Patient assessment and feasibility of treatment in older patients with cancer: results from the IN-GHO® Registry

Abstract

Purpose Predicting feasibility of treatment in older patients with cancer is a major clinical task. The Initiative Geriatrische Hämatologie und Onkologie (IN-GHO®) registry prospectively collected data on the comprehensive geriatric assessment (CGA), physician’s and patient’s-self assessment of fitness for treatment, and the course of treatment in patients within a treatment decision aged ≥ 70 years. Patients and methods The registry included 3169 patients from 93 centres and evaluated clinical course and treatment outcomes 2–3 and 6 months after initial assessment. Fitness for treatment was classified as fit, compromised and frail according to results of a CGA, and in addition by an experienced physician’s and by patient’s itself. Feasibility of treatment (termed IN-GHO®-FIT) was defined as a composite endpoint, including willingness to undergo the same treatment again in retrospect, no modification or unplanned termination of treatment, and no early mortality (within 90 days). Results CGA classified 30.0% as fit, 35.8% as compromised, and 34.2% as frail. Physician’s and patient’s-self assessment classified 61.8%/52.3% as fit, 34.2%/42.4% as compromised, and 3.9%/5.3%, as frail, respectively. Survival status at day 180 was available in 2072 patients, of which 625 (30.2%) had died. After 2–3 months, feasibility of treatment could be assessed in 1984 patients. 62.8% fulfilled IN-GHO®-FIT criteria. Multivariable analysis identified physician’s assessment as the single most important item regarding feasibility of treatment. Conclusion Geriatricians were involved in 2% of patients only. Classification of fitness for treatment by CGA, and physician’s or patient’s-self assessment showed marked discrepancies. For the prediction of feasibility of treatment no single item was superior to physician’s assessment. However CGA was not performed by trained geriatricians.

Impact of Geriatric Assessment on the Tolerability of Combination Chemotherapy in Older Patients with Advanced Cancer: A Matched-Pair Analysis

“…On the other hand, surveys from France and the USA showed that the majority of older cancer patients are willing to receive intensive combination chemotherapy [18]. Because of these reasons, the American Society of Clinical Oncology recommended a GA for all older patients with cancer in 2018 [1].…”

“…Patients at the age of 70 years and above are usually defined as older patients due to their increased risk of vulnerability [1]. Geriatric assessment (GA) is a multidimensional assessment of older adults.…”

“…Geriatric assessment (GA) is a multidimensional assessment of older adults. In oncology, it may identify patient's vulnerabilities that are not captured in daily routine practice to guide further diagnostic and therapeutic interventions [1]. In 2018, the ASCO guideline for geriatric oncology [2] stated that GA results should be applied to develop an individualized treatment plan for older cancer patients including the management of nononcologic problems.…”