Predictive value of each geriatric assessment domain for older patients with cancer: A systematic review

Bruijnen, Cheryl P.; Harten-Krouwel, Diny G. van; Koldenhof, J.J.; Emmelot-Vonk, Mariëlle H.; Witteveen, Petronella O.

doi:10.1016/j.jgo.2019.02.010

Cited by 49 publications

(43 citation statements)

References 67 publications

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“…Possibly, CT‐based body composition measures need to be combined with functional measures such as handgrip strength and physical performance to predict relevant patient outcomes. Moreover, other domains of the Comprehensive Geriatric Assessment such as nutritional status and cognition have prognostic value and could contribute to the prediction of adverse outcomes in older patients with CRC . Future research needs to clarify the prognostic value of these measures in addition to CT‐based body composition measures over time, to predict the risk of adverse outcomes in older patients with CRC.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

Looijaard¹,

Meskers²,

Slee-Valentijn³

et al. 2019

The Oncologist

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Background Current literature is inconsistent in the associations between computed tomography (CT)‐based body composition measures and adverse outcomes in older patients with colorectal cancer (CRC). Moreover, the associations with consecutive treatment modalities have not been studied. This study compared the associations of CT‐based body composition measures with surgery‐ and chemotherapy‐related complications and survival in older patients with CRC. Materials and Methods A retrospective single‐center cohort study was conducted in patients with CRC aged ≥65 years who underwent elective surgery between 2010 and 2014. Gender‐specific standardized scores of preoperative CT‐based skeletal muscle (SM), muscle density, intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), subcutaneous adipose tissue, IMAT percentage, SM/VAT, and body mass index (BMI) were tested for their associations with severe postoperative complications, prolonged length of stay (LOS), readmission, and dose‐limiting toxicity using logistic regression and 1‐year and long‐term survival (range 3.7–6.6 years) using Cox regression. Bonferroni correction was applied to account for multiple testing. Results The study population consisted of 378 patients with CRC with a median age of 73.4 (interquartile range 69.5–78.4) years. Severe postoperative complications occurred in 13.0%, and 39.4% of patients died during follow‐up. Dose‐limiting toxicity occurred in 77.4% of patients receiving chemotherapy (n = 53). SM, muscle density, VAT, SM/VAT, and BMI were associated with surgery‐related complications, and muscle density, IMAT, IMAT percentage, and SM/VAT were associated with long‐term survival. After Bonferroni correction, no CT‐based body composition measure was significantly associated with adverse outcomes. Higher BMI was associated with prolonged LOS. Conclusion The associations between CT‐based body composition measures and adverse outcomes of consecutive treatment modalities in older patients with CRC were not consistent or statistically significant. Implications for Practice Computed tomography (CT)‐based body composition, including muscle mass, muscle density, and intermuscular, visceral, and subcutaneous adipose tissue, showed inconsistent and nonsignificant associations with surgery‐related complications, dose‐limiting toxicity, and overall survival in older adults with colorectal cancer. This study underscores the need to verify whether CT‐based body composition measures are worth implementing in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

Looijaard¹,

Meskers²,

Slee-Valentijn³

et al. 2019

The Oncologist

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“…These domains cover the four cardinal components of CGAphysical health, functional status, psychological health, and socioenvironmental factors [12][13][14]. Furthermore, almost all of the individual domains of the FI-CGA-10 were associated with adverse outcomes in older adults with cancer [58,59]. The comprehensiveness of this coverage of CGA domains supports the content validity of our new scale.…”

Section: Discussionmentioning

confidence: 74%

A 10-Item Frailty Index Based on a Comprehensive Geriatric Assessment (FI-CGA-10) in Older Adults with Cancer: Development and Construct Validation

et al. 2021

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Background. A frailty index (FI) based on domain-level deficits identified through a comprehensive geriatric assessment (CGA) has been previously developed and validated in general geriatric patients. Our objectives were to construct an FI-CGA and to assess its construct validity in the geriatric oncology setting. Methods. Five hundred forty consecutive Japanese patients with cancer who underwent a CGA on a geriatric oncology service were included (median age 80 years, range 66-96 years). We developed a 10-item frailty index based on deficits in 10 domains (FI-CGA-10): cognition, mood, communication, mobility, balance, nutrition, basic and instrumental activities of daily living, social support, and comorbidity. Deficits in each domain were scored as 0 (no problem), 0.5 (minor problem), and 1.0 (major problem). Scores were calculated by dividing the sum of the scores for each domain by 10 and then categorized as fit (<0.2), pre-frail (0.2-0.35), and frail (>0.35). Construct validity was tested by correlating the FI-CGA-10 with other established frailty measures. Results. FI-CGA-10 was well approximated by the gamma distribution. Overall, 20% of patients were fit, 41% were pre-frail, and 39% were frail. FI-CGA-10 was correlated with Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (r = 0.83), CSHA rules-based frailty definition (r = 0.67), and CSHA Function Score (r = 0.77). Increasing levels of frailty were significantly associated with functional and cognitive impairments, high comorbidity burden, poor self-rated health, and low estimated survival probabilities. Conclusion.The FI-CGA-10 is a user-friendly and constructvalidated measure for quantifying frailty from a CGA. The Oncologist 2021;26:1-10 Implications for Practice: This article describes the construction of a user-friendly 10-item frailty index based on a comprehensive geriatric assessment (FI-CGA-10) for older adults with cancer: cognition, mood, communication, mobility, balance, nutrition, basic and instrumental activities of daily living, social support, and comorbidity. The FI-CGA-10 simplifies the original FI-CGA used in the general geriatric setting while maintaining its content validity. The index's construct validity was demonstrated in a cohort of older adults with various cancer types. The advantage of the FI-CGA-10 is that a frailty score can be calculated more readily and interpreted in a more clinically sensible manner than the original FI-CGA.

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“…Our study adds to earlier studies by focusing on a broad range of geriatric domains and their accumulation in an outpatient geriatric population. To date, available literature focused mainly on the association of separate geriatric domains with mortality in specific patient categories, for example, oncology, renal or heart failure patients [12,13,15], hospitalized geriatric patients [10,11,14], or solely on individual components [2,[31][32][33], with inconsistent findings. As a result, knowledge on the relation between a CGA, its geriatric domains and mortality in an outpatient geriatric population has remained sparse.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Previous research has shown the value of separate geriatric domains in predicting adverse health outcomes in hospitalized patients or in disease-specific populations, such as oncology or heart failure populations [10][11][12][13][14][15]. To the best of our knowledge and somewhat surprising, however, the relation between different geriatric domain deficits and mortality in older patients referred to an outpatient geriatric clinic has not been studied.…”

Section: Introductionmentioning

confidence: 99%

Mortality Risk and Its Association with Geriatric Domain Deficits in Older Outpatients: The Amsterdam Ageing Cohort

et al. 2021

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Introduction: In older patients, life expectancy is determined by a complex interaction of multiple geriatric domains. A comprehensive geriatric assessment (CGA) captures different geriatric domains. Yet, if and how components of the CGA are related to mortality in an outpatient geriatric setting is unknown. In the Amsterdam Ageing Cohort, we therefore studied distribution and accumulation of geriatric domain deficits in relation to mortality. Methods: All patients received a CGA as part of standard care, independent of referral reason. We summarized deficits on the CGA, using predefined cutoffs, in 5 geriatric domains: somatic, mental, nutritional, physical, and social domain. Information on mortality was obtained from the Dutch municipal register. We used age- and sex-adjusted Cox proportional hazards analyses to relate the separate domains and accumulation of impaired domains to overall mortality. Results: From the 1,055 geriatric outpatients (53% female; age 79 ± 7 years), 172 patients (16%) had died after 1.7 ± 1.1 years. In 626 patients (59%), 3 or more domains were impaired. All domains were independently associated with mortality, with the highest hazard for the somatic domain (HR 3.7 [1.7–8.0]) and the lowest hazard for the mental domain (HR 1.5 [1.1–12.0]). In addition, accumulation of impaired domains showed a gradually increased mortality risk, ranging from HR 2.2 (0.8–6.1) for 2 domains to HR 9.6 (3.7–24.7) for all 5 domains impaired. Conclusions: This study provides evidence that impairment in multiple geriatric domains is highly prevalent and independently and cumulatively associated with mortality in an outpatient geriatric setting.

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Predictive value of each geriatric assessment domain for older patients with cancer: A systematic review

Cited by 49 publications

References 67 publications

Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

A 10-Item Frailty Index Based on a Comprehensive Geriatric Assessment (FI-CGA-10) in Older Adults with Cancer: Development and Construct Validation

Mortality Risk and Its Association with Geriatric Domain Deficits in Older Outpatients: The Amsterdam Ageing Cohort

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