Association Between Geriatric Assessment and Post-Chemotherapy Functional Status in Older Patients with Cancer

Abstract

Background Maintaining functional status is among the most important patient-centered outcomes for older adults with cancer. This study investigated the association between comprehensive geriatric assessment (CGA) and progressive disease or decline of IADL-independence 1 year after chemotherapy, overall survival (OS), and premature termination of chemotherapy. CGA-based functional status and quality of life (QOL) 1 year after chemotherapy are also described. Methods This prospective cohort study involved patients aged ≥65 years treated with chemotherapy for any cancer type. CGA and the G8-screening tool were performed before and after the completion of chemotherapy. Analyses were adjusted for tumor type and treatment intent: (a) indolent hematological malignancies, (b) aggressive hematological malignancies, c) solid malignancies treated with curative intent, and (d) solid malignancies treated with palliative intent. Results All 291 included patients lived in The Netherlands; 193 (67.4%) lived fully independent prior to chemotherapy. The median age was 72 years; 164 (56.4%) were male. IADL independence, CGA-based functional status, and QOL were maintained in half of the patients 1 year after chemotherapy. An abnormal G8-score before chemotherapy was a higher risk for progressive disease or a decline of IADL-independence (OR 3.60, 95% CI, 1.98-6.54, P < .0001), prematurely terminated chemotherapy (OR 2.12, 95% CI, 1.24-3.65, P = .006), and shorter median OS (HR 1.71, 95% CI, 1.16-2.52, P = .007). The impact of an abnormal G8-score differed across tumor type (oncological or hematological) and treatment indication (adjuvant or palliative). Conclusion An abnormal G8 score before chemotherapy is associated with progressive disease and functional decline after chemotherapy and shorter median OS, especially in patients with solid malignancies.

Instrumental activities of daily living in older patients with metastatic prostate cancer: results from the meet-URO network ADHERE prospective study

“…CGA and the geriatric G8 screening assessments were performed before and after the completion of chemotherapy. They found that an abnormal geriatric G8 score before chemotherapy was a risk factor for a decline of IADL-independence (OR 3.60, 95% CI 1.98–6.54, p < 0.0001), prematurely terminated chemotherapy (OR 2.12, 95% CI 1.24–3.65, p = 0.006), and shorter median OS (HR 1.71, 95% CI 1.16–2.52, p = 0.007) especially in patients with solid malignancies 33 . These data, as well as our analysis, confirm the interdependence between IADL and geriatric G8 score, and how much the impairment in daily activity and cognition might impact treatment and clinical outcomes in older cancer patients.…”

Surgery vs. radiotherapy in a population-based cohort of elderly patients with early-stage small-cell lung cancer: an IPTW propensity-score analysis

“…These studies highlight that age alone should not preclude considerations of chemotherapy. A validated functional assessment tool, such as the comprehensive geriatric assessment (CGA), can be used to identify fit elderly patients who are able to receive chemotherapy and should be introduced into clinical practice ( 29 , 30 ). Our findings suggest that elderly patients should be considered for chemotherapy, and chemotherapy regimens should deviate according to each individualized patient’s performance or medical comorbidities.…”

Resectability, Resections, Survival Outcomes, and Quality of Life in Older Adult Patients with Metastatic Colorectal Cancer (the RAXO-Study)

“…Though the evidence supporting the use of CGA is already convincing in oncology [37][38][39], the lack of geriatricians is the most frequent reason for not using CGA in daily routine [40]. If a geriatrician is not available, at least a geriatric screening should be implemented to identify those in risk of frailty [41][42][43].…”