Centre hospitalier de Nice, Nice, France
Rabia Boulahssass , Sebastien Gonfrier , Bereder Isabelle , Ludovic Evesque , Andre Gary , Jean Michel Hannoun Levi , Delphine Borchiellini , Patrice Brocker , Gerard Cavaglione , Emmanuel Barranger , Emmanuel Benizri Jr., Anne-Claire Frin , Anne Creisson , Thomas Kreitmann , jean-Louis Bernard Sr., Gilles Poissonnet , Jean Amiel , Joel Guigay , Eric Francois , Olivier Guerin
Background: Previous studies were shown that the CGA influence the therapeutic decision and help in the care plan.Aims of this study are :1) Determine the influence of the CGA for the therapeutic decision in elderly metastatic cancers (MC). 2) To determine the impact of the CGA on guided geriatric interventions in MC Methods: The PACA East cohort is a multicentric and prospective cohort study approved by an ethics committee. At the baseline, a standardized CGA was performed (MMSE,MNA,Grip strength, ADL, IADL ,CIRSg,Charlson,lee,PS,Gait speed, QLQc30,G8,Balducci). During the follow up from April 2012 to October 2014, treatments made and guided interventions were collected. We collected the final decision, the rate and the type of modification according to the CGA in MC and in non MC for making a comparison. Results: In the cohort 312 patients had a MC with a median age of 82y. The CGA influence the therapeutic decision in 28% in MC (n = 312) versus 20% (n = 736) in non MC (p = 0,004).The CGA modified the decision for best supportive care (BSC) for 10% (n = 106) in this cohort (n = 1048) and in 17% (n = 55/312) in MC versus 7%(n = 51/736) in non MC (p < 0,001). The dependence on ADL and IADL was more found in elderly patients with MC (p = 0,042 /p = 0,007) and they had more nursing interventions (p < 0,001). Patients with MC had a worse QoL (p < 0,001) , more depression (p = 0,012) , poor PS (p < 0,001) and they have more psychological interventions (p = 0,01) and more specialized pain evaluation (p = 0,007). The G8 and the nutritional status assessed by the MNA were worse for patients with MC (p < 0,001) and they had more nutritional interventions (p = 0,001).We observed no significant differences regarding gait speed, isolation, balducci score and cognitive function but also no difference on rate of physiotherapist interventions, of social interventions and on modification of care course for rehabilitation by the geriatric team between the 2 groups. Conclusions: Guided geriatric interventions seems to be correlated to deficits assessed by the geriatrian. This study confirms the importance of the CGA in the decision , but also in the global care plan in patients with MC.
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