Geriatric assessment in elderly patients with prostate cancer. Identifying vulnerable older adults with cancer: integrating geriatric assessment into oncology practice. Comprehensive Geriatric Assessment in Elderly Cancer Patients: An Experience in an Outpatient Population Role of geriatric intervention in the treatment of older patients with cancer: rationale and design of a phase III multicenter trial Geriatric assessment is associated with completion of chemotherapy, toxicity, and survival in older adults with cancer. Implementing a geriatric assessment in cooperative group clinical cancer trials: CALGB 360401. Improving the quality of life of geriatric cancer patients with a structured multidisciplinary intervention: a randomized controlled trial. Comprehensive geriatric assessment and comorbidities predict survival in geriatric oncology The feasibility of inpatient geriatric assessment for older adults receiving induction chemotherapy for acute myelogenous leukemia. A comprehensive geriatric intervention detects multiple problems in older breast cancer patients. Geriatric evaluation and management units in the care of the frail elderly cancer patient. Multidimensional geriatric assessment in treatment decision in elderly cancer patients: 6-year experience in an outpatient geriatric oncology service. Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study. Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia. An attempt to correlate a "Multidimensional Geriatric Assessment" (MGA), treatment assignment and clinical outcome in elderly cancer patients: results of a phase II open study. Postdischarge geriatric assessment of hospitalized frail elderly patients. Geriatric screening results and the association with severe treatment toxicity after the first cycle of (radio)chemotherapy.
As a result of demographic evolution , oncologists will treat more and more elderly patients with prostate cancer . Aging is frequently associated with the coexistence of several medical complications that can increase the complexity of cancer treatment decision-making . Unfortunately , clinical oncologists need to be more familiar with the multidimensional assessment of elderly patients . To acquire this skill , we implemented a multidimensional geriatric assessment program at our cancer center . This instrument prospect ively assessed 60 elderly patients with prostate cancer . Herein , we describe geriatric aspects detected in our patient sample and report treatment options proposed to elderly patients with prostate cancer at different disease stages . The minimal comprehensive geriatric assessment ( mini-CGA ) procedure revealed that 66 % of our patient population was dependent in one or more of the Katz Activities of Daily Living and 87 % were dependent in 1 or more of the Lawton Instrumental Activities of Daily Living ; all patients had significant comorbidity according to the Cumulative Illness Rating Scale-Geriatrics  , 75 % having at least one severe comorbidity . We identified 19 cases of drug interaction . We also observed that half of these patients had a risk of falling and some physical disability ; 45 % had cognitive disorders requiring more investigation ; one third had depressive symptoms . Finally , 65 % of the patients were either malnourished or at risk of malnutrition . Many of these problems were unknown before the mini-CGA processing and may interfere with cancer and cancer treatment . Thus , the correct management of elderly patients with cancer requires comprehensive geriatric assessment as well as relevant disease staging at diagnosis . This approach will help us to propose the most appropriate treatment with the main aim of preserving quality of life OBJECTIVES To integrate the principles of geriatric assessment into the care of older patients with cancer in order to identify vulnerable older adults and develop interventions to optimize cancer treatment . DESIGN A brief , comprehensive , self-administered question naire and intervention algorithm were developed consisting of measures of  geriatric assessment  that are brief , reliable , vali date d , and predictive of mortality and morbidity in older patients . SETTING Academic tertiary care cancer center and community-based satellite practice . PARTICIPANTS Patients aged 65 and older with cancer . MEASUREMENTS The question naire solicits information about the patient 's functional status , comorbidity , psychological status , nutritional status , and social support . A scoring algorithm for referral to a multidisciplinary team was developed . RESULTS Two hundred forty-five of 250 patients completed the question naire ( mean age 76 , range 65 - 95 ) . The majority of patients were women ( 71 % ) , white ( 95 % ) , married ( 52 % ) , and retired ( 90 % ) , with a variety of tumor types and stages . Most patients ( 78 % ) completed the question naire on their own and reported acceptance of question naire length ( 91 % ) , no difficult questions ( 94 % ) , no up setting questions ( 96 % ) , and no missing questions ( 89 % ) . The mean time to completion was 15 minutes , with a median of 12.5 ( st and ard deviation 10 , range 2 - 60 ) . Information from this question naire helped identify physical and psychological impairments , poor nutrition , lack of social support , and untreated comorbidities . Appropriate referrals to a multidisciplinary team were made . CONCLUSION This brief , comprehensive , self-administered question naire is feasible for use in the outpatient oncology setting and helped identify the needs of geriatric oncology patients . Prospect i ve trials are needed to determine the effectiveness of the interventions offered Aims and background Cancer is an age-related disease , and the increase in life expectancy will lead to a progressive increase of cancer cases in the elderly ( ≥70 years of age ) . We have created a group called GONG ( Gruppo Oncologico Geriatrico ) to apply cancer geriatric assessment in elderly cancer patients , in order to select which of them are eligible for oncological treatment or supportive care only . Patients and methods We applied this model to evaluate 153 patients from March 2004 to August 2005 . Our model included three categories of patients : frail ( at least one of the following items : Activities of Daily Living scale < 80 , ≥3 comorbidities unrelated to the tumor according to the Charlson Index , performance status ≤60/≥3 according respectively to Karnofsky and the ECOG scale , ≥1 geriatric syndrome ) ; borderline ( patients with multiple comorbidities not affecting performance status or ability in daily activities ) ; non-frail . Results Applying the aforementioned criteria , we found 30 borderline , 14 frail and 109 non-frail patients . Statistical analysis showed a significant difference in mortality between frail and non-frail patients ( P < 0.05 ) , whereas there was no difference between borderline and non-frail patients . Conclusions Our model was thus able to identify patients at higher risk of death . These results confirm the importance of cancer geriatric assessment also for the clinical evaluation of oncological patients . Additional r and omized studies with a larger number of patients , also in an adjuvant setting , should be performed to confirm the effectiveness of this approach Background In the general geriatric population , programs linking geriatric evaluation with interventions are effective for improving functional status and survival of the patients . Whether or not these interventions improve health related quality of life ( HRQoL ) or overall survival ( OS ) in older patients with cancer is not yet clear . Indeed , r and omized data on the effect of such interventions on survival and HRQoL are rare and conflicting . We describe the rationale and design of a phase III multicenter trial aim ed at assessing the efficacy of geriatric intervention in the management of elderly patients with cancer . Methods / design Approximately 1200 patients , 70 years and older , considered in need of a geriatric intervention based on the G8 screening tool will be r and omized into two intervention arms . The ‘ Usual-care ’ arm involves st and ard oncological care based on pre-defined oncological protocol s. In addition to the st and ard oncological care , the ‘ Case-management ’ arm involves a multidimensional geriatric assessment and interventions tailored for the patient . Efficacy will be assessed using a co- primary endpoint encompassing OS and HRQoL. Discussion This trial has been design ed to assess whether focused geriatric case management can either improve OS or HRQoL in elderly cancer patients considered in need of geriatric assessment .Trial registration Clinical trials.gov ID : NCT02704832 OBJECTIVES Our purpose was to determine whether geriatric assessment s are associated with completion of a chemotherapy course , grade III/IV toxicity or survival in older adults with cancer . MATERIAL S AND METHODS In this prospect i ve cohort study , patients aged 65 years and older with colorectal , lung , or breast cancer or lymphoma completed a  brief geriatric assessment prior to chemotherapy . Endpoints included completion of the planned number of chemotherapy cycles , grade III/IV toxicity and survival . Multivariate logistic regression determined which factors were independently associated with completion of therapy , grade III/IV toxicity or death . RESULTS Sixty-five patients were enrolled in the study . The median age was 73 years ( range 65–89 ) .  Geriatric syndromes were common , including depression ( 21.5 % ) , dependence on others to carry out instrumental activities of daily living ( 38.5 % ) and activities of daily living ( 10.8 % ) , and comorbidities ( mild 47.7 % , moderate 20 % , severe 15.4 % ) . Of the 65 participants , 67.6%completed the planned number of chemotherapy cycles . Curative intent therapy [ OR 4.97 ( 95 % CI 1.21–18.81 ) ] , Eastern Cooperative Oncology Group ( ECOG ) performance status 2–3 [ OR 0.089 ( 0.015–0.53 ) ] and renal function [ OR 1.03 ( 1.00–1.06 ) per ml/min ] were significantly associated with therapy completion . Furthermore , 31.1 % experienced grade III/IV nonhematologic toxicity . Moderate to severe comorbidities significantly increased the risk of grade III/IV non-hematologic toxicity [ OR 6.13 ( 1.65–22.74 ) ] . Patients who received chemotherapy with curative intent had lower mortality [ HR 0.15 ( 0.06–0.42 ) ] , while patients who reported a fall in themonth prior to chemotherapy had an increased risk of death [ HR 3.20 ( 1.13–9.11 ) ] . CONCLUSIONS Geriatric assessment is associatedwith completion of a planned number of cycles of chemotherapy , grade III/IV non-hematologic toxicity , and mortality PURPOSE Factors captured in a geriatric assessment can predict morbidity and mortality in older adults , but are not routinely measured in cancer clinical trials . This study evaluated the implementation of a geriatric assessment tool in the cooperative group setting . PATIENTS AND METHODS Patients age ≥ 65 with cancer , who enrolled on cooperative group cancer trials , were eligible to enroll on Cancer and Leukemia Group B ( CALGB ) 360401 . They completed a  geriatric assessment tool  before initiation of protocol therapy , consisting of valid and reliable geriatric assessment measures which are primarily self-administered and require minimal re sources and time by healthcare providers . The assessment measures functional status , comorbidity , cognitive function , psychological state , social support , and nutritional status . The protocol specified criteria for incorporation of the tool in future cooperative group trials was based on the time to completion and percent of patients who could complete their portion without assistance . Patient satisfaction with the tool was captured . RESULTS Of the 93 patients who enrolled in this study , five ( 5 % ) met criteria for cognitive impairment and three did not complete the cognitive screen , leaving 85 assessable patients ( median age , 72 years ) . The median time to complete the geriatric assessment tool  was 22 minutes , 87 % of patients ( n = 74 ) completed their portion without assistance , 92 % ( n = 78 ) were satisfied with the question naire length , 95 % ( n = 81 ) reported no difficult questions , and 96 % ( n = 82 ) reported no up setting questions . One hundred percent of health care professionals completed their portion . CONCLUSION This brief , primarily self-administered  geriatric assessment tool met the protocol specified criteria for inclusion in future cooperative group clinical trials OBJECTIVE To examine the potential impact of elderly age on response to participation in a structured , multidisciplinary quality -of-life ( QOL ) intervention for patients with advanced cancer undergoing radiation therapy .  METHODS Study design was a r and omized stratified , two group , controlled clinical trial in the setting of a tertiary care comprehensive cancer center . Subjects with newly diagnosed cancer and an estimated 5-year survival rate of 0%-50 % who required radiation therapy  were recruited and r and omly assigned to either an intervention group or a st and ard care group . The intervention consisted of eight 90-min sessions design ed to address the five QOL domains of cognitive , physical , emotional , spiritual , and social functioning . QOL was measured using Spitzer uniscale and linear analogue self- assessment ( LASA ) at baseline and weeks 4 , 8 , and 27 . RESULTS Of the 103 study participants , 33 were geriatric ( 65 years or older ) , of which 16 ( mean age 72.4 years ) received the intervention and 17 ( mean age 71.4 years ) were assigned to the st and ard medical care . The geriatric participants who completed the intervention had higher QOL scores at baseline , at week 4 and at week 8 , compared to the control participants . SIGNIFICANCE OF RESULTS Our results demonstrate that geriatric patients with advanced cancer undergoing radiation therapy will benefit from participation in a structured multidisciplinary QOL intervention . Therefore , geriatric individuals should not be excluded from participating in a cancer QOL intervention , and , in fact , elderly age may be an indicator of strong response to a QOL intervention . Future research should further explore this finding Objectives : The comprehensive geriatric assessment ( CGA ) can detect geriatric problems and potentially improve survival , physical , and cognitive state of patients , as well as increase an older person ’s chances of staying at home longer . In older people , the number and severity of comorbidity increase with age and are an important determinant of survival . The aim of the study was to assess to which extent CGA and comorbidities could be seen as determinants of survival . Material s and methods : This study analyzed data from two hospitals that included geriatric assessment s of patients aged 70 years and more with cancer linked to mortality .  Logistic regression was used to model survival predictors . Results : Two hundred and five various cancer patients ( 47 % females ) with a median age of 79 were included . They presented with a lot of undiagnosed geriatric problems . Screening scales ( G8 , SEGA ) , cognitive , and psychological disorders , and low albumin levels appeared to be independent survival factors . A frailty profile classification was associated with higher mortality . The average comorbidity was grade d 2 according to the Charlson scale . By the geriatric cumulative illness rating scale ( CIRS-G ) , the arithmetic average number of affected organ systems was 5 ( range 0–10 ) in all patients . Cardiovascular disorders were the most common comorbidity . Renal insufficiency and anaemia were negatively associated with survival . Conclusion : Old cancer patients present a lot of comorbidities and newly diagnosed geriatric problems . Several tools provide determinants of survival in old cancer patients . Prospect i ve trials evaluating the utility of a CGA to guide interventions to improve quality of cancer care in older adults are justified OBJECTIVES To test the feasibility and utility of a bedside geriatric assessment ( GA ) to detect impairment in multiple geriatric domains in older adults initiating chemotherapy for acute myelogenous leukemia ( AML ) . DESIGN Prospect i ve observational cohort study . SETTING Single academic institution . PARTICIPANTS Individuals aged 60 and older with newly diagnosed AML and planned chemotherapy . MEASUREMENTS Bedside GA was performed during inpatient exmination for AML . GA measures included the modified Mini-Mental State Examination ; Center for Epidemiologic Studies Depression Scale ; Distress Thermometer , Pepper Assessment Tool for Disability ( includes self- reported activities of daily living ( ADLs ) , instrumental ADLs , and mobility questions ) ; Short Physical Performance Battery ( includes timed 4-m walk , chair st and s , st and ing balance ) ; grip strength , and Hematopoietic Cell Transplantation Comorbidity Index . RESULTS Of 54 participants ( mean age 70.8 ± 6.4 ) eligible for this analysis , 92.6 % completed the entire GA battery ( mean time 44.0 ± 14 minutes ) . The following impairments were detected : cognitive impairment , 31.5 % ; depression , 38.9 % ; distress , 53.7 % ; impairment in ADLs , 48.2 % ; impaired physical performance , 53.7 % ; and comorbidity , 46.3 % . Most were impaired in one ( 92.6 % ) or more ( 63 % ) functional domains . For the 38 participants rated as having good performance status according to st and ard oncologic assessment ( Eastern Cooperative Oncology Performance Scale score ≤1 ) , impairments in individual GA measures ranged from 23.7 % to 50 % . Significant variability in cognitive , emotional , and physical status was detected even after stratification according to tumor biology ( cytogenetic risk group classification ) . CONCLUSION Inpatient GA was feasible and added new information to st and ard oncology assessment , which may be important for stratifying therapeutic risk in older adults with AML UNLABELLED Studies of comprehensive geriatric assessment ( CGA ) have shown the importance of follow-up for effectiveness , but this has not been tested in an oncology clinic . In this pilot study , we enrolled 15 early breast cancer patients , aged 70 and older . They received a multidisciplinary CGA every 3 months and structured follow-up from the SAOP nurse practitioner , dietitian , social worker , and pharmacist according to risk . Total follow-up was 6 months . Median age of evaluable patients was 79 years ( range 72 - 87 ) .  Median number of comorbidities by Cumulative Index Rating Scale-Geriatric ( CIRS-G ) was 5 ( 3 - 9 ) at baseline . Ten patients were at pharmacological risk , five at psychosocial risk , and eight at nutritional risk . Patients presented on average six problems initially , and three new problems during follow-up . The intervention directly influenced oncological treatment in four cases . It ensured continuity/coordination of care in seven cases . Success rate in addressing problems was 87 % . Mean Functional Assessment of Cancer Treatment-Breast ( FACT-B ) scores improved from 110.5 ( S.D. 16.7 ) to 116.3 ( S.D. 16.5 ) ( t=0.025 ) . Function and independence were maintained . CONCLUSIONS Older patients with early breast cancer have a high prevalence of comorbidity . A CGA with follow-up has potential for improving the treatment and prognosis of these patients and is feasible in an academic oncology setting BACKGROUND Geriatric assessment has been suggested as a possibly useful approach in dealing with frail elderly cancer patients . METHODS This was a secondary subset analysis from a r and omized 2 x 2 factorial trial in 11 Department of Veterans Affairs medical centers . Hospitalized , frail patients at least 65 years old , after stabilization of their acute illness , were r and omized to receive care in a geriatric inpatient unit , a geriatric outpatient clinic , both , or neither .  The interventions involved core teams that provided geriatric assessment and patient management . We identified 99 patients with a diagnosis of cancer by The International Classification of Diseases , 9th Revision ( ICD-9 ) codes , excluding all nonmelanoma skin cancers . Outcomes collected at discharge , 6 months , and 1 year after r and omization were survival , changes in health-related quality of life ( using the Medical Outcomes Study 36-Item Short-Form general health survey [ SF-36 ] ) , activities of daily living , physical performance , health service utilization , and costs . RESULTS There was no effect on mortality ( 1-year survival 59.6 % ) . The changes in the SF-36 scores from r and omization for emotional limitation , mental health and bodily pain ( also sustained at 1 year ) on the SF-36 were better for geriatric inpatient care cancer patients at discharge . There was no difference in SF-36 scores between geriatric outpatient and usual outpatient care . Days of hospitalization and overall costs were equivalent for the interventions and usual care over the 1-year study . CONCLUSIONS This study suggests that inpatient geriatric assessment and management may be an effective approach to the management of pain and psychological status in the elderly cancer inpatient at no greater length of hospitalization or extra cost than usual care This prospect i ve cohort study of consecutive elderly cancer patients was undertaken to evaluate the role of the multidimensional geriatric assessment ( MGA ) as an aid in treatment decision-making . A total of 571 cancer patients ( aged > or = 70 ) were enrolled during 6-year ( 1999 - 2005 ) . All underwent MGA as part of the first evaluation . In multivariate analysis , the probability of receiving active , instead of palliative , treatment was negatively associated with increasing age ( odds ratio=0.69 every 5 years , p=0.005 ) , living alone ( OR=0.54 , p=0.031 ) , dependence in activities of daily living ( ADL score > 0 , OR=0.41 , p=0.003 ) and a low body-mass index ( BMI ) ( OR=0.51 , p=0.061 ) ; while a positive association emerged for instrumental activities of daily living ( IADL ) score ( OR=1.12 per point , p=0.019 ) . Our data suggest that MGA , in addition to age , is a useful tool in clinical practice for deciding cancer treatment in elderly patients , with a major independent role played by living alone , ADL , IADL and BMI PURPOSE To identify Comprehensive Geriatric Assessment ( CGA ) components independently associated with changes in planned cancer treatment . PATIENTS AND METHODS We prospect ively included 375 consecutive elderly patients with cancer ( ELCAPA01 study ) assessed by geriatricians using the CGA .  Multivariate analysis was used to identify factors associated with changes in the cancer treatment ( intensification , decrease , or delayed > 2 weeks ) . Change was defined as a difference between the initial treatment proposal and the final treatment selected in a multidisciplinary meeting . RESULTS Mean age was 79.6 years ( st and ard deviation [ SD ] , 5.6 years ) , and 197 ( 52.5 % ) were women . The most common tumor location was the digestive system ( 58.7 % ) . The mean number of comorbidities was 4.2 ( SD , 2.7 ) per patient , and the mean Cumulative Illness Rating Scale for Geriatrics score was 11.8 ( SD , 5.3 ) . After the CGA , the initial cancer treatment plan was modified for 78 ( 20.8 % ) of 375 patients ( 95 % CI , 16.8 to 25.3 ) , usually to decrease treatment intensity ( 63 [ 80.8 % ] of 78 patients ) . By univariate analysis , cancer treatment changes were associated with Eastern Cooperative Oncology Group performance status ≥ 2 ( 73.3 % in the group with changes v 41.1 % in the in the group without changes ; P < .001 ) , dependency for one or more activities of daily living ( ADL ; 59.0 % v 24.2 % ; P < .001 ) , malnutrition ( 81.8 % v 51.2 % ; P < .001 ) , cognitive impairment ( 38.5 % v 24.9 % ; P = .023 ) , depression ( 52.6 % v 21.7 % ; P < .001 ) , and greater number of comorbidities ( mean , 4.8 [ SD , 2.9 ] v 4.0 [ SD , 2.6 ] ; P = .02 ) . By multivariate analysis , factors independently associated with cancer treatment changes were a lower ADL score ( odds ratio [ OR ] , 1.25 per 0.5-point decrease ; CI , 1.04 to 1.49 ; P = .016 ) and malnutrition ( OR , 2.99 ; CI , 1.36 to 6.58 ; P = .007 ) . CONCLUSION Functional status assessed by the ADL score and malnutrition were independently associated with changes in cancer treatment We investigated the predictive value of geriatric assessment ( GA ) on overall survival ( OS ) for older adults with acute myelogenous leukemia ( AML ) . Consecutive patients ≥ 60 years with newly diagnosed AML and planned intensive chemotherapy were enrolled at a single institution . Pretreatment GA included evaluation of cognition , depression , distress , physical function ( PF ) ( self-reported and objective ly measured ) , and comorbidity . Objective PF was assessed using the Short Physical Performance Battery ( SPPB , timed 4-m walk , chair st and s , st and ing balance ) and grip strength . Cox proportional hazards models were fit for each GA measure as a predictor of OS . Among 74 patients , the mean age was 70 years , and 78.4 % had an Eastern Cooperative Oncology Group ( ECOG ) score ≤ 1 . OS was significantly shorter for participants who screened positive for impairment in cognition and objective ly measured PF . Adjusting for age , gender , ECOG score , cytogenetic risk group , myelodysplastic syndrome , and hemoglobin , impaired cognition ( Modified Mini-Mental State Exam < 77 ) and impaired objective PF ( SPPB < 9 ) were associated with worse OS . GA methods , with a focus on cognitive and PF , improve risk stratification and may inform interventions to improve outcomes for older AML patients OBJECTIVES To establish a correlation between a specific MGA category , an appropriate preventively established treatment and clinical outcome in a population of elderly cancer patients . The ultimate goal was to verify whether the appropriate treatment given to elderly cancer patients according to their MGA category could translate into a better clinical outcome assessed as clinical response and toxicity , i.e whether this process might achieve a clinical ly meaningful impact . PATIENTS AND METHODS We carried out a phase II open , prospect i ve non-r and omized study in 75 elderly cancer patients ( lung , head and neck , colorectal , gynecologic and breast ) hospitalized at the Department of Medical Oncology , University of Cagliari , Italy . All patients underwent MGA evaluation  and were assigned to three different categories : fit , intermediate and frail . Thereafter , an appropriate preventively established treatment was administered and the clinical outcome was assessed . The clinical outcome after 3 month treatment was defined on the basis of objective clinical response and toxicity . The difference of clinical outcome in the MGA categories was assessed by ANOVA test . Moreover , the correlation between MGA category and the clinical outcome ( clinical response and toxicity ) was assessed by Spearman 's correlation test . RESULTS A better clinical response was observed in fit patients as compared both to intermediate and frail patients . Treatment toxicity was comparable in the different MGA categories . The correlation analysis between MGA category , clinical response to treatment and toxicity showed that there was a significant direct correlation with clinical response and no correlation with toxicity . Overall , the regression analysis showed that MGA was predictive of clinical outcome , in the sense that it is truly predictive for clinical response and no predictive for toxicity . CONCLUSION Our study demonstrates that the MGA , although time-consuming , is a useful and cost-benefit effective tool to appropriately select elderly cancer patients to be treated effectively in terms of a survival advantage and those who would benefit mainly in terms of improvement of quality of life . Moreover , the treatment preventively established for each MGA category was shown to be adequate and accomplished the most appropriate performances in terms of effectiveness and toxicity BACKGROUND The diffusion of comprehensive geriatric assessment services has been rather limited in North America partly because of reimbursement and organizational constraints . OBJECTIVE To evaluate the impact of a comprehensive geriatric assessment intervention for frail older patients that is started before hospital discharge and is continued at home . METHODS Patients older than 65 years were selected who had either unstable medical problems , recent functional limitations , or potentially reversible geriatric clinical problems . Patients ( n = 354 ) were r and omly assigned to either the intervention group or a control group . Information on survival , readmissions , nursing home placement , medication use , and health status was collected at 30 and 60 days after hospital discharge . RESULTS No differences were observed between the two treatment groups in survival , hospital readmission , or nursing home placement by 60 days . After adjustment for baseline characteristics , no significant differences were observed between the two groups on measures of physical functioning , social functioning , role limitations , health perceptions , pain , mental health , energy and /or fatigue , health change , or overall well-being . CONCLUSIONS Although efficacy has been demonstrated for some forms of comprehensive geriatric assessment , the types of services that are easier to establish ( inpatient consultation services and ambulatory assessment ) have not been shown to improve outcomes . Our results indicate that outcomes are unaffected by a limited form of comprehensive geriatric assessment begun in the hospital and completed at home . Further efforts are needed to develop and to evaluate realistic approaches to comprehensive geriatric assessment BACKGROUND Screening tools are used in geriatric oncology to determine who should receive a Comprehensive Geriatric Assessment ( CGA ) . However , in this prospect i ve study , we evaluated the association between geriatric screening results , measured with the G8 and Groningen Frailty Indicator ( GFI ) , and severe treatment toxicity . METHODS Patients over 65 years with various types and stages of cancer were screened with the G8 and the GFI prior to the start of treatment . The association between geriatric screening results and Serious Adverse Events ( SAE ) after the first cycle of (radio)chemotherapy were studied with bivariate analysis ( normal versus abnormal screening test ) and logistic regression analysis . RESULTS From 170 screened patients , 85 patients were eligible for this study . The median age was 76 years ( range : 66 - 88 years ) . The treatment intent was curative in 46 % and palliative in 54 % . A SAE occurred in 15 patients ( 18 % ) of which three result ed in death . There was no significant association between the G8 , as a dichotomous predictor ( p = 0.376 ) or as a continuous predictor ( p = 0.298 ) , and risk of a SAE . We also found no significant association for the GFI analysed as a dichotomous predictor ( cut-off ≥4 : p = 0.384 ; cut-off ≥3 : p = 0.773 ) , nor as a continuous predictor ( p = 0.734 ) . All associations remained insignificant when adjusted for treatment type and comorbidity . CONCLUSION The G8 and the GFI can be used to select patients for CGA , but they do not seem to be predictive for short-term severe treatment toxicity
Geriatric assessment  was most often completed to describe a patient 's health and functional status .
Geriatric assessment  in the oncology setting is feasible , and some domains are associated with adverse outcomes .
However , there is limited evidence that geriatric assessment impacted treatment decision making .
BACKGROUND Geriatric assessment is a multidisciplinary diagnostic process that evaluates the older adult 's medical , psychological , social , and functional capacity .
No systematic review of the use of geriatric assessment in oncology has been conducted .
The goals of this systematic review were : 1 ) to provide an overview of all geriatric assessment instruments used in the oncology setting ; 2 ) to examine the feasibility and psychometric properties of those instruments ; and 3 ) to systematic ally evaluate the effectiveness of geriatric assessment in predicting or modifying outcomes ( including the impact on treatment decision making , toxicity of treatment , and mortality ) .