An analysis of prognostic factors of comprehensive geriatric assessment (CGA) and development of a clinical scoring system in elderly Asian cancer patients.

Abstract

9165 Background: Certain components of the comprehensive geriatric assessment (CGA) correlate with survival in elderly cancer patients. The purpose of this study was to determine the impact of each CGA domain on overall survival and to develop a prognostic scoring system to stratify elderly cancer patients into risk groups. Methods: A retrospective analysis of CGA data collected from 318 consecutive cancer patients who attended the outpatient geriatric oncology clinic at the National Cancer Center Singapore, aged 70 years and above was performed. Univariate and multivariate analyses were done using Cox proportional hazard method to identify significant prognostic factors within the CGA. A simple scoring algorithm to predict overall survival was developed using the regression coefficients from the multivariate model with total clinical scores ranging from 0 to 6. Results: Median age of the 318 patients was 77 years old (range: 70-94 years). ECOG performance status, functional status (ADL/IADL) and presence of geriatric syndromes were shown to be highly co-dependent variables. In our model, poor ECOG performance status (≥ 2 vs. < 2: HR=2.28, 95% CI= 1.44 - 3.61), high malnutrition risk (high risk vs. low risk: HR=2.59, 95% CI= 1.64 -4.10) and advance stage of disease (late vs. early: HR=2.14, 95% CI= 1.25–3.67) were independent predictors of survival. The patients with high risk clinical score 5-6 (HR=4.92, 95%CI = 2.72–8.87) and moderate risk score 3-4 (HR=2.09, 95%CI = 1.09–4.02) had significantly higher mortality rates compared to those classified as low risk score 0-2. The 2-year survival rate for low, moderate and high risk groups were 74.9% (95%CI 58.9-85.4), 50.9% (95% CI 37.0–63.3) and 23.2% (95% CI 16.8–30.1) respectively. Longer term follow-up and a larger sample size may identify factors that will significantly distinguish the low and moderate risk groups. Conclusions: The results confirm the importance of the CGA in the assessment of the elderly cancer patient. The development of the risk scoring system incorporating few key prognostic factors helps stratify patients into risk groups for further intervention. No significant financial relationships to disclose.