Improving clinical outcomes in elderly oncology patients

Abstract

6075 Background: Clinical decision-making for elderly patients with cancer is often challenged by limited outcome data from clinical trials; concerns regarding toxicities and co-morbidities; and inability to readily select patients who might tolerate more intensive therapy. Thus, chronological age is often used as the primary criteria for decisions. Multidisciplinary assessment of aging can be performed using the Comprehensive Geriatric Assessment (CGA) tool. The Screening Geriatric Assessment (SGA) is a briefer version and may quickly predict older patients who might tolerate standard therapy. Methods: A prospective trial (N=57) was conducted to determine the role of SGA in treatment decision-making and improving clinical outcomes. Published evidence, NCCN guidelines for the elderly, and consensus of clinicians at the Atlanta VA Medical Center were used to develop treatment standards for all stages/cell types of non-small cell lung cancer(N=39) or non-Hodgkin's lymphoma (N=18). Consenting patients at point of clinical decision-making were enrolled into Cohort A (age ≥ 65; N=29) or B (age 50–64; N=28). All patients were screened for functionality and given an objective score based on the SGA at time of enrollment. Scores were used to assign patients to category 1 (standard care), 2 (equivocal; CGA also given), or 3 (frailty). Results: No significant difference in SGA scores was found for Cohort A vs. younger subjects. Significantly more older patients (75%) were able to finish their prescribed treatment, both radiation and chemotherapy, compared to the younger cohort (47%) (p=0.012). Strong negative correlation was found between relative dose intensity (RDI) delivered and SGA category (p=.005). A regression model was developed that explained 40% of the variance for RDI delivered; primary predictors were thrombocytopenia and febrile neutropenia (p=.04; adjusted r2 =.24). Conclusions: The SGA may serve to promote use of standard-of-care to treat elderly patients, and as a practical screening tool to identify older and younger patients at risk for suboptimal clinical outcomes. Chronological age alone is a poor predictor of dose reductions/delays, toxicities, or ability to complete therapy. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Amgen, Inc.