Supportive Care in Cancer

, Volume 24, Issue 11, pp 4807–4813 | Cite as

Geriatric assessment factors are associated with mortality after hospitalization in older adults with cancer

  • Sushma Jonna
  • Leslie Chiang
  • Jingxia Liu
  • Maria B. Carroll
  • Kellie Flood
  • Tanya M. WildesEmail author
Original Article



Survival in older adults with cancer varies given differences in functional status, comorbidities, and nutrition. Prediction of factors associated with mortality, especially in hospitalized patients, allows physicians to better inform their patients about prognosis during treatment decisions. Our objective was to analyze factors associated with survival in older adults with cancer following hospitalization.


Through a retrospective cohort study, we reviewed 803 patients who were admitted to Barnes-Jewish Hospital’s Oncology Acute Care of Elders (OACE) unit from 2000 to 2008. Data collected included geriatric assessments from OACE screening questionnaires as well as demographic and medical history data from chart review. The primary end point was time from index admission to death. The Cox proportional hazard modeling was performed.


The median age was 72.5 years old. Geriatric syndromes and functional impairment were common. Half of the patients (50.4 %) were dependent in one or more activities of daily living (ADLs), and 74 % were dependent in at least one instrumental activity of daily living (IADLs). On multivariate analysis, the following factors were significantly associated with worse overall survival: male gender; a total score <20 on Lawton’s IADL assessment; reason for admission being cardiac, pulmonary, neurologic, inadequate pain control, or failure to thrive; cancer type being thoracic, hepatobiliary, or genitourinary; readmission within 30 days; receiving cancer treatment with palliative rather than curative intent; cognitive impairment; and discharge with hospice services.


In older adults with cancer, certain geriatric parameters are associated with shorter survival after hospitalization. Assessment of functional status, necessity for readmission, and cognitive impairment may provide prognostic information so that oncologists and their patients make more informed, individualized decisions.


Geriatric assessment Cancer Mortality Prediction Elderly Aging 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests. They have full control of all primary data and agree to allow the journal to review the data if requested.


  1. 1.
    Ries EMKC, Hankey BF, et al. SEER cancer statistics review: 1975–2000. National Cancer Institute, Bethesda, MDGoogle Scholar
  2. 2.
    Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 27(17):2758–2765. doi: 10.1200/JCO.2008.20.8983 CrossRefPubMedGoogle Scholar
  3. 3.
    Lewis JH, Kilgore ML, Goldman DP, Trimble EL, Kaplan R, Montello MJ, Housman MG, Escarce JJ (2003) Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol 21(7):1383–1389CrossRefPubMedGoogle Scholar
  4. 4.
    Scher KS, Hurria A (2012) Under-representation of older adults in cancer registration trials: known problem, little progress. J Clin Oncol 30(17):2036–2038. doi: 10.1200/JCO.2012.41.6727 CrossRefPubMedGoogle Scholar
  5. 5.
    Walter LC, Brand RJ, Counsell SR, Palmer RM, Landefeld CS, Fortinsky RH, Covinsky KE (2001) Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 285(23):2987–2994CrossRefPubMedGoogle Scholar
  6. 6.
    Earle CC, Neville BA, Landrum MB, Ayanian JZ, Block SD, Weeks JC (2004) Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol 22(2):315–321. doi: 10.1200/JCO.2004.08.136 CrossRefPubMedGoogle Scholar
  7. 7.
    Anshushaug M, Gynnild MA, Kaasa S, Kvikstad A, Gronberg BH (2015) Characterization of patients receiving palliative chemo- and radiotherapy during end of life at a regional cancer center in Norway. Acta Oncol 54(3):395–402. doi: 10.3109/0284186X.2014.948061 CrossRefPubMedGoogle Scholar
  8. 8.
    Prigerson HG, Bao Y, Shah MA, Paulk ME, LeBlanc TW, Schneider BJ, Garrido MM, Reid MC, Berlin DA, Adelson KB, Neugut AI, Maciejewski PK (2015) Chemotherapy use, performance status, and quality of life at the end of life. JAMA Oncol 1(6):778–784. doi: 10.1001/jamaoncol.2015.2378 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    National Hospice and Palliative Care Organization: NHPCO FY2012 national summary of hospice care.
  10. 10.
    O’Connor NR, Hu R, Harris PS, Ache K, Casarett DJ (2014) Hospice admissions for cancer in the final days of life: independent predictors and implications for quality measures. J Clin Oncol 32(28):3184–3189. doi: 10.1200/JCO.2014.55.8817 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Extermann M, Aapro M, Bernabei RB, Cohen HJ, Droz JP, Lichtman S, Mor V, Monfardini S, Repetto L, Sorbye L, Topinkova E (2005) Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hemat 55(3):241–252. doi: 10.1016/j.critrevonc.2005.06.003 CrossRefGoogle Scholar
  12. 12.
    Caillet P, Laurent M, Bastuji-Garin S, Liuu E, Culine S, Lagrange JL, Canoui-Poitrine F, Paillaud E (2014) Optimal management of elderly cancer patients: usefulness of the comprehensive geriatric assessment. Clin Interv Aging 9:1645–1660. doi: 10.2147/CIA.S57849 PubMedPubMedCentralGoogle Scholar
  13. 13.
    Soubeyran P, Fonck M, Blanc-Bisson C, Blanc JF, Ceccaldi J, Mertens C, Imbert Y, Cany L, Vogt L, Dauba J, Andriamampionona F, Houede N, Floquet A, Chomy F, Brouste V, Ravaud A, Bellera C, Rainfray M (2012) Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. J Clin Oncol 30(15):1829–1834. doi: 10.1200/JCO.2011.35.7442 CrossRefPubMedGoogle Scholar
  14. 14.
    Falandry C, Weber B, Savoye AM, Tinquaut F, Tredan O, Sevin E, Stefani L, Savinelli F, Atlassi M, Salvat J, Pujade-Lauraine E, Freyer G (2013) Development of a geriatric vulnerability score in elderly patients with advanced ovarian cancer treated with first-line carboplatin: a GINECO prospective trial. Ann Oncol 24(11):2808–2813. doi: 10.1093/annonc/mdt360 CrossRefPubMedGoogle Scholar
  15. 15.
    Giantin V, Valentini E, Iasevoli M, Falci C, Siviero P, De Luca E, Maggi S, Martella B, Orru G, Crepaldi G, Monfardini S, Terranova O, Manzato E (2013) Does the multidimensional prognostic index (MPI), based on a comprehensive geriatric assessment (CGA), predict mortality in cancer patients? Results of a prospective observational trial. J Geriatr Oncol 4(3):208–217. doi: 10.1016/j.jgo.2013.04.008 CrossRefPubMedGoogle Scholar
  16. 16.
    Kanesvaran R, Li H, Koo KN, Poon D (2011) Analysis of prognostic factors of comprehensive geriatric assessment and development of a clinical scoring system in elderly Asian patients with cancer. J Clin Oncol 29(27):3620–3627. doi: 10.1200/JCO.2010.32.0796 CrossRefPubMedGoogle Scholar
  17. 17.
    Tougeron D, Di Fiore F, Thureau S, Berbera N, Iwanicki-Caron I, Hamidou H, Paillot B, Michel P (2008) Safety and outcome of definitive chemoradiotherapy in elderly patients with oesophageal cancer. Brit J Cancer 99(10):1586–1592. doi: 10.1038/sj.bjc.6604749 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Bo M, Cacello E, Ghiggia F, Corsinovi L, Bosco F (2007) Predictive factors of clinical outcome in older surgical patients. Arch Gerontol Geriat 44(3):215–224. doi: 10.1016/j.archger.2006.05.007 CrossRefGoogle Scholar
  19. 19.
    Kim KI, Park KH, Koo KH, Han HS, Kim CH (2013) Comprehensive geriatric assessment can predict postoperative morbidity and mortality in elderly patients undergoing elective surgery. Arch Gerontol Geriat 56(3):507–512. doi: 10.1016/j.archger.2012.09.002 CrossRefGoogle Scholar
  20. 20.
    Maione P, Perrone F, Gallo C, Manzione L, Piantedosi F, Barbera S, et al. (2005) Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. J Clin Oncol 23(28):6865–6872. doi: 10.1200/JCO.2005.02.527 CrossRefPubMedGoogle Scholar
  21. 21.
    Ramjaun A, Nassif MO, Krotneva S, Huang AR, Meguerditchian AN (2013) Improved targeting of cancer care for older patients: a systematic review of the utility of comprehensive geriatric assessment. J Geriatr Oncol 4(3):271–281. doi: 10.1016/j.jgo.2013.04.002 CrossRefPubMedGoogle Scholar
  22. 22.
    Hamaker ME, Vos AG, Smorenburg CH, de Rooij SE, van Munster BC (2012) The value of geriatric assessments in predicting treatment tolerance and all-cause mortality in older patients with cancer. Oncologist 17(11):1439–1449. doi: 10.1634/theoncologist.2012-0186 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Flood KL, Carroll MB, Le CV, Ball L, Esker DA, Carr DB (2006) Geriatric syndromes in elderly patients admitted to an oncology-acute care for elders unit. J Clin Oncol 24(15):2298–2303. doi: 10.1200/JCO.2005.02.8514 CrossRefPubMedGoogle Scholar
  24. 24.
    Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919CrossRefPubMedGoogle Scholar
  25. 25.
    Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9(3):179–186CrossRefPubMedGoogle Scholar
  26. 26.
    Watson YI, Arfken CL, Birge SJ (1993) Clock completion: an objective screening test for dementia. J Am Geriatr Soc 41(11):1235–1240CrossRefPubMedGoogle Scholar
  27. 27.
    Kawas C, Karagiozis H, Resau L, Corrada M, Brookmeyer R (1995) Reliability of the blessed telephone information-memory-concentration test. J Geriatr Psychiatry Neurol 8(4):238–242CrossRefPubMedGoogle Scholar
  28. 28.
    Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr (2004) Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 291(20):2441–2447. doi: 10.1001/jama.291.20.2441 CrossRefPubMedGoogle Scholar
  29. 29.
    Reuben DB, Rubenstein LV, Hirsch SH, Hays RD (1992) Value of functional status as a predictor of mortality: results of a prospective study. Am J Med 93(6):663–669CrossRefPubMedGoogle Scholar
  30. 30.
    Wolfson C, Wolfson DB, Asgharian M, M’Lan CE, Ostbye T, Rockwood K, Hogan DB, Clinical Progression of Dementia Study Group (2001) A reevaluation of the duration of survival after the onset of dementia. N Engl J Med 344(15):1111–1116. doi: 10.1056/NEJM200104123441501 CrossRefPubMedGoogle Scholar
  31. 31.
    Saunders ND, Nichols SD, Antiporda MA, Johnson K, Walker K, Nilsson R, Graham L, Old M, Klisovic RB, Penza S, Schmidt CR (2015) Examination of unplanned 30-day readmissions to a comprehensive cancer hospital. J Oncol Pract 11(2):e177–e181. doi: 10.1200/JOP.2014.001546 CrossRefPubMedGoogle Scholar
  32. 32.
    Manzano JG, Gadiraju S, Hiremath A, Lin HY, Farroni J, Halm J (2015) Unplanned 30-day readmissions in a general internal medicine hospitalist service at a comprehensive cancer center. J Oncol Pract 11(5):410–415. doi: 10.1200/JOP.2014.003087 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Chiang LY, Liu J, Flood KL, Carroll MB, Piccirillo JF, Stark S, Wang A, Wildes TM (2015) Geriatric assessment as predictors of hospital readmission in older adults with cancer. J Geriatr Oncol 6(4):254–261. doi: 10.1016/j.jgo.2015.04.003 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Aaldriks AA, Maartense E, le Cessie S, Giltay EJ, Verlaan HA, van der Geest LG, Kloosterman-Boele WM, Peters-Dijkshoorn MT, Blansjaar BA, van Schaick HW, Nortier JW (2011) Predictive value of geriatric assessment for patients older than 70 years, treated with chemotherapy. Crit Rev Oncol Hematol 79(2):205–212. doi: 10.1016/j.critrevonc.2010.05.009 CrossRefPubMedGoogle Scholar
  35. 35.
    Read WL, Tierney RM, Page NC, Costas I, Govindan R, EL S, Piccirillo JF (2004) Differential prognostic impact of comorbidity. J Clin Oncol 22(15):3099–3103. doi: 10.1200/JCO.2004.08.040 CrossRefPubMedGoogle Scholar
  36. 36.
    Wedding U, Rohrig B, Klippstein A, Pientka L, Hoffken K (2007) Age, severe comorbidity and functional impairment independently contribute to poor survival in cancer patients. J Cancer Res Clin Oncol 133(12):945–950. doi: 10.1007/s00432-007-0233-x CrossRefPubMedGoogle Scholar
  37. 37.
    Nagel G, Wedding U, Rohrig B, Katenkamp D (2004) The impact of comorbidity on the survival of postmenopausal women with breast cancer. J Cancer Res Clin Oncol 130(11):664–670. doi: 10.1007/s00432-004-0594-3 CrossRefPubMedGoogle Scholar
  38. 38.
    Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, Levine RM, Lubiner ET, Reyes P, FJ S 3rd, Balducci L (2012) Predicting the risk of chemotherapy toxicity in older patients: the chemotherapy risk assessment scale for high-age patients (CRASH) score. Cancer 118(13):3377–3386. doi: 10.1002/cncr.26646 CrossRefPubMedGoogle Scholar
  39. 39.
    Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, Lichtman SM, Gajra A, Bhatia S, Katheria V, Klapper S, Hansen K, Ramani R, Lachs M, Wong FL, Tew WP (2011) Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 29(25):3457–3465. doi: 10.1200/JCO.2011.34.7625 CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Maas HA, Janssen-Heijnen ML, Olde Rikkert MG, Machteld Wymenga AN (2007) Comprehensive geriatric assessment and its clinical impact in oncology. Eur J Cancer 43(15):2161–2169. doi: 10.1016/j.ejca.2007.08.002 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Sushma Jonna
    • 1
  • Leslie Chiang
    • 2
  • Jingxia Liu
    • 3
  • Maria B. Carroll
    • 4
  • Kellie Flood
    • 5
  • Tanya M. Wildes
    • 1
    Email author
  1. 1.Department of MedicineWashington University School of MedicineSt LouisUSA
  2. 2.University of California San DiegoSan DiegoUSA
  3. 3.Division of Public Health SciencesWashington University School of MedicineSt LouisUSA
  4. 4.Department of NeurologyWashington University School of MedicineSt LouisUSA
  5. 5.University of Alabama at BirminghamBirminghamUSA

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