Abstract P6-09-07: Impact of comprehensive geriatric assessment on treatment decision and follow-up in older breast cancer patients
Authors: Kenis C , Decoster L , Bode H , Bastin J , Lobelle J-P , Milisen K , van Puyvelde K , Paridaens R , Neven P , Fontaine C , de Grève J , Flamaing J , Wildiers H 
Published: August 2014

Abstract
Purpose: This study aims to investigate the impact of comprehensive Geriatric Assessment (CGA) on treatment decisions in a large cohort of older breast cancer patients. We also studied the functional evolution during treatment and the development of severe toxicity in patients receiving chemotherapy and we looked for predictive baseline markers of functional decline and toxicity.
Patients and methods: This study is part of a study on CGA in older cancer patients in 6 tumor types. We selected the breast cancer cohort for this presentation: 379 older breast cancer patients were recruited in 2 Belgian university hospitals. Patients aged 70 years or older with a newly diagnosed or progressive breast cancer for which treatment initiation or change was considered, were eligible. At baseline, an evaluation was performed of the oncological parameters as well as a CGA including geriatric screening with G8 and Flemish version of the TRST, pain, social situation, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), presence of falls, MNA, GDS-15, MOB-T for fatigue, MMSE, polypharmacy, and Charlson Comorbidity Index (CCI). CGA results were communicated to the treating physician and after treatment decision, the physician was interviewed by a trained healthcare worker using a predefined questionnaire focusing on unknown geriatric problems revealed by CGA, subsequent planning of geriatric interventions, and impact on treatment decision. At 2–3 months follow-up, functionality was reassessed and severe toxicity in patients receiving chemotherapy (n = 98) was recorded. Predictors for functional decline (ADL increase of ≥2 points and IADL decrease of ≥1 point compared to baseline) and severe haematological and non-haematological toxicity were identified by multivariate analysis.
Results: 79,2% of treating physicians were aware of CGA results at the time of treatment decision. CGA revealed unknown geriatric problems in 70,5% of cases, leading to geriatric intervention in 5,4% of patients. Treatment was adapted according to age and standard clinical approach (without CGA taken into account) in 41,1% of cases and CGA results led to an additional change of treatment decision in 5,4%. At follow-up, 47,9% of patients was dependent on at least one of the activities of ADL (compared to 54,1% at baseline) and 64,7% was dependent on at least one of IADL (compared to 58,1% at baseline). Functional decline at 2–3 months was predicted by baseline ADL, IADL and ECOG-PS, but no markers were found to predict chemotherapy toxicity (which occurred in 22/98 pts: 14 hematological toxicity gr III-IV, and 10 non-hematological toxicity gr III-IV)
Conclusion: CGA revealed unknown information in the majority (70.5%) of breast cancer patients but led to a geriatric intervention and a change in treatment decision in a minority of pts (both 5.4%). Baseline functionality measures (ADL, IADL, ECOG-PS) were found to be predictive for functional decline at 2–3 months, but predictors for severe chemotherapy toxicity could not be identified.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-09-07.