The Value of Geriatric Assessments in Predicting Treatment Tolerance and All‐Cause Mortality in Older Patients With Cancer

• Published in: The oncologist (Dayton, Ohio) Vol. 17; no. 11; pp. 1439 - 1449
• Main Authors: Hamaker, Marije E., Vos, Alinda G., Smorenburg, Carolien H., Rooij, Sophia E., Munster, Barbara C.
• Format: Journal Article
• Language: English
• Published: Durham, NC, USA AlphaMed Press 01.11.2012
• Subjects: Aged; Aged, 80 and over; Aging; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Comorbidity; Comprehensive geriatric assessment; Elderly; Geriatric Assessment; Geriatric Oncology; Humans; Neoplasms - drug therapy; Neoplasms - mortality; Neoplasms - radiotherapy; Neoplasms - therapy; Nutritional Status; Prognostication; Treatment tolerance
• ISSN: 1083-7159; 1549-490X; 1549-490X
• DOI: 10.1634/theoncologist.2012-0186

Learning Objectives After completing this course, the reader will be able to: Describe the predictive value of geriatric assessments for survival in older cancer patients. Describe the predictive value of geriatric assessments for treatment tolerance (such as toxicity of chemotherapy and perioperative complications) in older cancer patients. Explain the concept of frailty compared to individual geriatric conditions. This article is available for continuing medical education credit at CME.TheOncologist.com Background. Awareness of the use of geriatric assessments for older patients with cancer is increasing. The aim of this review is to summarize all available evidence on the association between geriatric assessments and relevant oncologic outcomes. Method. A systematic search was conducted in Medline and Embase of studies on geriatric assessment in oncology, focusing on the association between baseline assessment and outcome. Results. The literature search identified 2008 reports; 51 publications from 37 studies were selected for inclusion in the review. The quality of studies was heterogeneous and generally poor. A median of five geriatric conditions were assessed per study (interquartile range: 4–8). Little consistency was found in the results of the studies. Furthermore, different tools appear to be predictive depending on the outcome measure: frailty, nutritional status, and comorbidity assessed by the Cumulative Illness Rating Scale for Geriatrics were predictive for all‐cause mortality; frailty was predictive for toxicity of chemotherapy; cognitive impairment and activities of daily living impairment were predictive for chemotherapy completion; and instrumental activities of daily living impairment was predictive for perioperative complications. Conclusion. Although various geriatric conditions appear to be of some value in predicting outcome in elderly patients with cancer, the results are too inconsistent to guide treatment decisions. Further research is needed to elucidate the role of geriatric assessments in the oncologic decision‐making process for these patients. 摘要 背景. 对老年癌症患者进行老年人身心健康评价的意识正在日益提高。本综述旨在总结老年人身心健康评价和相关肿瘤转归的所有有效证据。 方法. 从Medline和Embase数据库系统搜索肿瘤学领域中与老年人身心健康评价有关的研究，着重于基线评估与转归之间的关联。 结果 经文献检索确定了2008篇报道；选择来自37项研究的51篇公开发表文献纳入本综述。研究间存在异质性且研究质量普遍不高。平均每篇文献评估了5种老年病（四分位间距：4~8）。各项研究几乎未出现一致性结果。此外，根据所采用的不同结局观察指标，各种评估工具均有一定的预测价值：经老年病学累积疾病评价量表评估的虚弱、营养状况和合并症对全因死亡有预测价值；虚弱对化疗药物的毒性反应有预测价值；认知损害和日常活动障碍对化疗能否完成有预测价值；工具性日常生活活动障碍对围手术期并发症有预测价值。 结论 尽管各种老年病对预测老年癌症患者的转归似有一定价值，但以上结果过于不一致，难以用于指导治疗决策。需要开展进一步研究以阐明肿瘤治疗决策过程中对此类患者进行老年人身心健康评价的作用。 This review aims to summarize all available evidence on the association between geriatric assessments and relevant oncologic outcomes.