Prognostic factors for the feasibility of chemotherapy and the Geriatric Prognostic Index (GPI) as risk profile for mortality before chemotherapy in the elderly

Figures & data

Table I. Baseline characteristics of 494 elderly cancer patients.

	Median (range)	N (%)
Age	75 (70–92)
• 70–74 years		237 (48.0)
• 75–79 years		170 (34.4)
• ≥ 80 years		87 (17.6)
Male gender		246 (49.9)
Type of malignancy:
• Upper digestive tract		64 (13.0)
• Lower digestive tract		142 (28.7)
• Hematological		110 (22.3)
• Breast		61 (12.3)
• Gynecological		38 (7.7)
• Prostate		29 (5.9)
• Lung		21 (4.3)
• Urinary tract		11 (2.2)
• Other		18 (3.6)
Purpose of treatment:
• Adjuvant/ curative		206 (41.7)
• Palliative		288 (58.3)

Table II. Results of the geriatric assessments of 494 elderly cancer patients.

Test	Score	N (%)
MNA*	well nourished (risk of) malnutrition* unknown	316 (64.5) 174 (35.5) 4
GFI	< 4 pts ≥ 4 pts unknown	344 (69.8) 149 (30.2) 1
IQCODE	≤ 3.30 pts > 3.30 pts unknown	418 (87.1) 62 (12.9) 14
MMSE	> 24 pts ≤ 24 pts unknown	445 (91.0) 44 (9.0) 5

*(Risk of) malnutrition defined as a score of ≤ 11 on the MNA screening section or less than 24 pts on the assessment section (see Addendum 1).

Table III. Outcome of geriatric assessment of MNA (N = 490), GFI (N = 493), IQCODE (N = 480) and MMSE (N = 489) for feasibility of chemotherapy and overall mortality in elderly cancer patients.

Feasibility	N = 353 ≥ 4 cycles, n (%)	N = 141 < 4 cycles, n (%)	Univariable analysis, odds ratio (95% CI)	p-Value	Multivariable analysis*, odds ratio (95% CI)	p-Value
MNA
Well nourished	245 (69.8)	71 (51.1)	ref		ref
(Risk of) malnutrition	106 (30.2)	68 (48.9)	2.21 (1.48–3.31)	< 0.001	2.30 (1.48–3.58)	< 0.001
GFI
Not frail	258 (73.1)	86 (61.4)	ref		ref
(risk of) frailty	95 (26.9)	54 (38.6)	1.71 (1.13–2.58)	0.01	1.68 (1.08–2.62)	0.02
IQCODE
Normal risk	300 (87.0)	118 (87.4)	ref
Cognitive decline	45 (13.0)	17 (12.6)	0.96 (0.53–1.75)	0.90	–
MMSE
No cognitive dysfunction	322 (92.3)	123 (87.9)	ref
Cognitive dysfunction	27 (7.7)	17 (12.1)	1.65 (0.87–3.13)	0.13	–

Mortality	Alive, N (%)	Deceased, N (%)	Univariable analysis, hazard ratio (95% CI)	p-Value	Multivariable analysis*, hazard ratio (95% CI)	p-Value
MNA
Well nourished	75 (76.5)	241 (61.5)	ref		ref
(Risk of) malnutrition	23 (23.5)	151 (38.5)	1.68 (1.37–2.06)	< 0.001	1.86 (1.48–2.34)	< 0.001
GFI
Not frail	75 (76.5)	269 (68.1)	ref		ref
(risk of) frailty	23 (23.5)	126 (31.9)	1.47 (1.19–1.82)	< 0.001	1.77 (1.41–2.22)	< 0.001
IQCODE
Normal risk	86 (88.7)	332 (86.7)	ref
Cognitive decline	11(1.3)	51 (13.3)	1.12 (0.83–1.50)	0.46	–
MMSE
No cognitive dysfunction	90 (92.8)	355 (90.6)	ref
Cognitive dysfunction	7 (7.2)	37 (9.4)	1.36 (0.97–1.91)	0.08	–

Hazard and odds ratios [with 95% confidence intervals (CI)] were calculated using either Cox regression or logistic regression analysis.

*Adjusted for sex, age, purpose of treatment, type of malignancy.

Table IV. Independent effects of MNA and GFI items for feasibility of chemotherapy and overall mortality in 494 elderly cancer patients.

Feasibility	Present N (%)	≥ 4 cycles, %	< 4 cycles, %	Univariable analysis, odds ratio (95% CI)	p-Value	Multivariable analysis, odds ratio (95% CI)	p-Value
MNA
Declining food intake in past 3 months (A)*	217 (44.2%)	39.3%	56.4%	2.00 (1.34–3.00)	0.001	–	–
Weight loss in past 3 months (B)	179 (36.5%)	32.3%	47.1%	1.88 (1.26–2.80)	0.002	–	–
Psychological stress or acute disease in past 3 months (D)	120 (24.4%)	19.7%	36.4%	2.34 (1.52–3.61)	< 0.001	2.10 (1.31–3.38)	0.002
Dementia or depression (E)	35 (7.1%)	4.6%	13.6%	3.29 (1.64–6.60)	0.001	3.44 (1.50–7.90)	0.004
Using > 3 prescript drugs (H)	181 (36.6%)	31.7%	48.9%	2.06 (1.38–3.07)	< 0.001	1.96 (1.27–3.03)	0.002
Self-view of nutritional status (O)	99 (20.0%)	17.0%	27.7%	1.87 (1.18–2.96)	0.008	–	–
Poor self-rated health (P)	129 (26.1%)	22.1%	36.2%	2.00 (1.31–3.06)	0.001	–	–

Mortality	Present N (%)	Alive, %	Deceased, %	Univariable analysis, hazard ratio (95% CI)	p-Value	Multivariable analysis, hazard ratio (95% CI)	p-Value
MNA
Declining food intake in past 3 months (A)	217 (44.2%)	32.7%	47.1%	1.63 (1.33–1.98)	< 0.001	1.82 (1.47–2.24)	< 0.001
Psychological stress or acute disease in past 3 months (D)	120 (24.4%)	14.3%	27.0%	1.38 (1.11–1.73)	0.004	–	–
Using > 3 prescript drugs (H)	181 (36.6%)	24.2%	39.7%	1.58 (1.29–1.94)	< 0.001	1.38 (1.12–1.71)	0.003
Declining protein intake (K)	90 (18.2%)	12.1%	19.7%	1.49 (1.16–1.91)	0.002	–	–
Intake ≤ 5 cups of fluid per day (M)	35 (7.1%)	2.0%	8.4%	1.76 (1.23–2.52)	0.002	–	–
Self-rated nutritional problems (N)	99 (20.0%)	11.1%	22.3%	1.81 (1.42–2.30)	< 0.001	–	–
Poor self-rated health (P)	129 (26.1%)	18.2%	28.1%	1.62 (1.30–2.02)	< 0.001	–	–
GFI
Dependence in shopping (Q1)	59 (12.0%)	4.1%	13.9%	2.02 (1.51–2.69)	< 0.001	1.77 (1.31–2.40)	< 0.001
Dependence in (un)dressing (Q3)	12 (2.4%)	0.0%	3.0%	2.34 (1.31–4.16)	0.004	–	–
Poor self-rated physical fitness (Q5)	196 (39.8%)	29.6%	42.3%	1.42 (1.16–1.74)	0.001	–	–
Weight loss in past 6 months (Q8)	191 (38.7%)	32.7%	40.3%	1.38 (1.13–1.69)	0.002	–	–

Hazard and odds ratios [with 95% confidence intervals (CI)] were calculated using either Cox regression or logistic regression analysis. Independent predictors in a multivariable Cox-regression model using a stepwise procedure with an entry criterion of p < 0.01, while adjusted for sex, age, purpose of treatment, and type of malignancy.

*A: Item A of MNA, Q5: question 5 of GFI.

Table V. C-statistic coefficients of the different additional models for feasibility of chemotherapy and mortality.

Model	Feasibility	Mortality
Gender, age, purpose of treatment, and type of malignancy	0.61	0.66
MNA + GFI, dichotomized	0.65	0.69
MNA-D + MNA-E + MNA-H	0.69	–
MNA-A + MNA-H + GFI-Q1	–	0.70
GPI score	–	0.70

MNA-A, declining food intake in past 3 months; MNA-D, psychological stress or acute disease in past 3 months; MNA-E, dementia or depression; MNA-H, using > 3 prescript drugs; GFI-Q1, dependence in shopping.

Figure 1. Kaplan–Meier curves of overall survival in 494 elderly patients with various types of cancer according to: [A] MNA item A, [B] MNA item H, [C] GFI question 1 and [D] sum score of these three items.