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An attempt to correlate “Comprehensive Geriatric Assessment” (CGA), treatment assignment and clinical outcome in elderly cancer patients: results of a Phase II open study
9th SIOG Meeting, October 16–18, 2008, Montreal, Canada: Posters on date of diagnosis, and (3) permission from attending physician to contact. Measurement: Data were collected over seven-years of follow-up from consenting patients’ medical records, telephone interviews, and the National Death Index. Outcomes included all cause mortality and selfreported tolerance of treatment side-effects. Four geriatric assessment domains were described by six individual measures: (1) socio-demographic by adequate finances; (2) clinical by Charlson Comorbidity Index [CCI], body mass index [BMI]; (3) function by number of physical function impairments, and (4) psychosocial by 5-Item Mental Health Index [MHI5], Medical Outcomes Study-Social Support Survey [MOS-SS]. Analysis: Associations were evaluated using student t-tests, bivariate and multivariate logistic regression analyses. Results: The mean age of the population was 73.9 years. The majority had adequate finances to meet their needs. About half of the women had stage I disease, nearly one-third had stage IIA disease, the majority (82%) received either a mastectomy or breast conserving surgery followed by radiation, and nearly one-quarter received chemotherapy. Women who died over follow-up were older, had more comorbidity and functional impairments, and lower MHI5 and MOSSS scores (p < 0.05). Women who tolerated treatment side-effects well had less comorbidity and functional impairment and higher MHI5 and MOS-SS scores (p < 0.05). In multivariable logistic regression including age and stage, four measures representing all four geriatric assessment domains predicted mortality: ORAdequateFinances = 0.48 (95%CI 0.27– 0.85), ORCCI 1 = 1.62 (95%CI 1.11–2.35), ORNoFunctionalImpairment = 1.72 (95%CI 1.06–3.15), ORMHI5 80 = 0.62 (0.41–0.94).Three measures from two domains (clinical, psychosocial) predicted tolerance of treatment sideeffects: ORCCI 1 = 0.38 (95%CI 0.18–0.79), ORMHI5 80 = 2.33 (95%CI 1.12–4.83), ORMOS−SS 80 = 2.17 (95%CI 1.01–4.73). Conclusion: This study provides longitudinal evidence that geriatric assessment domains individually predict mortality at seven-years of followup and are related to tolerance of treatment side-effects, independent of age and stage of disease. Cancer-specific geriatric assessment may provide an effective prognostic tool identifying potential targets for intervention and optimizing the clinical management and outcomes of older cancer patients. P.4 An attempt to correlate “Comprehensive Geriatric Assessment” (CGA), treatment assignment and clinical outcome in elderly cancer patients: results of a Phase II open study C. Madeddu, E. Massa, G. Astara, M. Dess`ı, S. Lepori, M. Pisano, C. Spiga, F.M. Tanca, E. Patteri, L. Deiana, G. Mantovani *. Department of Medical Oncology, University of Cagliari, Cagliari, Italy Objectives: To establish a correlation between a specific comprehensive geriatric assessment (CGA) category, an appropriate preventively established treatment and clinical outcome in a population of elderly cancer patients. The ultimate goal was to verify whether the appropriate treatment given to elderly cancer patients according to their CGA category could translate into a better clinical outcome assessed as clinical response and toxicity, i.e whether this process might achieve a clinically meaningful impact. Patients and Methods: We carried out a phase II open, prospective nonrandomized study in 90 elderly cancer patients (lung, head and neck, colorectal, gynecologic and breast) hospitalized at the Department of Medical Oncology, University of Cagliari, Italy. All patients underwent CGA evaluation and were assigned to 3 different categories: fit, intermediate and frail. Thereafter, an appropriate preventively established treatment was administered and the clinical outcome was assessed. The clinical outcome after 3 months of treatment was defined on the basis of objective clinical response and toxicity. The difference of clinical outcome in the CGA categories was assessed by ANOVA test. Moreover, the correlation between CGA category and the clinical outcome (clinical response and toxicity) was assessed by Spearman’s correlation test. Results: A better clinical response was observed in fit patients as compared to both intermediate and frail patients. Treatment toxicity was comparable in the different CGA categories. The correlation analysis between CGA
S29 category, clinical response to treatment and toxicity showed that there was a significant direct correlation with clinical response and no correlation with toxicity. Overall, the regression analysis showed that CGA was predictive of clinical outcome, in the sense that it is truly pedictive for clinical response and no predictive for toxicity. Conclusion: Our study demonstrates that the CGA, although timeconsuming, has a good cost-benefit ratio and is a useful tool to properly select elderly cancer patients in order to design tailor-made effective treatments in terms of survival advantage and improvement of quality of life. Moreover, the treatment preventively established for each MGA category was shown to be adequate and accomplished the most appropriate performances in terms of effectiveness and toxicity. P.5 Sensitization of a medical oncology team to geriatric problems: a pilot study of Leon-Berard Cancer Centre in Lyon (France) S. Perrin *, S. Reynier, C. Terret, and the nursing team of a medical oncology unit at Leon-Berard Cancer Centre, Lyon, France. Leon-Berard Cancer Centre, Lyon, France Purpose of the study: With the population ageing, the number of elderly patients with cancer is steadily increasing. Hospitals that specialize in cancer treatment will likely require higher-level knowledge and skills in geriatrics. The cancer geriatrics unit at Leon-Berard Cancer Center has sought to raise the awareness of professionals working in a medical oncology unit to the specific problems most frequently encountered by elderly patients. Summarised description of the project: A screening tool including 10 geriatric-oriented items was used in hospitalized patients 70 years to identify those at risk of functional decline and/or those actually becoming dependent. The questionnaire was administered by the nurse or auxiliary nurse in charge of the patient within 24 hours of hospital admission. Patients were considered at risk and/or becoming dependent when their score was >4. Results: During the first 2 months of the study, 16 patients (12 men, 4 women) were included. Median age was 75.4 years (range, 71–86 years). The most frequent tumors were: prostate cancer (5), digestive cancer (3) and non Hodgkin’s lymphoma (3). Eight patients had a screening score of 4 or more. The main geriatric problems identified were: weight loss in the past 3 months (8), impaired walking ability (8), intake of more than 5 drugs daily (7), and need of help for daily living (bathing, dressing and meals) (7). Conclusions: The nursing team admitted that they had been surprised by the high number of geriatric problems identified by the screening and they became aware of the difficulties encountered by their patients. The study will be continued. A work program addressing geriatric issues is currently under development in the unit. Members of the cancer geriatrics unit viewed the study as a positive step toward sensitization to geriatric problems in a hospital treating cancer patients. This should help improve the clinical and social trajectories of the patients at various stages of their disease. P.6 Consultation service for senior oncology patients: our 2 year experience in a new outpatient-based clinic D. Wan-Chow-Wah1,2 *, F. Strohschein3 , J. Monette1,2 , C. Pepe3 , G. Papadopoulos1 , M. Monette2 , J. Bianco1 , F. Retornaz1,2 , H. Bergman1,2 . 1 Division of Geriatric Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada, 2 Solidage Research Group on Integrated Services for Older Persons, Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, McGill University, Montreal, Quebec, Canada, 3 Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Quebec, Canada Purpose: To promote a comprehensive approach to the care of older patients with cancer and their families by collaborating with the treating team to develop an individualized, integrated plan of care and make recommendations based on physical and functional assessment.
S29 category, clinical response to treatment and toxicity showed that there was a significant direct correlation with clinical response and no correlation with toxicity. Overall, the regression analysis showed that CGA was predictive of clinical outcome, in the sense that it is truly pedictive for clinical response and no predictive for toxicity. Conclusion: Our study demonstrates that the CGA, although timeconsuming, has a good cost-benefit ratio and is a useful tool to properly select elderly cancer patients in order to design tailor-made effective treatments in terms of survival advantage and improvement of quality of life. Moreover, the treatment preventively established for each MGA category was shown to be adequate and accomplished the most appropriate performances in terms of effectiveness and toxicity. P.5 Sensitization of a medical oncology team to geriatric problems: a pilot study of Leon-Berard Cancer Centre in Lyon (France) S. Perrin *, S. Reynier, C. Terret, and the nursing team of a medical oncology unit at Leon-Berard Cancer Centre, Lyon, France. Leon-Berard Cancer Centre, Lyon, France Purpose of the study: With the population ageing, the number of elderly patients with cancer is steadily increasing. Hospitals that specialize in cancer treatment will likely require higher-level knowledge and skills in geriatrics. The cancer geriatrics unit at Leon-Berard Cancer Center has sought to raise the awareness of professionals working in a medical oncology unit to the specific problems most frequently encountered by elderly patients. Summarised description of the project: A screening tool including 10 geriatric-oriented items was used in hospitalized patients 70 years to identify those at risk of functional decline and/or those actually becoming dependent. The questionnaire was administered by the nurse or auxiliary nurse in charge of the patient within 24 hours of hospital admission. Patients were considered at risk and/or becoming dependent when their score was >4. Results: During the first 2 months of the study, 16 patients (12 men, 4 women) were included. Median age was 75.4 years (range, 71–86 years). The most frequent tumors were: prostate cancer (5), digestive cancer (3) and non Hodgkin’s lymphoma (3). Eight patients had a screening score of 4 or more. The main geriatric problems identified were: weight loss in the past 3 months (8), impaired walking ability (8), intake of more than 5 drugs daily (7), and need of help for daily living (bathing, dressing and meals) (7). Conclusions: The nursing team admitted that they had been surprised by the high number of geriatric problems identified by the screening and they became aware of the difficulties encountered by their patients. The study will be continued. A work program addressing geriatric issues is currently under development in the unit. Members of the cancer geriatrics unit viewed the study as a positive step toward sensitization to geriatric problems in a hospital treating cancer patients. This should help improve the clinical and social trajectories of the patients at various stages of their disease. P.6 Consultation service for senior oncology patients: our 2 year experience in a new outpatient-based clinic D. Wan-Chow-Wah1,2 *, F. Strohschein3 , J. Monette1,2 , C. Pepe3 , G. Papadopoulos1 , M. Monette2 , J. Bianco1 , F. Retornaz1,2 , H. Bergman1,2 . 1 Division of Geriatric Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada, 2 Solidage Research Group on Integrated Services for Older Persons, Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, McGill University, Montreal, Quebec, Canada, 3 Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Quebec, Canada Purpose: To promote a comprehensive approach to the care of older patients with cancer and their families by collaborating with the treating team to develop an individualized, integrated plan of care and make recommendations based on physical and functional assessment.