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PLoS One. 2016 Feb 26;11(2):e0149732. doi: 10.1371/journal.pone.0149732. eCollection 2016.

Frailty Markers and Treatment Decisions in Patients Seen in Oncogeriatric Clinics: Results from the ASRO Pilot Study.

Author information

1
Unité de coordination en oncologie gériatrique, Centre Gérontologique Départemental, Marseille, France.
2
Département de Gériatrie, Centre Hospitalo-Universitaire, Nantes, France.
3
Aix Marseille Université, Laboratoire de Santé Publique EA 3279, Faculté de médecine Centre d'Evaluation de la Pharmacodépendance-Addictovigilance (CEIP-A) de Marseille (PACA-Corse) Associé, Marseille, France.
4
Unité de coordination en oncologie gériatrique, Institut Paoli Calmette, Marseille, France.
5
Department of Family Medicine, Mcgill University, Montréal, QC H3T 1E2, Canada.
6
Unité de soins et de recherche en médecine interne et maladies infectieuses, Hôpital Européen, Marseille, France.

Abstract

BACKGROUND:

Comprehensive Geriatric Assessment (CGA) is the gold standard to help oncologists select the best cancer treatment for their older patients. Some authors have suggested that the concept of frailty could be a more useful approach in this population. We investigated whether frailty markers are associated with treatment recommendations in an oncogeriatric clinic.

METHODS:

This prospective study included 70 years and older patients with solid tumors and referred for an oncogeriatric assessment. The CGA included nine domains: autonomy, comorbidities, medication, cognition, nutrition, mood, neurosensory deficits, falls, and social status. Five frailty markers were assessed (nutrition, physical activity, energy, mobility, and strength). Patients were categorized as Frail (three or more frailty markers), pre-frail (one or two frailty markers), or not-frail (no frailty marker). Treatment recommendations were classified into two categories: standard treatment with and without any changes and supportive/palliative care. Multiple logistic regression models were used to analyze factors associated with treatment recommendations.

RESULTS:

217 patients, mean age 83 years (± Standard deviation (SD) 5.3), were included. In the univariate analysis, number of frailty markers, grip strength, physical activity, mobility, nutrition, energy, autonomy, depression, Eastern Cooperative Oncology Group Scale of Performance Status (ECOG-PS), and falls were significantly associated with final treatment recommendations. In the multivariate analysis, the number of frailty markers and basic Activities of Daily Living (ADL) were significantly associated with final treatment recommendations (p<0.001 and p = 0.010, respectively).

CONCLUSION:

Frailty markers are associated with final treatment recommendations in older cancer patients. Longitudinal studies are warranted to better determine their use in a geriatric oncology setting.

PMID:
26918947
PMCID:
PMC4769181
DOI:
10.1371/journal.pone.0149732
[Indexed for MEDLINE]
Free PMC Article

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