Geriatric Oncology Clinic Research Articles

Beyond the black box of geriatric assessment: Understanding enhancements to care by the geriatric oncology clinic.

Comprehensive geriatric assessment (CGA) of older adults with cancer aids treatment decision-making and prognostication. Much less is known about the supportive care elements or enhancements to care afforded by the CGA. We characterized the enhancements to care provided by a geriatric oncology clinic and determined how these vary by indication for referral. All patients age 65 or older referred to a single academic geriatric oncology clinic between July 2015 (clinic opening) and June 2017 were included. Treatment enhancements were prospectively recorded in 5 categories: educational support, comorbidity management, symptom management, oncologic treatment delivery, and peri-operative management recommendations. Indications for referral were categorized into 3 groups: pre-treatment (n = 97, 44%), on active treatment (n = 89, 41%), and survivorship phase (n = 33, 15%). Data were analyzed using descriptive statistics and multivariable logistic regression. 219 patients were seen during the study period (mean age 79.7 years, 69% male). Overall, educational support (96%) and comorbidity management (95%) were the most common enhancements, whereas peri-operative management (10%) was the least common and provided only to pre-treatment patients. Enhancements to cancer treatment delivery were offered more often to patients pre-treatment than on active treatment (61% versus 41%, p < 0.001). Other enhancements to care did not vary by indication for referral. Educational support and comorbidity management are nearly universally offered. Most enhancements to care do not vary by indication for referral. Understanding the enhancements to care provided by geriatric oncology clinics can help with resource planning and program design.

Impact of a geriatric oncology (GO) clinic on cancer treatment plans and supportive care for older adults with genitourinary (GU) cancer.

238 Background: Older adults with cancer are complex due to multiple comorbidities, polypharmacy, and functional/cognitive impairments, leading to over-treatment and undertreatment. Studies examining the impact of geriatric assessment (GA) in older adults with various cancers found a median of 39% of treatment plans were revised after the GA ( Ann Oncol 2014; 25:307). Although these findings support the need for a GO clinic, whether such a clinic leads to changes in treatment in patients with GU malignancies is not clear. We examined the impact on the treatment plan of a GO assessment in GU patients, along with other enhancements to patient care for consecutive patients referred to the GO clinic in a tertiary care hospital. Methods: All referred older adults (age 65+) with a GU malignancy seen in the GO clinic at the Princess Margaret Cancer Centre, Toronto, Canada between July 2015 and June 2017 were included. Patients were seen by a geriatric oncologist and GO nurse and treatment recommendations were provided to the referring oncologist. Pre- and post-GO clinic treatment plans and enhancements to supportive care were recorded prospectively. Analyses were descriptive. Results: 98 patients (mean age 80) were seen in the GO clinic, of whom 35 were seen pre-treatment (25 prostate, 5 kidney, 5 bladder). 31 of 35 were referred for input on the treatment plan. The initial treatment plan included surgery (n = 6), radiation (n = 14), systemic therapy (n = 8), and hormonal therapy (n = 11). The final treatment plan was intensified in 1 patient, reduced in 6 patients, changed to best supportive care in 8 patients, and unchanged in 15 patients. Overall, GO resulted in a treatment modification in 52% of patients. Enhancements to care included comorbidity management (87%), educational support (94%), disease-related symptoms (39%), and peri-operative management (19%). Conclusions: The GO clinic results in modifications to the proposed treatment plan in over half of referred patients (predominantly a reduction in treatment intensity), and enhancements to care in the vast majority of patients. GO clinics have the potential to avoid overtreatment and improve care for older adults with GU malignancies.

Hematology-Oncology Fellows' Training in Geriatrics and Geriatric Oncology: Findings From an American Society of Clinical Oncology-Sponsored National Survey.

Older adults compose the majority of patients with cancer in the United States; however, it is unclear how well geriatrics or geriatric oncology training is being incorporated into hematology-oncology (hem-onc) fellowships. A convenience sample of hem-onc fellows completed a (written or electronic) survey assessing their education, clinical experiences, and perceived proficiency in geriatric oncology during training; knowledge base in geriatric oncology; confidence in managing older adults with cancer; and general attitudes toward geriatric oncology principles. Forty-five percent of respondents (N = 138) were female, 67% were based in the United States, and most (60%) were past their first year of training. Most fellows rated geriatric oncology as important or very important (84%); however, only 25% reported having access to a geriatric oncology clinic and more than one half (53%) reported no lectures in geriatric oncology. Fellows reported fewer educational experiences in geriatric oncology than in nongeriatric oncology. For example, among procedure-based activities, 12% learned how to perform a geriatric assessment but 78% learned how to perform a bone marrow biopsy ( P < .05). Of those completing the knowledge-based items, 41% were able to identify correctly the predictors of chemotherapy toxicity in older adults with cancer. Despite the prevalence of cancer in older adults, hem-onc fellows report limited education in or exposure to geriatric oncology. The high value fellows place on geriatric oncology suggests that they would be receptive to additional training in this area.

Prognostic value of the G8 and modified-G8 screening tools for multidimensional health problems in older patients with cancer

BackgroundThe G8 screening tool has been developed to identify older cancer patients requiring a geriatric assessment for tailoring therapy. Little is known about its prognostic value, particularly by tumour site. An optimised version has been recently developed, but no prognostic information is available. We compared the prognostic value of both instruments overall and by tumour site. MethodsData were from a prospective cohort of cancer patients ≥70 years old referred to 1 of 6 French geriatric oncology clinics between 2007 and 2014 (n = 1333). Endpoints were overall 1- and 3-year survival. Cox proportional-hazards models were built to assess the predictive value of abnormal G8 and modified-G8 scores, based on published cut-offs or by classes of increasing risk. Sensitivity analyses involved adjusting for age, gender, treatment, metastasis, and tumour site (digestive, breast, urinary tract, prostate, other solid cancers, and haematological malignancies) and stratifying by tumour site and metastatic status. ResultsAbnormal scores were independently associated with overall 1-year survival: adjusted hazard ratio [aHR] = 4.3[G8]/4.9[modified-G8] and 3-year survival: aHR = 2.9/2.6; all p <0.0001. Associations persisted after stratifying by metastatic status and in most cancer sites (exceptions: colorectal (G8) and upper digestive cancer (both tools) [1-year analysis]; digestive cancers (both tools) [3-year analysis]). For both tools, classes of increasing risk showed a graded relationship with mortality (p < 0.0001). ConclusionsOur results identified both abnormal G8 and modified-G8 scores as strong and consistent predictors of overall survival, regardless of metastatic status or tumour site. These findings strengthen the clinical utility of these instruments in the geriatric oncology setting.

A joint geriatric oncology clinic for the management of elderly women diagnosed with breast cancer: The Brighton experience

Introduction: 30% of diagnosis of breast cancer occurs in women aged over 70 years.

Development and implementation of a multidisciplinary geriatric oncology (GO) clinic in Mexico.

e21519Background: Cancer is an age related disease, and the number of older cancer patients will rise dramatically in the next decades. This will be proportionally higher for developing countries l...

Supportive care in older adults with cancer - An update of research in 2015.

The motto of the Multinational Association for Supportive Care in Cancer (MASCC) is "supportive care makes excellent cancer care possible". This is especially important in the care of older adults with cancer. The use of geriatric assessment in this patient population enables targeted supportive care interventions to work alongside appropriate anticancer therapy. It is the opinion of this author that geriatric oncology is mostly about the provision of streamlined, appropriate supportive care. There are many facets of supportive care of patients with cancer that are important regardless of age. These include issues such as the use of appropriate antiemetics, infection management, oral health, nutritional intervention, psychosocial care, and palliative care. This article provides an update on novel yet important supportive care research specifically in older adults with cancer published in peer-reviewed journals in 2015. This year saw important publications in geriatric assessment, psychosocial care, in the information and supportive care needs of older adults and the role of pharmacists and rehabilitation specialists in the geriatric oncology clinic.

Comprehensive Geriatric Assessment (CGA) based risk factors for increased caregiver burden among elderly Asian patients with cancer.

This study aims to identify Comprehensive Geriatric Assessment (CGA) based risk factors to help predict caregiver burden among elderly patients with cancer. The study evaluated 249 patients newly diagnosed with cancer, aged 70years and above, who attended the geriatric oncology clinic at the National Cancer Centre Singapore between 2007 and 2010. Out of 249 patients, 244 patients had information available on family caregiver burden and were analysed. On univariate analysis, ADL dependence, lower IADL scores, ECOG performance status of 3-4, higher fall risk, lower scores in dominant hand grip strength test and mini mental state examination, polypharmacy, higher nutritional risk, haemoglobin <12g/dL and presence of geriatric syndromes were significantly associated with mild to severe caregiver burden. On multivariate analysis, only ECOG performance status of 3-4 (odds ratio [OR], 4.47; 95% confidence interval [CI], 2.27-8.80) and haemoglobin <12g/dL (OR, 2.38; 95% CI, 1.14-4.99) were associated with an increased probability of mild to severe caregiver burden. The model achieved a good fit (Hosmer-Lemeshow's p=0.196) and discrimination (area under the curve [AUC]=0.742; bias-corrected AUC=0.737). Based on this, patients were stratified into 3 risk groups with different proportion of patients with increased caregiver burden (low risk: 3.9% vs intermediate risk: 18.8% vs high risk: 39.6%; p<0.001). ECOG performance status and haemoglobin were associated with increased caregiver burden among elderly patients with cancer. Using these two factors in the clinic may help clinicians identify caregivers at risk and take preventive action to mitigate that.

Comparison of older adult symptom occurrence rates in a geriatric-oncology clinic with meta-analysis for adults receiving chemotherapy.

102 Background: The majority of cancers occur in older adults, yet there is limited information on their symptom experience because they are under-represented in studies. To address this gap we examined registry data from two partnered geriatric oncology clinics, our aims are to: 1) identify older patients’ symptom occurrence rates and 2) compare symptom occurrence rates to published norms for adults with cancer. Methods: At presentation, patients completed the MD Anderson Symptom Inventory with symptoms coded as present or absent. Prevalence rates were compared to rates from a meta-analysis (Reilly et al., 2013) of adult cancer patients receiving chemotherapy which included pooled data from 21 studies (age M = 58 years, Range 118 = 97 years.) Differences were tested with Chi-Square. Results: As compared to published data, older patients (N = 291, M = 80.6 years, SD = 6.47, 52% &gt; 80 yrs.) reported higher rates for the following symptoms: drowsiness (65% vs. 43%), trouble remembering (60% vs. 44%), distress (50% vs. 41%), sadness (49% vs.34%) (p’s &lt; .01), and dry mouth (55% vs. 48%, p = .03). Lower rates were reported for nausea/vomiting (23% vs 40%/ 13 vs 27%, p’s &lt; .001). There was no significant difference for the rates of fatigue (60%), difficulty sleeping (52%), pain (50%), decreased appetite (49%), dyspnea (48%), and numbness/tingling (38%). Conclusions: Older adults referred to specialized geriatric oncology clinic present with multiple symptoms. These patients had a mean age of eighty, may reflect the frail and vulnerable and were not often receiving active treatment. Results reinforce that it is especially important to assess and intervene on cognitive and psychological status in older patients. Nausea/Vomiting were less common in older adults perhaps due to lower chemotherapy rates. Limitations exist as we were not able to control for other factors affecting symptoms in the analysis. Nonetheless, results are consistent with older adults reporting many symptoms at a similar or higher rate than prior studies including all adults receiving chemotherapy. Increased study of the symptom experience in older oncology patients is critical to advance palliative care and symptom science.

Geriatric assessment findings independently associated with clinical depression in 1092 older patients with cancer: the ELCAPA Cohort Study.

We aim to assess the prevalence and associated factors of clinical depression in older patients with cancer. We studied a prospective cohort of cancer patients aged ≥ 70 years and referred to geriatric oncology clinics between 2007 and 2012. A multidimensional geriatric assessment was performed before choosing the cancer-treatment strategy. Clinical depression was diagnosed by senior geriatricians by a semi-structured interview. It encompassed criteria of the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) and of the International Classification of Diseases (10th edition). Multivariate logistic regression was performed. Of 1121 consecutive patients, 1092 had available data (mean age, 80.4 years; women, 48.8%; metastases, 51.3%; cancer location: colorectal 21.1%, breast 16.8%, kidney, bladder or urinary tract 14.0%, and prostate 11.4%). The overall prevalence of clinical depression was 28.4% (95% confidence interval, 25.7-31.2). Factors independently associated with clinical depression by multivariate analysis adjusting for all following factors plus gender, and metastasis were impaired mobility (adjusted odds ratio [aOR], 2.35; 1.59-3.46), impaired functional status defined as Eastern Cooperative Oncology Group Performance Status ≥ 2 (aOR, 2.39; 1.66-3.43) or as activities of daily living < 6 (aOR, 2.43; 1.73-3.41), inpatient status (aOR, 1.68; 1.20-2.37), inadequate social support (aOR, 1.66; 1.16-2.37), cognitive impairment (aOR, 1.76; 1.24-2.49), polypharmacy defined as five or more non-antidepressant drugs (aOR, 1.65; 1.14-2.38), multimorbidity (aOR additional CIRS-G point , 1.08; 1.04-1.12), and cancer-related pain (aOR, 1.76; 1.26-2.46). In older patients with as-yet untreated cancer at various sites and stages, clinical depression was highly prevalent. Clinical depression was independently associated with several geriatric assessment findings (impaired mobility and function, inadequate social support, cognitive impairment, polypharmacy, and multimorbidity) independently from gender, tumor site, and metastatic status.

Assessment of Solid Cancer Treatment Feasibility in Older Patients: A Prospective Cohort Study

To assess solid cancer treatment feasibility in older patients. Between 2007 and 2010, 385 consecutive elderly patients (mean age: 78.9 ± 5.4 years; 47.8% males) with solid malignancies referred to two geriatric oncology clinics were included prospectively. We recorded feasibility of first-line chemotherapy (planned number of cycles in patients without metastases and three to six cycles depending on tumor site in patients with metastases), surgery (patient alive 30 days after successfully performed planned surgical procedure), radiotherapy (planned dose delivered), and hormonal therapy (planned drug dose given), and we recorded overall 1-year survival. Main tumor sites were colorectal (28.6%), breast (23.1%), and prostate (10.9%), and 47% of patients had metastases. Planned cancer treatment was feasible in 65.7% of patients with metastases; this proportion was 59.0% for chemotherapy, 82.6% for surgery, 100% for radiotherapy, and 85.2% for hormonal therapy. In the group without metastases, feasibility proportions were 86.8% overall, 72.4% for chemotherapy, 95.7% for surgery, 96.4% for radiotherapy, and 97.9% for hormonal therapy. Factors independently associated with chemotherapy feasibility were good functional status defined as Eastern Cooperative Oncology Group performance status <2 (p < .0001) or activities of daily living >5 (p = .01), normal mobility defined as no difficulty walking (p = .01) or no fall risk (p = .007), and higher creatinine clearance (p = .04). Feasibility rates were considerably lower for chemotherapy than for surgery, radiotherapy, and hormonal therapy. Therefore, utilization of limited geriatric oncology resources may be optimized by preferential referral of elderly cancer patients initially considered for chemotherapy to geriatric oncology clinics.

Functional disability and presence of frailty markers in older cancer patients referred to a geriatric oncology clinic

involved in functional independence, and Instrumental Activities of Daily Living, that involve a more complex interactionsbetween and the environment. Objectives: To estimate the prevalence of dependence in ADL and IADL in older patients with prostate cancer in Mato Grosso do Sul, Brazil. Methods: This is a cross-sectional study analysing preliminary data with prostate cancer patients, 60 years and over, who are participants in a cohort study being conducted in Campo Grande and Rio de Janeiro, Brazil. Individuals are recruited before starting treatment and followed upwith interviews at 6, 12 and 24 months after recruitment. Katz’s scale was used to evaluate dependency on Basic Activities of Daily Life and Lawton’s Scale was used for assessment of dependency onInstrumental Activities of Daily Living. A descriptive analysis of the characteristics of the study population was performed through frequency distributions. Results: This study includes the first 100 participants recruited in Campo Grande. Thesample had a predominance of with 60 to 79 years while those aged 80 and over corresponded only to 14% of them. More than half (54%) of the subjects were married and had low educational level (35% were illiterate and 50% had 1 to 8 years of schooling). In regard to the activities of daily living evaluated by ADL, most individuals (ranging between 97 and 99%)reported performing them without help”. The exception was the question about sphincter control, in which only 85% claimed to have full control. Eighty-three percent of the patients were classified as independent on ADL. At the ages 60 to 69 years, this percentage corresponded to 91% of the patients andin the age groups 70-79 years and 80 years and over, this percentage was 81 and 84%, respectively. Regarding the IADL, the percentage of completion of activities unaided ranged between 60 and 86%. The prevalence of IADL dependency was 53%. In the age group 60-69 years, 67% of the patients were classified as independent in IADL, while in the age group 70-79 years only 42%were independent. At 80 years and over, all were dependent on IADL. When ADL and IADL were considered together, the dependency reached 14% of the sample. Conclusion: The study showed s a predominance of under 80 years of age, which were still living with their partners and had low educational level. In relation to functionality, the analysis revealed relatively healthy prostate cancer patients, with certain dependency only in a few of the more complex activities that require interaction with the environment and society in general. Dependency on both, ADL and IADL, increased with age, as expected.

Geriatric syndromes increased the nutritional risk in elderly cancer patients independently from tumoursite and metastatic status. The ELCAPA-05 cohort study

We assessed the prevalence and risk factors of malnutrition in elderly cancer patients. We studied a prospective cohort of solid cancer patients aged ≥70 years at referral to two geriatric oncology clinics between 2007 and 2010. Nutrition was evaluated using the Mini-Nutritional Assessment (MNA) using validated cut-offs (<17: malnutrition, 17-23.5: at-risk for malnutrition). Patients with non-digestive tumours (breast, prostate, urinary tract) and with digestive (colorectal, upper digestive tract and liver) were analysed separately using multinomial logistic regression. Of 643 consecutive patients, 519 had available data (median age, 80; men, 48.2%; metastases, 46.3%; digestive cancer 47.8%). In non-digestive group, 13.3% had malnutrition versus 28.6% in digestive group. The link between metastasis and malnutrition was significantly higher in non-digestive group (adjusted odds ratio [ORa ], 25.25; 95%CI: 5.97-106.8) than in digestive group (ORa, 2.59; 1.08-6.24; p for heterogeneity = 0.04). Other factors independently associated with malnutrition were cognitive impairment (ORa MMMSE ≤ 24 versus > 24 in non-digestive group: 16.68; 4.89-56.90 and in digestive group: 3.93; 1.34-11.50), and depressed mood (ORa MiniGDS ≥1 versus <1 in non-digestive group: 11.11; 3.32-37.17 and in digestive group: 3.25; 1.29-8.15) and fall risk (ORa fall risk versus no fall risk in non-digestive group: 4.68; 1.77-12.37; in digestive group: 100% of malnourished patients were faller's). We highlighted, in elderly cancer patients, the high prevalence of malnutrition and that geriatrics syndromes (i.e. cognitive impairment, depressed mood and fall risk) were independent risk factors for malnutrition. Moreover, metastatic status was significantly much more strongly associated with malnutrition in non-digestive than digestive tumours.

The impact of cancer therapy on cognition in the elderly

Cancer and cancer therapy-related cognitive impairment (formerly known as chemobrain or chemo-fog) are often described in the literature. In the past, studies have failed to prove the existence of cancer therapy-related cognitive dysfunction. However, more recently, prospective trials have shown that patients undergoing chemotherapy do display impairment in specific cognitive domains. Aging confers an increased risk of developing cancer, as well as cognitive impairment. The Geriatric Oncology clinic of the Segal Cancer Centre, Jewish General Hospital in Montreal was founded in 2006 to address the unique needs of older cancer patients. We will describe two cases of cancer therapy-related cognitive impairment from our Geriatric Oncology clinic. The first case is that of a 75 year old male diagnosed with stage III non-small cell lung carcinoma who complained of forgetfulness since starting carboplatin-paclitaxel. The second case is that of a 65 year old female diagnosed with stage I, estrogen-receptor-positive breast cancer who had undergone lumpectomy followed by adjuvant cyclophosphamide, methotrexate and fluorouracil chemotherapy, radiation therapy and was on exemestane when she was evaluated. We will also briefly review the literature of cancer therapy-related cognitive impairment.

Analysis of the health and functional status of cancer patients referred to a Geriatric Oncology clinic: An update

Analysis of the health and functional status of cancer patients referred to a Geriatric Oncology clinic: An update

Analysis of Prognostic Factors of Comprehensive Geriatric Assessment and Development of a Clinical Scoring System in Elderly Asian Patients With Cancer

To determine the impact of each comprehensive geriatric assessment (CGA) domain on overall survival (OS) and develop a prognostic scoring system for elderly patients with cancer. A retrospective analysis of CGA data collected from 249 consecutive patients with cancer who attended the outpatient geriatric oncology clinic at the National Cancer Center Singapore age 70 years or older was performed. Univariate and multivariate analyses were performed using Cox proportional hazards method to identify significant prognostic factors within the CGA. A simple nomogram to predict OS was developed using regression coefficients from the multivariate model. Concordance between predicted and observed response of the individual patient score was evaluated by means of Harrell's c-index. Calibration was performed using simulated data via bootstrap. Median age of the patients was 77 years (range, 70 to 94 years). In our model, age (hazard ratio [HR], 1.04; 95% CI, 1.01 to 1.07), abnormal albumin level (HR, 1.97; 95% CI, 1.23 to 3.15), poor Eastern Cooperative Oncology Group performance status (≥ 2 v < 2: HR, 1.77; 95% CI, 1.15 to 2.72), abnormal geriatric depression scale status (HR, 1.81; 95% CI, 1.29 to 2.56), high malnutrition risk (high v low risk: HR, 1.84; 95% CI, 1.17 to 2.87), and advanced disease stage (late v early: HR, 1.71; 95% CI, 0.98 to 2.95) were independent predictors of survival. Results confirm the importance of the CGA in assessment of elderly patients with cancer. The development of this nomogram incorporating these prognostic factors helps predict OS of patients, for further intervention.

Infancy of an Australian geriatric oncology program—characteristics of the first 200 patients

Abstract Objectives The aging population brings with it increased cancer related morbidity and mortality. Comprehensive Geriatric Assessment (CGA) identifies areas of concern for the older patient with cancer that may not be detected with traditional oncological methods of assessment. However CGA is resource intensive and thus screening tools have been developed. Having developed a screening tool, we present the characteristics of the first 200 patients seen by our geriatric oncology clinic. Materials and methods All patients aged 70 and over were invited to complete a self-reported screening questionnaire at time of referral to oncology services, covering domains addressed by the CGA. These questionnaires were then reviewed at a weekly multidisciplinary meeting. From this, five key measures, supplemented by medical chart review and clinical impression, were used to classify patients into fit, vulnerable or frail categories. Results For the first 200 patients, the average age was 76.7 years, and 54% were male. The majority were community living, and 72% were being treated palliatively. Twenty-eight percent were classified fit, 60% vulnerable, and 13% frail. The fit, vulnerable and frail groups differed significantly in comorbidities, polypharmacy, memory concerns, falls, weight loss, physical function and exhaustion. Conclusion Elderly patients referred to an Australian geriatric oncology program are a heterogenous group. The use of a screening tool for geriatric assessment was a feasible and acceptable method for assessing older patients with cancer. Further work is required to examine the prognostic value of classifying patients into fit, vulnerable and frail.

An analysis of prognostic factors of comprehensive geriatric assessment (CGA) and development of a clinical scoring system in elderly Asian cancer patients.

9165 Background: Certain components of the comprehensive geriatric assessment (CGA) correlate with survival in elderly cancer patients. The purpose of this study was to determine the impact of each CGA domain on overall survival and to develop a prognostic scoring system to stratify elderly cancer patients into risk groups. Methods: A retrospective analysis of CGA data collected from 318 consecutive cancer patients who attended the outpatient geriatric oncology clinic at the National Cancer Center Singapore, aged 70 years and above was performed. Univariate and multivariate analyses were done using Cox proportional hazard method to identify significant prognostic factors within the CGA. A simple scoring algorithm to predict overall survival was developed using the regression coefficients from the multivariate model with total clinical scores ranging from 0 to 6. Results: Median age of the 318 patients was 77 years old (range: 70-94 years). ECOG performance status, functional status (ADL/IADL) and presence of geriatric syndromes were shown to be highly co-dependent variables. In our model, poor ECOG performance status (≥ 2 vs. < 2: HR=2.28, 95% CI= 1.44 - 3.61), high malnutrition risk (high risk vs. low risk: HR=2.59, 95% CI= 1.64 -4.10) and advance stage of disease (late vs. early: HR=2.14, 95% CI= 1.25–3.67) were independent predictors of survival. The patients with high risk clinical score 5-6 (HR=4.92, 95%CI = 2.72–8.87) and moderate risk score 3-4 (HR=2.09, 95%CI = 1.09–4.02) had significantly higher mortality rates compared to those classified as low risk score 0-2. The 2-year survival rate for low, moderate and high risk groups were 74.9% (95%CI 58.9-85.4), 50.9% (95% CI 37.0–63.3) and 23.2% (95% CI 16.8–30.1) respectively. Longer term follow-up and a larger sample size may identify factors that will significantly distinguish the low and moderate risk groups. Conclusions: The results confirm the importance of the CGA in the assessment of the elderly cancer patient. The development of the risk scoring system incorporating few key prognostic factors helps stratify patients into risk groups for further intervention. No significant financial relationships to disclose.

Mini-Cog: A brief screening tool for cognitive impairment in older cancer patients.

9064 Background: The incidence of both cancer and cognitive impairment (CI) increases with age. Up to 20% of older cancer patients may have baseline CI, which may be overlooked in a busy oncology practice due to time constraints, staff availability, and complexity of the screening tools. This review compares the prevalence of CI as measured by different screening tools and describes the role of the Mini-Cog (MC) in evaluating CI in older cancer patients. Methods: A retrospective chart review of patients age ≥65 years referred to a Geriatric Oncology clinic with a new diagnosis of solid tumors, lymphoma, or multiple myeloma who had baseline cognitive assessment evaluated by 5 screening tools: Single-item memory question, three-item recall (3IR), clock drawing test (CDT), Mini-Cog (3IR and CDT), and Mini-Mental Status Exam (MMSE). Outcome measures include CI as detected by any of these screening tools and their association with the MMSE score. Results: Participants (n=191) had a mean age of 78 ± 6.6 years (65-99 years) with 68.1% ≥ 75 years, 78% Caucasian, 60.7% women and 51.3% ≥ 12 years of education. Tumor types included breast (33%), colorectal (17%), lung (15%), prostate (9%), and other (26%). 22% had stage IV disease. Among the 77% (n = 147) of patients with a normal MMSE (score >24), 84% had a normal MC, 65% a normal recall and 60% a normal CDT. The overall prevalence of CI in this population was approximately 35%. Conclusions: CI in older cancer patients may be more common than previously expected. Since CI may impact decision making capacity and treatment outcome, identifying CI is essential. The MC is a short and easy to administer screening tool that is not confounded by language or education. Based on our review, the MC may be an effective alternative to the MMSE. Screening for CI with MC should be considered for all older cancer patients. A prospective study to evaluate the applicability of the MC in detecting any CI in this population is warranted. Prevalence of CI by age and screening tools Age (yrs) Memory question Recall CDT MC MMSE 65-74 27.78% 36.07% 38.92% 14.75% 16.39% 75-84 41.18% 40.82% 53.68% 15.18% 24.49% 85-94 34.78% 74.07% 64% 51.85% 29.63% >94 50% 80% 75% 60% 40% Total 36.14% 45.03% 50.82% 28.8% 23.04% No significant financial relationships to disclose.

Does a Geriatric Oncology Consultation Modify the Cancer Treatment Plan for Elderly Patients?

This study was performed to describe the treatment plan modifications after a geriatric oncology clinic. Assessment of health and functional status and cancer assessment was performed in older cancer patients referred to a cancer center. Between June 2004 and May 2005, 105 patients 70 years old or older referred to a geriatric oncology consultation at the Institut Curie cancer center were included. Functional status, nutritional status, mood, mobility, comorbidity, medication, social support, and place of residence were assessed. Oncology data and treatment decisions were recorded before and after this consultation. Data were analyzed for a possible correlation between one domain of the assessment and modification of the treatment plan. Patient characteristics included a median age of 79 years and a predominance of women with breast cancer. About one half of patients had an independent functional status. Nearly 15% presented severe undernourishment. Depression was suspected in 53.1% of cases. One third of these patients had >2 chronic diseases, and 74% of patients took > or =3 medications. Of the 93 patients with an initial treatment decision, the treatment plan was modified for 38.7% of cases after this assessment. Only body mass index and the absence of depressive symptoms were associated with a modification of the treatment plan. The geriatric oncology consultation led to a modification of the cancer treatment plan in more than one third of cases. Further studies are needed to determine whether these modifications improve the outcome of these older patients.