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Martinez-Tapia C, Laurent M, Paillaud E, Caillet P, Ferrat E, Lagrange JL, Rwabihama JP, Allain M, Chahwakilian A, Boudou-Rouquette P, Bastuji-Garin S, Audureau E. Predicting Frailty and Geriatric Interventions in Older Cancer Patients: Performance of Two Screening Tools for Seven Frailty Definitions-ELCAPA Cohort. Cancers (Basel) 2022; 14:cancers14010244. [PMID: 35008408 PMCID: PMC8750824 DOI: 10.3390/cancers14010244] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/23/2021] [Accepted: 12/25/2021] [Indexed: 02/01/2023] Open
Abstract
Screening tools have been developed to identify patients warranting a complete geriatric assessment (GA). However, GA lacks standardization and does not capture important aspects of geriatric oncology practice. We measured and compared the diagnostic performance of screening tools G8 and modified G8 according to multiple clinically relevant reference standards. We included 1136 cancer patients ≥ 70 years old referred for GA (ELCAPA cohort; median age, 80 years; males, 52%; main locations: digestive (36.3%), breast (16%), and urinary tract (14.8%); metastases, 43.5%). Area under the receiver operating characteristic curve (AUROC) estimates were compared between both tools against: (1) the detection of ≥1 or (2) ≥2 GA impairments, (3) the prescription of ≥1 geriatric intervention and the identification of an unfit profile according to (4) a latent class typology, expert-based classifications from (5) Balducci, (6) the International Society of Geriatric Oncology task force (SIOG), or using (7) a GA frailty index according to the Rockwood accumulation of deficits principle. AUROC values were ≥0.80 for both tools under all tested definitions. They were statistically significantly higher for the modified G8 for six reference standards: ≥1 GA impairment (0.93 vs. 0.89), ≥2 GA impairments (0.90 vs. 0.87), ≥1 geriatric intervention (0.85 vs. 0.81), unfit according to Balducci (0.86 vs. 0.80) and SIOG classifications (0.88 vs. 0.83), and according to the GA frailty index (0.86 vs. 0.84). Our findings demonstrate the robustness of both screening tools against different reference standards, with evidence of better diagnostic performance of the modified G8.
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Affiliation(s)
- Claudia Martinez-Tapia
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
| | - Marie Laurent
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Internal Medicine and Geriatric Department, AP-HP, Hôpital Henri-Mondor, F-94010 Creteil, France
| | - Elena Paillaud
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Geriatric Oncology Unit, AP-HP, Hôpital Europeen Georges Pompidou, F-75015 Paris, France
| | - Philippe Caillet
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Geriatric Oncology Unit, AP-HP, Hôpital Europeen Georges Pompidou, F-75015 Paris, France
| | - Emilie Ferrat
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Primary Care Department, School of Medicine, Université Paris Est Créteil (UPEC), F-94010 Créteil, France
| | - Jean-Léon Lagrange
- Department of Medical Oncology, AP-HP, Hôpital Henri-Mondor, F-94010 Creteil, France;
| | - Jean-Paul Rwabihama
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Geriatric Department, AP-HP, Hôpital Joffre-Dupuytren, F-91210 Draveil, France
| | - Mylène Allain
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Clinical Research Unit (URC Mondor), AP-HP, Hôpital Henri-Mondor, F-94010 Creteil, France
| | - Anne Chahwakilian
- Oncogeriatrics, Geriatric Department, AP-HP, Hôpital Broca, F-75013 Paris, France;
| | | | - Sylvie Bastuji-Garin
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Public Health Department, AP-HP, Hôpital Henri-Mondor, F-94010 Creteil, France
| | - Etienne Audureau
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Clinical Research Unit (URC Mondor), AP-HP, Hôpital Henri-Mondor, F-94010 Creteil, France
- Public Health Department, AP-HP, Hôpital Henri-Mondor, F-94010 Creteil, France
- Correspondence: ; Tel.: +33-149-813-664
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van Winden MEC, Garcovich S, Peris K, Colloca G, de Jong EMGJ, Hamaker ME, van de Kerkhof PCM, Lubeek SFK. Frailty screening in dermato-oncology practice: a modified Delphi study and a systematic review of the literature. J Eur Acad Dermatol Venereol 2020; 35:95-104. [PMID: 32403174 PMCID: PMC7818261 DOI: 10.1111/jdv.16607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022]
Abstract
Background Appropriate management and prevention of both under‐ and overtreatment in older skin cancer patients can be challenging. It could be helpful to incorporate frailty screening in dermato‐oncology care, since frailty is associated with adverse health outcomes. Objectives This study aimed to identify and prioritize the requirements a frailty screening tool (FST) should fulfil in dermato‐oncology practice and to select the best existing FST(s) for this purpose. Methods A modified two‐round Delphi procedure was performed among 50 Italian and Dutch specialists and patients to review and prioritize a list of potential FST requirements, using a 5‐point Likert scale. Consensus was defined as a mean score of ≥4.0. A systematic literature search was performed to identify existing multidomain FSTs, which were then assessed on the requirements resulting from the modified Delphi procedure. Results Consensus was achieved on evaluation of comorbidities (4.3 ± 0.7), polypharmacy (4.0 ± 0.9) and cognition (4.1 ± 0.8). The FST should have appropriate measurement properties (4.0 ± 1.0), be quickly executed (4.2 ± 0.7), clinically relevant (4.3 ± 0.7), and both easily understandable (4.1 ± 1.2) and interpretable (4.3 ± 0.7). Of the 26 identified FSTs, four evaluated the content‐related domains: the Geriatric‐8 (G8), the modified Geriatric‐8 (mG8), the Groningen Frailty Indicator (GFI) and the Senior Adult Oncology Program 2 (SAOP2) screening tool. Of these, the G8 was the most extensively studied FST, with the best psychometric properties and execution within 5 min. Conclusions The G8 appears the most suitable FST for assessing frailty in older adults with skin cancer, although clinical studies assessing its use in a dermato‐oncology population are needed to further assess whether or not frailty in this particular patient group is associated with relevant outcomes (e.g. complications and mortality), as seen in previous studies in other medical fields.
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Affiliation(s)
- M E C van Winden
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Garcovich
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - K Peris
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Colloca
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M E Hamaker
- Department of Geriatrics, Diakonessenhuis, Zeist, The Netherlands
| | - P C M van de Kerkhof
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S F K Lubeek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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van Walree IC, Scheepers E, van Huis-Tanja L, Emmelot-Vonk MH, Bellera C, Soubeyran P, Hamaker ME. A systematic review on the association of the G8 with geriatric assessment, prognosis and course of treatment in older patients with cancer. J Geriatr Oncol 2019; 10:847-858. [DOI: 10.1016/j.jgo.2019.04.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/17/2019] [Accepted: 04/20/2019] [Indexed: 12/13/2022]
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Yu IS, Cheung WY. Metastatic Colorectal Cancer in the Era of Personalized Medicine: A More Tailored Approach to Systemic Therapy. Can J Gastroenterol Hepatol 2018; 2018:9450754. [PMID: 30519549 PMCID: PMC6241232 DOI: 10.1155/2018/9450754] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 10/30/2018] [Indexed: 12/21/2022] Open
Abstract
Colorectal cancer is the second most common malignancy diagnosed in Canada. Despite declining incidence and mortality rates in recent years, there is still a significant number of cases that are metastatic at presentation. Fluoropyrimidine-based chemotherapy was the backbone of colorectal cancer treatment, but the addition of irinotecan and oxaliplatin to form combination regimens has significantly improved overall survival. In the past decade, the development of novel biologic agents including therapies directed against vascular endothelial growth factor and epidermal growth factor receptor has further altered the landscape of metastatic colorectal cancer treatment. However, clinical trials have demonstrated that not all patients respond to these therapies similarly and consideration must be given to individual patient- and tumor-related factors. A more tailored and biomarker driven approach to treatment selection can optimize outcomes and avoid unnecessary adverse effects. In this review article, we offer a comprehensive overview of the panel of clinical- and tumor-associated characteristics that influence treatment decisions in metastatic colorectal cancer and how this sets the foundation for a more personalized treatment strategy in oncology.
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Affiliation(s)
- Irene S. Yu
- University of British Columbia, Vancouver, Canada
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5
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Noor A, Gibb C, Boase S, Hodge JC, Krishnan S, Foreman A. Frailty in geriatric head and neck cancer: A contemporary review. Laryngoscope 2018; 128:E416-E424. [PMID: 30329155 DOI: 10.1002/lary.27339] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To provide a summary of the current frailty literature relating to head and neck cancer. DATA SOURCES Ovid MEDLINE, PubMed, Google Scholar. METHODS A comprehensive review of the literature was performed from 2000 to 2017 using key words frailty, elderly, geriatric, surgery, otolaryngology, head and neck cancer. RESULTS The aging population has led to an increased diagnosis of head and neck cancer in elderly patients. The prevalence of comorbidities, disabilities, geriatric syndromes and social issues can make treatment planning and management in this population challenging. Chronological age alone may not be the optimal approach to guiding treatment decisions, as there is marked heterogeneity amongst this age group. Individualization of treatment can be achieved by assessing for the presence of frailty, which has growing evidence as an important marker of health status in geriatric oncology. Frailty is a complex geriatric syndrome characterized by a state of increased vulnerability to stressors and is associated with morbidity, mortality, and treatment toxicity. Screening for frailty may provide an efficient method to identify those who would benefit from further assessment or pretreatment optimization, and to provide prognostic information to assist clinicians and patients in formulating the most ideal treatment plan for the elderly individual with head and neck cancer. CONCLUSIONS Frailty has emerged as an important concept in geriatric oncology, with wide significance in head and neck cancer. Incorporating frailty assessments into clinical practice may provide otolaryngologists pertinent information regarding health status and outcomes leading to optimal care of the elderly cancer patient. Laryngoscope, 128:E416-E424, 2018.
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Affiliation(s)
- Anthony Noor
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Catherine Gibb
- Department of Medicine, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Sam Boase
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - John-Charles Hodge
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Suren Krishnan
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew Foreman
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
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Russo C, Giannotti C, Signori A, Cea M, Murialdo R, Ballestrero A, Scabini S, Romairone E, Odetti P, Nencioni A, Monacelli F. Predictive values of two frailty screening tools in older patients with solid cancer: a comparison of SAOP2 and G8. Oncotarget 2018; 9:35056-35068. [PMID: 30416679 PMCID: PMC6205549 DOI: 10.18632/oncotarget.26147] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/01/2018] [Indexed: 12/27/2022] Open
Abstract
Objectives Comprehensive Geriatric Assessment (CGA), the gold standard for detecting frailty in elderly cancer patients, is time-consuming and hard to apply in routine clinical practice. Here we compared the performance of two screening tools for frailty, G8 and SAOP2 for their accuracy in identifying vulnerable patients. Material and Methods We tested G8 and SAOP2 in 282 patients aged 65 or older with a diagnosis of solid cancer and candidate to undergo surgical, medical and/or radiotherapy treatment. CGA, including functional and cognitive status, depression, nutrition, comorbidity, social status and quality of life was used as reference. ROC curves were used to compare two screening tools. Results Mean patient age was 79 years and 54% were female. Colorectal and breast cancer were the most common types cancer (49% and 24%). Impaired CGA, G8, and SAOP2 were found in 62%, 89%, and 94% of the patients, respectively. SAOP2 had a better sensitivity (AUC 0.85, p<0.032) than G8 (AUC 0.79), with higher performance in breast cancer patients (AUC 0.93) and in patients aged 70-80 years (AUC 0.87). Conclusions G8 and SAOP2 both showed good screening capacity for frailty in the cancer patient population we examined with SAOP2 showing a slightly better performance than G8.
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Affiliation(s)
- Chiara Russo
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, Italy
| | - Chiara Giannotti
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, Italy
| | - Alessio Signori
- DISSAL, Section of Biostatistics, Department of Health Sciences, University of Genova, Genoa, Italy
| | - Michele Cea
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, Italy
| | - Roberto Murialdo
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, Italy
| | - Alberto Ballestrero
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, Italy
| | - Stefano Scabini
- Hospital Policlinic San Martino, Oncological Surgery and Implantable Systems, Genoa, Italy
| | - Emanuele Romairone
- Hospital Policlinic San Martino, Oncological Surgery and Implantable Systems, Genoa, Italy
| | - Patrizio Odetti
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, Italy
| | - Alessio Nencioni
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, Italy
| | - Fiammetta Monacelli
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, Italy
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Bellera CA, Artaud F, Rainfray M, Soubeyran PL, Mathoulin-Pélissier S. Modeling individual and relative accuracy of screening tools in geriatric oncology. Ann Oncol 2018; 28:1152-1157. [PMID: 28327973 DOI: 10.1093/annonc/mdx068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Classification probabilities reflect to what degree a screening test represents the true disease state and include true positive (TPF) and false positive fractions (FPF). With two tests, one can compare TPF and FPF using relative probabilities which offer advantages in terms of interpretation and statistical modeling. Our objective was to highlight how individual and relative TPF and FPF can be easily estimated and compared within a regression modeling framework. This allows the modeling of tests' accuracy while adjusting for multiple covariates, and thus provides valuable information in addition to the crude TPF and FPF. We illustrate our purpose with the G8 and VES-13 screening tests aimed at identifying elderly cancer patients in need for a comprehensive geriatric assessment (CGA). Methods Prospective cohort with a paired design. TPF and FPF of each test, as well as relative TPF and FPF were modeled using log-linear models. Results G8 detected patients in need for CGA better than VES-13 at the expense of misclassifying a large number of normal patients. Both tests had better TPF with older age and poorer performance status (PS), and for all cancer subtypes compared with prostate cancer. Effect of age and PS on TPF was more pronounced with VES-13. Age affected FPF, but not differentially. Conclusions Regression modeling helps provide a thorough assessment of the accuracy of diagnostic tests and should be used more frequently. In the context of screening, we encourage the use of G8 as failing to identify patients in need of a CGA might be more problematic than over-detection. Moreover, although we identified variables associated with the sensitivity of these tests, this association was less pronounced for the G8.
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Affiliation(s)
- C A Bellera
- Clinical Research and Clinical Epidemiology Unit, Department of Clinical Research and Medical Information, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux
- Clinical Epidemiology Unit, INSERM CIC 14.01, Bordeaux
- Team EPICENE, University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux
| | - F Artaud
- Clinical Research and Clinical Epidemiology Unit, Department of Clinical Research and Medical Information, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux
- Clinical Epidemiology Unit, INSERM CIC 14.01, Bordeaux
| | - M Rainfray
- Gerontology Service, Centre Hospitalier Universitaire, Bordeaux
- University of Bordeaux, Bordeaux
| | - P L Soubeyran
- University of Bordeaux, Bordeaux
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
| | - S Mathoulin-Pélissier
- Clinical Research and Clinical Epidemiology Unit, Department of Clinical Research and Medical Information, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux
- Clinical Epidemiology Unit, INSERM CIC 14.01, Bordeaux
- Team EPICENE, University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux
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Sealy MJ, Nijholt W, Stuiver MM, van der Berg MM, Roodenburg JL, van der Schans CP, Ottery FD, Jager-Wittenaar H. Content validity across methods of malnutrition assessment in patients with cancer is limited. J Clin Epidemiol 2016; 76:125-36. [DOI: 10.1016/j.jclinepi.2016.02.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 02/01/2016] [Accepted: 02/22/2016] [Indexed: 12/30/2022]
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Denewet N, De Breucker S, Luce S, Kennes B, Higuet S, Pepersack T. Comprehensive geriatric assessment and comorbidities predict survival in geriatric oncology. Acta Clin Belg 2016; 71:206-13. [PMID: 27169550 DOI: 10.1080/17843286.2016.1153816] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
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. MATERIALS AND METHODS This study analyzed data from two hospitals that included geriatric assessments 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 graded 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. Prospective trials evaluating the utility of a CGA to guide interventions to improve quality of cancer care in older adults are justified.
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Sattar S, Alibhai SMH, Spoelstra SL, Fazelzad R, Puts MTE. Falls in older adults with cancer: a systematic review of prevalence, injurious falls, and impact on cancer treatment. Support Care Cancer 2016; 24:4459-69. [PMID: 27450557 DOI: 10.1007/s00520-016-3342-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this systematic review was to update and expand the existing systematic review with the aim to answer the following questions: (1) How often do older adults (OA)s with cancer fall? (2) What are the predictors of falls in OA with cancer? (3) What is the rate of injurious falls and predictors of injurious falls in OA with cancer? (4) What are the circumstances and outcomes of falls in this population? (5) How do falls in cancer patients affect subsequent cancer treatment? METHODS Medline, Pubmed, Embase, and CINAHL were searched. Eligible studies included clinical trials, cross-sectional, cohort, case-control, and qualitative studies in which the entire sample or a sub-group of the sample were OA aged 60 and above, had cancer, in which falls were examined as a primary or secondary outcome and published in English. RESULTS Twenty-seven studies met our inclusion criteria with most involving the outpatient setting. Fall rates and injurious fall rates varied widely. Consistent predictors of falls were prior falls among outpatients and cognitive impairment among inpatients. There were no data on impact of falls on cancer treatment. Data on circumstances of falls were limited. CONCLUSION Falls and fall-related injuries are common in older cancer patients. However, little is known about circumstances of falls and impact of falls on cancer treatment. Many known fall predictors in community-dwelling OA have not been explored in oncology. More research is needed to address gaps in these areas.
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Affiliation(s)
- Schroder Sattar
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite, Toronto, ON, 130M5T 1P8, Canada.
| | - Shabbir M H Alibhai
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, 200 Elizabeth Street, Toronto, M5G 2C4, Canada
| | - Sandra L Spoelstra
- Kirkhof College of Nursing, Grand Valley State University, 301 Michigan Street, NE, Michigan, MI, 49502, USA
| | - Rouhi Fazelzad
- Library and Information Services, University Health Network, 5-407, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite, Toronto, ON, 130M5T 1P8, Canada
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Liuu E, Caillet P, Curé H, Anfasi N, De Decker L, Pamoukdjian F, Canouï-Poitrine F, Soubeyran P, Paillaud E. [Comprehensive geriatric assessment (CGA) in elderly with cancer: For whom?]. Rev Med Interne 2016; 37:480-8. [PMID: 26997159 DOI: 10.1016/j.revmed.2016.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/17/2015] [Accepted: 02/20/2016] [Indexed: 12/27/2022]
Abstract
Scientific societies recommend the implementation of a comprehensive geriatric assessment (CGA) in cancer patients aged 70 and older. The EGA is an interdisciplinary multidimensional diagnostic process seeking to assess the frail older person in order to develop a coordinated plan of treatment and long-term follow-up. Identification of comorbidities and age-induced physiological changes that may increase the risk of anticancer treatment toxicities is essential to better assess the risk-benefit ratio in elderly cancer patients. The systematic implementation of a CGA for each patient is difficult to perform in daily practice. Therefore, it is recommended to screen vulnerable patients who will benefit from a complete CGA. Our work presents the vulnerability screening tools validated by at least two independent studies in a cancer elderly population setting. Among seven screening tools, the G8 and the VES13 are the most effective, and have been validated specifically in older population with cancer. The G8 is recommended by scientific societies and the French National Cancer Institute (INCa) because of its easy implementation in daily clinical practice, its high sensitivity and fair specificity. Although studies are underway to improve its performance, the G8 is currently the simplest tool to routinely identify older cancer patients who should have a complete assessment in geriatric oncology.
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Affiliation(s)
- E Liuu
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France
| | - P Caillet
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France; Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France
| | - H Curé
- Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Medical oncology department, Grenoble university hospital, CS 10127 Grenoble, France
| | - N Anfasi
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - L De Decker
- Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Department of internal medicine and geriatrics, Nantes university hospital, 44093 Nantes, France
| | - F Pamoukdjian
- Unité de coordination en oncogériatrie, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - F Canouï-Poitrine
- CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France; Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Service de santé publique, hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - P Soubeyran
- Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Institut Bergonié, université de Bordeaux, CS 61283 Bordeaux, France
| | - E Paillaud
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France; Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France.
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12
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O'Donovan A, Mohile SG, Leech M. Expert consensus panel guidelines on geriatric assessment in oncology. Eur J Cancer Care (Engl) 2015; 24:574-89. [PMID: 25757457 DOI: 10.1111/ecc.12302] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 12/27/2022]
Abstract
Despite consensus guidelines on best practice in the care of older patients with cancer, geriatric assessment (GA) has yet to be optimally integrated into the field of oncology in most countries. There is a relative lack of consensus in the published literature as to the best approach to take, and there is a degree of uncertainty as to how integration of geriatric medicine principles might optimally predict patient outcomes. The aim of the current study was to obtain consensus on GA in oncology to inform the implementation of a geriatric oncology programme. A four-round Delphi process was employed. The Delphi method is a structured group facilitation process, using multiple iterations to gain consensus on a given topic. Consensus was reached on the optimal assessment method and interventions required for the commonly employed domains of GA. Other aspects of GA, such as screening methods and age cut-off for assessment, represented a higher degree of disagreement. The expert panel employed in this study clearly identified the criteria that should be included in a clinical geriatric oncology programme. In the absence of evidence-based guidelines, this may prove useful in the care of older cancer patients.
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Affiliation(s)
- A O'Donovan
- Applied Radiation Therapy Trinity (ARTT), Trinity College Dublin, Ireland
| | - S G Mohile
- James Wilmot Cancer Center, University of Rochester, Rochester, NY, USA
| | - M Leech
- Applied Radiation Therapy Trinity (ARTT), Trinity College Dublin, Ireland
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13
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Wildes TM, Dua P, Fowler SA, Miller JP, Carpenter CR, Avidan MS, Stark S. Systematic review of falls in older adults with cancer. J Geriatr Oncol 2015; 6:70-83. [PMID: 25454770 PMCID: PMC4297689 DOI: 10.1016/j.jgo.2014.10.003] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 08/26/2014] [Accepted: 10/07/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Older adults frequently experience falls, at great cost to themselves and society. Older adults with cancer may be at greater risk for falls and have unique risk factors. MATERIALS AND METHODS We undertook a systematic review of the available medical literature to examine the current evidence regarding factors associated with falls in older adults with cancer. PubMed, Embase, CINAHL, CENTRAL, DARE, Cochrane Database of Systematic Reviews and clinical trials.gov were searched using standardized terms for concepts of oncology/cancer, people 60 and older, screening, falls and diagnosis. Eligible studies included cohort or case-control studies or clinical trials in which all patients, or a subgroup of patients, had a diagnosis of cancer and in which falls were either the primary or secondary outcome. RESULTS We identified 31 studies that met our inclusion criteria. Several studies suggest that falls are more common in older adults with a diagnosis of cancer than those without. Among the 11 studies that explored factors associated with outpatient falls, some risk factors for falls established in the general population were also associated with falls in older adults with cancer, including dependence in activities of daily living and prior falls. Other factors associated with falls in a general population, such as age, polypharmacy and opioid use, were not predictive of falls among oncology populations. Falls among older adults with cancer in the inpatient setting were associated with established risk factors for falls in people without cancer, but also with factors unique to an oncology population, such as brain metastases. CONCLUSIONS Falls in older adults with cancer are more common than in the general population, and are associated with risk factors unique to people with cancer. Further study is needed to establish methods of screening older adults with cancer for fall risk and ultimately implement interventions to reduce their risk of falls. Identifying which older adults with cancer are at greater risk for falls is a requisite step to ultimately intervene and prevent falls in this vulnerable population.
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Affiliation(s)
- Tanya M Wildes
- Washington University School of Medicine, Division of Medical Oncology, St Louis, MO, USA.
| | - Priya Dua
- Barnes-Jewish Hospital, Siteman Cancer Center, St Louis, MO, USA
| | - Susan A Fowler
- Washington University School of Medicine, Bernard Becker Medical Library, St Louis, MO, USA
| | - J Philip Miller
- Washington University School of Medicine, Division of Biostatistics, St Louis, MO, USA
| | - Christopher R Carpenter
- Washington University School of Medicine, Department of Emergency Medicine, St Louis, MO, USA
| | - Michael S Avidan
- Washington University School of Medicine, Department of Anesthesiology, St Louis, MO, USA
| | - Susan Stark
- Washington University School of Medicine, Department of Occupational Therapy, St Louis, MO, USA
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14
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Soubeyran P, Bellera C, Goyard J, Heitz D, Curé H, Rousselot H, Albrand G, Servent V, Jean OS, van Praagh I, Kurtz JE, Périn S, Verhaeghe JL, Terret C, Desauw C, Girre V, Mertens C, Mathoulin-Pélissier S, Rainfray M. Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study. PLoS One 2014; 9:e115060. [PMID: 25503576 PMCID: PMC4263738 DOI: 10.1371/journal.pone.0115060] [Citation(s) in RCA: 336] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 11/12/2014] [Indexed: 12/13/2022] Open
Abstract
Background Geriatric Assessment is an appropriate method for identifying older cancer patients at risk of life-threatening events during therapy. Yet, it is underused in practice, mainly because it is time- and resource-consuming. This study aims to identify the best screening tool to identify older cancer patients requiring geriatric assessment by comparing the performance of two short assessment tools the G8 and the Vulnerable Elders Survey (VES-13). Patients and Methods The diagnostic accuracy of the G8 and the (VES-13) were evaluated in a prospective cohort study of 1674 cancer patients accrued before treatment in 23 health care facilities. 1435 were eligible and evaluable. Outcome measures were multidimensional geriatric assessment (MGA), sensitivity (primary), specificity, negative and positive predictive values and likelihood ratios of the G8 and VES-13, and predictive factors of 1-year survival rate. Results Patient median age was 78.2 years (70-98) with a majority of females (69.8%), various types of cancer including 53.9% breast, and 75.8% Performance Status 0-1. Impaired MGA, G8, and VES-13 were 80.2%, 68.4%, and 60.2%, respectively. Mean time to complete G8 or VES-13 was about five minutes. Reproducibility of the two questionnaires was good. G8 appeared more sensitive (76.5% versus 68.7%, P = 0.0046) whereas VES-13 was more specific (74.3% versus 64.4%, P<0.0001). Abnormal G8 score (HR = 2.72), advanced stage (HR = 3.30), male sex (HR = 2.69) and poor Performance Status (HR = 3.28) were independent prognostic factors of 1-year survival. Conclusion With good sensitivity and independent prognostic value on 1-year survival, the G8 questionnaire is currently one of the best screening tools available to identify older cancer patients requiring geriatric assessment, and we believe it should be implemented broadly in daily practice. Continuous research efforts should be pursued to refine the selection process of older cancer patients before potentially life-threatening therapy.
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Affiliation(s)
- Pierre Soubeyran
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
- University of Bordeaux, Bordeaux, France
- * E-mail:
| | - Carine Bellera
- Clinical and Epidemiological Research unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
- INSERM U897 (Institut national de la santé et de la recherche médicale), CIC1401 (Centre d′investigation clinique), Institut Bergonié, Bordeaux, France
| | - Jean Goyard
- Oncogeriatric Coordination unit, Centre Jean Perrin, Clermont-Ferrand, France
| | - Damien Heitz
- Oncology and Hematology unit, Centre Hospitalier Universitaire de Strasbourg - Hôpital de Hautepierre, Strasbourg, France
| | - Hervé Curé
- Geriatric unit, Institut Jean Godinot, Reims, France
| | - Hubert Rousselot
- Cancer Support unit, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre les Nancy, France
| | - Gilles Albrand
- Geriatric Evaluation and Management unit, Antoine Charial Hospital, Francheville, Lyon, France
| | | | - Olivier Saint Jean
- Internal Medicine unit, Hôpital européen Georges-Pompidou, Paris, France
| | - Isabelle van Praagh
- Oncogeriatric Coordination unit, Centre Jean Perrin, Clermont-Ferrand, France
| | - Jean-Emmanuel Kurtz
- Oncology and Hematology unit, Centre Hospitalier Universitaire de Strasbourg - Hôpital de Hautepierre, Strasbourg, France
| | | | - Jean-Luc Verhaeghe
- Surgical Oncology unit, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre les Nancy, France
| | | | - Christophe Desauw
- Senology unit, Hôpital Saint Vincent de Paul, Université Catholique de Lille, Lille, France
| | - Véronique Girre
- Oncology and Haematology unit, Centre Hospitalier Départemental, La Roche sur Yon, France
| | - Cécile Mertens
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
- Department of Clinical Gerontology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Simone Mathoulin-Pélissier
- University of Bordeaux, Bordeaux, France
- Clinical and Epidemiological Research unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
- INSERM U897 (Institut national de la santé et de la recherche médicale), CIC1401 (Centre d′investigation clinique), Institut Bergonié, Bordeaux, France
| | - Muriel Rainfray
- University of Bordeaux, Bordeaux, France
- Department of Clinical Gerontology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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15
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Decoster L, Van Puyvelde K, Mohile S, Wedding U, Basso U, Colloca G, Rostoft S, Overcash J, Wildiers H, Steer C, Kimmick G, Kanesvaran R, Luciani A, Terret C, Hurria A, Kenis C, Audisio R, Extermann M. Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations†. Ann Oncol 2014; 26:288-300. [PMID: 24936581 DOI: 10.1093/annonc/mdu210] [Citation(s) in RCA: 485] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Screening tools are proposed to identify those older cancer patients in need of geriatric assessment (GA) and multidisciplinary approach. We aimed to update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on the use of screening tools. MATERIALS AND METHODS SIOG composed a task group to review, interpret and discuss evidence on the use of screening tools in older cancer patients. A systematic review was carried out and discussed by an expert panel, leading to a consensus statement on their use. RESULTS Forty-four studies reporting on the use of 17 different screening tools in older cancer patients were identified. The tools most studied in older cancer patients are G8, Flemish version of the Triage Risk Screening Tool (fTRST) and Vulnerable Elders Survey-13 (VES-13). Across all studies, the highest sensitivity was observed for: G8, fTRST, Oncogeriatric screen, Study of Osteoporotic Fractures, Eastern Cooperative Oncology Group-Performance Status, Senior Adult Oncology Program (SAOP) 2 screening and Gerhematolim. In 11 direct comparisons for detecting problems on a full GA, the G8 was more or equally sensitive than other instruments in all six comparisons, whereas results were mixed for the VES-13 in seven comparisons. In addition, different tools have demonstrated associations with outcome measures, including G8 and VES-13. CONCLUSIONS Screening tools do not replace GA but are recommended in a busy practice in order to identify those patients in need of full GA. If abnormal, screening should be followed by GA and guided multidisciplinary interventions. Several tools are available with different performance for various parameters (including sensitivity for addressing the need for further GA). Further research should focus on the ability of screening tools to build clinical pathways and to predict different outcome parameters.
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Affiliation(s)
- L Decoster
- Department of Medical Oncology, Oncologisch Centrum, UZ Brussel, Vrije Universiteit Brussel, Brussels
| | - K Van Puyvelde
- Department of Geriatric Medecine, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - S Mohile
- Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, Rochester, USA
| | - U Wedding
- Department of Internal Medicine II, Jena University Hospital, Jena, Germany
| | - U Basso
- Department of Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padova
| | - G Colloca
- Department of Geriatric Medicine, Università Cattolica Sacro Cuore, Rome, Italy
| | - S Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - J Overcash
- Ohio State University Comprehensive Cancer Center, College of Nursing, Columbus, USA
| | - H Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - C Steer
- Border Medical Oncology, Wodonga, Australia
| | - G Kimmick
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, USA
| | - R Kanesvaran
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - A Luciani
- Division of Medical Oncology, S. Paolo Hospital, Milan, Italy
| | - C Terret
- Department of Medical Oncology, Centre Léon-Bérard, Lyon, France
| | - A Hurria
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, USA
| | - C Kenis
- Department of General Medical Oncology and Geriatric Medecine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - R Audisio
- Department of Surgery, University of Liverpool, St Helens Teaching Hospital, Liverpool, UK
| | - M Extermann
- Moffitt Cancer Center, University of South Florida, Tampa, USA
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