title: Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Modulated chemotherapy according to modified comprehensive geriatric assessment in 100 consecutive elderly patients with diffuse large B-cell lymphoma. A multicentre phase II randomised trial of weekly docetaxel/gemcitabine followed by erlotinib on progression, vs the reverse sequence, in elderly patients with advanced non small-cell lung cancer selected with a comprehensive geriatric assessment (the GFPC 0504 study) 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. Lung cancer chemotherapy decisions in older patients: the role of patient preference and interactions with physicians EORTC elderly task force position paper: approach to the older cancer patient. Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study. Evaluation of efficacy and safety of FOLFIRI for elderly patients with gastric cancer: a first-line phase II study. Predictors of tolerance to chemotherapy in older cancer patients: a prospective pilot study. Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. Results of comprehensive geriatric assessment effect survival in patients with malignant lymphoma The feasibility of inpatient geriatric assessment for older adults receiving induction chemotherapy for acute myelogenous leukemia. Hematologic improvement and response in elderly AML/RAEB patients treated with valproic acid and low-dose Ara-C. Implementing a geriatric assessment in cooperative group clinical cancer trials: CALGB 360401. A multicenter phase II randomized trial of gemcitabine followed by erlotinib at progression, versus the reverse sequence, in vulnerable elderly patients with advanced non small-cell lung cancer selected with a comprehensive geriatric assessment (the GFPC 0505 study). Cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab versus epirubicin, cyclophosphamide, vinblastine, prednisone and rituximab for the initial treatment of elderly “fit” patients with diffuse large B-cell lymphoma: results from the ANZINTER3 trial of the Intergruppo Italiano Linfomi
abstract: 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 Chemotherapy is associated with toxicity in elderly patients with potentially curable malignancies , posing the dilemma of whether to intensify therapy , thereby improving the cure rate , or de-escalate therapy , thereby reducing toxicity , with consequent risks for under- or overtreatment . Adequate tools to define doses and combinations have not been identified for lymphoma patients . We conducted a prospect i ve trial aim ed to evaluate the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment ( CGA ) in elderly ( aged ≥70 years ) patients with diffuse large B-cell lymphoma ( DLBCL ) . In June 2000 to March 2006 , 100 patients were stratified using a CGA into three groups ( fit , unfit , and frail ) , and they received a rituximab plus cyclophosphamide , doxorubicin , vincristine , and prednisone modulated in dose and drugs according to comorbidities and activities of daily living ( ADL ) and instrumental ADL scores . Treatment was associated with a complete response rate of 81 % and mild toxicity : grade 4 neutropenia in 14 % , anemia in 1 % , and neurological and cardiac toxicity in 2 % of patients . At a median follow-up of 64 months , 51 patients were alive , with 5-year disease-free , overall , and cause-specific survival rates of 80 % , 60 % , and 74 % , respectively . Chemoimmunotherapy adjustments based on a CGA are associated with manageable toxicity and excellent outcomes in elderly patients with DLBCL . Wide use of this CGA-driven treatment may result in better cure rates , especially in fit and unfit patients Background : Elderly cancer patients form a heterogeneous population in which therapeutic decision-making is often difficult . The aim of this r and omised phase II trial was to evaluate the feasibility and activity of weekly docetaxel/gemcitabine ( DG ) followed by erlotinib after progression ( arm A ) vs erlotinib followed by DG after progression ( arm B ) in fit elderly patients with advanced non small-cell lung cancer ( NSCLC ) . Methods : Elderly chemotherapy-naive patients with stage IIIB/IV NSCLC were selected after a comprehensive geriatric assessment ( socioeconomic , cognitive , depression , ADL and IADL assessment s ) . The primary endpoint was the time to second progression ( TTP2 ) . Overall survival ( OS ) , the time to first progression ( TTP1 ) and safety were secondary endpoints . Results : Between July 2006 and November 2008 , 22 centres enrolled 100 patients .  TTP2 was 7.5 and 5.8 months in arm A and arm B , respectively ; TTP1 was 4.7 and 2.7 months ; and the median OS time was 9.4 and 7.1 months ; the respective 1-year survival rates were 36.2 and 31.4 % . There was no major unexpected toxicity . Conclusion : These results suggest that weekly DG , followed by erlotinib , is a promising treatment for fit elderly patients with NSCLC ; the efficacy of the reverse sequence was insufficient to recommend it for EGFR-non-selected patients 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 Lung cancer chemotherapy decisions in patients ≥70 years old are complex because of toxicity , comorbidity and the limited data on patient preferences . We examined the relationships between preferences and chemotherapy use in this group of patients . Methods and patients We used a question naire describing four hypothetical lung cancer treatment options .  Eighty-three elderly ( ≥70 years old ) lung cancer patients were informed about their diagnosis and therapeutic choices and then asked to choose one of the four options . Patients had previously been included in a prospect i ve study to explore geriatric evaluation in an oncology unit and all had given written informed consent . Results Older patients ( n=83 ) diagnosed with lung cancer ( non-small- and small-cell lung cancer ) from January 2006 to February 2008 were recruited from a single centre . The mean patient age was 77 years ( range : 70–91 ) . Eighty-one patients ( 97.6 % ) were men . Non-small-cell lung cancer ( NSCLC ) was the diagnosis in 63 patients ( 76 % ) . Most patients selected active treatment ( 38.6 % most survival benefit , 18 % less survival benefit ) and 31.3 % selected no active treatment . Elderly lung cancer patients were significantly more likely to accept aggressive treatments despite high reported toxicities . Although most of the patients were symptomatic at diagnosis , the “ symptom relief ” option was chosen less frequently than the options that could prolong survival . Factors significantly related to patients ’ attitude toward chemotherapy were age ( p<0.001 ) , frailty ( p=0.0039 ) , depression and poor performance status ( PS ) . Conclusion Elderly lung cancer patients want to be involved in the decision-making process . Survival was the main treatment objective for more than half of the patients in this study . We have not found other published studies about elderly lung cancer patients ’ decisions about chemotherapy As a result of an increasing life expectancy , the incidence of cancer cases diagnosed in the older population is rising . Indeed , cancer incidence is 11-fold higher in persons over the age of 65 than in younger ones . Despite this high incidence of cancer in older patients , solid data regarding the most appropriate approach and best treatment for older cancer patients are still lacking , mostly due to under-representation of these patients in prospect i ve clinical trials . The clinical behaviour of common malignant diseases , e.g. breast , ovarian and lung cancers , lymphomas and acute leukaemias , may be different in older patients because of intrinsic variation of the neoplastic cells and the ability of the tumour host to support neoplastic growth . The decision to treat or not these patients should be based on patients ' functional age rather than the chronological age . Assessment of patients ' functional age includes the evaluation of health , functional status , nutrition , cognition and the psychosocial and economic context . The purpose of this paper is to focus on the influence of age on cancer presentation and cancer management in older cancer patients and to provide suggestions on clinical trial development and methodology in this population 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 OBJECTIVE Current chemotherapy protocol s for gastric cancer present high toxicity . The FOLFIRI regimen has shown promising results with elderly colorectal cancer patients and for gastric cancer patients but this is the first report on elderly gastric cancer patients . DESIGN In this multicenter non-r and omized phase II trial , we administered the FOLFIRI chemotherapy protocol ( irinotecan [ 180 mg/m(2 ) ] , fluorouracil [ 5-FU ] [ 400 mg/m(2 ) ] and folinic acid 400 mg/m(2 ) or 200mg/m(2 ) of l-folinic acid ) to patients aged over 70 years with locally-advanced or metastatic gastric cancer combined with Comprehensive Geriatric Assessment ( CGA ) . Responses were assessed at 2 months . RESULTS Forty-two patients received eight cycles of the FOLFIRI regimen , with 82.5 % of patients showing disease control : 10 patients ( 26 % ) showing objective ( partial or complete ) responses and 23 ( 57.5 % ) showing stable disease . One-year overall survival ( OS ) was 41.5 % [ 95%CI 26.5 - 56.0 ] and one-year progression-free survival ( PFS ) was 31.8 % [ 95%CI 18.4 - 46.1 % ] . We observed 10 Grade 3/4 hematologic toxicities with one febrile neutropenia . CGA data demonstrated that geriatric functions were not altered by treatment and that nutritional status improved over treatment . CONCLUSIONS Results show excellent disease control and relatively high survival rates with limited toxicity similar to younger patients indicating that this regimen should be considered as a possible treatment in advanced gastric cancer of the elderly Few data are available to help predict which older cancer patient is at risk of developing chemotherapy-related toxicity . This study was a pilot for a project design ing a predictive risk score . Chemotherapy patients aged 70 years and older were prospect ively enrolled .  Chemotherapies were adjusted for their published toxicity . 60 patients were enrolled , 59 were evaluable . Mean dose-intensity was 90.3 % , range 33.3 - 129.0 % . 47 % of the patients experienced grade 4 haematological and /or grade 3 - 4 non-haematological toxicity . Published toxicity ( MAX2 ) , diastolic blood pressure , marrow invasion and lactate dehydrogenase ( LDH ) were all associated with toxicity ( P<0.1 ) ; Body Mass Index , previous chemotherapy , red blood cells , platelets , polymedication with dose-intensity ; and polymedication with FACT-G change . After adjustment for the published toxicity , the variables retained their significance , except for LDH and polymedication ( for dose-intensity ) . Although the size of this pilot study imposes a cautious interpretation , patient-related and chemotherapy-related variables correlated independently with toxicity . Design ing a composite predictive score to use in assessing the toxicity of multiple chemotherapy regimens therefore appears to be a valid undertaking BACKGROUND The purpose of this study was to determine the relationship of frailty and 6-month postoperative costs . METHODS Subjects aged ≥ 65 years undergoing elective colorectal operations were enrolled in a prospect i ve observational study . Frailty was assessed by a vali date d measure of function , cognition , nutrition , comorbidity burden , and geriatric syndromes . Frailty was quantified by summing the number of positive characteristics in each subject . RESULTS Sixty subjects ( mean age , 75 ± 8 years ) were studied . Inpatient mortality was 2 % ( n = 1 ) . Overall , 40 % of subjects ( n = 24 ) were considered nonfrail , 22 % ( n = 13 ) were prefrail , and 38 % ( n = 22 ) were frail . With advancing frailty , hospital costs increased ( P < .001 ) and costs from discharge to 6-months increased ( P < .001 ) . Higher degrees of frailty were related to increased rates of discharge institutionalization ( P < .001 ) and 30-day readmission ( P = .044 ) . CONCLUSIONS A simple , brief preoperative frailty assessment accurately forecasts increased surgical hospital costs and postdischarge to 6-month healthcare costs after colorectal operations in older adults 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 test the feasibility and utility of a bedside geriatric assessment ( GA ) to detect impairment in multiple geriatric domains in older adults initiating chemotherapy for acute myelogenous leukemia ( AML ) . DESIGN Prospect i ve observational cohort study . SETTING Single academic institution . PARTICIPANTS Individuals aged 60 and older with newly diagnosed AML and planned chemotherapy . MEASUREMENTS Bedside GA was performed during inpatient exmination for AML . GA measures included the modified Mini-Mental State Examination ; Center for Epidemiologic Studies Depression Scale ; Distress Thermometer , Pepper Assessment Tool for Disability ( includes self- reported activities of daily living ( ADLs ) , instrumental ADLs , and mobility questions ) ; Short Physical Performance Battery ( includes timed 4-m walk , chair st and s , st and ing balance ) ; grip strength , and Hematopoietic Cell Transplantation Comorbidity Index . RESULTS Of 54 participants ( mean age 70.8 ± 6.4 ) eligible for this analysis , 92.6 % completed the entire GA battery ( mean time 44.0 ± 14 minutes ) . The following impairments were detected : cognitive impairment , 31.5 % ; depression , 38.9 % ; distress , 53.7 % ; impairment in ADLs , 48.2 % ; impaired physical performance , 53.7 % ; and comorbidity , 46.3 % . Most were impaired in one ( 92.6 % ) or more ( 63 % ) functional domains . For the 38 participants rated as having good performance status according to st and ard oncologic assessment ( Eastern Cooperative Oncology Performance Scale score ≤1 ) , impairments in individual GA measures ranged from 23.7 % to 50 % . Significant variability in cognitive , emotional , and physical status was detected even after stratification according to tumor biology ( cytogenetic risk group classification ) . CONCLUSION Inpatient GA was feasible and added new information to st and ard oncology assessment , which may be important for stratifying therapeutic risk in older adults with AML The histone deacetylase inhibitor ( HDACi ) valproic acid ( VPA ) has been shown to be active on acute myeloid leukemia ( AML ) and refractory anemia with excess of blasts ( RAEB ) . Thirty-one elderly AML/RAEB patients ( AML n=25 ; RAEB n=6 ) with a high rate of comorbidity were entered in a phase II study with low-dose cytarabine ( Ara-C ) and VPA .  Fitness was evaluated by means of the Comprehensive Geriatric Assessment ( CGA ) , including the Cumulative Illness Rating Scale ( CIRS ) score , the self-sufficiency scores of Activity of Daily Living ( ADL ) and Instrumental Activity of Daily Living ( IADL ) . Eight patients obtained a lasting complete remission and 3 other patients obtained hematologic improvement for a total response rate of 35 % . Five of 11 responding patients were relapsed or resistant after a previous treatment with Ara-C. Seven of 11 responding patients were assessed as frail at enrollment and /or had IADL impairment . Grade s 3 and 4 toxicities were mainly hematological . Low-dose Ara-C and VPA is a relatively non-toxic combination with good therapeutic activity in elderly patients with AML/RAEB . This therapeutic approach represents an alternative treatment for patients who can not undergo st and ard induction therapy 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 BACKGROUND The aim of this r and omized phase II trial was to evaluate the feasibility and activity of weekly gemcitabine ( G ) followed by erlotinib at disease progression ( arm A ) versus erlotinib followed by G at progression ( arm B ) in vulnerable elderly patients with advanced non small-cell lung cancer ( NSCLC ) , selected on the basis of a comprehensive geriatric assessment ( CGA ) . METHODS Vulnerable elderly chemotherapy-naive patients with stage IIIB/IV NSCLC were selected after a CGA ( socioeconomic , cognitive and emotional status , depression , nutritional status , ADL and IADL assessment s ) . The primary endpoint was the time to second progression ( TTP2 ) . Overall survival ( OS ) , time to first progression ( TTP1 ) and safety were secondary endpoints . RESULTS Between May 2006 and January 2010 , 21 centers enrolled 100 patients , of whom 94 were eligible .  TTP2 was 4.3 and 3.5 months in arm A and arm B , respectively ; TTP1 was 2.5 and 2.2 months ; and the median OS time was 4.4 and 3.9 months . The respective one-year survival rates were 27.3 % and 20 % . There was no major unexpected toxicity . CONCLUSION In vulnerable elderly patients with NSCLC not selected for EGFR expression , both strategies were feasible but had modest efficacy . Further studies are needed to identify elderly patients who should receive palliative care only Abstract We conducted a prospect i ve study to compare epirubicin , cyclophosphamide , vinblastine , prednisone and rituximab ( R-miniCEOP ) with cyclophosphamide , doxorubicin , vincristine , prednisone and rituximab ( R-CHOP ) for the treatment of “ fit ” elderly patients with diffuse large B-cell lymphoma ( DLBCL ) . Patients over the age of 65 with stage II – IV DLBCL were screened with a comprehensive geriatric assessment . Patients were r and omized to receive six courses of R-miniCEOP ( n = 114 ) or R-CHOP ( n = 110 ) . Overall , the rate of complete remission was 70 % ( p = 0.466 ) . After a median follow-up of 42 months , 5-year event-free survival ( EFS ) rates were 46 % and 48 % for R-miniCEOP and R-CHOP , respectively ( p = 0.538 ) . Patients older than 72 years and with low-risk disease had a better outcome when treated with R-miniCEOP ( p = 0.011 ) . Overall R-CHOP and R-miniCEOP are similarly effective for elderly “ fit ” patients with DLBCL . The less intense R-miniCEOP may be an acceptable option for the treatment of relatively older patients with low-risk disease
target: Consistent with our previous review , several domains of GA are associated with adverse outcomes .
background: BACKGROUND Our previous systematic review of geriatric assessment ( GA ) in oncology included a literature search up to November 2010 .
  However , the quickly evolving field warranted an up date .
  Aims of this review : ( i ) provide an overview of all GA instruments developed and /or in use in the oncology setting ; ( ii ) evaluate effectiveness of GA in predicting/modifying outcomes ( e.g. treatment decision impact , treatment toxicity , mortality , use of care ) .