PARIS – About half of older cancer patients have unrecognized medical problems that may need to be addressed, according to the results of a prospective, multicenter study being conducted in Belgium.
Initial findings from the ongoing study of 1,347 elderly individuals with a mean age of 77 years and a variety of malignant diseases indicate that 51.4% of patients assessed using a systematic battery of geriatric screening tests had additional problems.
The additional problems reported were reduced physical functioning (20.4%), nutritional deficiencies coupled with fatigue (19.2%), falls (16.6%), depression (14.3%), pain (12.6%), cognitive impairments (8.3%), and a lack of social support or problems linked to their social status (5.3%).
"Forty-two per cent of physicians were not aware of the geriatric assessment results at the time of treatment decision," said Cindy Kenis, R.N., of the University Hospitals Leuven (Belgium).
At the annual meeting of the International Society of Geriatric Oncology, Ms. Kenis emphasized the need for better communication between health care professionals who treat elderly patients, specifically between geriatricians and oncologists.
The goal of the study is to look at the utility of a systemic geriatric assessment at 10 institutions in patients aged 70 years and older who have one of six specific tumor types. Currently, almost 39% of study participants have breast cancer, about 22% have colorectal cancer, 14% have hematologic malignancies, nearly 12% have lung cancer, approximately 8% have prostate cancer, and roughly 5% have ovarian carcinomas.
"You have to screen, you have to perform a geriatric assessment, and you have to do something with the results."
Nearly two-thirds of the patients being evaluated are women, with 65% undergoing systematic geriatric assessment at diagnosis and 35% at progression of their malignant disease.
Patients in the study were first screened with the G8 questionnaire, an eight-item tool that can be easily used by oncologists. If the G8 score was 14 or less out of a total of 17, indicating some possible impairment, a full geriatric assessment was performed. This was done in 72.5% of the study population.
The full geriatric assessment includes the evaluation of Activities of Daily Living, Independent or Instrumental Activities of Daily Living, fall history, Mobility-Tiredness questionnaire, the Mini-Mental State Examination, the four-item Geriatric Depression Scale, the Mini Nutritional Assessment, the Charlson Comorbidity Index, and polypharmacy.
Physicians also completed a questionnaire about their awareness of the results of geriatric assessment and treatment plans.
The results of the geriatric assessment led to interventions being planned to address previously unknown problems in a third of patients, with treatment decisions influenced in 15.5%.
While all of these assessments have been used in the study, which may have some oncologists reeling from the additional work involved, Dr. Stuart M. Lichtman of the 65+ clinical geriatrics program at Memorial Sloan-Kettering Cancer Center in New York commented that geriatric assessment did not need to be as complicated in practice. A variety of tools are available to physicians, but the key thing is to be aware and to ask a few simple questions, advised Dr. Lichtman, professor of medicine at Cornell University, New York, who chaired the meeting’s scientific committee and was not involved in the study.
Ms. Kenis agreed with his observations in an interview. "One of the main things is that we have to do an assessment, and that we don’t just perform the assessment, but we actually do something with it."
The study findings support a "three-step" approach in geriatric oncology, Ms. Kenis said: "You have to screen, you have to perform a geriatric assessment, and you have to do something with the results."
The study is supported by the Belgian government as part of the National Cancer Plan. Ms. Kenis said she had no relevant financial disclosures. The society is also known as the Société Internationale d’Oncologie Gériatrique (SIOG).