Demographic stratification, evaluation of symptoms burden on basis of gender, and implications of G8 questionnaires in elderly patients with cancer in Bangladesh.
Authors: Islam Muhammad Rafiqul , Siddiqua Syeda Masuma , Islam Rashedul , Hossain Anwar , Saha Beauty , Sultana Sharmin , Khatun Nazrina 
Published: June 2023

12060

Background: Geriatric oncology is a new concept worldwide, as well as in Bangladesh. Presently, there is a scarcity of data regarding the geriatric perspective of malignant patients in Bangladesh. Our study investigated the demographic differentiation, evaluation of symptoms burden on the basis of gender, and implications of the G8 questionaries in elderly cancer patients from a tertiary cancer care center in Bangladesh. This will help physicians to understand cancer in the elderly better, integrate their biological and epidemiological characteristics, and promote a longer life expectancy without compromising their quality of life in resource-constrained regions. Methods: This study included all the newly diagnosed and histologically confirmed primary solid tumors among age ≥60 years at the National Institute of Cancer Research & Hospital (NICRH), a tertiary care center in Bangladesh, during the year 2019 and 2020. For all statistical analyses, P<0.05 was considered significant. Results: Of 8057 solid tumor patients, 2823 were geriatric patients (35.04%). Male dominant patients' mean BMI was 20.23 ±SD 4.26 and 35.4% were malnourished. The low SES was 63.7%i and 68.5% of patients were illiterate. Pain was the most common symptom (37.44%), followed by GI symptoms (31.77%), whereas 33.1% suffered from more than one symptom. in the disease distribution, lung cancer was 52.4% irrespective of sex, followed by GIT 17% and HBS cancer 10%. Breast 24.58% and GIT 17.77% were the second most common malignancy in females and males, respectively. Among them, 22.1% of patients were metastatic at presentation and 25% had a comorbid condition. About 17.4% of patients were completely disabled. Low BMI with high ECOG status had more symptoms (p=.004). Gender, nutrition and socioeconomic condition strongly correlated with the patient's functional status and symptomatic presentation. Females were more comorbid with symptomatic metastases at presentation (p=0.020), and males presented with late-stage cancer (p=0.002). Compared to male elderly patients, female elderly patients suffered more from malnutrition and obesity (p=<.000). Polypharmacy rates for elderly males were lower than those for elderly females (p=0.000). Food intake behavior, weight loss, mobility, and health-related perception did not differ based on gender during or after treatment. Based on G8 scoring, we found that 12.3% were in the worse group, 70.2% in the intermediate group and the good group contained 17.5%. According to the cut-off value (≤11), 71.9% of patients needed the CGA evaluation. Conclusions: A high number of elder patients with multiple symptoms makes comprehensive management more challenging. A frail elderly patient's gender, SES, education, disease type, and stage along with performance status at the time of presentation of their disease are important prognostic factors.