title: Single-Agent Gemcitabine in Previously Untreated Elderly Patients with Advanced Bladder Carcinoma: Response to Treatment and Correlation with the Comprehensive Geriatric Oral Etoposide in Elderly Patients with Advanced Non Small Cell Lung Cancer: A Clinical and Pharmacological Study Obese frailty, physical performance deficits, and falls in older men with biochemical recurrence of prostate cancer on androgen deprivation therapy: a case-control study. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Multidimensional geriatric assessment in treatment decision in elderly cancer patients: 6-year experience in an outpatient geriatric oncology service. Comprehensive geriatric assessment in Korean elderly cancer patients receiving chemotherapy Predicting falls in older patients using components of a comprehensive geriatric assessment [Lung cancer in the elderly: performance status and/or geriatric indices?]. A comprehensive geriatric intervention detects multiple problems in older breast cancer patients. Geriatric evaluation and management units in the care of the frail elderly cancer patient. Physicians' judgement and comprehensive geriatric assessment (CGA) select different patients as fit for chemotherapy. A phase II study of weekly carboplatin and paclitaxel as first-line treatment of elderly patients with advanced ovarian cancer. A Multicentre Italian Trial in Ovarian cancer (MITO-5) study. Age, severe comorbidity and functional impairment independently contribute to poor survival in cancer patients Carboplatin/cyclophosphamide or carboplatin/paclitaxel in elderly patients with advanced ovarian cancer? Analysis of two consecutive trials from the Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens. Quality of life, geriatric assessment and survival in elderly patients with non-small-cell lung cancer treated with carboplatin-gemcitabine or carboplatin-paclitaxel: NVALT-3 a phase III study. Prediction of falls in older adults with cancer: a preliminary study Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Predictors of treatment failures during chemotherapy: A prospective study on 110 older cancer patients. A prospective, longitudinal study of the functional status and quality of life of older patients with breast cancer receiving adjuvant chemotherapy. Importance of a comprehensive geriatric assessment in prediction of complications following thoracic surgery in elderly patients. Pre-operative assessment of cancer in the elderly (PACE): a comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery. Geriatric assessment in elderly patients with prostate cancer. Lymphoma in elderly patients: novel functional assessment techniques provide better discrimination among patients than traditional performance status measures. Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study. Prevalence of functional disability among elderly patients with cancer. Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Does frailty predict hospitalization, emergency department visits, and visits to the general practitioner in older newly-diagnosed cancer patients? Results of a prospective pilot study. Cognitive function of older patients receiving adjuvant chemotherapy for breast cancer: a pilot prospective longitudinal study. Analysis of treatment practices for elderly cancer patients in Ontario, Canada. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. Results of comprehensive geriatric assessment effect survival in patients with malignant lymphoma An attempt to correlate a "Multidimensional Geriatric Assessment" (MGA), treatment assignment and clinical outcome in elderly cancer patients: results of a phase II open study. Effectiveness of a geriatric evaluation unit. A randomized clinical trial. Components of geriatric assessments predict thoracic surgery outcomes. Comprehensive Geriatric Assessment in Elderly Cancer Patients: An Experience in an Outpatient Population Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Implementing a geriatric assessment in cooperative group clinical cancer trials: CALGB 360401. Identifying vulnerable older adults with cancer: integrating geriatric assessment into oncology practice. Evaluation of the effectiveness of treatment with erythropoietin on anemia, cognitive functioning and functions studied by comprehensive geriatric assessment in elderly cancer patients with anemia related to cancer chemotherapy.
abstract: Objective : The study aim ed at evaluating the activity and toxicity of gemcitabine monochemotherapy in a unselected series of elderly patients with advanced bladder cancer . The secondary objectives were to establish whether there is a correlation between treatment and Comprehensive Geriatric Assessment ( CGA ) and , in addition , to determine overall patient survival . Methods : Treatment consisted of six courses of chemotherapy with gemcitabine at a dosage of 1,200 mg/m2 on days 1 and 8 , every 21 days . CGA , as described by Gruppo Italiano di Oncologia Geriatrica , was assessed for evaluating the functional status of patients before , during , and after treatment . Results : Twenty-five patients were enrolled ( M/F 22/3 ) , 22 of these were evaluable for response and 23 for toxicity . Characteristics of patients : median age 76 years ( range 71–87 ) ; ECOG performance status ( PS ) 1 in 12 patients and 2 in 13 patients ; clinical stage III in 6 patients and IV in 19 patients . At the end of the therapy the parameters of CGA improved in 4 cases ( 17 % ) , remained unchanged in 17 cases ( 74 % ) and worsened only in 2 cases ( 9 % ) . Two patients were not evaluable . Response evaluation showed 3 ( 13.5 % ) complete responses ( CRs ) and 7 ( 32 % ) partial responses ( PRs ) , for an overall response rate of 45.5 % [ 95 % confidence interval ( CI ) , 24.3–65.7 % ] . Three ( 13.5 % ) patients had stable disease ( SD ) and 9 ( 41 % ) disease progression ( DP ) . Median overall survival was 8 months and median time to progression was 5 months . Treatment was generally well tolerated , with 1 patient having grade 3 gastrointestinal toxicity and 3 having grade 4 neutropenia . Conclusions : We conclude that gemcitabine can be safely administered in monochemotherapy , is effective and does not worsen the functional status of elderly patients with advanced bladder cancer Abstract Seventeen elderly patients with advanced progressive non small cell lung cancer ( NSCLC ) were treated with oral etoposide at the daily dose of 100 mg for 14 days every 3 - 4 weeks with pharmacokinetic monitoring . One partial response and 6 stabilizations were documented with a median overall duration of 13 weeks ( range 8 - 32 ) . The median survival was 24 weeks with an apparent advantage for non-progressive patients ( 40 weeks vs. 18 weeks ) . The treatment was well tolerated especially by those patients without concomitant illness , suggesting the crucial role of a careful selection of the geriatric population . Toxicity was not related to the etoposide plasma level , but was clearly dependent on comorbidity . A geriatric assessment rather than chronological age therefore appears to be more reliable in the selection of elderly patients for clinical trials . The easy self-management , favorable toxicity profile and synergy with other compounds makes oral etoposide suitable for further clinical -pharmacological studies in elderly patients OBJECTIVES To test the hypothesis that early and rogen deprivation therapy ( ADT ) has no proven survival advantage in older men with biochemical recurrence ( BCR ) of prostate cancer ( PCa ) , and it may contribute to geriatric frailty . METHODS We conducted a case-control study of men aged 60 + years with BCR on ADT ( n = 63 ) vs PCa survivors without recurrence ( n = 71 ) .  Frailty prevalence , " obese " frailty , Short Physical Performance Battery ( SPPB ) scores , and falls were compared . An exploratory analysis of frailty biomarkers ( C-reactive protein , erythrocyte sedimentation rate , hemoglobin , albumin , and total cholesterol ) was performed . Summary statistics and univariate and multivariate regression analyses were conducted . RESULTS More patients on ADT  were obese ( body mass index > 30 ; 46.2 % vs 20.6 % ; P = .03 ) . There were no statistical differences in SPPB ( P = .41 ) or frailty ( P = .20 ) . Using a proposed " obese " frailty criteria , 8.7 % in ADT group were frail and 56.5 % were " prefrail , " compared with 2.9 % and 48.8 % of controls ( P = .02 ) . Falls in the last year were higher in the ADT group ( 14.3 % vs 2.8 % ; P = .02 ) . In analyses controlling for age , clinical characteristics , and comorbidities , the ADT group trended toward significance for " obese " frailty ( P = .14 ) and falls ( OR = 4.74 , P = .11 ) . Comorbidity significantly increased the likelihood of " obese " frailty ( P = .01 ) and falls ( OR 2.02 , P = .01 ) . CONCLUSIONS Men with BCR on ADT  are frailer using proposed modified " obese " frailty criteria . They may have lower performance status and more falls . A larger , prospect i ve trial is necessary to establish a causal link between ADT use and progression of frailty and disability BACKGROUND Development of a geriatric screening tool is necessary to identify elderly cancer patients who would benefit from comprehensive geriatric assessment ( CGA ) .  We develop and evaluate the G-8 screening tool against various reference tests . PATIENTS AND METHODS Analyses were based on 364 cancer patients aged>70 years scheduled to receive first-line chemotherapy included in a multicenter prospect i ve study . The G-8 consists of seven items from the Mini Nutritional Assessment ( MNA ) question naire and age . Our primary reference test is based on a set of seven CGA scales : Activities Daily Living ( ADL ) , Instrumental ADL , MNA , Mini-Mental State Exam , Geriatric Depression Scale , Cumulative Illness Rating Scale-Geriatrics , and Timed Get Up and Go . We considered the presence of at least one question naire with an impaired score as an abnormal reference exam . Additional reference exams are also discussed . RESULTS The prevalence of being at risk varied from 60 % to 94 % according to the various definitions of the reference test . When considering the primary reference test , a cut-off value of 14 for the G-8 tool provided a good sensitivity estimate ( 85 % ) without deteriorating the specificity excessively ( 65 % ) . CONCLUSION The G-8 shows good screening properties for identifying elderly cancer patients who could benefit from CGA This prospect i ve cohort study of consecutive elderly cancer patients was undertaken to evaluate the role of the multidimensional geriatric assessment ( MGA ) as an aid in treatment decision-making . A total of 571 cancer patients ( aged > or = 70 ) were enrolled during 6-year ( 1999 - 2005 ) . All underwent MGA as part of the first evaluation . In multivariate analysis , the probability of receiving active , instead of palliative , treatment was negatively associated with increasing age ( odds ratio=0.69 every 5 years , p=0.005 ) , living alone ( OR=0.54 , p=0.031 ) , dependence in activities of daily living ( ADL score > 0 , OR=0.41 , p=0.003 ) and a low body-mass index ( BMI ) ( OR=0.51 , p=0.061 ) ; while a positive association emerged for instrumental activities of daily living ( IADL ) score ( OR=1.12 per point , p=0.019 ) . Our data suggest that MGA , in addition to age , is a useful tool in clinical practice for deciding cancer treatment in elderly patients , with a major independent role played by living alone , ADL , IADL and BMI Background Growing evidence suggests that a comprehensive geriatric assessment ( CGA ) in older patients with cancer can detect unsuspected health problems , predict survival , and predict tolerance to chemotherapy . However , studies regarding CGA in cancer patients are scarce in Asia . Methods We prospect ively enrolled 65 elderly cancer patients who were c and i date s of systemic chemotherapy between July 2006 and March 2008 . Baseline CGA data including demographic information , comorbidity , functional status by means of Activities of Daily Living ( ADL ) , and Instrumental Activities of Daily Living ( IADL ) , cognition , psychological state , nutritional status , and medication were collected and analyzed . Quality of life ( QoL ) was assessed by the EORTC question naire QLQ-C30 . Results Of the 65 patients , the median age was 71 years ( range , 65–80 ) , 49 ( 75 % ) were males , and 58 ( 89 % ) had Eastern Cooperative Oncology Group performance status ( ECOG PS ) 0 or 1 . All patients had solid tumor , 74 % received palliative chemotherapy , and 18 % received adjuvant chemotherapy . Twenty-five percent of patients had Charlson ’s comorbidity index score of 2 or more , 23 % were ADL dependent , and 14 % were IADL dependent . Using Mini-Mental Status Exam ( MMSE ) , it was found that 51 % of patients had mild cognitive impairment ( MMSE score 17–24 ) , and 5 % had cognitive impairment ( ≤16 ) . Forty percent of patients had depression by Short form Geriatric Depression Scale ( SGDS ) , 19 % had malnutrition by Mini-Nutritional Assessment ( MNA ) , and 23 % had body mass index ( BMI ) less than 19.4 kg/m2 ( lowest 10 % ) . Global health status/ quality of life ( QoL ) was less than 50 % in 39 % of patients . Frail patients according to the Balducci classification had significantly poor ECOG PS and worse global health status/QoL.  Conclusion CGA was feasible and could detect multiple unsuspected health problems including functional impairment and malnutrition in Korean elderly cancer patients receiving chemotherapy This prospect i ve study evaluated components of a comprehensive geriatric assessment ( CGA ) to identify rates and predictors of falls in older patients . Fall rates and scores on components of the CGA were compared among adults aged 70 or older in three groups : patients with cancer receiving chemotherapy , patients with cancer not receiving chemotherapy , and community-dwelling adults without cancer . Older adults in the chemotherapy group were hypothesized to fall significantly more often than those in the nonchemotherapy group . Among the patients with cancer , scores on the Activities of Daily Living Scale were a significant predictor of falls . The scores were the only domain of the CGA found to be a significant predictor ; therefore , more research is needed to better underst and fall risk assessment among older patients with cancer . Nurses should conduct fall risk assessment s with measures of functional status as included in a CGA INTRODUCTION Demographic aging poses a problem of management in patients over 65 years old with lung cancer ( LC ) .  Performance status ( PS ) is an index of global activity that , in part , determines treatment . Geriatric indices allow a multifactorial assessment of the elderly subject . The aim of our study is to evaluate whether PS correlates with the geriatric indices in elderly patients with lung cancer . METHODS In a single centre prospect i ve study the  geriatric indices ( ADL , IADL , PINI , MMS )  and the Charlson score ( CS )  were measured before treatment . RESULTS Forty one patients aged 75.7 + /- 6.6 years were included in the study .  PS 3 - 4 was found in 15 % of patients and 44 % had stage IV disease . Half of them were ADL dependent and 95 % were IADL dependent . A MMS<24 was found in 29 % and 17 % had a PINI > 20 . The CS was 2.7 + /- 2.1 . There was a correlation between PS and the geriatric indices but no correlation between PS and CS . CONCLUSION PS is significantly correlated with the geriatric indices but is independent of CS . PS appears to be a good parameter for the assessment of global activity in the elderly subject with LC UNLABELLED Studies of comprehensive geriatric assessment ( CGA ) have shown the importance of follow-up for effectiveness , but this has not been tested in an oncology clinic . In this pilot study , we enrolled 15 early breast cancer patients , aged 70 and older . They received a multidisciplinary CGA every 3 months and structured follow-up from the SAOP nurse practitioner , dietitian , social worker , and pharmacist according to risk . Total follow-up was 6 months . Median age of evaluable patients was 79 years ( range 72 - 87 ) .  Median number of comorbidities by Cumulative Index Rating Scale-Geriatric ( CIRS-G ) was 5 ( 3 - 9 ) at baseline . Ten patients were at pharmacological risk , five at psychosocial risk , and eight at nutritional risk . Patients presented on average six problems initially , and three new problems during follow-up . The intervention directly influenced oncological treatment in four cases . It ensured continuity/coordination of care in seven cases . Success rate in addressing problems was 87 % . Mean Functional Assessment of Cancer Treatment-Breast ( FACT-B ) scores improved from 110.5 ( S.D. 16.7 ) to 116.3 ( S.D. 16.5 ) ( t=0.025 ) . Function and independence were maintained . CONCLUSIONS Older patients with early breast cancer have a high prevalence of comorbidity . A CGA with follow-up has potential for improving the treatment and prognosis of these patients and is feasible in an academic oncology setting BACKGROUND Geriatric assessment has been suggested as a possibly useful approach in dealing with frail elderly cancer patients . METHODS This was a secondary subset analysis from a r and omized 2 x 2 factorial trial in 11 Department of Veterans Affairs medical centers . Hospitalized , frail patients at least 65 years old , after stabilization of their acute illness , were r and omized to receive care in a geriatric inpatient unit , a geriatric outpatient clinic , both , or neither .  The interventions involved core teams that provided geriatric assessment and patient management . We identified 99 patients with a diagnosis of cancer by The International Classification of Diseases , 9th Revision ( ICD-9 ) codes , excluding all nonmelanoma skin cancers . Outcomes collected at discharge , 6 months , and 1 year after r and omization were survival , changes in health-related quality of life ( using the Medical Outcomes Study 36-Item Short-Form general health survey [ SF-36 ] ) , activities of daily living , physical performance , health service utilization , and costs . RESULTS There was no effect on mortality ( 1-year survival 59.6 % ) . The changes in the SF-36 scores from r and omization for emotional limitation , mental health and bodily pain ( also sustained at 1 year ) on the SF-36 were better for geriatric inpatient care cancer patients at discharge . There was no difference in SF-36 scores between geriatric outpatient and usual outpatient care . Days of hospitalization and overall costs were equivalent for the interventions and usual care over the 1-year study . CONCLUSIONS This study suggests that inpatient geriatric assessment and management may be an effective approach to the management of pain and psychological status in the elderly cancer inpatient at no greater length of hospitalization or extra cost than usual care INTRODUCTION Elderly cancer patients are a very heterogeneous population . A comprehensive geriatric assessment ( CGA ) shall help to identify more precisely those patients who are fit , compared to those who are vulnerable or frail , when deciding on chemotherapeutical treatment . METHODS In a prospect i ve trial , 200 cancer patients treated in an out-patient setting were judged by their physician for their fitness for chemotherapy as fit , vulnerable or frail . A CGA was performed thereafter . We determined the feasibility of a CGA in an out-patient setting and the frequency of changes within the different assessment tools and compared physicians ' judgement with the CGA results . RESULTS Physicians judged 64.3 % of their patients as fit , 32.4 % as vulnerable , and 3.2 % as frail . A CGA was completed by 97.5 % of patients and lasted 20min per patients ( range : 9 - 47min ) . 26.5 % of all patients had no deficits in the CGA . The CGA identified a mean of 1.7 problems per patient , 1.3 in patients judged as fit , 2.3 in those judged as vulnerable , and 4.2 in those judged as frail . A  CGA  is more sensitive in classifying patients as fit compared to vulnerable or frail than physicians ' judgement . CONCLUSION A CGA is feasible and detects more elderly cancer patients as being unfit for chemotherapy than physicians ' judgement . Further trials including disease and treatment related end-points are needed BACKGROUND Carboplatin/paclitaxel every 3 weeks is the st and ard for patients with ovarian cancer , but elderly patients frequently receive modified schedules or single agent chemotherapy to avoid toxicity . A phase II study was conducted to describe tolerability of a weekly schedule of both drugs in elderly patients . METHODS Patients aged > or=70 years with stage IC-IV ovarian cancer , performance status < or=2 , were eligible . Treatment was carboplatin ( AUC 2)+paclitaxel ( 60 mg/m2 ) on days 1 , 8 , 15 every 4 weeks , up to six cycles . A two-stage design was applied with lack of unacceptable toxicity as primary endpoint ; 26 patients were required at the final stage , with at least 23 of them without unacceptable toxicity to conclude for a positive result . Geriatric assessment was performed by activity daily living ( ADL ) and instrumental ADL ( IADL ) scales . RESULTS Twenty-six patients were analysed ( median age 77 years , range 70 - 84 ) . Performance status was 0 in 10 and 1 in 16 patients ; 14 patients had two or more comorbidities ; 8 and 18 patients had some dependency in ADL or IADL . Twenty-three patients ( 88.5 % ) were treated without suffering unacceptable toxicity . Unacceptable toxic events were grade 3 heart rhythm , grade 3 increase of liver transaminases and prolonged haematological toxicity . Grade 1 neuropathy was reported in four cases . Out of 13 patients evaluable by RECIST , 5 partial responses were observed ( response rate 38.5 % ) . Two complete responses were observed among six patients with non-target lesions . Eight patients eligible for CA-125 response assessment had a response after six cycles . Median estimated progression-free survival was 13.6 months , and median overall survival was 32.0 months . CONCLUSIONS In a series of elderly ovarian cancer patients , characterized by a high incidence of comorbidities and functional impairment , weekly carboplatin and paclitaxel demonstrated a favourable toxicity profile Purpose With the increasing number of elderly patients suffering from cancer , comorbidity and functional impairment become common problems in patients with cancer . Both comorbidity and functional impairment are associated with a shorter survival time in cancer patients , but their independent role has rarely been addressed before . Methods Within a prospect i ve trial we recruited 427 cancer patients , irrespective of age and type of cancer , admitted as in patients prior to the start of chemotherapy .  Comorbidity was assessed with the cumulative illness rating scale ( CIRS-G ) , functional impairment with WHO performance status ( WHO-PS ) , basal ( ADL ) and instrumental ( IADL ) activities of daily living . Results Median follow-up was 34.2 months . A total , 61.4 % . of patients died . Median survival time was 21.0 months . Age , kind of tumour ( solid vs. haematological ) , treatment approach ( non-curative vs. curative ) , WHO-PS ( 2–4 vs. 0–1 ) , IADL ( < 8 vs. 8) , and severe comorbidity ( CIRS-level 3–4 vs. none ) were significantly associated with shorter survival time in univariate analysis . In a multivariate Cox-regression- analysis , age ( HR 1.019 ; 95%-CI 1.007–1.032 ; P = 0.003 ) , kind of tumour ( HR 1.832 ; 95%-CI 1.314–2.554 ; P < 0.001 ) , WHO-PS ( HR 1.455 ; 95%-CI 1.059–2.000 ; P = 0.021 ) , and comorbidity level 3–4 ( HR 1.424 ; 95%-CI 1.012–2.003 ; P = 0.043 ) maintained their significant association . Conclusions Age , severe comorbidity , functional impairment , and kind of tumour are independently related to shorter survival time in cancer patients BACKGROUND To determine the feasibility of two chemotherapy regimens in elderly patients with advanced ovarian carcinoma ( AOC ) . PATIENTS AND METHODS Eighty-three patients > or=70 years were previously enrolled in a trial evaluating carboplatin and cyclophosphamide ( CC ) .  On the basis of identical eligibility criteria , 75 further patients were enrolled in a trial evaluating carboplatin and paclitaxel ( Taxol ) ( CP ) . The primary end point of these studies was the feasibility of six courses of chemotherapy  .  Comprehensive geriatric assessment ( CGA ) parameters were assessed in terms of prognostic factors . RESULTS More patients in the CC group presented with performance status of two or more , depression symptoms , use of co-medications , hypoalbuminemia , abnormal Mini-Mental Status score , or sub-optimal surgery . Both regimens appeared feasible : 75.6 % in the CC group and 68.1 % in the CP group completed six courses . CC and CP groups had similar overall survival ( OS ) . Independent prognostic factors of poorer OS were the following : increasing age ( P = 0.013 ) , depression symptoms at baseline ( P < 0.001 ) , International Federation of Gynecology and Obstetrics stage IV ( P = 0.001 ) , and use of paclitaxel ( P = 0.025 ) . CONCLUSION As this is a non-r and omised retrospective review of two consecutive studies , no firm conclusion can be drawn . It seems , however , that in elderly patients with AOC the use of paclitaxel results in more toxicity . CGA parameters and particularly emotional disorders might help to determine a priori the risk/benefit ratio of chemotherapy in this patient population BACKGROUND Elderly patients with advanced non-small-cell lung cancer ( NSCLC ) may derive similar benefit from platinum-based chemotherapy as younger patients .  Quality of life ( QoL ) and comprehensive geriatric assessment ( CGA ) is often advocated to assess benefits and risks . PATIENTS AND METHODS A total of 181 chemotherapy-naive patients [ ≥70 years , performance score ( PS ) of 0 - 2 ] with stage III-IV NSCLC received carboplatin and gemcitabine ( CG ) ( n = 90 ) or carboplatin and paclitaxel ( CP ) ( n = 91 ) every 3 weeks for up to four cycles . Primary end point was change in global QoL from baseline compared with week 18 . Pretreatment CGA and mini geriatric assessment during and after treatment were undertaken . A principal component ( PC ) analysis was carried out to determine the underlying dimensions of CGA and QoL and subsequently related to survival . RESULTS There were no changes in QoL after treatment . The number of QoL responders ( CG arm , 12 % ; CP arm , 5 % ) was not significantly different . CGA items were only associated with neuropsychiatric toxicity . Quality -adjusted survival was not different between treatment arms . The PC analysis derived from nine CGA , six QoL and one PS score indicated only one dominant dimension . This dimension was strongly prognostic , and physical and role functioning , Groningen Frailty Indicator and Geriatric Depression Scale were its largest contributors . CONCLUSIONS Paclitaxel or gemcitabine added to carboplatin did not have a differential effect on global QoL. CGA was associated with toxic effects in a very limited manner . CGA and QoL items measure one underlying dimension , which is highly prognostic PURPOSE / OBJECTIVES To determine the extent to which falls occur in older adult patients with cancer ; to identify how falls relate to depression , age , functional status , and cognition ; and to develop a model for predicting falls . DESIGN Descriptive , prospect i ve , quantitative . SETTING Patients in the Senior Adult Oncology Program at the H. Lee Moffitt Cancer Center and Research Institute . SAMPLE 165 patients aged 70 years or older with any diagnosis of cancer , treatment type , and stage . METHODS Data were collected during a one-time interview using a comprehensive geriatric assessment consisting of the Instrumental Activities of Daily Living ( IADL ) Scale , Activities of Daily Living ( ADL ) Scale , Geriatric Depression Scale , Mini-Mental State Examination , and a fall assessment .  MAIN RESEARCH VARIABLES Falls , functional status , depression , cognition , age , and gender . FINDINGS IADL scores were found to be a predictor of falls while controlling for age and ADL status . An IADL score of 22 predicts a 21 % risk of a fall . Fall risk increases to 81 % at an IADL score of 9 . CONCLUSIONS IADL score is a predictor of falls in this older adult population with cancer . ADL scores are not a predictor of falls when IADL is included in the model . IMPLICATION S FOR NURSING Nurses must play a vital role in conducting fall screening and risk assessment s for older adults with cancer OBJECTIVE To examine the association between the outcomes of a pre-operative comprehensive geriatric assessment ( CGA ) and the risk of severe post-operative complications in elderly patients electively operated for colorectal cancer . METHODS One hundred seventy-eight consecutive patients ≥ 70 years electively operated for all stages of colorectal cancer were prospect ively examined . A pre-operative CGA was performed , and patients were categorized as fit , intermediate , or frail . The main outcome measure was severe complications within 30 days of surgery . RESULTS Twenty-one patients ( 12 % ) were categorized as fit , 81 ( 46 % ) as intermediate , and 76 ( 43 % ) as frail . Eighty-three patients experienced severe complications , including three deaths ; 7/21 ( 33 % ) of fit patients , 29/81 ( 36 % ) of intermediate patients and 47/76 ( 62 % ) of frail patients ( p=0.002 ) . Increasing age and ASA classification were not associated with complications in this series . CONCLUSION CGA can identify frail patients who have a significantly increased risk of severe complications after elective surgery for colorectal cancer Several instruments have been proposed to improve treatment decisions in elderly cancer patients , but evidence of their impact in clinical practice is limited . The aim of this study was to analyze the role of clinical and functional factors in predicting serious adverse events , including death , severe toxicity or treatment interruption , during chemotherapy in elderly cancer patients . The survey evaluated elderly with lung or colon or breast cancer treated with chemotherapy , followed by S. Giovanni Battista Hospital . We enrolled 110 consecutive patients older than 70 years of age with lung ( n=45 ) , colon ( n=50 ) and breast ( n=15 ) cancer between October 2004 and October 2005 . Overall , 73/110 patients ( 66.4 % ) experienced adverse events as death ( n=14 ) , grade s III and IV toxicity ( n=40 ) , or treatment interruption for other reasons ( n=19 ) . The variables with stronger predictivity were advanced stage , toxicity of treatment , level of comorbidity and Karnofsky performance status ( KPS ) . instrumental activities of daily living ( IADL ) index and age itself were not independent predictors . In conclusion our results confirm the need of a careful selection of elderly patients suitable for chemotherapy  , giving more weight to comorbidity and KPS scores than to age itself . The potential role of other functional evaluations need to be further assessed in r and omized controlled trials OBJECTIVES To examine the toxicity experienced by a cohort of older women receiving adjuvant chemotherapy for breast cancer and the longitudinal effect on their functional status and quality of life ( QOL ) . DESIGN A geriatric assessment measuring functional status , comorbidity , mood , nutritional status , and QOL was performed before chemotherapy , at the end of chemotherapy , and 6 months later . SETTING This prospect i ve longitudinal study was conducted at Memorial Sloan-Kettering Cancer Center , New York , New York . PARTICIPANTS Fifty patients aged 65 and older with Stage I to III breast cancer receiving any adjuvant chemotherapy ; 49 were evaluable . MEASUREMENTS The chemotherapy regimen and the toxicity to chemotherapy were recorded . A  geriatric assessment  was performed before the start of chemotherapy , on completion of chemotherapy , and 6 months after completion of chemotherapy .  QOL testing was performed at the same times . RESULTS Patients ( mean age 68 , range 65 - 84 ) received an anthracycline-based chemotherapy regimen ( n=15 ) or cyclophosphamide 600 mg/m2 intravenously ( i.v . ) , methotrexate 40 mg/m2 i.v . , 5-fluorouracil 600 mg/m2 i.v . every 3 weeks for eight cycles ( n=34 ) . Grade 3 or 4 toxicity occurred in 53 % ( n=26 ) , hematological toxicity in 27 % ( n=13 ) , and nonhematological toxicity in 31 % ( n=15 ) . Despite toxicity , there was no significant longitudinal change in functional status or QOL . CONCLUSION Despite toxicity from adjuvant chemotherapy , this cohort of relatively young older patients maintained their functional status and QOL from before chemotherapy to 6 months postchemotherapy . Subtle changes in higher-order functioning would require assessment using different geriatric assessment tools BACKGROUND The prevalence of comorbidities and functional impairment among elderly patients may enhance the risk of operation-related complications , but the importance of these conditions in elderly patients undergoing thoracic surgery remains unclear . METHODS One hundred twenty patients > /= 60 years of age who underwent thoracic surgery  were registered prospect ively and examined . A comprehensive geriatric assessment ( CGA ) that evaluated such diverse areas as functional status ( ie , performance status and activities of daily living [ ADLs ] using the Barthel index ) , comorbidity , nutrition ( ie , body mass index , arm-muscle circumference , albumin level , transferrin level , lymphocyte count , and cholinesterase level ) , and cognitive function ( ie ,  mini-mental state examination [ MMSE ] and negative emotions for operation )  was performed in the 2 weeks before patients underwent the operation . RESULTS The diseases of the 120 patients were as follows : lung cancer , 85 patients ; mediastinal tumor , 14 patients ; bullas , 12 patients ; and other diseases , 9 patients .  Postoperative complications developed in 20 patients ( 16.7 % ) . The patients with dependence for performing the ADLs , and dementia were more likely to develop postoperative complications ( p = 0.041 , and p = 0.0065 , respectively ) . The patients who experienced longer operation times ( ie , > /= 300 min ; p = 0.018 ) were more likely to have complications . The incidence of prolonged air leak in the patients with malnutrition increased seven-fold ( p = 0.045 ) and that of postoperative infectious diseases in those patients with obesity increased 24-fold ( p = 0.0013 ) , while all patients who developed delirium had low scores in the MMSE preoperatively ( p = 0.0003 ) . Using multiple logistic regression , the best model was obtained with a combination of MMSE ( p = 0.031 ) and the Barthel index ( p = 0.04 ) . When the operation variables were added to this model , the operation time had the strongest effect ( p = 0.016 ) . CONCLUSIONS Dependence for the performance of ADLs and impaired cognitive conditions are important predictors of postoperative complications , especially when the operation time is long . CGA is necessary in addition to the conventional cardiopulmonary functional assessment in elderly patients BACKGROUND Cancer is a disease that particularly affects the elderly and , although surgery is the first treatment choice , many elderly cancer patients do not receive st and ard surgery because they are considered unfit for treatment due to an inaccurate estimation of operative risk . Pre-operative Assessment of Cancer in the Elderly ( PACE ) was developed in order to address the need to provide detailed information about the functional reserve of the elderly cancer patient to aid individualised management . METHODS PACE incorporates a battery of vali date d instruments including the  Comprehensive Geriatric Assessment ( CGA ) , Brief Fatigue Inventory ( BFI ) , Eastern Cooperative Oncology Group Performance Status ( ECOG-PS ) , and American Society Anesthesiologists ( ASA ) grade . An international prospect i ve study was conducted with 460 consecutive elderly cancer patients ( 216 breast , 146 GIT , 71 GUT , 27 other ) receiving PACE prior to receiving elective surgery .  RESULTS Three hundred and eighty four patients ( 83.4 % ) were observed to have at least one co-morbidity ; the most common being hypertension ( n=246 , 53.5 % ) . More than two thirds of the patients had good functional and mental status according to PACE . After adjusting for age , sex and type of cancer , six of the seven items of PACE were found to be significantly associated with co-morbidities ( according to the Satariano 's Index of Co-morbidities ( SIC ) ) . A multivariate analysis identified IADL , BFI and ASA to be the most important instruments in explaining SIC . DISCUSSION PACE has been effectively used to describe the functional capacity and health status in an international cohort of elderly cancer patients . The majority of PACE instruments have been found to be significantly associated with co-morbidities ( SIC ) and can distinguish between type and severity of cancer . PACE represents a useful tool in evaluating onco-geriatric fitness for surgery As a result of demographic evolution , oncologists will treat more and more elderly patients with prostate cancer . Aging is frequently associated with the coexistence of several medical complications that can increase the complexity of cancer treatment decision-making . Unfortunately , clinical oncologists need to be more familiar with the multidimensional assessment of elderly patients . To acquire this skill , we implemented a multidimensional geriatric assessment program at our cancer center . This instrument prospect ively assessed 60 elderly patients with prostate cancer . Herein , we describe geriatric aspects detected in our patient sample and report treatment options proposed to elderly patients with prostate cancer at different disease stages . The minimal comprehensive geriatric assessment ( mini-CGA ) procedure revealed that 66 % of our patient population was dependent in one or more of the Katz Activities of Daily Living and 87 % were dependent in 1 or more of the Lawton Instrumental Activities of Daily Living ; all patients had significant comorbidity according to the Cumulative Illness Rating Scale-Geriatrics  , 75 % having at least one severe comorbidity . We identified 19 cases of drug interaction . We also observed that half of these patients had a risk of falling and some physical disability ; 45 % had cognitive disorders requiring more investigation ; one third had depressive symptoms . Finally , 65 % of the patients were either malnourished or at risk of malnutrition . Many of these problems were unknown before the mini-CGA processing and may interfere with cancer and cancer treatment . Thus , the correct management of elderly patients with cancer requires comprehensive geriatric assessment as well as relevant disease staging at diagnosis . This approach will help us to propose the most appropriate treatment with the main aim of preserving quality of life BACKGROUND Age > 60 years and impaired performance status ( PS ) are adverse prognostic features in the International Prognostic Index for non-Hodgkin 's lymphoma ; however , patients aged > 60 years compose a heterogeneous population , and commonly used PS measures are subjective and incomplete . PATIENTS AND METHODS Vali date d tests are used in geriatric population s to predict mortality and functional decline . The timed " up and go " test measures the time required to st and , walk a set distance , and return . The Tinetti Gait and Balance test  measures gait and balance , and the  h and grip assesses grip strength . We evaluated these tests in a heterogeneous cohort of older patients with lymphoma , as a first step in identifying prognostic subsets that might differ in the ability to tolerate disease and treatment . The mean age of the patients ( N = 25 ) was 70 years , with 13 men and 12 women . Five patients were newly diagnosed , 15 had aggressive histology , and 10 had indolent disease . Two subjects had Eastern Cooperative Oncology Group PS 0 , 20 had PS 1 , and 3 had PS 2 . Assessment s could be conducted in < 5 minutes . Within the largest group ( PS 1 ; n = 20 ) , these tests demonstrated a range of functional status measures . RESULTS The interquartile range/median ( higher values reflect greater variance ) was 73.1 for the h and grip , 42.3 for the " up and go , " and 1.8 for the Tinetti test . CONCLUSION Accepted geriatric assessment tools can identify subgroups of older patients with lymphoma with distinct functional status . Prospect i ve trials in larger and more homogeneous patient population s will define the potential of these tools to assist in guiding therapy and predicting outcomes PURPOSE To identify Comprehensive Geriatric Assessment ( CGA ) components independently associated with changes in planned cancer treatment . PATIENTS AND METHODS We prospect ively included 375 consecutive elderly patients with cancer ( ELCAPA01 study ) assessed by geriatricians using the CGA .  Multivariate analysis was used to identify factors associated with changes in the cancer treatment ( intensification , decrease , or delayed > 2 weeks ) . Change was defined as a difference between the initial treatment proposal and the final treatment selected in a multidisciplinary meeting . RESULTS Mean age was 79.6 years ( st and ard deviation [ SD ] , 5.6 years ) , and 197 ( 52.5 % ) were women . The most common tumor location was the digestive system ( 58.7 % ) . The mean number of comorbidities was 4.2 ( SD , 2.7 ) per patient , and the mean Cumulative Illness Rating Scale for Geriatrics score was 11.8 ( SD , 5.3 ) . After the CGA , the initial cancer treatment plan was modified for 78 ( 20.8 % ) of 375 patients ( 95 % CI , 16.8 to 25.3 ) , usually to decrease treatment intensity ( 63 [ 80.8 % ] of 78 patients ) . By univariate analysis , cancer treatment changes were associated with Eastern Cooperative Oncology Group performance status ≥ 2 ( 73.3 % in the group with changes v 41.1 % in the in the group without changes ; P < .001 ) , dependency for one or more activities of daily living ( ADL ; 59.0 % v 24.2 % ; P < .001 ) , malnutrition ( 81.8 % v 51.2 % ; P < .001 ) , cognitive impairment ( 38.5 % v 24.9 % ; P = .023 ) , depression ( 52.6 % v 21.7 % ; P < .001 ) , and greater number of comorbidities ( mean , 4.8 [ SD , 2.9 ] v 4.0 [ SD , 2.6 ] ; P = .02 ) . By multivariate analysis , factors independently associated with cancer treatment changes were a lower ADL score ( odds ratio [ OR ] , 1.25 per 0.5-point decrease ; CI , 1.04 to 1.49 ; P = .016 ) and malnutrition ( OR , 2.99 ; CI , 1.36 to 6.58 ; P = .007 ) . CONCLUSION Functional status assessed by the ADL score and malnutrition were independently associated with changes in cancer treatment This study is part of a larger multicenter prospect i ve study conducted in Italy to assess the efficacy of the comprehensive geriatric assessment ( CGA ) among elderly patients with cancer ( i.e. aged 65 years or older ) . The prevalence of functional limitations , and its association with selected characteristics , was investigated among 303 elderly patients consecutively admitted at the Department of Medical Oncology , IRCCS Centro di Riferimento Oncologico , Aviano ( Northeast Italy ) , between 1995 and 1998 . These patients had a median age of 72 years ( range , 65 - 94 ) , and were affected by haematological ( n=182 ) or solid tumours ( n=121 ) . At baseline , their physical function was assessed , in addition to performance status ( PS ) , by means of the  activity of daily living ( ADL ) and the  instrumental activities of daily living ( IADL ) scales . Overall , 17 % of the patients had a limitation for ADL , and 59 % for IADL , the prevalence of functional disabilities increased with age . Specifically , 8 % of patients had continence limitations and 13 % had limitations in taking the prescribed drugs . By multivariate analysis , a poor PS turned out to be a strong independent determinant of both ADL and IADL disabilities BACKGROUND A number of elderly cancer patients do not receive st and ard surgery for solid tumors because they are considered unfit for treatment as a consequence of inaccurate estimation of the operative risk . To tailor treatment to onco-geriatric series , oncologists are now beginning to use a comprehensive geriatric assessment ( CGA ) . This study investigates the value of an extended CGA in assessing the suitability of elderly patients for surgical intervention . PATIENTS AND METHODS Preoperative assessment of cancer in the elderly ( PACE ) incorporates vali date d instruments including the CGA , an assessment of fatigue and performance status and an anaesthesiologist 's evaluation of operative risk . An international prospect i ve study was conducted using 460 consecutively recruited elderly cancer patients who received PACE prior to elective surgery .  Mortality , post-operative complications ( morbidity ) and length of hospital stay were recorded up to 30 days after surgery . RESULTS Poor health in relation to disability ( assessed using the instrumental activities of daily living ( IADL ) ) , fatigue and performance status ( PS ) were associated with a 50 % increase in the relative risk of post-operative complications . Multivariate analysis identified moderate/severe fatigue , a dependent IADL and an abnormal PS as the most important independent predictors of post-surgical complications . Disability assessed by activities of daily living ( ADL ) , IADL and PS were associated with an extended hospital stay . CONCLUSION PACE represents a valuable tool in enhancing the decision process concerning the c and idacy of elderly cancer patients for surgical intervention and can reduce inappropriate age-related inequity in access to surgical intervention . It is recommended that PACE be used routinely in surgical practice Research on the use of health care by older newly-diagnosed cancer patients is sparse . We investigated whether frailty predicts hospitalization , emergency department ( ED ) and general practitioner ( GP ) visits in older cancer patients in a prospect i ve pilot study . Newly-diagnosed cancer patients aged 65 years and over were recruited in the Segal Cancer Centre , Jewish General Hospital , Montreal , Canada . One hundred ten patients participated , mean age 74.1 , 70 % women . During 1 year follow-up , 52 patients ( 47.3 % ) had cancer-related hospitalizations , 23 patients ( 20.9 % ) had ED visit and 17 patients ( 15.5 % ) had GP visit . No frailty marker predicted hospitalization or visits to the GP . Cognitive impairment suspicion was the only frailty marker that predicted ED visits ( odds ratio 4.97 ; 95%CI 1.14 - 21.69 ) . Although health care use was considerable in this sample , most frailty markers were not associated with health care use in this pilot study OBJECTIVES To report on the longitudinal cognitive functioning of older women receiving adjuvant chemotherapy for breast cancer . DESIGN Neuropsychological and functional status testing were performed before chemotherapy and 6 months after chemotherapy . SETTING Cancer center . PARTICIPANTS Thirty-one patients aged 65 and older with Stage I to III breast cancer . Of the 31 patients enrolled , three refused post-testing , and 28 were evaluable . MEASUREMENTS The following domains of cognitive function were examined : attention ; verbal memory ; visual memory ; and verbal , spatial , psychomotor , and executive functions . RESULTS Participants had a mean age of 71 ( range 65 - 84 ) : 39 % Stage I , 50 % Stage II , and 11 % Stage III . The number of scores 2 st and ard deviations ( SDs ) below the norm were calculated for each patient before and 6 months after chemotherapy ; 14 ( 50 % ) had no change , 11 ( 39 % ) worsened , and three ( 11 % ) improved ( P=.05 ) . Seven patients ( 25 % ) experienced a decline in cognitive function , defined as a 1-SD decline from pre- to post-testing in two or more neuropsychological domains . Exploratory analyses revealed no significant difference between functional status , comorbidity , and depression scale scores and change in overall quality -of-life scores before and after chemotherapy . CONCLUSION In this cohort of older women receiving adjuvant chemotherapy , a subset experienced a decline in cognitive function from before chemotherapy to 6 months after chemotherapy . Further prospect i ve study is needed to confirm these observations and to identify the subgroup at special risk PURPOSE Older patients are underrepresented in many areas of cancer services utilization and in clinical trial enrollment . This study evaluates whether age , when adjusted for sex , comorbidity , stage , tumor site , geography , and time period , is predictive of cancer treatment practice . METHODS First , we used the Ontario Cancer Registry ( OCR ) to examine for any apparent differences in treatment practice s between elderly ( > or = 70 years ) and younger patients in the last three decades . Second , we performed a chart review of 1,505 patients with lung , breast , and colorectal cancers seen in Ontario either at an urban center , the Princess Margaret Hospital , or at a rural center , the Northwestern Regional Cancer Centre . Patients were r and omly selected from two time periods , 1977 to 1978 and 1997 ; and the study population was to comprise at least 50 % elderly patients . RESULTS OCR data demonstrated that , in some setting s , such as colorectal cancer , the proportions of elderly cancer patients who were referred to cancer centers and who received any cancer treatment were lower than their younger counterparts . The chart review data showed that increasing age was a significant negative predictor for receiving any cancer treatment ( P < .001 , multivariate analysis ) and for having a clinical trial discussion with the treating specialist ( P < .001 , multivariate analysis ) . CONCLUSION Independent of other factors , older age is consistently a cause of disparity in cancer treatment practice and in clinical trial discussion with patients . By increasing the accrual rate of elderly cancer patients in clinical trials , a better underst and ing of appropriate therapies for this patient population can be obtained and may , thereby , impact on their cancer-related morbidity and mortality PURPOSE Older adults are vulnerable to chemotherapy toxicity ; however , there are limited data to identify those at risk . The goals of this study are to identify risk factors for chemotherapy toxicity in older adults and develop a risk stratification schema for chemotherapy toxicity . PATIENTS AND METHODS Patients age ≥ 65 years with cancer from seven institutions completed a prechemotherapy assessment  that captured sociodemographics , tumor/treatment variables , laboratory test results , and geriatric assessment variables ( function , comorbidity , cognition , psychological state , social activity/support , and nutritional status ) . Patients were followed through the chemotherapy course to capture grade 3 ( severe ) , grade 4 ( life-threatening or disabling ) , and grade 5 ( death ) as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events . RESULTS In total , 500 patients with a mean age of 73 years ( range , 65 to 91 years ) with stage I to IV lung ( 29 % ) , GI ( 27 % ) , gynecologic ( 17 % ) , breast ( 11 % ) , genitourinary ( 10 % ) , or other ( 6 % ) cancer joined this prospect i ve study . Grade 3 to 5 toxicity occurred in 53 % of the patients ( 39 % grade 3 , 12 % grade 4 , 2 % grade 5 ) . A predictive model for grade 3 to 5 toxicity was developed that consisted of geriatric assessment variables , laboratory test values , and patient , tumor , and treatment characteristics . A scoring system in which the median risk score was 7 ( range , 0 to 19 ) and risk stratification schema ( risk score : percent incidence of grade 3 to 5 toxicity ) identified older adults at low ( 0 to 5 points ; 30 % ) , intermediate ( 6 to 9 points ; 52 % ) , or high risk ( 10 to 19 points ; 83 % ) of chemotherapy toxicity ( P < .001 ) . CONCLUSION A risk stratification schema can establish the risk of chemotherapy toxicity in older adults . Geriatric assessment variables independently predicted the risk of toxicity Purpose The prevalence of elderly and comorbid patients ( pts ) with malignant lymphoma ( ML ) will steadily increase in future . Elderly patients comprise a heterogeneous population . Comprehensive geriatric assessment ( CGA ) is an established diagnostic tool in geriatric medicine . However , the prognostic value in patients with ML is unclear . We sought to establish a relationship between results of CGA and survival time in patients with ML . Methods Newly diagnosed patients with ML and indication for chemotherapeutical treatment were prospect ively recruited in an observational trial . In addition to usual diagnostic work up , a CGA including activities of daily living ( ADL ) , instrumental activities of daily living ( IADL ) and comorbidities  was performed . Association of patients ’ characteristics and results of CGA with survival were analysed according to Kaplan – Meier method and in a multivariate Cox-regression analysis . Results About 143 patients were included , median age was 63 years , 63 patients were women . Median follow-up of surviving patients was 62 months . Sixty-six patients died within this time . Advanced age , poor Karnofsky performance status , dependence in ADL and IADL and presence of severe comorbidity were significantly associated with shorter survival time . In a Cox-regression analysis , IADL ( HR 2.1 ; 95 % CI 1.1–3.9 ) and comorbidity ( HR 1.9 ; 95 % CI 0.9–3.9 ) were independent and strongest associated with survival time . Conclusion Results of CGA , such as IADL and comorbidities , are prognostic variables for survival of patients with ML . Results should be vali date d in homogeneous clinical groups and if confirmed included in diagnostic and therapeutic algorithm OBJECTIVES To establish a correlation between a specific MGA category , an appropriate preventively established treatment and clinical outcome in a population of elderly cancer patients . The ultimate goal was to verify whether the appropriate treatment given to elderly cancer patients according to their MGA category could translate into a better clinical outcome assessed as clinical response and toxicity , i.e whether this process might achieve a clinical ly meaningful impact . PATIENTS AND METHODS We carried out a phase II open , prospect i ve non-r and omized study in 75 elderly cancer patients ( lung , head and neck , colorectal , gynecologic and breast ) hospitalized at the Department of Medical Oncology , University of Cagliari , Italy . All patients underwent MGA evaluation  and were assigned to three different categories : fit , intermediate and frail . Thereafter , an appropriate preventively established treatment was administered and the clinical outcome was assessed . The clinical outcome after 3 month treatment was defined on the basis of objective clinical response and toxicity . The difference of clinical outcome in the MGA categories was assessed by ANOVA test . Moreover , the correlation between MGA category and the clinical outcome ( clinical response and toxicity ) was assessed by Spearman 's correlation test . RESULTS A better clinical response was observed in fit patients as compared both to intermediate and frail patients . Treatment toxicity was comparable in the different MGA categories . The correlation analysis between MGA category , clinical response to treatment and toxicity showed that there was a significant direct correlation with clinical response and no correlation with toxicity . Overall , the regression analysis showed that MGA was predictive of clinical outcome , in the sense that it is truly predictive for clinical response and no predictive for toxicity . CONCLUSION Our study demonstrates that the MGA , although time-consuming , is a useful and cost-benefit effective tool to appropriately select elderly cancer patients to be treated effectively in terms of a survival advantage and those who would benefit mainly in terms of improvement of quality of life . Moreover , the treatment preventively established for each MGA category was shown to be adequate and accomplished the most appropriate performances in terms of effectiveness and toxicity We r and omly assigned frail elderly in patients with a high probability of nursing-home placement to an innovative geriatric evaluation unit intended to provide improved diagnostic assessment , therapy , rehabilitation , and placement . Patients r and omly assigned to the experimental ( n = 63 ) and control ( n = 60 ) groups were equivalent at entry . At one year , patients who had been assigned to the geriatric unit had much lower mortality than controls ( 23.8 vs. 48.3 per cent , P less than 0.005 ) and were less likely to have initially been discharged to a nursing home ( 12.7 vs. 30.0 per cent , P less than 0.05 ) or to have spent any time in nursing home during the follow-up period ( 26.9 vs. 46.7 per cent , P less than 0.05 ) . The control-group patients had substantially more acute-care hospital days , nursing-home days , and acute-care hospital readmissions . Patients in the geriatric unit were significantly more likely to have improvement in functional status and morale than controls ( P less than 0.05 ) . Direct costs for institutional care were lower for the experimental group , especially after adjustment for survival . We conclude that geriatric evaluation units can provide substantial benefits at minimal cost for appropriate groups of elderly patients , over and above the benefits of traditional hospital approaches BACKGROUND No tool currently exists to rapidly allow surgeons to objective ly quantify surgical risk in geriatric patients . The goal of our prospect i ve study was to determine if individual questions extracted from vali date d screens for common geriatric syndromes would have predictive value for surgical risk in geriatric patients with thoracic neoplasms . METHODS Patients ≥ 70 y old were recruited to participate in a prospect i ve , IRB-approved study involving the preoperative administration of vali date d screening tests . Patients were given the  geriatric depression scale ( GDS ) , nutrition screening initiative nutritional health checklist ( NSI NHC ) , mini mental status exam ( MMSE ) , brief fatigue inventory ( BFI ) , and assessed for activities of daily living ( ADLs ) and instrumental activities of daily living ( IADLs ) .  All patients enrolled in this study were scheduled for thoracic surgery . RESULTS Patients who responded to having a dependency in the IADL " shopping " were more likely to have major complications and to be discharged to a non-home location than those without a dependency ( P = 0.011 , 0.003 ) . Patients who answered " yes " to questions 1 , 9 , and 10 of the NSI NHC had a longer mean length of stay compared with patients who answered " no " ( P = 0.039 , 0.010 , 0.031 ) . Answering " yes " to GDS question 2 correlated with the incidence of major complications ( r = 0.270 P = 0.037 ) . Answering " yes " to GDS question 12 increased the likelihood of being discharged to a non-home location postoperatively ( odds ratio = 11.64 , 95 % CI , 0.68 - 202.86 , P = 0.047 ) . CONCLUSIONS Our data indicate that an abbreviated , rapid presurgical assessment can be developed for estimating operative risk , length of stay , and discharge destination in geriatric patients with thoracic malignancies using individual questions from previously vali date d screening tools Aims and background Cancer is an age-related disease , and the increase in life expectancy will lead to a progressive increase of cancer cases in the elderly ( ≥70 years of age ) . We have created a group called GONG ( Gruppo Oncologico Geriatrico ) to apply cancer geriatric assessment in elderly cancer patients , in order to select which of them are eligible for oncological treatment or supportive care only . Patients and methods We applied this model to evaluate 153 patients from March 2004 to August 2005 . Our model included three categories of patients : frail ( at least one of the following items : Activities of Daily Living scale < 80 , ≥3 comorbidities unrelated to the tumor according to the Charlson Index , performance status ≤60/≥3 according respectively to Karnofsky and the ECOG scale , ≥1 geriatric syndrome ) ; borderline ( patients with multiple comorbidities not affecting performance status or ability in daily activities ) ; non-frail . Results Applying the aforementioned criteria , we found 30 borderline , 14 frail and 109 non-frail patients . Statistical analysis showed a significant difference in mortality between frail and non-frail patients ( P < 0.05 ) , whereas there was no difference between borderline and non-frail patients . Conclusions Our model was thus able to identify patients at higher risk of death . These results confirm the importance of cancer geriatric assessment also for the clinical evaluation of oncological patients . Additional r and omized studies with a larger number of patients , also in an adjuvant setting , should be performed to confirm the effectiveness of this approach BACKGROUND Data from prospect i ve clinical trials are needed to better define st and ards of care in elderly patients with advanced ovarian carcinoma and to demonstrate the interest of Comprehensive Geriatric Assessment ( CGA ) in this fragile and heterogeneous population . PATIENTS AND METHODS From July 1998 to October 2000 , 83 advanced ovarian carcinoma patients > 70 years old received carboplatin AUC 5 and cyclophosphamide 600 mg/m2 , on day 1 of six 28-day cycles . The clinical and biological geriatric covariates prospect ively studied were : comorbidities , comedications , cognitive functions ( Mini-Mental test ) , nutritional status and autonomy . RESULTS Patient characteristics were : median age 76 years , serous histology ( 73 % ) , FIGO stage III ( 75 % ) , optimal initial surgery ( 21 % ) and performance status ( PS ) > or = 2 ( 44 % ) . Sixty patients ( 72 % ) received six chemotherapy cycles without severe toxicity ( STox ) or tumor progression . Multivariate analysis retained three factors as independent predictors of STox : symptoms of depression at baseline ( P = 0.006 ) , dependence ( P = 0.048 ) and PS > or = 2 ( P = 0.026 ) . Independent prognostic factors identified for overall survival ( Cox model ) were depression ( P = 0.003 ) , FIGO stage IV ( P = 0.007 ) and more than six different comedications per day ( P = 0.043 ) . CONCLUSION CGA could predict STox and overall survival of elderly advanced ovarian carcinoma patients PURPOSE Factors captured in a geriatric assessment can predict morbidity and mortality in older adults , but are not routinely measured in cancer clinical trials . This study evaluated the implementation of a geriatric assessment tool in the cooperative group setting . PATIENTS AND METHODS Patients age ≥ 65 with cancer , who enrolled on cooperative group cancer trials , were eligible to enroll on Cancer and Leukemia Group B ( CALGB ) 360401 . They completed a  geriatric assessment tool  before initiation of protocol therapy , consisting of valid and reliable geriatric assessment measures which are primarily self-administered and require minimal re sources and time by healthcare providers . The assessment measures functional status , comorbidity , cognitive function , psychological state , social support , and nutritional status . The protocol specified criteria for incorporation of the tool in future cooperative group trials was based on the time to completion and percent of patients who could complete their portion without assistance . Patient satisfaction with the tool was captured . RESULTS Of the 93 patients who enrolled in this study , five ( 5 % ) met criteria for cognitive impairment and three did not complete the cognitive screen , leaving 85 assessable patients ( median age , 72 years ) . The median time to complete the geriatric assessment tool  was 22 minutes , 87 % of patients ( n = 74 ) completed their portion without assistance , 92 % ( n = 78 ) were satisfied with the question naire length , 95 % ( n = 81 ) reported no difficult questions , and 96 % ( n = 82 ) reported no up setting questions . One hundred percent of health care professionals completed their portion . CONCLUSION This brief , primarily self-administered  geriatric assessment tool met the protocol specified criteria for inclusion in future cooperative group clinical trials OBJECTIVES To integrate the principles of geriatric assessment into the care of older patients with cancer in order to identify vulnerable older adults and develop interventions to optimize cancer treatment . DESIGN A brief , comprehensive , self-administered question naire and intervention algorithm were developed consisting of measures of  geriatric assessment  that are brief , reliable , vali date d , and predictive of mortality and morbidity in older patients . SETTING Academic tertiary care cancer center and community-based satellite practice . PARTICIPANTS Patients aged 65 and older with cancer . MEASUREMENTS The question naire solicits information about the patient 's functional status , comorbidity , psychological status , nutritional status , and social support . A scoring algorithm for referral to a multidisciplinary team was developed . RESULTS Two hundred forty-five of 250 patients completed the question naire ( mean age 76 , range 65 - 95 ) . The majority of patients were women ( 71 % ) , white ( 95 % ) , married ( 52 % ) , and retired ( 90 % ) , with a variety of tumor types and stages . Most patients ( 78 % ) completed the question naire on their own and reported acceptance of question naire length ( 91 % ) , no difficult questions ( 94 % ) , no up setting questions ( 96 % ) , and no missing questions ( 89 % ) . The mean time to completion was 15 minutes , with a median of 12.5 ( st and ard deviation 10 , range 2 - 60 ) . Information from this question naire helped identify physical and psychological impairments , poor nutrition , lack of social support , and untreated comorbidities . Appropriate referrals to a multidisciplinary team were made . CONCLUSION This brief , comprehensive , self-administered question naire is feasible for use in the outpatient oncology setting and helped identify the needs of geriatric oncology patients . Prospect i ve trials are needed to determine the effectiveness of the interventions offered The primary aim of the present study was to examine the relationship of changes in hemoglobin levels following recombinant human erythropoietin ( rHuEPO ) treatment to changes in cognitive functioning studied by Mini Mental State Examination ( MMSE ) in elderly cancer patients undergoing chemotherapy treatment . The secondary aim was that to assess the relationship of changes in hemoglobin levels following rHuEPO treatment to changes in functions studied by Comprehensive Geriatic Assessment ( CGA ) , such as Activity of Daily Living ( ADL ) , Instrumental Activities of Daily Living ( IADL ) , Geriatric Depression Scale ( GDS ) and the Mini Nutritional Assessment ( MNA ) . To this end , hemoglobin levels and cognitive functioning were evaluated in a sample of cancer patients prior to the start of chemotherapy treatment and again after 4 , 8 and 12 weeks of treatment with chemotherapy plus rHuEPO .  Ten elderly patients ( mean age 71.4 years ) were enrolled . At baseline , enrolled patients had a mean Hb value of 10.3g/dl . After 4 weeks of rHuEPO treatment , Hb values increased significantly ( p<0.0001 ) , with a mean increase of 1.2g/dl ( range : 0.2 - 2.1 ) . Remarkably , 8 out of 10 ( 80 % ) showed an increase of Hb levels > or=1g/dl in comparison to baseline and therefore were considered responders . At baseline , four patients ( 40 % ) showed a moderate cognitive impairment , whilst six patients ( 60 % ) showed a normal cognitive function . After 4 weeks of rHuEPO treatment nine patients ( 90 % ) showed a significant improvement of cognitive functions in comparison to baseline ( p<0.005 ) : eight of them were responders also to rHuEPO in terms of correction of anemia . The Spearman 's rank correlation test showed a statistical significant correlation between Hb increase and increase in cognitive functioning assessed by MMSE after 4 weeks ( p=0.049 ) , 8 weeks ( p=0.044 ) and 12 weeks ( p=0.031 ) of rHuEPO treatment . Therefore , the findings of this study provide support for the hypothesis that significant increases in hemoglobin over the course of chemotherapy supplemented with rHuEPO administration would be accompanied by significant improvement in cognitive performance over the same interval
target: Geriatric assessment  was most often completed to describe a patient 's health and functional status .
  Geriatric assessment  in the oncology setting is feasible , and some domains are associated with adverse outcomes .
  However , there is limited evidence that geriatric assessment impacted treatment decision making .
background: BACKGROUND Geriatric assessment is a multidisciplinary diagnostic process that evaluates the older adult 's medical , psychological , social , and functional capacity .
  No systematic review of the use of geriatric assessment in oncology has been conducted .
  The goals of this systematic review were : 1 ) to provide an overview of all geriatric assessment instruments used in the oncology setting ; 2 ) to examine the feasibility and psychometric properties of those instruments ; and 3 ) to systematic ally evaluate the effectiveness of geriatric assessment in predicting or modifying outcomes ( including the impact on treatment decision making , toxicity of treatment , and mortality ) .