Predicting outcome in older patients with cancer: Comprehensive geriatric assessment and clinical judgment

K.S. Versteeg; S.M.L.M. Looijaard; M.S. Slee-Valentijn; H.M.W. Verheul; A.B. Maier; I.R.H.M. Konings

doi:10.1016/j.jgo.2020.08.009

Predicting outcome in older patients with cancer: Comprehensive geriatric assessment and clinical judgment

K.S. Versteeg
, S.M.L.M. Looijaard
, M.S. Slee-Valentijn
, H.M.W. Verheul
, A.B. Maier
, I.R.H.M. Konings

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Objectives: Comprehensive Geriatric Assessment (CGA) has been incorporated into geriatric oncology to prevent unfavorable outcome from anticancer treatment. This study determined the value of CGA and medical oncologist's clinical judgment in predicting unfavorable outcome and explored whether treatment decisions can be based on CGA.

Patients and Methods: In this prospective cohort study, a multidomain CGA was performed by a geriatric nurse and geriatrician in 110 consecutive patients aged ≥70 years, newly referred to a multidisciplinary oncology clinic. CGA domains included comorbidity, polypharmacy, mood, cognition, nutrition, functionality and physical performance. Medical oncologist's clinical judgment on expected tolerance of standard treatment was noted (N = 62). Unfavorable outcome was defined as any ≥grade three chemotherapy toxicity, dose reduction, postponement of treatment, death before start of treatment and early progression before first evaluation of treatment (N = 80).

Results: CGA identified multidomain problems in 77 out of 110 patients (70.0%) and the medical oncologist had doubts about standard treatment tolerance in 30 out of 62 patients (48.4%). Unfavorable outcome occurred in 48 out of 80 patients (60%) who received anticancer treatment but could not be predicted by CGA, medical oncologists' clinical judgment or their combination. There was discrepancy between CGA and clinical judgment in 24 out of 62 patients (38.7%).

Conclusion: Neither CGA, medical oncologist's clinical judgment or a combination could predict unfavorable outcome in our heterogeneous sample. CGA and clinical judgment did not align in more than one-third of patients.

Original language	English
Pages (from-to)	49-56
Number of pages	8
Journal	Journal of Geriatric Oncology
Volume	12
Issue number	1
Early online date	14 Sept 2020
DOIs	https://doi.org/10.1016/j.jgo.2020.08.009
Publication status	Published - Jan 2021

Bibliographical note

Funding

European Union’s Horizon 2020: Marie-Sklodowska-Curie grant agreement no. 675003; PANINI. The funding was not specifically given for the Multidisciplinary Older Oncology Patient Clinic. This work was supported by the European Union’s Horizon 2020 research and innovation program under the Marie-Sklodowska-Curie grant agreement no. 675003 ( PANINI program). The funders had no role in the study design, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication. This work was supported by the European Union's Horizon 2020 research and innovation program under the Marie-Sklodowska-Curie grant agreement no. 675003 (PANINI program). The funders had no role in the study design, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication.

Funders	Funder number
European Union's Horizon 2020 research and innovation program
Horizon 2020 Framework Programme	675003

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Access to Document

10.1016/j.jgo.2020.08.009

Persistent URL (handle)

Persistent link

Cite this

@article{b98cb004d2184156a81a4694d9ee7f5b,

title = "Predicting outcome in older patients with cancer: Comprehensive geriatric assessment and clinical judgment",

abstract = "Objectives: Comprehensive Geriatric Assessment (CGA) has been incorporated into geriatric oncology to prevent unfavorable outcome from anticancer treatment. This study determined the value of CGA and medical oncologist's clinical judgment in predicting unfavorable outcome and explored whether treatment decisions can be based on CGA. Patients and Methods: In this prospective cohort study, a multidomain CGA was performed by a geriatric nurse and geriatrician in 110 consecutive patients aged ≥70 years, newly referred to a multidisciplinary oncology clinic. CGA domains included comorbidity, polypharmacy, mood, cognition, nutrition, functionality and physical performance. Medical oncologist's clinical judgment on expected tolerance of standard treatment was noted (N = 62). Unfavorable outcome was defined as any ≥grade three chemotherapy toxicity, dose reduction, postponement of treatment, death before start of treatment and early progression before first evaluation of treatment (N = 80). Results: CGA identified multidomain problems in 77 out of 110 patients (70.0\%) and the medical oncologist had doubts about standard treatment tolerance in 30 out of 62 patients (48.4\%). Unfavorable outcome occurred in 48 out of 80 patients (60\%) who received anticancer treatment but could not be predicted by CGA, medical oncologists' clinical judgment or their combination. There was discrepancy between CGA and clinical judgment in 24 out of 62 patients (38.7\%). Conclusion: Neither CGA, medical oncologist's clinical judgment or a combination could predict unfavorable outcome in our heterogeneous sample. CGA and clinical judgment did not align in more than one-third of patients.",

author = "K.S. Versteeg and S.M.L.M. Looijaard and M.S. Slee-Valentijn and H.M.W. Verheul and A.B. Maier and I.R.H.M. Konings",

note = "{\textcopyright} 2020 The Authors.",

year = "2021",

month = jan,

doi = "10.1016/j.jgo.2020.08.009",

language = "English",

volume = "12",

pages = "49--56",

journal = "Journal of Geriatric Oncology",

issn = "1879-4068",

publisher = "Elsevier Ltd",

number = "1",

}

TY - JOUR

T1 - Predicting outcome in older patients with cancer

T2 - Comprehensive geriatric assessment and clinical judgment

AU - Versteeg, K.S.

AU - Looijaard, S.M.L.M.

AU - Slee-Valentijn, M.S.

AU - Verheul, H.M.W.

AU - Maier, A.B.

AU - Konings, I.R.H.M.

PY - 2021/1

Y1 - 2021/1

N2 - Objectives: Comprehensive Geriatric Assessment (CGA) has been incorporated into geriatric oncology to prevent unfavorable outcome from anticancer treatment. This study determined the value of CGA and medical oncologist's clinical judgment in predicting unfavorable outcome and explored whether treatment decisions can be based on CGA. Patients and Methods: In this prospective cohort study, a multidomain CGA was performed by a geriatric nurse and geriatrician in 110 consecutive patients aged ≥70 years, newly referred to a multidisciplinary oncology clinic. CGA domains included comorbidity, polypharmacy, mood, cognition, nutrition, functionality and physical performance. Medical oncologist's clinical judgment on expected tolerance of standard treatment was noted (N = 62). Unfavorable outcome was defined as any ≥grade three chemotherapy toxicity, dose reduction, postponement of treatment, death before start of treatment and early progression before first evaluation of treatment (N = 80). Results: CGA identified multidomain problems in 77 out of 110 patients (70.0%) and the medical oncologist had doubts about standard treatment tolerance in 30 out of 62 patients (48.4%). Unfavorable outcome occurred in 48 out of 80 patients (60%) who received anticancer treatment but could not be predicted by CGA, medical oncologists' clinical judgment or their combination. There was discrepancy between CGA and clinical judgment in 24 out of 62 patients (38.7%). Conclusion: Neither CGA, medical oncologist's clinical judgment or a combination could predict unfavorable outcome in our heterogeneous sample. CGA and clinical judgment did not align in more than one-third of patients.

AB - Objectives: Comprehensive Geriatric Assessment (CGA) has been incorporated into geriatric oncology to prevent unfavorable outcome from anticancer treatment. This study determined the value of CGA and medical oncologist's clinical judgment in predicting unfavorable outcome and explored whether treatment decisions can be based on CGA. Patients and Methods: In this prospective cohort study, a multidomain CGA was performed by a geriatric nurse and geriatrician in 110 consecutive patients aged ≥70 years, newly referred to a multidisciplinary oncology clinic. CGA domains included comorbidity, polypharmacy, mood, cognition, nutrition, functionality and physical performance. Medical oncologist's clinical judgment on expected tolerance of standard treatment was noted (N = 62). Unfavorable outcome was defined as any ≥grade three chemotherapy toxicity, dose reduction, postponement of treatment, death before start of treatment and early progression before first evaluation of treatment (N = 80). Results: CGA identified multidomain problems in 77 out of 110 patients (70.0%) and the medical oncologist had doubts about standard treatment tolerance in 30 out of 62 patients (48.4%). Unfavorable outcome occurred in 48 out of 80 patients (60%) who received anticancer treatment but could not be predicted by CGA, medical oncologists' clinical judgment or their combination. There was discrepancy between CGA and clinical judgment in 24 out of 62 patients (38.7%). Conclusion: Neither CGA, medical oncologist's clinical judgment or a combination could predict unfavorable outcome in our heterogeneous sample. CGA and clinical judgment did not align in more than one-third of patients.

U2 - 10.1016/j.jgo.2020.08.009

DO - 10.1016/j.jgo.2020.08.009

M3 - Article

SN - 1879-4068

VL - 12

SP - 49

EP - 56

JO - Journal of Geriatric Oncology

JF - Journal of Geriatric Oncology

IS - 1

ER -

Predicting outcome in older patients with cancer: Comprehensive geriatric assessment and clinical judgment

Abstract

Bibliographical note

Funding

UN SDGs

Access to Document

Persistent URL (handle)

Fingerprint

Cite this