Relevance of Geriatric Assessment in Older Patients With Colorectal Cancer

Decoster, Lore; Vanacker, Leen; Kenis, Cindy; Prenen, Hans; Cutsem, E. Van; Auwera, Jacques Van der; Eetvelde, Ellen Van; Puyvelde, Katrien Van; Flamaing, Johan; Milisen, Koen; Lobelle, Jean Pierre; Grève, Jacques De; Wildiers, Hans

doi:10.1016/j.clcc.2016.07.010

Cited by 27 publications

(34 citation statements)

References 26 publications

(43 reference statements)

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“…VES-13 outperformed Eastern Cooperative Oncology Group Performance Status (ECOG PS) and age. In a study of treatment delivery in older patients with CRC, the authors found that 20% of patients who were fit according to the GA did not receive standard treatment [33], and interpreted this as under-treatment. They also found that 58% of patients who were considered at risk based on the GA did receive standard treatment, with a subsequent risk of over-treatment.…”

Section: Geriatric Assessment and Colorectal Cancermentioning

confidence: 99%

Integration of Geriatric Assessment in the Care of Patients with Gastrointestinal Malignancies

Rostoft

2017

Visc Med

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Background: The majority of patients with gastrointestinal (GI) malignancies are older. Recently, it has become evident that elements from a geriatric assessment (GA) are powerful predictors of outcomes such as postoperative morbidity and mortality, length of stay, type of treatment received, and survival across several GI tumor types in older adults. A GA is a systematic evaluation of functional status, comorbidities, polypharmacy, cognition, nutritional status, emotional status, and social support. Methods: A PubMed search was performed in order to identify clinical studies investigating the association between GA and outcomes in patients with GI malignancies. Results: A total of 31 studies were included in this review. For colorectal cancer, the evidence linking GA variables and frailty to negative outcomes is substantial and consistent. The data regarding other GI malignancies is more limited, but generally shows the same findings. Conclusion: Increasing data shows that elements from a GA and frailty are consistently associated with negative short- and long-term treatment outcomes in older patients with GI malignancies. Future studies should investigate the impact of geriatric interventions on outcomes.

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Section: Geriatric Assessment and Colorectal Cancermentioning

confidence: 99%

Integration of Geriatric Assessment in the Care of Patients with Gastrointestinal Malignancies

Rostoft

2017

Visc Med

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“…In the present study only 14.6% of patients presented with an ECOG-PS ≥ 2, while in 66.8% of patients at least two out of seven GA deficiencies were detected. In this heterogeneous mCRC population, commonly used PS scales therefore seem inferior to GA for making a clear distinction between fit and unfit patients, mainly because PS scales are normally assigned using cancer-related PS and not geriatric parameters such as non-cancer related functional status or comorbidities [38,39].…”

Section: Discussionmentioning

confidence: 99%

Integrating geriatric assessment in the first line chemotherapy treatment in older patients with metastatic colorectal cancer: Results of a prospective observational cohort study (AVAPLUS)

Decoster

Kenis

Naessens³

et al. 2018

Journal of Geriatric Oncology

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This study aims to investigate the use of chemotherapy with or without bevacizumab in older patients with metastatic colorectal cancer (mCRC) in current daily practice and to identify predictive parameters for treatment-related outcomes. Patients and Methods: This is a Belgian multi-centre, observational cohort study. Patients ≥ 70 years old with mCRC considered suitable for first-line chemotherapy were eligible for inclusion. At baseline geriatric screening and assessment was performed. Treatment choice was at the discretion of the investigator. Treatment duration, Progression Free Survival (PFS) and safety were recorded. Results: Between August 2011 and July 2013, 252 patients with mCRC were included of which 50.8% were treated with bevacizumab. Median treatment duration was 5.5 months and median PFS was 8.9 months. Approximately 50% of patients experienced severe adverse events, most frequently diarrhea. In multivariate analysis, baseline Eastern Cooperative Oncology Group (ECOG)-performance status (PS) was predictive for treatment duration (p = 0.0047), PFS (p b 0.0001) and severe toxicity and baseline nutritional status for PFS (p = 0.0007). In patients with a good ECOG-PS, nutritional status was predictive for PFS. Conclusions: In current daily practice in Belgium, half of older patients with colorectal cancer treated with chemotherapy also receive bevacizumab. Nearly half of older patients presented with severe toxicity during treatment. Baseline nutritional status is a predictive marker for PFS. Patients with a baseline ECOG-PS ≥ 2 have shorter PFS and higher risk of severe toxicity and should therefore be treated with caution.

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“…With longer and healthier living, the number of older adults with colon cancer is rising, comprising the greatest proportion of new colon cancers—now one of the most common cancers in those older than 75 years [ 1 , 3 , 4 , 5 , 6 ]. Considerable efforts have focused on tailoring treatment approaches for older adults with colorectal cancer by considering the heterogeneity of health statuses in older adults highlighted by the concepts of physiologic age and frailty [ 7 , 8 , 9 , 10 , 11 ]. Furthermore, advancements in minimally invasive surgical and endoscopic techniques offer added benefits for older adults [ 12 , 13 , 14 ].…”

Section: Are Older Adults Represented In Current Colorectal Cancer Screening Guidelines?mentioning

confidence: 99%

“…While the comprehensive geriatric assessment is the reference standard process to determine multidimensional health status and develop integrated management plans for older adults, this is not feasible for all older adults and abbreviated screening strategies are advocated [ 36 , 37 ]. This strategy recognizes that an individual’s health status is better understood as multidimensional, including physical, functional, cognitive, and social elements rather than chronologic age alone [ 7 , 8 ]. Many suggested screening tools aim to identify frailty, a state of vulnerability to stressors and increased risk of adverse health outcomes due to multisystem decline in physiologic reserve and function [ 9 , 38 , 39 ].…”

Section: What Unique Considerations Are Needed When Assessing Older Adults For Screening?mentioning

confidence: 99%

What Should We Recommend for Colorectal Cancer Screening in Adults Aged 75 and Older?

2021

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The current recommendation to stop colorectal cancer screening for older adults is based on a lack of evidence due to systematic exclusion of this population from trials. Older adults are a heterogenous population with many available strategies for patient-centered assessment and decision-making. Evolutions in management strategies for colorectal cancer have made safe and effective options available to older adults, and the rationale to screen for treatable disease more reasonably, especially given the aging Canadian population. In this commentary, we review the current screening guidelines and the evidence upon which they were built, the unique considerations for screening older adults, new treatment options, the risks and benefits of increased screening and potential considerations for the new guidelines.

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Relevance of Geriatric Assessment in Older Patients With Colorectal Cancer

Cited by 27 publications

References 26 publications

Integration of Geriatric Assessment in the Care of Patients with Gastrointestinal Malignancies

Integration of Geriatric Assessment in the Care of Patients with Gastrointestinal Malignancies

Integrating geriatric assessment in the first line chemotherapy treatment in older patients with metastatic colorectal cancer: Results of a prospective observational cohort study (AVAPLUS)

What Should We Recommend for Colorectal Cancer Screening in Adults Aged 75 and Older?

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