Comprehensive,Geriatric,Assessment, - PowerPoint PPT Presentation

Comprehensive,Geriatric,Assessment, Achieving)pa,ent.centered)cancer)care ) Pierre,Soubeyran, Medical)Oncology,)Bordeaux,)France) 1"

Health,status9adapted,cancer,care, Balance)of)risks)and)benefits) • Benefits,iden=cal,whatever,age, – Response)to)treatment)and)disease)control) – Quality)of)life)improvement) • Risks,higher,in,the,elderly, • Heterogeneity,of,problems,encountered, – Age.related)physiological)problems) – Elderly.specific)problems)at)baseline)) • cogni(on,"nutri(on,"func(onal"impairment,"social"problems,"…" – Elderly.specific)outcome)during)treatment)) • confusion,"loss"of"weight,"func(onal"decline,"…" 2"

How,to,design,treatment,, with,appropriate,, efficacy,/,toxicity,ra=o,?, 3"

In9depth,evalua=on,of,health,status, • Standard,evalua=on, – Performance)status) – Organ)func,on) • Crea(nine"clearance" • Liver"tests…" – Nutri,onal)status) • Weight,"albumin…" • Geriatric,assessment, – Designed)for)the)oldest) – To)be)implemented)in)oncology) 4"

Which,tools,to,be,used,?, • Domains,to,be,explored, – Comorbidi,es:) )CIRS.G) – Cogni,on:) )MMSE) – Nutri,on:) )weight,)albumin,)MNA) – Dependencies:) )BADL,)IADL) – Mood:) )GDS) – Falls: )Timed)Get)up)and)go) – Geriatric)syndroms) 5"

Which,tools,to,be,used,?, • Domains,to,be,explored, – Comorbidi,es:) )CIRS.G) – Cogni,on:) )MMSE) – Nutri,on:) )weight,)albumin,)MNA) – Dependencies:) )BADL,)IADL) – Mood:) )GDS) – Falls: )Timed)Get)up)and)go) – Geriatric)syndroms) To,which,purpose,?, 6"

Which,events,to,predict,?, 364 patients Early death < 6 m. Functional Hospitalization decline for toxicity Odd ratio (95% CI) Odd ratio (95% CI) Odd ratio (95% CI) 50 /299 Events 59 /339 47 /354 Extension (M+ vs M-) 4.1 (1.65-10.1) Sex 2.62 (1.31-5.28) Platelet count <150 G/l 3.8 (1,3-10,8) Clinician opinion ns 0.51 (0,26-0,99) PS ns ns MNA ≤, 23.5 2.91 (1.31-56.48) ns 4.19 (1,7-10,3) Get up and go > 20 s 2.51 (1,31-4,82) ns IADL ≤)7 ns 3 (1,13-8,09) GDS15 ≥ 6 2.4 (1,23-4,66) MMS ns ns ADL ns CIRS-G Soubeyran)JCO)2012) Soubeyran)ASCO2012) Warkus)SIOG2011) 7"

Predic=on,of,toxicity, Martine Extermann, Cancer 2012;118:3377-86 Arti Hurria, J Clin Oncol 2011;29:3457-65 8"

Predic=on,of,toxicity, Martine Extermann, Cancer 2012;118:3377-86 Geriatric,assessment,tools, can,be,useful,to,manage, Arti Hurria, J Clin Oncol 2011;29:3457-65 elderly,pa=ents, 9"

CGA,is,=me9consuming,:,screening,tools, 10"

CGA,is,=me9consuming,:,screening,tools, Gold,standard:, Impaired,Mul=dimensional,Geriatric,Assessment,(MGA) , Impaired,MGA,if,, ≥,one,abnormal,ques=onnaire, – CIRS.G):) )at)least)one)grade) ≥ ) 3) – ADL):) )score)≤) 5) – IADL):) )score)≤) 7) – Timed)Get)up)and)Go):) )>)20) s) – MNA):) )score)≤) 23,5) SeMng:, Pa=ents,>70,with,cancer , – MMSE):) )score)≤) 23) – GDS.15):) )score) ≥ ) 11" 6)

CGA,is,=me9consuming,:,screening,tools, Gold,standard:, Impaired,Mul=dimensional,Geriatric,Assessment,(MGA) , Impaired,MGA,if,, ≥,one,abnormal,ques=onnaire, – CIRS.G):) )at)least)one)grade) ≥ ) Time 3) Se Sp PPV NPV K (mn) – ADL):) )score)≤) 5) 76.6% 64.4% 89.6% 40.7% G8 0.65 4.4 +/- 2.9 – IADL):) )score)≤) (74-79) (58.6-70) (87.6-91.5) (36.1-45.4) 7) 68.7% 74.3% 91.5% 37.1% VES13 – Timed)Get)up)and)Go):) 0.64 4.3 +/- 4.6 )>)20) (65.9-71.4) (68.8-79.3) (89.4-93.3) (33.2-41.3) s) – MNA):) )score)≤) 23,5) SeMng:, Pa=ents,>70,with,cancer , – MMSE):) )score)≤) 23) – GDS.15):) )score) ≥ ) 12" 6)

CGA,is,=me9consuming,:,screening,tools, Gold,standard:, Impaired,Mul=dimensional,Geriatric,Assessment,(MGA) , Impaired,MGA,if,, ≥,one,abnormal,ques=onnaire, – CIRS.G):) )at)least)one)grade) ≥ ) Time 3) Se Sp PPV NPV K (mn) – ADL):) )score)≤) 5) 76.6% 64.4% 89.6% 40.7% G8 0.65 4.4 +/- 2.9 – IADL):) )score)≤) (74-79) (58.6-70) (87.6-91.5) (36.1-45.4) 7) 68.7% 74.3% 91.5% 37.1% VES13 – Timed)Get)up)and)Go):) 0.64 4.3 +/- 4.6 )>)20) (65.9-71.4) (68.8-79.3) (89.4-93.3) (33.2-41.3) s) – MNA):) )score)≤) CGA,is,useful, 23,5) And,screening,of,feasible, SeMng:, Pa=ents,>70,with,cancer , – MMSE):) )score)≤) 23) – GDS.15):) )score) ≥ ) 13" 6)

How,to,organize,?, Management >14 G8 Screening Standard ≤ 14 Evaluation and cautious management 14"

How,to,organize,?, Management >14 G8 Screening Standard ≤ 14 Selection procedure MGA ? CGA ? Other ? Cautious Management Oncologist + Geriatrician 15"

How,to,organize,?, The)French)UCOG)model ) ,,,, CHU,HEGP/,CLCC,I,Curie, CHU,La,Pi=é/C,Foix, CHU,H,Mondor , , • Geriatric,Oncology,Coordina=ng,Units, Lille, , CHU/CLCC, , , CH,Senlis/Creil, , – 15)already)created)since)2006) CHU/ , Str CLCC, Rouen, CHU – A)few)more)to)be)accredited)soon) , Nantes/Angers, CHU/CLCC, , CH,La,Roche/Yon, Dijon, CHU/CLCC/ , CH/, • Main,goals,of,the,UCOG,in,each,region, CHU/CLCC/CH,, Cl,Privées, Clermont, Ferrand, , , Limoges, Lyon, CHU/Cl., CHU/CLCC/Cl, , Privées, Privées, Bordeaux, – Organize)cancer)care)for)older)pa,ents) CHU/CLCC, , Marseille, , Toulouse, CLCC/CDG,, – Par,cipate)to)teaching)and)training) CHU/CLCC, – Perform)research)in)the)geriatric)oncology)field) – Inform)pa,ents)and)public) 16"

How,to,organize,?, Other)proposals ) Diffuse,large,B9cell,lymphomas, Age,,CIRS9G,,ADL, CIRS9G,,ADL,,IADL, Geriatric,syndromes, Classify, Classify, Unfit, Unfit, Frail, Fit, Fit, Hide,the,results, Use,the,results,to,adapt,chemo,, And,observe,84,,cases, And,treat,100,cases, Geriatric,assessments,superior, Geriatric,assessments,may,, To,clinical,judgment,, help,treatment,planning, Alessandra'Tucci,'Cancer'2009' Michele'Spina,'The'Oncologist'2012 " Pascal'Chaibi,'CROH'2010' Any,cancer, Philippe'Caillet'J'Clin'Oncol'2011' 17"

What,to,do,with,the,results,?, • Geriatric,interven=on, – Laurence)Rubenstein,)N)Engl)J)Med)1984) • 123"frail"elderly"inpa(ents,"78"y"median"age" • Randomized"controlled"trial" • Geriatric"evalua(on"unit" • Reduced"mortality"at"1"y:"48.3%"to"23.8%" – Ruth)McCorkle,)JAGS)2000) • 375"postMsurgical"cancer"pa(ents,"60"to"92" • Randomized"controlled"interven(on"study" • Home"care"interven(on"by"advanced"prac(ce"nurses" • NonMstra(fied"analysis"not"significant" • Risk"of"death"decreased"in"the"interven(on"group" – ASer"adjus(ng"for"stage"and"length"of"stay" 18"

Conclusion, • S=ll,a,lot,to,do,!, • SIOG,CGA,Task,Force,2012, – Screening)tools) – CGA)in)geriatric)oncology) – Geriatric)interven,on) – Frailty) 19"