Comprehensive Geriatric Assessment in the Decision-Making Process in Elderly Patients With Cancer: ELCAPA Study
| Autor: | Sylvie Bastuji-Garin, Muriel Berle, Stéphane Culine, Nicoleta Reinald, Florence Canoui-Poitrine, Philippe Caillet, Elena Paillaud, Johanna Vouriot, Sébastien Krypciak |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty Activities of daily living Multivariate analysis Decision Making MEDLINE Comorbidity Rating scale Neoplasms Internal medicine Activities of Daily Living medicine Humans Prospective Studies Prospective cohort study Geriatric Assessment Aged Aged 80 and over Geriatrics Depression business.industry Malnutrition Cancer medicine.disease Oncology Multivariate Analysis Physical therapy Female Cognition Disorders business |
| Zdroj: | Journal of Clinical Oncology. 29:3636-3642 |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/jco.2010.31.0664 |
| Popis: | Purpose To identify Comprehensive Geriatric Assessment (CGA) components independently associated with changes in planned cancer treatment. Patients and Methods We prospectively included 375 consecutive elderly patients with cancer (ELCAPA01 study) assessed by geriatricians using the CGA. Multivariate analysis was used to identify factors associated with changes in the cancer treatment (intensification, decrease, or delayed > 2 weeks). Change was defined as a difference between the initial treatment proposal and the final treatment selected in a multidisciplinary meeting. Results Mean age was 79.6 years (standard deviation [SD], 5.6 years), and 197 (52.5%) were women. The most common tumor location was the digestive system (58.7%). The mean number of comorbidities was 4.2 (SD, 2.7) per patient, and the mean Cumulative Illness Rating Scale for Geriatrics score was 11.8 (SD, 5.3). After the CGA, the initial cancer treatment plan was modified for 78 (20.8%) of 375 patients (95% CI, 16.8 to 25.3), usually to decrease treatment intensity (63 [80.8%] of 78 patients). By univariate analysis, cancer treatment changes were associated with Eastern Cooperative Oncology Group performance status ≥ 2 (73.3% in the group with changes v 41.1% in the in the group without changes; P < .001), dependency for one or more activities of daily living (ADL; 59.0% v 24.2%; P < .001), malnutrition (81.8% v 51.2%; P < .001), cognitive impairment (38.5% v 24.9%; P = .023), depression (52.6% v 21.7%; P < .001), and greater number of comorbidities (mean, 4.8 [SD, 2.9] v 4.0 [SD, 2.6]; P = .02). By multivariate analysis, factors independently associated with cancer treatment changes were a lower ADL score (odds ratio [OR], 1.25 per 0.5-point decrease; CI, 1.04 to 1.49; P = .016) and malnutrition (OR, 2.99; CI, 1.36 to 6.58; P = .007). Conclusion Functional status assessed by the ADL score and malnutrition were independently associated with changes in cancer treatment. |
| Databáze: | OpenAIRE |
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