title: Prognostic factors for the feasibility of chemotherapy and the Geriatric Prognostic Index (GPI) as risk profile for mortality before chemotherapy in the elderly.
abstract: BACKGROUND
  Comprehensive geriatric assessment (CGA) is a multidimensional method to detect frailty in elderly patients. Time saving could be accomplished by identifying those individual items that classify elderly cancer patients at risk for feasibility of chemotherapy and for mortality.
  
  
  METHODS
  Patients older than 70 years of age were assessed before the first chemotherapy administration. GA consisted of the Mini Nutritional Assessment (MNA), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Groningen Frailty Indicator (GFI) and Mini Mental State Examination (MMSE). Predictive individual items for feasibility of chemotherapy and mortality were entered in the multivariable logistic regression and Cox-regression models, and a three-item sum scale was constructed: the Geriatric Prognostic Index (GPI).
  
  
  RESULTS
  The 494 patients had a median age of 75 years (range 70-92 years). The majority of the patients had malignancies of the digestive tract (41.7%) followed by hematological tumors (22.3%). Three items of the MNA ('psychological distress or acute disease in the past three months', 'neuropsychological problems' and 'using > 3 prescript drugs') independently predicted for feasibility of chemotherapy. Two items of the MNA and one of the GFI ('declining food intake in past 3 months', 'using > 3 prescript drugs', and 'dependence in shopping') independently predicted for mortality. In comparison with patients without any positive item on the three-item GPI, patients with one, two or three positive items had hazard ratios (HRs) of 1.58, 2.32, and 5.58, respectively (all p < 0.001).
  
  
  CONCLUSIONS
  With only three items of the MNA, feasibility of chemotherapy can be predicted. The three-item GPI may help to identify elderly cancer patients at elevated risk for mortality.
authors: a Institute of Mental Health , Bouman GGZ Rotterdam , The Netherlands.
authors: Ab A
authors: AA
authors: Aaldriks
authors: b Department of Internal Medicine , Reinier de Graaf Hospital , Delft , The Netherlands.
authors: Ed
authors: E
authors: Maartense
authors: c Department of Clinical Oncology , Leiden University Medical Center , Leiden , The Netherlands.
authors: Hans J W R
authors: HJ
authors: Nortier
authors: d Comprehensive Cancer Centre The Netherlands , Utrecht , The Netherlands.
authors: Lydia G M
authors: LG
authors: van der Geest
authors: e Department of Medical Statistics and Department of Clinical Epidemiology , Leiden University Medical Center , Leiden , The Netherlands.
authors: Saskia
authors: S
authors: le Cessie
authors: f Department of Internal Medicine , Groene Hart Hospital , Gouda , The Netherlands.
authors: Bea C
authors: BC
authors: Tanis
authors: g Department of Internal Medicine , Haga Hospital , The Hague , The Netherlands.
authors: Johanneke E A
authors: JE
authors: Portielje
authors: g Department of Internal Medicine , Haga Hospital , The Hague , The Netherlands.
authors: Paula
authors: P
authors: Ypma
authors: h Department of Psychiatry , Leiden University Medical Center , Leiden , The Netherlands.
authors: Erik J
authors: EJ
authors: Giltay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis; D005240:Feasibility Studies; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D009483:Neuropsychological Tests; D015596:Nutrition Assessment; D011379:Prognosis; D012044:Regression Analysis; D013315:Stress, Psychological / Q000175:diagnosis