The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients – A systematic review

Hamaker, Marije E.; Molder, Marthe te; Thielen, Noortje; Munster, Barbara C. Van; Schiphorst, A. H. W.; Huis, Lieke H. van

doi:10.1016/j.jgo.2018.03.014

Cited by 208 publications

(166 citation statements)

References 42 publications

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“…In previous studies exploring the impact of geriatric evaluations on treatment decisions in older patients with cancer, the oncologic treatment was modified in 8 to 54% of all patients (with a median of 28%) (14). In our study, the initial cancer treatment plan was changed in only 16.7 % of patients.…”

Section: Discussionmentioning

confidence: 66%

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

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Bréchemier

Steinmeyer

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 66%

“…But there is little knowledge on which CGA domain could influence changes in cancer treatment decision. Only a few studies have tried to identify CGA parameters associated with change in cancer treatment plan (14).…”

Section: Introductionmentioning

confidence: 99%

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

Sourdet

Bréchemier

Steinmeyer

et al. 2020

Preprint

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“…The systematic review by Hamaker et al . reported that in the 35 studies that met the inclusion criteria, the oncological treatment plan was altered primarily to a less intensive treatment option after a geriatric evaluation . However, because GA have not become widespread throughout Japan, it is very difficult to carry out GA in an outpatient setting.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 The systematic review by Hamaker et al reported that in the 35 studies that met the inclusion criteria, the oncological treatment plan was altered primarily to a less intensive treatment option after a geriatric evaluation. 16 However, because GA have not become widespread throughout Japan, it is very difficult to carry out GA in an outpatient setting. We used three GA tools (CGA7, VES-13 and G8) in the present study to cover all items related to seven factors (function, comorbidity, cognition, depression, nutrition, polypharmacy and social support) that are indispensable to the evaluation of older patients with cancer that can be used in a short period of time.…”

Section: Discussionmentioning

confidence: 99%

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

Tsubata

Shiratsuki

Okuno

et al. 2019

Geriatrics Gerontology Int

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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.

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“…While often stated as a time‐consuming and infeasible process, the total time actually required by the healthcare provider is little (Hamaker, Wildes, & Rostoft, ). Additionally, the issues GA uncovers influence treatment decision‐making and course of treatment because it predicts not only treatment‐related complications and survival but also appears to improve treatment tolerance and completion (Hamaker et al, ).…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy in the oldest old: Choices and outcomes

et al. 2019

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Treatment decision‐making in older patients with cancer is difficult due to a paucity of data evaluating chemotherapy tolerability in this population. We investigated the feasibility of chemotherapy in the oldest old and performed a singl‐centre retrospective analysis of patients aged ≥80 years initiating chemotherapy for one of five common solid malignancies or non‐Hodgkin lymphoma between 2010 and 2016. Treatment plan and course were extracted from medical files. Primary outcome was whether chemotherapy was completed according to plan, defined as a calculated relative dose intensity (RDI) ≥85%. A total of 104 patients receiving 129 chemotherapy lines were included. Median age at diagnosis was 82 years (range 80–94 years). Most patients (64%) received palliative intent chemotherapy. Primary and secondary chemotherapy adaptations were implemented in 63% and 65% of the cases, and hospitalisation occurred in a quarter. 52% of all cases completed chemotherapy according to plan. Almost half of the chemotherapy regimens started in the oldest old were not completed according to plan, despite frequently implemented upfront adaptations. The decision to start chemotherapy in these patients should be carefully considered. To improve decision‐making in current practice, there is a need for the implementation of validated tools assessing chemotherapy feasibility in these patients.

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The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients – A systematic review

Cited by 208 publications

References 42 publications

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

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

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

Chemotherapy in the oldest old: Choices and outcomes

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