Geriatric Oncology Research Articles

Exploring the Language Used to Describe Older Patients at Multidisciplinary Cancer Conferences

Older adults with cancer often present with distinct complexities that complicate their care, yet the language used to discuss their management at multidisciplinary cancer conferences (MCCs) remains poorly understood. A mixed methods study was conducted at a tertiary cancer centre in Toronto, Canada, where MCCs spanning five tumour sites were attended over six months. For presentations pertaining to a patient aged 75 or older, a standardized data collection form was used to record their demographic, cancer-related, and non-cancer-related information, as well as the presenter’s specialty and training level. Descriptive statistics and thematic analysis were employed to explore MCC depictions of older patients (n = 75). Frailty status was explicitly mentioned in 20.0% of presentations, but discussions more frequently referenced comorbidity burden (50.7%), age (33.3%), and projected treatment tolerance (30.7%) as surrogate measures. None of the presentations included mentions of formal geriatric assessment (GA) or validated frailty tools; instead, presenters tended to feature select GA domains and subjective descriptions of appearance (“looks to be fit”) or overall health (“relatively healthy”). In general, MCCs appeared to rely on age-focused language that may perpetuate ageism. Further work is needed to investigate how frailty and geriatric considerations can be objectively incorporated into discussions in geriatric oncology.

Access barriers for geriatric oncology care in Mexico

En México, como derecho humano, se ha procurado la cobertura universal en salud. Consecuencia de la transición demográfica y el incremento en la expectativa de vida, se estima que entre el 30 y 70% de los pacientes con cáncer son adultos mayores. Relacionado con el envejecimiento, el adulto mayor con cáncer es considerado social y médicamente vulnerable, lo que hace imperativa la necesidad de una atención multidisciplinaria como parte del estándar de cuidado y atención, mismas que no han sido consideradas un tema prioritario en salud. Las disparidades para recibir una atención oportuna y adecuada en el adulto mayor con cáncer, suelen ser producto de las barreras en el acceso a este tipo de servicios, por lo que el objetivo de este artículo es: identificar las barreras de acceso para la atención en oncología geriátrica; barreras relacionadas a la fragmentación y barreras propias del sistema de salud en México.

Trends in Medicare utilization and reimbursement for hematology/oncology procedures from 2012 to 2023: A geriatric oncology perspective

AbstractObjectivesGiven the scarcity of data exploring reimbursement trends in the field of hematology/oncology, we sought to characterize these trends for common procedures in this field from 2012 to 2023.MethodsUsing the Centers for Medicare and Medicaid Services' Physician Fee Schedule Look‐Up Tool we collected reimbursement data for 40 hematology/oncology procedure codes from 2012 to 2023. Data was adjusted to 2023 United States (US) dollars using the Consumer Price Index (CPI).ResultsFrom 2012 to 2023 gross reimbursement for the facility price decreased 4.4% and increased 9.2% for the non‐facility price. When adjusted for inflation, compensation decreased 96.1% and 96.6%, respectively. None of the 40 examined Current Procedural Terminology (CPT) codes increased in net reimbursement over the study period.ConclusionsMedicare reimbursement for common hematology/oncology procedures decreased from 2012 to 2023. Further research is necessary to explore the implications of these trends on the delivery of patient care.

Immune Checkpoint Inhibitors in Geriatric Oncology.

This manuscript will update prior reviews of immune checkpoint inhibitors (ICIs) in light of basic science, translational, and clinical discoveries in the field of cancer immunology and aging. ICIs have led to significant advancements in the treatment of cancer. Landmark trials of ICIs have cited the efficacy and toxicity experienced by older patients, but most trials are not specifically designed to address outcomes in older patients. Underlying mechanisms of aging, like cellular senescence, affect the immune system and may ultimately alter the host's response to ICIs. Validated tools are currently used to identify older adults who may be at greater risk of developing complications from their cancer treatment. We review changes in the aging immune system that may alter responses to ICIs, report outcomes and toxicities in older adults from recent ICI clinical trials, and discuss clinical tools specific to older patients with cancer.

Metronomic Chemotherapy in Elderly Patients.

This review describes the most relevant studies found in the scientific literature regarding metronomic chemotherapy (MCT) in the geriatric oncology population to support its use as a feasible treatment of care in the frail elderly patients. Recent years have seen a reevaluation of cancer chemotherapeutic drugs and MCT is an emerging schedule in phase II and III clinical trials. Ageing is one of the risk factors for the development of cancer, the incidence of whom increases dramatically in people who live longer. To date, standard oncological protocols involve chemotherapeutic drugs in short cycles of therapy at the maximum tolerated dose (MTD). Although these therapeutic regimens may be successful, they can cause important adverse drug reactions, especially in elderly or frail patients. MCT is a different modality of delivery of chemotherapeutic drugs (frequent low dose for prolonged time) and it looks at the overcoming of the limitations and disadvantages of MTD, in particular the toxicity aspect. We reviewed the experience of clinicians who have used MCT in clinical trials enrolling elderly patients with different cancer types.

Improving timeliness to initial assessment in a geriatric oncology clinic: A quality improvement project

Improving timeliness to initial assessment in a geriatric oncology clinic: A quality improvement project

“Palliative geriatric oncology?” Special features of the treatment of incurable diseases and very old patients with cancer

“Palliative geriatric oncology?” Special features of the treatment of incurable diseases and very old patients with cancer

How representative are participants in geriatric oncology clinical trials? The case of the 5C RCT in geriatric oncology: A cross-sectional comparison to a geriatric oncology clinic

IntroductionFrail older adults make up a substantial portion of the older adult population. However, frail patients are often excluded from randomized controlled trials. This underrepresentation restricts the extent to which trial findings can be generalized to this population. We compared a sample from the Canadian 5C Randomized Controlled Trial investigating comprehensive geriatric assessment (CGA) in the geriatric oncology setting in terms of frailty to patients referred to the Older Adults with Cancer Clinic (OACC) to determine if the trial sample was representative of the normal geriatric oncology practice. Materials and MethodsBaseline CGA data of 5C Trial participants seen at the Princess Margaret Cancer Centre (PM), were compared to data from OACC patients that were seen during the duration of the 5C trial (between April 2018 and April 2020) and that satisfied the 5C inclusion criteria. To assess the frailty of samples, sex, age, disease site, comorbidity level, medical optimization, social supports, functional status, falls risk, nutrition, cognition, and mood were compared between 5C participants and OACC patients using Fisher's exact and independent samples t-test. ResultsA sample of 115 5C participants and 205 OACC patients were included. The mean age of 5C participants and OACC patients was 75.4 and 81.6 years, respectively (p < 0.001). The distribution of disease sites was significantly different between the samples (p < 0.001) and OACC patients were also significantly more impaired compared to 5C participants in comorbidity (23.4% versus 10.4% high comorbidity) (p = 0.001), IADL dependence (55.1% versus 42.6%) (p = 0.036), impaired physical function (70.6% versus 31.3%) (p < 0.001), falls risk (67.8% versus 27%) (p < 0.001), impaired nutrition (55.6% versus 40.9%) (p = 0.014), and cognition (47.2% versus 10%) (p < 0.001). There were no differences in sex, medication optimization, poor social supports, and impaired mood between the samples. DiscussionThe 5C sample was less frail and younger than patients seen in the geriatric oncology clinic. Finding strategies to address barriers to the inclusion of frailer older adults is important to increase their representation in future trials to allow findings to be generalized to this vulnerable population.Trial Registration: Clinicaltrials.gov # NCT03154671

Implementation of a geriatric oncology service at the Royal Marsden Hospital

IntroductionDespite significant evidence supporting the benefits of comprehensive oncogeriatric assessment in the management of older patients with cancer, the adoption of specialised geriatric oncology programs in the United Kingdom remains limited. Descriptions of clinic structure and models, patient demographics and baseline characteristics, resource utilisation, and predictors of resource utilisation are lacking in this population, which may complicate or impede the planning, resourcing, and development of further services in this subspecialty on a national and regional basis. Materials and MethodsBetween November 2021 and April 2023, 244 patients commencing systemic anticancer treatment at the Royal Marsden Hospital, London underwent geriatric screening using the Senior Adult Oncology Programme-3 (SAOP3) screening tool. Baseline clinical factors (sex, age, Charlson Comorbidity Index score, Cumulative Illness Rating Scale-Geriatric [CIRS-G] score, Katz Index score, Barthel Index score, treatment intent, and Eastern Cooperative Oncology Group Performance Status [ECOG-PS]) were assessed as predictors of geriatric impairments and need for multidisciplinary referral and intervention using a negative binomial regression analysis. Referral rates to multidisciplinary teams were assessed against ECOG-PS score using point-biserial correlation, as well as against a historical control using descriptive statistics. ResultsThe median age of participants was 77; 75.8% were female. Breast cancer was the most prevalent diagnosis (61.9%). Most patients (67.6%) were undergoing treatment in the palliative setting. Two hundred eleven (86.5%) patients were identified as having at least one geriatric impairment. Six hundred forty-nine multidisciplinary referrals were made, of which 583 (86.7%) were accepted by the referred patient. Higher ECOG PS was positively associated with geriatric impairments in physiotherapy, occupational therapy, dietetics, pharmacy, and welfare rights domains, as well as with the overall number of geriatric impairments. DiscussionThe Royal Marsden Senior Adult Oncology Programme represents the first geriatric oncology service in a tertiary cancer centre in the United Kingdom. Following implementation of SAOP3 screening, we observed a substantial increase in referrals to all multidisciplinary teams, suggestive of previously underrecognized needs among this population. The need for multidisciplinary intervention was strongly correlated with baseline ECOG-PS score, but not with other measured clinical variables, including comorbidity or functional indices.

Involvement of family members of older patients with cancer in triadic decision-making processes during medical consultations on an outpatient ward - an observational exploratory study using quantitative and qualitative methods

IntroductionThere is a growing interest in the involvement of family members of older patients with cancer in decision-making processes. The aim of this study is to identify how and to what extent family members, together with patients and physicians, are involved in triadic decision-making processes in clinical practice. Materials and MethodsThis study was conducted using an exploratory observational design. The Observer Patient Involvement Scale for patients with Multiple Chronicle Conditions (OPTIONMCC) was used to assess the interaction in triadic decision-making between patients, family members, and physicians. Physicians' behaviour was scored on a Likert-scale ranging from 0 (not observed) to 4 (executed to a high standard), while the behaviour of patients and their family members was scored on a scale from 0 (no or minimum participation) to 2 (active participation). Atlas.ti software was used to facilitate coding, and the SPSS statistical analysis platform was used to explore correlations between the shared decision-making (SDM) skills of the physician and the participation of patients and their family members. ResultsIn total, ten physicians performed 25 consultations with older patients and 30 family members. Patients showed higher levels of participation in the SDM process than family members (OPTIONMCC mean scores 0.96 vs 0.61). Physicians' SDM skills were observed at a low or moderate skill level (OPTIONMCC mean score 1.81). Exploratory correlation analysis showed that higher physician scores were related to higher levels of both patients' and family members' involvement in the decision-making process. The level of family members' involvement in SDM varied from no involvement at all to active involvement. Qualitative analysis of family involvement revealed that relatives are likely to: emphasize patients' values and goals of care; inquire about different treatment options; assist in the deliberation process; and ask for clarification of the further medical process. Physicians showed responsive behaviour towards family members but seldom actively involved them in the SDM process. DiscussionThe study findings suggest that there is a need to include strategies to facilitate family involvement in current SDM models for older patients with cancer. Healthcare professionals in geriatric oncology might benefit from additional training covering family dynamics and managing challenging situations.

Big Data for Geriatric Oncology Research

Cancer is the second leading cause of death in North Carolina and approximately half of cancers are diagnosed in older adults (≥ 65 years). Cancer clinical trials in older adults are limited and there is a lack of evidence on optimal care strategies in this population. We highlight how big data can fill in gaps in geriatric oncology research.

Potentially inappropriate medications, their adverse events, and impact on geriatric vulnerabilities, frailty, and survival in older Indian patients with cancer: A retrospective observational study

Background: Older adults often have chronic diseases for which they receive multiple drugs, which may be potentially inappropriate. Objectives: We aimed to describe the potentially inappropriate medications (PIMs) leading to adverse drug events (ADEs) in older patients with cancer. Our secondary objectives were to evaluate the association of nutrition, cognition, and frailty with PIM-related ADEs and to assess the impact of PIM-related ADEs on overall survival (OS). We also investigated the cut-off for defining polypharmacy as related to ADEs. Materials and Methods: This was a retrospective observational study on patients with cancer aged 60 years and over who were assessed in the geriatric oncology clinic at the Tata Memorial Hospital (Mumbai, India) from June 2018 to August 2022. Medications, PIM assessment, nutrition (assessed by Mini Nutritional Assessment [MNA]), cognition (assessed by Mini Mental State Examination [MMSE] and Hindi Mental State Examination), and frailty (assessed by the Clinical Frailty Scale [CFS]) were extracted from the geriatric oncology clinic database. PIMs were identified using the Beers criteria, European Union-7 (EU[7])-PIM, Screening Tool of Older person’s Prescriptions/Screening tool to Alert to Right Treatment (STOPP/START), Fit fOR The Aged (FORTA), and PRISCUS list. Results: In total, 1472 patients were assessed in the geriatric oncology clinic, of which 823 (55.9%) were enrolled in the study. There were 1287 PIMs detected in 823 patients, of which 431 (33.5%) led to ADEs and 856 (66.5%) did not. Proton pump inhibitors and tramadol were the most common PIMs identified. ADEs were noted in 54 (14.7%) patients on proton pump inhibitors and in 145 (61.1%) patients on tramadol. ADEs were significantly associated with malnutrition, lower cognition, and frailty. The median MNA score in patients without and with ADEs was 20.5 (interquartile range [IQR], 17.5-24.0) and 19.5 (IQR, 15.5–23.5), respectively; P, 0.001. The median MMSE score for the patients without and with ADEs was 28 (IQR, 26-29) and 27 (IQR: 25-29), respectively; P, 0.001. The median CFS scores for the patients without and with ADEs were 3 (IQR, 2-4) and 4 (IQR, 3-5), respectively; P &lt; 0.001. The median OS in patients without and with ADEs was 13.1 months (95% confidence interval [CI], 10.64-17.87) and 10.2 months (95% CI, 8.80-12.85), respectively; P, 0.002. The optimal cut-off for polypharmacy leading to ADEs was 4.5 medications. Conclusions: There is a dire need to recognize and appropriately manage PIMs in older patients with cancer as PIM-related toxicities may negatively impact survival. Monitoring PIMs and following the recommendations to optimize the dose, avoid the drug, and find alternatives may improve the oncologic outcomes. Future studies should focus on adding a control group of patients not on PIMs, following up on PIM after recommendations, and investigating the impact of these recommendations on oncologic outcomes (Clinical Trials Registry-India: CTRI/2020/04/024675).

Performance of potentially inappropriate medications assessment tools in older Indian patients with cancer.

Polypharmacy and potentially inappropriate medication (PIM) use are common problems in older adults. Safe prescription practices are a necessity. The tools employed for the identification of PIM sometimes do not concur with each other. A retrospective analysis of patients ≥60 years who visited the Geriatric Oncology Clinic of the Tata Memorial Hospital, Mumbai, India from 2018 to 2021 was performed. Beer's-2015, STOPP/START criteria v2, PRISCUS-2010, Fit fOR The Aged (FORTA)-2018, and the EU(7)-PIM list-2015 were the tools used to assess PIM. Every patient was assigned a standardized PIM value (SPV) for each scale, which represented the ratio of the number of PIMs identified by a given scale to the total number of medications taken. The median SPV of all five tools was considered the reference standard for each patient. Bland-Altman plots were utilized to determine agreement between each scale and the reference. Association between baseline variables and PIM use was determined using multiple logistic regression analysis. Of the 467 patients included in this analysis, there were 372 (79.66%) males and 95 (20.34%) females with an average age of 70 ± 5.91 years. The EU(7)-PIM list was found to have the highest level of agreement given by a bias estimate of 0.010, the lowest compared to any other scale. The 95% CI of the bias was in the narrow range of -0.001 to 0.022, demonstrating the precision of the estimate. In comparison, the bias (95%) CI of Beer's criteria, STOPP/START criteria, PRISCUS list, and FORTA list were -0.039 (-0.053 to -0.025), 0.076 (0.060 to 0.092), 0.035 (0.021 to 0.049), and -0.148 (-0.165 to -0.130), respectively. Patients on polypharmacy had significantly higher PIM use compared to those without (OR = 1.47 (1.33-1.63), p = <0.001). The EU(7)-PIM list was found to have the least bias and hence can be considered the most reliable among all other tools studied.

Unveiling Psychological Perspectives on Aging Minds and Cancer: A Review

In geriatric oncology, the intersection of aging complexities and cancer care intricacies shapes the journey of elderly individuals facing cancer. This review explores emotional, cognitive, and social dynamics influencing their experiences and care. Following a cancer diagnosis, older adults navigate a spectrum of emotions—from shock to resilience—crucial in shaping coping strategies and treatment decisions. The toll of cancer treatments, compounded by age-related vulnerabilities, underscores the need for tailored care plans that account for social and familial dynamics. Cognitive functions undergo shifts influenced by aging and treatments, emphasizing the importance of understanding these changes in decision-making processes. Caregiver-patient relationships emerge as pivotal, impacting cognitive well-being and necessitating interventions supporting both parties. Psychological interventions, from counselling to mindfulness practices, offer avenues for comprehensive care. Integrating these interventions into multidisciplinary care fosters resilience and enriches survivorship experiences among elderly cancer patients. This review advocates a personalized approach in geriatric oncology, emphasizing tailored interventions and comprehensive care strategies that honour individual experiences. Future research directions focus on exploring emotional resilience, cognitive adaptability, and intervention outcomes to enhance care for elderly individuals navigating cancer’s challenges. In conclusion, geriatric oncology demands personalized, multidisciplinary care strategies that integrate psychological support and acknowledge the complexities of aging. This integration marks a transformative shift towards holistic care, paving the way for tailored and effective interventions supporting elderly patients throughout their cancer journey.

DEVELOPING A GERIATRIC ONCOLOGY FELLOWSHIP SUBSPECIALTY TRACK FOR ADVANCED PRACTICE PROVIDERS

Abstract Although a relatively young subspeciality, geriatric oncology is a fast-growing discipline. As the population ages, clinicians skilled in geriatric oncology principles and management are needed to care for an increasingly complex older adult population. Educating Advanced Practice Providers (APP) in geriatric oncology may offer innovative ways of increasing access to care, supporting patient health, and improving quality of life. The need for trained clinicians represented a unique opportunity for the development of a geriatric oncology focused APP fellowship subspecialty track at our institution. In 2019, with support from the Samuels Foundation, an electronic geriatric oncology needs assessment was completed among the APPs at our institution. Data from this needs assessment and from a thorough literature review were used to develop the geriatric oncology fellowship track curriculum. With support from APP leadership at our institution, the fellowship track launched in September, 2021. It is a 12-month postgraduate academic program that focuses on geriatric assessment, risk stratification prior to cancer directed therapies, management of geriatric syndromes, and geriatric co-management. Additionally in 2023, the fellowship track will include an elective in a long-term care facility. We believe this unique elective rotation will be a strong addition to the clinical experience of the fellow. Our current program has one position per fellowship year with the goal of increasing the number of positions in the future. This is a major step forward in the education of APPs in the care of older adults with cancer that we hope will be replicated across the country.

INTEGRATING AGE-FRIENDLY CARE INTO THE ONCOLOGY CONTINUUM

Abstract The number of older adults diagnosed with cancer is steadily rising, and measures for equitable, high-quality care in oncology are relatively undefined. The Association of Community Cancer Centers (ACCC), in collaboration with the Institute for Healthcare Improvement (IHI), led the first oncology-focused cohort guided by the 4Ms Framework for Age-Friendly Health Systems. Representatives from 22 cancer programs across the United States participated in a learning and action period to collaborate on building a program that provides optimal care for the older adult population. The Action Community consisted of a six-part didactic webinar series led by subject matter experts in geriatric oncology to apply the 4Ms model: What Matters, Mobility, Mentation, and Medication. ACCC asked sites to evaluate their program’s alignment with current standards using the ACCC Geriatric Gap Assessment tool and IHI’s 4Ms Care Description. Throughout the webinar series, participating sites in hospital and ambulatory settings identified a multidisciplinary team to improve workflows. The respondents answered questions regarding the frequency of assessments, documentation, and addressing inequities in their cancer program. Through a webinar poll, 90% of the participants from the multidisciplinary cancer team stated that medication was the most challenging “M” to implement and that further guidance from faculty experts was needed. More than half of the sites are progressing to earn level one (participant) or level two (committed to care excellence) recognition in the Age-Friendly Health Systems movement. ACCC has provided and will continue to provide health systems with resources for scale-up in their Age-Friendly journey.

U.S. REMOTE CANCER CARE FOR OLDER ADULTS: A SYSTEMATIC REVIEW AND SOCIAL NETWORK ANALYSIS

Abstract Telemedicine and telehealth services are a promising solution for older cancer patients who are susceptible to infectious diseases, like COVID-19, and travel a longer distance to their closest hospital. To provide all-inclusive oncology care, understanding social disparities in access to remote cancer care is crucial. Yet, little is known about the accessibility of these technologies among US cancer patients in later life. The present study aimed to evaluate the main sociocultural factors associated with older patients of virtual oncology care interventions in the US. This systematic review explored the literature on telemedicine for geriatric oncology and patients’ accessibility to remote health technologies. PubMed, CINAHL, Scopus, and Web of Science databases were searched. Using Bibliometrix, Science of Science (Sci2) Tool, and Gephi, Social Network Analysis (SNA) was conducted to identify the central and intermediate factors linked to remote cancer care for older US adults. Among 427 retrieved articles, 19 articles, published between 2003 and 2023, met the eligibility criteria. The selected studies were focused on rural cancer patients (20%) and telehealth during COVID-19 outbreaks (20%), followed by lifestyle interventions (15%), ehealth literacy (10%), prostate or breast cancer (5%), older sexual minority men with prostate cancer (5%), and patients’ race, age, and region (5%). Findings also highlighted that gender, digital health literacy (technology readiness), and location are the key determinants of telemedicine access and use among older US cancer patients. Multiple socio-demographic aspects of older patients need to be considered for implementing equitable access to remote oncology care.

Defining an Abnormal Geriatric Assessment: Which Deficits Matter Most?

At present, there is no clear definition of what constitutes an abnormal geriatric assessment (GA) in geriatric oncology. Various threshold numbers of abnormal GA domains are often used, but how well these are associated with treatment plan modification (TPM) and whether specific GA domains are more important in this context remains uncertain. A retrospective review of the geriatric oncology clinic database at Princess Margaret Cancer Centre in Toronto, Canada, including new patients seen for treatment decision making from May 2015 to June 2022, was conducted. Logistic regression modelling was performed to determine the association between various predictor variables (including the GA domains and numerical thresholds) and TPM. The study cohort (n = 736) had a mean age of 80.7 years, 46.1% was female, and 78.3% had a VES-13 score indicating vulnerability (≥3). In the univariable analysis, the best-performing threshold number of abnormal domains based on area under the curve (AUC) was 4 (AUC 0.628). The best-performing multivariable model (AUC 0.704) included cognition, comorbidities, and falls risk. In comparison, the multivariable model with the sole addition of the threshold of 4 had an AUC of 0.689. Overall, an abnormal GA may be best defined as one with abnormalities in the domains of cognition, comorbidities, and falls risk. The optimal numerical threshold to predict TPM is 4.

External validation and diagnostic value of the Elderly Functional Index version 2.0 for assessing functional status and frailty in older Danish patients with gastrointestinal cancer receiving chemotherapy: A prospective, clinical study

IntroductionPatient perspectives on functioning are often overlooked in oncology practice. This study externally validates the ELderly Functional Index (ELFI), a patient-reported measure for assessing multidimensional functioning, in older patients with gastrointestinal cancer receiving chemotherapy. The study compares ELFI scoring methods, evaluates its diagnostic value with geriatric oncology tools, and proposes a cut-off point for clinical use. Materials and MethodsDanish patients aged ≥70 years with gastrointestinal cancer undergoing chemotherapy from a prospective, observational study were included. Two ELFI scoring methods, item-based and domain-based, were compared. Internal consistency reliability, validity, and correlations between ELFI, its component scales, and measures of functioning/frailty (including Eastern Cooperative Oncology Group Performance Status [ECOG-PS], Geriatric-8 [G8], Vulnerable Elders Survey-13 [VES-13], Timed-Up-and-Go [TUG], and 30-s chair stand test [30CST]) were investigated. Sensitivity and specificity analyses evaluated the ability of ELFI to predict frailty outcomes and identified frailty thresholds. Receiver operating characteristic analyses assessed the diagnostic ability of ELFI, alongside other measures, for oncological outcomes and frailty differentiation. Equipercentile equating methods enabled ECOG-PS, ELFI, and G8 mapping. ResultsOne hundred fifty-four patients (median age 73.5 years, range 70–85) undergoing curative- or palliative-intent chemotherapy (49%) were included. ELFI demonstrated good internal consistency (Cronbach's alpha = 0.82) and acceptable convergent, structural, and discriminant validity. ELFI showed moderate to very strong correlations with its component scales (r = 0.40–0.93), and weaker correlations with frailty measures (r = 0.02–0.60). ELFI score < 80 indicated frailty risk, with almost fivefold risk of ECOG-PS 2 at follow-up (odds ratio[OR] = 4.8, 95% confidence interval [CI] 1.4–15.9), and predicted G8, VES-13, TUG, and 30CST frailty at follow-up, not completing planned chemotherapy (OR = 3.1; 95%CI 1.5–6.2), mono-therapy (OR = 3.5; 95%CI 1.5–8.1), initial dose reduction (OR = 4.9; 95%CI 2.0–12.1), and shorter overall survival (hazard ratio = 2.0, 95%CI 1.4–3.0). A preliminary crosswalk between ECOG-PS, ELFI, and G8 was established. DiscussionELFI was validated as a concise patient-reported measure of functional status in older patients with cancer and its relationship to frailty. ELFI demonstrated comparable predictive ability to other tools for oncological outcomes. Both scoring methods yielded similar results, with the domain-based method (ELFI v2.0) endorsed for consistency. ELFI v2.0 score of 80 was suggested as the frailty threshold in this population, supporting its clinical utility.

Feasability of a trimodal prehabilitation program in geriatric oncology

Feasability of a trimodal prehabilitation program in geriatric oncology