Ageing is a global phenomenon and has huge impact in healthcare. Still emerging in developing nations, there has been no major national innitiative focusing on oncologic geriatric patients (pts). The study describes a program to > 70y cancer pts in A C Camargo Cancer Center. We hypothesized that incorporating CGA into daily practice can improve individualized care.
Previous aims were to evaluate if: 1) CGA could be feasible in daily practice; 2) it could be useful as a tool in treatment/tx decision making; 3) analyse the impact of CGA in the selection of tx, with its ability to predict complications (such as dosis reduction, hospitalization, or tx discontinuation) in an Oncogeriatric Unit. The present study is to present the long term survival of those pts, candidates to receive systemic tx, who underwent CGA assessments, which included scales of: ADL (Katz, Lawton), mini-nutritional assessment, depression (GDS), comorbidities and polypharmacy. Patients were classified as fit, borderline or frail. Fit pts received mainly full treatment; frail/borderline pts, mainly modified tx or specific supportive care.
From Oct 25/10-Dec/12/12, 638 pts were included to be prospectively evaluated - female 55%; cancers (%): breast 26, prostate 12, colorectal 12, hematologic 8. Katz A = 68%, Lawton 27=45%; polipharmacy ( > =5): 48%; depression 29%, undernutrition: 21%. We have previously presented (ASCO 2014) that there was an association between the choice of oncologic treatment (original vs modified or with additional dose reduction) with Katz, Lawton, depression and nutrition scales (p < =0.035); as well as the ability to complete the individualized proposed treatment, which was correlated with Lawton (p = 0.04) scale. Hospitalization during chemotherapy was associated with comorbidities, altered Katz, Lawton and depression scales (p < =0.038). With 610 pts evaluable, median survival was 51.7 months.
We could find a high long term survival of 70+ cancer pts, showing CGA to be feasible and allowing long term survival follow-up. However, many pts have been lost to follow-up. How to better perform in pts' adherence and to reduce bias must be a concern in real world geriatric oncology.
Clinical trial identification
Legal entity responsible for the study
Aldo L.A. Dettino; Grupo de Assistencia, Ensino e Pesquisa em Oncologia (GAEPO).
Has not received any funding.
All authors have declared no conflicts of interest.