MANCHESTER, ENGLAND – Undertaking a few simple baseline assessments in elderly patients may help predict their risk of worsening physical function and falls occurring 2-3 months into cancer therapy, a prospective, multicenter study has shown.
Nearly a fifth (17.2%) of 811 patients in the analysis experienced a worsening in Activities of Daily Living (ADL) during treatment. Instrumental Activities of Daily Living (IADL) scores decreased in 38.9%, and 17.5% had at least one fall.
Cindy Kenis, R.N.
"Parameters from the CGA [Comprehensive Geriatric Assessment] before treatment in older cancer patients can identify at-risk patients for decline in functionality and development of falls," Cindy Kenis, R.N., of the University Hospitals Leuven (Belgium), annual meeting of the International Society of Geriatric Oncology (SIOG).
This emphasizes the need to "make sure that we foresee the necessary support for older cancer patients based on the results of a geriatric screening and evaluation for the different geriatric problems detected," Ms. Kenis added later in an interview.
A total of 937 patients aged 70 years or older were included in the study. The median age was 76 years, and 63.5% of the study population were female. The most common malignancy was breast cancer (40.4%); other malignancies included colon cancer (20.6%), hematologic malignancies (15.9%), prostate cancer (9%), lung cancer (7.8%), and ovarian cancer (6.3%).
Several geriatric assessment tools were used at baseline, including the G8 and the Flemish Triage Risk Screening Tool (TRST), followed by a Comprehensive Geriatric Assessment (CGA).
Follow-up assessments after 2-3 months’ cancer treatment were ADL, IADL, the number of falls, and chemotherapy toxicity. A decline in functionality occurred if there was a worsening of ADL by 2 or more points and IADL by 1 or more points, or if the patient had a fall.
Worsening ADL could be predicted by baseline scores in three measures: IADL, a mininutritional assessment (MNA), and the Flemish TRST (all P less than .05).
Patients classified as "dependent" on IADL at baseline (a score less than 8 for women and less than 5 for men) were almost twice as likely to have worsening ADL at any time point during follow-up as were those not seen as dependent on IADL at baseline (odds ratio, 0.54).
Patients at risk for malnutrition or malnourishment (a score less than 24 on MNA) also had about twice the risk of decline in ADL at the time point of follow-up as did those who had higher MNA scores (OR, 0.51).
Furthermore, patients classified as having a geriatric risk profile (a Flemish TRST score of 1 or higher) also had about twice the risk of ADL decline at follow-up as did those not having a geriatric risk profile (OR, 0.48).
Worsening IADL was predicted by baseline ECOG performance status (PS), Geriatric Depression Scale (GDS)–15 scores, and having chemotherapy (all P less than .05).
Patients with a PS of 0 or 1 at baseline were twice as likely to experience a decline in IADL as were those with worse PS (OR, 2.00). "This sounds somewhat contradictory," Ms. Kenis acknowledged, "but [it] can be explained by the fact that patients who already scored 2 or more on ECOG baseline, couldn’t get much worse," she explained.
Patients with a geriatric risk profile in need of further in-depth CGA (a Flemish TRST score of 1 or greater) had about twice the risk of IADL decline than as did those without such a profile (OR, 0.52).
Patients at risk for depression (a GDS-15 score less than 5) had about a third more risk of a decline in IADL as did those not at risk for depression (OR, 0.58).
Patients who had received any type of chemotherapy were also more likely to experience a decline in IADL (OR, 0.62).
Prior falls, baseline ADL, G8 assessment, living situation, and the disease setting (new diagnosis or cancer progression) were predictive of a future fall (all P less than .05):
• Patients who had already experienced a fall in the year before study inclusion were almost four times more likely to have another fall during follow-up than those who had not had a prior fall the year before (OR, .62).
• Patients classified as dependent on ADL at baseline (Belgian Katz scale score greater than 6) had about three times more risk of new falls. (OR, 0.42).
• Patients in need of further in-depth CGA (G8 score up to 14) had about four times more risk of new falls (OR, 0.38).
• Living alone was also predictive, almost doubling the risk of a fall (OR, 0.63).