Abstract
BackgroundComprehensive Geriatric Assessment (CGA) is the gold standard to help oncologists select the best cancer treatment for their older patients. Some authors have suggested that the concept of frailty could be a more useful approach in this population. We investigated whether frailty markers are associated with treatment recommendations in an oncogeriatric clinic.MethodsThis prospective study included 70 years and older patients with solid tumors and referred for an oncogeriatric assessment. The CGA included nine domains: autonomy, comorbidities, medication, cognition, nutrition, mood, neurosensory deficits, falls, and social status. Five frailty markers were assessed (nutrition, physical activity, energy, mobility, and strength). Patients were categorized as Frail (three or more frailty markers), pre-frail (one or two frailty markers), or not-frail (no frailty marker). Treatment recommendations were classified into two categories: standard treatment with and without any changes and supportive/palliative care. Multiple logistic regression models were used to analyze factors associated with treatment recommendations.Results217 patients, mean age 83 years (± Standard deviation (SD) 5.3), were included. In the univariate analysis, number of frailty markers, grip strength, physical activity, mobility, nutrition, energy, autonomy, depression, Eastern Cooperative Oncology Group Scale of Performance Status (ECOG-PS), and falls were significantly associated with final treatment recommendations. In the multivariate analysis, the number of frailty markers and basic Activities of Daily Living (ADL) were significantly associated with final treatment recommendations (p<0.001 and p = 0.010, respectively).ConclusionFrailty markers are associated with final treatment recommendations in older cancer patients. Longitudinal studies are warranted to better determine their use in a geriatric oncology setting.
Highlights
Both the incidence of cancer and the risk of death due to cancer increase with age [1]
Performance Status (ECOG-PS), and falls were significantly associated with final treatment recommendations
Frailty markers are associated with final treatment recommendations in older cancer patients
Summary
Both the incidence of cancer and the risk of death due to cancer increase with age [1]. Demographic projections for 2030 suggest that people older than 65 will represent almost 25% of the European population, and death by cancer will represent the first cause of mortality. Management of cancer in the elderly population is challenging because of potential underlying health problems that may interfere with treatment. The International Society of Geriatric Oncology (SIOG) [2], and several literature reviews recommend an approach based on comprehensive geriatric assessments (CGA) to help specialists in selecting the best cancer treatment [1,3,4,5,6]. Decision could be either palliative of curative. Comprehensive Geriatric Assessment (CGA) is the gold standard to help oncologists select the best cancer treatment for their older patients. We investigated whether frailty markers are associated with treatment recommendations in an oncogeriatric clinic
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