Abstract
ObjectivesComprehensive Geriatric Assessment (CGA) has been incorporated into geriatric oncology to prevent unfavorable outcome from anticancer treatment. This study determined the value of CGA and medical oncologist's clinical judgment in predicting unfavorable outcome and explored whether treatment decisions can be based on CGA. Patients and MethodsIn this prospective cohort study, a multidomain CGA was performed by a geriatric nurse and geriatrician in 110 consecutive patients aged ≥70 years, newly referred to a multidisciplinary oncology clinic. CGA domains included comorbidity, polypharmacy, mood, cognition, nutrition, functionality and physical performance. Medical oncologist's clinical judgment on expected tolerance of standard treatment was noted (N = 62). Unfavorable outcome was defined as any ≥grade three chemotherapy toxicity, dose reduction, postponement of treatment, death before start of treatment and early progression before first evaluation of treatment (N = 80). ResultsCGA identified multidomain problems in 77 out of 110 patients (70.0%) and the medical oncologist had doubts about standard treatment tolerance in 30 out of 62 patients (48.4%). Unfavorable outcome occurred in 48 out of 80 patients (60%) who received anticancer treatment but could not be predicted by CGA, medical oncologists' clinical judgment or their combination. There was discrepancy between CGA and clinical judgment in 24 out of 62 patients (38.7%). ConclusionNeither CGA, medical oncologist's clinical judgment or a combination could predict unfavorable outcome in our heterogeneous sample. CGA and clinical judgment did not align in more than one-third of patients.
Highlights
For medical oncologists, predicting treatment toxicity and clinical outcome in older patients with cancer is challenging while complication rates are high [1,2,3]
One of the main goals of a Comprehensive Geriatric Assessment (CGA) is to objectively identify patients who will benefit from anticancer treatment to prevent under- and overtreatment of older patients with cancer [8,9,10,11] and to initiate interventions and supportive care based on impaired domains
Medical oncologists were asked for their clinical judgment on the expected tolerance of standard anticancer treatment as part of usual care before they were made aware of the results of the CGA, if this was not possible due to logistic reasons, clinical judgment was not taken into account
Summary
For medical oncologists, predicting treatment toxicity and clinical outcome in older patients with cancer is challenging while complication rates are high [1,2,3]. Treatment decisions are mostly based on clinical judgment and subjective performance scales such as the Karnofsky performance score. These scales are not as sensitive in older populations as in younger populations [4,5], potentially leading to suboptimal treatment of older patients with cancer [6,7]. Versteeg et al / Journal of Geriatric Oncology 12 (2021) 49–56
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