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Basic Assessment of the Older Cancer Patient

  • Geriatric Oncology
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Opinion statement

Cancer is a disease of the elderly (median age 67 in the US), and this is a population with a variable health status. Therefore, treating the older half of the cancer population will present the challenge of not only addressing tumor diversity (the side often referred to in “personalized cancer care” discussions), but patient diversity as well as the interaction between these two heterogeneities. In that sense, geriatric oncology is the ultimate personalized cancer care. In this article, we will address the recent updates in the basic assessment of the patient’s condition, and their implication for clinical and research use. The main progresses reported in the last couple of years pertain to geriatric screening tests, and to prediction of the tolerance to treatment. Some important data on the impact of comorbidities on cancer behavior have emerged, but the clinical implications of these data are still being sorted out. We recommend a two-step approach to the basic evaluation of the older cancer patient. First a short screening with a tested screening instrument. Then further work-up of the geriatric findings in parallel with the oncology work-up to define an integrated treatment plan.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Extermann M, Hurria A. Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol. 2007;25:1824–31.

    Article  PubMed  Google Scholar 

  2. Popa M, Wallace K, Brunello A, Extermann M. The impact of polypharmacy on toxicity from chemotherapy in elderly patients: focus on cytochrome P-450 inhibition and protein binding effects. Proc Am Soc Clin Oncol. 2008;26:503s.

    Google Scholar 

  3. Corcoran ME. Polypharmacy in the older patient with cancer. Cancer Control. 1997;4:419–28.

    PubMed  Google Scholar 

  4. Overcash JA, Beckstead J, Extermann M, et al. The abbreviated comprehensive geriatric assessment (aCGA): a retrospective analysis. Crit Rev Oncol Hematol. 2005;54:129–36.

    Article  PubMed  Google Scholar 

  5. Overcash JA, Beckstead J, Moody L, et al. The abbreviated comprehensive geriatric assessment (aCGA) for use in the older cancer patient as a prescreen: scoring and interpretation. Crit Rev Oncol Hematol. 2006;59:205–10.

    Article  PubMed  Google Scholar 

  6. Kellen E, Bulens P, Deckx L, et al. Identifying an accurate pre-screening tool in geriatric oncology. Crit Rev Oncol Hematol. 2010;75:243–8.

    Article  PubMed  Google Scholar 

  7. Johnson D, Blair J, Balducci L, et al: The Assessment of Clinical Resources in a Senior Adult Oncology Program., European Oncology Nursing Society Meeting Innsbruck, Austria, 2006.

  8. Extermann M, Green T, Tiffenberg G, Rich CJ. Validation of the Senior Adult Oncology Program (SAOP) 2 screening questionnaire. Crit Rev Oncol Hematol. 2009;69:185.

    Google Scholar 

  9. Mion LC, Palmer RM, Anetzberger GJ, et al. Establishing a case-finding and referral system for at-risk older individuals in the emergency department setting: the SIGNET model. J Am Geriatr Soc. 2001;49:1379–86.

    Article  PubMed  CAS  Google Scholar 

  10. Kenis C, Geeraerts A, Braesl T, Milisen K, Flamaing J, Wielders H. The Flemish version of the Triage Risk Screening Tool (TRST): a multidimensional short screening tool for the assessment of elderly patients. Crit Rev Oncol Hematol. 2006;60:S31.

    Google Scholar 

  11. Kenis C, Schuermans H, Van Custem E, Verhoel G, Vansteenkiste J, Vergote I, et al. Screening for a geriatric risk profile in older cancer patients: a comparative study of the predictive validity of three screening tools. Crit Rev Oncol Hematol. 2009;72:S22.

    Article  Google Scholar 

  12. Saliba D, Orlando M, Wenger NS, et al. Identifying a short functional disability screen for older persons. J Gerontol A Biol Sci Med Sci. 2000;55:M750–6.

    Article  PubMed  CAS  Google Scholar 

  13. Mohile SG, Bylow K, Dale W, et al. A pilot study of the vulnerable elders survey-13 compared with the comprehensive geriatric assessment for identifying disability in older patients with prostate cancer who receive androgen ablation. Cancer. 2007;109:802–10.

    Article  PubMed  Google Scholar 

  14. Luciani A, Ascione G, Bertuzzi C, et al. Detecting disabilities in older patients with cancer: comparison between comprehensive geriatric assessment and vulnerable elders survey-13. J Clin Oncol. 2010;28:2046–50.

    Article  PubMed  Google Scholar 

  15. Falci C, Brunello A, Monfardini S. Detecting functional impairment in older patients with cancer: is vulnerable elders survey-13 the right prescreening tool? An open question. J Clin Oncol. 2010;28:e665–6. author reply e667.

    Article  PubMed  Google Scholar 

  16. Schuurmans H, Steverink N, Lindenberg S, et al. Old or frail: what tells us more? J Gerontol A Biol Sci Med Sci. 2004;59:M962–5.

    Article  PubMed  Google Scholar 

  17. Bellera C, Rainfray M, Mathoulin-Pélissier S, Soubeyran P. Validation of a screening tool in geriatric oncology: the Oncodage project. Crit Rev Oncol Hematol. 2008;68:S22.

    Article  Google Scholar 

  18. Katz S, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA. 1963;185:94–9.

    Google Scholar 

  19. Lawton MP. Scales to measure competence in everyday activities. Psychopharmacol Bull. 1988;24:609–14.

    PubMed  CAS  Google Scholar 

  20. Sheikh J, Yesavage JA. Geriatric Depression Scale (GDS). Recent evidence and Development of a shorter version. Clin Gerontol. 1986;5:165–71.

    Article  Google Scholar 

  21. Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.

    Article  PubMed  CAS  Google Scholar 

  22. Guigoz Y, Vellas, B,Garry, PJ. Mini Nutritional Assessment: A practical assessment tool for grading nutritional state of elderly patients, Facts Research and Intervention in Geriatrics, Serdi Publishing Company, 1997, pp. 15–60.

  23. Miller MD, Paradis CF, Houck PR, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res. 1992;41:237–48.

    Article  PubMed  CAS  Google Scholar 

  24. Brunello A, Kapoor R, Extermann M. Hyperglycemia during chemotherapy for hematologic and solid tumors is correlated with increased toxicity. Am J Clin Oncol, 2010.

  25. Extermann M, Boler I, Reich R, Lyman GH, Brown RH, DeFelice J, Levine RM, Lubiner ET, Reyes P, Schreiber FJ. The CRASH score (Chemotherapy Risk Assessment Scale for High-Age Patients): Design and validation. Presented at the Proc Annual Meeting Am Soc Clin Oncol, Chicago, IL, 2010. An oral ASCO presentation of one of the two first formally designed instruments to predict toxicity of chemotherapy in the elderly.

  26. Extermann M, Albrand G, Chen H, et al. Are older French patients as willing as older American patients to undertake chemotherapy? J Clin Oncol. 2003;21:3214–9.

    Article  PubMed  Google Scholar 

  27. Extermann M, Chen H, Cantor AB, et al. Predictors of tolerance to chemotherapy in older cancer patients: a prospective pilot study. Eur J Cancer. 2002;38:1466–73.

    Article  PubMed  CAS  Google Scholar 

  28. Gore E, Bae K, Langer C, et al. Phase I/II Trial of a COX-2 inhibitor with limited field radiation for intermediate prognosis patients who have locally advanced non-small-cell lung cancer: radiation therapy oncology group 0213. Clin Lung Cancer. 2011;12:125–30.

    Article  PubMed  Google Scholar 

  29. Stewart A, Ware JE. Measuring Functioning and Well-Being: The Medical Outcomes Study Approach. Durham: Duke University Press; 1992.

    Google Scholar 

  30. Fillenbaum GG, Smyer MA. The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. J Gerontol. 1981;36:428–34.

    PubMed  CAS  Google Scholar 

  31. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–8.

    PubMed  CAS  Google Scholar 

  32. Katzman R, Brown T, Fuld P, et al. Validation of a short Orientation-Memory-Concentration Test of cognitive impairment. Am J Psychiatry. 1983;140:734–9.

    PubMed  CAS  Google Scholar 

  33. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.

    Article  PubMed  CAS  Google Scholar 

  34. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32:705–14.

    Article  PubMed  CAS  Google Scholar 

  35. Hurria A, Cirrincione CT, Muss HB, et al. Implementing a Geriatric Assessment in Cooperative Group Clinical Cancer Trials: CALGB 360401. J Clin Oncol: official journal of the American Society of Clinical Oncology. 2011;29:1290–6.

    Google Scholar 

  36. Satariano WA, Ragland DR. The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med. 1994;120:104–10.

    PubMed  CAS  Google Scholar 

  37. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76.

    Article  PubMed  CAS  Google Scholar 

  38. Mendoza TR, Wang XS, Cleeland CS, et al. The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer. 1999;85:1186–96.

    Article  PubMed  CAS  Google Scholar 

  39. Audisio RA, Pope D, Ramesh HS, et al. Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Crit Rev Oncol Hematol. 2008;65:156–63.

    Article  PubMed  CAS  Google Scholar 

  40. Schrijvers D, Highley M, De Bruyn E, et al. Role of red blood cells in pharmacokinetics of chemotherapeutic agents. Anticancer Drugs. 1999;10:147–53.

    Article  PubMed  CAS  Google Scholar 

  41. Giannelli SV, Patel KV, Windham BG, et al. Magnitude of underascertainment of impaired kidney function in older adults with normal serum creatinine. J Am Geriatr Soc. 2007;55:816–23.

    Article  PubMed  Google Scholar 

  42. Van Pottelbergh G, Van Heden L, Mathei C, et al. Methods to evaluate renal function in elderly patients: a systematic literature review. Age Ageing. 2010;39:542–8.

    Article  PubMed  Google Scholar 

  43. Extermann MPM, Druta M, Wallace K, Brunello A, Balducci L. Drug interactions assessed with Drug Interaction Facts™ are associated with increased risk of chemotoxicity in older cancer patients receiving chemotherapy. Presented at the Am Assoc Cancer Res, Denver, CO, April 18–22, 2009.

  44. Loprinzi CL, Ravdin PM, de Laurentiis M, et al. Do American oncologists know how to use prognostic variables for patients with newly diagnosed primary breast cancer? J Clin Oncol. 1994;12:1422–6.

    PubMed  CAS  Google Scholar 

  45. Slevin ML, Stubbs L, Plant HJ, et al. Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. BMJ. 1990;300:1458–60.

    Article  PubMed  CAS  Google Scholar 

  46. Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross C, Lichtman SM, Katheria V, Klapper S, Tew WP. Predicting chemotherapy toxicity in older adults with cancer: A prospective 500 patients multicenter study. Presented at the Proc Annual Meeting Am Soc Clin Oncol, 2010. An oral ASCO presentation of one of the two first formally designed instruments to predict toxicity of chemotherapy in the elderly.

  47. Janssen-Heijnen ML, Extermann M, Boler IE. Can first cycle CBCs predict older patients at very low risk of neutropenia during further chemotherapy? Crit Rev Oncol Hematol, 2010.

  48. Audisio RA, Ramesh H, Longo WE, et al. Preoperative assessment of surgical risk in oncogeriatric patients. Oncologist. 2005;10:262–8.

    Article  PubMed  Google Scholar 

  49. Alibhai SM, Naglie G, Nam R, et al. Do older men benefit from curative therapy of localized prostate cancer? J Clin Oncol. 2003;21:3318–27.

    Article  PubMed  Google Scholar 

  50. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56.

    Article  PubMed  CAS  Google Scholar 

  51. Ensrud KE, Ewing SK, Cawthon PM, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J Am Geriatr Soc. 2009;57:492–8.

    Article  PubMed  Google Scholar 

  52. Ensrud KE, Ewing SK, Taylor BC, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med. 2008;168:382–9.

    Article  PubMed  Google Scholar 

  53. Kiely DK, Cupples LA, Lipsitz LA. Validation and comparison of two frailty indexes: The MOBILIZE Boston Study. J Am Geriatr Soc. 2009;57:1532–9.

    Article  PubMed  Google Scholar 

  54. Gruenewald TL, Seeman TE, Karlamangla AS, et al. Allostatic load and frailty in older adults. J Am Geriatr Soc. 2009;57:1525–31.

    Article  PubMed  Google Scholar 

  55. Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007;62:738–43.

    PubMed  Google Scholar 

  56. Fallah N, Mitnitski A, Searle SD, et al. Transitions in frailty status in older adults in relation to mobility: a multistate modeling approach employing a deficit count. J Am Geriatr Soc. 2011;59:524–9.

    Article  PubMed  Google Scholar 

  57. Soubeyran P, Khaled H, MacKenzie M, Debois M, Fortpied C, de Bock R, et al. Diffuse large B-cell and peripheral T-cell non-Hodgkin’s lymphoma in the frail elderly. A phase II EORTC trial with a progressive and cuatious treatment emphasizing geriatric assessment. J Geriatr Oncol. 2011;2:36–44.

    Article  Google Scholar 

  58. Monfardini S, Aversa SM, Zoli V, et al. Vinorelbine and prednisone in frail elderly patients with intermediate-high grade non-Hodgkin’s lymphomas. Ann Oncol. 2005;16:1352–8.

    Article  PubMed  CAS  Google Scholar 

  59. Jiralerspong S, Palla SL, Giordano SH, et al. Metformin and pathologic complete responses to neoadjuvant chemotherapy in diabetic patients with breast cancer. J Clin Oncol. 2009;27:3297–302.

    Article  PubMed  CAS  Google Scholar 

  60. Kuderer NM, Dale DC, Crawford J, et al. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer. 2006;106:2258–66.

    Article  PubMed  Google Scholar 

  61. Robb C, Boulware D, Overcash J, et al. Patterns of care and survival in cancer patients with cognitive impairment. Crit Rev Oncol Hematol. 2010;74:218–24.

    Article  PubMed  Google Scholar 

  62. Gupta SK, Lamont EB. Patterns of presentation, diagnosis, and treatment in older patients with colon cancer and comorbid dementia. J Am Geriatr Soc. 2004;52:1681–7.

    Article  PubMed  Google Scholar 

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Correspondence to Martine Extermann MD.

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Extermann, M. Basic Assessment of the Older Cancer Patient. Curr. Treat. Options in Oncol. 12, 276–285 (2011). https://doi.org/10.1007/s11864-011-0161-5

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