The prognostic value of G8 for functional decline.

Abstract

Clinical experience suggests that functional decline (FD) during treatment may have a major adverse impact on outcome. Geriatric assessment of older patients before cancer treatment is usually based on use of a screening tool (such as G8) followed by comprehensive geriatric assessment (CGA). However, many oncology teams cannot implement geriatric oncology management due to non-availability of geriatricians. Consequently, we decided to evaluate whether a procedure using G8 and routinely available factors could help oncologists foresee the outcome in patients ≥70: we firstly evaluated whether functional decline is a determinant of early death, then searched for predictors of early functional decline (measured before initiation of the second cycle of chemotherapy), including G8 but voluntarilly excluding CGA. We tested the value of clinical, biological factors and early FD to predict early death on a cohort of 292 patients (≥70 years) treated with first-line chemotherapy. We then used a logistic regression model to search for pretreatment predictors of FD, including the same factors and G8 but excluding CGA. FD occurred in 48 patients. In multivariate analyses, early FD (OR = 4.13, 95% CI [1.89; 9.04], p < .01), disease extension (OR = 4.55, 95% CI [1.96; 10.57]; p < .01), and being male (OR = 2.59, 95% CI [1.12; 5.97], p = .02) were significant prognostic factors for early death; G8 was the only significant factor associated with FD (OR = 4.38, 95% CI [1.28; 14.92], p = .018). FD has an important prognostic significance in patients ≥70 treated with chemotherapy, and G8 predicts for its occurrence. These data reinforce the routine use of G8 in the management of these patients.