Comprehensive Geriatric Assessment and quality of life after localized prostate cancer radiotherapy in elderly patients

Abstract

IntroductionRadiotherapy can diminish quality of life (QoL) for prostate cancer patients. Our objective was to evaluate the effect of radiotherapy on QoL in men aged 75 years or older treated with radiotherapy for a localized prostate cancer, and to identify predictors of reduced QoL.Patients and methodsWe prospectively administered a battery of geriatric (MNA, GDS, Get up and Go Test, CIRS-G, ADL, IADL, MMSE), toxicity (IPSS; IIEF 5), and QoL (QLQ C30) screening tests in 100 elderly patients before and two months after prostate cancer radiotherapy (NCT 02876237). Patients ≥ 75 years undergoing radiotherapy with a curative intent for localized prostate cancer with or without androgen deprivation therapy (ADL) were eligible for study inclusion. Correlations between patient-assessed QoL and tumor characteristics, radiotherapy treatment or CGA parameters were sought using the Fisher or the Mann and Whitney tests. Changes in QoL parameters over time were analyzed using the Wilcoxon signed-rank test.ResultsAt study entry, scores for IADL impairments were present in 51%, reduced autonomy in activities of daily living in 16%, cognitive impairment found in 20%, depression-related symptoms in 31%, and 66% of patients had significant co-morbidities. Eight percent were judged to be at risk of fall and 2% were found to be undernourished. Severely impaired (IPSS ≥ 20) urinary function was observed in 11.2% and 13.5% of patients before and two months after completion of radiotherapy respectively. Significantly decreased QoL (> 20 points) at two months after treatment was found in 13% of patients and a moderate but clinically relevant reduction (10 to 20 points) in 17% of patients. No tumor characteristic, treatment, or oncogeriatric parameter was predictive of reduced QoL following prostate cancer radiotherapy.ConclusionDespite sometimes markedly diminished oncogeriatric parameters, prostate cancer radiotherapy was generally well tolerated in these elderly patients. We found no predictive factor to determine which patients would experience impaired quality of life following radiotherapy.

Impact of Androgen Deprivation Therapy Associated to Conformal Radiotherapy in the Treatment of D’Amico Intermediate-/High-Risk Prostate Cancer in Older Patients

“…Only a minority of the population (≤3%) experienced grade ≥3 post-radiation AE in comparison with other study [ 25 ]. Older age (>70 years) was a risk factor for increased urinary toxicity in some studies; these results contrast with our work and Goineau et al study [ 26 ]. Acute and long-term gastrointestinal AE was acceptable; in literature, older age is a risk factor of digestive toxicity [ 27 ].…”

Can Comprehensive Geriatric Assessment Predict Tolerance of Radiotherapy for Localized Prostate Cancer in Men Aged 75 Years or Older?

“…The appropriate French ethics committees approved the study (number 2014-A00300-47), and all patients gave consent for participation. A detailed description of the study methods has been published previously [29].…”

Personalised treatment for older adults with cancer: The role of frailty assessment

“…Notwithstanding the limitations imposed by research design, many of these studies have indicated that CGA can influence care. Goineau et al [94], in a study of patients (n = 100; 75 years) with localised prostate cancer, undergoing radiotherapy treatment, found no association between CGA and QoL. However, they discovered IADL impairments at baseline in half of study participants, as well as ADL impairments in 16% of patients.…”