Predictive factors of early death in older women with gynecological cancer: A prospective cohort study.

Abstract

e24034 Background: Comprehensive geriatric assessment (CGA) correlate with risk of early mortality in older adult patients. Methods: a prospective cohort study. older woman with a recent diagnosis of gynecological cancer were from eight community hospitals and cancer center in Northeast Brazil and were recruited during their first medical appointment at the outpatient oncologic clinic. A basal CGA was done before the treatment decision (ADL, Charlson Comorbidity Index- CCI, Karnofsky Performance status – KPS, GDS15, IPAQ, MMSE, MNA, MNA-SF, PS, PPS, Polipharmacy, QLQc30, TUG). During the follow up of six months, information about the treatments performed, the targeted interventions and early death was collected. Overall survival was estimated using the Kaplan–Meier method, and survival curves were compared using the Log rank test for categorical variables. A multivariate Cox proportional hazards model was used to select early death risk factors. Results: 274 patients with a median age of 72 years, 13.5% died within 180 days. 29,7% cervical cancer, 122 (44,5%),endometrial cancer, 53(19,3%) ovary cancer and 17( 6,2%) vulvar cancer. The mean global QL was higher among survivors and the probability of survival was higher in patients who had better QL (p < 0.001). After adjustments for risk factors (cervical cancer topography, metastatic disease and Karnofsky ≤ 50), Global QoL was a protective factor (HR = 0.99; 95%CI 0.98-1.00; p = 0.031). Cervical cancer topography 95%CI HR = 2.28 1.18-4.40 p = 0.014). MNA < 17 95 %CIHR = 9.72 (3.85-24.50 , p < 0.001) TUG ( HR = 3,87 ; 95 % CI 1,93 - 7,74 p = 0.004). Conclusions: A better score in the Global QoL assessment , a good nutritional status by MNA and low risk of falls by TUG were protective factor for early death in older women with gynecological cancer.Cervical cancer is the highest risk of early death topography. Risk factors for early death can be identified in the admission of older women with gynecological cancer, allowing better care planning.