1420PD - Screening tool for unfitness in geriatric oncology: what does it tell us in daily practice?

Date 01 October 2012
Event ESMO Congress 2012
Session Public health and familial cancer
Topics Geriatric Oncology
Presenter Catherine Terret
Authors C. Terret1, S. Perrin2
  • 1Medical Oncology, Centre Léon Bérard, 69008 - LYON/FR
  • 2Geriatric Oncology Program / Medical Oncology, Centre Léon Bérard, 69008 - LYON/FR

 

Abstract

Background

We are facing a growing number of cancer patients (pts) aged ≥ 70 years. However, cancer treatment decision-making appears a difficult task in such heterogeneous population as solid recommendations are still lacking. The G8 scale was designed to help discriminate older cancer patients needing a geriatrician's opinion before cancer treatment decision-making. This 8-item tool can be completed in <5 minutes and scores range from 0 to 17 (best). The ONCODAGE study confirmed that G8 scores <15 selected pts needed a geriatrician's opinion. With this cut-off, G8 sensitivity and specificity were respectively 68% and 74%.

Objectives

We have decided to implement the G8 scale in daily practice at our Comprehensive Cancer Centre to study the feasibility of such a tool in outpatient clinics and to evaluate the proportion of elderly pts requiring geriatric resources. Study design: An auxiliary nurse administered G8 to pts ≥70 years with newly diagnosed cancer or relapse at their first attendance in our oncology clinics.

Results

From January to April 2012, 101 pts completed the G8 scale. They were mainly men (64); mean age was 81 years (70-98). Main primary tumor sites were lung (16), prostate (14), hematologic malignancies (14), head & neck (13), breast (12), digestive tract (12), and sarcoma (6). Only a quarter of pts had an advanced-stage disease and half of them had a localized tumor. Around two thirds (68 out of 101) of the pts obtained a G8 score <15. Most frequently impaired items were item H (number of medications) with 65 pts indicating that they took > 3 drugs, and items A and B on nutritional aspects telling respectively that 30 pts had mild to severe anorexia and 35 pts had lost ≥ 1 kg in the last 3 months.

Discussion

G8 appears easy to implement in daily practice in the outpatient setting. However, our results, as well as those of the ONCODAGE study, indicate that around 7 out 10 pts should be referred to a geriatric team before cancer treatment decision-making. This approach is clearly not realistic in daily practice due to the lack of geriatric resources. Alternatively, we are considering another process including a second step of screening in order to select more accurately older pts candidate to geriatric evaluation.

Disclosure

All authors have declared no conflicts of interest.