Abstract
6110 Background: Therapeutic decision remains complex when a cancer is diagnosed in elderly pts. Our aim was to evaluate the frequency of CI in this population and its impact on therapeutic decision. Methods: An oncogeriatric evaluation including Comprehensive Geriatric Assessment (CGA) is systematically performed for all elderly cancer pts referred in our unit. We reviewed data of all pts assessed by geriatric oncologist at our institution from January 2009 to June 2011. Results: 378 pts were identified, among them a CI was noted in 87. Median age was 84 years (range 71 –94), 70 % ≥ 80 years. Most of the pts (78/87) were referred at the time of diagnosis. Metastatic disease was diagnosed in 32 pts (52%) and Diffuse Large B Cell Lymphoma stage III or IV in 21 pts (81 %). In 41 pts, CI was already diagnosed: Alzheimer disease (AD) (n=38) and Vascular Dementia (n=3). CGA help to identify CI in 46 additional pts: AD (n=36); Vascular Dementia (n=2) and Mild Cognitive Impairment (n=8). 45/87 pts (52 %) were dependant for at least one activity of daily living (ADL). As a result of CGA and benefit/risk oncologic assessment, best supportive care was recommended in 12 pts. Among them, only 4 pts presented with advanced metastatic disease (main reason for palliative care). Pts in whom “best supportive care” decision (n=12) was recommended were more dependants than those who received specific anticancer therapy (n=75): dependence for at least 2 ADL: 10/12 pts (83%) versus 16/75 (21%); and presented more AD already diagnosed (11/12 versus 30/75). In the remaining 75 pts, specific cancer therapy was proposed, including chemotherapy (n=67), surgery (n=5), radiotherapy (n=3) and hormonotherapy (n=9). Treatment was initiated as recommended in all but 4 pts (best supportive care decision taken following discussion with pts and relatives). During the follow-up, only 11/75 pts needed to be placed in nursing home because of loss of autonomy. A survival ≥ 1 year was observed in 27/75 (36%) pts. An update of cognitive performance will be presented. Conclusions: Our data support that even if CI is frequent in elderly pts with malignancies, specific anticancer therapy remains feasible and should be considered in most elderly pts with CI.
Published Version
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