K. Van Puyvelde

Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations†

BACKGROUND Screening tools are proposed to identify those older cancer patients in need of geriatric assessment (GA) and multidisciplinary approach. We aimed to update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on the use of screening tools. MATERIALS AND METHODS SIOG composed a task group to review, interpret and discuss evidence on the use of screening tools in older cancer patients. A systematic review was carried out and discussed by an expert panel, leading to a consensus statement on their use. RESULTS Forty-four studies reporting on the use of 17 different screening tools in older cancer patients were identified. The tools most studied in older cancer patients are G8, Flemish version of the Triage Risk Screening Tool (fTRST) and Vulnerable Elders Survey-13 (VES-13). Across all studies, the highest sensitivity was observed for: G8, fTRST, Oncogeriatric screen, Study of Osteoporotic Fractures, Eastern Cooperative Oncology Group-Performance Status, Senior Adult Oncology Program (SAOP) 2 screening and Gerhematolim. In 11 direct comparisons for detecting problems on a full GA, the G8 was more or equally sensitive than other instruments in all six comparisons, whereas results were mixed for the VES-13 in seven comparisons. In addition, different tools have demonstrated associations with outcome measures, including G8 and VES-13. CONCLUSIONS Screening tools do not replace GA but are recommended in a busy practice in order to identify those patients in need of full GA. If abnormal, screening should be followed by GA and guided multidisciplinary interventions. Several tools are available with different performance for various parameters (including sensitivity for addressing the need for further GA). Further research should focus on the ability of screening tools to build clinical pathways and to predict different outcome parameters.

RELEVANCE OF A SYSTEMATIC GERIATRIC SCREENING AND ASSESSMENT IN OLDER PATIENTS WITH CANCER RESULTS OF A PROSPECTIVE MULTICENTRIC STUDY

BACKGROUND To evaluate the large-scale feasibility and usefulness of geriatric screening and assessment in clinical oncology practice by assessing the impact on the detection of unknown geriatric problems, geriatric interventions and treatment decisions. PATIENTS AND METHODS Eligible patients who had a malignant tumour were ≥70 years old and treatment decision had to be made. Patients were screened using G8; if abnormal (score ≤14/17) followed by Comprehensive Geriatric Assessment (CGA). The assessment results were communicated to the treating physician using a predefined questionnaire to assess the topics mentioned above. RESULTS One thousand nine hundred and sixty-seven patients were included in 10 hospitals. Of these patients, 70.7% had an abnormal G8 score warranting a CGA. Physicians were aware of the assessment results at the time of treatment decision in two-thirds of the patients (n = 1115; 61.3%). The assessment detected unknown geriatric problems in 51.2% of patients. When the physician was aware of the assessment results at the time of decision making, geriatric interventions were planned in 286 patients (25.7%) and the treatment decision was influenced in 282 patients (25.3%). CONCLUSION Geriatric screening and assessment in older patients with cancer is feasible at large scale and has a significant impact on the detection of unknown geriatric problems, leading to geriatric interventions and adapted treatment.

atetra, a new software program to analyse tetraploid microsatellite data: comparison with tetra and tetrasat

Despite the importance of tetraploid species, most population genetic studies deal with diploid ones because of difficulties in analysing codominant microsatellite data in tetraploid species. We developed a new software program—atetra—which combines both the rigorous method of enumeration for small data sets and Monte Carlo simulations for large ones. We discuss the added value of atetra by comparing its precision, stability and calculation time for different population sizes with those obtained from previous software programs tetrasat and tetra. The influence of the number of simulations on the calculation stability is also investigated. atetra and tetrasat proved to be more precise when compared with tetra, which, however, remains faster. atetra has the same precision than tetrasat, but is much faster, can handle an infinite number of partial heterozygotes and calculates more genetic variables. The more user‐friendly interface of atetra reduces possible mistakes.

A Belgian survey on geriatric assessment in oncology focusing on large-scale implementation and related barriers and facilitators

OBJECTIVES The aim of this study is to describe a large-scale, Belgian implementation project about geriatric assessment (=GA) in daily oncology practice and to identify barriers and facilitators for implementing GA in this setting. Design / setting / participants: The principal investigator of every participating hospital (n=22) was invited to complete a newly developed questionnaire with closed- and open-ended questions. The closed-ended questions surveyed how GA was implemented. The open-ended questions identified barriers and facilitators for the implementation of GA in daily oncology practice. Descriptive statistics and conventional content analysis were performed as appropriate. RESULTS Qualifying criteria (e.g. disease status and cancer type) for GA varied substantially between hospitals. Thirteen hospitals (59.1%) succeeded to screen more than half of eligible patients. Most hospitals reported that GA data and follow-up data had been collected in almost all screened patients. Implementing geriatric recommendations and formulating new geriatric recommendations at the time of follow-up are important opportunities for improvement. The majority of identified barriers were organizational, with high workload, lack of time or financial/staffing problems as most cited. The most cited facilitators were all related to collaboration. CONCLUSION Interventions to improve the implementation of GA in older patients with cancer need to address a wide range of factors, with organization and collaboration as key elements. All stakeholders, seeking to improve the implementation of GA in older patients with cancer, should consider and address the identified barriers and facilitators.

Nuclear cyp73 intron fragment length polymorphism supports morphological analysis of Salix species and hybrids.

Abstract The polyploid Salix alba L.–Salix fragilis L. hybrid complex still presents major difficulties in morphological identification. Most of the measured characters show a low diagnostic value for unambiguously identifying the parental species and their hybrid Salix × rubens Schrank due to continuous variation creating a large overlap in leaf and catkin morphology. Fragment length polymorphism of nuclear cyp73 intron markers was used to identify species and hybrids. This multilocus genotyping could be applied in a morphological analysis of trees from hybrid zones and allowed to demonstrate that morphological features of leaves and catkins clearly separated S. alba from S. fragilis. The hybrid individuals largely overlapped with both parental species but appeared to be morphologically more similar to S. fragilis than to S. alba. Cyp73 analysis of 11 Salix taxa revealed intermediate positions of two hybrid taxa with S. alba, namely S. × rubens and S. × sepulcralis Simonkai with their respective parental species S. fragilis and S. babylonica L. Additionally, the cyp73 intron multilocus genotypes clustered tetraploid taxa separately from diploid willows. Cyp73 introns are valuable markers for fast, reliable and straightforward genotyping in willow species and hybrids.

Abstract P6-09-07: Impact of comprehensive geriatric assessment on treatment decision and follow-up in older breast cancer patients

Purpose: This study aims to investigate the impact of comprehensive Geriatric Assessment (CGA) on treatment decisions in a large cohort of older breast cancer patients. We also studied the functional evolution during treatment and the development of severe toxicity in patients receiving chemotherapy and we looked for predictive baseline markers of functional decline and toxicity. Patients and methods: This study is part of a study on CGA in older cancer patients in 6 tumor types. We selected the breast cancer cohort for this presentation: 379 older breast cancer patients were recruited in 2 Belgian university hospitals. Patients aged 70 years or older with a newly diagnosed or progressive breast cancer for which treatment initiation or change was considered, were eligible. At baseline, an evaluation was performed of the oncological parameters as well as a CGA including geriatric screening with G8 and Flemish version of the TRST, pain, social situation, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), presence of falls, MNA, GDS-15, MOB-T for fatigue, MMSE, polypharmacy, and Charlson Comorbidity Index (CCI). CGA results were communicated to the treating physician and after treatment decision, the physician was interviewed by a trained healthcare worker using a predefined questionnaire focusing on unknown geriatric problems revealed by CGA, subsequent planning of geriatric interventions, and impact on treatment decision. At 2–3 months follow-up, functionality was reassessed and severe toxicity in patients receiving chemotherapy (n = 98) was recorded. Predictors for functional decline (ADL increase of ≥2 points and IADL decrease of ≥1 point compared to baseline) and severe haematological and non-haematological toxicity were identified by multivariate analysis. Results: 79,2% of treating physicians were aware of CGA results at the time of treatment decision. CGA revealed unknown geriatric problems in 70,5% of cases, leading to geriatric intervention in 5,4% of patients. Treatment was adapted according to age and standard clinical approach (without CGA taken into account) in 41,1% of cases and CGA results led to an additional change of treatment decision in 5,4%. At follow-up, 47,9% of patients was dependent on at least one of the activities of ADL (compared to 54,1% at baseline) and 64,7% was dependent on at least one of IADL (compared to 58,1% at baseline). Functional decline at 2–3 months was predicted by baseline ADL, IADL and ECOG-PS, but no markers were found to predict chemotherapy toxicity (which occurred in 22/98 pts: 14 hematological toxicity gr III-IV, and 10 non-hematological toxicity gr III-IV) Conclusion: CGA revealed unknown information in the majority (70.5%) of breast cancer patients but led to a geriatric intervention and a change in treatment decision in a minority of pts (both 5.4%). Baseline functionality measures (ADL, IADL, ECOG-PS) were found to be predictive for functional decline at 2–3 months, but predictors for severe chemotherapy toxicity could not be identified. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-09-07.