title: Prediction of treatment-related toxicity and outcome with geriatric assessment in elderly patients with solid malignancies treated with chemotherapy: a systematic review.
abstract: BACKGROUND
  The number of older patients with cancer is increasing. Standard clinical evaluation of these patients may not be sufficient to determine individual treatment strategies and therefore Geriatric Assessment (GA) may be of clinical value. In this review, we summarize current literature that is available on GA in elderly patients with solid malignancies who receive chemotherapy. We focus on prediction of treatment toxicity, mortality and the role of GA in the decision-making process.
  
  
  METHODS
  We conducted a systematic search in PubMed. Studied populations needed to fulfill the following criteria: 65 years or older, diagnosis of solid malignancy, treatment with chemotherapy, submission to GA, either designed to study prediction of treatment toxicity or mortality or to evaluate the role of GA in the decision-making process.
  
  
  RESULTS
  Our search provided 411 publications. Thirteen met the predefined criteria. These studies revealed: (i) up to 64% of elderly patients suffer from severe toxicity caused by polychemotherapy, (ii) Nutritional status, functionality and comorbidity are often associated with worse outcome, (iii) GA reveals (unknown) geriatric problems in more than 50% of elderly patients with cancer and (iv) 21%-53% of chemotherapy regimens are being modified based on GA.
  
  
  CONCLUSIONS
  In geriatric oncology, an accurate predictive test to guide anticancer treatment in order to prevent serious toxicity is needed. The value of GA in predicting toxicity and mortality in older patients with cancer undergoing treatment with chemotherapy has not been proven. It may be valuable in revealing geriatric problems but current evidence for its usefulness to guide treatment decisions in this setting is limited. However, we are convinced that GAs should be carried out to optimize treatment strategies in elderly patients with cancer to improve treatment efficacy and minimize toxicity.
authors.affiliation: Department of Medical Oncology, VU University Medical Center, Amsterdam.
authors.forename: K S
authors.initials: KS
authors.lastname: Versteeg
authors.affiliation: Department of Medical Oncology, VU University Medical Center, Amsterdam.
authors.forename: I R
authors.initials: IR
authors.lastname: Konings
authors.affiliation: Department of Internal Medicine, Spaarne Hospital, Hoofddorp.
authors.forename: A M
authors.initials: AM
authors.lastname: Lagaay
authors.affiliation: Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: A A
authors.initials: AA
authors.lastname: van de Loosdrecht
authors.affiliation: Department of Medical Oncology, VU University Medical Center, Amsterdam. Electronic address: h.verheul@vumc.nl.
authors.forename: H M W
authors.initials: HMW
authors.lastname: Verheul
mesh_terms: D000368:Aged; D000375:Aging; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000473:pathology; D015577:Geriatric Assessment; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D011379:Prognosis; D016896:Treatment Outcome
keywords: cancer; decision making; elderly; geriatric assessment; geriatric oncology