Abbreviated geriatric assessment (GA) in new oncology patients and its association with early death

Autor: Blase N. Polite, William Dale, Michael Maranzano, James A. Wallace, Selina Lai-ming Chow, Anu Radha Neerukonda
Rok vydání: 2020
Předmět:
Zdroj: Journal of Clinical Oncology. 38:12035-12035
ISSN: 1527-7755
0732-183X
DOI: 10.1200/jco.2020.38.15_suppl.12035
Popis: 12035 Background: The ASCO 2018 Geriatric Oncology Guidelines support the broad application of GA to risk-stratify patients age ≥65 undergoing cancer-directed therapy. Despite this, GA has not been widely adopted due largely to perceived time and resource constraints. We administered an abbreviated GA by medical assistants (MAs) in an outpatient oncology clinic to explore its feasibility and correlation with adverse events. Methods: This is a single-institution, retrospective study of adults establishing oncology care at an academic medical center from 11/2016-4/2017. MAs completed an abbreviated GA of well-validated tests. Cognitive function was screened by the Mini-Cog (score < 4) and physical function by the Five Times Sit-to-Stand Test (FTSST ≥ 15 seconds). Patient-reported Outcomes (PRO) screened for malnutrition by the Malnutrition Screening Test (MST ≥ 2), for vulnerability by Vulnerable Elders Survey (VES-13 ≥ 3) and for depression by Patient Health Questionnaire-4 (PHQ-4 > 2). The first result within 3 months of the initial visit was used for analysis. ED visits, inpatient admissions and early death, defined as within the first 6 months from the initial visit, were collected from the electronic medical record. GA results and baseline characteristics were modeled for these events using univariate logistic regression. Multivariable regression was performed when univariate regression revealed at least 2 factors with p< 0.1. Results: New patients 65+ years (n=304, median age 72) established care in our practice during this six-month period. Nearly all patients (n=285, 94%) completed at least one GA test. Fewer patients completed the Mini-Cog and FTSST (60% completed) compared to the PRO screenings (83-90% completed). Those with any positive GA screening test were nearly 3 times as likely to die within 6 months of their initial outpatient visit compared with those with no deficits (OR 2.95, 95% CI 1.11-9.30). Those with FTSST ≥ 15 sec or unable to complete were more likely to have an ED visit within 6 months (OR 2.40, 95%CI 1.04-5.46).No other individual screening test had a statistically significant association with adverse events. Conclusions: An abbreviated version of GA completed by MAs can be incorporated into new oncology patient visits for all older adults, and those with any abnormalities on screening tests had a higher likelihood of early death. [Table: see text]
Databáze: OpenAIRE
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