Association Between Chronologic Age and Geriatric Assessment–Identified Impairments: Findings From the CARE Registry

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  • 1 Institute for Cancer Outcomes and Survivorship,
  • | 2 O’Neal Comprehensive Cancer Center, and
  • | 3 Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama;
  • | 4 Revital Cancer Rehabilitation, Select Medical, Mechanicsburg, Pennsylvania; and
  • | 5 Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado.
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Background: The NCCN Guidelines for Older Adult Oncology recommend that, when possible, older adults with cancer undergo a geriatric assessment (GA) to provide a comprehensive health appraisal to guide interventions and appropriate treatment selection. However, the association of age with GA-identified impairments (GA impairments) remains understudied and the appropriate age cutoff for using the GA remains unknown. Patients and Methods: We designed a cross-sectional study using the Cancer and Aging Resilience Evaluation (CARE) registry of older adults with cancer. We included adults aged ≥60 years diagnosed with gastrointestinal malignancy who underwent a patient-reported GA prior to their initial consultation at the gastrointestinal oncology clinic. We noted the presence of GA impairments and frailty using Rockwood’s deficit accumulation approach. We studied the relation between chronologic age and GA impairments/frailty using Spearman rank correlation and chi-square tests of trend. Results: We identified 455 eligible older adults aged ≥60 years with gastrointestinal malignancies; the median age was 68 years (range, 64–74 years) and colorectal (33%) and pancreatic (24%) cancers were the most common cancer type. The correlation between chronologic age and number of geriatric impairments was weak and did not reach statistical significance (Spearman ρ, 0.07; P=.16). Furthermore, the prevalence of domain-specific impairments or frailty was comparable across the 3 age groups (60–64 years, 65–74 years, ≥75 years) with the exception of comorbidity burden. Notably, 61% of patients aged 60 to 64 years had ≥2 GA impairments and 35% had evidence of frailty, which was comparable to patients aged 65 to 74 years (66% and 36%, respectively) and ≥75 years (70% and 40%, respectively). Conclusions: Using chronologic age alone to identify which patients may benefit from GA is problematic. Future studies should identify screening tools that may identify patients at high risk of frailty and GA impairments.

Submitted July 2, 2020; final revision received September 25, 2020; accepted for publication October 26, 2020. Published online June 11, 2021.

Previous presentation: This study was presented in abstract form at the 2020 ASCO Virtual Scientific Program; May 29–31, 2020. Abstract 12048.

Author contributions: Study concept and design: Giri, Williams. Data acquisition: Giri, Williams. Data analysis and interpretation: Giri, Williams. Statistical analysis: Giri, Williams. Supervision: Williams, Bhatia. Manuscript preparation: All authors. Critical revision: All authors.

Disclosures: Dr. Giri has disclosed receiving grant/research support from Carevive Systems and Pack Health LLC, and honoraria from Carevive Systems. Dr. Williams has disclosed serving as a consultant for Carevive Systems. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This work was supported in part by the Walter B. Frommeyer Fellowship in Investigative Medicine at the University of Alabama at Birmingham and the NCI of the NIH (K08CA234225; G.R. Williams).

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Correspondence: Smith Giri, MD, MHS, Division of Hematology/Oncology, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 500, Birmingham, AL 35233. Email: smithgiri@uabmc.edu

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