Evaluation of comprehensive geriatric assessment impact in oncological decision-making process.

Abstract

e24020 Background: Elderly patients (pts) diagnosed with cancer may present frailty conditions at baseline that could have a direct impact on tolerance and toxicity of oncological treatments (ttm). Comprehensive geriatric assessment (CGA) is considered a useful tool in the approach of these pts. CGA allows assessing functional reserve and potentially treatable comorbidities, leading to pt classification into 3 categories (fit, medium fit, unfit) before ttm decision. We evaluated the implantation of a CGA program in our center and its impact on ttm-decision and ttm-related toxicities. Furthermore, we evaluated survival outcomes. Methods: Retrospective, observational, single-institution analysis between 2017-2020. Pts ≥70 years with a cancer diagnosis and suspected frailty were evaluated by Oncogeriatry division before ttm decision. Pt characteristics at baseline (functional status [st], cognitive st, nutritional st, and comorbidity) were recorded. IBM SPSS Statistics software was used for statistical analysis. Variance analysis was calculated with Kolmogorov-Smirnov. Survival was calculated with Kaplan-Meier. Results: 147 pts were included (median [m] age 83 years). Referred pts presented good functional st (mBarthel Index 95), cognitive st (mMMSE 28, mMiniCog 3), and nutritional st (m abbreviated MNA13), and low comorbidity (mCharlson Index 1). After CGA, 49% pts were classified as fit, 28.6% as medium fit, and 22.4% as unfit. 71.4% pts received cancer-specific ttm (fit 91.6%, medium-fit 78.5%, unfit 18%). The correlation index between the initial ttm proposal and final ttm performed after CGA was 56.4% (76% in fit, 57.1% in medium-fit, and 12% in unfit). 18.4% of pts had ttm-related complications. 74 pts died during follow-up (34.7% fit, 59.5% medium fit, 72.7% unfit). 35.4% of deaths were related to cancer and 10.9% to comorbidity. Only 4 deaths were related to ttm. The median survival was 29 months (mo) in fit, 12.8 mo in medium-fit, and 8.5 mo in unfit pts. Conclusions: The majority of pts had preserved cognitive functions and low comorbidity, and were independent for daily-life activities. After CGA, almost 50% pts had modifications in their initial treatment strategy (higher rates in medium fit and unfit). Most fit pts received standard oncospecific ttm and had higher survival rates compared to unfit pts. These results show the relevance of geriatric approach in elderly cancer pts, which allows a personalized ttm.