Alterations in comprehensive geriatric assessment decrease survival of elderly patients with cancer

Matthieu Frasca ,Audrey Mailliez,Olivier Rigal,Laeticia Stefani,Alain Ravaud,Mathilde Gisselbrecht,Virginie Leroy,Laure De Decker,Valérie Quipourt,Serge Bologna,Sylvain Ladoire,Valérie Le Brun-Ly,Christian Gisselbrecht,Claire Falandry,Merle Patrick,Hélène Nehme,Matthieu Debray,Nicolas Jovenin,Aurélien Minard,Christian Rose,Brigitte Maget,Philippe Caillet,Emmanuelle Bourbouloux,Arnauld Villers,Luc Thiberville,Pierre Feugier,F Rousseau ,J L Lagrange ,Sandrine Lavau‐Denès ,Simone Mathoulin‐Pélissier ,Carine Bellera ,B Comte ,Catherine Thiéblemont ,Karen Leffondré ,Florence Wœrth ,J Bonnal ,Étienne Brain ,Pierre Soubeyran ,Erwan De Monès Del Pujol ,Laurent Balardy ,Élisabeth Carola ,G Jeannin ,Muriel Rainfray ,L Ribiere ,Loïc Mourey ,P Chaïbi

doi:10.1016/j.ejca.2017.11.013

Abstract

IntroductionA comprehensive geriatric assessment (CGA) evaluating several domains of health is recommended for elderly patients with cancer. Effects of altered domains on the risk of death in this population need to be clarified. The aim of this study was to estimate the independent association of each CGA domain to overall survival (OS). MethodPatients included in the ONCODAGE cohort completed a CGA at baseline. Cox models (one per domain) estimated the hazard ratio (HR) of death for each CGA domain. Directed Acyclic Graphs (DAGs) selected specific sets of adjustment factors for each model. ResultsThe analysis included 1264 patients (mean age: 78 years, women: 70%). Median follow-up was 5.2 years, and 446 patients died. Each altered domain had a detrimental effect on survival, sometimes dependent on gender, age, education or time from inclusion. Nutritional status had a time-varying effect, with higher mortality rates if altered only within the first 3 years of follow-up. In case of altered mobility, the risk of death was higher only for the youngest patients and, in case of altered autonomy, only for the youngest women. An altered neurological state led to higher mortality rates; this effect increased with the level of education. Patients with altered psychological status or more than four comorbidities at baseline had also higher mortality rates. ConclusionsPatients with an altered CGA domain have a higher risk of death than those without any alteration. The effect of some alterations is different in some subgroups or at a given time of the treatments.

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