Department of Medical Oncology, Tata Memorial Centre, Mumbai, India.
Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India.
Clin Oncol (R Coll Radiol). 2024 Jan;36(1):e61-e71. doi: 10.1016/j.clon.2023.11.003. Epub 2023 Nov 7.
Global guidelines recommend that all older patients with cancer receiving chemotherapy should undergo a geriatric assessment. However, utilisation of the geriatric assessment is often constrained by its time-intensive nature, which limits its adoption in settings with limited resources and high demand. There is a lack of evidence correlating the results of the geriatric assessment with survival from the Indian subcontinent. Therefore, the aims of the present study were to assess the impact of the geriatric assessment on survival in older Indian patients with cancer and to identify the factors associated with survival in these older patients.
This was an observational study, conducted in the geriatric oncology clinic of the Tata Memorial Hospital (Mumbai, India). Patients aged 60 years and older with cancer who underwent a geriatric assessment were enrolled. We assessed the non-oncological geriatric domains of function and falls, nutrition, comorbidities, cognition, psychology, social support and medications. Patients exhibiting impairment in two or more domains were classified as frail.
Between June 2018 and January 2022, we enrolled 897 patients. The median age was 69 (interquartile range 65-73) years. The common malignancies were lung (40.5%), oesophagus (31.9%) and genitourinary (12.1%); 54.6% had metastatic disease. Based on the results of the geriatric assessment, 767 (85.4%) patients were frail. The estimated median overall survival in fit patients was 24.3 (95% confidence interval 18.2-not reached) months, compared with 11.2 (10.1-12.8) months in frail patients (hazard ratio 0.54; 95% confidence interval 0.41-0.72, P < 0.001). This difference in overall survival remained significant after adjusting for age, sex, primary tumour and metastatic status (hazard ratio 0.56; 95% confidence interval 0.41-0.74, P < 0.001). In the patients with a performance status of 0 or 1 (n = 454), 365 (80.4%) were frail; the median overall survival in the performance status 0-1 group was 33.0 months (95% confidence interval 24.31-not reached) in the fit group versus 14.4 months (95% confidence interval 12.25-18.73) in the frail patients (hazard ratio 0.50; 95% confidence interval 0.34-0.74, P = 0.001). In the multivariate analysis, the geriatric assessment domains that were predictive of survival were function (hazard ratio 0.68; 95% confidence interval 0.52-0.88; P = 0.003), nutrition (hazard ratio 0.64; 95% confidence interval 0.48-0.85, P = 0.002) and cognition (hazard ratio 0.67; 95% confidence interval 0.49-0.91, P = 0.011).
The geriatric assessment is a powerful prognostic tool for survival among older Indian patients with cancer. The geriatric assessment is prognostic even in the cohort of patients thought to be the fittest, i.e. performance status 0 and 1. Our study re-emphasises the critical importance of the geriatric assessment in all older patients planned for cancer-directed therapy.
全球指南建议所有接受化疗的老年癌症患者都应进行老年评估。然而，由于其时间密集型的性质，其在资源有限且需求高的环境中的应用受到限制。缺乏将老年评估的结果与来自印度次大陆的生存相关联的证据。因此，本研究的目的是评估老年评估对老年印度癌症患者生存的影响，并确定与这些老年患者生存相关的因素。
这是一项观察性研究，在印度孟买塔塔纪念医院（Tata Memorial Hospital）的老年肿瘤学诊所进行。纳入接受老年评估的年龄在 60 岁及以上的癌症患者。我们评估了非肿瘤学的老年功能和跌倒、营养、合并症、认知、心理、社会支持和药物使用等领域。表现出两个或更多领域受损的患者被归类为虚弱。
2018 年 6 月至 2022 年 1 月期间，我们共纳入了 897 名患者。中位年龄为 69 岁（四分位距 65-73 岁）。常见的恶性肿瘤为肺癌（40.5%）、食管癌（31.9%）和泌尿生殖系统肿瘤（12.1%）；54.6%的患者有转移性疾病。根据老年评估的结果，767 名（85.4%）患者为虚弱。功能良好的患者估计中位总生存期为 24.3 个月（95%置信区间为 18.2-未达到），而虚弱患者为 11.2 个月（10.1-12.8 个月）（风险比 0.54；95%置信区间 0.41-0.72，P<0.001）。在功能状态为 0 或 1 的患者（n=454）中，365 名（80.4%）为虚弱；功能状态 0-1 组的中位总生存期在功能状态良好的患者中为 33.0 个月（95%置信区间为 24.31-未达到），而在虚弱患者中为 14.4 个月（95%置信区间为 12.25-18.73）（风险比 0.50；95%置信区间 0.34-0.74，P=0.001）。在多变量分析中，预测生存的老年评估领域是功能（风险比 0.68；95%置信区间 0.52-0.88；P=0.003）、营养（风险比 0.64；95%置信区间 0.48-0.85，P=0.002）和认知（风险比 0.67；95%置信区间 0.49-0.91，P=0.011）。
老年评估是印度老年癌症患者生存的有力预后工具。即使在被认为是最健康的患者（即功能状态 0 和 1）队列中，老年评估也是预后因素。我们的研究再次强调了在所有计划接受癌症治疗的老年患者中进行老年评估的重要性。
