title: Evaluation of the Quality of Prognosis Studies in Systematic Reviews How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center Geriatric screening results and the association with severe treatment toxicity after the first cycle of (radio)chemotherapy. Modulated chemotherapy according to modified comprehensive geriatric assessment in 100 consecutive elderly patients with diffuse large B-cell lymphoma. "Timed Up & Go": A Screening Tool for Predicting 30-Day Morbidity in Onco-Geriatric Surgical Patients? A Multicenter Cohort Study Role of geriatric intervention in the treatment of older patients with cancer: rationale and design of a phase III multicenter trial Screening for predictors of adverse outcome in onco-geriatric surgical patients: A multicenter prospective cohort study. Geriatric evaluation and management units in the care of the frail elderly cancer patient. 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. Nutritional Advice in Older Patients at Risk of Malnutrition during Treatment for Chemotherapy: A Two-Year Randomized Controlled Trial Abridged geriatric assessment is a better predictor of overall survival than the Karnofsky Performance Scale and Physical Performance Test in elderly patients with cancer. 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. Evaluation of geriatric assessment in patients with chronic lymphocytic leukemia: Results of the CLL9 trial of the German CLL study group Comprehensive geriatric assessment in elderly patients with newly diagnosed aggressive non-Hodgkin lymphoma treated with multi-agent chemotherapy. Effect of nurse case management on the treatment of older women with breast cancer. A specialized home care intervention improves survival among older post-surgical cancer patients. Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Poor nutritional status is associated with other geriatric domain impairments and adverse postoperative outcomes in onco-geriatric surgical patients - A multicentre cohort study. Comprehensive geriatric assessment and comorbidities predict survival in geriatric oncology Independence and health related quality of life in 200 onco-geriatric surgical patients within 6 months of follow-up: Who is at risk to lose? Prognostic significance of geriatric assessment in combination with laboratory parameters in elderly patients with aggressive non-Hodgkin lymphoma Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. Cumulative deficit model of geriatric assessment to predict the postoperative outcomes of older patients with solid abdominal cancer. Outcome of frail elderly patients with diffuse large B-cell lymphoma prospectively identified by Comprehensive Geriatric Assessment: results from a study of the Fondazione Italiana Linfomi Prediction of Postoperative Complications Following Elective Surgery in Elderly Patients with Colorectal Cancer Using the Comprehensive Geriatric Assessment Comprehensive geriatric assessment of risk factors associated with adverse outcomes and resource utilization in cancer patients undergoing abdominal surgery. Frailty is an independent predictor of survival in older patients with colorectal cancer. Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Functional decline in older patients with cancer receiving first-line chemotherapy. Predictors of 1-Year Mortality in a Prospective Cohort of Elderly Patients With Cancer. Frailty and malnutrition predictive of mortality risk in older patients with advanced colorectal cancer receiving chemotherapy. Geriatric assessment is associated with completion of chemotherapy, toxicity, and survival in older adults with cancer.
abstract: Prognosis studies are investigations of future events or the evaluation of associations between risk factors and health outcomes in population s of patients ( 1 ) . The results of such studies improve our underst and ing of the clinical course of a disease and assist clinicians in making informed decisions about how best to manage patients . Prognostic research also informs the design of intervention studies by helping define subgroups of patients who may benefit from a new treatment and by providing necessary information about the natural history of a disorder ( 2 ) . There has recently been a rapid increase in the use of systematic review methods to synthesize the evidence on research questions related to prognosis . It is essential that investigators conducting systematic review s thoroughly appraise the method ologic quality of included studies to be confident that a study 's design , conduct , analysis , and interpretation have adequately reduced the opportunity for bias ( 3 , 4 ) . Caution is warranted , however , because inclusion of method ologically weak studies can threaten the internal validity of a systematic review ( 4 ) . This follows abundant empirical evidence that inadequate attention to biases can cause invalid results and inferences ( 5 - 9 ) . However , there is limited consensus on how to appraise the quality of prognosis studies ( 1 ) . A useful framework to assess bias in such studies follows the basic principles of epidemiologic research ( 10 , 11 ) . We focus on 6 areas of potential bias : study participation , study attrition , prognostic factor measurement , confounding measurement and account , outcome measurement , and analysis . The main objectives of our review of review s are to describe methods used to assess the quality of prognosis studies and to describe how well current practice s assess potential biases . Our secondary objective is to develop recommendations to guide future quality appraisal , both within single studies of prognostic factors and within systematic review s of the evidence . We hope this work facilitates future discussion and research on biases in prognosis studies and systematic review s. Methods Literature Search and Study Selection We identified systematic review s of prognosis studies by search ing MEDLINE ( 1966 to October 2005 ) using the search strategy recommended by McKibbon and colleagues ( 12 ) . This strategy combines broad search terms for systematic review s ( systematic review .mp ; meta- analysis .mp ) and a sensitive search strategy for prognosis studies ( cohort , incidence , mortality , follow-up studies , prognos * , predict * , or course ) . We also search ed the reference lists of included review s and method ologic papers to identify other relevant publications . We restricted our search to English- language publications . One review er conducted the search and selected the studies . Systematic review s , defined as review s of published studies with a comprehensive search and systematic selection , were included if they assessed the method ologic quality of the included studies by using 1 or more explicit criteria . We excluded studies if they were meta-analyses of independent patient data only , if their primary goal was to investigate the effectiveness of an intervention or specific diagnostic or screening tests , or if they included studies that were not done on humans . Data Extraction and Synthesis Individual items included in the quality assessment of the systematic review s were recorded as they were reported in the publication ( that is , the information that would be available to readers and future review ers ) . We review ed journal Web sites and contacted the authors of the systematic review s for additional information when authors made such an offer in their original papers . When review s assessed different study design s by using different sets of quality items , we extracted only those items used to assess cohort studies . We constructed a comprehensive list of distinct items that the review s used to assess the quality of their included studies . The full text of each review was screened . All items used by the review authors to assess the quality of studies were extracted into a computerized spreadsheet by 1 review er . Two experienced review ers , a clinical epidemiologist and an epidemiologist , independently synthesized the quality items extracted from the prognosis review s to determine how well the systematic review s assessed potential biases . We did this in 3 steps : 1 ) identified distinct concepts or domains addressed by the quality items ; 2 ) grouped each extracted quality item into the appropriate domain or domains ; and 3 ) identified the domains necessary to assess potential biases in prognosis studies . We then used this information to assess how well the review s ' quality assessment included items from the domains necessary to assess potential biases . After completing each of the first 3 steps , the review ers met to attempt to reach a consensus . The consensus process involved each review er presenting his or her observations and results , followed by discussion and debate . A third review er was available in cases of persistent disagreement or uncertainty . In the first step , all domains addressed by the quality items were identified . The first review er iteratively and progressively defined the domains as items were extracted from the included review s. The second review er defined domains from a r and om list of all extracted quality items . Limited guidance was provided to the review ers so that their assessment s and definitions of domains would be independent . The review ers agreed on a final set of domains that adequately and completely defined all of the extracted items . In the second step , review ers independently grouped each extracted item into the appropriate domains . Review ers considered each extracted item by asking , What is each particular quality item addressing ? or What are the review 's authors getting at with the particular quality assessment item ? . Items were grouped into the domain or domains that best represented the concepts being addressed . For example , the extracted items at least 80 % of the group originally identified was located for follow-up and follow-up was sufficiently complete or does n't jeopardize validity were each independently classified by both review ers as assessing the domain completeness of follow-up adequate , whereas the extracted item quantification and description of all subjects lost to follow-up was classified as assessing the domain completeness of follow-up described . In the third step , we identified the domains necessary to assess potential biases . Each review er considered the ability of the identified domains to adequately address , at least in part , 1 of the following 6 potential biases : 1 ) study participation , 2 ) study attrition , 3 ) prognostic factor measurement , 4 ) confounding measurement and account , 5 ) outcome measurement , and 6 ) analysis . Domains were considered to adequately address part of the framework if information garnered from that domain would inform the assessment of potential bias . For example , both review ers judged that the identified domain study population represents source population or population of interest assessed potential bias in a prognosis study , whereas the domain research question definition did not , although the latter is an important consideration in assessing the inclusion of studies in a systematic review . Finally , on the basis of our previous ratings , we looked at whether each review included items from the domains necessary to assess the 6 potential biases . We calculated the frequency of systematic review s by assessing each potential bias and the number of review s that adequately assessed bias overall . From this systematic synthesis , we developed recommendations for improving quality appraisal in future systematic review s of prognosis studies . We used Microsoft Access and Excel 2002 ( Microsoft Corp. , Redmond , Washington ) for data management and SAS for Windows , version 9.1 ( SAS Institute , Inc. , Cary , North Carolina ) for descriptive statistics . Role of the Funding Sources The funding sources , the Canadian Institutes of Health Research , the Canadian Chiropractic Research Foundation , the Ontario Chiropractic Association , and the Ontario Ministry of Health and Long Term Care , did not have a role in the collection , analysis , or interpretation of the data or in the decision to su bmi t the manuscript for publication . Results We identified 1384 potentially relevant articles . Figure 1 shows a flow chart of studies that were included and excluded . Figure 2 shows the number of review s identified by year of publication . We excluded 131 systematic review s of prognosis studies that did not seem to include any quality assessment of the included studies ; this represented 44 % of prognosis review s. We included 163 review s of prognosis studies in our analysis ( 13 - 175 ) . The most common topics were cancer ( 15 % ) , musculoskeletal disorders and rheumatology ( 13 % ) , cardiovascular ( 10 % ) , neurology ( 10 % ) , and obstetrics ( 10 % ) . Other review s included a wide range of health and health care topics . Sixty-three percent of the review s investigated the association between a specific prognostic factor and a particular outcome ; the remainder investigated multiple prognostic factors or models . The number of primary studies included in each systematic review ranged from 3 to 167 ( median , 18 [ interquartile range , 12 to 31 ] ) . A complete description of the included review s is available from the authors on request . Figure 1 . Flow diagram of inclusion and exclusion criteria of systematic review s. Figure 2 . Number of systematic review s of prognosis studies identified over time . Quality Items One hundred fifty-three review s provided adequate detail to allow extraction of quality items . Eight hundred eighty-two distinct quality items were extracted from the review s. Most review s developed their own set of quality items , with only a few applying criteria from previous review s. Most quality items Objective Cancer is one of the most common diagnoses in elderly patients . Of all types of abdominal cancer , colorectal cancer ( CRC ) is undoubtedly the most frequent . Median age at diagnosis is approximately 70 years old worldwide . Due to the multiple comorbidities affecting elderly people , frailty evaluation is very important in order to avoid over- or under-treatment . This pilot study was design ed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC . Methods Patients with 70 years old and older undergoing elective surgery for CRC were prospect ively enrolled in the study . The patients were preoperatively screened using 11 internationally-vali date d-frailty- assessment tests . The endpoints of the study were long-term mortality and living situation . The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors . Results Forty-six patients were studied . The median follow-up time after surgery was 4.6 years ( range , 2.9 - 5.7 years ) and no patients were lost to follow-up . The overall mortality rate was 39 % . Four of the patients who survived ( 4/28 , 14 % ) lost their functional autonomy . The preoperative impaired Timed Up and Go ( TUG ) , Eastern Cooperative Group Performance Status ( ECOG PS ) , Instrumental Activities of Daily Living ( IADLs ) , Vulnerable Elders Survey ( VES-13 ) scoring systems were significantly associated with increased long term mortality risk . Conclusion Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk . The TUG , ECOG-PS , IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability . Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients BACKGROUND Screening tools are used in geriatric oncology to determine who should receive a Comprehensive Geriatric Assessment ( CGA ) . However , in this prospect i ve study , we evaluated the association between geriatric screening results , measured with the G8 and Groningen Frailty Indicator ( GFI ) , and severe treatment toxicity . METHODS Patients over 65 years with various types and stages of cancer were screened with the G8 and the GFI prior to the start of treatment . The association between geriatric screening results and Serious Adverse Events ( SAE ) after the first cycle of (radio)chemotherapy were studied with bivariate analysis ( normal versus abnormal screening test ) and logistic regression analysis . RESULTS From 170 screened patients , 85 patients were eligible for this study . The median age was 76 years ( range : 66 - 88 years ) . The treatment intent was curative in 46 % and palliative in 54 % . A SAE occurred in 15 patients ( 18 % ) of which three result ed in death . There was no significant association between the G8 , as a dichotomous predictor ( p = 0.376 ) or as a continuous predictor ( p = 0.298 ) , and risk of a SAE . We also found no significant association for the GFI analysed as a dichotomous predictor ( cut-off ≥4 : p = 0.384 ; cut-off ≥3 : p = 0.773 ) , nor as a continuous predictor ( p = 0.734 ) . All associations remained insignificant when adjusted for treatment type and comorbidity . CONCLUSION The G8 and the GFI can be used to select patients for CGA , but they do not seem to be predictive for short-term severe treatment toxicity 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 Objective To determine the predictive value of the “ Timed Up & Go ” ( TUG ) , a vali date d assessment tool , on a prospect i ve cohort study and to compare these findings to the ASA classification , an instrument commonly used for quantifying patients ’ physical status and anesthetic risk . Background In the onco-geriatric surgical population it is important to identify patients at increased risk of adverse post-operative outcome to minimize the risk of over- and under-treatment and improve outcome in this population . Methods 263 patients ≥70 years undergoing elective surgery for solid tumors were prospect ively recruited . Primary endpoint was 30-day morbidity . Pre-operatively TUG was administered and ASA-classification was registered . Data were analyzed using multivariable logistic regression analyses to estimate odds ratios ( OR ) and 95 % confidence intervals ( 95%-CI ) . Absolute risks and area under the receiver operating characteristic curves ( AUC ’s ) were calculated . Results 164 ( 62.4 % ) patients ( median age : 76 ) underwent major surgery . 50 ( 19.5 % ) patients experienced major complications . 50.0 % of patients with high TUG and 24.8 % of patients with ASA≥3 experienced major complications ( absolute risks ) . TUG and ASA were independent predictors of the occurrence of major complications ( TUG : OR 3.43 ; 95%-CI = 1.13–10.36 . ASA1 vs. 2:OR 5.67 ; 95%-CI = 0.86–37.32 . ASA1 vs. 3&4:OR 11.75 ; 95%-CI = 1.62–85.11 ) . AUCTUG was 0.66 ( 95%-CI = 0.57–0.75 , p<0.001 ) and AUCASA was 0.58 ( 95%-CI = 0.49–0.67 , p = 0.09 ) . Conclusions Twice as many onco-geriatric patients at risk of post-operative complications , who might benefit from pre-operative interventions , are identified using TUG than when using ASA Background In the general geriatric population , programs linking geriatric evaluation with interventions are effective for improving functional status and survival of the patients . Whether or not these interventions improve health related quality of life ( HRQoL ) or overall survival ( OS ) in older patients with cancer is not yet clear . Indeed , r and omized data on the effect of such interventions on survival and HRQoL are rare and conflicting . We describe the rationale and design of a phase III multicenter trial aim ed at assessing the efficacy of geriatric intervention in the management of elderly patients with cancer . Methods / design Approximately 1200 patients , 70 years and older , considered in need of a geriatric intervention based on the G8 screening tool will be r and omized into two intervention arms . The ‘ Usual-care ’ arm involves st and ard oncological care based on pre-defined oncological protocol s. In addition to the st and ard oncological care , the ‘ Case-management ’ arm involves a multidimensional geriatric assessment and interventions tailored for the patient . Efficacy will be assessed using a co- primary endpoint encompassing OS and HRQoL. Discussion This trial has been design ed to assess whether focused geriatric case management can either improve OS or HRQoL in elderly cancer patients considered in need of geriatric assessment .Trial registration Clinical trials.gov ID : NCT02704832 AIMS The aim of this study was to investigate the predictive ability of screening tools regarding the occurrence of major postoperative complications in onco-geriatric surgical patients and to propose a scoring system . METHODS 328 patients ≥ 70 years undergoing surgery for solid tumors were prospect ively recruited . Preoperatively , twelve screening tools were administered . Primary endpoint was the incidence of major complications within 30 days . Odds ratios ( OR ) and 95 % confidence intervals ( 95 % CI ) were estimated using logistic regression . A scoring system was derived from multivariate logistic regression analysis . The area under the receiver operating characteristic curve ( AUC ) was applied to evaluate model performance . RESULTS At a median age of 76 years , 61 patients ( 18.6 % ) experienced major complications . In multivariate analysis , Timed Up and Go ( TUG ) , ASA-classification and Nutritional Risk Screening ( NRS ) were predictors of major complications ( TUG>20 OR 3.1 , 95 % CI 1.1 - 8.6 ; ASA ≥ 3 OR 2.8 , 95 % CI 1.2 - 6.3 ; NRS impaired OR 3.3 , 95 % CI 1.6 - 6.8 ) . The scoring system , including TUG , ASA , NRS , gender and type of surgery , showed good accuracy ( AUC : 0.81 , 95 % CI 0.75 - 0.86 ) . The negative predictive value with a cut-off point > 8 was 93.8 % and the positive predictive value was 40.3 % . CONCLUSIONS A substantial number of patients experience major postoperative complications . TUG , ASA and NRS are screening tools predictive of the occurrence of major postoperative complications and , together with gender and type of surgery , compose a good scoring system 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 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 Objective We tested the effect of dietary advice dedicated to increase intake in older patients at risk for malnutrition during chemotherapy  , versus usual care , on one-year mortality . Method We conducted a multicentre , open-label interventional , stratified ( centre ) , parallel r and omised controlled trial , with a 1∶1 ratio , with two-year follow-up . Patients were aged 70 years or older treated with chemotherapy for solid tumour and at risk of malnutrition ( MNA , Mini Nutritional Assessment 17–23.5 ) . Intervention consisted of diet counselling with the aim of achieving an energy intake of 30 kCal/kg body weight/d and 1.2 g protein/kg/d , by face-to-face discussion targeting the main nutritional symptoms , compared to usual care . Interviews were performed 6 times during the chemotherapy sessions for 3 to 6 months . The primary endpoint was 1-year mortality and secondary endpoints were 2-year mortality , toxicities and chemotherapy outcomes . Results Between April 2007 and March 2010 we r and omised 341 patients and 336 were analysed : mean ( st and ard deviation ) age of 78.0 y ( 4·9 ) , 51.2 % male , mean MNA 20.2 ( 2.1 ) . Distribution of cancer types was similar in the two groups ; the most frequent were colon ( 22.4 % ) , lymphoma ( 14.9 % ) , lung ( 10.4 % ) , and pancreas ( 17.0 % ) . Both groups increased their dietary intake , but to a larger extent with intervention ( p<0.01 ) . At the second visit , the energy target was achieved in 57 ( 40.4 % ) patients and the protein target in 66 ( 46.8 % ) with the intervention compared respectively to 13 ( 13.5 % ) and 20 ( 20.8 % ) in the controls . Death occurred during the first year in 143 patients ( 42.56 % ) , without difference according to the intervention ( p = 0.79 ) . No difference in nutritional status changes was found . Response to chemotherapy was also similar between the groups . Conclusion Early dietary counselling  was efficient in increasing intake but had no beneficial effect on mortality or secondary outcomes . Cancer cachexia antianabolism may explain this lack of effect . Trial Registration Clinical Trials.gov OBJECTIVES Comprehensive geriatric assessment ( CGA ) is a complex and interdisciplinary approach to evaluate the health status of elderly patients . The Karnofsky Performance Scale ( KPS ) and Physical Performance Test ( PPT ) are less time-consuming tools that measure functional status . This study was design ed to assess and compare abridged geriatric assessment ( GA ) , KPS and PPT as predictive tools of mortality in elderly patients with cancer . MATERIAL S AND METHODS This prospect i ve interventional study included all individuals aged > 70years who were diagnosed with cancer during the study period . Subjects were interviewed directly using a procedure that included a clinical test and a question naire composed of the KPS , PPT and abridged GCA .  Overall survival ( OS ) was the primary endpoint . The log rank test was used to compare survival curves , and Cox 's regression model ( forward procedure ) was used for multivariate survival analysis . RESULTS One hundred patients were included in this study . Abridged GA was the only tool found to predict mortality [ median OS for unfit patients ( at least two impairments ) 467days vs 1030days for fit patients ; p=0.04 ] . Patients defined as fit by mean PPT score ( > 20 ) had worse median OS ( 560 vs 721days ) ; however , this difference was not significant ( p=0.488 on log rank ) . Although median OS did not differ significantly between patients with low ( ≤80 ) and high ( > 80 ) KPS scores ( 467 and 795days , respectively ; p=0.09 ) , survival curves diverged after nearly 120days of follow-up . Visual and hearing impairments were the only components of abridged GA of prognostic value . CONCLUSION Neither KPS nor PPT were shown to predict mortality in elderly patients with cancer whereas abridged GA was predictive . This study suggests a possible role for visual and hearing assessment as screening for patients requiring CGA 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 Abstract Multidimensional geriatric assessment ( GA ) has been demonstrated to predict outcomes in older patients with cancer . This study evaluated GA in a cohort of older patients with chronic lymphocytic leukemia ( CLL ) . Seventy-five of 97 subjects with CLL who were enrolled in a clinical trial of the German CLL Study Group underwent GA prior to the start of study treatment ( low-dose chemotherapy with fludarabine ) . GA included  cumulative illness rating scale ( CIRS ) , timed-up- and -go ( TUG ) test , dementia detection ( DEMTECT ) test and instrumental activities of daily living ( IADL ) index . There was little correlation between CIRS , TUG , DEMTECT or IADL results and treatment toxicity , feasibility or efficacy in this study . CIRS and IADL had no statistically significant impact on overall prognosis . However , under-performance in TUG or DEMTECT test was strongly associated with poor survival . The latter findings provide a rationale to further investigate geriatric  assessment in CLL and in the context with other CLL treatments OBJECTIVES The purpose of this prospect i ve observational study is to evaluate the relation of the comprehensive geriatric assessment ( CGA ) to tolerability and survival of multi-agent chemotherapy for curative intent in elderly patients with aggressive non-Hodgkin lymphoma ( NHL ) . MATERIAL S AND METHODS Patients who were 1 ) age ≥65 years , 2 ) newly diagnosed aggressive NHL , and 3 ) treated with multi-agent chemotherapy within 2 weeks from the time of diagnosis were enrolled from January 2011 to June 2014 . Baseline clinical , laboratory , and CGA data being composed of  Mini Nutritional Assessment -Short Form ( MNA-SF ) , Korean version of Mini Mental Status Exam , Korean-Geriatric Depression Scale , and Groningen Frailty Index ( GFI ) , were collected and analyzed for the relation to the outcome factors . RESULTS Seventy patients were included ; the median age was 73.5 years , 27 ( 38.6 % ) patients were Eastern Cooperative Oncology Group ( ECOG ) performance status ( PS ) of 2 or more , and half of the patients were high or high-intermediate risk by age-adjusted international prognostic index ( aaIPI ) . Most patients received CHOP or CHOP-like chemotherapy . Factors affecting discontinuation of chemotherapy within 12 weeks were poor MNA-SF , poor GFI , poor PS , and presence of B symptom . Among those , poor MNA-SF was independent of other variables in multivariate analysis . Poor MNA-SF , bone marrow involvement , and baseline anemia of hemoglobin<10 g /dL were found to be independent factors associated with inferior overall survival whereas aaIPI factors were not . CONCLUSION MNA-SF predicted tolerability to multi-agents chemotherapy and overall survival in elderly patients with aggressive NHL who were treated  with multi-agent chemotherapy OBJECTIVES To evaluate the effect of nurse case management on the treatment of older women with breast cancer . DESIGN R and omized prospect i ve trial . SETTING Sixty surgeons practicing at 13 community and two public hospitals in southeast Texas . PARTICIPANTS Three hundred thirty-five women ( 166 control and 169 intervention ) aged 65 and older newly diagnosed with breast cancer . INTERVENTION Women seeing surgeons r and omized to the intervention group received the services of a nurse case manager for 12 months after the diagnosis of breast cancer . MEASUREMENTS The primary outcome was the type and use of cancer-specific therapies received in the first 6 months after diagnosis . Secondary outcomes were patient satisfaction and arm function on the affected side 2 months after diagnosis . RESULTS More women in the intervention group received  breast-conserving surgery  ( 28.6 % vs 18.7 % ; P=.031 ) and  radiation therapy  ( 36.0 % vs 19.0 % ; P=.003 ) . Of women undergoing breast-conserving surgery , greater percentages in the case management group received  adjuvant radiation  ( 78.3 % vs 44.8 % ; P=.001 ) and axillary dissection ( 71.4 % vs 44.8 % ; P=.057 ) . Women in the case management group were also more likely to receive more breast reconstruction surgery ( 9.3 % vs 2.6 % , P=.054 ) , and women in the case management group with advanced cancer were more likely to receive chemotherapy ( 72.7 % vs 30.0 % , P=.057 ) . Two months after surgery , higher percentages of women in the case manager group had normal arm function ( 93 % vs 84 % ; P=.037 ) and were more likely to state that they had a real choice in their treatment ( 82.2 % vs 69.9 % , P=.020 ) . Women with indicators of poor social support were more likely to benefit from nurse case management .  CONCLUSION Nurse case management results in more appropriate management of older women with breast cancer CONTEXT Changes in the healthcare system have result ed in shortened hospital stays , moving the focus of care from the hospital to the home . Patients are discharged post-operatively with ongoing needs , and whether they receive nursing care post-hospitalization can influence their recovery and survival . Little information is available about the factors that influence outcomes , including the survival of older cancer patients after cancer surgery . OBJECTIVE To compare the length of survival of older post-surgical cancer patients who received a specialized home care intervention provided by advanced practice nurses ( APNs ) with that of patients who received usual follow-up care in an ambulatory setting .  We also assessed potential predictors of survival in terms of depressive symptoms , symptom distress , functional status , comorbidities , length of hospital stay , age of patient , and stage of disease . DESIGN A r and omized controlled intervention study . SETTING Discharged older cancer patients after surgery at a Comprehensive Cancer Center in southeastern Pennsylvania . PATIENTS Three hundred seventy-five patients aged 60 to 92 , newly diagnosed with solid cancers , were treated surgically between February 1993 and December 1995 . One hundred ninety patients were r and omized to the intervention groups and 185 to the usual care group .  INTERVENTION The intervention was a st and ardized protocol that consisted of st and ard assessment and management post-surgical guidelines , doses of instructional content , and schedules of contacts . The intervention lasted 4 weeks and consisted of three home visits and five telephone contacts provided by APNs . Both the patients and their family caregivers received comprehensive clinical assessment s , monitoring , and teaching , including skills training . MAIN OUTCOME MEASURE Time from enrollment of patients into the study until death or last date known alive at the end of November 1996 . RESULTS During the 44-month follow-up period , 93 ( 24.8 % ) of 375 patients died . Forty-one ( 22 % ) of those who died were patients in the specialized home care intervention group , compared with 52 ( 28 % ) in the usual care group . Stage of disease at diagnosis differed between the two groups at baseline ( 38 % late stage patients in the intervention group compared with 26 % in the control group , P = .01 ) , so stratified analysis was performed . Overall , the specialized home care intervention group was found to have increased survival ( P = .002 using stratified log-rank test ) . Among early stage patients only , there was no difference in survival between the intervention and control groups . Among late stage patients , there was improved survival in the intervention group . For example , 2-year survival among late stage intervention group cases was 67 % compared with 40 % among control cases . When Cox 's proportional hazard model was used to adjust for significant baseline covariates , the relative hazard of death in the usual care group was 2.04 ( CI : 1.33 to 3.12 ; P = .001 ) after adjusting for stage of disease and surgical hospitalization length of stay . CONCLUSIONS This is the first empirical study of post-surgical cancer patients to link a specialized home care intervention by advanced practice nurses with improved survival . Additional research is needed to test home care interventions aim ed at maintaining quality of life outcomes and their effects on survival of post-surgical cancer patients 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 BACKGROUND Nutritional status ( NS ) , though frequently affected in onco-geriatric patients , is no st and ard part of a geriatric assessment . The aim of this study was to analyse the association between a preoperatively impaired NS and geriatric domain impairments and adverse postoperative outcomes in onco-geriatric surgical patients . METHODS 309 patients ≥70 years undergoing surgery for solid tumours were prospect ively recruited .  Nine screening tools were preoperatively administered as part of a geriatric assessment . NS was based on BMI , weight loss and food intake . Odds ratio 's ( OR ) and 95 % confidence intervals ( 95 % CI ) were estimated using logistic regression analysis . The occurrence of 30-day adverse postoperative outcomes was recorded . RESULTS At a median age of 76 years , 107 patients ( 34.6 % ) had an impaired NS . Decreased performance status and depression were associated with an impaired NS , when adjusted for tumour characteristics and comorbidities ( ORPS>1 3.46 ; 95 % CI 1.56 - 7.67 . ORGDS>5 2.11 ; 95 % CI 1.05 - 4.26 ) . An impaired NS was an independent predictor for major complications ( OR 3.3 ; 95 % CI 1.6 - 6.8 ) . Ten out of 11 patients who deceased had an impaired NS . CONCLUSION An impaired NS is prevalent in onco-geriatric patients considered to be fit for surgery . It is associated with decreased performance status and depression . An impaired NS is a predictor for adverse postoperative outcomes . NS should be incorporated in a geriatric assessment Objectives : The comprehensive geriatric assessment ( CGA ) can detect geriatric problems and potentially improve survival , physical , and cognitive state of patients , as well as increase an older person ’s chances of staying at home longer . In older people , the number and severity of comorbidity increase with age and are an important determinant of survival . The aim of the study was to assess to which extent CGA and comorbidities could be seen as determinants of survival . Material s and methods : This study analyzed data from two hospitals that included geriatric assessment s of patients aged 70 years and more with cancer linked to mortality .  Logistic regression was used to model survival predictors . Results : Two hundred and five various cancer patients ( 47 % females ) with a median age of 79 were included . They presented with a lot of undiagnosed geriatric problems . Screening scales ( G8 , SEGA ) , cognitive , and psychological disorders , and low albumin levels appeared to be independent survival factors . A frailty profile classification was associated with higher mortality . The average comorbidity was grade d 2 according to the Charlson scale . By the geriatric cumulative illness rating scale ( CIRS-G ) , the arithmetic average number of affected organ systems was 5 ( range 0–10 ) in all patients . Cardiovascular disorders were the most common comorbidity . Renal insufficiency and anaemia were negatively associated with survival . Conclusion : Old cancer patients present a lot of comorbidities and newly diagnosed geriatric problems . Several tools provide determinants of survival in old cancer patients . Prospect i ve trials evaluating the utility of a CGA to guide interventions to improve quality of cancer care in older adults are justified AIMS Comprehensive Geriatric Assessment ( CGA ) provides information on aspects of older patients to predict risks and benefits of interventions . METHODS To evaluate the application of CGA ( including quality of life ( QOL ) )  for the risk prediction of postoperative dependence and QOL in elderly patients with malignant tumours , a prospect i ve observational study including 200 patients > 70 years was performed . The primary outcome was postoperative activities of daily living ( ADL < 95 ) , secondary outcome was QOL at 6 months . Multivariate regression was performed to assess the impact of associated factors ( socio-demographic , clinical , functional , cognitive variables , resilience , and EORTC-QLQ-C30 QOL ) . RESULTS Median age of patients was 75 ( 70 - 88 ) years with 69 % males . The majority of operations was for colon carcinoma ; morbidity was 24.8 % , mortality 1.5 % . Impairment in ADL ( < 95 ) affected 6.7 % ( 13/195 ) pre- , and 9.7 % ( 12/124 ) post-operatively . Analyzing factors predicting loss of ADL , the following reached significance : BMI ( OR : 1.7 ; p = 0.019 ) , ADL ( OR : 0.67 ; p = 0.0317 ) , and of the QLQ-C30 : diarrhea ( OR : 1.04 ; p = 0.013 ) , emotional functioning ( OR : 0.91 ; p = 0.0242 ) , physical functioning ( OR : 0.92 ; p = 0.027 ) . QOL paralleled ADL ( pre-op : 65.4 to 67 postoperatively , respectively ) ; predictive were : Karnofsky Index ( Parameter Estimate ( PE ) : 0.55 ; p = 0.0003 ) and ( QLQ-C30 ) emotional functioning ( PE : 0.14 ; p = 0.0208 ) . CONCLUSIONS Those considered for oncologic surgery can be assured that few lose independence . CGA/QOL highlight signs of vulnerability and options for pre-habilitation . Registries including a minimal CGA data set will make pre- selection s reproducible and objectify risk/benefit estimations - relevant for those withheld from potentially curative surgery Abstract The age-adjusted International Prognostic Index ( IPI ) is an important prognostic factor for patients with non-Hodgkin lymphoma ( NHL ) . We investigated whether a geriatric assessment ( GA ) is of additional prognostic value in NHL . In this prospect i ve cohort study of 44 patients aged 70 years or older with NHL receiving rituximab , cyclophosphamide , doxorubicin , vincristine and prednisone ( R-CHOP )  , a GA was administered before the start of chemotherapy . GA was composed of the  Mini Nutritional Assessment ( MNA ) , Groningen Frailty Indicator ( GFI ) , Informant Question naire on Cognitive Decline in the Elderly ( IQCODE ) , Mini Mental State Examination ( MMSE ) and levels of albumin , creatinine , lactate dehydrogenase ( LDH ) and hemoglobin . Multivariate analyses were performed using logistic regression and the Cox regression model . After adjustment for sex , age , comorbidity and univariate laboratory values with p ≤ 0.1 , abnormal MNA and GFI scores and low hemoglobin level were associated with not being able to complete the intended chemotherapy : odds ratio ( OR ) 8.29 ( 95 % confidence interval [ CI ] : 1.24–55.6 ; p = 0.03 ) , 9.17 ( 95 % CI : 1.51–55.8 ; p = 0.02 ) and 5.41 ( 95 % CI : 0.99–29.8 ; p = 0.05 ) , respectively . Adjusted for sex , age , comorbidity , age-adjusted IPI and univariate laboratory values with p ≤ 0.1 , frailty by GFI and low hemoglobin were associated with worse survival , with a hazard ratio ( HR ) of mortality of 2.55 ( 95 % CI : 1.07–6.10 ; p = 0.04 ) and 4.90 ( 95 % CI : 1.76–13.7 ; p = 0.002 ) , respectively . We conclude that ( risk of ) malnutrition , measured with the MNA , frailty , measured with the GFI , and low hemoglobin level had additional predictive value for early treatment withdrawal , and GFI and hemoglobin were , independent of the age-adjusted IPI , predictive for an increased mortality risk 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 OBJECTIVE The geriatric assessment ( GA ) has proven to be of great value for clinicians treating older patients . However , a clear consensus on the optimal set of GA instruments is lacking , particularly for surgical patients . Therefore , the aim of this prospect i ve study was to compare the prevalence of frailty , depending on the number of incorporated GA domains , and to evaluate its accuracy in predicting postoperative outcome . MATERIAL S AND METHODS Seventy-five patients aged 65 years and older , qualified for abdominal surgery due to solid cancer , were enrolled . The GA included a wide variety of vali date d tools that evaluate functional , mobility , nutritional , co-morbidity , polypharmacy , and psychosocial domains .  RESULTS Depending on the number of incorporated GA domains the frequency of frailty was 23 - 97 % . The cumulative score rather than individual components of the GA , turned out to be an independent risk factor of 30-day postoperative morbidity . In predicting 30-day " any " and " major " morbidities , the area under the curve was 0.67 - 0.72 and 0.70 - 0.82 ( model including the severity of the surgery ) vs. 0.57 - 0.66 and 0.50 - 0.65 ( model not including the severity of the surgery ) , respectively . CONCLUSION The number of incorporated GA domains has a great influence on the prevalence of frailty and on adequate surgical risk assessment . The summary deficit score based on Pre-operative Assessment of Cancer in the Elderly ( PACE ) or the GA consisting of functional , mobility , cognitive , depression , nutritional , co-morbidity , polypharmacy , and social support assessment domains can predict 30-day postoperative morbidity . However , only models with addition of the severity of surgery show moderate to good predictive value Abstract In 2003 the Fondazione Italiana Linfomi ( FIL ) started a clinical research program for investigating initial treatment of frail elderly patients with diffuse large B-cell lymphoma ( DLBCL ) identified by Comprehensive Geriatric Assessment ( CGA ) . From 2003 to 2006 , 334 elderly patients underwent CGA assessment , and 99 patients were classified as frail . Frail patients had a median age of 78 years , stage III – IV disease in 62 % and age-adjusted International Prognostic Index ( aaIPI ) of 2–3 in 53 % . Treatment consisted of several different regimens according to physician discretion . After a median follow-up of 36 months , 5-year overall survival ( OS ) was 28 % . In multivariate analysis , aaIPI 2–3 ( p = 0.005 ) and the presence of respiratory comorbidity ( p = 0.044 ) were the only factors that showed independent correlation with OS . Frail patients had a poorer outcome compared with fit patients also if they were treated with rituximab-containing combination chemotherapy ( hazard ratio 2.37 , 95 % confidence interval 1.48–3.78 ; p < 0.001 ) . CGA is a valid tool to prospect ively identify frail subjects among elderly patients with DLBCL Aims : The study aims to determine whether the Comprehensive Geriatric Assessment ( CGA ) could predict complications of colorectal cancer ( CRC ) surgery and identify the problems . So we compared the prognostic value of the CGA with patient characteristics and determined predictive scores . Methods : A total of 156 patients aged 75 years and older , who underwent surgery for CRC at Osaka University Hospital , were enrolled . Each patient was examined by the CGA prospect ively , and all postoperative complications were obtained from the medical records . The CGA included the  Barthel Index ( BI ) , Vitality Index , instrumental activities of daily living ( iADL ) , Mini-Mental State Examination ( MMSE ) and Geriatric Depression Score ( GDS ) .  All elements were retrospectively compared in patients with or without postoperative complications , including delirium , surgical site infection and ileus . Results : Overall , postoperative complications developed in 76 patients ( 48.7 % ) . The BI and MMSE were associated with the incidence of complications , and BI , iADL , MMSE and GDS were significantly related with delirium . Multivariate logistic analysis identified the MMSE as a significant determinant of postoperative complications after adjusting for other determined predictive scores including the prognostic nutritional index and performance status . Conclusion : The CGA was a useful predictor of postoperative complications in elderly patients when administered before surgery for CRC BACKGROUND The purpose of this prospect i ve study was to identify risk factors for adverse outcomes or increased re source utilization after  abdominal cancer surgery in geriatric patients . METHODS Baseline clinical and geriatric assessment variables  including functional status , nutritional status , comorbidity index , mental status , depression scale score , fatigue inventory scale , and polypharmacy scale were prospect ively recorded for patients age ≥65 undergoing intra-abdominal oncologic surgery .  Outcome variables included morbidity , mortality , discharge to nursing facility , prolonged hospital stay , and readmission . RESULTS Of 111 patients , surgery type was colorectal in 40 % , hepatopancreatobiliary in 30 % , and gastric/duodenal in 14 % . Variables associated with discharge to a nursing facility on multivariate analysis included weight loss ≥10 % ( OR 6.52 [ 95 % CI : 1.43 - 29.76 ] , P = 0.02 ) , ASA score ≥2 ( OR 5.08 [ 1.13 - 22.77 ] , P = 0.03 ) , and ECOG score ≥2 ( OR 4.51 [ 1.03 - 19.71 ] , P = 0.04 ) . Variables independently associated with prolonged hospital stay included weight loss ≥10 % ( OR 4.03 [ 1.13 - 14.43 ] , P = 0.03 ) , the presence of polypharmacy ( OR 2.45 [ 1.09 - 5.48 ] , P = 0.03 ) , and distant disease ( OR 0.37 [ 0.15 - 0.91 ] , P = 0.03 ) . No variables were associated with morbidity or readmission . CONCLUSIONS Pre-operative clinical and geriatric assessment tools can help predict the need for discharge to a nursing facility or increased length of stay . Future studies will be required to identify patients suitable for interventions to decrease hospital and post-discharge re source utilization BACKGROUND Colorectal cancer ( CRC ) is prevalent in the older population .  Geriatric assessment ( GA ) has previously been found to predict treatment tolerance and postoperative complications in older cancer patients . The aim of this study was to explore whether GA also predicts 1-year and 5-year survival after  CRC surgery in older patients and to compare the predictive power of GA with that of established prognostic factors such as TNM classification of malignant tumors ( TNM ) stage and age . MATERIAL S AND METHODS A cohort of 178 CRC patients aged 70 and older were followed prospect ively . All patients went through elective surgery , and GA was performed presurgery . The GA result ed in patients being divided into two groups : frail or nonfrail . All patients were followed for 5 years or until death . Data were analyzed by Kaplan-Meier plots and the Cox proportional hazards model . RESULTS Seventy-six patients ( 43 % ) were frail , and one hundred and two ( 57 % ) were nonfrail . Twenty-three patients ( 13 % ) died during the first year after surgery . One-year survival was 80 % in the frail group and 92 % in the nonfrail group . Five-year survival was significantly lower in frail ( 24 % ) than nonfrail patients ( 66 % ) , and this difference was apparent both within the stratums of TNM stages 0-II and TNM stage III . In multivariable analysis adjusting for TNM stage , age , and sex , frailty was an independent prognostic factor for survival . CONCLUSION A GA-based frailty assessment predicts 1-year and 5-year survival in older patients after surgery for CRC . In localized and regional disease , the impact of frailty upon 5-year survival is comparable with that of TNM stage 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 To determine factors associated with early functional decline during first-line chemotherapy in older patients . PATIENTS AND METHODS Patients age ≥ 70 years receiving first-line chemotherapy for cancer were prospect ively considered for inclusion across 12 centers in France . Functional decline was defined as a decrease of ≥ 0.5 points on the Activities of Daily Living ( ADL ) scale between the beginning of chemotherapy and the second cycle . Factors associated with functional decline were sought from pretreatment abbreviated comprehensive geriatric assessment , including ADL , Instrumental ADL ( IADL ) , Mini-Nutritional Assessment ( MNA ) , Mini-Mental State Examination ( MMSE ) , Geriatric Depression Scale ( GDS15 ) , and Timed Get Up and Go ( GUG ) test  , and from comorbidities ( Cumulative Illness Rating Scale-Geriatrics ) , MAX2 index , and baseline biologic and clinical information . RESULTS Of 364 included patients , 50 experienced functional decline ( 16.7 % ; median , 0.5 points ) . Abnormal preadmission performance status , IADL , GDS15 , MMSE , GUG , and MNA were associated with increased likelihood of functional decline ( univariate analysis ) . In the multivariate model adjusted for baseline ADL and MAX2 index , high baseline GDS ( odds ratio [ OR ] , 2.16 ; 95 % CI , 1.09 to 4.30 ; P = .03 ) and low IADL scores ( OR , 2.87 ; 95 % CI , 1.06 to 7.79 ; P = .04 ) were independently associated with increased risk of functional decline . CONCLUSION Our results outline associations between baseline depression , instrumental dependencies , and early functional decline  during chemotherapy for older patients . ADL should be sequentially evaluated early during treatment . Baseline evaluation of GDS15 and IADL may be proposed to anticipate this event BACKGROUND Mortality prediction is crucial to select the optimal treatment in elderly cancer patients . Our objective was to identify cancer-related factors and Comprehensive Geriatric Assessment ( CGA ) findings associated with 1-year mortality in elderly in patients and out patients with cancer . METHODS We prospect ively included patients aged ≥70 years who had solid or hematologic malignancies and in whom the CGA was performed by geriatricians in two French teaching hospitals . We identified independent predictors of 1-year mortality after study inclusion , using multivariate Cox models stratified on inpatient/outpatient status . We built three multivariate Cox models , since strong correlations linked activities of daily living ( ADL ) , Eastern Cooperative Oncology Group Performance Status ( ECOG-PS ) , and timed get-up- and -go test ( GUG ) results ; and since physicians ' preferences for these three assessment s vary . A sensitivity analysis was performed using multiple imputation . RESULTS Of the 993 patients ( mean age , 80.2 years ; 51.2 % men ) , 58.2 % were out patients and 46 % had metastatic disease . Colorectal cancer was the most common malignancy ( 21.4 % ) . Mortality rates after 6 and 12 months were 30.1 % and 41.2 % , respectively . In all models , tumor site and metastatic status ( p < .001 ) , age > 80 years ( p < .05 ) , higher number of severe comorbidities ( p < .05 ) , and malnutrition ( p < .001 ) were associated with death independently from impaired ECOG-PS ( p < .001 ) , ADL ( p < .001 ) , and GUG ( p < .001 ) . The adverse effect of metastatic status differed significantly across tumor sites , being greatest for breast and prostate cancer ( p < .001 ) . Multiple imputation produced similar results . CONCLUSION The predictors of 1-year mortality identified in our study may help physicians select the optimal cancer-treatment strategy in elderly patients INTRODUCTION In general , geriatric assessment ( GA ) provides the combined information on comorbidity and functional , nutritional and psychosocial status and may be predictive for mortality outcome of cancer patients . The impact of geriatric assessment on the outcome of older patients with colorectal cancer treated with chemotherapy is largely unknown . METHODS In a prospect i ve study , 143 patients with colorectal cancer who were 70years and older were assessed before chemotherapy  by Mini Nutritional Assessment ( MNA ) , Informant Question naire on Cognitive Decline in the Elderly ( IQCODE ) , Groningen Frailty Indicator ( GFI ) and Mini Mental State Examination ( MMSE ) . RESULTS Fifty-four ( 38 % ) patients received adjuvant chemotherapy and 89 ( 62 % ) patients received palliative chemotherapy .  Malnutrition and frailty were prevalent in 39 ( 27 % , assessed by MNA ) and 34 ( 24 % , by GFI ) patients , respectively ; whereas cognitive impairment was prevalent in 19 ( 13 % , by IQCODE ) and 11 ( 8 % , by MMSE ) patients , respectively . In patients with palliative chemotherapy , poor MNA scores were associated with receiving less than 4cycles of chemotherapy ( p=0.008 ) . Poor MNA and GFI scores were associated with increased hazard ratios ( HR ) for mortality for patients with palliative chemotherapy : HR=2.76 ( 95 % confidence interval [ CI ] : 1.60 - 4.77 ; p<0.001 ) and HR=2.72 ( 95 % CI : 1.58 - 4.69 ; p<0.001 ) , respectively , after adjustment for several clinical parameters . CONCLUSIONS Malnutrition and frailty were strongly associated with an increased mortality risk in patients who underwent palliative chemotherapy . Furthermore , a poor score on MNA was predictive for less tolerance of chemotherapy . Our findings may help the oncologist in future decision making and advice for elderly patients with colorectal cancer OBJECTIVES Our purpose was to determine whether geriatric assessment s are associated with completion of a chemotherapy course , grade III/IV toxicity or survival in older adults with cancer . MATERIAL S AND METHODS In this prospect i ve cohort study , patients aged 65 years and older with colorectal , lung , or breast cancer or lymphoma completed a  brief geriatric assessment prior to chemotherapy . Endpoints included completion of the planned number of chemotherapy cycles , grade III/IV toxicity and survival . Multivariate logistic regression determined which factors were independently associated with completion of therapy , grade III/IV toxicity or death . RESULTS Sixty-five patients were enrolled in the study . The median age was 73 years ( range 65–89 ) .  Geriatric syndromes were common , including depression ( 21.5 % ) , dependence on others to carry out instrumental activities of daily living ( 38.5 % ) and activities of daily living ( 10.8 % ) , and comorbidities ( mild 47.7 % , moderate 20 % , severe 15.4 % ) . Of the 65 participants , 67.6%completed the planned number of chemotherapy cycles . Curative intent therapy [ OR 4.97 ( 95 % CI 1.21–18.81 ) ] , Eastern Cooperative Oncology Group ( ECOG ) performance status 2–3 [ OR 0.089 ( 0.015–0.53 ) ] and renal function [ OR 1.03 ( 1.00–1.06 ) per ml/min ] were significantly associated with therapy completion . Furthermore , 31.1 % experienced grade III/IV nonhematologic toxicity . Moderate to severe comorbidities significantly increased the risk of grade III/IV non-hematologic toxicity [ OR 6.13 ( 1.65–22.74 ) ] . Patients who received chemotherapy with curative intent had lower mortality [ HR 0.15 ( 0.06–0.42 ) ] , while patients who reported a fall in themonth prior to chemotherapy had an increased risk of death [ HR 3.20 ( 1.13–9.11 ) ] . CONCLUSIONS Geriatric assessment is associatedwith completion of a planned number of cycles of chemotherapy , grade III/IV non-hematologic toxicity , and mortality
target: All eight domains were predictive for at least one of the investigated outcomes but the results were quite variable across studies .
  Physical function and nutritional status were the domains most often associated with mortality and systemic treatment-related outcomes , and the domain physical function was most often associated with postoperative complications .
  Overall , this review demonstrates that the GA should minimally consist of physical function and nutritional status , when the aim is to predict patients -related outcomes of older patients with cancer , although the results are quite heterogeneous .
background: BACKGROUND A geriatric assessment ( GA ) is increasingly used to help guide treatment decisions in older patients with cancer .
  However , there is no consensus regarding which domains should be included in the GA .
  In addition , the field of geriatric oncology moves very fast and as a result many new studies have been published since the last review in 2015 .
  Therefore , the objective of this systematic review is to evaluate which domains of the GA could predict patient-related treatment outcomes of older patients with cancer and thereby should be included in a GA .