The Effect of A Geriatric Assessment on Treatment Decisions for Patients with Lung Cancer

Abstract

BackgroundDecision-making for older patients with lung cancer can be complex and challenging. A geriatric assessment (GA) may be helpful and is increasingly being used since 2005 when SIOG advised to incorporate this in standard work-up for the elderly with cancer. Our aim was to evaluate the value of a geriatric assessment in decision-making for patients with lung cancer.MethodsBetween January 2014 and April 2016, data on patients with lung cancer from two teaching hospitals in the Netherlands were entered in a prospective database. Outcome of geriatric assessment, non-oncologic interventions, and suggested adaptations of oncologic treatment proposals were evaluated.Results83 patients (median age 79 years) were analyzed with a geriatric assessment, of which 59% were treated with a curative intent. Half of the patients were classified as ECOG PS 0 or 1. The majority of the patients (78%) suffered from geriatric impairments and 43% (n = 35) of the patients suffered from three or more geriatric impairments (out of eight analyzed domains). Nutritional status was most frequently impaired (52%). Previously undiagnosed impairments were identified in 58% of the patients, and non-oncologic interventions were advised for 43%. For 33% of patients, adaptations of the oncologic treatment were proposed. Patients with higher number of geriatric impairments more often were advised a reduced or less intensive treatment (p < 0.001).ConclusionA geriatric assessment uncovers previously unknown health impairments and provides important guidance for tailored treatment decisions in patients with lung cancer. More research on GA-stratified treatment decisions is needed.

Geriatric assessment in clinical practice for patients with stage IV non-small-cell lung cancer: The Grup de Investigació I Divulgació Oncològica experience

“…Our study results strongly support this observation, since the presence of multiple geriatric impairments was observed in patients with good PS who, accordingly, were classified as vulnerable or frail based on GA. These results are consistent with literature reviews (Schulkes et al, 2016) and previous studies (Decoster et al, 2017) (Schulkes et al, 2017).…”

“…In this regard, GA‐stratified treatment allocation in NSCLC patients previously demonstrated benefits in the ESOGIA clinical trial, where, despite the lack of improvement in terms of survival, decreased overall toxicity and lower treatment aggressivity were reported (Corre et al, ). Indeed, lower all‐grade toxicity and less aggressive treatment with no loss of efficacy are important arguments in favour of allocating treatment on the basis of the GA, and this concept has been supported by other studies (Schulkes et al, ).…”

“…Indeed, lower all-grade toxicity and less aggressive treatment with no loss of efficacy are important arguments in favour of allocating treatment on the basis of the GA, and this concept has been supported by other studies (Schulkes et al, 2016(Schulkes et al, , 2017.…”

Immune Checkpoint Inhibitors in Real‐World Treatment of Older Adults with Non–Small Cell Lung Cancer

“…The role of geriatric assessment (GA) has been gradually incorporated into clinical practice since its introduction by the International Society of Geriatric Oncology (SIOG) in 2005 . GA was shown to be instrumental in chemotherapy treatment decision making for older adults with NSCLC . In addition, GA may be able to better define older patients’ functional status (“physiologic age”) rather than reliance merely on age cutoffs (“chronologic age”) .…”

“…34 GA was shown to be instrumental in chemotherapy treatment decision making for older adults with NSCLC. 6,35,36 In addition, GA may be able to better define older patients' functional status ("physiologic age") rather than reliance merely on age cutoffs ("chronologic age"). 37 Currently, GA is recommended to aid in such decision making for older adults with cancer by multiple organizations including the SIOG, American Society of Clinical Oncology (ASCO), and National Comprehensive Cancer Network.…”