Formal geriatric assessment, An imperative for the older person with cancer

The authors evaluate the role of cognitive, functional, and affective geriatric assessment measures in elderly cancer patients, and analyze the associations between these factors, stage of malignancy, and cancer treatment choices.

Fifty consecutive patients older than 65 years of age who were referred to the Geriatric Oncology Clinic at the University of New Mexico Health Sciences Center in Albuquerque were evaluated using standard geriatric assessment tools. Each person underwent a complete history and physical examination. An extensive chart review established the type of cancer, stage at diagnosis, and treatment modalities used. The Karnofsky performance status scale score also was determined at this initial evaluation.

The group had a mean age of 74.9 years; 60% were women and 40% were men. The most common cancers were breast (28%) and prostate (16%). Fifty-two percent of the patients had localized disease and 48% had distant disease. Seventy-four percent had received treatment by the time of the initial assessment, with 62% undergoing combination therapy. The most common noncancer diagnoses were cardiovascular disease, hypertension, and osteoarthritis. Scores on standardized measures indicated that the majority of patients were independent. Those who did not receive treatment were more functionally impaired than those who received treatment. Twenty-seven percent of the sample were impaired cognitively and 24% were depressed. There were no statistical differences in functional, cognitive, or affective status between stages of disease for specific malignancies.

Age alone is a poor predictor of outcome in cancer treatment and is an inappropriate factor by which to exclude persons with cancer from clinical trials. Treatment decisions based on age alone may lead to inadequate treatment. In this report, functional dependence was more prevalent in nontreated patients and was unrelated to the stage of disease. These results support the need for formal geriatric assessment, including measures of cognitive, functional, and affective status, in elderly persons with cancer. Further studies on the role of functional, cognitive, and affective status at the time of cancer diagnosis, as well as how these parameters might alter treatment decisions, are warranted. In addition, further investigation to identify which of these multiple variables influence treatment outcome are needed.