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Pilot study of the implementation of G8 screening tool, Cognitive screening assessment and Chemotherapy Toxicity assessment in older adults with cancer in a Tertiary University Hospital in Ireland

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Abstract

Background

Comprehensive geriatric assessment (CGA) is recommended by international guidelines prior to initiation of systemic anti-cancer treatment (SACT). In practice, CGA is limited by time constraints, lack of resources and expert interpretation.

Aims

The primary objective of this pilot study was to establish the prevalence of frailty (assessed by G8), cognitive impairment (assessed by Mini-Cog), and risk of chemotherapy toxicity (assessed by CARG Chemo-Toxicity Calculator) among patients (pts) ≥65 years commencing SACT. We selected these three screening tools due to the ease of conducting them in a busy outpatient setting. In addition, they have been validated to predict frailty and risk of toxicity from SACT among older adults with cancer.

Methods

Eligible participants were identified from medical oncology clinics. Assessments were conducted in an outpatient setting by treating physicians. Pt records were reviewed to gather demographic and cancer details. Statistical analyses were conducted using SPSS statistical software.

Results

Sixty-three participants were enrolled. The mean age of participants was 73yrs (range=65-88). Thirty-three (52.4%) were female and 30 (47.6%) were male. The majority (n=38, 60.3%) had metastatic cancer. The mean G8 score was 11.9 (range=6-19). Eighty-three percent had a G8 score ≤14. Mini-Cog was positive in 13 pts (21%). The mean CARG score was 7.5 (range=0-16), and 80% had a risk of at least 50% grade ≥3 toxicity. Of these, 48 (76.2%) received chemotherapy and 15 (23.8%) received non-cytotoxic SACT. In multi-variate analyses, age, cancer type, treatment type, and disease stage did not impact G8, Mini-Cog, or CARG scores.

Conclusions

Our study has several limitations but suggests that the majority of older adults with cancer would qualify for formal CGA assessment. The risk of high-grade toxicity from SACT is substantial in this cohort. Chronological age was not found to negatively impact pts’ frailty, cognition, or risk of toxicity.

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References

  1. National Cancer Registry, Ireland (2018) Cancer Factsheet - Overview & Most Common Cancers. https://www.ncri.ie/publications/statistical-reports/cancer-ireland-1994-2018-estimates-2018-2020-annual-report-national. Accessed 13 Mar 2022

  2. Sheehan A, O’Sullivan R (2020) Ageing and Public Health - an overview of key statistics in Ireland and Northern Ireland (Presentation) Dublin: Institute of Public Health

  3. Department of Health, Ireland (2017) National Cancer Strategy 2017-2026. https://assets.gov.ie/9315/6f1592a09583421baa87de3a7e9cb619.pdf. Accessed on 4 Feb 2022

  4. Carioli G, Malvezzi M, Bertuccio P et al (2019) Cancer mortality in the elderly in 11 countries worldwide, 1970–2015. Ann Oncol 30(8):1344–1355. https://doi.org/10.1093/annonc/mdz178

    Article  CAS  PubMed  Google Scholar 

  5. Hutchins LF, Unger JM, Crowley JJ et al (1999) Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 341(27):2061–7. https://doi.org/10.1056/NEJM199912303412706

    Article  CAS  PubMed  Google Scholar 

  6. Talarico L, Chen G, Pazdur R (2004) Enrollment of elderly patients in clinical trials for cancer drug registration: a 7-year experience by the US Food and Drug Administration. J Clin Oncol 22(22):4626–31. https://doi.org/10.1200/JCO.2004.02.175

    Article  PubMed  Google Scholar 

  7. Newcomb PA, Carbone PP (1993) Cancer treatment and age: patient perspectives. J Natl Cancer Inst 85(19):1580–4. https://doi.org/10.1093/jnci/85.19.1580

    Article  CAS  PubMed  Google Scholar 

  8. Craigs CL, Bennett MI, Hurlow A et al (2018) Older age is associated with less cancer treatment: a longitudinal study of English cancer patients. Age Ageing 47(6):833–840. https://doi.org/10.1093/ageing/afy094

    Article  PubMed  Google Scholar 

  9. Miller ED, Fisher JL, Haglund KE et al (2018) Identifying patterns of care for elderly patients with non-surgically treated stage III non-small cell lung cancer: an analysis of the national cancer database 13(1):196. https://doi.org/10.1186/s13014-018-1142

    Article  Google Scholar 

  10. Kenis C, Bron D, Libert Y et al (2013) Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study. 24(5):1306–12. https://doi.org/10.1093/annonc/mds619

    Article  CAS  Google Scholar 

  11. Dale W, Williams GR, MacKenzie RA et al (2021) How Is Geriatric Assessment Used in Clinical Practice for Older Adults With Cancer? A Survey of Cancer Providers by the American Society of Clinical Oncology. JCO Oncol Pract 17(6):336–344. https://doi.org/10.1200/OP.20.00442

    Article  PubMed  Google Scholar 

  12. van Decoster K, Puyvelde SM 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):288–300. https://doi.org/10.1093/annonc/mdu210

    Article  CAS  PubMed  Google Scholar 

  13. Bellera CA, Rainfray M, Mathoulin-Pélissier S et al (2012) Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol 23(8):2166–2172. https://doi.org/10.1093/annonc/mdr587

    Article  CAS  PubMed  Google Scholar 

  14. Takahashi M, Komine K, Yamada H et al (2017) The G8 screening tool enhances prognostic value to ECOG performance status in elderly cancer patients: A retrospective, single institutional study. PLoS One 12(6):e0179694. https://doi.org/10.1371/journal.pone.0179694

  15. Martinez-Tapia C, Paillaud E, Liuu E et al (2017) Prognostic value of the G8 and modified-G8 screening tools for multidimensional health problems in older patients with cancer. Eur J Cancer 83:211–219. https://doi.org/10.1016/j.ejca.2017.06.027

    Article  PubMed  Google Scholar 

  16. Van Walree IC, Scheepers E, van Huis-Tanja L et al (2019) A systematic review on the association of the G8 with geriatric assessment, prognosis and course of treatment in older patients with cancer. J Geriatr Oncol 10(6):847–858. https://doi.org/10.1016/j.jgo.2019.04.016

    Article  PubMed  Google Scholar 

  17. Tuch G, Soo WK, Luo KY et al (2021) Cognitive Assessment Tools Recommended in Geriatric Oncology Guidelines: A Rapid Review. Curr Oncol 28(5):3987–4003. https://doi.org/10.3390/curroncol28050339

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hurria A, Mohile S, Gajra A et al (2016) Validation of a Prediction Tool for Chemotherapy Toxicity in Older Adults With Cancer. J Clin Oncol 34(20):2366–2371. https://doi.org/10.1200/JCO.2015.65.4327

    Article  PubMed  PubMed Central  Google Scholar 

  19. Huisingh-Scheetz M, Walston J (2017) How should older adults with cancer be evaluated for frailty? J Geriatr Oncol 8(1):8–15. https://doi.org/10.1016/j.jgo.2016.06.003

    Article  PubMed  Google Scholar 

  20. Handforth C, Clegg A, Young C et al (2015) The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol 26(6):1091–1101. https://doi.org/10.1093/annonc/mdu540

    Article  CAS  PubMed  Google Scholar 

  21. Horgan AM, Leighl NB, Coate L et al (2012) Impact and feasibility of a comprehensive geriatric assessment in the oncology setting: a pilot study. Am J Clin Oncol 35(4):322–328. https://doi.org/10.1097/COC.0b013e318210f9ce

    Article  PubMed  Google Scholar 

  22. Sourdet S, Brechemier D, Steinmeyer Z et al (2020) Impact of the comprehensive geriatric assessment on treatment decision in geriatric oncology. BMC Cancer 20:384. https://doi.org/10.1186/s12885-020-06878-2

    Article  PubMed  PubMed Central  Google Scholar 

  23. Muscaritoli M, Lucia S, Farcomeni A et al (2017) Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study. Oncotarget 8(45):79884-79896. https://doi.org/10.18632/oncotarget.20168

  24. Balducci L, Goetz-Parten D, Steinman MA (2013) Polypharmacy and the management of the older cancer patient. Ann Oncol 24 Suppl 7(Suppl 7):vii36-40. https://doi.org/10.1093/annonc/mdt266

  25. Sharma M, Loh KP, Nightingale G et al (2016) Polypharmacy and potentially inappropriate medication use in geriatric oncology. J Geriatr Oncol 7(5):346–53. https://doi.org/10.1016/j.jgo.2016.07.010

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Malik U, Alam Z, Loucks A et al (2020) Downstream consequences of abnormal cognitive screening in older adults seen pretreatment in a geriatric oncology clinic. J Geriatr Oncol 11(5):784–789. https://doi.org/10.1016/j.jgo.2019.10.022

    Article  PubMed  Google Scholar 

  27. Rodin MB, Mohile SG (2007) A practical approach to geriatric assessment in oncology. J Clin Oncol. 25(14):1936–44. https://doi.org/10.1200/JCO.2006.10.2954

    Article  PubMed  Google Scholar 

  28. Nie X, Liu D, Li Q et al (2013) Predicting chemotherapy toxicity in older adults with lung cancer. J Geriatr Oncol 4(4):334–9. https://doi.org/10.1016/j.jgo.2013.05.002

    Article  PubMed  Google Scholar 

  29. Hamid M, Hannan M, Myo Oo N et al (2022) Chemotherapy Toxicity in Older Adults Optimized by Geriatric Assessment and Intervention: A Non-Comparative Analysis. Curr Oncol 29(9):6167–6176. https://doi.org/10.3390/curroncol29090484

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lund CM, Vistisen KK, Olsen AP et al (2021) The effect of geriatric intervention in frail older patients receiving chemotherapy for colorectal cancer: a randomised trial (GERICO). Br J Cancer 124(12):1949–1958. https://doi.org/10.1038/s41416-021-01367-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Li D, Sun CL, Kim H et al (2021) Geriatric Assessment-Driven Intervention (GAIN) on Chemotherapy-Related Toxic Effects in Older Adults With Cancer: A Randomized Clinical Trial. JAMA Oncol 7(11):e214158. https://doi.org/10.1001/jamaoncol.2021.4158

  32. Mohile SG, Mohamed MR, Xu H et al (2021) Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study. Lancet 398(10314):1894–1904. https://doi.org/10.1016/S0140-6736(21)01789-X

    Article  PubMed  PubMed Central  Google Scholar 

  33. Soo WK, King MT, Pope A et al (2022) Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) in older people with cancer starting systemic anticancer treatment in Australia: a multicentre, open-label, randomised controlled trial. The Lancet Healthy Longev 3(9):e617–e627. https://doi.org/10.1016/S2666-7568(22)00169-6

    Article  PubMed  Google Scholar 

  34. Thibaud V, Billy C, Prud’homm J et al (2022) Inside the Black Box: A Narrative Review on Comprehensive Geriatric Assessment-Driven Interventions in Older Adults with Cancer. Cancers (Basel). 14(7):1642. https://doi.org/10.3390/cancers14071642

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Medical Oncology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

    Maha AlSendi, Calvin R Flynn, Muhammad R Khan, Paul Selvadurai, John Crown, Raymond S McDermott, Janice M Walshe, David W Fennelly, Emer O Hanrahan, Mark Doherty & Michaela J Higgins

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  1. Maha AlSendi
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  2. Calvin R Flynn
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  3. Muhammad R Khan
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Correspondence to Maha AlSendi.

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AlSendi, M., Flynn, C.R., Khan, M.R. et al. Pilot study of the implementation of G8 screening tool, Cognitive screening assessment and Chemotherapy Toxicity assessment in older adults with cancer in a Tertiary University Hospital in Ireland. Ir J Med Sci 193, 45–50 (2024). https://doi.org/10.1007/s11845-023-03446-y

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