Geriatric assessment may help decision-making in elderly patients with inoperable, locally advanced non-small-cell lung cancer

Antonio, Maite; Saldaña, Juana; Linares, Jenniffer; Jc, Ruffinelli; Palmero, Ramón; Navarro, Arturo; Arnaiz,; Brao, Isabel; Aso, Samantha; Padrones, Susana; Navarro, A.; González‐Barboteo, Jesús; Jm, Borràs; Cardenal, Felipe; Nadal, Ernest

doi:10.1038/bjc.2017.455

Cited by 37 publications

(25 citation statements)

References 48 publications

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“…Specifically, we found that vulnerable patients were less likely than nonvulnerable patients to receive anticancer treatment, likely reflecting clinicians' tendency to avoid use of anticancer treatment among frail, older patients. 35,36 Ultimately, our findings help identify vulnerable patients at risk for poor outcomes and should inform future efforts to target these patients with interventions addressing their distinct geriatric and supportive care concerns. Several limitations merit discussion.…”

Section: Discussionmentioning

confidence: 93%

“…Our study describes the supportive care needs of older adults with advanced cancer and identifies a vulnerable subgroup of patients at risk for poor outcomes. Although prior studies have highlighted that older patients categorized as vulnerable may experience worse chemotherapy tolerability, greater physical and cognitive functional decline, and inferior survival, [17][18][19]35,36 information was lacking on the relationship between vulnerability and QoL, symptoms, and healthcare use among patients with cancer. In our study, vulnerable patients reported worse physical function, which may contribute to their poor QoL, high symptom burden, greater healthcare use, and worse survival.…”

Section: Discussionmentioning

confidence: 99%

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Screening Tool Identifies Older Adults With Cancer at Risk for Poor Outcomes

Nipp

Thompson

Temel

et al. 2020

Journal of the National Comprehensive Cancer Network

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Background: Oncologists often struggle with managing the complex issues unique to older adults with cancer, and research is needed to identify patients at risk for poor outcomes. Methods: This study enrolled patients aged ≥70 years within 8 weeks of a diagnosis of incurable gastrointestinal cancer. Patient-reported surveys were used to assess vulnerability (Vulnerable Elders Survey [scores ≥3 indicate a positive screen for vulnerability]), quality of life (QoL; EORTC Quality of Life of Cancer Patients questionnaire [higher scores indicate better QoL]), and symptoms (Edmonton Symptom Assessment System [ESAS; higher scores indicate greater symptom burden] and Geriatric Depression Scale [higher scores indicate greater depression symptoms]). Unplanned hospital visits within 90 days of enrollment and overall survival were evaluated. We used regression models to examine associations among vulnerability, QoL, symptom burden, hospitalizations, and overall survival. Results: Of 132 patients approached, 102 (77.3%) were enrolled (mean [M] ± SD age, 77.25 ± 5.75 years). Nearly half (45.1%) screened positive for vulnerability, and these patients were older (M, 79.45 vs 75.44 years; P=.001) and had more comorbid conditions (M, 2.13 vs 1.34; P=.017) compared with nonvulnerable patients. Vulnerable patients reported worse QoL across all domains (global QoL: M, 53.26 vs 66.82; P=.041; physical QoL: M, 58.95 vs 88.24; P<.001; role QoL: M, 53.99 vs 82.12; P=.001; emotional QoL: M, 73.19 vs 85.76; P=.007; cognitive QoL: M, 79.35 vs 92.73; P=.011; social QoL: M, 59.42 vs 82.42; P<.001), higher symptom burden (ESAS total: M, 31.05 vs 15.00; P<.001), and worse depression score (M, 4.74 vs 2.25; P<.001). Vulnerable patients had a higher risk of unplanned hospitalizations (hazard ratio, 2.38; 95% CI, 1.08–5.27; P=.032) and worse overall survival (hazard ratio, 2.26; 95% CI, 1.14–4.48; P=.020). Conclusions: Older adults with cancer who screen positive as vulnerable experience a higher symptom burden, greater healthcare use, and worse survival. Screening tools to identify vulnerable patients should be integrated into practice to guide clinical care.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Screening Tool Identifies Older Adults With Cancer at Risk for Poor Outcomes

Nipp

Thompson

Temel

et al. 2020

Journal of the National Comprehensive Cancer Network

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“…Very little is known about the use and the predictive value of a geriatric assessment in HNC, because most of the studies included low patient numbers and therefore have a lack of power. In other fields of medicine, a geriatric assessment is well established to guide decision making or to identify unknown geriatric impairments (such as cognitive impairment and functional dependency), which can be taken into account before or during treatment . To our knowledge, it is not previously reported that the use of a walking device is associated with 1‐year mortality.…”

Section: Discussionmentioning

confidence: 99%

Geriatric assessment and 1‐year mortality in older patients with cancer in the head and neck region: A cohort study

et al. 2019

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Background The aim is to describe the association of functional capacity and cognitive functioning with 1‐year mortality in older patients with cancer in the head and neck region. Methods We performed a cohort study in which all patients aged 70 years and older received a geriatric screening before treatment. Main outcome was 1‐year mortality. Results A total of 102 patients were included. Median age was 78.7 years (interquartile range [IQR], 72.3‐84.5), 25% were cognitive impaired, 40% were malnourished, and 28.4% used a walking device. Overall, 1‐year mortality was 42.3%. Male sex (hazard ratio [HR], 4.30; 95% confidence interval [CI], 1.35‐13.67), malnutrition (HR, 2.55; 95% CI, 1.19‐5.16), and using a walking device (HR, 2.80; 95% CI 1.13‐6.93) were associated with higher mortality risk, independent of stage and comorbidities. Conclusion In older patients with head and neck cancer, the mortality rates are high. Nutritional status and mobility are determinants of 1‐year mortality, independent of tumor stage, age, and comorbidity.

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“…16 Higher scores on the Vulnerable Elders Survey were associated with shorter survival and a higher risk of grade 3-4 toxicity. 16 Risk factors predictive of radiation pneumonitis and acute oesophagitis The risk of radiation pneumonitis and acute oesophagitis are the primary normal tissue toxicity considerations that limit treatment delivery. Both patient and tumour factors may help predict the risk.…”

Section: Impact Of Patient Agementioning

confidence: 96%

“…In a recent publication of 85 patients over 75 with stage III NSCLC, 37% of patients were rated as fit (no disability on the activities of daily living [ADL] or instrumental activities of daily living [IADL] scales, comorbidity score <2) and 48% as medium-fit (<3 IADL, no ADL disability, comorbidity score <3). 16 Higher scores on the Vulnerable Elders Survey were associated with shorter survival and a higher risk of grade 3–4 toxicity. 16 …”

Section: Patient Assessment For Chemoradiotherapymentioning

confidence: 97%

Practical implications to contemplate when considering radical therapy for stage III non-small-cell lung cancer

Storey

Hanna²,

Greystoke

et al. 2020

Br J Cancer

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The type of patients with stage III non-small-cell lung cancer (NSCLC) selected for concurrent chemoradiotherapy (cCRT) varies between and within countries, with higher-volume centres treating patients with more co-morbidities and higher-stage disease. However, in spite of these disease characteristics, these patients have improved overall survival, suggesting that there are additional approaches that should be optimised and potentially standardised. This paper aims to review the current knowledge and best practices surrounding treatment for patients eligible for cCRT. Initially, this includes timely acquisition of the full diagnostic workup for the multidisciplinary team to comprehensively assess a patient for treatment, as well as imaging scans, patient history, lung function and genetic tests. Such information can provide prognostic information on how a patient will tolerate their cCRT regimen, and to perhaps limit the use of additional supportive care, such as steroids, which could impact on further treatments, such as immunotherapy. Furthermore, knowledge of the safety profile of individual double-platinum chemotherapy regimens and the technological advances in radiotherapy could aid in optimising patients for cCRT treatment, improving its efficacy whilst minimising its toxicities. Finally, providing patients with preparatory and ongoing support with input from dieticians, palliative care professionals, respiratory and care-of-the-elderly physicians during treatment may also help in more effective treatment delivery, allowing patients to achieve the maximum potential from their treatments.

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Geriatric assessment may help decision-making in elderly patients with inoperable, locally advanced non-small-cell lung cancer

Abstract: Comprehensive geriatric assessment and VES-13 showed independent prognostic value. Comprehensive geriatric assessment may help to identify elderly patients fit enough to be treated with cCRT.

Cited by 37 publications

References 48 publications

Screening Tool Identifies Older Adults With Cancer at Risk for Poor Outcomes

Screening Tool Identifies Older Adults With Cancer at Risk for Poor Outcomes

Geriatric assessment and 1‐year mortality in older patients with cancer in the head and neck region: A cohort study

Practical implications to contemplate when considering radical therapy for stage III non-small-cell lung cancer

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