Physicians' judgement and comprehensive geriatric assessment (CGA) select different patients as fit for chemotherapy

Crit Rev Oncol Hematol. 2007 Oct;64(1):1-9. doi: 10.1016/j.critrevonc.2007.05.001. Epub 2007 Jul 5.

Abstract

Introduction: Elderly cancer patients are a very heterogeneous population. A comprehensive geriatric assessment (CGA) shall help to identify more precisely those patients who are fit, compared to those who are vulnerable or frail, when deciding on chemotherapeutical treatment.

Methods: In a prospective trial, 200 cancer patients treated in an out-patient setting were judged by their physician for their fitness for chemotherapy as fit, vulnerable or frail. A CGA was performed thereafter. We determined the feasibility of a CGA in an out-patient setting and the frequency of changes within the different assessment tools and compared physicians' judgement with the CGA results.

Results: Physicians judged 64.3% of their patients as fit, 32.4% as vulnerable, and 3.2% as frail. A CGA was completed by 97.5% of patients and lasted 20min per patients (range: 9-47min). 26.5% of all patients had no deficits in the CGA. The CGA identified a mean of 1.7 problems per patient, 1.3 in patients judged as fit, 2.3 in those judged as vulnerable, and 4.2 in those judged as frail. A CGA is more sensitive in classifying patients as fit compared to vulnerable or frail than physicians' judgement.

Conclusion: A CGA is feasible and detects more elderly cancer patients as being unfit for chemotherapy than physicians' judgement. Further trials including disease and treatment related end-points are needed.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use*
  • Feasibility Studies
  • Frail Elderly
  • Geriatric Assessment / methods*
  • Humans
  • Judgment*
  • Neoplasms / drug therapy
  • Patient Selection*
  • Physicians

Substances

  • Antineoplastic Agents