Background: Comprehensive Geriatric Assessment (CGA) is an essential tool for identifying underlying conditions that may influence treatment outcomes in older cancer patients. CGA facilitates the individualization of chemotherapy plans, reduces the risk of adverse events, and improves prognosis. However, its implementation in routine clinical practice remains limited. Objective: To conduct a CGA. in older cancer patients undergoing chemotherapy and to evaluate the association between geriatric characteristics and modifications of chemotherapy regimens after a three-month follow-up. Methods: A descriptive cross-sectional study with a prospective longitudinal follow-up over 3 months was conducted among older patients with colorectal cancer (aged ≥60 years) receiving chemotherapy at the Department of Medical Oncology, University Medical Center Ho Chi Minh City. The chi-square test (with Fisher’s exact correction, when appropriate) was used to examine the association between geriatric characteristics, clinical conditions, and changes in chemotherapy regimen. Results: A total of 180 older adults were included (mean age: 66.4 ± 5.3 years; range: 60–88). ADL and IADL dependence were observed in 14.4% and 18.9% of patients, respectively. The mean Charlson Comorbidity Index was 4.76 ± 2.1. Malnutrition was present in 65.6%, cognitive impairment in 11.7%, depression risk in 35%, polypharmacy in 86.1%, and fall risk in 6.7%. Chemotherapy was intensified in 4.0%, dose-reduced in 8.3%, and discontinued in 13.3% of patients. ADL dependency and risk of falls were found to be associated with changes in chemotherapy regimen, with p-values of 0.043 and 0.047, respectively, indicating borderline statistical significance. Conclusions: In the exploratory analysis, ADL dependency and risk of falls were found to be associated with changes in the chemotherapy regimen after 3 months among older patients with cancer receiving chemotherapy. However, these findings should be confirmed in studies with larger sample sizes and multivariable analyses.
COMPREHENSIVE GERIATRIC ASSESSMENT IN OLDER CANCER PATIENTS UNDERGOING CHEMOTHERAPY AT UNIVERSITY MEDICAL CENTER HO CHI MINH CITY
0
Views
0
Downloads
Keywords
Comprehensive Geriatric Assessment, older adults, cancer, chemotherapy.
Abstract
References
[1]
Soubeyran P, Fonck M, Blanc-Bisson C, Blanc JF, Ceccaldi J, Mertens C, et al. Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2012 May 20;30(15):1829-34. doi: 10.1200/jco.2011.35.7442.
Google Scholar
[2]
Kim JW, Kim YJ, Lee KW, Chang H, Lee JO, Kim KI, et al. The early discontinuation of palliative chemotherapy in older patients with cancer. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2014 Mar;22(3):773-81. doi: 10.1007/s00520-013-2033-y.
Google Scholar
[3]
Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen ML, Extermann M, et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2014 Aug 20;32(24):2595-603. doi: 10.1200/jco.2013.54.8347.
Google Scholar
[4]
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2024;74(3):229-63. doi: https://doi.org/10.3322/caac.21834.
Google Scholar
[5]
Retornaz F, Guillem O, Rousseau F, Morvan F, Rinaldi Y, Nahon S, et al. Predicting Chemotherapy Toxicity and Death in Older Adults with Colon Cancer: Results of MOST Study. The oncologist. 2020 Jan;25(1):e85-e93. doi: 10.1634/theoncologist.2019-0241.
Google Scholar
[6]
Feliu J, Custodio AB, Pinto-Marín A, Higuera O, Pérez-González M, Del Pino L, et al. Predicting Risk of Severe Toxicity and Early Death in Older Adult Patients Treated with Chemotherapy. Cancers. 2023 Sep 21;15(18). doi: 10.3390/cancers15184670.
Google Scholar
[7]
Munir A, Huws A, Khan S, Sharaiha Y, Holt S, Khawaja S. Geriatric assessment tool application in treatment recommendations for older women with breast cancer. Breast (Edinburgh, Scotland). 2022 Jun;63:101-7. doi: 10.1016/j.breast.2022.03.012.
Google Scholar
[8]
Mohamed MR, Rich DQ, Seplaki C, Lund JL, Flannery M, Culakova E, et al. Primary Treatment Modification and Treatment Tolerability Among Older Chemotherapy Recipients With Advanced Cancer. JAMA network open. 2024 Feb 5;7(2):e2356106. doi: 10.1001/jamanetworkopen.2023.56106.
Google Scholar
[9]
Bang HJ, Shim HJ, Kim GR, Hwang JE, Bae WK, Chung IJ, et al. Geriatric functional assessment for decision-making on adjuvant chemotherapy in older colon cancer patients. The Korean journal of internal medicine. 2022 May;37(3):660-72. doi: 10.3904/kjim.2021.324.
Google Scholar
[10]
Rier HN, Meinardi MC, van Rosmalen J, Westerweel PE, de Jongh E, Kitzen J, et al. Association Between Geriatric Assessment and Post-Chemotherapy Functional Status in Older Patients with Cancer. The oncologist. 2022 Nov 3;27(11):e878-e88. doi: 10.1093/oncolo/oyac131.
Google Scholar