancer patients with cognitive impairment have a higher risk of death compared to those with normal cognitive function (28)(29)(30). These results can be easily explained.…”

Section: Discussionsupporting

confidence: 92%

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

Dubruille

Libert

Roos

et al. 2015

Journal of Geriatric Oncology

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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.

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Section: Discussionsupporting

confidence: 92%

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

Dubruille

Libert

Roos

et al. 2015

Journal of Geriatric Oncology

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“…35 These impairment were independently associated with worse outcomes in patients with cancer. [38][39][40][41][42] Second, geriatric assessment can predict survival and adverse events of treatment to assist clinical decision making. Treatment decisions in older patients with cancer can be challenging, as other comorbid conditions may limit life expectancy and the ability to tolerate oncologic treatment.…”

Section: Why Perform a Geriatric Assessment?mentioning

confidence: 99%

What Every Oncologist Should Know About Geriatric Assessment for Older Patients With Cancer: Young International Society of Geriatric Oncology Position Paper

Loh

Soto‐Pérez‐de‐Celis

Hsu

et al. 2018

JOP

134

105

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Aging is a heterogeneous process. Most newly diagnosed cancers occur in older adults, and it is important to understand a patient's underlying health status when making treatment decisions. A geriatric assessment provides a detailed evaluation of medical, psychosocial, and functional problems in older patients with cancer. Specifically, it can identify areas of vulnerability, predict survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice; however, the uptake is hampered by limitations in both time and resources, as well as by a lack of expert interpretation. In this review, we describe the utility of geriatric assessment by using an illustrative case and provide a practical approach to geriatric assessment in oncology. CASE J.K. is a 73-year-old man who presented to his primary care physician complaining of bright red blood per rectum. He has a medical history of coronary artery disease, hypertension, hyperlipidemia, and cerebrovascular disease. He is on aspirin, lisinopril, metoprolol, and atorvastatin. A subsequent colonoscopy revealed a 3-cm mass in his descending colon. Biopsy of the mass showed invasive adenocarcinoma. He underwent computed tomography scans of the chest, abdomen, and pelvis, which showed no evidence of metastases. A laparoscopic colectomy was performed, and his cancer was staged as T2N2 (stage III) and microsatellite stable. He is referred to you to discuss adjuvant chemotherapy.

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“…The risk of hospital death from febrile neutropenia and documented infections increases markedly with the number of comorbidities as well [60]. Cognitive impairment can reduce by half the overall survival of older cancer patients [61]. Interestingly, the impact is visible in an equal proportion for patients with early and advanced stage cancer.…”

Section: The Impact Of Comorbiditymentioning

confidence: 98%

Basic Assessment of the Older Cancer Patient

Extermann

2011

Curr. Treat. Options in Oncol.

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Cancer is a disease of the elderly (median age 67 in the US), and this is a population with a variable health status. Therefore, treating the older half of the cancer population will present the challenge of not only addressing tumor diversity (the side often referred to in "personalized cancer care" discussions), but patient diversity as well as the interaction between these two heterogeneities. In that sense, geriatric oncology is the ultimate personalized cancer care. In this article, we will address the recent updates in the basic assessment of the patient's condition, and their implication for clinical and research use. The main progresses reported in the last couple of years pertain to geriatric screening tests, and to prediction of the tolerance to treatment. Some important data on the impact of comorbidities on cancer behavior have emerged, but the clinical implications of these data are still being sorted out. We recommend a two-step approach to the basic evaluation of the older cancer patient. First a short screening with a tested screening instrument. Then further work-up of the geriatric findings in parallel with the oncology work-up to define an integrated treatment plan.

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Patterns of care and survival in cancer patients with cognitive impairment

Cited by 76 publications

References 20 publications

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

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

What Every Oncologist Should Know About Geriatric Assessment for Older Patients With Cancer: Young International Society of Geriatric Oncology Position Paper

Basic Assessment of the Older Cancer Patient

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