G8 Score Research Articles

The Predictive Value of the G8 Questionnaire in Older Patients with Lung Cancer or Mesothelioma before Systemic Treatment

AimsThe standard evaluation of older lung cancer or mesothelioma patients for systemic anti-cancer treatment, based on performance status, is inaccurate. We used the G8 questionnaire to assess a patient's fitness for chemotherapy and explored the correlations between G8 scores, treatment decisions and clinical outcomes. Materials and methodsIn total, 201 older patients (≥70 years) with advanced lung cancer or mesothelioma were prospectively assessed by standard clinical methods and a G8 questionnaire. Treatment decisions before and after reviewing the G8 score were documented. Patients were divided into low (<11), intermediate (11–14) and high (>14) G8 score groups. Patients' characteristics, treatment plans and clinical outcomes among each G8 score group were compared. Similar analyses were compared between good (<2) and poor (≥2) performance status. Results10.1% of patients' treatment plans changed after oncologists reviewed G8 scores. The G8 score correlated inversely with performance status. More patients with low G8 scores (22.5%) were offered the best supportive care compared with 4.5% in intermediate and 1.9% in high G8 score groups. More patients (30.1%) with low G8 scores had treatment changed from chemotherapy to best supportive care on the planned day of their treatment, compared with intermediate (7.5%) and high (6.1%) G8 score groups. High G8 score patients received higher chemotherapy intensity and survived longer than patients with intermediate or low G8 scores. ConclusionsThe G8 score with two cut-off values can predict functional status, chemotherapy tolerability and prognosis in older patients with lung cancer or mesothelioma, thus supporting oncologists on treatment decisions for this population.

A Two-Step Frailty Assessment Strategy in Older Patients With Solid Tumors: A Decision Curve Analysis.

The intended clinical value of frailty screening is to identify unfit patients needing geriatric assessment (GA) and to prevent unnecessary GA in fit patients. These hypotheses rely on the sensitivity and specificity of screening tests, but they have not been verified. We performed a cross-sectional analysis of outpatients age ≥ 70 years with prostate, breast, colorectal, or lung cancer included in the ELCAPA cohort study (ClinicalTrials.gov identifier: NCT02884375) between February 2007 and December 2019. The diagnostic accuracy of the G8 Geriatric Screening Tool (G8) and modified G8 scores for identifying unfit patients was determined on the basis of GA results. We used decision curve analysis to calculate the benefit of frailty screening for detecting unfit patients and avoiding unnecessary GA in fit patients across different threshold probabilities. We included 1,648 patients (median age, 81 years), and 1,428 (87%) were unfit. The sensitivity and specificity were, respectively, 85% (95% CI, 84 to 87) and 59% (95% CI, 57 to 61) for G8, and 86% (95% CI, 84 to 87) and 60% (95% CI, 58 to 63) for the modified G8 score. For decision curve analysis, the net benefit (NB) for identifying unfit patients were 0.72 for G8, 0.72 for the modified G8, and 0.82 for GA at a threshold probability of 0.25. At a threshold probability of 0.33, the NBs were 0.71, 0.72, and 0.80, respectively. At a threshold probability of 0.5, the NBs were 0.68, 0.69, and 0.73, respectively. No screening tool reduced unnecessary GA in fit patients at predefined threshold probabilities. Although frailty screening tests showed good diagnostic accuracy, screening showed no clinical benefits over the GA-for-all strategy. NB approaches, in addition to diagnostic accuracy, are necessary to assess the clinical value of tests.

Usefulness of the G8 Screening Tool in Determining Treatment Strategies for Definitive Radiotherapy of Esophageal Cancer in the Elderly

<h3>Purpose/Objective(s)</h3> Recent clinical trials for chemoradiotherapy (CRT) in esophageal cancer, such as ARTDECO and CONCORDE used elective nodal irradiation (ENI). However, it is often difficult to perform standard CRT for the elderly in the real world, and also there is no clear consensus on the criteria for this decision. Recently the G8 screening tool for geriatric assessment has been attracting attention in the oncology field. This study aimed to investigate the relationship between the treatment strategy of definitive RT and the G8 score for esophageal cancer in the elderly. <h3>Materials/Methods</h3> We analyzed 81 esophageal cancer patients aged ≥65 years (27 aged ≤74 years, 26 aged 75-79 years, and 28 aged ≥80 years) who received definitive RT between 2018 and 2021. The G8 screening tool was performed at the first visit to the radiation oncology department. The treatment strategy was decided by a conference between the radiation oncologist and esophageal surgeon, and the G8 score was not used to determine the treatment strategy. Standard RT was defined as ENI and a total dose ≥50 Gy, and standard chemotherapy (ChT) was defined as two cycles of platinum (70 mg/m2) and 5FU (700 mg/m2 for 4 days) concurrently. Patients who underwent standard RT and standard ChT were defined as the standard group and the rest as the non-standard group. The Mann-Whitney U test was used to compare the two groups, and statistical significance was set at p<0.05. The Receiver Operating Characteristic (ROC) curve was used to calculate the cutoff value. <h3>Results</h3> The mean G8 scores by age were 12.7 (range: 7-17) for ≤74 years, 12.9 (range: 7-17) for 75-79 years, and 10.4 (range: 4.5-15) for ≥80 years, and significantly lower scores for ≥80 years, but no significant difference between ≤74 and 75-79 years. There were 26 patients in the standard group, of which only one was ≥80 years. In the patients ≤79 years, the G8 score was significantly higher in the standard group (mean: 13.9 points in the standard group and 11.6 points in the non-standard group) (p<0.01), but age was not significantly different between the standard and non-standard groups (p=0.94). The cut-off value of the G8 score calculated by the ROC curve was 13 points. In patients ≥80 years, 10 patients received CRT (1 standard ChT, 9 reduced ChT), and 15 of 18 patients in the RT alone group received only local RT. In the patients ≥80 years, the G8 score was significantly higher in the CRT group (mean: 12.5 points in the CRT group and 9.2 points in the RT group) (p<0.01), but age was not significantly different between the CRT and RT groups (p=0.08). The cut-off value of the G8 score calculated by the ROC curve was 12 points. <h3>Conclusion</h3> Our results suggest that the G8 screening tool may be useful in determining the treatment strategy of definitive RT for esophageal cancer in the elderly. Future investigation of the relationship between the G8 score and treatment outcomes is required.

Chemobrain, Olfactory and Lifestyle Assessment in Onco-Geriatrics: Sex-Mediated Differences between Chemotherapy and Immunotherapy.

A possible link between chemotherapy and cognitive impairment has been identified. In the literature, this condition is usually called chemobrain and can mostly affect some memory domain but can lead also to other cognitive impairments. Olfaction, which is known to be linked with cognitive domain and the nociception system, can also be affected by chemotherapy. The aim of this study was to investigate the main cognitive and olfactory abilities and the functional and nutritional state of a cohort of chemotherapy and immunotherapy onco-geriatric patients and control geriatrics subjects. Cognitive, olfactory, geriatric and nutritional assessments were performed through the Mini Mental State Examination (MMSE), Sniffin’ Sticks Screening 12, G8 test and a questionnaire on the adherence of the Mediterranean diet, respectively. Our findings show a gender effect on the MMSE. Overall results indicate more pronounced impairments both at the cognitive and frailty level regardless of the type of therapy. On the other hand, the Sniffin’ Sticks performances highlight a significant decrease in olfactory perception ability of subjects following immunotherapy. Significant correlations between olfactory performance and MMSE and G8 scores were also found, as well as between MMSE and G8 measures.

Safety and Efficacy of a First-Line Chemotherapy Tailored by G8 Score in Elderly Metastatic or Locally Advanced Gastric and Gastro-Esophageal Cancer Patients: A Real-World Analysis.

Introduction: Gastric (GC) and gastro-esophageal cancer (GEC) are common neoplasms in the elderly. However, in clinical practice, the correct strategy for elderly patients who might benefit from chemotherapy (CT) is unknown. Prospective data are still poor. In this context, we performed a retrospective analysis of GC patients aged ≥75 years and treated at our institutions. Material and Methods: We retrospectively analyzed 90 patients with confirmed metastatic GC or GEC, treated with an upfront CT. Inclusion criteria were patients aged ≥75 years, PS 0–2, normal bone marrow/liver/renal function and no major comorbidities. All patients received a G8 score, and some patients with G8 ≤14 received a comprehensive geriatric assessment (CGA). The primary goal was to perform a safety evaluation based on the incidence of adverse events (AE), and the secondary goal was to determine the efficacy (PFS and OS). The chi-square test and the Kaplan–Meier method were used to estimate the outcomes. The statistical significance level was set at p < 0.05. Results: Toxicity rates were quite low: G1/G2 (51.1%) and G3/G4 (25.5%). No toxic deaths were reported. The median PFS was 6.21 months and the median OS 11 months. The G8 score and PS ECOG significantly influenced both PFS and OS. A statistically significant correlation among G8, weight loss, hypoalbuminemia and risk of G3/G4 adverse events was also found. Conclusion: Our research on selected elderly patients did not detect broad differences of efficacy and tolerability compared to a young population. Our study, although retrospective and small-sized, showed that G8 score might be an accurate tool to identify elderly GC/GEC patients who could be safely treated with CT, further recognizing patients who could receive a doublet CT and who may require a single agent chemotherapy or a baseline dose reduction.

Impact of perioperative red blood cell transfusion, anemia of cancer and global health status on the prognosis of elderly patients with endometrial and ovarian cancer.

IntroductionPerioperative red blood cell (RBC) transfusions have been associated with increased morbidity and worse oncological outcome in some solid neoplasms. In order to elucidate whether RBC transfusions themselves, the preoperative anemia of cancer (AOC), or the impaired global health status might explain this impact on patients with endometrial cancer (EC) or ovarian cancer (OC), we performed a retrospective, single-institution cohort study.Materials and methodsWomen older than 60 years with EC or OC were included. The influence of RBC transfusions, AOC, and frailty status determined by the G8 geriatric screening tool (G8 score), as well as the clinical-pathological cancer characteristics on progression-free survival (PFS) and overall survival (OS), was determined by using the Kaplan-Meier method and the Cox regression analyses.ResultsIn total, 263 patients with EC (n = 152) and OC (n = 111) were included in the study. Patients with EC receiving RBC transfusions were faced with a significantly shorter 5-year PFS (79.8% vs. 26.0%; p < 0.001) and 5-year OS (82.6% vs. 25.7%; p < 0.001). In multivariable analyses, besides established clinical-pathological cancer characteristics, the RBC transfusions remained the only significant prognostic parameter for PFS (HR: 1.76; 95%-CI [1.01–3.07]) and OS (HR: 2.38; 95%-CI [1.50–3.78]). In OC, the G8 score stratified the cohort in terms of PFS rates (G8-non-frail 53.4% vs. G8-frail 16.7%; p = 0.010) and AOC stratified the cohort for 5-year OS estimates (non-anemic: 36.7% vs. anemic: 10.6%; p = 0.008). Multivariable Cox regression analyses determined the G8 score and FIGO stage as independent prognostic factors in terms of PFS (HR: 2.23; 95%-CI [1.16–4.32] and HR: 6.52; 95%-CI [1.51–28.07], respectively). For OS, only the TNM tumor stage retained independent significance (HR: 3.75; 95%-CI [1.87–7.53]).DiscussionThe results of this trial demonstrate the negative impact of RBC transfusions on the prognosis of patients with EC. Contrastingly, the prognosis of OC is altered by the preoperative global health status rather than AOC or RBC transfusions. In summary, we suggested a cumulatively restrictive transfusion management in G8-non-frail EC patients and postulated a more moderate transfusion management based on the treatment of symptomatic anemia without survival deficits in OC patients.

1596P The G8 screening tool as an independent predictor of survival in elderly cancer patients

Parallel to the ever-growing elderly population, cancer incidence increases with age, due to the fact that population ageing and the consequent increase of life expectancy give more time for cellular dysfunctions including senescence to appear, indirectly favoring carcinogenesis. Geriatric assessment has been increasingly recognized as a prognostic tool to detect frailty in elderly cancer patients. In particular, the G8 score is a simple and reproducible instrument to identify elderly patients who should undergo full geriatric evaluation.

Management of Biochemical Recurrence of Prostate Cancer After Curative Treatment: A Focus on Older Patients.

Following a treatment with curative intent, a biochemical recurrence may be diagnosed, often many years after the primary treatment. The consequences of this relapse on survival are very heterogeneous. The expected specific survival at relapse is above 50% at 10 years. Therefore, its management needs to be balanced with the individual life expectancy. The relapse needs to be categorized as either a low- or high-risk category. The latter has to be considered for salvage therapy, provided the individual life expectancy is long enough. It is evaluated through an initial geriatric assessment, starting with the G8 score as well as the mini-Cog. A comprehensive geriatric assessment might be needed based on the G8 score. Patients will then be categorized as either fit, vulnerable, or frail. If a local salvage therapy is considered, the relapse localization might be of interest in some situations. Available salvage therapies in senior adults have nothing special compared to salvage of younger men, except for aggressive local therapy, which might be less well tolerated. The key objective in managing a biochemical recurrence in senior adults is to find the right balance between under- and over-treatment in a shared decision process. In many frail and vulnerable men, a clinically oriented watchful waiting should be preferred, while fit men with an aggressive relapse and a significant life expectancy need an active therapy.

Loneliness, social isolation, and social support in older adults with active cancer during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic has had a considerable impact on mental health. The social distancing and stay-at-home orders have likely also impacted loneliness, social isolation, and social support. Older adults, particularly those with comorbidities such as cancer, have a greater potential to be impacted. Here we assessed loneliness, social isolation, and social support in older adults undergoing active cancer treatment during the pandemic. Materials and methodsA mixed methods study in which quantitative data and qualitative response items were collected in parallel was conducted in 100 older adults with cancer. Participants completed a survey by telephone with a series of validated questionnaires to assess the domains of loneliness, social isolation, and social support as well as several open-ended questions. Baseline demographics and geriatric assessments were summarized using descriptive statistics. Bivariate associations between social isolation and loneliness and social support and loneliness were described using Spearman correlation coefficients. Conventional content analysis was performed on the open-ended questions. ResultsIn a population of older adults with cancer, 3% were noted to be severely lonely, although 27% percent screened positive as having at least one indicator of loneliness by the University of California, Los Angeles (UCLA) Three Item Loneliness Scale. There was a significant positive correlation between loneliness and social isolation (r = +0.52, p < 0.05) as well as significant negative correlation between loneliness and social support (r = −0.49, p < 0.05). There was also a significant negative correlation between loneliness and emotional support (r = −0.43, p < 0.05). There was no significant association between loneliness and markers of geriatric impairments, including comorbidities, G8 score or cognition. DiscussionReassuringly, in this cohort we found relatively low rates of loneliness and social isolation and high rates of social support. Consistent with prior studies, loneliness, social isolation, and social support were found to be interrelated domains; however, they were not significantly associated with markers of geriatric impairments. Future studies are needed to study if cancer diagnosis and treatment may mediate changes in loneliness, social isolation, and social support in the context of the pandemic as well as beyond.

Association Between Geriatric Assessment and Post-Chemotherapy Functional Status in Older Patients with Cancer.

Maintaining functional status is among the most important patient-centered outcomes for older adults with cancer. This study investigated the association between comprehensive geriatric assessment (CGA) and progressive disease or decline of IADL-independence 1 year after chemotherapy, overall survival (OS), and premature termination of chemotherapy. CGA-based functional status and quality of life (QOL) 1 year after chemotherapy are also described. This prospective cohort study involved patients aged ≥65 years treated with chemotherapy for any cancer type. CGA and the G8-screening tool were performed before and after the completion of chemotherapy. Analyses were adjusted for tumor type and treatment intent: (a) indolent hematological malignancies, (b) aggressive hematological malignancies, c) solid malignancies treated with curative intent, and (d) solid malignancies treated with palliative intent. All 291 included patients lived in The Netherlands; 193 (67.4%) lived fully independent prior to chemotherapy. The median age was 72 years; 164 (56.4%) were male. IADL independence, CGA-based functional status, and QOL were maintained in half of the patients 1 year after chemotherapy. An abnormal G8-score before chemotherapy was a higher risk for progressive disease or a decline of IADL-independence (OR 3.60, 95% CI, 1.98-6.54, P < .0001), prematurely terminated chemotherapy (OR 2.12, 95% CI, 1.24-3.65, P = .006), and shorter median OS (HR 1.71, 95% CI, 1.16-2.52, P = .007). The impact of an abnormal G8-score differed across tumor type (oncological or hematological) and treatment indication (adjuvant or palliative). An abnormal G8 score before chemotherapy is associated with progressive disease and functional decline after chemotherapy and shorter median OS, especially in patients with solid malignancies.

Outcomes of comprehensive geriatric assessment and surgical management in head and neck cancers of the elderly: an observational study.

The aims of this study were to assess the survival benefit of optimal vs suboptimal management in elderly patients presenting with upper aerodigestive tract (UADT) cancer for which surgery was the standard of care, and determine if comprehensive geriatric assessment (CGA) was a prognostic factor for survival. This single-center retrospective cohort study was conducted from January 2014 to December 2018. Included patients were aged 70 or older at the time of diagnosis, and presented with UADT cancer with a theoretical indication for curative-intent surgery according to international guidelines. A total of 188 patients were included, with a median age of 78years. Treatment included surgery in 67.6% of cases and was considered optimal in 60.6% of patients. The overall 3-year survival was 55.2%, and was significantly better in case of optimal vs suboptimal treatment (74.5% vs 25.8%, p < 0.001). In univariate analysis, factors associated with a significantly improved 3-year survival included surgery (p < 0.001), age < 80years, performance status < 2 and G8 score > 14. In multivariate analysis, CGA was associated with a better survival. In patients aged over 70 presenting with UADT cancer for which the standard of care is surgery, an optimal management is associated with better overall survival. Receiving a CGA seems to provide a survival benefit in patients with a G8 score ≤ 14, through an optimization of the care pathway before and after the cancer treatment.

Reliable Prediction of Post-Operative Complications' Rate Using the G8 Screening Tool: A Prospective Study on Elderly Patients Undergoing Surgery for Kidney Cancer.

In the last years the incidence of renal neoplasms has been steadily increasing, along with the average age of patients at the time of diagnosis. Surgical management for localized disease is becoming more challenging because of patients’ frailty. We conducted a multi-center prospective study to evaluate the role of the G8 as a screening tool in the assessment of intra and post-operative complications of elderly patients (≥70 y.o.) undergoing surgery for kidney cancer. A total of 162 patients were prospectively enrolled between January 2015 to January 2019 and divided into two study groups (frail vs. not-frail) according to their geriatric risk profile based on G8 score. Several factors (i.e., age, CCI, ASA score, preoperative anemia, RENAL score, surgical procedures, and techniques) were analyzed to identify whether any of them would configure as a statistically significant predictor of surgical complications. According to the G8 Score, 90 patients were included in the frail group. A total of 52 frail patients vs. 4 non-frail patients developed a postoperative complication of any kind (p < 0.001). Of these, 11 were major complications and all occurred in the frail group. Our results suggest that the G8 screening tool is an effective and useful instrument to predict the risk of overall complications in elderly patients prior to renal surgery.

Clinical decision-making in older patients with cancer: a cross-sectional single-centre study to assess the impact of clinical judgement and patient preferences

ABSTRACT Objective The heterogeneity in the population of older patients with cancer makes clinical decision-making difficult. We investigated the agreement between the G8 score and clinical judgment in frailty assessments, determined the impact of a life-expectancy calculator, and explored patient and caregiver preferences towards the treatment goal. Methods Patients aged ≥75 years in need of new oncological treatment were prospectively enrolled between June 2020 and February 2021. Frailty was estimated by the oncologist and caregiver and compared to the G8 estimation. We examined whether the oncologist changed the fit/frail estimation based on life expectancy calculated using the ePrognosis tool. The main treatment goals, either longevity or quality of life (QoL), from the patient’s and caregiver’s perspective were noted and compared. Results Forty-nine patients were included in the analysis. Comparison of the oncologist’s and the caregiver’s frailty estimation with the G8 assessment showed agreement and a Kappa coefficient of 58.3% (0.231) and 60% (0.255), respectively. The ePrognosis score and the odds of change in the frailty estimation by the oncologist showed no correlation. Regarding preferences, 28 (57.1%) and 17 (34.7%) patients and eighteen (47.3%) and seventeen (44.7%) caregivers chose longevity and QoL, respectively. The observed agreement and Kappa coefficient were 78.8% and 0.578. Conclusion Compared to the G8 assessment, frailty was underestimated by both oncologists and caregivers. Most of the patients chose longevity over QoL, and the preferences between the patient and the caregiver matched in the majority of cases.

Pilot study of the implementation of G8 screening tool, cognitive screening assessment and chemotherapy toxicity assessment in older adults with cancer in a tertiary University Hospital in Ireland.

e24019 Background: 11% of Ireland’s population is above the age of 65. This is projected to double to 1.4 million by 2040 corresponding to doubling of cancer cases. Clinical trials often exclude patients (pts) ≥70; therefore, it can be challenging to apply evidence based treatment (tx) to this population. Data from the National Cancer Registry of Ireland suggests under tx of older patients (pts). Comprehensive Geriatric assessment (CGA) is recommended by the National Comprehensive Cancer Network (NCCN) and the International Society of Geriatric Oncology (SIOG). In practice, CGA is limited by time constraints, lack of resources and expert interpretation. Geriatric screening tools can help identify frail pts who are most likely to benefit from CGA. The primary objective of this pilot study was to establish the prevalence of frailty (assessed by G8), presence of cognitive impairment (assessed by Mini-Cog), and risk of chemo-toxicity (assessed by Chemo-Toxicity Calculator) among pts ≥ 65 years (yrs) starting systemic anti-cancer tx. Methods: Pts ≥65yrs starting new systemic anticancer tx were identified between 1st of December 2020 to 31ST of September 2021 in St. Vincent’s University Hospital. Verbal consent was obtained. Printed versions of the G8 screening tool and Mini-Cog were used. CARG chemo-toxicity score was conducted online ( www.mycarg.org/tools ). .The assessment was conducted by consultants, specialist registrars and registrars. Data including pts’ age, type of malignancy, stage of cancer, and planned treatment were recorded. Analysis was conducted by SPSS statistical software, V.25(SPSS Institute, IBM Corp., 2017). Results: We identified 56 pts ≥65 years.27 (48.1%) were females and 29 (50.8%) were males. The majority of treated pts, N = 33 (58.1%) had metastatic cancer. The median G8 score was 12 (IQR 9.6-14). 83.9% of pts had a G8 score ≤14. Mini-Cog was found to be positive in 11 pts (19.6%). The median CARG score was 7 (IQR 6-11) and the median risk of toxicity 51% (IQR 44-78%). Of these, 44 (78.2%) received chemotherapy and 12 pts (21.4%) received non-chemotherapy systemic tx. In multi-variate analyses, age, type of cancer, planned treatment, and stage of disease did not impact G8, Min-cog, and CARG scores. Conclusions: In this single center study of elderly pts, more than 80% of pts had a positive G8 score representing a need for formal CGA assessment. The risk of toxicity was substantial with almost 50% risk of grade ≥ 3 toxicity in this cohort. Chronological age was not found to negatively impact patient’s frailty, cognition, or risk of toxicity. Interpretation of this pilot study is limited by small sample size, possible inter-operator variability, and lack of self-reported assessment.

P-190 The Geriatric 8 score is associated with risk of hospitalisation and 6-month survival in patients with incurable pancreatic cancer receiving gemcitabine and capecitabine

Assessing frailty in cancer patients can aid treatment decisions, target geriatric interventions and improve outcomes. The G8 score is a screening tool to detect frailty, however there are limited data on its utility in patients receiving chemotherapy for pancreatic cancer. We assessed the G8 score retrospectively in a population of older patients with incurable pancreatic cancer receiving gemcitabine and capecitabine chemotherapy. We performed a retrospective analysis of patients aged 65 or older, who had received Gemcitabine and capecitabine in the Northern Ireland Cancer Centre identified from electronic clinical databases. Clinico-pathological, treatment and outcome data were collected. Outcomes were 6-month survival, grade 3 toxicities, and hospitalisation risk 6 months from starting treatment. Toxicities were graded according to CTCAE v5. Descriptive statistics Fischer’s exact test was used to assess G8 scores and individual domains with outcomes. Univariable and multivariable analysis were undertaken assessing associations between the individual G8 domains and outcomes. Kaplan-Meier techniques were used to assess survival. SPSS version 26 was used. 95 patients treated between 11/2017 and 8/2021, were identified. Median age 73 (IQR 70 – 77) and 53% female. All G8 variables were collected except patient reported health status. 48% had metastatic disease and 52%, locally advanced disease. The median G8 score was 10.5 (IQR 9-12). Median overall survival in patients with a G8 score greater than 12 (n=22) was 13.9 months; and less than 12 (n=73), 8.6 months (log rank 2.4, p=0.118). 6 month and 12 month survival rates in the entire group were 65% and 39%, in G8 >12 77% and 50%, and in G8 12 and less 61% and 36%. Grade III toxicities were observed in 60% in both G8>12 and G8 12 and below p=0.888. Risk of hospitalisation or death in 6 months was associated with weight loss (p=0.048) and reduced BMI (p=0.04). A logistic regression model found the G8 domains were associated with risk of Hospitalisation or death at 6 months in this population (X2=29.9, p=0.008), explained 42.7% of variation of hospitalisation or death and correctly predicted 84.2% of cases. No individual variable was statistically significant in this model. This retrospective analysis suggests that the Geriatric- 8 score is associated with of risk of hospitalisation or death within 6 months of starting chemotherapy in older patients with pancreatic cancer. Given the poor survival of patients with advanced pancreatic cancer, time spent as an inpatient will have a greater proportional impact on quality of life compared to cancers with longer survival. Geriatric assessment may improve treatment decisions in these patients. Larger prospective studies are required to validate the utility of the G8 score specifically in older pancreatic cancer patients.

Preliminary findings of implementing the G8 screening tool in an academic cancer center.

12010 Background: Older patients often experience more toxicity from cancer treatments due to their functional age and co-morbidities. The G8 is a geriatric screening tool designed to identify patients who are appropriate for a comprehensive geriatric assessment (CGA) which will inform and optimize oncology therapeutic decision making, reduce toxicities and improve outcomes. Using a nurse-led assessment approach, we have implemented an EMR embedded G8 tool across our cancer center since June 2020. We aim to describe the characteristics of those patients who scored abnormal (≤ 14) on the G8. Methods: The demographic and clinical characteristics were collected from the EMR for those who were ≥ 65 and have completed the G8 screening tool from June 2020 to Jan 2022. Summary statistics such as means, standard deviations and proportions were reported. Comparisons of various endpoints between dichotomized (≤ 14 vs. &gt; 14) G8 scores were performed using pairwise two-sample t-test, pairwise proportion test, Fisher’s exact test and/or Pearson’s chi-squared test. Selected stakeholders were elicited for their perspectives on the implementation process. Results: 544 patients age ≥ 65 completed G8 screening with a mean score of 13.4 (± 2.3). The mean age was 75.2 (± 7.0), and 55.7% were females and 78.3% were non-Hispanic White. The most frequent cancer type was breast cancer (21.3%), followed by lung/respiratory cancer (18.2%), and GI cancer (15.8%). The percentage of patients appropriate for a CGA (based on an abnormal G8 score) was 59% (n = 332), of which only 10% (n = 31) were referred. A spearman correlation of 0.4 (p &lt; 0.001) between G8 scores and age was obtained. A statistically significant association between ECOG and G8 groups was found, but not for any comorbidities. The prevalence of current/former smoking and extreme polypharmacy (&gt; 10) is significantly higher in the G8 abnormal group. Implementation process evaluation found new patients with cancer overwhelmed with information, a lack of patient education and provider engagement, and an unstandardized referral process to CGA, were barriers for CGA referral. Conclusions: The G8 is an effective tool identifying patients appropriate for a CGA. An EMR embedded G8 steadily improved the G8 utilization uptake but not referral for CGA at our institution. To further improve awareness, utilization and referral, we are redesigning a hybrid workflow integrating patient-mediated MyChart implementation and nurse navigator engagement. EPIC enhancements are being designed to inform the oncologist of the patient’s G8 score, CGA referral status and the final CGA report.

A decision curve analysis of the clinical usefulness of a two-step frailty assessment strategy in older patients with prostate, breast, colorectal, or lung cancer.

12011 Background: Geriatric Assessment (GA) is recommended to assess the health status and select the most appropriate cancer treatment in older patients. However, GA is resource- and time-consuming. Thus, a two-step approach using frailty screening has been recommended. We aimed to evaluate the usefulness of frailty screening over GA for identifying unfit individuals who need GA and reducing unnecessary GA in fit individuals in a population of older outpatients with cancer. Methods: We analyzed patients age 70 and older with prostate, breast, colorectal, or lung cancer included in the multicenter, prospective ELCAPA cohort study (NCT02884375) between February 2007 and December 2019. All patients had a GA at inclusion. GA was the reference test. We defined unfit patients as those having at least one abnormal score in the following domains: functional status, mobility, comorbidity, cognition, mental health status, nutrition, and polypharmacy. We defined unfit patients according to the G8 and modified G8 scores using the recommended cut-offs (≤ 14 out of 17 points and ≥ 6 out of 35 points, respectively). We calculated each screening tool's sensitivity, specificity, and positive and negative predictive values. We used decision curve analysis to estimate the net benefit (the percentage of patients found to be unfit) of screening over GA. We assessed the avoided unnecessary GAs for each screening tool (reducing unnecessary GA in fit patients without decreasing the number of unfit patients undergoing [necessary] GA). We calculated these estimates across different threshold probabilities corresponding to the value of missing an unfit patient compared to exposing a fit patient to an unnecessary GA. A probability of 0.33 indicated that missing an unfit patient was two times worse than referring a fit patient to an unnecessary GA. A probability of 0.50 indicated that missing an unfit patient was the same as exposing a fit patient to an unnecessary GA. Results: We analyzed 1,648 patients with prostate (15%), breast (52%), colorectal (22%), or lung cancer (11%). The median age was 81 years, 559 patients (34%) had metastatic disease, and 1,428 patients (87%) were unfit. The sensitivity (95% CI) and specificity were 85% (84-87) and 59% (57-61) for the G8 score, and 86% (84-87) and 60% (58-63) for the modified G8 score. With a threshold probability of 0.33, the net benefit was 0.71 for the G8 score, 0.72 for the modified G8 score, and 0.80 for GA. With a threshold probability of 0.50, the net benefit was 0.68 for the G8 score, 0.69 for the modified G8 score, and 0.73 for GA. We did not observe a reduction in unnecessary GA of screening tools over GA. Conclusions: Frailty screening tools showed good diagnostic performances. However, our findings suggest that the GA-for-all strategy provides the higher clinical benefit in older patients with cancer.

Final results from a phase III randomized clinical trial of adjuvant endocrine therapy ± chemotherapy in women ≥ 70 years old with ER+ HER2- breast cancer and a high genomic grade index: The Unicancer ASTER 70s trial.

500 Background: Benefit of adjuvant chemotherapy (CT) in addition to endocrine therapy (ET) remains controversial for patients (pts) aged ≥ 70 years with oestrogen receptors-positive (ER+) HER2-negative (HER2-) breast cancer (BC). In a large prospective trial, we first assessed the tumour genomic grade index (GGI) in all pts, and second, randomized pts with a high GGI between CT + ET vs. ET alone. Methods: Eligible pts were women ≥ 70 years with ER+ HER2- primary BC or isolated local relapse, irrespective of other characteristics, for whom adjuvant systemic treatment was considered. G8 score, Charlson comorbidity index (CCI) and 4-year mortality Lee score were collected at baseline. GGI was centrally performed by RT-PCR on FFPE samples. Pts with low GGI were not recommended to receive CT and were followed in an observational cohort. Pts with high (+ equivocal) GGI were randomized 1:1 to CT + ET vs. ET alone, using G8, pN and centre for stratification. Investigators chose between 3 CT regimens: 4 cycles of doxorubicin/cyclophosphamide, non-pegylated liposomal doxorubicin/cyclophosphamide or docetaxel/cyclophosphamide, given q3w with G-CSF. Standard ET consisted of 5 years of aromatase inhibitor, tamoxifen or a sequence based on tolerance. Based on CALGB 49907 results, the primary objective was to demonstrate an overall survival (OS) benefit for CT (4-year assumptions 87.5 vs 80%, HR=0.60) in the intent to treat (ITT) population. With 171 events, the trial had 90% power to demonstrate a difference with a bilateral test α=0.05. Secondary objectives included BC specific survival (BCSS), invasive disease-free survival (iDFS), event-free survival (EFS), competing events, cost-effectiveness and Q-TWiST analysis, geriatric dimensions, willingness and quality of life. Results: Between 04/2012 and 05/2016, 1,969 pts from 61 French and 12 Belgian centres were enrolled. Of them, 1,089 (55%) were randomized between CT + ET and ET alone. Median follow-up was 5.8 years at the data cut-off (17/12/2021) with 180 OS events observed. Median age was 75 (70-92), G8 score, CCI and Lee score being &gt;14, ≤ 2, and ≤ 8 in 60%, 62% and 84% of pts, respectively. Tumours were ≥ pT2, pN+, isolated local relapses, with histological grade III, in 56%, 46%, 11% and 39% of cases, respectively. No significant OS difference was observed between arms (HR 0.85 [0.64-1.13], p=0.2538); 4-year OS was 90.5% in the CT + ET arm and 89.7% in the ET alone arm. The forest plot could not identify any subgroup deriving significant benefit from CT. ITT and per protocol analysis of secondary objectives (BCSS, iDFS, EFS) showed similar results. Conclusions: In this large phase III trial, we did not find a statistically significant OS benefit with the addition of CT to ET after surgery for ER+ HER2- BC with a high GGI. Analysis of the other outcome measures will be presented. Clinical trial information: NCT0156405.

P-239 Management of gastric cancer in vulnerable patients: Is there a particularity?

Gastric cancer is the third leading cause of cancer death in the world and the fourth in Marrakech with an ASIR of 4.15 per 100.000 residents. It is frequently diagnosed in the elderly and is associated with rapid deterioration of general health. Management of this frail population has always been a challenge because being less included in trials. The aim of our study is to make a descriptive analysis regarding the management of frail patients. We conducted a descriptive retrospective study evaluating 62 vulnerable patients diagnosed with gastric cancer between 2020-2021 at the medical oncology department of the Mohammed VI University Hospital in Marrakech-Morocco. Vulnerable patients were defined by an age ≥ 70 years old and/or those with a performance status ≥ 2. Between 2020-2021, 150 patients were diagnosed with gastric cancer, only 62 patients were included in this study. Most of our patients were males (60% vs 40%). The average age at diagnosis was 64 years of which 35 patients (56.4%) were aged ≥ 70 years and 48 (77%) had a PS ≥ 2. 19 patients (30.6%) had comorbidities. For elderly patients: 31 (88.5%) had a G8 score ≤ 14. The most frequent histological type was adenocarcinoma 57 (92%), of which 12 (21%) were in the form of signet ring cell type. 30.6% of the patients had locally advanced tumor and 63% had metastatic tumor. 35 of patients (56.5%) received chemotherapy, of which 83% received bi-chemotherapy such as CAPOX or FOLFOX in 86% of the cases and 17% received CAPECITABINE as a monotherapy. 12% underwent surgery after neoadjuvant chemotherapy, 18 patients (29%) were declared palliative care due to deterioration of general condition (PS 3-4), and 8 patients (13%) were lost to follow-up. Among patients who received chemotherapy: 33.60% presented chemotherapy induced toxicities including peripheral neuropathy G1-G2 in 33% of cases, 24% with G1-G4 neutropenia, 24% with asthenia 14% with G1 diarrhea. Data of first PFS and Overall survival are not mature, further follow-up is needed to provides these results. In our study, age was not an indicator for not giving chemotherapy. However, the decision to administer chemotherapy depended on the performance status. Bi-chemotherapy was not associated with excessive toxicity.

Using G8 and carg toxicity score to predict emergency room (ER) visits, hospitalizations, and mortality in older patients with newly diagnosed cancer.

12055 Background: ASCO and NCCN guidelines recommends Geriatric Screening (G8) and CARG chemotherapy toxicity tool assessment for all older patient before receiving chemotherapy as high risk G8 (&lt; 14) and CARG (≥10) are associated with increased chemotherapy toxicities. We conducted a pilot to understand predictors of high risk G8/CARG and if high risk G8/CARG can predict ER/hospitalization and mortality in community-based Oncology clinics in Kaiser Permanente Northern California. Methods: G8 and CARG were administered to all patients ≥65 years with newly diagnosed cancer from 5/1/21 to 12/31/21. Patients were followed for at least 30 days after assessment for ER/hospitalization and mortality. The median follow-up days from referral to ER/hospitalization was 96 days (range 0-273 days). Chi-Square tests were applied for G8/CARG risk category with demographic and utilization variables. Cox proportional-hazards models were performed to see the association between G8/CARG score and days from referral to ER/hospitalization, and days from referral to death, adjusted for age, sex, race, and cancer type. Results: During this pilot 1082 patients (52% female) completed G8, and 516 patients (57% female) completed CARG. Percentage of patients with high risk G8/CARG increased with each decade (G8: &lt; 70 yrs (58%), 70-79 (63%), 80-89 (90%), ≥ 90 (100%); p &lt; 0.001); (CARG: &lt; 70 yrs (19%), 70-79 (43%), 80-89 (65%), 90 and above (81%); p &lt; 0.001). More men than women had high risk CARG (48% vs. 39%, p = 0.012). Ethnicity was not associated with high risk G8 / CARG. Upper GI cancers (UGI) were associated with highest proportion of patients with high risk G8 (88%) and CARG (58%) whereas breast cancer (BC) had the lowest proportion of patients with high risk G8 (46%) and CARG (14%); p &lt; 0.001. In the adjusted G8 model for ER/hospitalization, high risk G8 vs low risk (HR 1.58, CI 1.23-2.03, p = 0.0003) was related to ER/hospitalization. In the adjusted CARG model for ER/ hospitalization, high risk CARG vs low risk (HR 2.42, CI 1.37-4.29, p = 0.0024) and medium risk CARG vs low risk (HR 2.17, CI 1.23-3.83, p = 0.0074) were related to ER/hospitalization. In the adjusted G8 model for mortality, high risk G8 vs low risk (HR 4.52, CI 2.28-8.97, p &lt; 0.0001) were related to mortality. In the adjusted CARG model for mortality, high risk CARG vs low risk (HR 3.92, CI 1.21-12.74, p = 0.023) and medium risk CARG vs low risk (HR 1.59, CI 0.48-5.33, p = 0.45) were related to mortality. Conclusions: This community-based pilot shows that increasing age is associated with high risk G8 / CARG. G8 and CARG assessment at the time of initial cancer diagnosis can predict early ER/hospitalization and mortality in older adults with cancer and should be included as a part of initial assessment.