title: The Effect of A Geriatric Assessment on Treatment Decisions for Patients with Lung Cancer.
abstract: Decision-making for older patients with lung cancer can be complex and challenging. A geriatric assessment (GA) may be helpful and is increasingly being used since 2005 when SIOG advised to incorporate this in standard work-up for the elderly with cancer. Our aim was to evaluate the value of a geriatric assessment in decision-making for patients with lung cancer.
  
  
  
  Between January 2014 and April 2016, data on patients with lung cancer from two teaching hospitals in the Netherlands were entered in a prospective database. Outcome of geriatric assessment, non-oncologic interventions, and suggested adaptations of oncologic treatment proposals were evaluated.
  
  
  
  83 patients (median age 79 years) were analyzed with a geriatric assessment, of which 59% were treated with a curative intent. Half of the patients were classified as ECOG PS 0 or 1. The majority of the patients (78%) suffered from geriatric impairments and 43% (n = 35) of the patients suffered from three or more geriatric impairments (out of eight analyzed domains). Nutritional status was most frequently impaired (52%). Previously undiagnosed impairments were identified in 58% of the patients, and non-oncologic interventions were advised for 43%. For 33% of patients, adaptations of the oncologic treatment were proposed. Patients with higher number of geriatric impairments more often were advised a reduced or less intensive treatment (p < 0.001).
  
  
  
  A geriatric assessment uncovers previously unknown health impairments and provides important guidance for tailored treatment decisions in patients with lung cancer. More research on GA-stratified treatment decisions is needed.
authors.affiliation: Department of Internal Medicine, Diakonessenhuis Utrecht/Zeist/Doorn, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands. kschulkes@diakhuis.nl.
authors.forename: Karlijn J G
authors.initials: KJ
authors.lastname: Schulkes
authors.affiliation: Department of Internal Medicine, Haga Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands.
authors.forename: Esteban T D
authors.initials: ET
authors.lastname: Souwer
authors.affiliation: Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
authors.forename: Marije E
authors.initials: ME
authors.lastname: Hamaker
authors.affiliation: Department of Pulmonology, Haga Hospital, The Hague, The Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: Codrington
authors.affiliation: Department of Pulmonology, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands.
authors.forename: Simone
authors.initials: S
authors.lastname: van der Sar-van der Brugge
authors.affiliation: Department of Pulmonology, UMC Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: Jan-Willem J
authors.initials: JJ
authors.lastname: Lammers
authors.affiliation: Department of Internal Medicine, Haga Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands.
authors.forename: Johanneke E A
authors.initials: JE
authors.lastname: Portielje
authors.affiliation: Department of Pulmonology, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
authors.forename: Leontine J R
authors.initials: LJ
authors.lastname: van Elden
authors.affiliation: Department of Internal Medicine, Haga Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands.
authors.forename: Frederiek
authors.initials: F
authors.lastname: van den Bos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D060825:Cognitive Dysfunction / Q000150:complications; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000628:therapy*; D008297:Male; D051346:Mobility Limitation; D009752:Nutritional Status
keywords: CGA; Frailty; Geriatric assessment; Pulmonary malignancies