title: Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study.
abstract: OBJECTIVE
  To identify Comprehensive Geriatric Assessment (CGA) components independently associated with changes in planned cancer treatment.
  
  
  METHODS
  We prospectively included 375 consecutive elderly patients with cancer (ELCAPA01 study) assessed by geriatricians using the CGA. Multivariate analysis was used to identify factors associated with changes in the cancer treatment (intensification, decrease, or delayed > 2 weeks). Change was defined as a difference between the initial treatment proposal and the final treatment selected in a multidisciplinary meeting.
  
  
  RESULTS
  Mean age was 79.6 years (standard deviation [SD], 5.6 years), and 197 (52.5%) were women. The most common tumor location was the digestive system (58.7%). The mean number of comorbidities was 4.2 (SD, 2.7) per patient, and the mean Cumulative Illness Rating Scale for Geriatrics score was 11.8 (SD, 5.3). After the CGA, the initial cancer treatment plan was modified for 78 (20.8%) of 375 patients (95% CI, 16.8 to 25.3), usually to decrease treatment intensity (63 [80.8%] of 78 patients). By univariate analysis, cancer treatment changes were associated with Eastern Cooperative Oncology Group performance status ≥ 2 (73.3% in the group with changes v 41.1% in the in the group without changes; P < .001), dependency for one or more activities of daily living (ADL; 59.0% v 24.2%; P < .001), malnutrition (81.8% v 51.2%; P < .001), cognitive impairment (38.5% v 24.9%; P = .023), depression (52.6% v 21.7%; P < .001), and greater number of comorbidities (mean, 4.8 [SD, 2.9] v 4.0 [SD, 2.6]; P = .02). By multivariate analysis, factors independently associated with cancer treatment changes were a lower ADL score (odds ratio [OR], 1.25 per 0.5-point decrease; CI, 1.04 to 1.49; P = .016) and malnutrition (OR, 2.99; CI, 1.36 to 6.58; P = .007).
  
  
  CONCLUSIONS
  Functional status assessed by the ADL score and malnutrition were independently associated with changes in cancer treatment.
authors.affiliation: University of Paris Est Creteil, Laboratoire d'Investigation Clinicque EA 4393, Assitance Publique-Hôpitaux de Paris Henri Mondor, Créteil, France
authors.forename: Philippe
authors.initials: P
authors.lastname: Caillet
authors.forename: Florence
authors.initials: F
authors.lastname: Canoui-Poitrine
authors.forename: Johanna
authors.initials: J
authors.lastname: Vouriot
authors.forename: Muriel
authors.initials: M
authors.lastname: Berle
authors.forename: Nicoleta
authors.initials: N
authors.lastname: Reinald
authors.forename: Sebastien
authors.initials: S
authors.lastname: Krypciak
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bastuji-Garin
authors.forename: Stephane
authors.initials: S
authors.lastname: Culine
authors.forename: Elena
authors.initials: E
authors.lastname: Paillaud
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications; D015897:Comorbidity; D003657:Decision Making; D003863:Depression / Q000150:complications; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications; D015999:Multivariate Analysis; D009369:Neoplasms / Q000628:therapy*; D011446:Prospective Studies