Geriatric screening results and the association with severe treatment toxicity after the first cycle of (radio)chemotherapy

Baitar, Abdelbari; Fraeyenhove, Frank Van; Vandebroek, A.; Droogh, E. De; Galdermans, D.; Mebis, Jeroen; Schrijvers, Dirk

doi:10.1016/j.jgo.2013.12.004

Cited by 29 publications

(19 citation statements)

References 22 publications

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“…44 The Geriatric 8 (G8) and GFI did not predict serious adverse events following first cycle of (radio)chemotherapy among older (65+) patients with cancer. 45 Only the Vulnerable Elders Survey score significantly predicted mortality among older patients with stage III/IV colorectal cancer undergoing chemotherapy in regression models controlling for ECOG PS, activities of daily living dependence, and age. 46 In retrospective regression models controlling for tumor characteristics, age, body mass index, number of medications, and chemotherapy, both a phenotypic frailty score and a cancer-specific comprehensive geriatric assessment were significantly associated with radiotherapy fatigue while the Karnofsky score was not.…”

Section: Importance Of the Frailty Syndrome Assessment To Cancer Carementioning

confidence: 97%

How should older adults with cancer be evaluated for frailty?

Huisingh-Scheetz

Walston

2017

Journal of Geriatric Oncology

103

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Traditionally used as a descriptive term, frailty is now a recognized medical syndrome identifying individuals with decreased physiologic reserve. Frailty is characterized by diminished strength, endurance, and reduced physiologic function. Several valid frailty screening tools exist in the literature, and these measures have been used to relate frailty to outcomes important to the older patient with cancer. Frail adults are at increased risk of adverse surgical outcomes and early findings suggest that frailty predicts poor chemotherapy tolerance. While much research is needed to explore the biologic relationships between frailty and cancer, there is an urgent need to implement frailty screening and management into the care of the older patient with cancer in order to improve outcomes in this vulnerable subset. The purpose of this paper is to provide an introduction of frailty to oncologists including a review of the definition, frailty screening tools, its clinical relevance to older patients with cancer, and a brief guide to frailty management.

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Section: Importance Of the Frailty Syndrome Assessment To Cancer Carementioning

confidence: 97%

How should older adults with cancer be evaluated for frailty?

Huisingh-Scheetz

Walston

2017

Journal of Geriatric Oncology

103

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“…ESAS is not a tool for geriatric or frailty screening. The vulnerable elders survey (VES-13) and G8 are often employed in the latter context [28,29]. However, comprehensive geriatric assessment was not part of our clinical routine work-up.…”

Section: Discussionmentioning

confidence: 99%

Patient-reported symptoms and performance status before palliative radiotherapy in geriatric cancer patients (octogenarians)

Nieder

Kämpe

2017

Technical Innovations & Patient Support in Radiation Oncolo

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To evaluate differences in baseline parameters including performance status and self-reported symptom burden between geriatric and non-geriatric cancer patients, and to assess the hypothesis that these factors might predispose older patients to incomplete radiotherapy and short survival. Patients and methods: Retrospective comparison of geriatric and non-geriatric patients treated with palliative radiotherapy (age P80 years and <80 years, respectively). Between 2013 and 2015, 26 geriatric and 76 non-geriatric patients were treated. The Edmonton symptom assessment system (ESAS) was employed to document baseline symptoms. Results: Most patients received radiotherapy for bone metastases, commonly 5-10 fractions. Geriatric patients had significantly less pain at rest and depression. No strong trends towards higher symptom burden in older patients emerged for any of the items. Overall survival was similar in the two subgroups with different age and also in a separate age-stratified analysis of patients with performance status >2. Relatively few patients were irradiated in the terminal stage of disease, defined as final 30 days of life (8% in geriatric and 12% in other patients, p = 0.73). A higher number of geriatric patients failed to complete their prescribed course of radiotherapy (14 vs. 3%, p = 0.08), despite lower rates of prescription of more than 10 fractions in this group (15 vs. 23%, p > 0.2). Conclusions: These data support utilization of palliative radiotherapy irrespective of age. However, care should be taken in assigning the right fractionation regimen in order to avoid lengthy treatment courses when survival is limited, such as in patients with performance status >2.

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“…Quando se avalia a AGA e seus resultados em relação à toxicidade ao tratamento quimioterápico, não existe um consenso na literatura. Há estudos que concluíram que os dados para uma tomada de decisão do tratamento utilizando a AGA como valor preditivo de toxicidade quimioterápica são inconsistentes, enquanto outros demonstraram relação direta entre estados de fragilidade, toxicidades e risco nutricional com mortalidade e possibilidade de não completar o tratamento quimioterápico 11,[14][15][16] .…”

Section: Métodounclassified

“…A AGA quando utilizada na oncogeriatria classifica os pacientes em saudáveis (passíveis de tratamento quimioterápico), vulneráveis (passíveis de intervenções menos invasivas) e frágeis (indicação de tratamento paliativo). Estudos relatam relação entre os resultados obtidos na avaliação geriátrica ampla e a tolerância ao tratamento quimioterápico, influenciando na escolha do manejo adequado para cada indivíduo 11,12 . Num estudo publicado em 2014, a AGA foi descrita como preditor de mortalidade, principalmente em pacientes avaliados como frágeis 13 .…”

Section: Introductionunclassified

Avaliação geriátrica ampla como preditor de morbimortalidade nos pacientes oncológicos vulneráveis submetidos ao tratamento quimioterápico

Lima

Germano²,

Domingues³

et al. 2019

Rev. Med. (São Paulo)

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Objetivos: O objetivo desse estudo foi determinar o valor preditivo da Avaliação Geriátrica Ampla (AGA) em relação à toxicidade e mortalidade nos pacientes oncológicos idosos classificados como vulneráveis, submetidos à quimioterapia. Método: Foi realizado um estudo de coorte prospectivo com coleta de informações extraídas de banco de dados já construído do projeto ÂNCORA e disponível online. Foram construídas tabelas de distribuição de frequência das variáveis estudadas e na análise univariada foi usado o chi-quadrado e Teste de Fisher, quando indicado. Por fim, considerou-se o nível de significância de 5% e todos os testes foram aplicados com 95% de confiança. Resultados: Em uma amostra total de 254 pacientes, o percentual de mortalidade foi de 37% e de intercorrências foi de 46,5%, sendo infecção a mais frequente. Houve associação entre o déficit nutricional e o aumento da mortalidade (p=0,003). Conclusão: Observou-se associação estatística entre o aumento da mortalidade em pacientes vulneráveis que realizaram quimioterapia (p=0,046), quando comparados aos pacientes saudáveis. Os resultados deste estudo reforçam constatações da literatura como o uso da AGA pode ajudar oncologistas e geriatras em suas tomadas de decisão.

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Geriatric screening results and the association with severe treatment toxicity after the first cycle of (radio)chemotherapy

Cited by 29 publications

References 22 publications

How should older adults with cancer be evaluated for frailty?

How should older adults with cancer be evaluated for frailty?

Patient-reported symptoms and performance status before palliative radiotherapy in geriatric cancer patients (octogenarians)

Avaliação geriátrica ampla como preditor de morbimortalidade nos pacientes oncológicos vulneráveis submetidos ao tratamento quimioterápico

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