Geriatric Assessment-Identified Deficits in Older Cancer Patients With Normal Performance Status

Jolly, Trevor A.; Deal, Allison M.; Nyrop, Kirsten A.; Williams, Grant R.; Pergolotti, Mackenzi; Wood, William A.; Alston, Shani; Gordon, Brittaney Belle E.; Dixon, Samara Ann; Moore, Susan; Taylor, W. Chris; Messino, Michael J.; Muss, Hyman B.

doi:10.1634/theoncologist.2014-0247

Cited by 200 publications

(124 citation statements)

References 51 publications

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“…KPS), may reveal problems relevant to cancer care that are both amendable, and may otherwise go unrecognized (9, 49). In this sample, a majority (65%) of older adults with had a least one functional deficit defined with specific sections of the GA and chosen as being amenable by OT/PT.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer

Pergolotti

Deal

Lavery

et al. 2015

Journal of Geriatric Oncology

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134

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Background Occupational and physical therapy (OT/PT) services seek to reduce morbidity, mortality, and improve the quality of life of individuals; however, little is known about the needs and use of OT/PT for older adults with cancer. The goal of this study was to describe the functional deficits and their associations with other factors, and to examine the use of OT/PT after a noted functional deficit. Materials and Methods This study analyzed data from an institution-based registry that included geriatric assessments of older adults with cancer linked to billing claims data. Logistic regression was used to model predictors of functional deficits. Use of OT/PT was determined and validated with medical chart review. Results 529 patients with cancer, a median age of 71, 78% were female, 87% Caucasian, 57% married, 53% post-secondary education, 63% with breast cancer were included. In a multivariable model, the odds of having any functional deficits increased with age [5 year OR: 1.31, 95% CI: (1.10, 1.57)] were higher for those with a high school diploma versus those with advanced degrees [OR: 1.66, 95% CI: (1.00, 2.77)] and were higher for patients with comorbidities [OR: 1.15, 95% CI: (1.10, 1.21)]. Of patients with functional deficits only 9% (10/111) received OT/PT within 12 months of a noted deficit. Discussion The odds of having any potentially modifiable functional deficit were higher in patients with increasing age, comorbid conditions, and with less than a college degree. Few were referred for OT/PT services suggesting major underutilization of these potentially beneficial services.

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Section: Discussionmentioning

confidence: 99%

The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer

Pergolotti

Deal

Lavery

et al. 2015

Journal of Geriatric Oncology

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134

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“…A brief geriatric assessment (GA) [18, 19] that our research team has used in several geriatric oncology studies [5, 20–23] will be used to determine if the patient has a functional deficit. The specific scales within the GA used for this functional deficit screen are described in detail below.…”

Section: Methodsmentioning

confidence: 99%

A randomized controlled trial of outpatient CAncer REhabilitation for older adults: The CARE Program

Pergolotti

Deal

Williams

et al. 2015

Contemporary Clinical Trials

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Background Large numbers of older adults (aged 65 years or older) are surviving cancer; however, many survivors report decreased quality of life (QOL) and limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL) both during and after treatment [1–3]. Occupational and physical therapy (OT/PT) are services focused on improving functional status and QOL that are largely unexplored and underutilized in cancer survivorship care [4, 5]. Methods/Design This is a randomized, single-blind, two-arm, single institution pilot study. Eighty-two patients will be recruited from a university-affiliated outpatient oncology clinic. Inclusion criteria include the following: aged 65 years or older, diagnosis of cancer within 5 years, English speaking, has at least one functional deficit, and able to safely participate in an outpatient rehabilitation program. Exclusion criteria are: currently receiving rehabilitation or eligible for hospice. Consented patients will be randomized into two groups: (1) the CARE (CAncer REhabilitation) Program consisting of outpatient OT/PT and (2) standard of care. Primary outcome: change in Nottingham Extended Activities of Daily Living (NEADL) scores from baseline to 3 months between CARE and control. Discussion This study is one of the first RCTs aimed at examining the effect of OT/PT in older adults with cancer. If positive, findings from this study will suggest the potential for outpatient OT/PT to improve the functional ability and QOL of older adults with cancer.

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“…Unfortunately, very few data are available in older patients. A study on trends in 21-gene recurrence score (RS) assay use among 132,222 women aged [66][67][68][69][70][71][72][73][74] and 75-94 years with BC post-surgery revealed no change in chemotherapy use despite increased RS testing and associated cost in patients ≥75 years [44]. Recent SEER database study (30% of patients aged ≥70years) reported a high BC-specific mortality for older patients with either no 21-gene assay performed or a RS ≥18, but not <18 [45].…”

Section: Role Of Adjuvant Systemic Therapy In Early Breast Cancementioning

confidence: 99%

“…Performance status does not appear to be sufficient for differentiating the heterogeneous older population with cancer [69,70]. Geriatric syndromes, i.e.…”

Section: Role Of Geriatric Assessments In Breast Cancer Treatmentmentioning

confidence: 99%

Controversial issues in the management of older adults with early breast cancer

Mislang

Cheung

Hamaker

et al. 2017

Journal of Geriatric Oncology

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It is well recognized that the incidence of breast cancer increases significantly with age.Despite this, older people remain under-represented in many clinical trials and their management relies on extrapolation of data from younger patients. Providing an aggressive intervention can be challenging, particularly in less fit older patients where a conservative approach is commonly perceived to be more appropriate. The optimal management of this population is unknown and treatment decision should be personalized. This review article will discuss several controversial issues in managing older adults with early breast cancer in a multidisciplinary setting, including the role of surgical treatment of the axilla in clinically node negative disease, radiotherapy after breast conservation surgery in low-risk tumors, personalizing adjuvant systemic therapy, and geriatric assessments in breast cancer treatment decisions.

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Geriatric Assessment-Identified Deficits in Older Cancer Patients With Normal Performance Status

Cited by 200 publications

References 51 publications

The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer

The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer

A randomized controlled trial of outpatient CAncer REhabilitation for older adults: The CARE Program

Controversial issues in the management of older adults with early breast cancer

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