Non-small cell lung cancer (NSCLCA) incidence increases with age. However, limited data available regarding their management and outcome due poor representation in clinical trials. The Geriatric assessment (GA) assists in identifying areas of concern, guides treatment decisions and predicts toxicity in older people with cancer. The aim was to investigate the outcome of GA on older people with advance NSCLCA.
Patients ≥70 years with newly diagnosed metastatic and unresectable NSCLCA referred to the Royal Adelaide Hospital cancer centre between 2009 and 2010 were included. Data was collected using a structured self-administered questionnaire (Adelaide Tool) covering Karnofsky Performance Scale, exhaustion (CES-D), weight loss, physical function (SF-36), instrumental activities of daily living, distress (10-point visual analogue scale [VAS]), memory, falls, pain (10 point VAS) and polypharmacy (≥5 medications). Frailty was assessed using an adapted version of Fried's frailty phenotype. Kaplan-Meier curves assessed the impact of frailty on 12 month.
There were 55 older people diagnosed with advance NCLCA with a median age of 74 years (range 71-90) and 66% (n = 36) were male. Patients frailty status was categorised as âfitâ (33%, n = 18), âvulnerableâ (47%, n = 26) or âfrailâ (20%, n = 11). The GA identified concerns relating to distress in 29% (n = 16), exhaustion in 22% (n = 12), falls in 18% (n = 10), memory in 18% (n = 10), pain in 23% (n = 13), polypharmacy in 65% (n = 36) and weight loss in 43% (n = 24). Most patients (70%, n = 39) received first line chemotherapy including doublet for 69% (n = 38) of patients and dose modification for 20% (n = 11) of patients. 38% of patients (n = 21) completed planned four cycles, 32% (n = 18) underwent second line treatment, while 29% (n = 16) received best supportive care. Overall survival was significantly worse for frail and vulnerable patients compared with fit patients (P = 0.01).
Routine incorporation of geriatric assessment like 'Adelaide Tool' provides important prognostic information and helps to identify areas of concerns. Limitations include small sample size and lack of toxicity data.
Clinical trial identification
All authors have declared no conflicts of interest.