, Volume 195, Issue 5, pp 619–626 | Cite as

Geriatric Assessment and Functional Decline in Older Patients with Lung Cancer

  • L. DecosterEmail author
  • C. Kenis
  • D. Schallier
  • J. Vansteenkiste
  • K. Nackaerts
  • L. Vanacker
  • N. Vandewalle
  • J. Flamaing
  • J. P. Lobelle
  • K. Milisen
  • J. De Grève
  • H. Wildiers



Older patients with lung cancer are a heterogeneous population making treatment decisions complex. This study aims to evaluate the value of geriatric assessment (GA) as well as the evolution of functional status (FS) in older patients with lung cancer, and to identify predictors associated with functional decline and overall survival (OS).


At baseline, GA was performed in patients ≥70 years with newly diagnosed lung cancer. FS measured by activities of daily living (ADL) and instrumental activities of daily living (IADL) was reassessed at follow-up to define functional decline and OS was collected. Predictors for functional decline and OS were determined.


Two hundred and forty-five patients were included in this study. At baseline, GA deficiencies were present in all domains and ADL and IADL were impaired in 51 and 63% of patients, respectively. At follow-up, functional decline in ADL was observed in 23% and in IADL in 45% of patients. In multivariable analysis, radiotherapy was predictive for ADL decline. No other predictors for ADL or IADL decline were identified. Stage and baseline performance status were predictive for OS.


Older patients with lung cancer present with multiple deficiencies covering all geriatric domains. During treatment, functional decline is observed in almost half of the patients. None of the specific domains of the GA were predictive for functional decline or survival, probably because of the high impact of the aggressiveness of this tumor type leading to a poor prognosis.


Older Lung cancer Geriatric assessment Functional decline 



This research was funded by the National Cancer Plan, action 24 of the Belgian Government.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    SEER cancer statistics factsheets: lung and bronchus cancer. National Cancer Institute. Bethesda.
  2. 2.
    Blanco JAG, Toste IS, Alvarez RF, Cuandrado GR, Gonzalez AM, Maltin IJ et al (2008) Age, comorbidity, treatment decision and prognosis in lung cancer. Age Ageing 37:715–718CrossRefPubMedGoogle Scholar
  3. 3.
    Peake MD, Thompson S, Lowe D, Pearson MG (2003) Ageism in the management of lung cancer. Age Ageing 32:171–177CrossRefPubMedGoogle Scholar
  4. 4.
    Janssen-Heijnen MLG, Smulders S, Lemmens VEPP, Smeenk FWJM, Van Geffen HJAA, Coebergh JWW et al (2004) Effect of comorbidity on the treatment and prognosis of elderly patients with non-small cell lung cancer. Thorax 59:602–607CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Lewis JH, Kilgore ML, Goldman DP et al (2003) Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol 21:1383–1389CrossRefPubMedGoogle Scholar
  6. 6.
    Wedding U, Kodding D, Pientka L et al (2007) Physicians’ judgement and comprehensive geriatric assessment (CGA) select different patients as fit for chemotherapy. Crit Rev Oncol Hematol 64:1–9CrossRefPubMedGoogle Scholar
  7. 7.
    Solomon D, Sue Brown A, Brummel-Smith K et al (2003) National Institutes of Health Consensus Development Conference Statement: geriatric assessment methods for clinical decision-making. J Am Geriatr Soc 51(10):1490–1494CrossRefPubMedGoogle Scholar
  8. 8.
    Kenis C, Bron D, Libert Y, Decoster L, Van Puyvelde K, Scaillet P et al (2013) Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study. Ann Oncol 24(5):1306–1312CrossRefPubMedGoogle Scholar
  9. 9.
    Kenis C, Decoster L, Van Puyvelde K, De Grève J, Conings G, Milisen K et al (2014) Performance of two geriatric screening tools in older patients with cancer. J Clin Oncol 32(1):19–26CrossRefPubMedGoogle Scholar
  10. 10.
    Decoster L, Van Puyvelde K, Mohile S, Weddong U, Basso U, Colloca G et al (2015) Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations. Ann Oncol 26(2):288–300CrossRefPubMedGoogle Scholar
  11. 11.
    Wildiers H, Heeren P, Puts M et al (2014) International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 32:2595–2603CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kenis C, Flamaing J, Debruyne PR et al (2015) A nationwide implementation of a multidisciplinary geriatric assessment and intervention program in Belgian older patients with cancer. J Geriatr Oncol 6(suppl 1):S13Google Scholar
  13. 13.
    Pottel L, Boterberg T, Pottel H et al (2012) Determination of an adequate screening tool for the identification of vulnerable elderly head and neck cancer patients treated with radio(chemo)therapy. J Geriatr Oncol 3:24–32CrossRefGoogle Scholar
  14. 14.
    Decoster L, Vanacker L, Kenis C, Prenen H, Van Cutsem E, Van Der Auwera J et al (2016) Relevance of geriatric assessment in older patients with colorectal cancer. Clin Colorectal Cancer. doi: 10.1016/j.clcc.2016.07.010 PubMedGoogle Scholar
  15. 15.
    Schulkens KJ, Souwer ETD, Hamaker ME et al (2017) The effect of geriatric assessment on treatment decisions for patients with lung cancer. Lung. doi: 10.1007/s00408-017-9983-7 Google Scholar
  16. 16.
    Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP et al (2011) Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 29:3457–3465CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Hurria A, Mohile S, Gajra A, Klepin H, Muss H, Chapman A et al (2016) Validation of a prediction tool for chemotherapy toxicity in older adults with cancer. J Clin Oncol 34:2366–2371CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J et al (2012) Predicting the risk of chemotherapy toxicity in older patients: the chemotherapy risk assessment scale for high-age patients (CRASH) score. Cancer 118:3377–3386CrossRefPubMedGoogle Scholar
  19. 19.
    Nie X, Liu D, Liu Q, Bai C (2013) Predicting chemotherapy toxicity in older adults with lung cancer. J Geriatr Oncol 4:334–339CrossRefPubMedGoogle Scholar
  20. 20.
    Girre V, Falcou MC, Gisselbrecht M, Gridel G, Mosseri V, Bouleuc C et al (2008) Does a geriatric oncology consultation modify the cancer treatment plan for elderly patients? J Gerontol Ser A 7:724–730CrossRefGoogle Scholar
  21. 21.
    Caillet P, Canoui-Poitrine F, Vouriot J, Berle M, Reinald N, Kryciak S et al (2011) Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study. J Clin Oncol 29:3636–3642CrossRefPubMedGoogle Scholar
  22. 22.
    Corre R, Greillier L, Le Caër H, Audigier-Valette C, Baize N, Bérard H et al (2016) Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small-cell lung cancer: the phase III randomized ESOGIA-GFPC-GECP 08-02 study. J Clin Oncol 34:1476–1483CrossRefPubMedGoogle Scholar
  23. 23.
    Chouliara Z, Miller M, Stott D et al (2004) Older people with cancer: perceptions and feelings about information, decision-making and treatment—a pilot study. Eur J Oncol Nurs 8:257–261CrossRefPubMedGoogle Scholar
  24. 24.
    Puts MTE, Monette J, Girre V, Wolfson C, Monette M, Batist G et al (2011) Changes in functional status in older newly-diagnosed cancer patients during cancer treatment: a six-month follow-up period. Results of a prospective pilot study. J Geriatr Oncol 2:112–120CrossRefGoogle Scholar
  25. 25.
    Ronning B, Wyller TB, Jordhoy MS, Nesbakken A, Bakka A, Seljeflot I et al (2014) Frailty indicators and functional status in older patients after colorectal cancer surgery. J Geriatr Oncol 5:26–32CrossRefPubMedGoogle Scholar
  26. 26.
    Kenis C, Decoster L, Bastin J, Bode H, Van Puyvelde K, De Grève J et al (2017) Functional decline in older patients with cancer receiving chemotherapy: a multicenter prospective study. J Geriatr Oncol 8:196–205CrossRefPubMedGoogle Scholar
  27. 27.
    Read WL, Tierney RM, Page IVC, Costas I, Govindar R, Spitznagel ELJ et al (2004) Differential prognostic impact of comorbidity. J Clin Oncol 22:3099–3130CrossRefPubMedGoogle Scholar
  28. 28.
    Maione P, Perrone F, Gallo C, Manzione L, Piantedosi FV, Barbera S et al (2005) Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced NSCLC receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. J Clin Oncol 23:6865–6872CrossRefPubMedGoogle Scholar
  29. 29.
    Pallis AG, Gridelli C, Wedding U, Faivre-Finn C, Veronesi G, Jaklitsch M et al (2014) Management of elderly patients with NSCLC updated expert’s opinion paper: EORTC elderly task force, lung cancer group and international society for geriatric oncology. Ann Oncol 25:1270–1283CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • L. Decoster
    • 1
    Email author
  • C. Kenis
    • 2
    • 3
  • D. Schallier
    • 1
  • J. Vansteenkiste
    • 4
  • K. Nackaerts
    • 4
  • L. Vanacker
    • 1
  • N. Vandewalle
    • 5
  • J. Flamaing
    • 3
    • 6
  • J. P. Lobelle
    • 7
  • K. Milisen
    • 8
  • J. De Grève
    • 1
  • H. Wildiers
    • 2
    • 9
  1. 1.Department of Medical Oncology, Oncologisch Centrum, UZ BrusselVrije Universiteit BrusselBrusselsBelgium
  2. 2.Department of General Medical OncologyUniversity Hospitals LeuvenLouvainBelgium
  3. 3.Department of Geriatric MedicineUniversity Hospitals LeuvenLouvainBelgium
  4. 4.Department of Respiratory OncologyUniversity Hospitals LeuvenLouvainBelgium
  5. 5.Department of Geriatric Medicine, UZ BrusselVrije Universiteit BrusselBrusselsBelgium
  6. 6.Department of Clinical and Experimental MedicineKU LeuvenLouvainBelgium
  7. 7.Consultant in StatisticsBeernemBelgium
  8. 8.Department of Public Health and Primary Care, Academic Centre for Nursing and MidwiferyKU LeuvenLouvainBelgium
  9. 9.Department of OncologyKU LeuvenLouvainBelgium

Personalised recommendations