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Comprehensive geriatric assessment: Complementary tool in patients with neoplasia of the gastrointestinal tract in a Brazilian university hospital
Background
The WHO (World Health Organization) defines an elderly person as an individual aged 60 years or over. A multidimensional evaluation has become necessary for the diagnosis of the clinical and functional demands of these patients. The CGA (Comprehensive Geriatric Assessment) is intended to supply such deficiencies in geriatric assessment. There is concern due to the paucity of data obtained from oncological clinical studies. A review of specialized literature highlights the ability of CGA to predict functional decline, estimate survival and even assist the physician in decision making.
Methods
This is a prospective study that aims to evaluate the population over 60 years of age of patients that receive chemotherapy for digestive tract neoplasms. The baseline categorical variables assessed belong to the CGA such as functionality, nutritional status, and social support, in focus in this analysis. The CGA questionnaire was applied at the beginning of the treatment of selected patients prospectively followed for a period of 3 months. The study had been approved by a local committee and all the patients signed a written free consent before inclusion.
Results
25 patients have been included. The mean age of patients was 69 years. 12 were 70 years or older. The primary tumor sites were: 10 patients with colon, 4 with rectal, 2 with stomach, 2 with esophageal, 6 with pancreas and 1 with biliary tract cancer. The predominant histology was adenocarcinoma. For all patients chemotherapy was proposed. Before starting the treatment, the CGA was applied. The instrument validated for assessing functionality, nutritional assessment and social support were respectively the Barthel Scale, the Mini Nutritional Assessment and the family APGAR Index (CGA components). 6 had a mild and 4 a moderate degree of dependence. For the initial nutritional assessment 18 patients were at risk of malnutrition and 5 were malnourished. In 3-month observation period: 20 followed with acceptable toxicity. Treatment break was associated with baseline poor nutritional status. All patients had some degree of dysfunction in social support.
Conclusions
The CGA as an initial assessment becomes an important instrument to predict outcomes in this age group. The importance of nutritional assessment is highlighted once nutritional risk or malnutrition were common. Most of the patients had been treated with accepted toxicity in a 3-month period. Dysfunction in social support was present in all patients.
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
