Importance of a comprehensive geriatric assessment in older cancer patients

Abstract

A multidimensional assessment is a key part of the treatment approach for older patients in a geriatric setring. Comorbidity, functional status, depression, cognitive impairment, nutritional status and insufficient social support have all been demonstrated to affect the survival of elderly and/or cancer patients, with relative risks of death often increased two to four times [ 11. A more effective evaluation of the clinical importance of comorbid conditions and functional limitations in patients over 70 years is provided by the Comprehensive Geriatric Assessment (CGA). Broad agreement exists on the areas that should be tested in a CGA (Table l), though the format of CGA is not standardised [2]. CGA investigates all the controversial areas which account for the heterogeneity of the older population. CGA is based on standardised interviews, evaluation of comorbidity, and a series of validates scales such as Katz’s Activities of Daily Living (ADL) [3], Lawton’s Instrumental Activities of Daily Living (IADL) [4], geriatric depression scale (GDS) [5], Folstein Mini Mental Status (MMS) [6] and nutritional assessment. CGA differs from the standard medical evaluation because it is focused on the functional status and quality of life of elderly patients, and it takes advantage of an interdisciplinary team. The functional status of the older person relates to the likelihood of survival. The assessment of Performance Status (PS) according to Karnofsky or the Eastern Co-operative Oncology Group (ECOG) scale [7] has limited utility in the elderly cancer population [S]. ADLs and IADLs are the most sensitive assessments of disabilities in older individuals. ADLs are the skills necessary for basic living and include feeding, grooming, transferring and toiletting [3]. IADLs include shopping, managing finances, housekeeping, laundry, meal preparation, handy ability to use transportation and telephone and ability to take medications, then the IADLs are those skills a person needs to live independently [4]. CGA is routinely employed in geriatric clinics and nursing homes, but is not yet widely used by oncologists, even though in patients treated for neoplasia, the capability of moving to ,get to the cancer centre, of reaching the responsible physician or nurse by phone in case of complications, and to take the prescribed drugs at home is very important [9]. CGA allows the collection of hornogeneous information among different Centres and a better estimation of life expectancy and might allow a better management and a more efficient care of elderly patients with cancer. In 1996, a CGA scale was developed and validated for the first time in an oncology setting by Monfardini and colleagues [9]. A clinical research