Geriatric functional assessment for decision-making on adjuvant chemotherapy in older colon cancer patients

Abstract

Background/Aims: Despite the increasing need for geriatric assessment prior to chemotherapy, the method for this assessment remains inadequate for older cancer patients. We aimed to propose a simple assessment method to predict the performance of adjuvant chemotherapy in older patients after colon cancer surgery.Methods: This prospective study included patients over 65 years of age who were scheduled for adjuvant chemotherapy after colon cancer surgery. Before initiating chemotherapy, their functional status was assessed on the basis of activities of daily living (ADL)/instrumental activities of daily living (IADL). These parameters were analyzed with clinical characteristics and the patterns of adjuvant chemotherapy. The focus was on the completion rate of adjuvant chemotherapy.Results: A total of 89 patients with a median age of 72 years were analyzed. Among them, 54 (61%) were non-impaired and 35 (39%) were impaired regarding their ADL/IADL classification. Low body mass index and impairment of ADL/IADLs were significantly associated with chemotherapy interruption. Among toxicities, fatigue and hand-foot syndrome were independent prognostic factors for chemotherapy interruption. Impairments of ADL/IADL were significantly associated with fatigue regardless of age. Based on age and ADL/IADL stratification, younger patients (≤ 72 years) and/or those who were ADL/IADL non-impaired were significantly more likely to complete adjuvant chemotherapy than older patients (> 72 years) and ADL/IADL impaired patients (<i>p</i> = 0.038). This was regardless of the chemotherapy regimen.Conclusions: Functional assessment using ADL/IADL is a convenient method to predict chemotherapy toxicity and performance. These results suggested that routine screening for ADL/IADLs could guide appropriate patient selection for the completion of adjuvant chemotherapy and predict expected outcomes.

Self Determination, Decision Making and Social Functioning as a Prognostic Factor among Hepatitis ‘B’ and ‘C’ Patients

“…Transmission of these diseases occurs through the exchange of contaminated blood, body fluids, and saliva, commonly during medical and dental procedures. In regions like Pakistan and other developing countries, the risk of transmission is exacerbated by unhygienic practices such as unsafe injections, traditional scarification, acupuncture, tattoos, body piercings, as well as through vertical (mother-to-child) and sexual transmission (2,3). The perception and management of one's health are deeply influenced by cultural and ethnic backgrounds, and are modulated by the immediate environment and living conditions.…”

Geriatric risk model for older patients with diffuse large B-cell lymphoma (GERIAD): a prospective multicenter cohort study

“…Although age-related functional decline and comorbidities are highly heterogeneous and associated with treatment outcomes in DLBCL [2][3][4][5][6][7][8], they are usually under-recognized in clinical practice. Comprehensive geriatric assessment is used in older patients with cancer to evaluate physical functioning, psychological health, level of comorbidities, and social well-being and can detect frail individuals who are not usually captured in routine assessment [9][10][11]. However, comprehensive geriatric assessment is not widely accepted for patients with DLBCL because it is time-consuming and has not been validated as a treatment guide.…”