Impact of a comprehensive geriatric assessment on decision‐making in older patients with hematological malignancies

Abstract

Objective Hematological treatment decisions in older adults with hematological malignancies are complex. Our objective is to study the impact of a comprehensive geriatric assessment on hematological treatment decision in older patients and the factors associated with change in treatment plan. Methods We conducted a cross‐sectional analysis of patients aged 65 years and above with hematological malignancies, hospitalized between 2008 and 2019 at the University Cancer Institute of Toulouse. They were assessed by a geriatrician/nurse team using a comprehensive geriatric assessment (CGA). A penalized logistic regression model with elastic net regularization was used to identify factors associated with change in hematological treatment plan. Results A total of 424 patients were included. Main hematological malignancies were lymphoma (36.1 %), acute myeloid leukemia (26.9 %) and myelodysplastic syndrome (19.8%). Change in hematological treatment plan was suggested after CGA for 92 patients (21.7%). Factors associated with change in treatment plan were functional impairment according to ADL and IADL scale, mobility impairment, the presence of comorbidity defined by the Charlson score >1 and increasing age. Conclusion A CGA has a significant impact on hematological treatment decision in older patients. Functional and mobility impairment, comorbidities and age are predictive factors of change in treatment plan.

Frailty assessment in the care of older people with haematological malignancies

“…For certain patients, however, the knowledge of frailty assessment results among the treatment decision makers will lead to a further refinement of the treatment plan. 71,72 In summary, the evidence base for frailty assessments and their effect on the care of older people with haematological cancer has grown significantly over the past two decades. Findings from studies have been increasingly transferred into clinical practice, mainly through the expanding use of appropriate screening (eg, G8) and, though more reluctantly, geriatric assessment.…”

“…71 In a single-centre study that was restricted to haematological malignancies and included 424 older patients with acute myeloid leukaemia, non-Hodgkin lymphoma, or myelodysplastic syndrome, a change of the haematological treatment plan after geriatric assessment was suggested in more than 20% of patients. 72 Based on geriatric assessment methods, a haematologyspecific assessment tool-the Geriatric Assessment in Haematology (GAH) scale-has been proposed. This 30-item tool has been developed from a cohort of patients with treatment-naive myelodysplastic syndrome, acute myeloid leukaemia, multiple myeloma, and chronic lymphocytic leukaemia.…”

Geriatric assessment in the management of older patients with cancer – A systematic review (update)

“…Overall, 29 studies addressed the comparison between the oncologic treatment plan before and after geriatric assessment, of which 21 described the change in treatment plan for individual patients [8,9,13,14,16,21,29,33,35,[39][40][41][42]48,52,53,59,60,66,72] and eight described differences in treatment choice between cohorts that did or did not undergo a geriatric assessment [10,20,23,26,46,55,57,63]. Three studies discussed the effect on communication and care planning [12,20,23].…”

“…Twenty-one studies described changes in the oncologic treatment for individual patients as a result of the geriatric assessment [8,9,13,14,16,21,29,33,35,[39][40][41][42]48,52,53,59,60,66,72]. The median proportion of patients in which the treatment plan changed was 31% (range 6-56%), primarily in favour of a less intensive treatment option (median 73% of changes, Appendix 2a).…”

“…For the eleven studies using a geriatric consultation [8,9,14,21,29,33,41,42,52,66,68], the median percentage of patients with treatment adjustments was 22% (range 7-49%); for studies using an assessment by the oncology team (n = 8) [13,16,35,39,40,48,59,72], it was 28% (6-45%). In the two studies using a multidisciplinary team evaluation [53,60], 54% and 56% of treatment choices were altered by the geriatric assessment (p-value for pooled data <0.001, Appendix 2b).…”