Geriatric Domains Research Articles

Geriatric assessment in daily oncology practice for nurses and allied health care professionals: Opinion paper of the Nursing and Allied Health Interest Group of the International Society of Geriatric Oncology (SIOG).

The management of older persons with cancer has become a major public health concern in developed countries because of the aging of the population and the steady increase in cancer incidence with advancing age. Nurses and allied health care professionals are challenged to address the needs of this growing population. The International Society of Geriatric Oncology (SIOG) Nursing and Allied Health (NAH) Interest Group described key issues that nurses and allied health care professionals face when caring for older persons with cancer. The domains of the Geriatric Assessment (GA) are used as a guiding framework. The following geriatric domains are described: demographic data and social support, functional status, cognition, mental health, nutritional status, fatigue, comorbidities, polypharmacy, and other geriatric syndromes (e.g. falls, delirium). In addition to these geriatric domains, quality of life (QoL) is described based on the overall importance in this particular population. Advice for integration of assessment of these geriatric domains into daily oncology practice is made. Research has mainly focused on the role of treating physicians but the involvement of nurses and allied health care professionals is crucial in the care of older persons with cancer through the GA process. The ability of nurses and allied health care professionals to perform this assessment requires specialized training and education beyond standard oncology knowledge.

Physical Performance Test and Karnofsky Performance Status are unable to identify elderly cancer patients requiring a Comprehensive Geriatric Assessment

BackgroundComprehensive geriatric assessment (CGA) is a multidimensional and interdisciplinary diagnostic process for medical and functional status (FS) used in elderly patients to evaluate health status. The Karnofsky Performance Scale (KPS) and Physical Performance Test (PPT) have been used as a measure of FS in older patients to screen heath status. ObjectiveWe designed this study to assess and compare the value of KPS and PPT as pre-screening tools for vulnerable elderly cancer patients using the CGA as a gold standard. MethodsThis is a prospective interventional study including cancer patients aged more than 70 years. Direct assessments were realized using a questionnaire composed of KPS, PPT and CGA, constructed by the authors after a review of the literature. ResultsOne hundred patients were included (median age 76 years–extremes 70–89). KPS and PPT were found to be positively correlated (Pearson correlation coefficient r = 0.680, P value < 0.001) with each other and negatively correlated with CGA with the former having a higher absolute r value (−0.779 vs −0.654 respectively, P < 0.05). All two had poor discrimination capacities when identifying patients having ≥2 impairments on the CGA, by means of a ROC curves analysis (area under the curve (AUC) for KPS = 0.206 versus 0.198 for PPT, with a P value > 0.05 on pair-wise comparison). ConclusionNeither KPS nor PPT were found to be good pre-screening tools for vulnerable elderly cancer patients in the outpatient setting. The CGA remains the preferred method for assessing alterations in geriatric domains.

Geriatric assessment of older patients with cancer in Australia--a multicentre audit.

The aim of this study is to determine the frequency of geriatric assessment in patients aged over 70 years in Australian medical oncology clinics. This was a multicentre audit in two parts: a retrospective file review of initial consultations with an oncologist and prospective audit of case presentations at multidisciplinary meetings (MDMs). Patients aged over 70 years presenting to a medical oncology clinic or being discussed at an MDM were eligible. Data was collected at six oncology centres in Victoria, NSW and Canberra from October 2009 to March 2010. Data was collected from 251 file reviews and 108 MDM discussions in a total of 304 patients. Median age was 76 years (range 70-95). The geriatric assessment (GA) domains most frequently assessed during an initial consultation were the presence of comorbidities (92%), social situation-living alone or with someone (80%), social supports (63%), any mention of at least one Activity of Daily Living (ADL) (50%) and performance status (49%). Less frequently assessed were any Instrumental Activity of Daily Living (IADL) (26%), presence of a geriatric syndrome (24%), polypharmacy (29%) and creatinine clearance (11%). Only one patient had all components of ADLs and IADLs assessed. During MDMs all the geriatric domains were comparatively less frequently assessed. No patients had all ADL and IADL components discussed formally in an MDM. This is the first multicentre audit that reveals the low rates of GA in Australian medical oncology practice and describes the GA domains considered important by oncology clinicians.

Developing a comprehensive cancer specific geriatric assessment tool.

Population aging is one of the most distinctive demographic events of this century. United Nations projections suggest that the number of older persons is expected to increase by more than double from 841 million in 2013 to >2 billion by 2050. It is estimated that 60% of the elderly patients may be affected by cancer and may present in the advanced stage. The aim of this paper was to develop a brief cancer-specific comprehensive geriatric assessment tool for use in a geriatric population with advanced cancer that would identify the various medical, psychosocial, and functional issues in the older person. Literature on assessment of geriatric needs in an oncology setting was reviewed such that validated tools on specific domains were identified and utilized. The domains addressed were socioeconomic, physical symptoms, comorbidity, functional status, psychological status, social support, cognition, nutritional status and spiritual issues. Validated tools identified were Kuppuswamy scale (socioeconomic), Edmonton Symptom Assessment Scale (Physical symptoms) and SAKK cancer-specific geriatric assessment tool, which included six standard geriatric measures covering five geriatric domains (comorbidity, functional status, psychological status, social support, cognition, nutritional status). The individual measures were brief, reliable, and valid and could be administered by the interviewer. The tool was developed for use under the geriatric palliative care project of the department of palliative medicine at Tata Memorial Hospital, Mumbai. We plan to test the feasibility of the tool in our palliative care set-up, conduct a needs assessment study and based on the needs assessment outcome institute a comprehensive geriatric palliative care project and reassess outcomes.

Optimal screening for increased risk for adverse outcomes in hospitalised older adults.

Background: screening for frailty might help to prevent adverse outcomes in hospitalised older adults.Objective: to identify the most predictive and efficient screening tool for frailty.Design and setting: two consecutive observational prospective cohorts in four hospitals in the Netherlands.Subjects: patients aged ≥70 years, electively or acutely hospitalised for ≥2 days.Methods: screening instruments included in the Dutch Safety Management Programme [VeiligheidsManagementSysteem (VMS)] on four geriatric domains (ADL, falls, undernutrition and delirium) were used and the Identification of Seniors At Risk, the 6-item Cognitive Impairment Test and the Mini-Mental State Examination were assessed. Three months later, adverse outcomes including functional decline, high-healthcare demand or death were determined. Correlation and regression tree analyses were performed and predictive capacities were assessed.Results: follow-up data were available of 883 patients. All screening instruments were similarly predictive for adverse outcome (predictive power 0.58–0.66), but the percentage of positively screened patients (13–72%), sensitivity (24–89%) and specificity (35–91%) highly differed. The strongest predictive model for frailty was scoring positive on ≥3 VMS domains if aged 70–80 years; or being aged ≥80 years and scoring positive on ≥1 VMS domains. This tool classified 34% of the patients as frail with a sensitivity of 68% and a specificity of 74%. Comparable results were found in the validation cohort.Conclusions: the VMS-tool plus age (VMS+) offers an efficient instrument to identify frail hospitalised older adults at risk for adverse outcome. In clinical practice, it is important to weigh costs and benefits of screening given the rather low-predictive power of screening instruments.

Pharmacological treatment of diabetes in older people.

The pharmacological management of diabetes in older people is complex and challenging. It requires a comprehensive understanding of the individual beyond the diabetes itself. Through the ageing years, the older individual presents with diabetes-related and non-related comorbidities and complications, develops functional limitations and psychological issues, and may lack social support and access to care. A disturbance in these categories, known as the four geriatric domains, will negatively affect diabetes self-management and self-efficacy, leading to poor outcomes and complications. Furthermore, older people with diabetes may be more interested in the management of other chronic conditions such as pain or impaired mobility, and diabetes may be lower in their list of priorities. Proper education must be provided to the older individual and caregivers, with continuous monitoring and counselling, especially when pharmacological interventions offer risks of side effects, adverse reactions and interactions with other medications. Informed shared medical decisions will help to improve adherence to the regimen; however, such discussions ought to be based on the best evidence available, which is unfortunately limited in this age group. We performed a review focused on pharmacological agents and summarize current evidence on their use for the treatment of diabetes in older people. We encourage clinicians to investigate and incorporate the four geriatrics domains in the selection and monitoring of these agents.

Models of Care in Geriatric Oncology.

Cancer is common in older adults and the approach to cancer treatment and supportive measures in this age group is continuously evolving. Incorporating geriatric assessment (GA) into the care of the older patient with cancer has been shown to be feasible and predictive of outcomes, and there are unique aspects of the traditional geriatric domains that can be considered in this population. Geriatric assessment-guided interventions can also be developed to support patients during their treatment course. There are several existing models of incorporating geriatrics into oncology care, including a consultative geriatric assessment, geriatrician "embedded" within an oncology clinic and primary management by a dual-trained geriatric oncologist. Although a geriatrician or geriatric oncologist leads the geriatric assessment, is it truly a multidisciplinary assessment, and often includes evaluation by a physical therapist, occupational therapist, pharmacist, social worker and nutritionist.

The discussion of age and geriatric assessment domains in oncology consultations

problem. Unfortunately, elderly cancer patients are under-represented in clinical trials for new cancer therapies. Chronological age itself is less important than biological events in driving the aging process within an individual. There is no simple way to assess biological age, and the best tool available to date is a Comprehensive Geriatric Assessment, however it is time consuming. For this reason, alternative screening tools are being evaluated Objectives: Two proposed screening tools; the Vulnerable Elders Survey-13 (VES-13) and the G8 were compared, to identify vulnerable patients who could avoid severe toxicities if offered best supportive care. Methods: All patients aged ≥60 years attending Alexandria Clinical Oncology Department between October 2011 and March 2012 were classified into two groups; group A included patients b70 years while group B included patients N70 years and were assessed with VES-13 and G8 before starting treatment, using the translated Arabic versions for both scoring systems. Receiver operating characteristics (ROC)-analysis was used to determine the diagnostic performance of both screening instruments taking into consideration the occurrence of severe toxicities as the outcome endpoint. Decision analysis tree was plotted for the two groups. Results: 138 patients were recruited, of which 39.9% and 46.4% were defined vulnerable when evaluated with VES-13 and G8 respectively. The areas under the ROC-curves of VES-13 (0.857) and G8 (0.4451) were significantly different (P b 0.001). A sensitivity and specificity of respectively 84% and 73.3% for VES-13 (cut-off ≥3) and 68% and 36.6% for G8 (cut-off ≤14) were obtained. The optimal cut-off score of 4 for VES-13 resulted in a sensitivity of 80% and a specificity of 80%, while 10 for G8 resulted in a sensitivity of 28% and a specificity of 86.6%. The difference between G8 and VES-13 in the decision analysis was not large but VES-13 showed superiority. The decision pathway of the highest utility outcome was using VES-13 for screening and treating ‘Fit’ patients. Vulnerable patients would avoid severe complications or inadequate treatment when offered best supportive care, until a tailored tolerable effective protocol is available. TestingVES-13 ‘Vulnerable’ patientswithG8 did not add significantly to the outcome. The utility outcome for both VES-13 and G-8 scoring systems did not differ whether the cutoff scores used were those proposed in literature or the newly proposed ones. Conclusion: VES-13 screening tool showed superiority over G-8 scoring system as regards sensitivity, specificity, accuracy and also utility outcome when taking into consideration the occurrence of severe toxicity as the outcome endpoint. To the time being, the patient who becomes vulnerable by VES-13 would be better offered best supportive care or a tailored tolerable effective protocol within the context of a prospective randomized trial. Disclosure of interest: None declared.

The relevance of a geriatric assessment for elderly patients with a haematological malignancy – A systematic review

Geriatric assessment is increasingly used to assess the health status of older cancer patients. We set out to assemble all available evidence on the relevance of a geriatric assessment in the treatment of older patients with haematological malignancies. A systematic Medline and Embase search for studies in which a geriatric assessment was used to detect health issues or to address the association between baseline geriatric assessment and outcome. 18 publications from 15 studies were included. The median age of patients was 73 years (range 58-86). Despite generally good performance status, the prevalence of geriatric impairments was high. Geriatric impairments were associated with a shorter overall survival in a relevant proportion of studies (instrumental activities 55%, nutritional status 67%, cognitive capacities 83%, objectively measured physical capacity 100%). Comorbidity, physical capacity and nutritional status retained their significance even in multivariate analyses in 50%, 75%, and 67% of analyses respectively, whereas age and performance status lost their predictive value in most studies. One study found an association between comorbidity and chemotherapy-related non-haematological toxicity. In another study a pronounced association between summarised outcome of geriatric assessment and chemotherapy-related toxicity as well as response to treatment was described. This review demonstrates that a geriatric assessment can detect multiple health issues, even in patients with good performance status. Impairments in geriatric domains have predictive value for mortality and also appear to be associated with toxicity and other outcome measures and should thus be integrated in individualised treatment algorithms.

The G8 Screening Tool Detects Relevant Geriatric Impairments and Predicts Survival In Elderly Blood Cancer Patients

IntroductionHaematological neoplasias in elderly represent a major challenge, as median age at diagnosis is 70+ years in frequent and clinically relevant diseases such as acute myeloid leukaemia (AML), multiple myeloma or chronic lymphocytic leukaemia (CLL). Thus, algorithms for individualised treatment of elderly are urgently needed. The G8 screening tool was developed to separate fit older cancer patients able to receive standard treatment from those that should undergo a geriatric assessment to guide tailoring of therapy. In this study the discriminative power and prognostic relevance of G8 in a well-defined cohort of elderly patients with a haematological malignancy was analysed. MethodsBetween September 2009 and May 2013, in 108 consecutive patients aged ≥67 years diagnosed with blood cancer at the Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University a multi-dimensional geriatric assessment (MGA) was performed. The most frequent entities included were AML (29%), myelodysplastic syndromes (23%) and aggressive or indolent Non-Hodgkin lymphomas (29 and 12%, respectively). MGA assessed the dimensions (instrumental) activities of daily living (ADL/iADL), cognition, mood, nutritional status, mobility, polypharmacy and social support. The G8-scoring was administered in parallel, using a cut-off ≤14. The discriminative power of the G8 for detecting the presence of an impaired geriatric assessment (defined as impairments in ≥2 geriatric domains) was calculated from a 2x2 table. For comparisons between patients with a normal G8 score and those with an impaired G8, the chi-square test and risk analysis were used for nominal and ordinal variables, as well as for continuous variables with a non-normal distribution; for continuous variables with a normal distribution, the Student t-test was used. The impact of variables on mortality was evaluated by uni- and multivariate Cox-regression analyses. ResultsPrevalance of geriatric conditions in haematological malignancies was high. Applying a cut-off ≥2 impaired domains, 70% of patients were scored as being impaired. Domains most often involved were iADL (iADL ≤6: 45%), polypharmacy (≥5 medications: 65%) and malnutrition (BMI ≤18kg/m2 and/or weight loss ≥1kg in last 3 months: 45%). An impaired G8 was observed in 61% of cases and revealed a significant correlation with MGA (cc=-0.624; p <0.001). However, the G8 lacked discriminative power for impairments on MGA, with a sensitivity of 69%, a specificity of 79%, a negative predictive value of 50% and a positive predictive value of 89%. One-year mortality was correlated with diagnosis of AML (hazard ratio (HR) 1.24, 95%-confidence interval (CI) 1.06-1.44; p=0.01)), impaired mobility (timed up and go test ≥12 seconds) (3.20 (1.26-8.14); p=0.02) and risk of malnutrition (1.31 (1.07-1.37); p=0.01) in uni- and in multivariate analyses. Remarkably, G8 was an independent predictor of mortality within the first year after inclusion, displaying a HR of 3.93 (95%-CI 1.67-9.22; p=0.002). ConclusionThis is the first report on the clinical and prognostic relevance of G8 in a well-defined cohort of elderly patients with a haematological malignancy. Clinical relevant restrictions were identified in a substantial proportion of patients. Due to the high prevalence of geriatric impairments, the G8 lacked discriminative power. However, G8 appears to be a powerful prognosticator and might thus represent a useful tool in treatment decisions. This novel finding certainly deserves further exploration. Disclosures:No relevant conflicts of interest to declare.

Geriatric assessment domains and age: How are these discussed in cancer multidisciplinary meetings?

Geriatric assessment domains and age: How are these discussed in cancer multidisciplinary meetings?

A prospective study examining PROs and other geriatric outcomes in older adults with prostate cancer undergoing chemotherapy.

9555 Background: Treatment of metastatic castration-resistant prostate cancer (mCRPC) with chemotherapy improves disease control and survival in older men (age 65+) based on large clinical trials. Its effects, though, on more frail elderly men are not well understood and chemotherapy may negatively impact frailty, daily function, physical performance, and quality of life (QOL), particularly outside the clinical trial setting. Methods: Men aged 65+ with mCRPC starting first-line chemotherapy were enrolled in this prospective observational pilot study. Physical function was assessed with the timed up and go (TUG) test, timed chair stands, and grip strength. Frailty was evaluated using the Vulnerable Elders Survey (VES-13) questionnaire in addition to functional status (OARS-IADL), social activities limitations and social support (MOS measures). Patients completed the FACT-P and FACT-G to measure prostate-specific QOL and general QOL, respectively. Assessments were completed before each cycle of chemotherapy. Pre-post within-group comparisons were done using student’s T-tests and linear regression. Results: 25 patients (mean age 75) receiving Docetaxel + Prednisone were enrolled, 3 of whom died and 2 dropped out. Both general and prostate-specific QOL improved over a median of 6 cycles. Patients’ instrumental activities of daily living (IADL) scores remained stable. On average, grip strength was stable and lower extremity function improved on both the TUG and Timed Chair Stands. At baseline, 13 of 25 patients (52%) were frail (VES score 3+). Of the patients that completed chemotherapy, 40% were frail. Conclusions: Contrary to our hypotheses, QOL did not decline in this frail elderly cohort, IADL function remained stable, and physical function remained stable or improved during first-line chemotherapy. Frailty also did not increase at the end of treatment as hypothesized. Older men with mCRPC appear to tolerate first-line chemotherapy fairly well in terms of QOL and geriatric domains.

Prospective Cohort Study of Geriatric Assessment in Older Patients with Acute Myeloid Leukemia

Abstract 4285 Background:The prognostic value of geriatric assessment variables in older adults with acute myelogenous leukemia (AML) is not known. Objective:To determine the relation between baseline geriatric assessment and survival in older patients with AML. Methods:We aimed to prospectively enroll all consecutive patients with AML ≥ 65 years of age who presented to Dana-Farber Cancer Institute between 2006–2011. Patients completed the EORTC-30 quality of life questionnaire at their initial visit, prior to receiving chemotherapy. We evaluated questions corresponding to geriatric domains including physical, social and cognitive functions, psychological state, nutrition and pain. We extracted patient demographics and clinico-pathologic data from medical records. Baseline Comorbidity score was calculated using the Hematopoietic Stem Cell Transplant Comorbidity Index (HCT-CI). We used Kaplan-Meier and Cox proportional hazards models to estimate survival. Results:101 patients with AML ≥ 65 consented to be followed and were available for analysis. Median age was 72 years (range: 65–90) and most patients were white (98%), male (62%) and had a performance status of 1 or less (79%). Only 38% of patients had more than one comorbidity, and only 3 patients required help with activities of daily living. The majority of patients (78%) received treatment. Of those treated, 45% underwent induction chemotherapy and 44% received decitabine or azacitidine. The one-year overall survival of the group was 37.4 % ±5.0% and the one-year disease-specific survival (DSS) was 39.0 % ±5.1%. Survival varied substantially based on treatment type (Figure 1). Self-reported difficulty with strenuous activity (Figure 2) and presence of pain were associated with decreased survival. On multivariate analysis, age at diagnosis >72 years vs. ≤ 72 years (Hazard Ratio [HR]=1.75; 95%CI 1.05 to 2.91), cytogenetic risk group (adverse vs. intermediate and favorable); HR=1.99; 95% CI 1.21 to 3.26), secondary vs. de novo AML (HR=1.61; 95% CI 1.00 to 2.62), comorbidity score >1 vs. ≤1 (HR=1.84; 95%CI 1.10 to 3.07), more vs. less difficulty with strenuous activity (HR=1.74; 95%CI 1.05 to 2.89), and pain more vs. less often (HR=2.16; 95% CI 1.17 to 3.98) were independent prognostic factors for worse survival. When we limited the analysis to the 80 patients with ECOG PS ≤1, difficulty with strenuous activities, pain, and comorbidity remained independent predictors for survival. Conclusions:In this highly selected population of older patients with AML, we found that geriatric assessment variables were independent prognostic factors for survival, even among patients with the best performance status. Our results support the use of geriatric assessment to more accurately predict prognosis in the older AML patient population. [Display omitted] [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Geriatric Assessment Variables Add Prognostic Value to the International Prognostic Scoring System

AbstractAbstract 4933 Background:Existing risk assessment systems for MDS such as the International Prognostic Scoring System (IPSS) do not include information on geriatric assessment domains.Objective: To determine whether baseline geriatric assessment variables add important prognostic information to the IPSS in a cohort of older patients with MDS.Methods: We aimed to prospectively enroll all consecutive patients with MDS ≥ 65 years of age who presented to Dana-Farber Cancer Institute between 2006 and 2011. All patients completed the EORTC QLQ C-30 quality of life questionnaire at their initial visit. We evaluated questions corresponding to geriatric domains including physical, social and cognitive functions, psychological state, nutrition and pain. We extracted patient demographics and clinico-pathologic data from medical records. Baseline comorbidity score was calculated using the Charlson Comorbidity Index. We used Kaplan-Meier and Cox proportional hazards models to estimate survival. Variables associated with mortality on univariate tests of significance were included in the multivariate model. We used a stepwise selection process to find the model that best predicted mortality.Results: 114 patients with MDS ≥ 65 consented to be followed and were available for analysis. The median age at diagnosis was 72. 5 years. The majority of patients were white (94. 8%), male (62. 4%) and had at least one household member (88. 2%) with whom they resided. 30% of patients had a body mass index > 30 kg/m2 and 91% had and albumin level > 3. 5 g/dL. Nearly 40% of patients had a Charlson score of 0, 16. 7% had a score of 1, 26. 3% had a score of 2 and 19. 3% had a score of 3 or greater. Only 23. 9% had an IPSS score consistent with low risk disease, while 71. 7% had intermediate and 4. 4% had high risk scores. 56 patients (49%) were initially treated with low dose chemotherapy (azacitidine or decitabine), 7% with induction chemotherapy, and 32% with experimental or other therapies. 11% of patients underwent a BMT, and 25% of these maintained complete remission (3 patients).The median survival of the cohort was 25 months. The strongest univariate predictor of overall survival was low serum albumin followed by history of chemotherapy or radiation, IPSS score, Charlson score, and questions on the ability to tolerate a long walk and whether physical symptoms or treatment had interfered with family life (Table 1). Age was not a significant predictor of mortality in this cohort. The multivariate model that best predicted survival included serum albumin, history of previous chemotherapy or radiation, IPSS score, and ability to take a long walk (Table 2).Conclusions: In this study of highly selected older adults with MDS, we found that markers of nutritional status and self-reported physical function added important prognostic information to the IPSS score. Our findings suggest the utility of developing comprehensive risk assessment tools for older patients with MDS that include geriatric as well as genetic and disease-specific domains.Table 1:Univariate Predictors of SurvivalVariableHazard Ratio (HR)95% CILow serum albumin (<3.5 g/dL)2.631.28, 5.41Previous chemotherapy or radiation2.061.10, 3.84IPSS score1.711.22, 2.40Charlson Comorbidity Index1.201.03, 1.38No impact of physical condition or medical treatment on family life0.570.34, 0.94No difficulty taking a long walk0.400.20, 0.79Table 2:Final Multivariate Model of SurvivalVariableHazard Ratio (HR)95% CILow serum albumin (<3.5 g/dL)2.292.29, 5.04Previous chemotherapy or radiation2.141.12, 4.09IPSS score1.651.12, 2.44No difficulty taking a long walk0.440.22, 0.88 Disclosures:No relevant conflicts of interest to declare.

The Feasibility of Inpatient Geriatric Assessment for Older Adults Receiving Induction Chemotherapy for Acute Myelogenous Leukemia

To test the feasibility and utility of a bedside geriatric assessment (GA) to detect impairment in multiple geriatric domains in older adults initiating chemotherapy for acute myelogenous leukemia (AML). Prospective observational cohort study. Single academic institution. Individuals aged 60 and older with newly diagnosed AML and planned chemotherapy. Bedside GA was performed during inpatient exmination for AML. GA measures included the modified Mini-Mental State Examination; Center for Epidemiologic Studies Depression Scale; Distress Thermometer, Pepper Assessment Tool for Disability (includes self- reported activities of daily living (ADLs), instrumental ADLs, and mobility questions); Short Physical Performance Battery (includes timed 4-m walk, chair stands, standing balance); grip strength, and Hematopoietic Cell Transplantation Comorbidity Index. Of 54 participants (mean age 70.8±6.4) eligible for this analysis, 92.6% completed the entire GA battery (mean time 44.0±14minutes). The following impairments were detected: cognitive impairment, 31.5%; depression, 38.9%; distress, 53.7%; impairment in ADLs, 48.2%; impaired physical performance, 53.7%; and comorbidity, 46.3%. Most were impaired in one (92.6%) or more (63%) functional domains. For the 38 participants rated as having good performance status according to standard oncologic assessment (Eastern Cooperative Oncology Performance Scale score ≤1), impairments in individual GA measures ranged from 23.7% to 50%. Significant variability in cognitive, emotional, and physical status was detected even after stratification according to tumor biology (cytogenetic risk group classification). Inpatient GA was feasible and added new information to standard oncology assessment, which may be important for stratifying therapeutic risk in older adults with AML.

Management of Elderly Patients with Advanced Infiltrating and Metastatic Bladder Cancer: An Oncogeriatric Approach

Bladder cancer is the fourth most common cancer in men older than 70 years. Muscle-infiltrating tumors can be cured by radical cystectomy but are associated with poor prognosis. Metastatic disease is not curable. The purpose of this article is to critically review the knowledge available on bladder cancers in elderly patients. We reviewed the recent literature on bladder cancer in the elderly, as well as updated concepts in geriatric oncology. The oncogeriatric setting was specifically explored. There is a large and growing body of research literature on infiltrating bladder cancers. Nevertheless only age and, in some instances, comorbidities are analyzed, whereas the different geriatric domains are generally overlooked. Whereas it is possible to draw conclusions on incidence, medical practice and complications of radical cystectomy in elderly patients, none of these allow a clear decision-making strategy to be defined. In metastatic disease, only a few articles have addressed the question of the specific management of elderly patients, principally because this population is considered to be unfit for cisplatin-based chemotherapy. None of the specific oncogeriatric domains has been extensively studied. Specific prospective studies should be designed to explore oncogeriatric domains, for example dependence, nutrition, cognition, thymic evaluation, comorbidities, polypharmacy and psychosocial evaluation. In infiltrating bladder cancer, these studies should be based on prospectively followed patient cohorts. In metastatic disease, specific prospective trials involving geriatric screening and/or comprehensive geriatric assessment are needed.

Inpatient Geriatric Assessment Detects Impairment Among Older Adults Receiving Induction Chemotherapy for Acute Myelogenous Leukemia.

Abstract 1401Poster Board I-423 Background:Acute myelogenous leukemia (AML) is a disease which largely affects older adults, for whom optimal therapy is unclear. Evidence-based strategies to identify those older adults who may tolerate and benefit from standard therapies are lacking. Objective:Test the utility of a bedside geriatric assessment (GA) to detect impairment in multiple geriatric domains among older adults initiating induction chemotherapy for AML. Methods:Ongoing prospective study of patients ≥60 years of age with newly diagnosed AML and planned induction chemotherapy admitted to Wake Forest University. Bedside geriatric assessment (GA) was performed during inpatient work-up for AML. GA measures included the Modified Mini-Mental Status Exam (3MS), Center for Epidemiologic Studies Depression Scale (CES-D), Distress thermometer, Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), Pepper Assessment Tool for Disability ([PAT-D], includes self- reported activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility questions), Short Physical Performance Battery ([SPPB], includes timed 4-meter walk, chair stands, standing balance), and grip strength. Results:26 of 29 eligible patients enrolled between 1/2009 and 8/2009. The median age was 68 (range 60-82) years, and 42.3% were female. Prior myelodysplastic syndrome was present in 34.6%, with intermediate or poor-risk cytogenetics in 95.6%. Baseline laboratory measures included white blood cell count (mean 17.3×103/mm3, SD 25.0×103), hemoglobin (mean 9.2g/dl, SD 1.5), lactate dehydrogenase (mean 282.4 U/L, SD 168.8). Mean baseline GA scores included: 3MS 83.0 (SD 14.7), CES-D 9.4 (SD 9.3), Distress 3.8 (SD 3.4), HCT-CI 1.3 (SD 1.6), PAT-D 1.4 (SD 0.7), SPPB 7.1 (SD 3.9), grip strength 32.4 kilograms (SD 9.2). Although 84.6% of subjects had an Eastern Cooperative Oncology Group (ECOG) Performance score <2, a substantial proportion met criteria for impairment in multiple geriatric domains.Characteristic% impairedPoor performance status (ECOG≥2)15.4Comorbidity (HCT-CI score >1)38.5Impairment in instrumental activities of daily living (IADL)34.6Impairment in objective physical function (SPPB<9)60.0Cognitive impairment (3MS<77)15.4Depression (CES-D ≥16)23.1Distress (score ≥4)50.0 Conclusions:GA measures detect abnormalities which are not adequately reflected by the ECOG performance score in older adults with AML. Future analyses from this ongoing study will evaluate whether these abnormalities are independently associated with treatment-related morbidity and survival. Disclosures:No relevant conflicts of interest to declare.

Geriatric Assessment (GA) May Identify Vulnerable Older Allogeneic Hematopoietic Cell Transplantation (HCT) Recipients

Comorbidity indices and performance status (PS) have been the primary tools used to predict HCT tolerance; however, these tools suffer from poor discriminative capacity. Geriatric Assessment (GA) has found widespread application to assess reduced physiologic reserve (i.e. vulnerability) among elderly adults. We hypothesized that a modified GA would identify vulnerable HCT recipients 50 years and older. We supplemented the standard pre-HCT evaluation (e.g. history, laboratory, PFT's) with a prospective GA integrating multiple geriatric domains.

Older breast cancer survivors: Geriatric assessment domains predicting mortality and tolerance of treatment side-effects

Older breast cancer survivors: Geriatric assessment domains predicting mortality and tolerance of treatment side-effects

Minimum geriatric screening tools to detect common geriatric problems.

Health services for the elderly are becoming increasingly important in industrialized nations, and comprehensive geriatric assessment (CGA) is one of the procedures designed to improve the health of this sector of the population. In 2003 a survey among Belgian geriatricians showed that despite the interest of the geriatric teams for comprehensive geriatric assessment, it was not used enough. Considering these results, as a first step, screening tools were proposed for the main geriatric domains (Minimum Geriatric Screening Tools, MGST). To assess the feasibility of a MGST within the teams of geriatric units and to evaluate the efficacy of a MGST on the detection rate of the geriatric problems of admitted subjects. Prospective observational survey. The teams were first asked to encode active geriatric problems suspected according to their conventional assessment. Then, in a second phase, a complete MGST was completed by the same team within the first week after admission. Three hundred and twenty six registrations from 33 centres were available. Mean (+/- SD) number of screened geriatric problems was 1.5 +/- 1.2 without MGST and 4.7 +/- 1.7 (p < 0.0001) using the MGST. Except for the assessment for the risk of falls, the MGST leads to a better screening for the seven other main geriatric domains (functional, continence, cognition, depression, nutrition, pain, social). An improvement associated with the use of simple minimal geriatric tools to screen geriatric problems was evident. This approach has additional value for education and quality assurance.