Geriatric screening and frailty intervention in older patients with cancer.

Frailty in older patients with cancer increases the risk of treatment related toxicity, mortality, physical decline, and quality of life. This review summarises various screening tools. Screening tools identifying frailty serve multiple purposes, providing awareness of health issues impacting oncologic treatment and prognosis and facilitating the delivery of a Comprehensive Geriatric Assessment (CGA). CGA is an overall health assessment and treatment targeting frailty. Providing CGA to older patients with cancer reduces the risk of toxicity and functional decline, increases treatment completion, and prevents loss of quality of life.

Tube feeding in dementia.

The number of people with dementia is expected to increase both in Denmark and globally. As dementia progresses dyphagia often develop, and increase risk of aspiration. Enteral nutrition via nasogatric and percutaneus feeding tube have several complications, and does not reduce the risk of pneumonia, hospital readmission, or decrease mortality. Neither does it have any positive effects on quality of life. On a national and international scale, a multidisciplinary team approach is recommended, but no international guidelines concerning this subject exist.

The impact of a tailored follow-up intervention on comprehensive geriatric assessment in older patients with cancer - a randomised controlled trial.

PURPOSE: Comprehensive Geriatric Assessment (CGA) can identify health problems in older persons. In addition, CGA includes intervention towards the identified problems. With follow up, more problems may be identified and the interventions can be adjusted. We wanted to compare CGA with or without tailored follow-up in a randomised design. PATIENTS AND METHODS: Patients 70+ years referred for oncology treatment with four primary tumour sites. Participants were randomised 1:1 to either control group with no follow-up or intervention group with a tailored follow-up by a multidisciplinary team. Primary outcome was adherence to cancer treatment. Secondary outcomes were daily life activities, physical performance and hospitalisation. RESULTS: In total, 363 participants were randomised. After randomisation only 301 were planned to receive specific cancer treatment. Median age was 75 years. Among the 301 participants, 52% of control group vs. 61% of intervention group completed treatment. Risk Rate (RR): 1.16 (95% Confidence Interval (CI): 0.95-1.42), p = .14. The impact varied between the included tumour-sites, p < .01. We found no difference in 90 days physical performance or daily life activities between groups. During the study period, 55% of controls vs. 47% in the intervention group were admitted to hospital, RR: 0.86 (95%CI: 0.69-1.07), p = .19. CONCLUSION: In frail and vulnerable patients with cancer, a tailored follow-up on CGA showed no differences in ability to complete initially planned cancer treatment. The impact varied between the included tumour sites. We did not find any impact of tailored follow-up on daily life activities, physical performance or hospitalisation.

Impact of comprehensive geriatric assessment on short-term mortality in older patients with cancer-a follow-up study.

PURPOSE: The aim of this study was to evaluate the impact of comprehensive geriatric assessment (CGA) linked to intervention on identified problems on 90-day mortality in older patients with cancer. PATIENTS AND METHODS: Eligible patients were 70 years or older and referred to the Oncology Department at Aarhus University Hospital in order to receive treatment for head and neck cancer (HNC), lung cancer (LC), upper gastrointestinal tract (UGI) cancer or colorectal cancer (CRC). All patients were intendedly invited for CGA. Patients for the study were identified by the oncology department. CGA evaluated six domains: comorbidity, autonomy, mental, cognitive, nutritional status and medication. Intervention was proposed if deficits were detected. Follow-up was performed 90 days after inclusion. RESULTS: From January 1st 2016 through July 31st 2018, 781 patients were identified. Sixty-seven patients were excluded. Median age: 76 (interquartile range: 72-80) years. Primary tumour sites: 5% HNC, 46% LC, 20% UGI and 29% CRC. A total of 407 patients had CGA, 307 had no CGA. Geriatric intervention was proposed in 325 patients (80%) and initiated in 319 patients (78%) in the CGA group. Within 90 days, 142 patients (20%) died. In the non-CGA group, 74 patients died (24%), versus 68 patients (17%) in the CGA group. A potential reduction of death in the CGA group was detected: crude odds ratio (OR): 0.63 (95% confidence interval: 0.43; 0.91), p = 0.014. Adjusted OR: 0.62 (95% confidence interval: 0.39; 1.00), p = 0.05. CONCLUSION: A CGA linked to oncology evaluation may reduce short-term mortality in older patients with cancer referred for oncological treatment.

Frailty status but not age predicts complications in elderly cancer patients: a follow-up study.

OBJECTIVES: The purposes were to investigate the health status of elderly cancer patients by comprehensive geriatric assessment (CGA) and to compare the complications with respect to baseline CGA and to evaluate the need for geriatric interventions in an elderly cancer patients' population. MATERIAL: Patients aged ≥70 years with lung cancer (LC), cancer of the head and neck (HNC), colorectal cancer (CRC), or upper gastro-intestinal cancer (UGIC) are referred to the Department of Oncology for cancer treatment. METHODS: CGA was performed prior to cancer treatment and addressed the following domains: Activities of daily living (ADL), instrumental ADL (IADL), comorbidity, polypharmacy, nutrition, cognition, and depression. Complications, defined as dose reduction and discontinuation of treatment due to grade 3-4 toxicity, hospital admission, shift to palliative treatment, or death within 90 days, were identified from the medical files. Patients were classified as fit, vulnerable, or frail by CGA. PRINCIPAL RESULTS: Patients (N = 217) with a median age of 75 years (range: 70-93 yeas) were included: 13% were fit, 35% vulnerable, and 52% frail. CGA significantly predicted admittance to hospital in frail and vulnerable patients compared to fit patients: risk ratio (RR) 2.12 (95% CI: 1.01; 4.46). Vulnerable and frail patients had higher absolute risk of death within 90 days compared to fit patients: 7% and 23% versus 0%. HR for death within 90 days in frail patients as compared to vulnerable patients was 3.50 (95% CI: 1.34; 9.15). More frail patients (88%) needed geriatric interventions than the vulnerable (46%) and fit patients (32%). Major conclusion: Few elderly cancer patients seem to be fit. CGA predicts admittance to hospital in a population of elderly patients with mixed cancer diseases. Frail and vulnerable patients have higher risk of death within 90 days as compared to fit patients.