Early breast cancer in elderly women: The value of Comprehensive Geriatric Assessment (CGA)

Abstract

8172 Background: Increased age-related prevalence of co-morbidity and functional impairment promote the risk of treatment intolerance and mortality in elderly cancer patients (pts). Clinical studies in these pts have shown the negative impact of coexistent disease on prognosis and disability, but few have underlined the relevance of thorough co-morbidity assessment. The Cumulative Illness Rating Scale-Geriatric (CIRS-G) provides a comprehensive co-morbidity assessment, including the measure of their severity. Methods: Women >70 years with early operable breast cancer were asked to undergo CGA at treatment start. CGA was conducted in the GEMU, according to the American Geriatric Society (AGS) guidelines, by a core team directed by a geriatrician. Assessment included information from various sources (pts, caregivers, general practitioners), and usual screening tools (ADL, IADL, POMA, GDS, MMSE, MNA), complete physical examination, standard lab. tests and X-ray. Co-morbidity was classified using the CIRS-G. Results: Of 76 pts (mean age: 77 +/- 4.7 years), 17% were at risk of cognitive deterioration, 30% of depression, 33% nutritional risk, 28% risk of fall. Most (66%) were fully independent in ADL, 46% in IADL. Median CIRS-G total score was 10. When tested, CIRS-G grade ≥2 co-morbidity was distributed as follows: 62% vascular disease, 31% psychiatric disease, 25% musculoskeletal or tegument disorders, 27% heart disease, and 18% sensory, 16% respiratory, 13% genitourinary, or 12% haematopoietic disorders. Results agree with reports from other geriatric teams using CGA. Conversely, when CGA process was used as a screening tool, median CIRS-G scores were lower. Extermann et al reported a median CIRS-G score of 5 in older breast cancer pts (Extermann, Crit Rev Oncol Hematol 2004). Conclusions: Older pts with early breast cancer have a high prevalence of co-morbidity and disability. CGA, done according to AGS guidelines, improves the quality of health status evaluation in the elderly. This work was supported by grant: PHRC n°98.064 of the Ministry of Health. No significant financial relationships to disclose.