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Abstract
Background. Comprehensive geriatric assessment (CGA) is a multidimensional method to detect frailty in elderly patients. Time saving could be accomplished by identifying those individual items that classify elderly cancer patients at risk for feasibility of chemotherapy and for mortality.
Material and methods. Patients older than 70 years of age were assessed before the first chemotherapy administration. GA consisted of the Mini Nutritional Assessment (MNA), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Groningen Frailty Indicator (GFI) and Mini Mental State Examination (MMSE). Predictive individual items for feasibility of chemotherapy and mortality were entered in the multivariable logistic regression and Cox-regression models, and a three-item sum scale was constructed: the Geriatric Prognostic Index (GPI).
Results. The 494 patients had a median age of 75 years (range 70–92 years). The majority of the patients had malignancies of the digestive tract (41.7%) followed by hematological tumors (22.3%). Three items of the MNA (‘psychological distress or acute disease in the past three months’, ‘neuropsychological problems’ and ‘using > 3 prescript drugs’) independently predicted for feasibility of chemotherapy. Two items of the MNA and one of the GFI (‘declining food intake in past 3 months’, ‘using > 3 prescript drugs’, and ‘dependence in shopping’) independently predicted for mortality. In comparison with patients without any positive item on the three-item GPI, patients with one, two or three positive items had hazard ratios (HRs) of 1.58, 2.32, and 5.58, respectively (all p < 0.001).
Conclusions. With only three items of the MNA, feasibility of chemotherapy can be predicted. The three-item GPI may help to identify elderly cancer patients at elevated risk for mortality.
Acknowledgements
The authors would like to thank Hermine Verlaan, Ria Peters-Dijkshoorn, Hans Polderdijk, Siepke Hiddema and Inge Roozen of the participating hospitals for performing the geriatric assessments, and Wilma Kloosterman-Boele of the Comprehensive Cancer Centre the Netherlands for collecting the clinical data. This work was supported by the Stichting Zorg & Leven, Oncologie (ZOLEON foundation). ZOLEON had no involvement in data collection, analyses and writing.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Supplementary material available online
Supplementary Addendum 1–4 available online at http://informahealthcare.com/doi/abs/10.3109/0284186X.2015.1068446