The use of the Comprehensive Geriatric Assessment (CGA) was found to have a significant impact on treatment decision-making in older patients with hematologic malignancies, according to the results of study published in the European Journal of Haematology.

The cross-sectional analysis included 424 older adult patients (aged ≥65 years) with hematologic malignancies who were hospitalized at the University Cancer Institute of Toulouse, France, between 2008 and 2019. Patients were evaluated by a geriatrician/nurse team using the CGA, and the investigators used statistical modelling to identify factors independently associated with a change in a patient’s hematologic treatment plan.

The study population was  55% men, and the median age was 80 years (range, 65-99 years). The most common hematologic malignancies among the patient population were lymphoma (36.1 %), acute myeloid leukemia (26.9 %), and myelodysplastic syndrome (19.8%). Most patients (75.5%) were evaluated prior to initiating treatment.


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After the CGA, a change in the hematologic treatment plan was proposed for 21.7% of the patients. Changes in treatment plans were predominantly in favor of palliative care (52%), decreases in dose intensity coupled with a proposal for dosage concession or modification of the chemotherapy protocol (23.9%), and reassessment with deferral of chemotherapy for at least 2 weeks after an acute episode (16.3%).

Factors independently associated with a change in treatment plan were measures of functional impairment and mobility impairment, the presence of comorbidity, and increasing age.

Limitations of the study included possible selection bias with referred patients being considered more frail and sicker, and that most patients were inpatients. Additionally, the prevalence of thymic and cognitive domains are likely underestimated due to less evaluation of these disorders using validated scales.

“Factors independently associated with change in hematological treatment plan identified in our study are major prognostic factors in hematology,” wrote the authors. “These parameters could be proposed and carried out by a nurse in hematology in order to select patients which could benefit from a CGA in terms of therapeutic decision making.”

Reference

Garric M, Sourdet S, Cabarrou B, et al. Impact of a comprehensive geriatric assessment on decision making in older patients with hematologic malignancies. Eur J Haematol. Published online December 19, 2020.  doi:10.1111/ejh.13570