Impact of geriatric assessment and Geriatric 8-based targeted interventions on quality of life in older adults with cancer.

Abstract

Introduction: Both Geriatric-8 (G8) and geriatric assessment (GA) assess frailty and facilitate providing appropriate interventions as recommended by the International Society for Geriatric Oncology. The main objective of this study is to evaluate the impact of G8 and GA-based interventions on the quality of life (QOL) of older adults with cancer.

Materials and methods: This is a prospective study of patients with cancer aged ≥70 y. A G8, GA, and a European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was performed at study entry. Targeted interventions were offered. After three months, a follow-up EORTC QLQ-C30 was repeated for patients who required interventions. The study's primary outcome measure was a comparison of pre-and post-geriatric intervention EORTC QLQ-C30 scores.

Results: Two hundred thirty patients were accrued. Median age was 74 y (range:70-90). Based on the GA, 11 % were classified as frail, 58 % as pre-frail, and 31 % as fit. A total of 79 % had a G8 scores ≤14. Patients who were pre-frail, frail, and those with G8 ≤ 14 had lower baseline EORTC QLQ-C30 function scores and higher EORTC QLQ-C30 symptom scores (p < 0.05). They also had significantly shorter overall survival (OS) compared to fit patients or those with G8 > 14. (hazard ratio: 2.54 95 % CI 1.46-4.43, p = 0.001 for frail vs fit patients; 1.72 95 % CI 1.18-2.53, p = 0.005 for pre-frail vs fit patients; 1.51 95 % CI 1.05-2.18, p = 0.03 for G8 ≤ 14 vs >14). Geriatric oncology (GO) interventions were suggested for 144 patients with 104 patients completing a second EORTC QLQ-C30. These patients reported significant improvements in the EORTC emotional and social functioning domains (mean difference + 4.6, p < 0.001 and + 12.3 p < 0.001, respectively), a significant reduction in the EORTC symptom scale of pain, insomnia, constipation, and financial difficulties (mean difference - 5.8 p = 0.003, -8.3 p < 0.001, -9.0 p < 0.001, and - 6 p = 0.01), with no significant deterioration in other QOL domains.

Discussion: GA-based targeted interventions delivered by a multidisciplinary GO service improved multiple QOL domains in older adult patients undergoing cancer treatment.