Identification of clinical parameters predictive of one-year survival using two geriatric tools in clinically fit older patients with hematological malignancies: Major impact of cognition
[en] Background
Little is known about the reliability of G8 screening tool and the prognostic value of clinical parameters within the Comprehensive Geriatric Assessment (CGA) in clinically fit older patients with hematological malignancies.
Materials and Methods
This study was performed to assess the reliability of G8 as a screening tool and to determine the predictive value of CGA items in terms of 1-year overall survival (OS). G8 and CGA were proposed to 107 consecutive patients (65–89 years) with hematological malignancies assessed by their physicians as clinically fit, meaning not exhibiting geriatric syndromes and/or irreversible comorbidities significantly impairing their daily function, and thus able to receive chemotherapy.
Results
Out of 107 patients, 90 patients were evaluable and completed both scales; 72% and 80% were defined as “vulnerable” when evaluated with G8 (≤14.5) or CGA (≥2 impairments) respectively. The area under ROC-curve of G8 compared to CGA was 0.749 ± 0.051. Neither G8 nor CGA total scores were predictive of 1-year OS. However, age (HR = 1.105, 95% CI: 1.016–1.202; p = 0.019), diagnosis (HR = 5.208, 95% CI: 1.895–14.310; p = 0.001) and cognitive status (HR = 3.260, 95% CI: 1.043–10.194; p = 0.042) were predictive of OS.
Conclusions
We conclude that in our selected hematological patients: 1) the G8 score does not help selecting patients for CGA, 2) the G8 and CGA total scores do not predict OS, and 3) in addition to the age and disease itself, cognitive impairment appears to be a powerful prognostic factor.
Disciplines :
Treatment & clinical psychology
Author, co-author :
Dubruille, Stéphanie; Université de Bruxelles
Libert, Yves; Université de Bruxelles
Roos, Myriam
Vandenbossche, Sandrine
Collard, Aurélie
Meuleman, Nathalie
Maerevoet, Marie
Etienne, Anne-Marie ; Université de Liège > Département de Psychologie > Psychologie de la santé
Reynaert, Christine
Razavi, Darius; Université de Bruxelles
Bron, Dominique
Language :
English
Title :
Identification of clinical parameters predictive of one-year survival using two geriatric tools in clinically fit older patients with hematological malignancies: Major impact of cognition
Alternative titles :
[en] Identification of clinical parameters predictive of one-year survival using two geriatric tools in clinically fit older patients with hematological malignancies: Major impact of cognition
Extermann M., Aapro M., Bernabei R., Cohen H.J., Droz J.P., Lichtman S., et al. 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. Hematol. 2005 Sep, 55(3):241-252.
Hamaker M.E., Prins M.C., Stauder R. The relevance of a geriatric assessment for elderly patients with a haematological malignancy--a systematic review. Leuk. Res. 2014 Mar, 38(3):275-283.
Extermann M., Meyer J., McGinnis M., Crocker T.T., Corcoran M.B., Yoder J., et al. A comprehensive geriatric intervention detects multiple problems in older breast cancer patients. Crit. Rev. Oncol. Hematol. 2004 Jan, 49(1):69-75.
Soubeyran PB G.C., Blanc F., Ceccaldi J., Blanc-Blisson J., Mertens C., et al. Validation of a screening test for elderly patients in oncology. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2008, 26. (abstr 20568).
Hamaker M.E., Jonker J.M., de Rooij S.E., Vos A.G., Smorenburg C.H., van Munster B.C. Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol. 2012 Oct, 13(10):e437-e444.
Hamaker M.E., Mitrovic M., Stauder R. The G8 screening tool detects relevant geriatric impairments and predicts survival in elderly patients with a haematological malignancy. Ann. Hematol. 2014 Jun, 93(6):1031-1040.
Morton L.M., Wang S.S., Devesa S.S., Hartge P., Weisenburger D.D., Linet M.S. Lymphoma incidence patterns by WHO subtype in the United States, 1992-2001. Blood 2006 Jan 1, 107(1):265-276.
Katz S., Downs T.D., Cash H.R., Grotz R.C. Progress in development of the index of ADL. Gerontologist 1970 Spring, 10(1):20-30.
Lawton M.P., Brody E.M. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969 Autumn, 9(3):179-186.
Podsiadlo D., Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J. Am. Geriatr. Soc. 1991 Feb, 39(2):142-148.
Lamb S.E., Jorstad-Stein E.C., Hauer K., Becker C. Prevention of falls network E, Outcomes consensus G. Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J. Am. Geriatr. Soc. 2005 Sep, 53(9):1618-1622.
Fieo R.A., Mortensen E.L., Rantanen T., Avlund K. Improving a measure of mobility-related fatigue (the mobility-tiredness scale) by establishing item intensity. J. Am. Geriatr. Soc. 2013 Mar, 61(3):429-433.
Guigoz Y., Vellas B., Garry P.J. Assessing the nutritional status of the elderly: the mini nutritional assessment as part of the geriatric evaluation. Nutr. Rev. 1996 Jan, 54(1 Pt 2):S59-S65.
Folstein M.F., Folstein S.E., McHugh P.R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 1975 Nov, 12(3):189-198.
Nasreddine Z.S., Phillips N.A., Bedirian V., Charbonneau S., Whitehead V., Collin I., et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J. Am. Geriatr. Soc. 2005 Apr, 53(4):695-699.
Zigmond A.S., Snaith R.P. The hospital anxiety and depression scale. Acta Psychiatr. Scand. 1983 Jun, 67(6):361-370.
Sheikh J.I.Y.J. Geriatric Depression Scale (GDS): Recent Evidence and Development of a Shorter Version 1986, The Haworth Press, New-york.
Gnjidic D., Hilmer S.N., Blyth F.M., Naganathan V., Waite L., Seibel M.J., et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J. Clin. Epidemiol. 2012 Sep, 65(9):989-995.
Charlson M.E., Pompei P., Ales K.L., MacKenzie C.R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chronic Dis. 1987, 40(5):373-383.
Mohile S.G., Bylow K., Dale W., Dignam J., Martin K., Petrylak D.P., 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 Feb 15, 109(4):802-810.
Kellen E., Bulens P., Deckx L., Schouten H., Van Dijk M., Verdonck I., et al. Identifying an accurate pre-screening tool in geriatric oncology. Crit. Rev. Oncol. Hematol. 2010 Sep, 75(3):243-248.
Oken M.M., Creech R.H., Tormey D.C., Horton J., Davis T.E., McFadden E.T., et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am. J. Clin. Oncol. 1982 Dec, 5(6):649-655.
Soubeyran P.B.C., Goyard J., Heitz D., Cure H., Rousselot H., et al. Validation of the G8 screening tool in geriatric oncology: the ONCODAGE project. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2011, 29. (Suppl.; abstr 9001).
Kenis C., Decoster L., Van Puyvelde K., De Greve J., Conings G., Milisen K., et al. Performance of two geriatric screening tools in older patients with cancer. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2014 Jan 1, 32(1):19-26.
Stauder R., Thein S.L. Anemia in the elderly: clinical implications and new therapeutic concepts. Haematologica 2014 Jul, 99(7):1127-1130.
Peyrade F., Jardin F., Thieblemont C., Thyss A., Emile J.F., Castaigne S., et al. Attenuated immunochemotherapy regimen (R-miniCHOP) in elderly patients older than 80years with diffuse large B-cell lymphoma: a multicentre, single-arm, phase 2 trial. Lancet Oncol. 2011 May, 12(5):460-468.
Schoch C., Kern W., Schnittger S., Buchner T., Hiddemann W., Haferlach T. The influence of age on prognosis of de novo acute myeloid leukemia differs according to cytogenetic subgroups. Haematologica 2004 Sep, 89(9):1082-1090.
Louwman W.J., Janssen-Heijnen M.L., Houterman S., Voogd A.C., van der Sangen M.J., Nieuwenhuijzen G.A., et al. Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: a population-based study. Eur. J. Cancer 2005 Mar, 41(5):779-785.
Robb C., Boulware D., Overcash J., Extermann M. Patterns of care and survival in cancer patients with cognitive impairment. Crit. Rev. Oncol. Hematol. 2010 Jun, 74(3):218-224.
Klepin H.D., Geiger A.M., Tooze J.A., Kritchevsky S.B., Williamson J.D., Pardee T.S., et al. Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia. Blood 2013 May 23, 121(21):4287-4294.
Granjon C.B.M., Frederico D., Blanc P., Gonthier R. Is there a risk of drug accidents in elderly subjects with cognitive disorders? A study of 82 demented institutionalized patients. NPG 2006, 6(35):21-28.
Lange M., Rigal O., Clarisse B., Giffard B., Sevin E., Barillet M., et al. Cognitive dysfunctions in elderly cancer patients: a new challenge for oncologists. Cancer Treat. Rev. 2014 Jul, 40(6):810-817.
Li W., Muftuler L.T., Chen G., Ward B.D., Budde M.D., Jones J.L., et al. Effects of the coexistence of late-life depression and mild cognitive impairment on white matter microstructure. J. Neurol. Sci. 2014 Mar 15, 338(1-2):46-56.
Wagner D.C., Short J.L. Longitudinal predictors of self-rated health and mortality in older adults. Prev. Chronic Dis. 2014, 11. E93.
Amieva H., Stoykova R., Matharan F., Helmer C., Antonucci T.C., Dartigues J.F. What aspects of social network are protective for dementia? Not the quantity but the quality of social interactions is protective up to 15years later. Psychosom. Med. 2010 Nov, 72(9):905-911.
Dubruille S., Libert Y., Merckaert I., Reynaert C., Vandenbossche S., Roos M., et al. The prevalence and implications of elderly inpatients' desire for a formal psychological help at the start of cancer treatment. Psychooncology 2014 Jul, 31.
Schagen S.B., van Dam F.S., Muller M.J., Boogerd W., Lindeboom J., Bruning P.F. Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer 1999 Feb 1, 85(3):640-650.
Hurria A., Goldfarb S., Rosen C., Holland J., Zuckerman E., Lachs M.S., et al. Effect of adjuvant breast cancer chemotherapy on cognitive function from the older patient's perspective. Breast Cancer Res. Treat. 2006 Aug, 98(3):343-348.
Mandelblatt J.S., Stern R.A., Luta G., McGuckin M., Clapp J.D., Hurria A., et al. Cognitive impairment in older patients with breast cancer before systemic therapy: is there an interaction between cancer and comorbidity?. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2014 Jun 20, 32(18):1909-1918.
Kendal W.S. Dying with cancer: the influence of age, comorbidity, and cancer site. Cancer 2008 Mar 15, 112(6):1354-1362.
Maas H.A., Janssen-Heijnen M.L., Olde Rikkert M.G., Machteld Wymenga A.N. Comprehensive geriatric assessment and its clinical impact in oncology. Eur. J. Cancer 2007 Oct, 43(15):2161-2169.
Lazarovici C.K.R., Leignel D., Fabre-Guillevin E., Minard A., Gisselbrecht M. Factors leading oncologists to refer elderly cancer patients for geriatric assessment. J. Geriatr. Oncol. 2011, 2:194-199.
