Evaluation of tolerance of Temozolomide in different strategies for management of the older person with glioblastoma

Abstract

Introduction: The diagnostic value of Comprehensive Geriatric Assessment(CGA) in oncology centres has not yet been established in India. Objectives: To assess whether CGA is feasible,reproducible and comparable in oncology patients in India. Methods: Biopsy proven cancer patients above 65 years,visiting our centres consenting for CGA, not Delirious or suffering from Encephalopathy were included in this analysis.The following components of CGA were assessed: Medical parameters, Nutritional Status, Depression, Neurocognitive functioning, Activities of Daily Living/Instrumental Activities of Daily Living and Quality of Life. A brief self-assembled battery of standardised & culture-fair tests: Mini-mental Status Examination(MMSE), Geriatric Depression Scale(GDS), OARS Activities of Daily Living/Instrumental Activities of Daily Living(ADL/IADL), WHOQuality of Life Scale BREF(WHO-QOL). A trained Psychologist conducted all CGAs with the help of primary oncologist, dietician and occupational therapist.As an exercise, to estimate the feasibility of CGA tools, 1 patient was selected for a detailed CGA(completion time 6 hours). Later, an abbreviated version was developed whereby administration time reduced to 20-30 minutes per CGA and conducted on OPD,IPD and Day Care settings Results: Total N = 46 patients, met our inclusion criteria. Male: Female ratio = 26:20; Age-wise distribution:N65:16,N70-11,N75= 5,N804,N85= 1; Solid Tumors: Lymphoma patients = 38:8. All patients had Performance status of 0,1 7 2(except 1)according to ECOG.18 out of 38 had more than or equal to 2 co-morbidities. Refer the following tables: Interestingly on ADL/IADL scale, Excellent ADL/IADL(n= 11) and Good ADL/IADL(n= 6) whereas mild-moderate impairment in ADL/ IADL(n= 17) and Severely impairment(n= 7), except 1 with complete impairment.On WHO-QOL BREF, on Physical Health Satisfied: Unsatisfied= 11:27; Psychological Health Satisfied:Unsatisfied= 32:6; Social Relationships Satisfied:Unsatisfied= 28:10; Environment Satisfied:Unsatisfied= 27:3 All patients with Severe impairment on any/all areas,had performance status of ≤2 according to oncologist’s review. Conclusion: CGA is a feasible, reproducible procedure involving a multidisciplinary approach. A trained Psychologist is needed as per international standards to administer & interpret psychometric tools used for CGAs.Approx.20% patients had severe impairment in either/ all of the areas, were deemed fit for chemotherapy by the Medical Oncologist.