Annexe Building, Mumbai, India
Abhijith Rajaram Rao , Anant Ramaswamy , Sharath Kumar Sr., Shreya Gattani , Ratan Dhekale , Jyoti Krishnamurthy , Sarika Mahajan , Anuradha Daptardar , Jayita Deodhar , Manjunath Nookala , Supriya Goud , Sucheta More , Dipti Nakti , Chetan Mudliya , Nandini Sharrel Menon , Vijay Maruti Patil , Vikram Gota , Shripad Dinanath Banavali , Kumar Prabhash , Vanita Noronha
Background: ASCO guidelines recommend that geriatric assessment (GA) should be performed in all older adults with cancer. However, GA is labor- and time-intensive, hence the uptake is poor, especially in crowded resource poor-settings. There are no data correlating GA with overall survival (OS) outcomes from the Indian subcontinent. Methods: A prospective observational study in the geriatric oncology clinic of the Tata Memorial Hospital in Mumbai, India. Patients aged 60 years and above, with cancer who underwent a GA were enrolled. The domains assessed included: function (basic and instrumental activities of daily living, timed-up-and-go), nutrition (body mass index, unintentional weight loss, mini-nutritional assessment), comorbidities, cognition, psychological (depression, anxiety), social support, and medication (polypharmacy and potentially inappropriate medications). Patients with > 2 deranged GA domains were considered frail. Results: Between June 2018 and January 2022, 909 patients were enrolled. The median age was 69 (IQR, 60-88) years. Common malignancies included lung (40%), esophagus (21%) and head and neck (11%); 53% had metastatic disease. 80% had > 2 impaired domains in GA patients had vulnerabilities in a median of 3 (IQR, 0-5) domains. Median OS in fit patients based on the GA was 17.5 (95% CI, 13.9-21.0) months vs 12.1 (95% CI, 10.1-14.0) months in frail patients, (HR 0.66; 95% CI, 0.49-0.88, p = 0.005), which remained significant after adjusting for age, sex, and stage (HR, 0.71; 95% CI: 0.53-0.94, p = 0.021). In the multivariate analysis (Table), the domains that were predictive of survival were nutrition (HR: 0.65, 95% CI: 0.47-0.92, p = 0.014), cognition (HR: 0.65; 95% CI: 0.46-0.91, p = 0.012) and fatigue (HR: 0.74, 95% CI: 0.56-0.98, p = 0.038). Conclusions: In older Indian patients with cancer, GA is a powerful prognosticator of survival. In settings where a complete GA is not possible, nutrition, cognition, and fatigue should be the minimum domains assessed. Clinical trial information: CTRI/2020/04/024675.
Domains assessed in the GA (n = 909) | Overall Survival in months | Multivariate | ||
---|---|---|---|---|
Median (95% CI) | HR | 95% CI | ||
Function | Normal | 14.2 (12.8-17.4) | 0.83 | 0.63-1.10 |
Abnormal | 9.3 (8.1-12.8) | |||
Falls | Normal | 12.9 (10.6-16.6) | 1.38 | 0.89-2.16 |
Abnormal | 14.1 (9.3-16.9) | |||
Nutrition | Normal | 17.5 (13.9-24.3) | 0.65 | 0.47-0.92 |
Abnormal | 10.2 (8.7-13.0) | |||
Comorbidities | Normal | 12.9 (10.2-17.1) | 0.97 | 0.73-1.29 |
Abnormal | 13.6 (10.7-16.9) | |||
Cognition | Normal | 14.5 (12.9-17.3) | 0.65 | 0.46-0.91 |
Abnormal | 8.7 (5.5-12.6) | |||
Psychological | Normal | 13.4 (10.3-17.3) | 0.99 | 0.69-1.40 |
Abnormal | 12.1 (6.1-18.0) | |||
Fatigue | Normal | 16.8 (12.1-18.0) | 0.74 | 0.56-0.98 |
Abnormal | 9.7 (7.5-14.5) | |||
Medications | Normal | 16.6 (10.7-15.7) | 1.00 | 0.74-1.35 |
Abnormal | 12.9 (5.1-16.8) | |||
Social Support | Normal | 13.2 (10.7-15.7) | 0.89 | 0.45-1.76 |
Abnormal | 10.9 (5.1-16.8) |
HR: hazard ratio; CI: confidence interval
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