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Individual components of geriatric assessment for prediction of five year survival after surgery for colorectal cancer
Abstracts
Geriatric Assessment P077 INDIVIDUAL COMPONENTS OF GERIATRIC ASSESSMENT FOR PREDICTION OF FIVE YEAR SURVIVAL AFTER SURGERY FOR COLORECTAL CANCER N. Ommundsen1,⁎, T.B. Wyller1, M.S. Jordhøy2, S. Rostoft1 1 Geriatric Medicine, OSLO UNIVERSITY HOSPITAL, Oslo 2 The Cancer Unit, Innlandet Hospital Trust, Hamar, Norway Introduction: Colorectal cancer (CRC) is a major cause of morbidity and mortality in the older population. Geriatric Assessment (GA) has been found to predict five year survival after surgery in this population, and is recommended as part of the decision-making process. GA encompasses a multitude of domains such as functional status, medication, comorbidity, nutrition, cognitive abilities and signs of depression, and takes 20–60 min to perform. Objectives: The aim of this study was to explore if any of the single components of the GA independently could predict survival. Methods: A cohort of 178 patients aged 70 + scheduled for CRCsurgery was followed prospectively. All patients went through a GA before surgery and were followed for five years or until death. Kaplan-Meier plot and Cox proportional hazards analyses were performed for investigation of the predictive power of the individual GA components for five year survival. Results: Median age was 80 years (range 70–94). 61% of patients had localized disease, 25% had regional disease (TNM stage III) and 12% had distant metastases (TNM stage IV). Five years after surgery, 48% of all patients were alive. In univariate analysis, functional status, medication, comorbidity, nutritional status and cognitive status were all predictive factors for survival. The only GA-element that was not a significant predictor for five-year survival, was depression. In multivariate analysis correcting for TNM-stage and sex, functional status, comorbidity and nutritional status remained individual prognostic factors for five year survival. Conclusion: Functional status, comorbidity and nutritional status independently predict five year survival after surgery for colorectal cancer in older patients. Disclosure of Interest: None declared. Keywords: Colorectal, Epidemiology doi:10.1016/j.jgo.2014.09.106
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basis for individualized treatment algorithms. Screening tools have been developed to facilitate therapy decision-making and detect patients in need of a full assessment. Objectives: Aim of this pilot study was to evaluate the discriminative power and the prognostic impact of the screening scores obtained with the Physical Performance Test (PPT) and the Vulnerable Elders Survey-13 (VES-13). Methods: In 77 cancer patients aged ≥60 years (median 74 years, range 60–93 years) from the Department of Internal Medicine V, Hematology and Oncology, Innsbruck Medical University, VES-13 and PPT were performed and compared with data from multidimensional geriatric assessment and clinical outcome. Results: Overall, of the 77 patients 70% were deemed impaired, as defined by impairments in two or more scores of the MGA. VES-13 showed 42% to be impaired, PPT 79%. Using a cut-off of ≤19, PPT exhibited better discriminative power than did the standard PPT (≤20). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of VES-13, PPT ≤20 and PPT ≤19 in the detection of impairments were 56% (88%, 82%), 91% (45%, 75%), 94% (80%, 89%), 45% (60%, 63%), respectively. The Area under the Curve (AUC) and overall accuracy were 0.73 (0.67, 0.79) and 66% (76%, 80%), respectively. Both impaired VES-13 and impaired PPT ≤19 correlated significantly with an unfavorable overall survival (p = 0.025 and p = 0.046, respectively). The predictive power of the two screening tools was independent of age, sex, tumor subtype, tumor prognosis and comorbidity. Conclusion: The Physical Performance Status (using a cut-off ≤19) exhibits favorable sensitivity, NPV and overall accuracy in elderly cancer patients next to the Vulnerable Elders Survey-13. Still, NPV is too low to adequately discriminate between fit and frail cancer patients. Nevertheless, PPT and VES-13 both have an important predictive power for survival. Disclosure of Interest: None declared. Keywords: Clinical trials, Longevity doi:10.1016/j.jgo.2014.09.107
Geriatric Assessment P079 HIGHER SYMPTOM BURDEN IS ASSOCIATED WITH FUNCTIONAL IMPAIRMENT AND FALLS IN OLDER ADULTS WITH CANCER A. Magnuson1,⁎, C. Pandya1, W. Dale2, J. Wallace2, M. Flannery1, S. Mohile1 1 University of Rochester, Rochester, United States 2 University of Chicago, Chicago, United States
Geriatric Assessment P078 RELEVANCE OF PPT AND VES-13 FOR MULTIDIMENSIONAL GERIATRIC ASSESSMENT AND FOR PREDICTION OF SURVIVAL IN ELDERLY CANCER PATIENTS J. Augschöll1,⁎, M.E. Hamaker2, G. Kemmler3, R. Stauder1 1 Hematology and Oncology, Innsbruck Medical University, Innsbruck, Austria 2 Diakonessenhuis, Utrecht, Netherlands 3 Innsbruck Medical University, Innsbruck, Austria Introduction: The multidimensional geriatric assessment (MGA) is a multidisciplinary evaluation of various dimensions of elderly patients, including functional, psychosocial and cognitive capacities, as well as nutritional status and comorbidities. Therefore it forms the
Introduction: Cancer symptoms (e.g., pain, nausea, dyspnea, anorexia) have been associated with decreased physical functioning. Both symptom burden and functional impairment can impact an older cancer patient's treatment tolerance. Objectives: The objective of this study was to determine the association between symptom burden and functional impairment in older adults with cancer. Methods: Patients age 65+ referred to the University of Rochester and Chicago Specialized Oncology Care and Research in Elderly (SOCARE) geriatric-oncology clinics underwent evaluation with geriatric assessment (GA) including Instrumental Activities of Daily Living (IADL), Medical Outcomes Survey (MOS) physical activity survey and falls in the previous six months. Short Physical Performance Battery (SPPB), was used to characterize physical disability. Impairment was defined as any assistance required for IADLs, any significant limitation
Geriatric Assessment P077 INDIVIDUAL COMPONENTS OF GERIATRIC ASSESSMENT FOR PREDICTION OF FIVE YEAR SURVIVAL AFTER SURGERY FOR COLORECTAL CANCER N. Ommundsen1,⁎, T.B. Wyller1, M.S. Jordhøy2, S. Rostoft1 1 Geriatric Medicine, OSLO UNIVERSITY HOSPITAL, Oslo 2 The Cancer Unit, Innlandet Hospital Trust, Hamar, Norway Introduction: Colorectal cancer (CRC) is a major cause of morbidity and mortality in the older population. Geriatric Assessment (GA) has been found to predict five year survival after surgery in this population, and is recommended as part of the decision-making process. GA encompasses a multitude of domains such as functional status, medication, comorbidity, nutrition, cognitive abilities and signs of depression, and takes 20–60 min to perform. Objectives: The aim of this study was to explore if any of the single components of the GA independently could predict survival. Methods: A cohort of 178 patients aged 70 + scheduled for CRCsurgery was followed prospectively. All patients went through a GA before surgery and were followed for five years or until death. Kaplan-Meier plot and Cox proportional hazards analyses were performed for investigation of the predictive power of the individual GA components for five year survival. Results: Median age was 80 years (range 70–94). 61% of patients had localized disease, 25% had regional disease (TNM stage III) and 12% had distant metastases (TNM stage IV). Five years after surgery, 48% of all patients were alive. In univariate analysis, functional status, medication, comorbidity, nutritional status and cognitive status were all predictive factors for survival. The only GA-element that was not a significant predictor for five-year survival, was depression. In multivariate analysis correcting for TNM-stage and sex, functional status, comorbidity and nutritional status remained individual prognostic factors for five year survival. Conclusion: Functional status, comorbidity and nutritional status independently predict five year survival after surgery for colorectal cancer in older patients. Disclosure of Interest: None declared. Keywords: Colorectal, Epidemiology doi:10.1016/j.jgo.2014.09.106
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basis for individualized treatment algorithms. Screening tools have been developed to facilitate therapy decision-making and detect patients in need of a full assessment. Objectives: Aim of this pilot study was to evaluate the discriminative power and the prognostic impact of the screening scores obtained with the Physical Performance Test (PPT) and the Vulnerable Elders Survey-13 (VES-13). Methods: In 77 cancer patients aged ≥60 years (median 74 years, range 60–93 years) from the Department of Internal Medicine V, Hematology and Oncology, Innsbruck Medical University, VES-13 and PPT were performed and compared with data from multidimensional geriatric assessment and clinical outcome. Results: Overall, of the 77 patients 70% were deemed impaired, as defined by impairments in two or more scores of the MGA. VES-13 showed 42% to be impaired, PPT 79%. Using a cut-off of ≤19, PPT exhibited better discriminative power than did the standard PPT (≤20). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of VES-13, PPT ≤20 and PPT ≤19 in the detection of impairments were 56% (88%, 82%), 91% (45%, 75%), 94% (80%, 89%), 45% (60%, 63%), respectively. The Area under the Curve (AUC) and overall accuracy were 0.73 (0.67, 0.79) and 66% (76%, 80%), respectively. Both impaired VES-13 and impaired PPT ≤19 correlated significantly with an unfavorable overall survival (p = 0.025 and p = 0.046, respectively). The predictive power of the two screening tools was independent of age, sex, tumor subtype, tumor prognosis and comorbidity. Conclusion: The Physical Performance Status (using a cut-off ≤19) exhibits favorable sensitivity, NPV and overall accuracy in elderly cancer patients next to the Vulnerable Elders Survey-13. Still, NPV is too low to adequately discriminate between fit and frail cancer patients. Nevertheless, PPT and VES-13 both have an important predictive power for survival. Disclosure of Interest: None declared. Keywords: Clinical trials, Longevity doi:10.1016/j.jgo.2014.09.107
Geriatric Assessment P079 HIGHER SYMPTOM BURDEN IS ASSOCIATED WITH FUNCTIONAL IMPAIRMENT AND FALLS IN OLDER ADULTS WITH CANCER A. Magnuson1,⁎, C. Pandya1, W. Dale2, J. Wallace2, M. Flannery1, S. Mohile1 1 University of Rochester, Rochester, United States 2 University of Chicago, Chicago, United States
Geriatric Assessment P078 RELEVANCE OF PPT AND VES-13 FOR MULTIDIMENSIONAL GERIATRIC ASSESSMENT AND FOR PREDICTION OF SURVIVAL IN ELDERLY CANCER PATIENTS J. Augschöll1,⁎, M.E. Hamaker2, G. Kemmler3, R. Stauder1 1 Hematology and Oncology, Innsbruck Medical University, Innsbruck, Austria 2 Diakonessenhuis, Utrecht, Netherlands 3 Innsbruck Medical University, Innsbruck, Austria Introduction: The multidimensional geriatric assessment (MGA) is a multidisciplinary evaluation of various dimensions of elderly patients, including functional, psychosocial and cognitive capacities, as well as nutritional status and comorbidities. Therefore it forms the
Introduction: Cancer symptoms (e.g., pain, nausea, dyspnea, anorexia) have been associated with decreased physical functioning. Both symptom burden and functional impairment can impact an older cancer patient's treatment tolerance. Objectives: The objective of this study was to determine the association between symptom burden and functional impairment in older adults with cancer. Methods: Patients age 65+ referred to the University of Rochester and Chicago Specialized Oncology Care and Research in Elderly (SOCARE) geriatric-oncology clinics underwent evaluation with geriatric assessment (GA) including Instrumental Activities of Daily Living (IADL), Medical Outcomes Survey (MOS) physical activity survey and falls in the previous six months. Short Physical Performance Battery (SPPB), was used to characterize physical disability. Impairment was defined as any assistance required for IADLs, any significant limitation