BACKGROUND: Mortality prediction is crucial to select the optimal treatment in elderly cancer patients.
Our objective was to identify cancer-related factors and Comprehensive Geriatric Assessment (CGA) findings associated with 1-year mortality in elderly inpatients and outpatients with cancer.
METHODS: We prospectively included patients aged ≥70 years who had solid or hematologic malignancies and in whom the CGA was performed by geriatricians in two French teaching hospitals. We identified independent predictors of 1-year mortality after study inclusion, using multivariate Cox models stratified on inpatient/outpatient status. We built three multivariate Cox models, since strong correlations linked activities of daily living (ADL), Eastern Cooperative Oncology Group Performance Status (ECOG-PS), and timed get-up-and-go test (GUG) results; and since physicians' preferences for these three assessments vary. A sensitivity analysis was performed using multiple imputation.
RESULTS: Of the 993 patients (mean age, 80.2 years; 51.2% men), 58.2% were outpatients and 46% had metastatic disease. Colorectal cancer was the most common malignancy (21.4%). Mortality rates after 6 and 12 months were 30.1% and 41.2%, respectively. In all models, tumor site and metastatic status (p < .001), age >80 years (p < .05), higher number of severe comorbidities (p < .05), and malnutrition (p < .001) were associated with death independently from impaired ECOG-PS (p < .001), ADL (p < .001), and GUG (p < .001). The adverse effect of metastatic status differed significantly across tumor sites, being greatest for breast and prostate cancer (p < .001). Multiple imputation produced similar results.
CONCLUSION: The predictors of 1-year mortality identified in our study may help physicians select the optimal cancer-treatment strategy in elderly patients.
Ferrat E, Paillaud E, Laurent M, Le Thuaut A, Caillet P, Tournigand C, Lagrange JL, Canouï-Poitrine F, Bastuji-Garin S. Are you the author?
Université Paris Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA 4393, UPEC, F-94010, Créteil, France; Primary Care Department, School of Medicine, Paris East Créteil University (UPEC), France; Geriatric Oncology Coordination Unit (UCOG); Public Health Department, Clinical Research Unit (URC Mondor); Medical Oncology Department; Radiotherapy Department, Henri-Mondor Teaching Hospital, APHP, Créteil, France.
Reference: J Gerontol A Biol Sci Med Sci. 2015 Apr 1. pii: glv025.