The added value of geriatric screening and assessment for predicting overall survival in older patients with cancer

Abstract

BACKGROUND:The aim of this study was to determine and compare the added prognostic value of screening tools, geriatric assessment (GA) components, and GA summaries to clinical information for overall survival (OS) in older patients with cancer. METHODS: A screening and a 10-item GA were systematically performed in patients ≥70 years old with cancer. Cox regression analyses were conducted to evaluate the added prognostic value for OS of screening tools, GA, and GA summaries to clinical information (age, stage, and tumor type) in 2 cohorts (A and B). Cox models were compared on the basis of the Akaike information criterion and the concordance probability estimate. The 2 cohorts for the analyses were similar but independent. RESULTS: A complete case analysis was available for 763 patients (median age, 76 years) in cohort A and for 402 patients (median age, 77 years) in cohort B. In both cohorts, most individual GA components were independent prognostic factors for OS. Nutritional status (assessed with the Mini Nutritional Assessment Short Form) and functional status (assessed with the Instrumental Activities of Daily Living) consistently displayed a strong capacity to predict OS. Less consistent results were found for screening tools. GA summaries performed the best in comparison with the screening tools and the individual GA components. CONCLUSIONS: Most individual GA components, especially nutritional status and functional status, are prognostic factors for OS in older patients with cancer. GA summaries provide more prognostic information than individual GA components but only moderately improve the prognostic baseline model with clinical information.

The prognostic value of 3 commonly measured blood parameters and geriatric assessment to predict overall survival in addition to clinical information in older patients with cancer

“…4 This study has been reported extensively previously. 4 This study has been reported extensively previously.…”

“…27 When taken together, this 10-item GA is a GA summary that integrates the results of every GA component mentioned above and thus captures the multidimensional GA as a whole evaluating the global health of the older patient with cancer. 4 Therefore, in the current study, we primarily compared the added prognostic value of the 10-item GA with that of laboratory parameters. In our previous article, we demonstrated that the 10-item GA provides more prognostic information than the individual GA components and screening tools because GA summaries are likely better at capturing the multidimensional process of aging.…”

“…4 For the current study, a subgroup of 328 patients for whom information was available regarding the 3 laboratory parameters was considered. 4 For the current study, a subgroup of 328 patients for whom information was available regarding the 3 laboratory parameters was considered.…”

“…4 Studies that evaluate the prognostic value of GA generally focus on the most prognostic individual GA components or on the best set of GA components. 4 Studies that evaluate the prognostic value of GA generally focus on the most prognostic individual GA components or on the best set of GA components.…”

“…2 One of the aims of the GA-based approach is to improve the estimation of life expectancy, which sometimes is a difficult task although very important in the treatment decision-making process. 4 Although the GA is currently the best approach with which to estimate a patient's degree of frailty, many efforts are made to identify suitable biomarkers with which to measure biological age or frailty and to evaluate their predictive value for clinical outcomes such as mortality. 3 However, these tools are not entirely suitable in geriatric oncology.…”