Abstract
Simple SummaryMost oncology patients today are ≥65 years, so we should include in our daily practice tools that facilitate the therapeutic approach for elderly patients. Care overburden makes it difficult to perform comprehensive geriatric assessments (CGAs). The aim of our prospective study was to analyze if frailty screening questionnaires, such as G8 or Charlson, could lead to rapid decision making about treatment change in a radiation oncology service. In a homogeneous population of 161 patients, with a median age of 75 years, we found that 28.7% were frail according to the G8 test, while the estimated survival at 10 years was 2.25% based on the Charlson test. The therapeutic modification increased to 21% after frailty analysis, and the radiotherapy prescribed was 5.8 times more likely to be modified in frail patients. Thus, we postulate that the frailty screening test, easier to integrate into clinical practice, is a reliable and efficient aid for optimal approach.Background: Care overburden makes it difficult to perform comprehensive geriatric assessments (CGAs) in oncology settings. We analyzed if screening tools modified radiotherapy in oncogeriatric patients. Methods: Patients ≥ 65 years, irradiated between December 2020 and March 2021 at the Hospital Provincial de Castellón, completed the frailty G8 and estimated survival Charlson questionnaires. The cohort was stratified between G8 score ≤ 14 (fragile) or >14 (robust); the cutoff point for the Charlson index was established at five. Results: Of 161 patients; 69.4% were male, the median age was 75 years (range 65–91), and the prevailing performance status (PS) was 0–1 (83.1%). Overall, 28.7% of the cohort were frail based on G8 scores, while the estimated survival at 10 years was 2.25% based on the Charlson test. The treatment administered changed up to 21% after frailty analysis. The therapies prescribed were 5.8 times more likely to be modified in frail patients based on the G8 test. In addition, patients ≥ 85 years (p = 0.01), a PS ≥ 2 (p = 0.008), and limited mobility (p = 0.024) were also associated with a potential change. Conclusions: CGAs remain the optimal assessment tool in oncogeriatry. However, we found that the G8 fragility screening test, which is easier to integrate into patient consultations, is a reliable and efficient aid to rapid decision making.
Highlights
One of the main risk factors for the development of tumors is advanced age
The comprehensive geriatric assessment (CGA), which analyzes functionality, comorbidities, polypharmacy, nutritional and psychological status, cognitive ability, and social support has been shown to be an excellent predictor of morbidity and mortality in oncological settings [8,9]
Functional situation, and comorbidities of patients aged over 65 years treated in the Radiation Oncology Service at the Provincial Hospital of Castellón; Analyze the usefulness of the G8 and the Charlson scales in the initial assessment of oncogeriatric patients and the possible influence of these instruments on the modification of our therapeutic approaches; Identify the intercurrent factors most strongly involved in modifying the treatments applied by the physicians in our service
Summary
One of the main risk factors for the development of tumors is advanced age. According to the American Society of Clinical Oncology (ASCO), 60% of American cancer patients are aged over 65 years [1], with these figures being similar in Spain (60.9%) [2]. The elderly population has more complex health and therapeutic needs This group implicitly has a lower functional reserve, is more likely to become frail, and is more vulnerable to stressors such as cancer or its treatments [5,6]. These factors, coupled with a lack of evidence, can sometimes lead to the omission of curative treatments, or in contrast, to the application of aggressive treatments [7]. Poor results are associated with greater toxicity after chemotherapy or surgery, greater therapeutic changes, and a poorer quality of life (QoL) [10–12] Care overburden makes it difficult to perform comprehensive geriatric assessments (CGAs) in oncology settings. We found that the G8 fragility screening test, which is easier to integrate into patient consultations, is a reliable and efficient aid to rapid decision making
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