nach oben

Current Geriatrics Reports

Erschienen in:

07.10.2017 | Hematology and Oncology (GR Williams, Section Editor)

Assessing Frailty and Vulnerability in Older Adults with Cancer

verfasst von: Kah Poh Loh, Sheryl Ramdass, Colin McHugh, Supriya G. Mohile, Ronald J. Maggiore

Erschienen in: Current Geriatrics Reports | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Aging is associated with decreased physiologic reserve, and older adults are more susceptible to cancer treatment toxicity. In this review, we discuss the implications of frailty and vulnerability in older patients with cancer. We also review a number of instruments that can be used to assess frailty and vulnerability and propose a practical approach to incorporate these tools in a general oncology or geriatric clinic.

Recent Findings

In older patients with cancer, frailty and vulnerability are associated with all-cause mortality, postoperative complications, and treatment intolerance/toxicities. If feasible, a comprehensive geriatric assessment should be used to assess of frailty and vulnerability. If a full geriatric assessment cannot be performed, screening tools such as the Balducci’s criteria, Vulnerable Elders Survey-13, Triage Risk Screening Tool, Groningen Frailty Index, and Geriatric 8 may be used.

Summary

Future studies should evaluate geriatric assessment domains that have the greatest predictive value for toxicity for each cancer type and treatment.

Ortman JM, Velkoff VA, Hogan H. An aging nation: the older population in the United States. 2014 May. Available at: https://www.census.gov/prod/2014pubs/p25-1140.pdf n.d.

Evaluating the older patient with cancer: understanding frailty and the geriatric assessment. - PubMed - NCBI n.d. https://www.ncbi.nlm.nih.gov/pubmed/20173172. Accessed 17 Apr 2017.

Hutchins LF, Unger JM, Crowley JJ, Coltman CAJ, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341:2061–7. https://doi.org/10.1056/NEJM199912303412706.CrossRefPubMed

Lewis JH, Kilgore ML, Goldman DP, Trimble EL, Kaplan R, Montello MJ, et al. Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol Off J Am Soc Clin Oncol. 2003;21:1383–9.CrossRef

Mohile SG, Xian Y, Dale W, Fisher SG, Rodin M, Morrow GR, et al. Association of a cancer diagnosis with vulnerability and frailty in older Medicare beneficiaries. JNCI J Natl Cancer Inst. 2009;101:1206–15. https://doi.org/10.1093/jnci/djp239.CrossRefPubMed

Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol Off J Am Soc Clin Oncol. 2011;29:3457–65. https://doi.org/10.1200/JCO.2011.34.7625.CrossRef

•• Hurria A, Mohile S, Gajra A, Klepin H, Muss H, Chapman A, et al. Validation of a prediction tool for chemotherapy toxicity in older adults with cancer. J Clin Oncol. 2016;34:2366–71. https://doi.org/10.1200/JCO.2015.65.4327. Validated tool to predict chemotherapy toxicity in older patients with solid tumors CrossRefPubMedPubMedCentral

•• Mohile SG, Velarde C, Hurria A, Magnuson A, Lowenstein L, Pandya C, et al. Geriatric assessment-guided care processes for older adults: a Delphi consensus of geriatric oncology experts. J Natl Compr Cancer Netw JNCCN. 2015;13:1120–30. Geriatric oncology expert consensus in caring for older patients with cancer CrossRefPubMed

The frailty syndrome: definition and natural history. - PubMed - NCBI n.d. https://www.ncbi.nlm.nih.gov/pubmed/?term=The+frailty+syndrome%3A+definition+and+natural+history.+Clin+Geriatr+Med. Accessed 23 Apr 2017.

10.

Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56.CrossRefPubMed

11.

Accumulation of deficits as a proxy measure of aging. - PubMed - NCBI n.d. https://www.ncbi.nlm.nih.gov/pubmed/?term=3.%09Mitnitski+AB%2C+Mogilner+AJ%2C+Rockwood+K.+Accumulation+of+deficits+as+a+proxy+measure+of+aging. Accessed 23 Apr 2017.

12.

•• Cohen HJ, Smith D, Sun C-L, Tew W, Mohile SG, Owusu C, et al. Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy. Cancer. 2016;122:3865–72. https://doi.org/10.1002/cncr.30269. Frailty and pre-fraity as measured using a comprehensive geriatric assessment were associated with adverse outcomes in older cancer patients CrossRefPubMed

13.

Dyer C, Ostwald S. Ageing and health: managing co-morbidities and functional disability in older people. In: Stuart-Hamilton I, editor. An introduction to gerontology. Cambridge: Cambridge University Press; 2011. p. 87–125.CrossRef

14.

Gill TM, Gahbauer EA, Han L, Allore HG. Trajectories of disability in the last year of life. N Engl J Med. 2010;362:1173–80. https://doi.org/10.1056/NEJMoa0909087.CrossRefPubMedPubMedCentral

15.

Saliba D, Elliott M, Rubenstein LZ, Solomon DH, Young RT, Kamberg CJ, et al. The vulnerable elders survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc. 2001;49:1691–9. https://doi.org/10.1046/j.1532-5415.2001.49281.x.CrossRefPubMed

16.

• Handforth C, Clegg A, Young C, Simpkins S, Seymour MT, Selby PJ, et al. The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol Off J Eur Soc Med Oncol. 2015;26:1091–101. https://doi.org/10.1093/annonc/mdu540. Almost half of older cancer patients were frail and they were at increased risk of chemotherapy intolerance, postoperative complications and mortality CrossRef

17.

Aaldriks AA, van der Geest LGM, Giltay EJ, le Cessie S, Portielje JEA, Tanis BC, et al. Frailty and malnutrition predictive of mortality risk in older patients with advanced colorectal cancer receiving chemotherapy. J Geriatr Oncol. 2013;4:218–26. https://doi.org/10.1016/j.jgo.2013.04.001.CrossRefPubMed

18.

Clough-Gorr KM, Thwin SS, Stuck AE, Silliman RA. Examining five- and ten-year survival in older women with breast cancer using cancer-specific geriatric assessment. Eur J Cancer Oxf Engl 1990. 2012;48:805–12. https://doi.org/10.1016/j.ejca.2011.06.016.

19.

Kristjansson SR, Rønning B, Hurria A, Skovlund E, Jordhøy MS, Nesbakken A, et al. A comparison of two pre-operative frailty measures in older surgical cancer patients. J Geriatr Oncol. 2012;3:1–7. https://doi.org/10.1016/j.jgo.2011.09.002.CrossRef

20.

Neuman HB, Weiss JM, Leverson G, O’Connor ES, Greenblatt DY, LoConte NK, et al. Predictors of short-term post-operative survival after elective colectomy in colon cancer patients ≥80 years of age. Ann Surg Oncol. 2013;20:1427–35. https://doi.org/10.1245/s10434-012-2721-8.CrossRefPubMedPubMedCentral

21.

Tan K-Y, Kawamura YJ, Tokomitsu A, Tang T. Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Am J Surg. 2012;204:139–43. https://doi.org/10.1016/j.amjsurg.2011.08.012.CrossRefPubMed

22.

Courtney-Brooks M, Tellawi AR, Scalici J, Duska LR, Jazaeri AA, Modesitt SC, et al. Frailty: an outcome predictor for elderly gynecologic oncology patients. Gynecol Oncol. 2012;126:20–4. https://doi.org/10.1016/j.ygyno.2012.04.019.CrossRefPubMed

23.

• Assessment of older patients with cancer: Edmonton Frail Scale (EFS) as a predictor of adverse outcomes in older patients undergoing radiotherapy. PubMed J n.d. https://ncbi.nlm.nih.gov/labs/articles/28024799/. Accessed 23 Apr 2017. Fraity as assessed using the EFS was not associated with adverse outcome in older patients undergoing radiotherapy.

24.

Puts MTE, Monette J, Girre V, Pepe C, Monette M, Assouline S, et al. Are frailty markers useful for predicting treatment toxicity and mortality in older newly diagnosed cancer patients? Results from a prospective pilot study. Crit Rev Oncol Hematol. 2011;78:138–49. https://doi.org/10.1016/j.critrevonc.2010.04.003.CrossRefPubMed

25.

• Spyropoulou D, Pallis AG, Leotsinidis M, Kardamakis D. Completion of radiotherapy is associated with the Vulnerable Elders Survey-13 score in elderly patients with cancer. J Geriatr Oncol. 2014;5:20–5. https://doi.org/10.1016/j.jgo.2013.08.002. Patients who were frail as measured using the VES-13 had increased probability of not completing radiotherapy CrossRefPubMed

26.

Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, et al. Predicting the risk of chemotherapy toxicity in older patients: the chemotherapy risk assessment scale for high-age patients (CRASH) score. Cancer. 2012;118:3377–86. https://doi.org/10.1002/cncr.26646.CrossRefPubMed

27.

Hurria A, Lachs MS, Cohen HJ, Muss HB, Kornblith AB. Geriatric assessment for oncologists: rationale and future directions. Crit Rev Oncol Hematol. 2006;59:211–7. https://doi.org/10.1016/j.critrevonc.2006.03.007.CrossRefPubMed

28.

Hurria A, Gupta S, Zauderer M, Zuckerman EL, Cohen HJ, Muss H, et al. Developing a cancer-specific geriatric assessment: a feasibility study. Cancer. 2005;104:1998–2005. https://doi.org/10.1002/cncr.21422.CrossRefPubMed

29.

St John PD, Tyas SL, Menec V, Tate R. Multimorbidity, disability, and mortality in community-dwelling older adults. Can Fam Physician. 2014;60:e272–80.PubMedPubMedCentral

30.

The National Comprehensive Cancer Network®. 2015. Older adult oncology: NCCN Guidelines. [ONLINE] Available at: http://www.nccn.org/professionals/physician_gls/pdf/senior.pdf. Accessed 09 Jan 16. n.d.

31.

Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz J-P, Lichtman S, et al. Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol. 2005;55:241–52. https://doi.org/10.1016/j.critrevonc.2005.06.003.CrossRefPubMed

32.

Hurria A, Cirrincione CT, Muss HB, Kornblith AB, Barry W, Artz AS, et al. Implementing a geriatric assessment in cooperative group clinical cancer trials: CALGB 360401. J Clin Oncol. 2011;29:1290–6. https://doi.org/10.1200/JCO.2010.30.6985.CrossRefPubMedPubMedCentral

33.

Hamaker ME, Jonker JM, de Rooij SE, Vos AG, Smorenburg CH, van Munster BC. Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol. 2012;13:e437–44. https://doi.org/10.1016/S1470-2045(12)70259-0.CrossRefPubMed

34.

• Kim JW, Kim S-H, Kim YJ, Lee K-W, Kim K-I, Lee JS, et al. A novel geriatric screening tool in older patients with cancer: the Korean cancer study group geriatric score (KG)-7. PLoS One. 2015;10:e0138304. https://doi.org/10.1371/journal.pone.0138304. A screening tool developed for prediction of abnormal geriatric assessment results with a sensitivity of 95% and specificity of 59% CrossRefPubMedPubMedCentral

35.

Balducci L, Extermann M. Management of cancer in the older person: a practical approach. Oncologist. 2000;5:224–37.CrossRefPubMed

36.

Kenig J, Zychiewicz B, Olszewska U, Richter P. Screening for frailty among older patients with cancer that qualify for abdominal surgery. J Geriatr Oncol. 2015;6:52–9. https://doi.org/10.1016/j.jgo.2014.09.179. Geriatric 8 had the highest sensitivity and negative predictive value in predicting frailty CrossRefPubMed

37.

•• Smets IHGJ, Kempen GIJM, Janssen-Heijnen MLG, Deckx L, Buntinx FJVM, van den Akker M. Four screening instruments for frailty in older patients with and without cancer: a diagnostic study. BMC Geriatr. 2014;14:26. https://doi.org/10.1186/1471-2318-14-26. The sensitivity for predicting abnormal geriatric assessment was the highest for Geriatric 8 followed by the Groningen Frailty Indicator CrossRefPubMedPubMedCentral

38.

• Martinez-Tapia C, Canoui-Poitrine F, Bastuji-Garin S, Soubeyran P, Mathoulin-Pelissier S, Tournigand C, et al. Optimizing the G8 screening tool for older patients with cancer: diagnostic performance and validation of a six-item version. Oncologist. 2016; https://doi.org/10.1634/theoncologist.2015-0326. Optimized Geriatric 8 (G8) has better performance than the original G8

39.

• Kenis C, Decoster L, Van Puyvelde K, De Grève J, Conings G, Milisen K, et al. Performance of two geriatric screening tools in older patients with cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2014;32:19–26. https://doi.org/10.1200/JCO.2013.51.1345. Both the Geriatric 8 and Flemish version of the Triage Risk Screening Tool have good sensitivities in detecting abnormal GA results CrossRef

40.

Meldon SW, Mion LC, Palmer RM, Drew BL, Connor JT, Lewicki LJ, et al. A brief risk-stratification tool to predict repeat emergency department visits and hospitalizations in older patients discharged from the emergency department. Acad Emerg Med Off J Soc Acad Emerg Med. 2003;10:224–32.CrossRef

41.

Multidimensional structure of the Groningen Frailty Indicator in community-dwelling older people. - PubMed - NCBI n.d. https://www.ncbi.nlm.nih.gov/pubmed/23968433. Accessed 23 Apr 2017.

42.

Bellera CA, Rainfray M, Mathoulin-Pélissier S, Mertens C, Delva F, Fonck M, et al. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol Off J Eur Soc Med Oncol ESMO. 2012;23:2166–72. https://doi.org/10.1093/annonc/mdr587.CrossRef

43.

A brief clinical instrument to classify frailty in elderly people. - PubMed - NCBI n.d. https://www.ncbi.nlm.nih.gov/pubmed/?term=A+brief+clinical+instrument+to+classify+frailty+in+elderly+people. Accessed 23 Apr 2017.

44.

Barber JH, Wallis JB, McKeating E. A postal screening questionnaire in preventive geriatric care. J R Coll Gen Pract. 1980;30:49–51.PubMedPubMedCentral

45.

•• Soubeyran P, Bellera C, Goyard J, Heitz D, Curé H, Rousselot H, et al. Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study. PLoS One. 2014:9. https://doi.org/10.1371/journal.pone.0115060. The largest prospective study which showed G8 as the best screening tool

46.

Stokoe* JM, Pearce J, Sinha R, Ring A. G8 and VES-13 scores predict chemotherapy toxicity in older patients with cancer. J Geriatr Oncol. 2012;3:S81. https://doi.org/10.1016/j.jgo.2012.10.096.CrossRef

47.

• An introduction to a head and neck cancer-specific frailty index and its clinical implications in elderly patients: a prospective observational study focusing on respiratory and swallowing functions ... - PubMed - NCBI n.d. https://www.ncbi.nlm.nih.gov/pubmed/27368883. Accessed 24 Apr 2017. Cancer-specific frailty screening index for head and neck cancer.

48.

•• Decoster L, Van Puyvelde K, Mohile S, Wedding U, Basso U, Colloca G, et al. Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations. Ann Oncol. 2015;26:288–300. https://doi.org/10.1093/annonc/mdu210. A systematic review of all screening tools that can be used if a full geriatric assessment is not feasible CrossRefPubMed

49.

• Ferrat E, Paillaud E, Caillet P, Laurent M, Tournigand C, Lagrange J-L, et al. Performance of four frailty classifications in older patients with cancer: prospective elderly cancer patients cohort study. J Clin Oncol. 2017;35:766–77. https://doi.org/10.1200/JCO.2016.69.3143. All four frailty classifications provided good prognostic information, although the performance varied with various cancer subtypes CrossRefPubMed

50.

Ingram SS, Seo PH, Martell RE, Clipp EC, Doyle ME, Montana GS, et al. Comprehensive assessment of the elderly cancer patient: the feasibility of self-report methodology. J Clin Oncol Off J Am Soc Clin Oncol. 2002;20:770–5. https://doi.org/10.1200/JCO.2002.20.3.770.CrossRef

51.

Magnuson A, Dale W, Mohile S. Models of care in geriatric oncology. Curr Geriatr Rep. 2014;3:182–9. https://doi.org/10.1007/s13670-014-0095-4. A good review of geriatric oncology care models CrossRefPubMedPubMedCentral

Titel: Assessing Frailty and Vulnerability in Older Adults with Cancer
verfasst von: Kah Poh Loh
Sheryl Ramdass
Colin McHugh
Supriya G. Mohile
Ronald J. Maggiore
Publikationsdatum: 07.10.2017
Verlag: Springer US
Erschienen in: Current Geriatrics Reports / Ausgabe 4/2017
Elektronische ISSN: 2196-7865
DOI: https://doi.org/10.1007/s13670-017-0222-0

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

16.04.2024 | Chronische Herzinsuffizienz | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Assessing Frailty and Vulnerability in Older Adults with Cancer

Abstract

Purpose of Review

Recent Findings

Summary

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Sind Betablocker auch für ältere herzschwache Personen nützlich?

Kein Abstrich bei chronischen Wunden ohne Entzündungszeichen!

Manche Gestagene können das Risiko für Meningeome erhöhen

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Update Innere Medizin

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2017

Care of the Elderly Patient with Infective Endocarditis

Sarcopenia in Oncology or Gerontology: What Is the Difference?

Atherosclerotic Cardiovascular Disease in Older Adults

Comorbidity, Physical Function, and Quality of Life in Older Adults with Acute Myeloid Leukemia

Implantable Cardioverter-Defibrillator Implantation, Continuation, and Deactivation in Elderly Patients

Primary Endocrine Therapy in Older Women with Breast Cancer

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Sind Betablocker auch für ältere herzschwache Personen nützlich?

Kein Abstrich bei chronischen Wunden ohne Entzündungszeichen!

Manche Gestagene können das Risiko für Meningeome erhöhen

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Update Innere Medizin