Comprehensive Geriatric assessment and its clinical impact in oncology

Published:September 13, 2007DOI:


      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.


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        • Epstein A.M.
        • Hall J.A.
        • Besdine R.
        • et al.
        The emergence of geriatric assessment units: the ‘new technology of geriatrics’.
        Ann Intern Med. 1987; 106: 299-303
        • Solomon D.
        • Brown A.S.
        • Brummel-Smith K.
        • et al.
        National Institutes of Health Consensus Development Conference statement: geriatric assessment methods for clinical decision-making.
        J Am Geriatr Soc. 1988; 36: 342-347
        • Stuck A.E.
        • Siu A.L.
        • Wieland D.
        • et al.
        Comprehensive geriatric assessment: a meta-analysis of controlled trials.
        Lancet. 1993; 342: 1032-1036
        • Applegate W.B.
        • Burns R.
        Geriatric medicine.
        JAMA. 1996; 275: 1812-1813
        • Cohen H.J.
        • Feussner J.R.
        • Weinberger M.
        • et al.
        A controlled trial of inpatient and outpatient geriatric evaluation and management.
        N Engl J Med. 2002; 346: 905-912
        • Reuben D.B.
        • Borok G.M.
        • Wolder-Tsadik G.
        • et al.
        A randomized trial of comprehensive geriatric assessment in the care of hospitalised patients.
        N Engl J Med. 1995; 332: 1345-1350
        • Stuck A.E.
        • Egger M.
        • Hammer A.
        • et al.
        Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis.
        JAMA. 2002; 287: 1022-1028
        • Olde Rikkert M.G.M.
        • Rigaud A.J.
        • van Hoeyweghen R.J.
        • et al.
        Geriatric syndromes: medical misnomer or progress in geriatrics.
        Neth J Med. 2003; 61: 83-87
        • Balducci L.
        • Santa G.
        Cancer in the frail patient.
        Hematol Oncol Clin North Am. 2000; 14: 235-251
        • Leibig B.
        • Olbrich G.
        • Scheibe G.
        Die Klinische Syndrome. Syndrome, Sequenze und Komplexe, part II. Krankheitsbilder.
        7th ed. Urban & Schwarzenberg, München1990
        • Inouye S.K.
        • Bogardus S.T.
        • Charpentier P.A.
        • et al.
        A multicomponent intervention to prevent delirium in hospitalized older patients.
        N Engl J Med. 1999; 340: 669-676
        • Tinetti M.E.
        • Baker D.L.
        • McAvay G.
        • et al.
        A multifactorial intervention to reduce the risk of falling among elderly people living in the community.
        N Engl J Med. 1994; 331: 821-827
        • Lipsitz L.A.
        • Pluchino F.C.
        • Wei J.Y.
        • et al.
        Syncope in institutionalized elderly: the impact of multiple pathological conditions and situational stress.
        J Chron Dis. 1986; 39: 619-630
        • Koroukian S.M.
        • Murray P.
        • Madigan E.
        Comorbidity, disability and geriatric syndromes in elderly cancer patients receiving home health care.
        J Clin Oncol. 2006; 24: 2304-2310
        • O’Keeffe S.
        • Lavan J.
        the prognostic significance of delirium in older hospital patients.
        J Am Geriatr Soc. 1997; 45: 174-178
        • Nardi R.
        • Fiorino S.
        • Borioni
        • et al.
        Comprehensive complexity assessment is a key tool for the prediction of in-hospital mortality in heart failure of aged patients admitted to internal medicine wards.
        Arch Gerontol Geriatr. 2007; 44: 279-288
        • Extermann M.
        • Meyer J.
        • McGinnis M.
        • et al.
        A comprehensive geriatric assessment detects multiple problems in older breast cancer patients.
        Crit Rev Oncol Hematol. 2004; 49: 69-75
        • Repetto L.
        • Fratino L.
        • Audisio R.A.
        • et al.
        Comprehensive Geriatric Assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study.
        J Clin Oncol. 2002; 20: 494-502
        • Flood K.I.
        • Carroll M.B.
        • Le C.V.
        • et al.
        Geriatric Syndromes in elderly patients admitted to an Oncology-Acute care for elders unit.
        J Clin Oncol. 2006; 24: 2298-2303
        • Terret C.
        • Albrand G.
        • Droz J.P.
        Multidimensional Geriatric Assessment reveals unknown medical problems in elderly cancer patients.
        J Clin Oncol. 2004; 22: 8167
      1. Zagonel V, Fratino L, Piselli P et al. The comprehensive geriatric assessment (CGA) predicts mortality among elderly cancer patients. Proc Am Soc Clin Oncol 2002;21:abstract 1458.

        • Del Mastro L.
        • Perrone F.
        • Repetto L.
        • et al.
        Weekly paclitaxel as first line chemotherapy in elderly advanced breast cancer patients: a phase II study of the Gruppo Italiano di Oncologica Geriatrica (CIOGer).
        Annal Oncol. 2005; 16: 253-258
        • Freyer G.
        • Lotholary A.
        • Delcambre C.
        • et al.
        Unexpected toxicities in elderly patients treated with oral idarubicin in metastatic breast cancer: the GINECO experience.
        Clin Oncol. 2004; 16: 17-23
        • Maione P.
        • Perrone F.
        • Gallo C.
        • et al.
        Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study.
        J Clin Oncol. 2005; 23: 6865-6872
        • Tredan O.
        • Geay J.F.
        • Touzet S.
        • et al.
        Carboplatin/cyclophosphamide or carboplatin/paclitaxel in elderly patients with advanced ovarian cancer? Analyses of two consecutive trials from the Groupe d’Ínvestigateurs Nationaux pour l’Etude des Cancer Ovariens.
        Annal Oncol. 2007; 18: 256-262
        • McCorkle R.
        • Strumpf N.
        • Nuamah I.F.
        • et al.
        A specialized home care intervention program improves survival among older post-surgical cancer patients.
        J Am Geriatr Soc. 2000; 48: 1707-1713
        • Rao A.V.
        • Hsieh F.
        • Feissner J.R.
        • Cohen H.J.
        Geriatric evaluation and management units in the care of the frail elderly cancer patients.
        J Gerontol A Biol Sci Med Sci. 2005; 60: 798-803
        • Given B.
        • Given C.
        • Azzouz F.
        • Stommel M.
        Physical functioning of elderly cancer patients prior to diagnosis and following initial treatment.
        Nurs Res. 2001; 50: 222-232
        • Inouye S.K.
        • Studenski S.
        • Tinetti M.E.
        • Kuchel G.A.
        Geriatric syndromes: clinical research, and policy implications of a core geriatric concept.
        J Am Geriatr Soc. 2007; 55: 780-792
        • Inouye S.K.
        • Peduzzi P.N.
        • Robison J.T.
        • et al.
        Importance of functional measures in predicting mortality among older hospitalized patients.
        JAMA. 1998; 27: 1187-1193
        • Freyer G.
        • Geay J.F.
        • Touzet S.
        • et al.
        Comprehensive Geriatric Assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study.
        Annal Oncol. 2005; 16: 1795-1800
        • Extermann M.
        • Chen H.
        • Cantor A.B.
        • et al.
        Eur J Cancer. 2002; 38: 1466-1473
        • Janssen-Heijnen M.L.
        • Houterman S.
        • Lemmens V.E.
        • Louwman M.W.
        • Maas H.A.
        • Coebergh J.W.
        Prognostic impact of increasing age and comorbidity in cancer patients: a population based approach.
        Crit Rev Oncol Hematol. 2005; 55: 231-240
        • Blower P.
        de Wit R, Goodin J, Aapro M.
        Crit Rev Oncol Hematol. 2005; 55: 117-142
        • Jatoi A.
        • Hillman S.
        • Stella P.J.
        • et al.
        Daily activities: exploring their spectrum and prognostic impact in older chemotherapy treated lung cancer patients.
        Support Care Cancer. 2003; 11: 460-464
        • Chen H.
        • Cantor A.
        • Meyer J.
        • et al.
        Can older cancer patients tolerate chemotherapy? A prospective pilot study.
        Cancer. 2003; 97: 1107-1114
        • Wefel J.S.
        • Lenzi R.
        • Theriault R.
        • et al.
        ‘Chemobrain’ in breast carcinoma? A prologue.
        Cancer. 2004; 101: 466-475
        • Van Herck P.
        • Vanhaecht K.
        • Sermeus W.
        Effects of clinical pathways: do they work?.
        J Integrated Care Pathways. 2004; 8: 95-105
        • Extermann M.
        • Aapro M.
        • Bernabei R.
        • et al.
        Use of comprehensive geriatric assessment in older cancer patients. Recommendations from the taskforce on CGA of the International Society of Geriatric Oncology (SIOG).
        Crit Rev Oncol Hematol. 2005; 55: 241-252
        • Ferucci L.
        Guralnik JM, Cavazzini C, et al.
        Crit Rev Oncol Hematol. 2003; 46: 127-137
        • Lally F.
        • Crome P.
        Understanding frailty.
        Postgrad Med J. 2007; 83: 16-20
        • Fried L.P.
        • Ferrucci L.
        • Darer J.
        • et al.
        Untangling the concepts of disability, frailty and comorbidity: implications for improved targeting and care.
        J Gerontol A Biol Sci Med SCi. 2004; 59: 255-263
      2. Rolfson DB, Majumdar SR, Tsuyuki RS et al. Validity and reliability of the Edmonton Frailty Scale.

        • Schuurmans M.
        • Steverink N.
        • Lindenberg S.
        • et al.
        Old and frail: What tells us more?.
        J Gerontol A Biol Sci Med Sci. 2004; 59A: 962-965
        • Slaets J.P.J.
        Vulnerability in the elderly: frailty.
        Med Clin N Am. 2006; 90: 593-601
        • Mohile S.G.
        • Bylow K.
        • Dale W.
        • et al.
        A pilot study of the Vulnerable Elders’ Survey-13 as compared to comprehensive geriatric assessment for identifying disability in older prostate cancer patients receiving androgen ablation.
        Cancer. 2007; 109: 802-810
      3. Step by step. Development of clinical care pathways for older cancer patients: necessary or desirable? De Vries M, van Weert JCM, Jansen J, Lemmens VEPP, Maas HAAM, Eur J Cancer 2007 (in press).