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A.L.A. Dettino
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P2.11 - Poster Session/ Palliative and Supportive Care (ID 230)
- Event: WCLC 2015
- Type: Poster
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.11-007 - Geriatric Oncology and Lung Cancer: Comprehensive Geriatric Assessment (CGA) Aspects Related to Outcomes and Important End-Points (ID 492)
09:30 - 09:30 | Author(s): A.L.A. Dettino
- Abstract
Background:
Interdisciplinary oncology approach for geriatric patients (pts) is essential to improve health care, in the global era of populational aging. A possible way to implement that is to use CGA and interventions directed by its findings. Lung cancer (LC) treatment is a good scenario to present the importance of CGA, since its pts are usually old and with multiple comorbidities.
Methods:
LC pts with 70+ years old were found in our cohort of more than 600 pts, evaluated from Jan/12-Dez/12, the period of implementation of CGA in the Geriatric Oncology Unit of A. C. Camargo Cancer Center, a tertiary cancer care institution in Sao Paulo-SP, Brazil. Important geriatric data were extracted to evaluate those pts, to exemplify the importance of a coordinated interdisciplinary treatment plan with better chances of improving favorable clinical end-points. CGA assessments included scales of: activities of daily living/ADL (basic: Katz; instrumental: Lawton), mini-nutritional assessment, depression (geriatric depression scale/GDS), comorbidities and polypharmacy. Fit pts received mainly full treatment; frail/borderline pts, mainly modified tx and/or specific supportive care.
Results:
Eighty pts with LC were part of a subgroup of the major cohort. Most relevant data at first visit are show in the table below. All pts were assessed with CGA by at least one nurse, before medical oncology evaluation - sometimes, by a psychologist as well. Table 1. Relevant CGA data and elderly with lung cancer (n=80).
* Some subjects may have variable not available. In addition, selected comorbidity count ranged 0-5 (median 2); polipharmacy 0-6 (median 5). Seventeen pts were in follow-up only (21%); 48 (60%) pts were under chemotherapy (isolated or combined with other therapies). Even though CGA domains were altered in around 60% of them, the planned treatment could be offered to 57 (71%) pts. Longer survival probability, in the series, was predicted by performance status (ECOG), BADL (Katz) and mini-nutritional assessment.Variable Categories or values Age Median (range) 75 (70-88) n (%)* Sex Male/Female 44/36 55/45 ECOG/PS 0-1/2-3 53/23 63/29 Histology Adeno/SCC/Small cel 42/17/8 53/21/10 BADL KATZ = A 60 75 Altered KATZ 20 25 IADL Lawton = 27 27 34 Altered Lawton 53 60 GDS Normal (0-4) 43 54 Altered (≥4) 17 21 Not available (na) 20 25 Nutrition Undernourished ( < 8) 15 19 Under risk (8-11) 24 30 Normal (12-14) 24 30 na 17 21
Conclusion:
CGA is gaining increasing importance in geriatric oncology. In the present LC subgroup cohort, even though in a small case series, it shows that many pts are vulnerable or even frail; however, interdisciplinary evaluation and multimodal treatment could be offered, without major complications. Limitations include missing data in any domain of CGA, for example. All efforts to better study and define CGA and help to implement interdisciplinary interventions may be utile to improve elderly quality of life and survival in LC care.
