Cumulative deficit model of geriatric assessment to predict the postoperative outcomes of older patients with solid abdominal cancer. The feasibility of inpatient geriatric assessment for older adults receiving induction chemotherapy for acute myelogenous leukemia. Abridged geriatric assessment is a better predictor of overall survival than the Karnofsky Performance Scale and Physical Performance Test in elderly patients with cancer. Role of geriatric intervention in the treatment of older patients with cancer: rationale and design of a phase III multicenter trial Geriatric screening results and the association with severe treatment toxicity after the first cycle of (radio)chemotherapy. Evaluation of geriatric assessment in patients with chronic lymphocytic leukemia: Results of the CLL9 trial of the German CLL study group 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. Identifying vulnerable older adults with cancer: integrating geriatric assessment into oncology practice. Geriatric assessment in elderly patients with prostate cancer. Implementing a geriatric assessment in cooperative group clinical cancer trials: CALGB 360401. Comprehensive geriatric assessment and comorbidities predict survival in geriatric oncology A comprehensive geriatric intervention detects multiple problems in older breast cancer patients. Improving the quality of life of geriatric cancer patients with a structured multidisciplinary intervention: a randomized controlled trial. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Screening for frailty among older patients with cancer that qualify for abdominal surgery. Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia. Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study.
OBJECTIVE The geriatric assessment ( GA ) has proven to be of great value for clinicians treating older patients . However , a clear consensus on the optimal set of GA instruments is lacking , particularly for surgical patients . Therefore , the aim of this prospect i ve study was to compare the prevalence of frailty , depending on the number of incorporated GA domains , and to evaluate its accuracy in predicting postoperative outcome . MATERIAL S AND METHODS Seventy-five patients aged 65 years and older , qualified for abdominal surgery due to solid cancer , were enrolled . The GA included a wide variety of vali date d tools that evaluate functional , mobility , nutritional , co-morbidity , polypharmacy , and psychosocial domains .  RESULTS Depending on the number of incorporated GA domains the frequency of frailty was 23 - 97 % . The cumulative score rather than individual components of the GA , turned out to be an independent risk factor of 30-day postoperative morbidity . In predicting 30-day " any " and " major " morbidities , the area under the curve was 0.67 - 0.72 and 0.70 - 0.82 ( model including the severity of the surgery ) vs. 0.57 - 0.66 and 0.50 - 0.65 ( model not including the severity of the surgery ) , respectively . CONCLUSION The number of incorporated GA domains has a great influence on the prevalence of frailty and on adequate surgical risk assessment . The summary deficit score based on Pre-operative Assessment of Cancer in the Elderly ( PACE ) or the GA consisting of functional , mobility , cognitive , depression , nutritional , co-morbidity , polypharmacy , and social support assessment domains can predict 30-day postoperative morbidity . However , only models with addition of the severity of surgery show moderate to good predictive value 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 OBJECTIVES Comprehensive geriatric assessment ( CGA ) is a complex and interdisciplinary approach to evaluate the health status of elderly patients . The Karnofsky Performance Scale ( KPS ) and Physical Performance Test ( PPT ) are less time-consuming tools that measure functional status . This study was design ed to assess and compare abridged geriatric assessment ( GA ) , KPS and PPT as predictive tools of mortality in elderly patients with cancer . MATERIAL S AND METHODS This prospect i ve interventional study included all individuals aged > 70years who were diagnosed with cancer during the study period . Subjects were interviewed directly using a procedure that included a clinical test and a question naire composed of the KPS , PPT and abridged GCA .  Overall survival ( OS ) was the primary endpoint . The log rank test was used to compare survival curves , and Cox 's regression model ( forward procedure ) was used for multivariate survival analysis . RESULTS One hundred patients were included in this study . Abridged GA was the only tool found to predict mortality [ median OS for unfit patients ( at least two impairments ) 467days vs 1030days for fit patients ; p=0.04 ] . Patients defined as fit by mean PPT score ( > 20 ) had worse median OS ( 560 vs 721days ) ; however , this difference was not significant ( p=0.488 on log rank ) . Although median OS did not differ significantly between patients with low ( ≤80 ) and high ( > 80 ) KPS scores ( 467 and 795days , respectively ; p=0.09 ) , survival curves diverged after nearly 120days of follow-up . Visual and hearing impairments were the only components of abridged GA of prognostic value . CONCLUSION Neither KPS nor PPT were shown to predict mortality in elderly patients with cancer whereas abridged GA was predictive . This study suggests a possible role for visual and hearing assessment as screening for patients requiring CGA 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 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 Abstract Multidimensional geriatric assessment ( GA ) has been demonstrated to predict outcomes in older patients with cancer . This study evaluated GA in a cohort of older patients with chronic lymphocytic leukemia ( CLL ) . Seventy-five of 97 subjects with CLL who were enrolled in a clinical trial of the German CLL Study Group underwent GA prior to the start of study treatment ( low-dose chemotherapy with fludarabine ) . GA included  cumulative illness rating scale ( CIRS ) , timed-up- and -go ( TUG ) test , dementia detection ( DEMTECT ) test and instrumental activities of daily living ( IADL ) index . There was little correlation between CIRS , TUG , DEMTECT or IADL results and treatment toxicity , feasibility or efficacy in this study . CIRS and IADL had no statistically significant impact on overall prognosis . However , under-performance in TUG or DEMTECT test was strongly associated with poor survival . The latter findings provide a rationale to further investigate geriatric  assessment in CLL and in the context with other CLL treatments 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 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 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 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 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 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 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 BACKGROUND Development of a geriatric screening tool is necessary to identify elderly cancer patients who would benefit from comprehensive geriatric assessment ( CGA ) .  We develop and evaluate the G-8 screening tool against various reference tests . PATIENTS AND METHODS Analyses were based on 364 cancer patients aged>70 years scheduled to receive first-line chemotherapy included in a multicenter prospect i ve study . The G-8 consists of seven items from the Mini Nutritional Assessment ( MNA ) question naire and age . Our primary reference test is based on a set of seven CGA scales : Activities Daily Living ( ADL ) , Instrumental ADL , MNA , Mini-Mental State Exam , Geriatric Depression Scale , Cumulative Illness Rating Scale-Geriatrics , and Timed Get Up and Go . We considered the presence of at least one question naire with an impaired score as an abnormal reference exam . Additional reference exams are also discussed . RESULTS The prevalence of being at risk varied from 60 % to 94 % according to the various definitions of the reference test . When considering the primary reference test , a cut-off value of 14 for the G-8 tool provided a good sensitivity estimate ( 85 % ) without deteriorating the specificity excessively ( 65 % ) . CONCLUSION The G-8 shows good screening properties for identifying elderly cancer patients who could benefit from CGA OBJECTIVE The Geriatric Assessment ( GA ) is an established method for evaluating and optimizing diagnostic and treatment plans . However , it requires experience and is time-consuming . Therefore , a variety of screening methods have been developed . The aim of this study was to compare their accuracy for predicting frailty among older patients with cancer qualified for abdominal surgery based on comparison to the GA . MATERIAL AND METHODS One hundred and thirty five consecutive patients ≥65years of age were prospect ively enrolled . The diagnostic performance of eight screening tests was evaluated : The Vulnerable Elderly Survey ( VES-13 ) , Triage Risk Screening Tool ( TRST ) , Geriatric 8 ( G8 ) , Groningen Frailty Index ( GFI ) , abbreviated Comprehensive Geriatric Assessment ( aCGA ) , Rockwood , Balducci and Fried score . RESULTS The prevalence of frailty as diagnosed by the GA was 73 % . Screening methods identified frail patients in 40 - 75.5 % of cases . The sensitivity and specificity of these tests in predicting frailty were 52%-97 % ( Fried score-G8 ) and 44 - 100 % ( G8-Rockwood score ) , respectively . The positive and negative predictive values were 82 - 100 % ( Balducci-Rockwood ) and 43 - 84 % ( TRST-G8 ) , respectively . Age significantly influenced the predictive value of the screening tests whereas gender and type of cancer did not . CONCLUSION At present , there is no universal screening test that adequately identifies frailty in at risk older patients . The results of this study showed that the aCGA and G8 were the best screens for older patients with cancer that qualified for elective abdominal surgery ; the G8 had the highest sensitivity and negative predictive value and the aCGA was a good overall assessment tool 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 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
Consistent with our previous review , several domains of GA are associated with adverse outcomes .
BACKGROUND Our previous systematic review of geriatric assessment ( GA ) in oncology included a literature search up to November 2010 .
However , the quickly evolving field warranted an up date .
Aims of this review : ( i ) provide an overview of all GA instruments developed and /or in use in the oncology setting ; ( ii ) evaluate effectiveness of GA in predicting/modifying outcomes ( e.g. treatment decision impact , treatment toxicity , mortality , use of care ) .