The comprehensive geriatric assessment (CGA) has been developed to individually assess the health status of older patients.
Methods
This article reviews the findings regarding the impact of a comprehensive geriatric assessment (CGA) on treatment and outcomes in patients with cancer.
Results
Several geriatric variables have been linked with the prognosis of older cancer patients, thus challenging the role of ECOG performance status in this population. A CGA may detect multiple untreated or undertreated problems in cancer patients. Although results are preliminary, some studies suggest that CGA may influence cancer treatment decisions and have a prognostic impact on patients with this disease.
Conclusions
More work is needed to simplify such assessments to make them more feasible and to determine when they should be used during a patient's clinical course.
References
1.
RaoA., HseihF., CohenH.J.Geriatric evaluation management units are useful in managing pain in the elderly cancer patient: from the VA Cooperative Study-006. Proc Annu Meet Am Soc Clin Oncol.2002; 21: 1434. Abstract.
2.
ExtermannM., OvercashJ., LymanG.H.Comorbidity and functional status are independent in older cancer patients. J Clin Oncol.1998; 16: 1582–1587.
3.
RepettoL., VenturinoA., VercelliM.Performance status and comorbidity in elderly cancer patients compared with young patients with neoplasia and elderly patients without neoplastic conditions. Cancer.1998; 82: 760–765.
4.
ExtermannM., AaproM.International issues. In: HunterC.P., JohnsonK.A., MussH.B., eds. Cancer in the Elderly.New York, NY: Marcel Dekker; 2000.
5.
RepettoL.Evaluation of the older person with cancer. 3rd International Conference on Geriatric Oncology. Tampa, Florida, November 1996.
6.
IngramS.S., SeoP.H., MartellR.E.Comprehensive assessment of the elderly cancer patient: the feasibility of self-report methodology. J Clin Oncol.2002; 20: 770–775.
7.
CrimminsE.M., SaitoY., ReynoldsS.L.Further evidence on recent trends in the prevalence and incidence of disability among older Americans from two sources: the LSOA and the NHIS. J Gerontol B Psychol Sci Soc Sci.1997; 52B: S59–S71.
8.
BoustaniM., PetersonB., HansonL.Screening for dementia in primary care: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med.2003; 138: 927–937.
9.
PassikS.D., DuganW., McDonaldM.V.Oncologists’ recognition of depression in their patients with cancer. J Clin Oncol.1998; 16: 1594–1600.
10.
KravitzR.L., ReubenD.B., DavisJ.W.Geriatric home assessment after hospital discharge. J Am Geriatr Soc.1994; 42: 1229–1234.
11.
FabacherD., JosephsonK., PietruszkaF.An in-home preventive assessment program for independent older adults: a randomized controlled trial. J Am Geriatr Soc.1994; 42: 630–638.
12.
AlessiC.A., StuckA.E., AronowH.U.The process of care in preventive in-home comprehensive geriatric assessment. J Am Geriatr Soc.1997; 45: 1044–1050.
13.
SilvermanM., MusaD., MartinD.C.Evaluation of outpatient geriatric assessment: a randomized multi-site trial. J Am Geriatr Soc.1995; 43: 733–740.
14.
ExtermannM., MeyerJ., McGinnisM.Comprehensive geriatric intervention detects multiple problems in older breast cancer patients. Crit Rev Oncol Hematol. Epub July 9, 2003.
15.
ExtermannM., ChenH., CantorA.B.Predictors of tolerance to chemotherapy in older cancer patients: a prospective pilot study. Eur J Cancer.2002; 38: 1466–1473.
16.
FreyerG., Le RolA., WeberB.Geriatric evaluation (GE) and feasibility of platin-based first-line chemotherapy in elderly patients with advanced ovarian cancer (AOC). Proc Annu Meet Am Soc Clin Oncol.2002; 21: 1432. Abstract.
17.
ZagonelV., FratinoL., PiselliP.The comprehensive geriatric assessment (CGA) predicts mortality among elderly cancer patients (ECP). Proc Annu Meet Am Soc Clin Oncol.2002; 21: 1458. Abstract.
18.
McCorkleR., StrumpfN.E., NuamahI.F.A specialized home care intervention improves survival among older post-surgical cancer patients. J Am Geriatr Soc.2000; 48: 1707–1713.
19.
BernardiD., MilanI., BalzarottiM.Comprehensive geriatric evaluation in elderly patients with lymphoma: feasibility of a patient-tailored treatment plan. J Clin Oncol.2003; 21: 754.
20.
CohenH.J., FeussnerJ.R., WeinbergerM.Effect of geriatric evaluation and management units and clinics on survival, health-related quality of life, and functional status: a VA Cooperative Trial. N Engl J Med.2002; 346: 905–912.
21.
OvercashJ.The case for a geriatric oncology program in a cancer center. In: BalducciL., LymanG.H., ErshlerW.B., eds. Comprehensive Geriatric Oncology.Amsterdam: Harwood Academic Publishers; 1998.
22.
RepettoL., FratinoL., AudisioR.A.Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol.2002; 20: 494–502.
23.
BalducciL., YatesJ.General guidelines for the management of older patients with cancer. Oncology (Huntingt).2000; 14: 221–227.
24.
StuckA.E., EggerM., HammerA.Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA.2002; 287: 1022–1028.
25.
ExtermannM.Comprehensive geriatric assessment basics for the cancer professional. J Oncol Manag.2003; 12: 13–17.
26.
FrasciG., LorussoV., PanzaN.Gemcitabine plus vinorelbine versus vinorelbine alone in elderly patients with advanced non-small-cell lung cancer. J Clin Oncol.2000; 18: 2529–2536.
27.
MurrayK.J., ScottC., ZachariahB.Importance of the mini-mental status examination in the treatment of patients with brain metastases: a report from the Radiation Therapy Oncology Group Protocol 91-04. Int J Radiat Oncol Biol Phys.2000; 48: 59–64.
28.
McCuskerJ., VerdonJ., TousignantP.Rapid emergency department intervention for older people reduces risk of functional decline: results of a multicenter randomized trial. J Am Geriatr Soc.2001; 49: 1272–1281.
29.
MionL.C., PalmerR.M., AnetzbergerG.J.Establishing a case-finding and referral system for at-risk older individuals in the emergency department setting: the SIGNET model. J Am Geriatr Soc.2001; 49: 1379–1386.
