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Journal of Clinical Oncology, Vol 20, Issue 2 (January), 2002: 494-502
© 2002 American Society for Clinical Oncology

Comprehensive Geriatric Assessment Adds Information to Eastern Cooperative Oncology Group Performance Status in Elderly Cancer Patients: An Italian Group for Geriatric Oncology Study

By Lazzaro Repetto, Lucia Fratino, Riccardo A. Audisio, Antonella Venturino, Walter Gianni, Marina Vercelli, Stefano Parodi, Denise Dal Lago, Flora Gioia, Silvio Monfardini, Matti S. Aapro, Diego Serraino, Vittorina Zagonel

From the Unità Operativa Geriatria Oncologica, Istituto Nazionale di Riposo e Cura per Anziani and Unità di Oncologia, Ospedale Fatebenefratelli Isola Tiberina, Roma; Divisione di Oncologia Medica and Servizio di Epidemiologia, Istituto di Ricovero e Cura a Carattere Scientifico, Centro di Riferimento Oncologico, Aviano; U.O. Oncologia Medica, Unità Sanitaria Locale 1 Imperiese, Presidio Ospedaliero, San Remo; Servizio Registro Tumori, Istituto Nazionale per la Ricerca sul Cancro, Genova; Divisione di Geriatria, Ospedale Demati, S. Angelo Lodigiano, Lodi; Divisione di Geriatria, Ospedale San Bortolo, Vicenza; Divisione di Oncologia Medica, Azienda Ospedale Università, Padova, Italy; Department of General Surgery, Whiston Hospital, Prescot, United Kingdom; and Clinique de Genolier, Genolier, Switzerland.

Address reprint requests to Lazzaro Repetto, MD, U.O. Geriatric Oncology, INRCA, Via Cassia 1167, 00189 Rome, Italy; email: l.repetto{at}inrca.it

PURPOSE: To appraise the performance of Comprehensive Geriatric Assessment (CGA) in elderly cancer patients (>= 65 years) and to evaluate whether it could add further information with respect to the Eastern Cooperative Oncology Group performance status (PS).

PATIENTS AND METHODS: We studied 363 elderly cancer patients (195 males, 168 females; median age, 72 years) with solid (n = 271) or hematologic (n = 92) tumors. In addition to PS, their physical function was assessed by means of the activity of daily living (ADL) and instrumental activities of daily living (IADL) scales. Comorbidities were categorized according to Satariano’s index. The association between PS, comorbidity, and the items of the CGA was assessed by means of logistic regression analysis.

RESULTS: These 363 elderly cancer patients had a good functional and mental status: 74% had a good PS (ie, lower than 2), 86% were ADL-independent, and 52% were IADL-independent. Forty-one percent of patients had one or more comorbid conditions. Of the patients with a good PS, 13.0% had two or more comorbidities; 9.3% and 37.7% had ADL or IADL limitations, respectively. By multivariate analysis, elderly cancer patients who were ADL-dependent or IADL-dependent had a nearly two-fold higher probability of having an elevated Satariano’s index than independent patients. A strong association emerged between PS and CGA, with a nearly five-fold increased probability of having a poor PS (ie, >= 2) recorded in patients dependent for ADL or IADL.

CONCLUSION: The CGA adds substantial information on the functional assessment of elderly cancer patients, including patients with a good PS. The role of PS as unique marker of functional status needs to be reappraised among elderly cancer patients.


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