The management of cancer in aging people remains a challenge for physicians. Specialists agree on the assistance provided by a multidimensional geriatric assessment (MGA) to guide the cancer treatment decision-making process. We aim to explore the use of MGA in treatment decision and to identify MGA parameters likely to influence the planned cancer treatment.
Material and Methods
We conducted a single-site retrospective study in patients older than 65 years suffering from various types of cancer who underwent MGA before cancer treatment decision. Logistic regression analyses were used for identification of predictive variables.
In the 266 patients' population, the mean age was 75.8 ± 7.4 years and 155 (58%) patients were men. Patients had solid tumors (95.4%) or hematologic malignancies (4.6%). Most of patients were in advanced setting (57%). The MGA revealed malnutrition (47%), cognitive/mood impairment (48%), functional decline (53%), and led to adjust medical care through reinforcing health status and fostering successful completion of cancer treatment plan for 259 (97%) patients.
The MGA changed cancer treatment in 47 (18%) patients. Functional and/or cognitive impairment, risk of falls, and polypharmacy were associated with treatment change in univariate analysis. No multivariate model was possible.
MGA leads to modification of treatment in only few patients. However, MGA enables a better understanding of patients' strengths and weaknesses essential to improve care management. Further improvements with integration of innovative specific tools are warranted to help decision-process in the increasing complexity of treatment plans available in older adults.
Abbreviations:MGA (Multidimensional Geriatric Assessment), KPS (Karnofsky Performance Status), ECOG-PS (Eastern Cooperative Oncology Group Performance Status), MMSE (Mini Mental State Examination), GDS (Geriatric Depression Scale), ADL (Activities of Daily Living), IADL (Instrumental Activities of Daily Living), POMA (Performance-Oriented Assessment of Mobility instrument), MNA (Mini Nutritional Assessment), BMI (Body Mass Index), CIRS-G (Cumulative Illness Rating Scale for Geriatrics), ELCAPA (Elderly Cancer Patient)
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Published online: June 01, 2018
Accepted: May 11, 2018
Received in revised form: February 21, 2018
Received: October 23, 2017
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