A B S T R A C T S
prior to the MDT, at which clinicians, blinded to the G8 result,
made a recommendation on appropriate treatment, including
referral for CGA if considered advisable. Patients considered
vulnerable (G8 score <14) were also to be referred for CGA.
Subsequent treatment and outcomes were recorded.
Over 6 months, 35 patients were recruited, median
age 74 (range 65-93). Seventeen (49%) patients were assessed
as vulnerable by the G8 score, including 7 (20%) whom the
MDT referred for CGA. Seven with G8 scores <14 did not
receive a CGA. Thirty (85.7%) underwent curative-intent
treatment, including 6 of 7 who had CGA. Of 10 vulnerable
patients who did not have CGA, 60% received curative-intent
treatment. Mean length of post-operative stay was 12.2 vs.
6.5 days in patients deemed vulnerable or fit by G8 scores,
respectively (p=0.46); completion rate of radical radiotherapy
was 75% vs. 100% in each group, respectively (p=0.13). Mean
post-operative length of stay in vulnerable patients who
underwent a CGA was 6.2 days vs. 17.3 days in those who
were not referred (p=0.79).
The G8 tool identified twice the number of
patients as vulnerable compared to theMDT.There was a trend
towards longer post-operative stay and lower radiotherapy
completion rates in patients deemed vulnerable by G8 scores.
Disclosure of interest:
G8, comprehensive geriatric assessment, head
and neck cancer
ALTERATION OF DOMAINS IN COMPREHENSIVE GERIATRIC
ASSESSMENTS AND SURVIVAL IN A FRENCH MULTICENTER
COHORT OF ELDERLY PATIENTS WITH CANCER
*, P. Soubeyran
, C. Bellera
, M. Rainfray
and French ONCODAGE group
Inserm U1219 Research Center, Epicene Team (Epidemiology of
Cancer and Environmental Exposure),
U1218 Research Unit,
Cancer Institute (INCa) Integrated Cancer Research Site (SIRIC),
Department of Medical Oncology, Institut
Bergonié, Comprehensive Cancer Center,
Clinical Research and
Clinical Epidemiology Unit, Institut Bergonié, Comprehensive
Cancer Centre, Bordeaux, France
More than 200,000 elderly patients are
treated for cancer every year in France. Major risks faced by
these patients include death and institutionalization. Frailty,
a group of disorders related to age, is predictive of these risks.
Frail elderly patients are usually detected by a comprehensive
geriatric assessment (CGA) that evaluates several domains
including nutritional status, autonomy, mobility, cognitive
and psychological status, and comorbidities.
This work aimed at estimating the association
between altered domains of CGA at cancer diagnosis and
overall survival (OS) of elderly patients with cancer. The
secondary objective was to estimate the association with
institutionalization at five years.
From 2008 to 2010, cancer patients were
consecutively included in a multicenter study (ONCODAGE) at
diagnosis.Twenty-three French centers participated. CGAwere
performed at baseline and included seven questionnaires:
mini nutritional assessment (MNA), activities of daily living
(ADL), instrumental ADL (IADL), timed get up and go (TUG),
mini-mental state examination (MMSE), geriatric depression
scale 15 (GDS-15) and cumulative illness rating scale (CIRS-G).
Survival and data on living place were collected at five years.
Sample baseline characteristics were described. Median
survival was estimated using Kaplan-Meier survival curves.
Relative risk of death was estimated for each CGA’s domain
using seven multivariate Cox models (one per questionnaire).
For institutionalization, logistic models were used. Each
time, adjustment factors were selected using directed acyclic
A total of 1264 patients were analyzed for OS
(mean age: 78 years, women: 70%, breast cancer: 55%, altered
autonomy: 42%, altered nutritional status: 41%). Median
follow-up was 5.2 years and 446 patients died during the
study period. Institutionalization was evaluated in 366
patients (mean age: 76 years, women: 80%, breast cancer:
72%, altered autonomy: 25%, altered nutritional status: 26%).
All CGA domains, if altered, were associated with a decreased
OS. For several domains, these effects were only statistically
significant during a certain period or for some patient
categories. Altered nutritional status was associated with
decreased OS at one and three years (HR=2.97, p<0.01 and
HR=2.24, p<0.01, respectively) but not at five years. Altered
autonomy and mobility were associated with a lower survival
for younger patients, and women when assessed by IADL
(ADL, IADL, TUG: HR=1.54, p<0.01; HR=1.46, p=0.02; HR=2.19,
p<0.01, respectively). Altered cognitive status and a decreased
OS were only associated for the most educated patients
(primary, secondary and graduated degrees: HR=1.84, p<0.01;
HR=2.67, p=0.01; HR=3.89, p=0.03, respectively). Psychological
status and more than four comorbidities were associated for
all patients (GDS-15: HR=1.38, p<0.01; CIRS-G: HR=1.64, p<0.01).
Only altered autonomy assessed by IADL and cognitive status
were associated with more institutionalizations (OR=8.90,
p<0.01; OR=6.30, p=0.02, respectively).
These results confirm the interest of CGA
for elderly people with cancer. Altered domains of CGA
were associated with a decreased five-year OS. Awareness
of the importance of these factors depending on patients’
characteristics can help provide appropriate supportive cares.
Disclosure of interest:
Cancer, comprehensive geriatric assessment,
elderly patient, institutionalization, survival