Implications of comprehensive geriatric assessment on quality of life in older adults with cancer: an integrative review

Sgnaolin, Valéria; Sgnaolin, Vanessa; Schneider, Rodolfo Herberto

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Revista Brasileira de Geriatria e Gerontologia

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Review Articles • Rev. bras. geriatr. gerontol. 24 (1) • 2021 • https://doi.org/10.1590/1981-22562021024.200297 copy

Implications of comprehensive geriatric assessment on quality of life in older adults with cancer: an integrative review

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Abstract

Comprehensive geriatric assessment (CGA) improves the quality of care for older adults with cancer, as it identifies geriatric problems and weaknesses that have implications for the health of the individual. Despite the benefits of CGA, difficulties related to time of application and cost of this tool limit its implementation in practice. The purpose of this review is to evaluate the relationship between CGA and the quality of life (QoL) of older adults with cancer, through an integrative review. A search was performed for articles in the PubMed, Medline, IBECS and Lilacs databases, published between 2015 and 2020, that addressed the implications of CGA on the QoL of older adults with cancer and, of the 298 studies found, 21 were selected for analysis. These studies revealed that CGA performs an important role in identifying older adults with a higher risk of QoL impairment during the course of cancer and cancer treatment, as well as guiding the indication of specific geriatric interventions that prevent the deterioration of QoL. Thus, the present review highlights the importance of the broad assessment of older adults with cancer, which, through different spheres, whether prognostic or interventionist, can play a fundamental role in preserving the QoL of this population. It is imperative that strategies are developed that incorporate CGA in the care of older adults with cancer.

Keywords
Geriatric Assessment; Neoplasms; Quality of Life

Authors Year/Country	Sample	Method/Objective	Instrument	Conclusions	Report of CGA and QoL
Pottel et al.²¹21 Pottel L, Lycke M, Boterberg T, Pottel H, Goethals L, Duprez F, et al. G-8 indicates overall and quality-adjusted survival in older head and neck cancer patients treated with curative radiochemotherapy. BMC Cancer. 2015;15:875. 2015 / Belgium	≥65 years, head and neck neoplasms, submitted to radiotherapy / N = 100	Cohort / Determine if CGA is indicative of long-term health-related QoL and overall survival	EQ-5D	Vulnerable patients had lower long-term health-related QoL levels	CGA was a predictor of QoL
Baier et al.²²22 Baier P, Ihorst G, Wolff-Vorbeck G, Hüll M, Hopt U, Deschler B. Independence and health related quality of life in 200 onco-geriatric surgical patients within 6 months of follow-up: Who is at risk to lose? Eur J Surg Oncol. 2016;42(12):1890-7. 2016 / Germany	> 70 years old, any neoplasia, submitted to surgery with curative intention / N = 200	Cohort / Assess the prognostic impact of CGA on independence and QoL six months after surgery	EORTC QLQ-C30	QoL correlated with Karnofsky index, emotional functioning and activities of daily living	CGA was a predictor of QoL
Hempenius et al.²³23 Hempenius L, Slaets JPJ, van Asselt D, de Bock TH, Wiggers T, van Leeuwen BL. Long Term Outcomes of a Geriatric Liaison Intervention in Frail Elderly Cancer Patients. PLoS ONE. 2016;11(2):e0143364. 2016 / Netherlands	≥65 years old, any neoplasm, submitted to elective surgery / N = 260	Clinical trial / Assess the long-term outcomes of a geriatric intervention for the prevention of delirium in frail older adults	Short Form-36 score	There were no differences between the intervention group and the usual treatment group for any of the outcomes three months after discharge.	Geriatric intervention based on CGA findings did not improve QoL
Pergolotti et al.²⁴24 Pergolotti M, Deal AM, Williams GR, Bryant AL, Bensen JT, Muss HB, et al. Activities, function, and health-related quality of life (HRQOL) of older adults with cancer. J Geriatr Oncol. 2017;8(4):249-54. 2017 / USA	≥65 years, any neoplasm / N = 768	Cohort / Describe functional status and QoL and identify associations with demographic variables, comorbidities and functional status	FACT-G	The presence of comorbidities and reduced levels of activity / functional capacity were associated with worse levels of QoL	CGA was a predictor of QoL
Ribi et al.²⁵25 Ribi K, Rondeau S, Hitz F, Mey U, Enoiu M, Pabst T, et al. Cancer-specific geriatric assessment and quality of life: important factors in caring for older patients with aggressive B-cell lymphoma. Support Care Cancer. 2017;25(9):2833-42. 2017 / Switzerland	B-cell lymphoma not eligible for intensive treatment / N = 57	Clinical trial / Characterize the patients by objective response and survival based on CGA and QoL and describe QoL changes after treatment	Domains assessed: physical well-being, mood, coping, functional status, tiredness, nausea/vomiting and taste disorders	CGA impairment is an important factor in clinical outcomes and interventions in specific geriatric domains translate into improved QoL	CGA was a predictor of QoL
Schmidt et al.²⁶26 Schmidt H, Boese S, Lampe K, Jordan K, Fiedler E, Müller-Werdan U, et al. Trans sectoral care of geriatric cancer patients based on comprehensive geriatric assessment and patient-reported quality of life - Results of a multicenter study to develop and pilot test a patient-centered interdisciplinary care concept for geriatric oncology patients (PIVOG). J Geriatr Onco.l 2017;8(4):262-70. 2017 / Germany	≥70 years, any neoplasm / N = 100	Clinical trial / Assess the impact of an CGA-based intervention program on QL preservation	EORTC QLQ-C30	Geriatric intervention demonstrated benefit in preserving QoL	Geriatric intervention based on CGA findings helps to preserve QoL
VanderWalde et al.²⁷27 VanderWalde NA, Deal AM, Comitz E, Stravers L, Muss H, Reeve BB, et al. Geriatric assessment as a predictor of tolerance, quality of life, and outcomes in older patients with head and Neck Cancers and Lung Cancers receiving radiation therapy. Int J Radiat Oncol Biol Phys. 2017;98(4):850-7. 2017 / USA	≥65 years, head and neck or lung cancer undergoing radiotherapy / N = 50	Cohort / Assess the association between functional status based on CGA and treatment tolerance results	EORTC QLQ-C30	There was no association between dysfunction and tolerance, but altered CGA was associated with continuous decline and lack of recovery of QoL	CGA was a predictor of QoL
Goineau et al.²⁸28 Goineau A, Campion L, d’Aillières B, Vié B, Ghesquière A, Béra G, et al. Comprehensive Geriatric Assessment and quality of life after localized prostate cancer radiotherapy in elderly patients. PLoS ONE. 2018;13(4):e0194173. 2018 / France	≥75 years old, prostate cancer, submitted to radiotherapy / N = 100	Cohort / Assess the effect of radiotherapy on QoL and identify predictors of QoL reduction	EORTC QLQ-C30	Radiotherapy for prostate cancer was well tolerated among this population and no predictive factor was found to determine which patients would have impaired QoL after radiotherapy	CGA was a predictor of QoL
Phaibulvatanapong et al.²⁹29 Phaibulvatanapong E, Srinonprasert V, Ithimakin S. Risk factors for chemotherapy-related toxicity and adverse events in elderly thai cancer patients: a prospective study. Oncology. 2018;94(3):149-60. 2018 / Thailand	≥70 years old, any neoplasm under systemic treatment / N = 151	Cohort / Assess factors that predispose individual to chemotherapy-related toxicity and QoL	FACT-G	Performance status and the presence of comorbidities were associated with a higher incidence of serious adverse events and worse QoL	CGA was a predictor of QoL
Puts et al.³⁰30 Puts MTE, Sattar S, Kulik M, MacDonald ME, McWatters K, Lee K, et al. A randomized phase II trial of geriatric assessment and management for older cancer patients. Support Care Cancer. 2018;26(1):109-17. 2018 / Canada	≥70 years old, gastrointestinal, genitourinary or EC II-IV breast cancer, before start of chemotherapy / N = 61	Clinical trial / Explore the feasibility and impact of CGA and an integrated care plan on QoL and cancer treatment decisions	EORTC QLQ-C30	Patients who received CGA-based support had better QoL levels	Geriatric intervention based on CGA findings helps to preserve QoL
Jeppesen et al.³¹31 Jeppesen SS, Matzen LE, Brink C, Bliucukiene R, Kasch S, Schytte T, et al. Impact of comprehensive geriatric assessment on quality of life, overall survival, and unplanned admission in patients with non-small cell lung cancer treated with stereotactic body radiotherapy. J Geriatr Oncol. 2018;9(6):575-82. 2018 / Denmark	Lung neoplasm T1-2N0M0, not candidates for surgical treatment / N = 51	Clinical trial / Investigate whether CGA as part of an interventionist tool can impact QoL and overall survival	EQ-5D	CGA did not impact QoL and overall survival in this population	Geriatric intervention based on CGA findings did not improve QoL
Kirkhus et al.¹⁴14 Kirkhus L, Harneshaug M, Benth LS, Gronberg BH, Rostoft S, Bergh S, et al. Modifiable factors affecting older patients’ quality of life and physical function during cancer treatment. J Geriatr Oncol. 2019;10(6):904-12. 2019 / Norway	≥70 years old, any neoplasm under systemic treatment / N = 288	Cohort / Identify potentially modifiable factors that affect physical function and QoL during cancer treatment	EORTC QLQ-C30	Depressive symptoms, reduced mobility and physical symptoms increased the risk of decreases in QoL scores	CGA was a predictor of QoL
Kirkhus et al. ³²32 Kirkhus L, Benth JS, Gronberg BH, Hjermstad MJ, Rostoft S, Harneshaug M, et al. Frailty identified by geriatric assessment is associated with poor functioning, high symptom burden and increased risk of physical decline in older cancer patients: Prospective observational study. Palliat Med. 2019;33(3):312-22. 2019 / Norway	≥70 years, any neoplasia / N = 288	Cohort / Investigate whether the frailty identified by an CGA was associated with an increased risk of QoL deterioration during cancer treatment and follow-up	EORTC QLQ-C30	Frail patients had significantly worse physical functioning and QoL during follow-up	CGA was a predictor of QoL
Mohile et al.³3 Mohile SG, Dale W, Somerfield MR, Schonberg MA, Boyd CM, Burhenn PS, et al. Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol. 2018;36(22):2326-47. 2019 / USA	≥70 years old, any neoplasm, impaired CGA domain / N = 541	Clinical trial / Determine whether providing CGA-guided recommendations to oncologists can improve communication about aging-related concerns	FACT-G	Geriatric assessment improves patient-centered communication about aging-related concerns, but has not changed QoL	Geriatric intervention based on CGA findings did not improve QoL
Quinten et al.³³33 Quinten C, Kenis C, Decoster L, Debruyne PR, de Groof I, Focan C, et al. Determining clinically important differences in health-related quality of life in older patients with cancer undergoing chemotherapy or surgery. Qual Life Res. 2019;28(3):663-76. 2019 / Belgium	≥70 years old, any neoplasia, submitted to chemotherapy or surgery, G8 ≤ 14 / N = 1424	Cohort / Determine the minimum estimates of clinically important differences in QoL and evaluate prognostic characteristics for these changes in QoL	EORTC QLQ-C30	Minimum estimates of clinically important differences in QoL vary by instrument and treatment, but can be used to assess significant changes in QoL	CGA was a predictor of QoL
Williams et al.⁵5 Williams GR, Deal AM, Sanoff HK, Nyrop KA, Guerard EJ, Pergolotti M, et al. Frailty and health-related quality of life in older women with breast cancer. Support Care Cancer. 2019;27(7):2693-98. 2019 / USA	≥65 years, breast cancer / N = 190	Cohort / Assess the association between frailty and QoL	PROMIS®	Frailty in older women with breast cancer was associated with worse QoL results	CGA was a predictor of QoL
de Boer et al.⁶6 de Boer AZ, Derks MGM, de Glas NA, Bastiaannet E, Liefers GJ, Stiggelbout AM. Metastatic breast cancer in older patients: A longitudinal assessment of geriatric outcomes. J Geriatr Oncol. 2020;11(6):969-75. 2020 / Netherlands	≥70 years, metastatic breast cancer / N = 100	Cohort / Assess the prevalence of psychosocial diseases and longitudinal changes in functional status, psychosocial functioning and QoL	EORTC QLQ-C30	High prevalence of psychiatric disorders in this population; its identification, through CGA can improve QoL	Geriatric intervention based on CGA findings helps to preserve QoL
Mian et al.¹⁶16 Mian H, Pond GR, Tuchman SA, Fiala MA, Wildes TM. Geriatric assessment and quality of life changes in older adults with newly diagnosed multiple myeloma undergoing treatment. J Geriatr Oncol. 2020;11(8):1279-84. 2020 / Canada	≥65 years, recent diagnosis of multiple myeloma / N = 40	Cohort / Understand the changes in the geriatric domains and QoL parameters during cancer treatment	FACT-G	In this population, QoL remained stable during the 6-month follow-up period; the Timed Up and Go test can provide a dynamic indicator of functional status and QoL	CGA was a predictor of QoL
Nipp et al.¹³13 Nipp RD, Temel B, Fuh CX, Kay P, Landay S, Lage D, et al. Pilot randomized trial of a transdisciplinary geriatric and palliative care intervention for older adults with cancer. J Natl Compr Canc Netw. 2020;18(5):591-8. 2020 / USA	≥65 years, incurable gastrointestinal or lung cancer / N = 62	Clinical trial / Determining the feasibility of a transdisciplinary intervention based on an CGA	FACT-G	Transdisciplinary intervention aimed at the care needs of older adults showed encouraging estimates to improve QoL	Geriatric intervention based on CGA findings helps to preserve QoL
Nipp et al. ⁸8 Nipp RD, Thompson LL, Temel B, Fuh CX, Server C, Kay PS, et al. Screening tool identifies older adults with cancer at risk for poor outcomes. J Natl Compr Canc Netw. 2020;18(3):305-13. 2020 / USA	≥70 years, recent diagnosis of incurable gastrointestinal neoplasm N = 132	Cohort / Determine whether categorizing patients as vulnerable by an CGA could identify those with the worst health outcomes	EORTC QLQ-C30	Patients identified as vulnerable by CGA have worse QoL and overall survival	CGA was a predictor of QoL
Quinten et al. ¹⁵15 Quinten C, Kenis C, Hamaker M, Coolbrandt A, Brouwers B, Dal Lago L, el al. The added value of geriatric assessment in evaluating a patient’s Health-Related Quality-of-Life: a study in ≥70-year-old early-stage invasive breast cancer patients. Eur J Cancer Care (Engl). 2020;e13278. 2020 / Belgium	≥70 years old, early stage breast cancer N = 109	Case-control / Assess the relationship between CGA and QoL	EORTC QLQ-C30	Functional measures of CGA are strongly correlated with the patient's self-reported functioning; the initial altered CGA has a modest probability of predicting deterioration of QoL	CGA was a predictor of QoL

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[1] Correspondence Valéria Sgnaolin v.sgnaolin@gmail.com