Impact of a comprehensive geriatric assessment on decision‐making in older patients with hematological malignancies

Autor:	Thomas Filleron, Zara Steinmeyer, Stéphane Gérard, D. Brechemier, Marie Garric, Loic Mourey, Loic Ysebaert, Laurent Balardy, Sandrine Sourdet, Bastien Cabarrou, Martin Gauthier, Stéphanie Lozano, Odile Beyne-Rauzy
Rok vydání:	2021
Předmět:	medicine.medical_specialty Activities of daily living Functional impairment Clinical Decision-Making Comorbidity Logistic regression Older patients Treatment plan Internal medicine Humans Medicine Geriatric Assessment Aged Aged 80 and over business.industry Age Factors Disease Management Cancer Geriatric assessment Hematology General Medicine Prognosis medicine.disease Cross-Sectional Studies Hematologic Neoplasms Health Impact Assessment business
Zdroj:	European Journal of Haematology. 106:616-626
ISSN:	1600-0609 0902-4441
DOI:	10.1111/ejh.13570
Popis:	Objective Hematological treatment decisions in older adults with hematological malignancies are complex. Our objective is to study the impact of a comprehensive geriatric assessment on hematological treatment decision in older patients and the factors associated with change in treatment plan. Methods We conducted a cross-sectional analysis of patients aged 65 years and above with hematological malignancies, hospitalized between 2008 and 2019 at the University Cancer Institute of Toulouse. They were assessed by a geriatrician/nurse team using a comprehensive geriatric assessment (CGA). A penalized logistic regression model with elastic net regularization was used to identify factors associated with change in hematological treatment plan. Results A total of 424 patients were included. Main hematological malignancies were lymphoma (36.1 %), acute myeloid leukemia (26.9 %) and myelodysplastic syndrome (19.8%). Change in hematological treatment plan was suggested after CGA for 92 patients (21.7%). Factors associated with change in treatment plan were functional impairment according to ADL and IADL scale, mobility impairment, the presence of comorbidity defined by the Charlson score > 1 and increasing age. Conclusion A CGA has a significant impact on hematological treatment decision in older patients. Functional and mobility impairment, comorbidities and age are predictive factors of change in treatment plan.
Databáze:	OpenAIRE
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