Comprehensive geriatric assessment and early treatment failure in nonagenarian patients with cancer, a retrospective monocentric study

IF 2.4 3区医学 Q3 ONCOLOGY

Cancer Epidemiology Pub Date : 2025-04-26 DOI:10.1016/j.canep.2025.102830

Aglaé Guerin , Zoé ap Thomas , Céline Nagera-Lazarovici , Geoffroy Beraud-Chaulet , Mariana Iacob , Florence Canoui-Poitrine , Elena Paillaud , Capucine Baldini , Arnaud Pagès , Maxime Frélaut

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Abstract

Background

The incidence of cancer among patients aged over 90 is increasing, but this population is poorly described in literature. This underrepresentation complicates decision-making for cancer treatments, despite the contribution of comprehensive geriatric assessment (CGA). This study aimed to describe early failure of specific anti-cancer treatments in a population of nonagenarians treated in a Comprehensive Cancer Center after undergoing a CGA.

Methods

This retrospective, monocentric cohort study included patients aged over 90 referred to an oncogeriatric team for CGA between 2019 and 2023, regardless of cancer type or planned treatment. The primary endpoint was the early treatment failure rate within 3 months of the initiation of treatment, defined as unplanned discontinuation, progression, or death.

Results

119 patients were included, with a median age of 91 years (range: 90–99 years), 53 % were men. The most common cancers were skin (30 %), head and neck (24 %), genito-urinary (12 %), and breast cancers (11 %). Most patients were independent for activities of daily living with a median ADL score of 6/6 and IADL score of 3/4. They had an average of 1.3 severe comorbidities. Half of them suffered from undernutrition. The geriatric oncology team recommended 53.8 % treatment modifications (94.5 % de-escalation). The most common treatments received were radiotherapy (27 %), surgery (18 %), hormonal therapy (10 %) and chemotherapy (9 %). A quarter of the patients received exclusive supportive care. Among patients receiving specific treatment, early failure occurred in 22.7 % (20/88). The 6-month survival probability from initiation of treatment was 69.2 % (95 % CI: 60.3 %, 76.8 %), varying significantly by treatment intent: 93.9 % (95 % CI: 80.4 %, 98.3 %) for curative treatments, 77.4 % (95 % CI: 64.5 %, 86.6 %) for palliative treatments, and 26.8 % (95 % CI: 14.3 %, 44.6 %) for exclusive supportive care.

Conclusion

In this population of nonagenarians, who benefit from a CGA to identify and manage patient frailties, anti-cancer treatments were carried out with few early treatment failures.

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综合老年评估和早期治疗失败的90岁癌症患者，回顾性单中心研究

90岁以上患者的癌症发病率正在增加，但文献对这一人群的描述很少。尽管全面的老年评估（CGA）做出了贡献，但这种代表性不足使癌症治疗的决策复杂化。本研究旨在描述在综合癌症中心接受CGA治疗的90多岁人群中特异性抗癌治疗的早期失败。方法：这项回顾性、单中心队列研究纳入了2019年至2023年期间，年龄超过90岁的CGA患者，无论癌症类型或计划治疗如何。主要终点是开始治疗后3个月内的早期治疗失败率，定义为计划外停药、进展或死亡。结果纳入119例患者，中位年龄91岁（范围：90-99岁），53. %为男性。最常见的癌症是皮肤（30% %）、头颈（24% %）、生殖-泌尿（12% %）和乳腺癌（11% %）。大多数患者日常生活活动独立，平均ADL评分为6/6，IADL评分为3/4。他们平均有1.3个严重的合并症。其中一半患有营养不良。老年肿瘤学团队推荐53.8% %的治疗修改（94.5% %的降级治疗）。最常见的治疗方法是放疗（27 %）、手术（18 %）、激素治疗（10 %）和化疗（9 %）。四分之一的患者接受了专门的支持性治疗。在接受特异性治疗的患者中，早期失败发生率为22.7% %（20/88）。从开始的治疗6个月生存概率是69.2 %(95 % CI: 60.3 %,76.8 %),由治疗意图明显不同:93.9 %(95 % CI: 80.4 %,98.3 %)为治疗治疗,77.4 %(95 % CI: 64.5 %,86.6 %)为姑息治疗,和26.8 %(95 % CI: 14.3 %,44.6 %)独家支持性护理。结论在这群受益于CGA识别和管理患者虚弱的90多岁人群中，进行了抗癌治疗，很少有早期治疗失败。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Epidemiology 医学-肿瘤学

CiteScore

4.50

自引率

3.80%

发文量

200

审稿时长

39 days

期刊介绍： Cancer Epidemiology is dedicated to increasing understanding about cancer causes, prevention and control. The scope of the journal embraces all aspects of cancer epidemiology including: • Descriptive epidemiology • Studies of risk factors for disease initiation, development and prognosis • Screening and early detection • Prevention and control • Methodological issues The journal publishes original research articles (full length and short reports), systematic reviews and meta-analyses, editorials, commentaries and letters to the editor commenting on previously published research.