Association between geriatric assessment domains and chemotherapy among older women with breast cancer.

To evaluate geriatric assessment (GA) domains in relation to clinically important outcomes in older breast cancer survivors. Six hundred sixty women diagnosed with primary breast cancer in four US geographic regions (Los Angeles, CA; Minnesota; North Carolina; and Rhode Island) were selected with disease stage I to IIIA, age >or= 65 years at date of diagnosis, and permission from attending physician to contact. Data were collected over 7 years of follow-up from consenting patients' medical records, telephone interviews, physician questionnaires, and the National Death Index. Outcomes included self-reported treatment tolerance and all-cause mortality. Four GA domains were described by six individual measures, as follows: sociodemographic by adequate finances; clinical by Charlson comorbidity index (CCI) and body mass index; function by number of physical function limitations; and psychosocial by the five-item Mental Health Index (MHI5) and Medical Outcomes Study Social Support Survey (MOS-SSS). Associations were evaluated using t tests, chi(2) tests, and regression analyses. In multivariable regression including age and stage, three measures from two domains (clinical and psychosocial) were associated with poor treatment tolerance; these were CCI >or= 1 (odds ratio [OR] = 2.49; 95% CI, 1.18 to 5.25), MHI5 score less than 80 (OR = 2.36; 95% CI, 1.15 to 4.86), and MOS-SSS score less than 80 (OR = 3.32; 95% CI, 1.44 to 7.66). Four measures representing all four GA domains predicted mortality; these were inadequate finances (hazard ratio [HR] = 1.89; 95% CI, 1.24 to 2.88; CCI >or= 1 (HR = 1.38; 95% CI, 1.01 to 1.88), functional limitation (HR = 1.40; 95% CI, 1.01 to 1.93), and MHI5 score less than 80 (HR = 1.34; 95% CI, 1.01 to 1.85). In addition, the proportion of women with these outcomes incrementally increased as the number of GA deficits increased. This study provides longitudinal evidence that GA domains are associated with poor treatment tolerance and predict mortality at 7 years of follow-up, independent of age and stage of disease.

9543 Background: Physical inactivity (PI), alcohol (A) and tobacco (T) abuse are associated with poor health outcomes in older adults, however, little is known about the prevalence of these HB and their associations with GA domains in older cancer patients (pts). This study explores the relationship between HB and GA in older BC pts. Methods: Between 03/2010-01/2013, 111 pts ≥65 yrs completed a predominantly self-administered GA (Hurria et al. Cancer 2005) comprising measures of comorbidity, polypharmacy, cognitive, functional, psychosocial and nutritional status as well as a nine-item HB questionnaire based on the 2006/7 National Health Interview Survey ( www.cdc.gov/nchs/nhis.htm ) assessing PI, A and T use. Fisher’s Exact and Wilcoxon Rank sum test were used to evaluate associations with GA measures. Results: Median age was 72 (range 65-94). Most pts were white (89%), married (61%), retired (86%) and at least high school graduates (96%). 51% never smoked while 45% were former and 4% current smokers. Former/current smokers were more likely than never smokers to have slower gait speeds (Timed “up and go” >14 second; 32 vs 14%; p=.04) and took more daily prescription medications (mean 5 vs. 4; p=.04). 52% of pts consumed at least one alcoholic drink per week (median 3.5). Modest alcohol consumption was associated with less activity of daily living (ADL) impairment (p=.03), lower mean BMI (29 vs. 26 kg/m2 p=.03) and greater non-prescription medication use (p=.04). 48% never performed vigorous activity and these pts were more likely than those exercising to have one or more functionally impairing comorbidities (p=.03); mainly arthritis. PI correlated with more impairment in both ADL (p<.0001) and instrumental ADL (p=.004). HB were not associated with demographic factors, treatment phase, weight loss, falls, sensory impairment, social activity, anxiety or depression in this dataset. Conclusions: PI, T and A use were common in this cohort of older BC pts and were associated with significant impairments in several GA domains. These findings reinforce the need for interventions to improve HB in older BC pts. Support: Breast Cancer Research Foundation, New York, NY and Lineberger Comprehensive Cancer Center, Chapel Hill, NC.

12050 Background: Use of GA by oncology specialists is low in Mexico, with some of the domains of the GA more frequently assessed than others in everyday practice. We aimed to explore factors associated to the evaluation of individual GA domains by Mexican cancer care providers. Methods: Secondary analysis of a mixed-methods study which consisted of an online cross-sectional survey of Mexican oncology specialists and follow-up interviews on the use of GA in cancer care. We performed multiple logistic regression analyses with frequency of evaluation of specific GA domains as the dependent variable (dichotomized as never/sometimes vs most of the time/always). Independent variables included age, gender, medical specialty, and practice size of the survey respondent, presence of a geriatrician in main practice site, and perceived confidence in managing common situations in older adults relevant for each GA domain (dichotomized as not at all/mildly vs very/completely). A p-value of < 0.05 was considered significant in each model. Results: Of 196 survey respondents, 62% were male, 50% surgical oncologists, 51% took care of > 10 patients per day, and 61.7% had access to a geriatrician at their main practice site. Frequently (most of the time/always) evaluated domains included: comorbidities (94.4%), daily function (72.9%), nutrition (67.3%), cognition (54.1%), depression (42.9%) and falls (42.3%). Self-perceived confidence in managing dementia (OR 2.72; 95% CI 1.42-5.51, p = 0.008) and being a surgical oncologist (OR 2.80; 95% CI 1.29-5.72, p = 0.003) were associated with increased evaluation of cognition. For nutrition, only self-perceived confidence in nutritional evaluation was associated (OR 3.86; 95% CI 2.0-7.46, p < 0.001). For comorbidities, self-perceived confidence in managing osteoporosis (OR 5.61; 95% CI 1.03-30.4, p = 0.046). For falls, significant factors included age (OR 1.04; 95% CI 1.01-1.07, p = 0.004), practice size (OR 0.46; 95% CI 0.23-0.91, p = 0.026), and self-perceived confidence in evaluation and prevention of falls (OR 6.31; 95% CI 3.19-12.46, p < 0.001). Age (OR 1.03; 95% CI 1.01-1.06, p = 0.011) and self-perceived confidence in managing depression (OR 2.52; 95% CI 1.33-4.78, p = 0.005) were associated with evaluation of depression. For daily function, no variables were significantly associated. Follow-up interviews showed quality and appropriateness of evaluations may not be ideal, such as asking only about orientation and level of consciousness when evaluating cognition. Conclusions: Self-perceived confidence in evaluating and managing common situations in older adults is associated with the evaluation of GA domains as part of everyday practice among cancer care providers in Mexico. This analysis supports the use of educational interventions to boost knowledge and confidence regarding the proper use of validated GA tools among oncology specialists.

The use of geriatric assessment (GA) by oncology specialists in Mexico is low. We aimed to explore factors associated with the evaluation of individual GA domains by Mexican oncology specialists. We performed an exploratory analysis of a sequential explanatory mixed-methods study consisting of an online cross-sectional survey of Mexican oncology specialists and follow-up interviews on the use of GA in cancer care. For each GA domain, we performed multivariable logistic regression analyses with the frequency of evaluation of the domains as the dependent variable (dichotomised as never/rarely/sometimes versus most of the time/always). A p-value <0.05 was considered significant. Qualitative data from the interviews were analysed inductively. Of 196 respondents, 62% were male, 50% were surgical oncologists, 51% took care of >10 patients per day and 61.7% had access to a geriatrician. Self-perceived confidence in managing common geriatric conditions was associated with the evaluation of specific GA domains. For instance, self-perceived confidence in managing dementia (OR 2.72; 95% CI 1.42–5.51, p = 0.008) was associated with cognition evaluation, while for evaluation of falls, self-perceived confidence in evaluation of falls (OR 6.31; 95% CI 3.19–12.46, p < 0.001) was significantly associated. Follow-up interviews showed quality and appropriateness of evaluations may not be ideal: in many cases, physicians do not use guideline-recommended tools. For example, evaluation of cognition is commonly performed through non-validated methods which may miss the detection of patients with an impairment in this domain, partly due to limitations in knowledge and time to use recommended tools. In conclusion, self-perceived confidence in evaluating and managing common situations in older adults was associated with the evaluation of GA domains as part of everyday practice in a sample of oncology specialists in Mexico. This analysis supports the use of educational interventions to boost knowledge and confidence regarding the proper use of validated GA tools among oncology specialists.

Geriatric assessment and treatment outcomes in older adults with cancer receiving immune checkpoint inhibitors

Geriatric assessment tool application in treatment recommendations for older women with breast cancer

Intensive chemotherapy (IC) can affect all geriatric assessment (GA) domains in older adults with acute myeloid leukemia (AML), but data on the effects of these changes on transplant outcomes are lacking. Therefore, we prospectively assessed the prognostic role of GA domains at diagnosis and allogeneic hematopoietic stem cell transplantation (allo-HSCT) in 51 patients with AML aged ≥60 years who achieved complete remission after IC. We performed both baseline and pre-allo-HSCT GA; moreover, physical function, including a short physical performance battery (SPPB), cognitive function, psychological function, nutritional status, and social support were examined. All GA domains showed dynamic changes between the two time points. The directions of change were statistically significant for social support, self-reported physical and psychological functions, and distress, but not for nutritional status, cognitive function, or physical function. Among all GA domains at each time point, only poor physical function and its submaneuvers at diagnosis but not at allo-HSCT were significantly associated with inferior survival. In particular, since the direction of change varied between patients, we found that patients whose physical function improved before allo-HSCT were more likely to survive longer than those with persistently impaired SPPB (55.6% vs. 28.6%, p=0.268). Finally, persistent impairment in SPPB (28.6% vs. 65.9%, p=0.006), tandem stand (0% vs. 63.3%, p=0.012), sit-and-stand (41.2% vs. 70.6%, p=0.009), and gait speed (38.5% vs. 68.4%, p=0.027) further strongly predicted inferior survival. This study showed that IC courses can induce dynamic changes in different directions in the GA domains of each patient and that changes in objectively measured physical function can predict transplant outcomes.

Purpose: To examine factors associated with changes in mobility and living arrangements in a comprehensive geriatric outpatient assessment after hip fracture. Method: Population-based prospective data on 887 consecutive hip fracture patients aged 65 years and older. The domains of the geriatric assessment were the independent and changes in mobility level and living arrangements 4 months postoperatively the outcome variables. Results: Of the survivors, 499 (73%) attended the assessment. The mobility level had declined in 39% of the attendees and 38% of them had moved to more supported living arrangements 4 months after the hip fracture. In the age-adjusted univariate logistic regression analyses, almost all the domains of the comprehensive geriatric assessment were significantly associated with both outcomes. In the forward stepwise multivariate analysis, disability in activities of daily living, poor performance in Timed Up and Go and comorbidity as measured by the American Society of Anesthesiologists scores remained significantly associated with the outcomes. Conclusions: While comorbidity and disability in activities of daily living and mobility are the major indicators of poor outcomes of mobility and living arrangements after hip fracture, all the domains in the comprehensive geriatric assessment deserve attention during hip fracture care and rehabilitation.Implications for RehabilitationIn almost half of the patients the mobility level and living arrangements had deteriorated 4 months after the hip fracture, suggesting an urgent need for more effective postoperative rehabilitation.Almost all the domains of the comprehensive geriatric assessment were associated with poor outcomes and require equal attention during the acute and postacute phases of hip fracture care and in the course of rehabilitation.A geriatric outpatient assessment a few months after the hip fracture provides a check-point for the outcomes and an opportunity to target interventions at different domains of the comprehensive assessment.

Although geriatric assessment (GA) has been used for a long time in the field of geriatrics and internal medicine, there are few studies on its application in the field of breast surgery. Therefore, the utility of specific GA domains for the assessment of older patients with breast cancer remains unclear. The aim of the present study was to evaluate the association between specific GA domains and the survival rate of older patients with breast cancer. We used the database of Peking Union Medical College Hospital to identify older patients who were newly diagnosed with breast cancer between 2012 and 2018 and retrospectively analysed the data of 541 patients aged ≥65 years. Patients with metastatic cancer and those with missing vital status data were excluded. The primary outcomes were overall survival (OS) and breast cancer-specific survival. The GA domains used in this study included functional status, comorbidities, and psychological state. Multivariate regression analysis was used to estimate hazard ratios for these three domains. After a median follow-up of 72 months, we observed a significant relationship between functional impairment and mortality (adjusted HR: 3.06, 95% confidence interval [CI]: 1.83-5.10, P<0.001). Similarly, patients with severe comorbidities (adjusted HR: 2.35; 95% CI: 1.16-4.75, P=0.017) and an impaired psychological state (adjusted HR: 2.82, 95% CI: 1.45-5.50, P=0.002) showed worse OS rates. Accordingly, addition of the three GA domains to the basic model, which included age, tumour stage, lymph node stage, and intrinsic molecular subtype as baseline variables, yielded higher C-statistics for mortality analysis (from 0.713 to 0.740). To our knowledge, this is the first study to include specific GA domains in a prognostic model for older patients with breast cancer in China. Three domains, namely functional status, comorbidities, and psychological state, should be considered for survival analyses in this particular population. The full model including these three GA domains may be more accurate in predicting the survival of older patients with breast cancer.

12039 Background: At present, there is no universal, objective, and evidence-based definition of what constitutes an abnormal geriatric assessment (GA) in geriatric oncology (GO). In the literature, a threshold number of abnormal GA domains (ranging from 1-4) is often used to define an abnormal GA. However, it is not well-established whether having a specific number of abnormal domains more frequently leads to treatment plan modification (TPM), a key goal of GA, or if particular domains have a greater impact on TPM. The primary objectives of this study are: (1) to determine how well the current definitions of an abnormal GA predict TPM following GA, and (2) to identify particular GA domains associated with TPM. Methods: A retrospective review of the GO clinic database at Princess Margaret Cancer Centre was conducted. All new patients seen in clinic from May 22, 2015 to June 10, 2022 who met the following criteria were included: (1) referred for treatment decision making, (2) received a complete GA, and (3) had a proposed oncologic treatment plan. Demographic, oncologic, and GA-domain variables were extracted. Univariate and multivariate logistic regression modelling was conducted using SPSS to determine each variable’s association with TPM; age, sex, frailty (VES-13) score, and treatment intent were included in all multivariate models. Area under the curve (AUC) was calculated for each model. Results: The study cohort (n = 736) had a mean age of 80.7 years (61-100), 46.1% was female, and 78.3% had a VES-13 score indicating vulnerability. In univariate analysis, age, VES-13 score, disease stage, treatment intent, all GA domains (except Medication Optimization and Social Supports), and all threshold numbers of abnormal domains (except 1 and 7) were significantly associated (p-value &lt; 0.050) with TPM. The best-performing threshold number of abnormal domains in univariate analysis was 4 (AUC 0.628). Overall, the best-performing multivariate model based on AUC was the model containing all 6 significant GA domains (AUC 0.710). In this model, age, treatment intent, Comorbidities, Falls Risk, and Cognition were independently associated with TPM (p-value &lt; 0.05). The multivariate model with a threshold of 4 abnormal domains alone had an AUC of 0.689 and age, VES-13 score, treatment intent, and the threshold were independently associated with TPM. Of the models which included a single GA domain plus the threshold, the models with Comorbidities and Cognition performed best, having AUCs of 0.699 and 0.700, respectively. Conclusions: Overall, our results suggest that an abnormal GA (leading to TPM) may be best defined as one with abnormalities in the domains of Comorbidities, Falls Risk, and Cognition. In terms of a strictly numerical threshold, a GA may be best defined as abnormal if at least 4 GA domains are abnormal. When at least 4 GA domains are abnormal, abnormalities in Comorbidities and Cognition appear to best predict TPM.

Relationships of self-perceived age with geriatric assessment domains in older adults with cancer

Does a young woman living with a smoker or taking a job working in a smoky bar have a greater chance of developing breast cancer? Some scientists believe that such situations can indeed raise a woman’s risk of developing breast cancer before the age of 50. Because epidemiological and toxicological studies show that women’s breast tissue may be especially sensitive to exposure to carcinogens prior to first pregnancy, these researchers contend that public education should be directed at alerting adolescents and young women to the potential risk. However, not everyone in the international public health community agrees that the evidence to date supports a link between passive smoking and breast cancer, and some say that women are being alarmed unnecessarily. This disagreement has sparked debate that is sometimes heated. The stakes are high because breast cancer is the most common cancer in women in industrialized countries, according to the WHO. It is the leading cancer killer of nonsmoking women, and second only to lung cancer deaths among women who smoke. Among the researchers interviewed for this article who disagree that there is enough evidence to link secondhand smoke (SHS) with breast cancer, the majority call the evidence to date “suggestive but not sufficient,” as the Surgeon General’s 2006 report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, put it. That characterization is based largely on the fact that the research considered when the Surgeon General’s report was being amassed did not clearly link even active smoking to breast cancer. Researchers in this camp do, however, stress that ongoing campaigns to prohibit smoking in public will protect the whole of society against the wide variety of ills proven to be caused by SHS. These include lung cancer, cardiovascular disease, and sudden infant death syndrome, among others. A smaller group contends that the question of whether or not SHS causes breast cancer is a political issue with the potential to compromise the scientific process. “A premature decision about causality could jeopardize the credibility of the entire review process and all of the other, established effects of secondhand smoke,” says Michael Thun, national vice president of epidemiology and surveillance research for the American Cancer Society. Adds Valerie Beral, director of the University of Oxford Cancer Research UK Epidemiology Unit, “To prematurely come to conclusions about the causation when there is a big division in the scientific community . . . is bad science.” Thun debated the subject in a series of public forums held in conjunction with scientific meetings. Taking the opposing view was Kenneth C. Johnson, a research scientist with the Public Health Agency of Canada, who was one of the first scientists to discern a potential link. During the debates, Johnson pointed out there are about the same number of studies linking breast cancer to passive smoking as there were linking lung cancer to SHS in 1986, when the Surgeon General concluded that passive smoking caused lung cancer. Johnson also says that more of the breast cancer studies are statistically significant, and that the estimated risk for breast cancer is higher.

Review question/objective What are the psychosocial experiences of women with breast cancer across the lifespan, including similarities and differences in the psychosocial experiences of younger, middle-aged and older women with breast cancer? Inclusion criteria Types of participants This review will consider studies that include women with a breast cancer diagnosis of any type or stage, with the exception of a cancer recurrence. Women with a recurrence will be excluded since the experience of recurrence has been shown, through research, to be dissimilar to the experience of the first diagnosis and treatment of the disease. The experience of women in all treatment modalities will be included (i.e. lumpectomy, mastectomy of all types with or without breast reconstruction, chemotherapy, radiation therapy and hormone therapy). This review will consider studies that include age as a primary area of interest in the study design. That is, the study will focus on: 1) younger women or older women, or 2) a psychosocial issue and compare it across the lifespan from younger to older. The definition of “younger” and “older” will not be described by the reviewers prior to the review because no consensus has been reached in the literature about defining “young” and “old” in cancer. However, this will be observed in the studies and reported on in the analysis. Therefore, studies that identify the participants as “young” and/or “old”, and provide a range of ages of the participants, will be included. Studies will be excluded if they do not define their population(s) by age or if they combine younger and older populations together. Phenomenon of interest The phenomenon of interest is women’s psychosocial experience of breast cancer, including the social, psychological, emotional, spiritual and quality-of-life aspects of cancer. Context This review will include women from all geographical regions. It will also include all cancer care contexts (e.g. acute care hospital, ambulatory care setting, home care, primary health care).

Depression among older adults with gastrointestinal malignancies

Communication about geriatric assessment domains in advanced cancer settings: "Missed opportunities".