Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment

Philippe Caillet,1,2 Marie Laurent,1,2 Sylvie Bastuji-Garin,1,3,4 Evelyne Liuu,2 Stephane Culine,5 Jean-Leon Lagrange,6 Florence Canoui-Poitrine,1,2,3,* Elena Paillaud1,2,* 1Laboratoire d’Investigation Clinique (LIC), Faculté de Medecine, Université Paris Est Cr&e...

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Autores principales:	Caillet P, Laurent M, Bastuji-Garin S, Liuu E, Culine S, Lagrange JL, Canoui-Poitrine F, Paillaud E
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Cancer. Geriatric Assessment. Elderly. Mortality. Chemotoxicity. Outcomes Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/8e38125956bd4af2b8b55b81f5294ea2
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spelling	oai:doaj.org-article:8e38125956bd4af2b8b55b81f5294ea22021-12-02T06:11:20ZOptimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment1178-1998https://doaj.org/article/8e38125956bd4af2b8b55b81f5294ea22014-09-01T00:00:00Zhttps://www.dovepress.com/optimal-management-of-elderly-cancer-patients-usefulness-of-the-compre-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Philippe Caillet,1,2 Marie Laurent,1,2 Sylvie Bastuji-Garin,1,3,4 Evelyne Liuu,2 Stephane Culine,5 Jean-Leon Lagrange,6 Florence Canoui-Poitrine,1,2,3,* Elena Paillaud1,2,* 1Laboratoire d’Investigation Clinique (LIC), Faculté de Medecine, Université Paris Est Créteil (UPEC), Créteil, Paris, 2Unité de Coordination d’Onco-Gériatrie, Département de Médecine Interne et Gériatrie, Hôpital Henri-Mondor, Assistance Publique – Hopitaux de Paris (AP-HP), Créteil, 3Service de Santé Publique, Hôpital Henri-Mondor, AP-HP, Créteil, 4Unité de Recherche Clinique, Hôpital Henri-Mondor, AP-HP, Créteil, 5Service d’Oncologie Médicale, Hôpital Saint-Louis, AP-HP, Paris, 6Service de Radiotherapie, Hôpital Henri-Mondor, AP-HP, Créteil, France*These authors contributed equally to this workBackground: Cancer is common in older patients, who raise specific treatment challenges due to aging-related, organ-specific physiologic changes and the presence in most cases of comorbidities capable of affecting treatment tolerance and outcomes. Identifying comorbid conditions and physiologic changes due to aging allows oncologists to better assess the risk/benefit ratio and to adjust the treatment accordingly. Conducting a Comprehensive Geriatric Assessment (CGA) is one approach developed for this purpose. We reviewed the evidence on the usefulness of CGA for assessing health problems and predicting cancer treatment outcomes, functional decline, morbidity, and mortality in older patients with solid malignancies. Methods: We searched Medline for articles published in English between January 1, 2000 and April 14, 2014, and reporting prospective observational or interventional studies of CGA feasibility or effectiveness in patients aged ≥65 years with solid malignancies. We identified studies with at least 100 patients, a multivariate analysis, and assessments of at least five of the following CGA domains: nutrition, cognition, mood, functional status, mobility and falls, polypharmacy, comorbidities, and social environment.Results: All types of CGA identified a large number of unrecognized health problems capable of interfering with cancer treatment. CGA results influenced 21%–49% of treatment decisions. All CGA domains were associated with chemotoxicity or survival in at least one study. The abnormalities that most often predicted mortality and chemotoxicity were functional impairment, malnutrition, and comorbidities.Conclusion: The CGA uncovers numerous health problems in elderly patients with cancer and can affect treatment decisions. Functional impairment, malnutrition, and comorbidities are independently associated with chemotoxicity and/or survival. Only three randomized published studies evaluated the effectiveness of CGA-linked interventions. Further research into the effectiveness of the CGA in improving patient outcomes is needed. Keywords: cancer, geriatric assessment, elderly, mortality, chemotoxicity, outcomesCaillet PLaurent MBastuji-Garin SLiuu ECuline SLagrange JLCanoui-Poitrine FPaillaud EDove Medical PressarticleCancer. Geriatric Assessment. Elderly. Mortality. Chemotoxicity. OutcomesGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 9, Pp 1645-1660 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cancer. Geriatric Assessment. Elderly. Mortality. Chemotoxicity. Outcomes Geriatrics RC952-954.6
spellingShingle	Cancer. Geriatric Assessment. Elderly. Mortality. Chemotoxicity. Outcomes Geriatrics RC952-954.6 Caillet P Laurent M Bastuji-Garin S Liuu E Culine S Lagrange JL Canoui-Poitrine F Paillaud E Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment
description	Philippe Caillet,1,2 Marie Laurent,1,2 Sylvie Bastuji-Garin,1,3,4 Evelyne Liuu,2 Stephane Culine,5 Jean-Leon Lagrange,6 Florence Canoui-Poitrine,1,2,3,* Elena Paillaud1,2,* 1Laboratoire d’Investigation Clinique (LIC), Faculté de Medecine, Université Paris Est Créteil (UPEC), Créteil, Paris, 2Unité de Coordination d’Onco-Gériatrie, Département de Médecine Interne et Gériatrie, Hôpital Henri-Mondor, Assistance Publique – Hopitaux de Paris (AP-HP), Créteil, 3Service de Santé Publique, Hôpital Henri-Mondor, AP-HP, Créteil, 4Unité de Recherche Clinique, Hôpital Henri-Mondor, AP-HP, Créteil, 5Service d’Oncologie Médicale, Hôpital Saint-Louis, AP-HP, Paris, 6Service de Radiotherapie, Hôpital Henri-Mondor, AP-HP, Créteil, France*These authors contributed equally to this workBackground: Cancer is common in older patients, who raise specific treatment challenges due to aging-related, organ-specific physiologic changes and the presence in most cases of comorbidities capable of affecting treatment tolerance and outcomes. Identifying comorbid conditions and physiologic changes due to aging allows oncologists to better assess the risk/benefit ratio and to adjust the treatment accordingly. Conducting a Comprehensive Geriatric Assessment (CGA) is one approach developed for this purpose. We reviewed the evidence on the usefulness of CGA for assessing health problems and predicting cancer treatment outcomes, functional decline, morbidity, and mortality in older patients with solid malignancies. Methods: We searched Medline for articles published in English between January 1, 2000 and April 14, 2014, and reporting prospective observational or interventional studies of CGA feasibility or effectiveness in patients aged ≥65 years with solid malignancies. We identified studies with at least 100 patients, a multivariate analysis, and assessments of at least five of the following CGA domains: nutrition, cognition, mood, functional status, mobility and falls, polypharmacy, comorbidities, and social environment.Results: All types of CGA identified a large number of unrecognized health problems capable of interfering with cancer treatment. CGA results influenced 21%–49% of treatment decisions. All CGA domains were associated with chemotoxicity or survival in at least one study. The abnormalities that most often predicted mortality and chemotoxicity were functional impairment, malnutrition, and comorbidities.Conclusion: The CGA uncovers numerous health problems in elderly patients with cancer and can affect treatment decisions. Functional impairment, malnutrition, and comorbidities are independently associated with chemotoxicity and/or survival. Only three randomized published studies evaluated the effectiveness of CGA-linked interventions. Further research into the effectiveness of the CGA in improving patient outcomes is needed. Keywords: cancer, geriatric assessment, elderly, mortality, chemotoxicity, outcomes
format	article
author	Caillet P Laurent M Bastuji-Garin S Liuu E Culine S Lagrange JL Canoui-Poitrine F Paillaud E
author_facet	Caillet P Laurent M Bastuji-Garin S Liuu E Culine S Lagrange JL Canoui-Poitrine F Paillaud E
author_sort	Caillet P
title	Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment
title_short	Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment
title_full	Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment
title_fullStr	Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment
title_full_unstemmed	Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment
title_sort	optimal management of elderly cancer patients: usefulness of the comprehensive geriatric assessment
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/8e38125956bd4af2b8b55b81f5294ea2
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Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment

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