[en] [en] INTRODUCTION: Geriatric screening and geriatric assessment (GS/GA) have proven their benefits in the care for older patients with cancer. However, less is known about the predictive value of GS/GA for outcomes. To research this, clinical data on GS/GA can be enriched with population-based data. In this article we describe the methods and feasibility of data linkage, and first clinical outcomes (GS/GA results and overall survival).
MATERIALS AND METHODS: A large cohort study consisting of patients aged ≥70 years with a new cancer diagnosis was established using linked data from clinical and population-based databases. Clinical data were derived from a previous prospective study where older patients with cancer were screened with G8, followed by GA in case of an abnormal result (GS/GA study; 2009-2015). These data were linked to cancer registration data from the Belgian Cancer Registry (BCR), reimbursement data of the health insurance companies (InterMutualistic Agency, IMA), and hospital discharge data (Technical Cell, TCT). Cox regression analyses were conducted to evaluate the prognostic value of the G8 geriatric screening tool.
RESULTS: Of the 8067 eligible patients with a new cancer diagnosis, linkage of data from the GS/GA study and data from the BCR was successful for 93.7%, resulting in a cohort of 7556 patients available for the current analysis. Further linkage with the IMA and TCT database resulted in a cohort of 7314 patients (96.8%). Based on G8 geriatric screening, 67.9% of the patients had a geriatric risk profile. Malnutrition and functional dependence were the most common GA-identified risk factors. An abnormal baseline G8 score (≤14/17) was associated with lower overall survival (adjusted HR [aHR] = 1.62 [1.50-1.75], p < 0.001).
DISCUSSION: Linking clinical and population-based databases for older patients with cancer has shown to be feasible. The GS/GA results at cancer diagnosis demonstrate the vulnerability of this population and the G8 score showed prognostic value for overall survival. The established cohort of almost 8000 patients with long-term follow-up will serve as a basis in the future for detailed analyses on long-term outcomes beyond survival.
Disciplines :
Oncology
Author, co-author :
Depoorter, Victoria; KU Leuven, Department of Oncology, Leuven, Belgium
Vanschoenbeek, Katrijn; Belgian Cancer Registry, Research Department, Brussels, Belgium
Decoster, Lore; Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Oncologisch Centrum - Department of Medical Oncology, Brussels, Belgium
De Schutter, Harlinde; Belgian Cancer Registry, Research Department, Brussels, Belgium
Debruyne, Philip R; General Hospital Groeninge, Kortrijk Cancer Centre, Kortrijk, Belgium, Anglia Ruskin University, Medical Technology Research Centre (MTRC), School of Life Sciences, Cambridge, UK, University of Plymouth, School of Nursing & Midwifery, Plymouth, UK
De Groof, Inge; Iridium Cancer Network Antwerp - Sint-Augustinus, Department of Geriatric Medicine, Wilrijk, Belgium
Bron, Dominique; ULB Institute Jules Bordet, Department of Hematology, Brussels, Belgium
Cornélis, Frank; Cliniques Universitaires Saint-Luc - UCLouvain, Department of Medical Oncology, Brussels, Belgium
Luce, Sylvie; University Hospital Erasme- Université Libre de Bruxelles ULB, Department Medical Oncology, Brussels, Belgium
Focan, Christian; Clinique CHC-MontLégia, Groupe Santé CHC-Liège, Department of Oncology, Liège, Belgium
Verschaeve, Vincent; GHDC Grand Hôpital de Charleroi, Department of Medical Oncology, Charleroi, Belgium
Debugne, Gwenaëlle; Centre Hospitalier de Mouscron, Department of Geriatric Medicine, Mouscron, Belgium
Langenaeken, Christine; AZ Klina, Department of Medical Oncology, Brasschaat, Belgium
Van Den Bulck, Heidi; Imelda Hospital, Department of Medical Oncology, Bonheiden, Belgium
Goeminne, Jean-Charles; CHU-UCL-Namur, Department of Medical Oncology, Namur, Belgium
Teurfs, Wesley; ZNA Stuivenberg, Department Medical Oncology, Antwerp, Belgium
Jerusalem, Guy ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'oncologie médicale
Schrijvers, Dirk; ZNA Middelheim, Department of Medical Oncology, Antwerp, Belgium
Petit, Bénédicte; Centre Hospitalier Jolimont, Department of Medical Oncology, La Louvière, Belgium
Rasschaert, Marika; University Hospital Antwerp, Department of Medical Oncology, Edegem, Belgium
Praet, Jean-Philippe; CHU St-Pierre - Free Universities Brussels, Department of Geriatric Medicine, Brussels, Belgium
Vandenborre, Katherine; AZ Vesalius, Department of Medical Oncology, Tongeren, Belgium
Milisen, Koen; University Hospitals Leuven - KU Leuven, Department of Geriatric Medicine - Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
Flamaing, Johan; University Hospitals Leuven - KU Leuven, Department of Geriatric Medicine - Department of Public Health and Primary Care, Gerontology and Geriatrics, Leuven, Belgium
Kenis, Cindy; University Hospitals Leuven, Department of General Medical Oncology - Department of Geriatric Medicine, Leuven, Belgium
Verdoodt, Freija; Belgian Cancer Registry, Research Department, Brussels, Belgium
Wildiers, Hans; University Hospitals Leuven - KU Leuven, Department of General Medical Oncology - Department of Oncology, Leuven, Belgium. Electronic address: hans.wildiers@uzleuven.be
Linking clinical and population-based data in older patients with cancer in Belgium: Feasibility and clinical outcomes.
Publication date :
March 2023
Journal title :
Journal of Geriatric Oncology
ISSN :
1879-4068
eISSN :
1879-4076
Publisher :
Elsevier Ltd, Netherlands
Volume :
14
Issue :
2
Pages :
101428
Peer reviewed :
Peer Reviewed verified by ORBi
Funding text :
The research project received funding from Kom op tegen Kanker (Stand up to Cancer), the Flemish cancer society . HW is a recipient of the Fonds voor Wetenschappelijk Onderzoek – Vlaanderen (funds from The Research Foundation – Flanders). The funders had no involvement in study design, analysis and interpretation of the data, writing of the report, and the decision to submit this article for publication.
Cancer in an ageing population in Belgium 2004–2016, 2018, Belgian Cancer Registry, Brussels.
Rechel, B., Grundy, E., Robine, J.M., Cylus, J., Mackenbach, J.P., Knai, C., et al. Ageing in the European Union. Lancet. 381 (2013), 1312–1322.
Kadambi, S., Loh, K.P., Dunne, R., Magnuson, A., Maggiore, R., Zittel, J., et al. Older adults with cancer and their caregivers - current landscape and future directions for clinical care. Nat Rev Clin Oncol 17 (2020), 742–755.
Clegg, A., Young, J., Iliffe, S., Rikkert, M.O., Rockwood, K., Frailty in elderly people. Lancet. 381 (2013), 752–762.
Handforth, C.C.A., Young, C., Simpkins, S., Seymour, M.T., Selby, P.J., Young, J., The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol 26 (2015), 1091–1101.
Wildiers, H., Heeren, P., Puts, M., Topinkova, E., Janssen-Heijnen, M.L., Extermann, M., et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 32 (2014), 2595–2603.
Mohile, S.G., Dale, W., Somerfield, M.R., Hurria, A., Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology summary. J Oncol Pract 14 (2018), 442–446.
Pallis, A.G., Fortpied, C., Wedding, U., Van Nes, M.C., Penninckx, B., Ring, A., et al. EORTC elderly task force position paper: approach to the older cancer patient. Eur J Cancer 46 (2010), 1502–1513.
Dotan, E., Walter, L.C., Browner, I.S., Clifton, K., Cohen, H.J., Extermann, M., et al. NCCN guidelines® insights: older adult oncology, version 1.2021. J Natl Compr Canc Netw 19 (2021), 1006–1019.
Hamaker, M.E., Te Molder, M., Thielen, N., van Munster, B.C., Schiphorst, A.H., van Huis, L.H., The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients - a systematic review. J Geriatr Oncol 9 (2018), 430–440.
Kenis, C., Baitar, A., Decoster, L., De Greve, J., Lobelle, J.P., Flamaing, J., et al. The added value of geriatric screening and assessment for predicting overall survival in older patients with cancer. Cancer. 124 (2018), 3753–3763.
Wildes, T.M., Ruwe, A.P., Fournier, C., Gao, F., Carson, K.R., Piccirillo, J.F., et al. Geriatric assessment is associated with completion of chemotherapy, toxicity, and survival in older adults with cancer. J Geriatr Oncol 4 (2013), 227–234.
Mohile, S.G., Epstein, R.M., Hurria, A., Heckler, C.E., Canin, B., Culakova, E., et al. Communication with older patients with Cancer using geriatric assessment: a cluster-randomized clinical trial from the National Cancer Institute Community oncology research program. JAMA Oncol 6 (2020), 196–204.
Kenis, C., Bron, D., Libert, Y., Decoster, L., Van Puyvelde, K., Scalliet, P., et al. Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study. Ann Oncol 24 (2013), 1306–1312.
Baitar, A., Kenis, C., Moor, R., Decoster, L., Luce, S., Bron, D., et al. Implementation of geriatric assessment-based recommendations in older patients with cancer: a multicentre prospective study. J Geriatr Oncol 6 (2015), 401–410.
Kenis, C., Decoster, L., Flamaing, J., Debruyne, P.R., De Groof, I., Focan, C., et al. Adherence to geriatric assessment-based recommendations in older patients with cancer: a multicenter prospective cohort study in Belgium. Ann Oncol 29 (2018), 1987–1994.
Soubeyran, P., Bellera, C., Goyard, J., Heitz, D., Cure, H., Rousselot, H., et al. Screening for vulnerability in older cancer patients: the ONCODAGE prospective multicenter cohort study. PLoS One, 9, 2014, e115060.
Depoorter, V., Vanschoenbeek, K., Kenis, C., De Schutter, H., Decoster, L., Wildiers, H., et al. The value of population-based databases to evaluate long-term patient outcomes: a multicentric research project in older patients with cancer. Belg J Med Oncol 15 (2021), 362–366.
Henau, K., Van Eycken, E., Silversmit, G., Pukkala, E., Regional variation in incidence for smoking and alcohol related cancers in Belgium. Cancer Epidemiol 39 (2015), 55–65.
Decoster, L., Van Puyvelde, K., Mohile, S., Wedding, U., Basso, U., Colloca, G., et al. Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendationsdagger. Ann Oncol 26 (2015), 288–300.
Loh, K.P., Soto-Perez-de-Celis, E., Hsu, T., de Glas, N.A., Battisti, N.M.L., Baldini, C., et al. What every oncologist should know about geriatric assessment for older patients with Cancer: young international society of geriatric oncology position paper. J Oncol Pract 14 (2018), 85–94.
Bruijnen, C.P., van Harten-Krouwel, D.G., Koldenhof, J.J., Emmelot-Vonk, M.H., Witteveen, P.O., Predictive value of each geriatric assessment domain for older patients with cancer: a systematic review. J Geriatr Oncol 10 (2019), 859–873.
Presley, C.J., Dotan, E., Soto-Perez-de-Celis, E., Jatoi, A., Mohile, S.G., Won, E., et al. Gaps in nutritional research among older adults with cancer. J Geriatr Oncol 7 (2016), 281–292.
Nightingale, G., Battisti, N.M.L., Loh, K.P., Puts, M., Kenis, C., Goldberg, A., et al. Perspectives on functional status in older adults with cancer: an interprofessional report from the International Society of Geriatric Oncology (SIOG) nursing and allied health interest group and young SIOG. J Geriatr Oncol 12 (2021), 658–665.
Mohile, S.G., Fan, L., Reeve, E., Jean-Pierre, P., Mustian, K., Peppone, L., et al. Association of cancer with geriatric syndromes in older Medicare beneficiaries. J Clin Oncol 29 (2011), 1458–1464.
Hoogendijk, E.O., Afilalo, J., Ensrud, K.E., Kowal, P., Onder, G., Fried, L.P., Frailty: implications for clinical practice and public health. Lancet. 394 (2019), 1365–1375.
Song, X., Mitnitski, A., Rockwood, K., Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc 58 (2010), 681–687.
Limpawattana, P., Phimson, K., Sookprasert, A., Sirithanaphol, W., Chindaprasirt, J., Prevalence of geriatric syndromes in elderly Cancer patients receiving chemotherapy. Curr Gerontol Geriatr Res, 2020, 2020, 9347804.
Koroukian, S.M., Murray, P., Madigan, E., Comorbidity, disability, and geriatric syndromes in elderly cancer patients receiving home health care. J Clin Oncol 24 (2006), 2304–2310.
Wada, S., Shimizu, K., Inoguchi, H., Shimoda, H., Yoshiuchi, K., Akechi, T., et al. The association between depressive symptoms and age in Cancer patients: a multicenter cross-sectional study. J Pain Symptom Manage 50 (2015), 768–777.
Avis, N.E., Levine, B., Naughton, M.J., Case, L.D., Naftalis, E., Van Zee, K.J., Age-related longitudinal changes in depressive symptoms following breast cancer diagnosis and treatment. Breast Cancer Res Treat 139 (2013), 199–206.
Sinoff, G., Thanatophobia (death anxiety) in the elderly: the problem of the Child's inability to assess their own Parent's death anxiety state. Front Med (Lausanne), 4, 2017, 11.
Peters, M.L., Patijn, J., Lamé, I., Pain assessment in younger and older pain patients: psychometric properties and patient preference of five commonly used measures of pain intensity. Pain Med 8 (2007), 601–610.
Lautenbacher, S., Peters, J.H., Heesen, M., Scheel, J., Kunz, M., Age changes in pain perception: a systematic-review and meta-analysis of age effects on pain and tolerance thresholds. Neurosci Biobehav Rev 75 (2017), 104–113.
Sharman Moser, S., Doyev, R., Cohen, B., Kurz, R., Sulo, S., Shalev, V., et al. Prevalence and characteristics of malnutrition among community-dwelling older adults in Israel. Clin Nutr ESPEN 28 (2018), 179–185.
Wei, K., Nyunt, M.S.Z., Gao, Q., Wee, S.L., Ng, T.P., Frailty and malnutrition: related and distinct syndrome prevalence and association among community-dwelling older adults: Singapore longitudinal ageing studies. J Am Med Dir Assoc 18 (2017), 1019–1028.
Wolters, M., Volkert, D., Streicher, M., Kiesswetter, E., Torbahn, G., O'Connor, E.M., et al. Prevalence of malnutrition using harmonized definitions in older adults from different settings - a MaNuEL study. Clin Nutr 38 (2019), 2389–2398.
Calvo, I., Olivar, J., Martínez, E., Rico, A., Díaz, J., Gimena, M., MNA® Mini nutritional assessment as a nutritional screening tool for hospitalized older adults; rationales and feasibility. Nutr Hosp 27 (2012), 1619–1625.
Baeyens, J.P., Belgian care programme for older patients. J Nutr Health Aging 14 (2010), 474–475.
van Walree, I.C., Scheepers, E., van Huis-Tanja, L., Emmelot-Vonk, M.H., Bellera, C., Soubeyran, P., et al. 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 (2019), 847–858.
Middelburg, J.G., Middelburg, R.A., van Zwienen, M., Mast, M.E., Bhawanie, A., Jobsen, J.J., et al. Impaired geriatric 8 score is associated with worse survival after radiotherapy in older patients with Cancer. Clin Oncol (R Coll Radiol) 33 (2021), e203–e210.
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 93 (2014), 1031–1040.
Agemi, Y., Shimokawa, T., Sasaki, J., Miyazaki, K., Misumi, Y., Sato, A., et al. Prospective evaluation of the G8 screening tool for prognostication of survival in elderly patients with lung cancer: a single-institution study. PLoS One, 14, 2019, e0210499.
Scheepers, E.R.M., van der Molen, L.F., van den Bos, F., Burgmans, J.P., van Huis-Tanja, L.H., Hamaker, M.E., The G8 frailty screening tool and the decision-making process in older breast cancer patients. Eur J Cancer Care (Engl), 2020, e13357.
Garcia, M.V., Agar, M.R., Soo, W.K., To T, Phillips, J.L., Screening tools for identifying older adults with cancer who may benefit from a geriatric assessment: a systematic review. JAMA Oncol 7 (2021), 616–627.
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 40 (1987), 373–383.
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 5 (1982), 649–655.
Aaronson, N.K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N.J., 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 85 (1993), 365–376.
Fayers, P., Aaronson, N.K., Bjordal, K., Sullivan, M., EORTC QLQ–C30 scoring manual. 1995, European Organisation for Research and Treatment of Cancer, Brussels.
InterMutualistisch Agentschap (IMA), Agence InterMutualiste (AIM). https://www.ima-aim.be/?lang=nl, 2023 [Accessed on: 2021 Aug 11].
Technische Cel - Cellule Technique (TCT). https://tct.fgov.be/webetct/etct-web/, 2023 [Accessed on: 2021 Aug 12].
