Comprehensive geriatric assessment in Korean elderly cancer patients receiving chemotherapy
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Growing evidence suggests that a comprehensive geriatric assessment (CGA) in older patients with cancer can detect unsuspected health problems, predict survival, and predict tolerance to chemotherapy. However, studies regarding CGA in cancer patients are scarce in Asia.
We prospectively enrolled 65 elderly cancer patients who were candidates of systemic chemotherapy between July 2006 and March 2008. Baseline CGA data including demographic information, comorbidity, functional status by means of Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL), cognition, psychological state, nutritional status, and medication were collected and analyzed. Quality of life (QoL) was assessed by the EORTC questionnaire QLQ-C30.
Of the 65 patients, the median age was 71 years (range, 65–80), 49 (75%) were males, and 58 (89%) had Eastern Cooperative Oncology Group performance status (ECOG PS) 0 or 1. All patients had solid tumor, 74% received palliative chemotherapy, and 18% received adjuvant chemotherapy. Twenty-five percent of patients had Charlson’s comorbidity index score of 2 or more, 23% were ADL dependent, and 14% were IADL dependent. Using Mini-Mental Status Exam (MMSE), it was found that 51% of patients had mild cognitive impairment (MMSE score 17–24), and 5% had cognitive impairment (≤16). Forty percent of patients had depression by Short form Geriatric Depression Scale (SGDS), 19% had malnutrition by Mini-Nutritional Assessment (MNA), and 23% had body mass index (BMI) less than 19.4 kg/m2 (lowest 10%). Global health status/quality of life (QoL) was less than 50% in 39% of patients. Frail patients according to the Balducci classification had significantly poor ECOG PS and worse global health status/QoL.
CGA was feasible and could detect multiple unsuspected health problems including functional impairment and malnutrition in Korean elderly cancer patients receiving chemotherapy.