Abstract
Comprehensive geriatric assessment (CGA) is a process that consists of a multidimensional
data-search and a process of analyzing and linking patient characteristics creating
an individualized intervention-plan, carried out by a multidisciplinary team. In general,
the positive health care effects of CGA are established, but in oncology both CGA
and the presence of geriatric syndromes still have to be implemented to tailor oncological
therapies to the needs of elderly cancer patients. In this paper the conceptualization
of geriatric syndromes, their relationship to CGA and results of clinical studies
using CGA in oncology are summarized. Geriatric syndromes are associated with increased
vulnerability and refer to highly prevalent, mostly single symptom states (falls,
incontinence, cognitive impairment, dizziness, immobility or syncope). Multifactorial
analysis is common in geriatric syndromes and forms part of the theoretical foundation
for using CGA.
In oncology patients, we reviewed the value of CGA on the following endpoints: recognition
of health problems, tolerance to chemotherapy and survival. Most studies performed
CGA to identify prognostic factors and did not include an intervention. The ability
of CGA to detect relevant health problems in an elderly population is reported consistently
but no randomized studies are available. CGA should explore the pre-treatment presence
of (in)dependence in Instrumental Activities of Daily Living (IADL), poor or moderately
poor quality of life, depressive symptoms and cognitive decline, and thereby may help
to predict survival. However, if scored by the Charlson comorbidity-index, comorbidities
are not convincingly related to survival. The few studies that included a CGA-linked
intervention show inconsistent results with regard to survival but compared to usual
care quality of life is improved in the surviving period. Functional performance scores
and dependency at home appeared to be independent predictive factors for toxicity,
similar to depressive symptoms and polypharmacy. Overall, CGA implements/collects
information additional to chronological age and Performance Score. So far in oncology
there are no prognostic validation studies reported using geriatric syndromes or information
based on CGA in its decision making strategies.
Keywords
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Article info
Publication history
Published online: September 13, 2007
Accepted:
August 1,
2007
Received in revised form:
July 31,
2007
Received:
May 26,
2007
Identification
Copyright
© 2007 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
