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S94
A B S T R A C T S
for frailty by G8, GFI and CGA. Independent from the outcome
decision for treatment by the oncologist or the outcome of
the frailty screening, all patients undergo CGA by a blinded
geriatrician. The outcome of CGA: no risk, intermediate risk
or high risk is blind for the oncologist, unless there is acute
danger for the patient when treatment should start. Goal is
to gain 120 patients in two years. The follow-up of patients
is six months to register treatment toxicity (laboratory
results), admission to hospital, dosis reduction and treatment
discontinuation. The outcomes of the screening assessment
tools will be validated against CGA and the decision for
treatment based on the oncologist experience. Outcome
of treatment will be weighted against the outcome of the
screening tools and CGA.
Results:
Since we are still including patients, no results
can be shown yet. However it is possible to point out
some difficulties in the progression of the study. First, the
inclusion by the oncologist group. In general the oncologist
are participating in a lot of (treatment) trials and they need
to be reminded to include our specific group of patients.
Especially the part of the patients who decided not to start
chemotherapy, the reason not to participate can be twofold.
First, these patients may not see the need for yet more
diagnostics and spending more time in hospital and second,
they might be more frail, and may be biased for other reasons
(such as family experience, general practioner attitude).
In this part our oncology nurses are playing an important
role, they are alert and have time to inform patients about
the screening. Besides, the geriatricians need to be flexible
to do all the screenings on the day of the oncologist’s visit
and to do the screening in the same way to prevent missing
values. Another major factor during this study period was a
huge merger between our and another hospital resulting in
the move of our oncology department to the other hospital
location, resulting in more logistic problems.
Conclusion:
When starting research, it is very important to
realize what extra burden it will bring on all the participants:
patients and docters. There is always the realization that the
motivation of all the participants takes a lot of time and effort
and that both parties need to be prepared for unexpected
events to occur, while simultaneously be ready to react to
these. Furthermore, there is a real need to have all the logistics
close together, to emphasize for patients that screening and
CGA is part of the diagnostic process and for oncologists that
geriatric screening is not something to be overlooked.
Disclosure of interest:
None declared
Keywords:
CGA, chemotherapy, frailty, geriatric assessment
P099
PERFORMANCE OF FOUR FRAILTY CLASSIFICATIONS IN
OLDER PATIENTS WITH CANCER: PROSPECTIVE ELCAPA
COHORT STUDY
E. Ferrat
1,
*, E. Paillaud
1
, P. Caillet
1
, M. laurent
1
, C. Tournigand
2
,
J.-L. Langrange
3
, J. P. Droz
4
, L. Balducci
5
, E. Audureau
1
,
F. Canoui-Poitrine
1
, S. Bastuji-Garin
1
on behalf of the ELCAPA
Study Group
1
CEPIA EA7376,
2
Département oncologie médicale, APHP Henri-
Mondor,
3
Département de radiothérapie, APHP Henri-Mondor,
Créteil,
4
Claude-Bernard-Lyon-1 University and Department of
Medical Oncology, Centre Léon-Bérard, Lyon, France,
5
H Lee Moffitt
Cancer Center and Research Institute, Tampa, FL, USA
Introduction:
Frailty classifications of older patients with
cancer have been developed to assist physicians in selecting
cancer treatments and geriatric interventions. They have
not been compared, and neither has their performance in
predicting outcomes been assessed.
Objectives:
Our objectives were to assess agreement
among four classifications and to compare their predictive
performance in a large cohort of in- and outpatients with
various cancers.
Methods:
We prospectively included 1021 patients aged
70 years who had solid or hematologic malignancies and
underwent a geriatric assessment in one of two French
teaching hospitals
between 2007 and 2012. Among them, 763
were assessed using four classifications, namely, Balducci,
SIOG 1, SIOG 2, and a latent class typology (LCT). Agreement
was assessed using the kappa (k) statistic. Outcomes were
1-year mortality and 6-month unscheduled admissions.
Results:
For classification into three categories (fit,
vulnerable, and frail) or two categories (fit vs. vulnerable/
frail or fit/vulnerable vs. frail), agreement among the four
classifications ranged from very poor (k
0.20) to good
(k
0.60). Agreement was best between SIOG 1 and LCT
and between SIOG 1 and Balducci. All four classifications
had good discrimination for 1-year mortality (C-index
0.70); discrimination was best with SIOG 1. For 6-month
unscheduled admissions, discrimination was good with all
four classifications (C-index
0.70).
Conclusion:
These four frailty classifications have good
prognostic performance among elderly in- and outpatients
with various cancers.They may be used by physicians to guide
decisions about cancer treatments and geriatric interventions
and/or to stratify older patients with cancer in clinical trials.
Disclosure of interest:
None declared
Keywords:
Cancer, elderly, Geriatric assessment, nursing/
allied health & socio-economic issues, mortality