Prospective clinical trial evaluating vulnerability and chemotherapy risk using geriatric assessment tools in older patients with lung cancer

Abstract

AimIn Japan, the number of older patients with cancer has been increasing. Assessment of performance status, cognitive function and social background is necessary for the treatment of older patients. The aims of the present study were: (i) to establish an evaluation system using electronic medical records; and (ii) to distinguish older patients as fit versus vulnerable or frail according to a geriatric assessment (GA) system score.MethodsWe incorporated GA tools in our electronic medical records system and carried out comprehensive assessments for patients with newly diagnosed lung cancer aged ≥65 years. The decision about primary treatment followed consultation with the clinical team and was not guided by GA scores. Subsequent treatment and outcomes were recorded.ResultsA total of 100 patients had completed GA. The average age was 75 years (range 65–94 years). Regarding GA results, 63% were positive on the Comprehensive Geriatric Assessment 7, 39% on the Vulnerable Elderly Survey‐13 and 84% on the Geriatric 8. The percentage of vulnerable patients (positive on all three GA) was significantly higher in the non‐standard therapy group (n = 19) than in the standard therapy group (n = 81; 78.9% vs 21.0%, P < 0.001). Among vulnerable patients who received standard therapy, 47% discontinued chemotherapy as a result of toxicity. Even if a patient was considered vulnerable based on GA scores, chemotherapy is possibly safe for those with EGFR mutations.ConclusionsWe confirmed the feasibility of this system. During decision‐making for older patients with cancer, a combination of GA helps prevent undertreatment or overtreatment. Geriatr Gerontol Int 2019; 19: 1108–1111.

Impacts of Frailty on Prognosis in Lung Cancer Patients: A Systematic Review and Meta-Analysis

“…The prognosis of treatment is not only related to the cancer, but also related to the patient's physical and functional status. Comprehensive geriatric assessment (CGA) may help clinicians to define patients as fit, vulnerable or unfit to treatment (11,12). Nevertheless, a phase III trail found the use of CGA to choose treatment did not improve survival but reduce treatment toxicity (13).…”

Age-Based Comparison of Hematological Toxicity in Patients with Lung Cancer

“…The Geriatric Oncology Guidelines published by the American Society of Clinical Oncology recommend the use of either CARG (Cancer and Aging Research Group) or CRASH (Chemotherapy Risk Assessment Scale for High-Age Patients) criteria to estimate the chemotherapy toxicity risk [4, 19]. A vulnerability evaluation using geriatric assessment tools could predict toxicity, failure, and outcomes of chemotherapy in older patients with lung cancer [20].…”

Factors associated with maintaining walking ability postoperation for hip fractures and the predictive value of the CGA7 score for postoperative walking ability

“…The CGA7 is a screening tool that extracts seven key items from a total of 40 items on four validated scales: the Barthel Index, the revised version of Hasegawa's Dementia Scale, the Vitality Index, and the Geriatric Depression Scale. 13,15,16 The CGA7 is used to assess aspects of the geriatric physical, psychological, and social domains. It comprises the following questions: CGA1 (motivation): "Can the subject greet the examiner by himself/herself?…”

“…However, screening tools to predict the clinical outcomes of hip fractures have been investigated. [10][11][12][13] Several screening tools may be applied, although faster and easier screening should be required. The conventional Comprehensive Geriatric Assessment (CGA) is a favorable tool for assessing patients with hip fractures.…”