Geriatric 8 Score Research Articles

Impact of stereotactic body radiation therapy on geriatric assessment and management for older patients with head and neck cancer using G8

PurposeManagement of head and neck cancers (HNC) in older adults is a common but challenging clinical scenario. We assess the impact of Stereotactic Body Radiation Therapy (SBRT) on survival utilizing the Geriatric-8 (G8) questionnaire. Materials and methods171 HNC patients, deemed medically unfit for definitive treatment, were treated with SBRT ± systemic therapy. G8 questionnaires were collected at baseline, at 4–6 weeks, and at 2–3 months post-treatment. Patients were stratified according to their baseline G8 score: <11 as ‘vulnerable’, 11–14 as ‘intermediate’, and >14 as ‘fit’. Overall survival (OS) was assessed through univariate Kaplan Meier analysis. Repeated measures ANOVA was used to determine if baseline characteristics affected G8 score changes. ResultsMedian follow-up was seventeen months. 60% of patients presented with recurrent HNC, 30% with untreated HNC primaries, and 10% with metastatic non-HNC primaries. Median age was 75 years. Median Charlson Comorbidity Index score was 2. 51% of patients were ‘vulnerable’, 37% were ‘intermediate’, and 12% were ‘fit' at baseline, with median survival of 13.2, 24.3, and 41.0 months, respectively (p = .004). Patients who saw a decrease in their follow-up G8 score (n = 69) had significantly lower survival than patients who had stable or increased follow-up G8 scores (n = 102), with median survival of 8.6 vs 36.0 months (p < .001). ConclusionThe G8 questionnaire may be a useful tool in upfront treatment decision-making to predict prognosis and prevent older patients from receiving inappropriate anti-cancer treatment. Decline in follow-up G8 scores may also predict worse survival and aid in goals of care following treatment.

Rate of complete chemotherapy as planned with comprehensive geriatric assessment guided intervention among vulnerable elderly cancer patients: A randomized-open-label study.

e24021 Background: The Geriatric 8 (G8) is a simplified screening tool to select the appropriate elderly patients for chemotherapy. Vulnerable patients with impaired G8 score might need additional comprehensive geriatric assessment (CGA) with intervention for individual problem. However, the impact of CGA and therapeutic intervention on rate of complete chemotherapy among these patients is rarely addressed. This study aims to evaluate the benefit of CGA guided intervention. Methods: A single center, randomized, open-label study which included newly diagnosed elderly cancer patients (age ≥ 65) with impaired G8 score (≤ 14) who were designated for chemotherapy. After the enrollment, patients were randomized to 1:1 ratio to receive CGA guided intervention (intervention group) or usual care (control group). The primary end point was the rate of complete chemotherapy at 90-day. Associated factors for complete chemotherapy were evaluated. Results: Between June 2019 and December 2019, 52 patients were randomized (26 patients for intervention group and 26 patients for control group). Mean age was 72 years, 59.6% was female, 40.4% had breast cancer and 51.9% had early stage cancer. With G8 assessment, 55.8% had intermediate (score 11-14) and 44.2% had low (score &lt; 11) impaired G8 score. All baseline characteristics were balanced. Using per protocol analysis, there was no significant difference in rate of complete chemotherapy between groups (61.9% vs 50%, OR 1.63; 95%Cl 0.51-5.23; p = 0.42). Considering subgroup analysis in the intermediate G8 score patients, the intervention group had a significant higher rate of complete chemotherapy than control group (81.8% vs 66.7%, OR 2.71; p = 0.02), but no significant difference in low G8 score group (40% vs 27.3%, OR 1.78; p = 0.58). In univariate analysis, age below 75 years, BMI &gt; 20 kg/m2 and intermediate G8 score showed significant factors for improving rate of complete chemotherapy. Conclusions: This is the first study in south-east Asia using CGA and intervention to improve rate of completion in chemotherapy. Although the CGA and intervention had no significant difference but had tendency to be better in completion rate of chemotherapy than usual care. The intermediate-impaired G8 score subgroup is more likely to benefit from CGA guided intervention for complete chemotherapy as planned.

The impact of frailty on the occurrence of immune-related adverse events in older patients with advanced melanoma.

e24028 Background: Immune checkpoint inhibitors (ICIs) have changed the melanoma treatment landscape by inducing durable responses and significantly improving survival. ICI can cause immune-related adverse events (irAES) ranging from mild to life threatening. Clinical trials have not shown major increase of irAES in older patients when compared to younger patients. However, older patients have been underrepresented and were relatively fit in these trials. In this study, we assessed the occurrence of irAEs treated with systemic corticosteroids and/or leading to treatment discontinuation (relevant irAEs) in older patients with melanoma and, if relevant irAEs occurred more often in frail patients, as assessed with the Geriatric 8 (G8). Methods: Patients ≥70 years diagnosed with advanced melanoma, about to start with ICI, and screened with a G8, were enrolled in this prospective observational study. Patients were classified according to the G8 score as “fit” (G8 score &gt;14) or “frail” (G8 score ≤14). Toxicity was scored according to CTCAE v4.03. Primary outcome was occurrence of relevant irAEs in “fit” and “frail” patients. Secondary outcomes were the occurrence of irAEs any grade and severe irAE (grade ≥3). Results: In total, 49 patients were included for statistical analyses. Thirty-three patients were classified fit according to the G8 and, 16 patients were frail. Relevant irAEs occurred statically significantly more often in in frail patients: 12 (75%) versus 15 patients (46%) ( p=0.05). In addition, more irAEs grade ≥3 were reported in frail patients, although not significant: 7 (44%) versus 8 patients (25%) ( p= 0.11). Conclusions: Frailty, classified by the G8, is associated with the occurrence of relevant irAEs in the older patient with advanced melanoma. These data need to be confirmed in larger series.

How to select candidates for microvascular head and neck reconstruction in the elderly? Predictive factors of postoperative outcomes

IntroductionThe proportion of elderly patients with head and neck cancer is increasing. However, predictive factors of postoperative outcomes are insufficiently explored in this population. In this study, we aimed to determine predictive factors of postoperative outcomes in elderly patients undergoing head and neck free-flap reconstructive surgery in order to determine criteria on which patient selection could be based. MethodsAll patients aged 65 years or over who underwent head and neck free-flap reconstructive surgery at our institution, between 2000 and 2016, were included in this retrospective study. Predictive factors of postoperative outcomes were investigated in uni- and multivariate analysis. ResultsTwo-hundred patients were included in the study. Older age (>70, >75 or > 80 yrs) had no significant impact on postoperative outcomes. Free flap failure local and general complications rates were 11%, 34% and 43%, respectively. Oromandibular reconstruction (p = 0.04) was significantly associated with free flap failure and salvage surgery (p = 0.04) with local complications. A high comorbidity level (Charlson Comorbidity Index score ≥ 4; p = 0.02) was associated with a higher risk of general complications. A G8 (Geriatric 8 questionnaire) score < 15 (p = 0.004), a high comorbidity level (Kaplan-Feinstein Index score ≥ 2; p = 0.04) and oromandibular reconstruction (p = 0.04) were associated with poor swallowing function at 6 months. ConclusionHead and neck free flap reconstruction should be offered to fit (G8 score ≥ 15) elderly patients without severe comorbidities (KFI < 2 or CCI < 4), particularly when oral/pharyngeal soft-tissue reconstruction is planned.

Treatment strategies for and outcomes of older patients with oral squamous cell carcinoma

The purpose of this study was to investigate factors that have a significant impact on decision making regarding treatment strategies and on the resultant outcomes in older patients with oral squamous cell carcinoma (OSCC). To define fit, vulnerable, and frail patients, as well as treatment strategies/outcomes, in patients 75 years of age and older with primary OSCC were retrospectively reviewed from the medical records. Among patients with stage I and II tumors, those with a Geriatric 8 (G8) score of 11.5 or greater had favorable outcomes and those with a score less than 11.5 had acceptable outcomes (5-year self-reliance [SR] rates: 80.8 and 53.5%, respectively). Among patients with stage III and IV tumors, those with the Eastern Cooperative Oncology Group-Performance status (ECOG-PS) score less than 2 and/or a G8 score 11.5 or greater mainly received standard therapy, had favorable outcomes (5-year SR rate: 66.7%). The 5-year SR rates of stage IV patients with an ECOG-PS score 2 or greater and those with a G8 score less than 11.5 were poor regardless of any treatment strategy. Although the 5-year SR rate of patients with standard therapy was 73.4%, that of patients receiving other curative therapies was 0%. In patients with stage III/IV, ECOG-PS 2 or greater, and/or G8 score less than 11.5, treatment was difficult, and the prognosis was poor.

Relationship between Geriatric 8 screening score and treatment selection in patients with prostate cancer.

206 Background: This study aimed to evaluate the geriatric 8 (G8) screening tool for detecting frailty in patients with prostate cancer. Methods: Between January 2017 and June 2019, we prospectively evaluated the G8 in 540 prostate cancer patients, 444 with localized stage M0 and 96 with metastatic stage M1 disease. The primary endpoint was the comparison of G8 scores in patients treated with robot-assisted radical prostatectomy (RARP), radiotherapy, androgen deprivation therapy alone (ADT-alone) for localized disease, and standard care for the M1 disease. Secondary endpoint included the cutoff estimation of G8 score and the influence of G8 on prognosis. Results: The median age was 75 years. G8 scores ≤14 indicating frailty were seen in 36% of RARP (n = 214), 57% of RT (n = 209), 91% of ADT-alone (n = 21), and 70% of M1 disease (n=96). The median G8 score in M0 patients was significantly higher than that in M1 patients (14.5 vs 12.8, respectively). The median G8 score in patients treated with RARP, RT and ADT-alone was 15, 14, and 12, respectively. The patients with RARP had significantly higher G8 score than that of RT or ADT-alone. The optimal G8 cutoff score for patients with M0 and M1 disease was 13.0 (AUC: 0.681). The overall survival was significantly shorter in patients with G8 &lt;13 than that of ≥13. Conclusions: The G8 score of patients with localized and metastatic PC was significantly different. Frailty was significantly associated with treatment selection and prognosis in patients with PC.

Can G8 Scoring in Patients with Geriatric Lung Cancer Help to Determine Curative Treatment?

Objective: The median age at diagnosis of lung cancer is 70 years and there are limited data in the literature regarding the treatment of elderly patients. In elderly patients, comorbid diseases, poor performance, and toxicity may lead to a surge in physicians' curative treatment and may remain untreated. The aim of this study was to evaluate the results of treatment in patients older than 70 years whose performances were evaluated by using Geriatric 8 score and to find out the response to curative treatment.&#x0D; Materials and Methods: 124 patients over 70 years of age were evaluated retrospectively. 68 patients with early stage or locally advanced non-small cell lung cancer who were inoperable but not suitable for stereotactic radiotherapy were evaluated retrospectively. Geriatric 8 (G8) screening test was used to identify elderly cancer patients who could benefit from curative treatment. Patients received curative chemoradiotherapy or radiotherapy alone.&#x0D; Results: In all patients (68), overall survival (83% for 1 year, 66% for 2 years) was median 18 months and disease free survival (58% for 1 year, 34.1% for 2 years) was median 14 months. As the G8 score increased, a statistically significant increase was observed in overall and disease free survival. Having weight loss or not, presence of accompanying disease, having good or bad health situation, having body mass index above and below 21, and the usage number of medications below or above 3 affects overall and disease free survival. When only the patients who received radiochemotherapy (n = 43) were evaluated, the mean survival (free of the ECOG performance score) was 12.8 months with G8 score less than 14 and 29.17 months with G8 score 14 and above and were statistically significant (p = 0.000).&#x0D; Conclusion: When making a treatment decision, clinical evaluation should be performed well in patients older than 70 years with non-small cell lung cancer (NSCLC). In our study, overall survival and disease free survival were found to be better in patients with a G8 score above 14. Therefore, we think that it may be appropriate to use curative concurrent radio chemotherapy in selected patients with high G8 score and not to decide on biological age in elderly patients.

Tumour immune infiltrate characterization in luminal breast cancer in three distinct age categories and its correlation with frailty

Abstract Background Immunosenescence, the age-related decrease in immune competence, is characterized by decreased adaptive immunity and increased low-grade inflammation. This may lead to altered anti-tumor immune responses and thus affect tumor immune infiltrate in older patients with cancer. However, detailed tumor infiltrate characterization in breast cancer (BC) has not yet been performed in the context of aging. Methods This exploratory study investigated age-related changes in the tumor microenvironment of patients with early BC (grade I-III, ER+, HER2-). Patients were subdivided into three age categories: 35-45 years (y) (N = 15), 55-65y (N = 19), ≥70y (N = 31). Stromal tumor infiltrating lymphocytes (sTILs) percentage was assessed following published guidelines. Immune infiltrate characterization was established by determining CD68 grade and scoring additional immune markers (CD3, CD4, CD5, CD8, CD20 and FOXP3) with a newly developed analysis pipeline using the QuPath software. In the oldest group, the geriatric 8 (G8) score was obtained as a correlate for clinical frailty level. Results With increasing age, sTILs percentage significantly decreased, concomitant with significantly lower Tcells (CD3+ and CD5+), cytotoxic Tcells (CD8+) and Bcells (CD20+) densities in the whole tumor area. When assessing tumor regions separately, significant age-related decreases in immune cell density in invasive front (CD3+, CD5+, CD8+, CD20+ cells) and tumor center (CD3+, CD5+, CD8+ cells) were observed. No age-related changes were seen for CD4+ and FOXP3+ cell infiltration nor for CD68 grade in the tumor. G8 score showed a significant inverse correlation with regulatory Tcells (FOXP3+) density in tumor center. However, spatial distribution of the immune cell populations did not depend on age nor frailty level. Conclusion In conclusion, sTILs percentage and density of several immune markers in the tumor significantly differed between young and older patients with BC. Moreover, density of regulatory T-cells was higher in frailer patients (lower G8 score). This may indicate that tumor immune responses in these patients may be less effective, and approaches for immunotherapy may vary depending on patients’ age/frailty level. Legal entity responsible for the study Hans Wildiers. Funding FWO. Disclosure All authors have declared no conflicts of interest.

365P - Measures of functional status in adults aged ≥70 years with advanced breast cancer (ABC) receiving palbociclib (PAL) combination therapy in POLARIS

BackgroundFew data are available on the treatment of ABC in older adults due to exclusion of this population from clinical trials. POLARIS is a real-world observational study in patients (pts) with hormone receptor–positive (HR+), human epidermal growth factor receptor 2–negative (HER2-) ABC receiving PAL in the United States (US) and Canada. This sub-group analysis evaluates outcomes in geriatric pts aged ≥70 years (y). MethodsBaseline (BL) demographics, clinical characteristics, dose modifications, ECOG performance status (PS), and adverse events (AEs) in the first 6 months (mo) were analyzed. Frailty and functional status were assessed with the Geriatric 8 (G8) and Activities of Daily Living (ADL) screening tools, respectively. G8 and ADL were captured at BL, monthly for the first 3mo, and every 3mo thereafter. G8 and ADL scores were stratified by severity (G8: ≤14=impaired; >14=normal; ADL: ≤5=impaired, >5=normal). Associations between treatment outcomes (ECOG PS, dose modifications, AEs) and G8 and ADL scores at BL and 6mo were analyzed with descriptive statistics and the Fisher-Freeman-Halton test. ResultsOf 860 pts enrolled at 114US sites, 282 (33%) were ≥70 y and had been observed for ≥6mo. At BL, 61% of this group had G8 scores ≤14, and 21% had ADL scores ≤5. At 6mo, 67% had G8 scores ≤14, 20% had ADL scores ≤5. BL G8 and ADL were associated with ECOG PS at BL and 6mo, ADL at 6mo was associated with ECOG PS at 6mo, and G8 at 6mo was marginally associated with ECOG PS at 6mo (Table). No association was seen between ECOG PS, ADL, or G8 scores and dose modifications or AEs. ConclusionsIn this subanalysis of geriatric pts from the ongoing POLARIS study associations were found between ECOG PS and frailty and functional status as assessed by G8 and ADL. G8 and ADL scores were generally maintained during the first 6mo of therapy, indicating functional status was preserved in this elderly population receiving PAL.Table365P Cross tabulations of ADL and G8 with ECOG PSTableBaseline ECOG PS=06mo ECOG PS=0# of pts with ECOG PS=0 / # pts with ADL or G8 score# of pts with ECOG PS=0 / # pts with ADL or G8 scoreADL ScoreBaseline≤512/526/20>583/19445/99(P<0.0001)(P=0.0012)6 month≤55/242/16>540/9536/80(P<0.0001)(P<0.0001)G8 ScoreBaseline≤1448/14925/74>1446/9523/40(P=0.0023)(P=0.0335)6 month≤1424/7620/62>1419/3818/32(P=0.0699)(P=0.0506)ADL=activities of daily living; ECOG=Eastern Cooperative Oncology Group; G8=Geriatric 8; PS=performance status. P value from the Fisher’s exact test on the association of either ADL (≤5, >5) or G8 (≤14, >14) with ECOG PS at the specified timepoint. ECOG PS=0 represents “fully active, able to carry on all pre-disease performance without restriction.” Clinical trial identificationNCT03280303. Editorial acknowledgementEditorial support was provided by Catherine Grillo of Complete Healthcare Communications, LLC (North Wales, PA), a CHC Group company, and was funded by Pfizer Inc. Legal entity responsible for the studyPfizer Inc. FundingPfizer Inc. DisclosureM.S. Karuturi: Advisory / Consultancy: Pfizer Inc. J.L. Blum: Advisory / Consultancy: Pfizer Inc. B. Telivala: Research grant / Funding (self): Cancer Specialists of North Florida. A. Bardia: Advisory / Consultancy: Novartis; Advisory / Consultancy: Pfizer Inc; Advisory / Consultancy: Spectrum Pharma. J.C. Cappelleri: Shareholder / Stockholder / Stock options, Full / Part-time employment: Pfizer Inc. E. Richardson: Full / Part-time employment: CPi Global CRO. Y. Wang: Shareholder / Stockholder / Stock options, Full / Part-time employment: Pfizer Inc. D. Tripathy: Advisory / Consultancy, Research grant / Funding (self): Novartis; Advisory / Consultancy, Research grant / Funding (self): Pfizer Inc. All other authors have declared no conflicts of interest.

Geriatric 8 can predict treatment outcomes of elderly patients with de novo AML who received low-dose chemotherapy

Abstract Background Geriatric assessments (GAs) used to evaluate various aspects in elderly patients have recently been introduced for their usefulness in predicting toxicities of cancer treatments and subsequent patient prognoses. Utilizing GAs to decide on treatment policies has been recommended. However, there are few reports on the relationship between Geriatric 8 (G8), a screening tool for GA, and treatment outcomes of elderly patients with de novo acute myeloid leukemia (AML) who received low-dose chemotherapy (LDC). Patients and Methods We reviewed 47 patients aged≥70 years who were newly diagnosed with de novo AML (except for acute promyelocytic leukemia) and received LDC as an initial treatment at our hospital between April 2012 and June 2018. We divided them into two groups (high: N = 11, low: N = 36) according to G8 scores (cutoff: 14 points) at the time of diagnosis and retrospectively analyzed the differences in clinical features and treatment outcomes. Results Statistically significant differences in age (median, 73 vs. 79 years, p = 0.009) were observed between the two groups. The proportions of sex, median white blood cell and bone marrow blast counts, and percentages of patients with unfavorable cytogenetic abnormalities did not differ significantly between groups. The most frequent initial LDC in both groups was low-dose cytarabine combined with acrarubicine. The complete remission rate and overall survival at two years were significantly higher in the G8 high-score group than those in the low-score group (72.7% vs. 19.4%; p = 0.002 and 55.6% vs. 11.0%; p Conclusion Our data suggest that G8 scores can predict treatment outcomes in elderly patients with de novo AML who received LDC.

Elderly patients affected by head and neck squamous cell carcinoma unfit for standard curative treatment: Is de-intensified, hypofractionated radiotherapy a feasible strategy?

ObjectivesThe aim of our work was to report on the clinical outcome of a moderately hyprofractionated radiotherapy regimen in elderly patients affected by head and neck squamous cell carcinoma (HNSCC). Material and methodsHNSCC aged ≥65 deemed unsuitable for curatively-intended concurrent chemo-radiotherapy or high-dose radiotherapy by clinical judgement were further evaluated with the Geriatric 8 (G8) questionnaire and Charlson comorbidity index (CCI). In case of a G8 score ≤14, a de-intensified radiation schedule of 40 Gy delivered in 16 fractions was prescribed. ResultsThirty-six patients were treated between 2011 and 2016. The median age of the cohort was 77.5 (range: 65–91 years) with a combined ECOG PS of 2–3 in 77.8% and CCI of ≥8 in 25% patients, respectively. At a median follow-up of 13 months (range 2–62 months), the 6-month and 1-year rates of loco-regional control and progression-free survival were 42%, 28% and 36% and 20%, respectively. At univariate analysis, log-rank test showed that age >75 years (p=0.036), worse PS (ECOG≥2; p=0.027), lower G8 score (<9; p=0.027) and PTV volume greater than 200 cc (p=0.038) had a significant correlation with PFS. The negative impact of the PTV volume on PFS was the only parameter confirmed in the multivariate analysis (HR 2.68; 95% CI: 1.24–5.81, p=0.013). No grade 4–5 toxicity was observed, while 13/36 patients (36%) had G3 acute side effects. ConclusionThe hypofractionated radiation schedule evaluated provides clinical benefit with low toxicity in frail, elderly patients affected by locally advanced HNSCC.

Prognostic Value of Geriatric 8 and Identification of Seniors at Risk for Hospitalized Patients Screening Tools for Patients With Lung Cancer

BackgroundBecause of the time-consuming aspect of geriatric assessments, cancer specialists are seeking shorter screening tools to distinguish fit and frail patients. We analyzed the predictive value of the Geriatric 8 (G8) and Identification of Seniors at Risk for Hospitalized Patients (ISAR-HP) in elderly patients with lung cancer. Patients and MethodsFrom January 2014 to April 2016, the data from patients with lung cancer aged > 70 years at 2 teaching hospitals in the Netherlands were included in a database. The patients were classified as potentially frail if they had a G8 of ≤ 14 or ISAR-HP of ≥ 2. ResultsOf the 142 included patients (median age, 77 years; interquartile range, 73-82 years), 108 (76%) were potentially frail. After correction for possible confounders, the potentially frail patients had a significantly greater risk of 1-year mortality (hazard ratio [HR], 4.08; 95% confidence interval [CI] 1.67-9.99; P = .02). Higher disease stage (HR, 1.72; 95% CI, 1.40-2.12; P < .001) was also a significant predictor of mortality; however, initial treatment (standard or otherwise) and age were not. When using both screening instruments separately, an impaired score on the G8 and higher disease stage were the variables remaining in the regression analyses (HR for impaired G8, 3.01; 95% CI, 1.35-6.72; P < .001). Patients with impaired scores on the ISAR-HP and G8 had more geriatric impairments than did patients with only an impaired G8 score. ConclusionG8 screening is useful for the prognostication of elderly patients with lung cancer and could be used in combination with ISAR-HP to increase specificity at the cost of sensitivity. Using the ISAR-HP as the only screening tool would be insufficient.

Timed Get Up and Go Test and Geriatric 8 Scores and the Association With (Chemo-)Radiation Therapy Noncompliance and Acute Toxicity in Elderly Cancer Patients

To investigate whether the Geriatric 8 (G8) and the Timed Get Up and Go Test (TGUGT) and clinical and demographic patient characteristics were associated with acute toxicity of radiation therapy and noncompliance in elderly cancer patients being irradiated with curative intent. Patients were eligible if aged ≥65years and diagnosed with breast, non-small cell lung, prostate, head and neck, rectal, or esophageal cancer, and were referred for curative radiation therapy. We recorded acute toxicity and noncompliance and identified potential predictors, including the G8 and TGUGT. We investigated 402 patients with a median age of 72years (range, 65-96years). According to the G8, 44.4% of the patients were frail. Toxicity grade ≥3 was observed in 22% of patients who were frail according to the G8 and 9.1% of patients who were not frail. The difference was 13% (confidence interval 5.2%-20%; P=.0006). According to the TGUGT 18.8% of the patients were frail; 21% of the frail according to the TGUGT developed toxicity grade ≥3, compared with 13% who were not frail. The difference was 7.3% (confidence interval -2.7% to 17%; P=.11). Overall compliance was 95%. Toxicity was most strongly associated with type of primary tumor, chemotherapy, age, and World Health Organization performance status. Compliance was associated with type of primary tumor and age. The usefulness of the TGUGT and G8 score in daily practice seems to be limited. Type of primary tumor, chemoradiotherapy, age, and World Health Organization performance status were more strongly associated with acute toxicity. Only chemoradiotherapy and age were associated with noncompliance. Overall the compliance was very high. To allow better-informed treatment decisions, a more accurate prediction of toxicity is desirable.

Geriatric assessment as a predictor of postoperative complications in elderly patients with hepatocellular carcinoma.

Older patients are considered to have increased risk for complications after major surgery, but age alone is not a reliable predictor of postoperative complications. However, no universal screening test adequately predicts postoperative complications in older patients. This prospective study recorded pertinent baseline geriatric assessment variables to identify risk factors for postoperative complications in hepatocellular carcinoma (HCC) for patients aged ≥70 years who undergo hepatectomy. We retrospectively analyzed 71 consecutive patients ≥70 years of age. Patients had geriatric assessments of baseline and later cognition, nutritional and functional status, and burden of comorbidities, completed preoperatively and at 1, 3, and 6 months postoperatively. Postoperative morbidities were recorded. Postoperative morbidities developed in 18 patients (25 %). Univariate analysis identified serum albumin, operating time and blood loss, cirrhosis, geriatric 8 (G8), and Mini Nutritional Assessment as possible risk factors for postoperative complications, but only G8 < 14 survived multivariate analysis as an independent predictor of complications. Our findings indicate that the G8 score, based on patients' nutritional assessments, is a useful screening method for older HCC patients who qualify for elective liver resection. Preoperative G8 scores can help forecast postoperative complications in older HCC patients. Future studies with larger numbers of patients, limited to HCC and liver resections, are needed to verify our results.

Validation of a screening tool in geriatric oncology: The Oncodage project

Assess the utility of the G8 screening tool and CGA for older adults with head and neck cancer.Patients 65 years or older with a primary malignancy of the head and neck region were presented at the multidisciplinary team (MDT) meeting. The Geriatric 8 (G8) questionnaire was administered prior. Clinicians, blinded to the G8 result, made a recommendation on appropriate treatment, including potential referral for CGA. Patients considered vulnerable (G8 score ≤ 14) were also to be referred for CGA. Treatment outcomes were recorded.Over 6 months, 35 patients were recruited, median age 74 (range 65–93). Seventeen (49%) patients were assessed as vulnerable by the G8 score, including 7 (20%) whom the MDT referred for CGA. Seven with G8 scores ≤ 14 did not receive a CGA. Thirty (85.7%) underwent curative intent treatment, including 6 of 7 who had CGA. Of 10 vulnerable patients who did not have CGA, 70% received curative-intent treatment. Mean length of post-operative stay was 12.2 vs. 6.5 days in patients deemed vulnerable or fit by G8 scores, respectively (p = 0.46); completion rate of radical radiotherapy was 75% vs. 100% in each group, respectively (p = 0.13). Mean post-operative length of stay in vulnerable patients who underwent a CGA was 6.2 days vs. 17.3 days in those who were not referred (p = 0.79).The G8 tool identified twice the number of patients as vulnerable compared to the MDT. There was a trend towards longer postoperative stay and lower radiotherapy completion rates in patients deemed vulnerable by G8 scores.