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J Geriatr Oncol. 2019 Jan 9. pii: S1879-4068(18)30265-0. doi: 10.1016/j.jgo.2018.12.004. [Epub ahead of print]

The prognostic value of G8 for functional decline.

Author information

1
Department of Medical Oncology, Institut Bergonié, Bordeaux, France.
2
Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France; ISPED, INSERM U1219 Bordeaux Population Health Center, Epicene Team, Bordeaux, France.
3
ISPED, INSERM U1219 Bordeaux Population Health Center, Epicene Team, Bordeaux, France.
4
Université de Bordeaux, France; Department of Geriatric Medicine, CHU Bordeaux, France.
5
Department of Medical Oncology, Institut Bergonié, Bordeaux, France; Université de Bordeaux, France; Inserm UMR1218, France. Electronic address: p.soubeyran@bordeaux.unicancer.fr.

Abstract

PURPOSE:

Clinical experience suggests that functional decline (FD) during treatment may have a major adverse impact on outcome. Geriatric assessment of older patients before cancer treatment is usually based on use of a screening tool (such as G8) followed by comprehensive geriatric assessment (CGA). However, many oncology teams cannot implement geriatric oncology management due to non-availability of geriatricians. Consequently, we decided to evaluate whether a procedure using G8 and routinely available factors could help oncologists foresee the outcome in patients ≥70: we firstly evaluated whether functional decline is a determinant of early death, then searched for predictors of early functional decline (measured before initiation of the second cycle of chemotherapy), including G8 but voluntarilly excluding CGA.

METHODS:

We tested the value of clinical, biological factors and early FD to predict early death on a cohort of 292 patients (≥70 years) treated with first-line chemotherapy. We then used a logistic regression model to search for pretreatment predictors of FD, including the same factors and G8 but excluding CGA.

RESULTS:

FD occurred in 48 patients. In multivariate analyses, early FD (OR = 4.13, 95% CI [1.89; 9.04], p < .01), disease extension (OR = 4.55, 95% CI [1.96; 10.57]; p < .01), and being male (OR = 2.59, 95% CI [1.12; 5.97], p = .02) were significant prognostic factors for early death; G8 was the only significant factor associated with FD (OR = 4.38, 95% CI [1.28; 14.92], p = .018).

CONCLUSIONS:

FD has an important prognostic significance in patients ≥70 treated with chemotherapy, and G8 predicts for its occurrence. These data reinforce the routine use of G8 in the management of these patients.

KEYWORDS:

Cancer; Chemotherapy; Early death; Functional decline; G8; Older patients

PMID:
30638869
DOI:
10.1016/j.jgo.2018.12.004

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