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Physicians' judgement and comprehensive geriatric assessment (CGA) select different patients as fit for chemotherapy.

Wedding U, Ködding D, Pientka L, Steinmetz HT, Schmitz S

Department of Internal Medicine II, Division of Haematology and Medical Oncology, Friedrich Schiller University, Erlanger Allee 101, 07747 Jena, Germany. ulrich.wedding@med.uni-jena.de

INTRODUCTION: Elderly cancer patients are a very heterogeneous population. A comprehensive geriatric assessment (CGA) shall help to identify more precisely those patients who are fit, compared to those who are vulnerable or frail, when deciding on chemotherapeutical treatment. METHODS: In a prospective trial, 200 cancer patients treated in an out-patient setting were judged by their physician for their fitness for chemotherapy as fit, vulnerable or frail. A CGA was performed thereafter. We determined the feasibility of a CGA in an out-patient setting and the frequency of changes within the different assessment tools and compared physicians' judgement with the CGA results. RESULTS: Physicians judged 64.3% of their patients as fit, 32.4% as vulnerable, and 3.2% as frail. A CGA was completed by 97.5% of patients and lasted 20min per patients (range: 9-47min). 26.5% of all patients had no deficits in the CGA. The CGA identified a mean of 1.7 problems per patient, 1.3 in patients judged as fit, 2.3 in those judged as vulnerable, and 4.2 in those judged as frail. A CGA is more sensitive in classifying patients as fit compared to vulnerable or frail than physicians' judgement. CONCLUSION: A CGA is feasible and detects more elderly cancer patients as being unfit for chemotherapy than physicians' judgement. Further trials including disease and treatment related end-points are needed.

Published 10 September 2007 in Crit Rev Oncol Hematol, 64(1): 1-9.
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