Predicting outcome in older patients with cancer: Comprehensive geriatric assessment and clinical judgment.

Autor: Versteeg KS; Amsterdam University Medical Center, VU Medical Center Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.; Amsterdam University Medical Center, VU Medical Center Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands. Electronic address: k.versteeg@amsterdamumc.nl., Looijaard SMLM; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands. Electronic address: s.looijaard@vu.nl., Slee-Valentijn MS; Center of Excellence in Geriatric Rehabilitation, Cordaan, Postbus 1103, 1000 BC Amsterdam, the Netherlands. Electronic address: mslee@cordaan.nl., Verheul HMW; Radboud University Medical Center, Radboud University, Department of Medical Oncology, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands. Electronic address: henk.verheul@radboudumc.nl., Maier AB; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, 300 Grattan Street, Victoria 3050, Melbourne, Australia.. Electronic address: andrea.maier@mh.org.au., Konings IRHM; Amsterdam University Medical Center, VU Medical Center Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.. Electronic address: i.konings@amsterdamumc.nl.
Jazyk: angličtina
Zdroj: Journal of geriatric oncology [J Geriatr Oncol] 2021 Jan; Vol. 12 (1), pp. 49-56. Date of Electronic Publication: 2020 Sep 14.
DOI: 10.1016/j.jgo.2020.08.009
Abstrakt: Objectives: Comprehensive Geriatric Assessment (CGA) has been incorporated into geriatric oncology to prevent unfavorable outcome from anticancer treatment. This study determined the value of CGA and medical oncologist's clinical judgment in predicting unfavorable outcome and explored whether treatment decisions can be based on CGA.
Patients and Methods: In this prospective cohort study, a multidomain CGA was performed by a geriatric nurse and geriatrician in 110 consecutive patients aged ≥70 years, newly referred to a multidisciplinary oncology clinic. CGA domains included comorbidity, polypharmacy, mood, cognition, nutrition, functionality and physical performance. Medical oncologist's clinical judgment on expected tolerance of standard treatment was noted (N = 62). Unfavorable outcome was defined as any ≥grade three chemotherapy toxicity, dose reduction, postponement of treatment, death before start of treatment and early progression before first evaluation of treatment (N = 80).
Results: CGA identified multidomain problems in 77 out of 110 patients (70.0%) and the medical oncologist had doubts about standard treatment tolerance in 30 out of 62 patients (48.4%). Unfavorable outcome occurred in 48 out of 80 patients (60%) who received anticancer treatment but could not be predicted by CGA, medical oncologists' clinical judgment or their combination. There was discrepancy between CGA and clinical judgment in 24 out of 62 patients (38.7%).
Conclusion: Neither CGA, medical oncologist's clinical judgment or a combination could predict unfavorable outcome in our heterogeneous sample. CGA and clinical judgment did not align in more than one-third of patients.
Competing Interests: Declaration of Competing Interest Kathelijn S. Versteeg, Stéphanie M.L.M. Looijaard, Monique S. Slee-Valentijn, Henk M.W. Verheul, Andrea B. Maier and Inge R.H.M. Konings declare that they have no conflict of interest.
(Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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