Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. A Prospective Cohort Study of the Effects of Adjuvant Breast Cancer Chemotherapy on Taste Function, Food Liking, Appetite and Associated Nutritional Outcomes Comprehensive geriatric assessment in Korean elderly cancer patients receiving chemotherapy Randomized phase III clinical trial of a combined treatment with carnitine + celecoxib ± megestrol acetate for patients with cancer-related anorexia/cachexia syndrome. The prevalence of nutrition impact symptoms and their relationship to quality of life and clinical outcomes in medical oncology patients Development of a geriatric vulnerability score in elderly patients with advanced ovarian cancer treated with first-line carboplatin: a GINECO prospective trial. Quality of life, geriatric assessment and survival in elderly patients with non-small-cell lung cancer treated with carboplatin-gemcitabine or carboplatin-paclitaxel: NVALT-3 a phase III study. Estimation of the risk for nutritional state degradation in patients with cancer: development of a screening tool based on results from a cross-sectional survey. Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study. Characteristics and treatment options of elderly Chinese patients with cancer as determined by Comprehensive Geriatric Assessment (CGA). One-Year Mortality in Older Patients with Cancer: Development and External Validation of an MNA-Based Prognostic Score Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. Impact of liposomal doxorubicin-based adjuvant chemotherapy on autonomy in women over 70 with hormone-receptor-negative breast carcinoma: A French Geriatric Oncology Group (GERICO) phase II multicentre trial. A prospective observational study assessing home parenteral nutrition in patients with gastrointestinal cancer: benefits for quality of life. Functional decline in older patients with cancer receiving first-line chemotherapy. Predictors of 1-Year Mortality in a Prospective Cohort of Elderly Patients With Cancer. Frailty and malnutrition predictive of mortality risk in older patients with advanced colorectal cancer receiving chemotherapy.
BACKGROUND Development of a geriatric screening tool is necessary to identify elderly cancer patients who would benefit from comprehensive geriatric assessment ( CGA ) .  We develop and evaluate the G-8 screening tool against various reference tests . PATIENTS AND METHODS Analyses were based on 364 cancer patients aged>70 years scheduled to receive first-line chemotherapy included in a multicenter prospect i ve study . The G-8 consists of seven items from the Mini Nutritional Assessment ( MNA ) question naire and age . Our primary reference test is based on a set of seven CGA scales : Activities Daily Living ( ADL ) , Instrumental ADL , MNA , Mini-Mental State Exam , Geriatric Depression Scale , Cumulative Illness Rating Scale-Geriatrics , and Timed Get Up and Go . We considered the presence of at least one question naire with an impaired score as an abnormal reference exam . Additional reference exams are also discussed . RESULTS The prevalence of being at risk varied from 60 % to 94 % according to the various definitions of the reference test . When considering the primary reference test , a cut-off value of 14 for the G-8 tool provided a good sensitivity estimate ( 85 % ) without deteriorating the specificity excessively ( 65 % ) . CONCLUSION The G-8 shows good screening properties for identifying elderly cancer patients who could benefit from CGA Background ‘ Taste ’ changes are commonly reported during  chemotherapy .  It is unclear to what extent this relates to actual changes in taste function or to changes in appetite and food liking and how these changes affect dietary intake and nutritional status . Patients and methods This prospect i ve , repeated measures cohort study recruited participants from three oncology clinics . Women ( n = 52 ) prescribed adjuvant chemotherapy  underwent st  and ardised testing of taste perception , appetite and food liking  at six time points to measure change from baseline . Associations between taste and hedonic changes and nutritional outcomes were examined . Results Taste function was significantly reduced early in chemotherapy cycles ( p<0.05 ) but showed recovery by late in the cycle . Ability to correctly identify salty , sour and umami tastants was reduced . Liking of sweet food decreased early and mid-cycle ( p<0.01 ) but not late cycle . Liking of savory food was not significantly affected . Appetite decreased early in the cycle ( p<0.001 ) . Reduced taste function was associated with lowest kilojoule intake ( r = 0.31 ; p = 0.008 ) as was appetite loss with reduced kilojoule ( r = 0.34 ; p = 0.002 ) and protein intake ( r = 0.36 ; p = 0.001 ) early in the third chemotherapy cycle . Decreased appetite early in the third and final chemotherapy cycles was associated with a decline in BMI ( p = < 0.0005 ) over the study period . Resolution of taste function , food liking and appetite was observed 8 weeks after chemotherapy completion . There was no association between taste change and dry mouth , oral mucositis or nausea . Conclusion The results reveal , for the first time , the cyclical yet transient effects of adjuvant chemotherapy on taste function and the link between taste and hedonic changes , dietary intake and nutritional outcomes . The results should be used to inform reliable pre-chemotherapy education Background Growing evidence suggests that a comprehensive geriatric assessment ( CGA ) in older patients with cancer can detect unsuspected health problems , predict survival , and predict tolerance to chemotherapy . However , studies regarding CGA in cancer patients are scarce in Asia . Methods We prospect ively enrolled 65 elderly cancer patients who were c and i date s of systemic chemotherapy between July 2006 and March 2008 . Baseline CGA data including demographic information , comorbidity , functional status by means of Activities of Daily Living ( ADL ) , and Instrumental Activities of Daily Living ( IADL ) , cognition , psychological state , nutritional status , and medication were collected and analyzed . Quality of life ( QoL ) was assessed by the EORTC question naire QLQ-C30 . Results Of the 65 patients , the median age was 71 years ( range , 65–80 ) , 49 ( 75 % ) were males , and 58 ( 89 % ) had Eastern Cooperative Oncology Group performance status ( ECOG PS ) 0 or 1 . All patients had solid tumor , 74 % received palliative chemotherapy , and 18 % received adjuvant chemotherapy . Twenty-five percent of patients had Charlson ’s comorbidity index score of 2 or more , 23 % were ADL dependent , and 14 % were IADL dependent . Using Mini-Mental Status Exam ( MMSE ) , it was found that 51 % of patients had mild cognitive impairment ( MMSE score 17–24 ) , and 5 % had cognitive impairment ( ≤16 ) . Forty percent of patients had depression by Short form Geriatric Depression Scale ( SGDS ) , 19 % had malnutrition by Mini-Nutritional Assessment ( MNA ) , and 23 % had body mass index ( BMI ) less than 19.4 kg/m2 ( lowest 10 % ) . Global health status/ quality of life ( QoL ) was less than 50 % in 39 % of patients . Frail patients according to the Balducci classification had significantly poor ECOG PS and worse global health status/QoL.  Conclusion CGA was feasible and could detect multiple unsuspected health problems including functional impairment and malnutrition in Korean elderly cancer patients receiving chemotherapy BACKGROUND & AIMS A phase III , r and omized non-inferiority study was carried out to compare a two-drug combination ( including nutraceuticals , i.e. antioxidants ) with carnitine + celecoxib ± megestrol acetate for the treatment of cancer-related anorexia/cachexia syndrome ( CACS ) : the primary endpoints were increase of lean body mass ( LBM ) and improvement of total daily physical activity . Secondary endpoint was : increase of physical performance tested by grip strength and 6-min walk test . METHODS Sixty eligible patients were r and omly assigned to : arm 1 , L-carnitine 4 g/day + Celecoxib 300 mg/day or arm 2 , L-carnitine 4 g/day + celecoxib 300 mg/day + megestrol acetate 320 mg/day , all orally . All patients received as basic treatment polyphenols 300 mg/day , lipoic acid 300 mg/day , carbocysteine 2.7 g/day , Vitamin E , A , C. Treatment duration was 4 months . Planned sample size was 60 patients . RESULTS The results did not show a significant difference between tre atment arms in both primary and secondary endpoints . Analysis of changes from baseline showed that LBM ( by dual-energy X-ray absorptiometry and by L3 computed tomography ) increased significantly in both arms as well as physical performance assessed by 6MWT . Toxicity was quite negligible and comparable between arms . CONCLUSIONS The results of the present study showed a non-inferiority of arm 1 ( two-drug combination ) vs arm 2 ( two-drug combination + megestrol acetate ) . Therefore , this simple , feasible , effective , safe , low cost with favorable cost-benefit profile , two-drug approach could be suggested in the clinical practice to implement CACS treatment Goals of workThe aims of this secondary analysis were to determine the prevalence of nutrition impact symptoms in medical oncology patients at 1 , 6 , and 12 months after commencement of chemotherapy  and to investigate the relationship of these symptoms to quality of life ( QoL ) and performance status . Material s and methods A prospect i ve longitudinal survey was conducted in 219 medical oncology patients who had commenced chemotherapy in the past month . The Rotterdam Symptom Assessment  scale assessed the number and distress level of symptoms . The association between symptoms and global QoL and performance status as measured by the Life Satisfaction Scale was investigated . Main results Symptom prevalence as determined by the proportion of patients experiencing at least one nutrition impact symptom was 79 % and 72 % at 1 and 6 months after starting chemotherapy . Even at 12 months , symptom prevalence was 46 % . The most common symptoms included dry mouth , nausea , and constipation with the most distressing symptoms reported as dry mouth , diarrhea , and stomach pain . A higher number of symptoms was associated with lower QoL ( T1 : r = −0.35 , n = 217 , P < 0.05 ; T2 : r = −0.406 , n = 194 , P < 0.001 ; T3 : r = −0.353 , n = 157 , P < 0.001 ) . Patients experiencing more symptoms were more likely to have lower performance status at T2 and T3 ( T2 : n = 189 , P = 0.019 ; T3 : n = 143 , P = 0.003 ) . Conclusion Nutrition impact symptoms were commonly experienced , even 12 months following commencement of chemotherapy , and were associated with poorer QoL and performance status . This highlights the importance of early identification and management of nutrition impact symptoms with adequate follow-up in order to provide optimal care for people with cancer BACKGROUND Two previous GINECO elderly specific studies in advanced ovarian cancer ( AOC ) patients highlighted the prognostic value of geriatric covariates for overall survival ( OS ) . PATIENTS AND METHODS This open-label prospect i ve trial was design ed to identify the impact of geriatric covariates on OS in AOC patients ≥70 years treated with first-line carboplatin .  RESULTS Geriatric covariates of the 111 patients included median age 79 years ( ≥80 years : 41 % ) ; performance status ( PS ) ≥2 : 47 % ; ≥3 major comorbidities : 24 % ; ≥4 comedications : 68 % ; activities of daily living ( ADL ) score < 6 : 55 % ; instrumental activities of daily living ( IADL ) score < 25 : 69 % ; Hospital Anxiety and Depression Scale ( HADS ) > 14 : 37 %  . The median OS was 17.4 months . Overall , 74 % of patients completed the six planned chemotherapy cycles . Grade 3 - 4 haematological toxic effects were frequent ( 50 % ) but manageable . Grade 3 - 4 non-haematological toxicities included fatigue ( 15 % ) , anorexia ( 12 % ) , infections ( 9 % ) and thrombosis ( 2 % ) . A survival score = exp(0.327*GVS ) was developed , where the geriatric vulnerability score ( GVS ) is the sum of the following ( each assigned a value of one ) : albuminaemia < 35 g/l ; ADL score < 6 ; IADL score < 25 ; lymphopaenia < 1 G/l ; and HADS > 14 . With a cut-off ≥3 , GVS discriminated two groups with significantly different OS , treatment completion , severe adverse events and unplanned hospital admissions rates . CONCLUSIONS The GVS is a valuable tool for identifying vulnerable patients when treating an elderly AOC population BACKGROUND Elderly patients with advanced non-small-cell lung cancer ( NSCLC ) may derive similar benefit from platinum-based chemotherapy as younger patients .  Quality of life ( QoL ) and comprehensive geriatric assessment ( CGA ) is often advocated to assess benefits and risks . PATIENTS AND METHODS A total of 181 chemotherapy-naive patients [ ≥70 years , performance score ( PS ) of 0 - 2 ] with stage III-IV NSCLC received carboplatin and gemcitabine ( CG ) ( n = 90 ) or carboplatin and paclitaxel ( CP ) ( n = 91 ) every 3 weeks for up to four cycles . Primary end point was change in global QoL from baseline compared with week 18 . Pretreatment CGA and mini geriatric assessment during and after treatment were undertaken . A principal component ( PC ) analysis was carried out to determine the underlying dimensions of CGA and QoL and subsequently related to survival . RESULTS There were no changes in QoL after treatment . The number of QoL responders ( CG arm , 12 % ; CP arm , 5 % ) was not significantly different . CGA items were only associated with neuropsychiatric toxicity . Quality -adjusted survival was not different between treatment arms . The PC analysis derived from nine CGA , six QoL and one PS score indicated only one dominant dimension . This dimension was strongly prognostic , and physical and role functioning , Groningen Frailty Indicator and Geriatric Depression Scale were its largest contributors . CONCLUSIONS Paclitaxel or gemcitabine added to carboplatin did not have a differential effect on global QoL. CGA was associated with toxic effects in a very limited manner . CGA and QoL items measure one underlying dimension , which is highly prognostic BACKGROUND In routine practice , the evaluation of the nutritional status of patients with cancer is not always performed although there is frequent modification as disease progresses . The vali date d screening and evaluation tools currently available are time-consuming and costly . In this study we analysed factors that could be used to identify patients likely to need nutritional surveillance or intervention . PATIENTS AND METHODS A cross-sectional survey was carried out for 2 weeks in June 2006 on 477 patients with cancer . RESULTS 30.2 % of the patients had lost more than 10 % of their body weight since the start of the illness . After adjustment , the factors significantly associated with weight loss were : depressive state ( OR = 3.49 ; P = 0.002 ) , digestive or ENT tumours ( OR = 3.20 ; P = < 0.001 ) , chemotherapy ( OR = 2.66 ; P = 0.011 ) , male gender ( OR = 2.30 ; P = 0.001 ) and professional status ( OR = 2.08 ; P = 0.02 ) . Using a logistic model , we calculated the risk of weight loss as a function of the presence of the identified predictive factors . CONCLUSION We report a simple screening tool , which will not replace the available evaluation methods but will enable targeting of the patients most likely , after a specific evaluation , to benefit from nutritional intervention . This remains to be vali date d in further prospect i ve studies PURPOSE To identify Comprehensive Geriatric Assessment ( CGA ) components independently associated with changes in planned cancer treatment . PATIENTS AND METHODS We prospect ively included 375 consecutive elderly patients with cancer ( ELCAPA01 study ) assessed by geriatricians using the CGA .  Multivariate analysis was used to identify factors associated with changes in the cancer treatment ( intensification , decrease , or delayed > 2 weeks ) . Change was defined as a difference between the initial treatment proposal and the final treatment selected in a multidisciplinary meeting . RESULTS Mean age was 79.6 years ( st and ard deviation [ SD ] , 5.6 years ) , and 197 ( 52.5 % ) were women . The most common tumor location was the digestive system ( 58.7 % ) . The mean number of comorbidities was 4.2 ( SD , 2.7 ) per patient , and the mean Cumulative Illness Rating Scale for Geriatrics score was 11.8 ( SD , 5.3 ) . After the CGA , the initial cancer treatment plan was modified for 78 ( 20.8 % ) of 375 patients ( 95 % CI , 16.8 to 25.3 ) , usually to decrease treatment intensity ( 63 [ 80.8 % ] of 78 patients ) . By univariate analysis , cancer treatment changes were associated with Eastern Cooperative Oncology Group performance status ≥ 2 ( 73.3 % in the group with changes v 41.1 % in the in the group without changes ; P < .001 ) , dependency for one or more activities of daily living ( ADL ; 59.0 % v 24.2 % ; P < .001 ) , malnutrition ( 81.8 % v 51.2 % ; P < .001 ) , cognitive impairment ( 38.5 % v 24.9 % ; P = .023 ) , depression ( 52.6 % v 21.7 % ; P < .001 ) , and greater number of comorbidities ( mean , 4.8 [ SD , 2.9 ] v 4.0 [ SD , 2.6 ] ; P = .02 ) . By multivariate analysis , factors independently associated with cancer treatment changes were a lower ADL score ( odds ratio [ OR ] , 1.25 per 0.5-point decrease ; CI , 1.04 to 1.49 ; P = .016 ) and malnutrition ( OR , 2.99 ; CI , 1.36 to 6.58 ; P = .007 ) . CONCLUSION Functional status assessed by the ADL score and malnutrition were independently associated with changes in cancer treatment OBJECTIVE China is experiencing a rapid increase in cancer incidence in elderly patients . In order to better underst and this group , a large study of patients from multiple tertiary centers in the Beijing area was design ed . This study was design ed to provide insight into their unique treatment preferences , including the use of traditional Chinese medicine ( TCM ) . MATERIAL S AND METHODS 803 patients from nine hospitals in the Beijing area were enrolled into this study . The inclusion criteria were patients who were 65 years or older and had a diagnosis of cancer at any stage . The CGA question naire used with these patients included the Chinese translation of the Gero-Oncology Health and Quality of Life Assessment tool . The question naire was provided to patients by a research nurse and was administered in M and arin . RESULTS The mean age of the patients was 72 years ( range 65 - 94 ) . The patients were mainly male ( 59.8 % ) and of Han ethnicity ( 95.4 % ) . About 45 % of these patients also had concurrent  TCM  in addition to their other cancer treatments . About 70 % were able to manage their activities of daily living without assistance . Patients on TCM were more likely to have higher number of co-morbidities compared to their counterparts . CONCLUSION This is the largest prospect i ve study of CGA assessment s done on elderly patients with cancer in Asia . The study demonstrates that CGA provides insights into underst and ing the needs of elderly Chinese patients with cancer .  TCM is used frequently in China , and its impact on quality of life needs further investigation Purpose The MNA ( Mini Nutritional Assessment ) is known as a prognosis factor in older population . We analyzed the prognostic value for one-year mortality of MNA items in older patients with cancer treated with chemotherapy  as the basis of a simplified prognostic score . Methods The prospect i ve derivation cohort included 606 patients older than 70 years with an indication of chemotherapy for cancers . The endpoint to predict was one-year mortality . The 18 items of the Full MNA , age , gender , weight loss , cancer origin , TNM , performance status and lymphocyte count were considered to construct the prognostic model . MNA items were analyzed with a backward step-by-step multivariate logistic regression and other items were added in a forward step-by-step regression . External validation was performed on an independent cohort of 229 patients . Results At one year 266 deaths had occurred . Decreased dietary intake ( p = 0.0002 ) , decreased protein-rich food intake ( p = 0.025 ) , 3 or more prescribed drugs ( p = 0.023 ) , calf circumference < 31 cm ( p = 0.0002 ) , tumor origin ( p<0.0001 ) , metastatic status ( p = 0.0007 ) and lymphocyte count < 1500/mm3 ( 0.029 ) were found to be associated with 1-year mortality in the final model and were used to construct a prognostic score . The area under curve ( AUC ) of the score was 0.793 , which was higher than the Full MNA AUC ( 0.706 ) . The AUC of the score in validation cohort ( 229 subjects , 137 deaths ) was 0.698 . Conclusion Key predictors of one-year mortality included cancer cachexia clinical features , comorbidities , the origin and the advanced status of the tumor . The prognostic value of this model combining a subset of MNA items and cancer related items was better than the full MNA , thus providing a simple score to predict 1-year mortality in older patients with an indication of chemotherapy PURPOSE Older adults are vulnerable to chemotherapy toxicity ; however , there are limited data to identify those at risk . The goals of this study are to identify risk factors for chemotherapy toxicity in older adults and develop a risk stratification schema for chemotherapy toxicity . PATIENTS AND METHODS Patients age ≥ 65 years with cancer from seven institutions completed a prechemotherapy assessment  that captured sociodemographics , tumor/treatment variables , laboratory test results , and geriatric assessment variables ( function , comorbidity , cognition , psychological state , social activity/support , and nutritional status ) . Patients were followed through the chemotherapy course to capture grade 3 ( severe ) , grade 4 ( life-threatening or disabling ) , and grade 5 ( death ) as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events . RESULTS In total , 500 patients with a mean age of 73 years ( range , 65 to 91 years ) with stage I to IV lung ( 29 % ) , GI ( 27 % ) , gynecologic ( 17 % ) , breast ( 11 % ) , genitourinary ( 10 % ) , or other ( 6 % ) cancer joined this prospect i ve study . Grade 3 to 5 toxicity occurred in 53 % of the patients ( 39 % grade 3 , 12 % grade 4 , 2 % grade 5 ) . A predictive model for grade 3 to 5 toxicity was developed that consisted of geriatric assessment variables , laboratory test values , and patient , tumor , and treatment characteristics . A scoring system in which the median risk score was 7 ( range , 0 to 19 ) and risk stratification schema ( risk score : percent incidence of grade 3 to 5 toxicity ) identified older adults at low ( 0 to 5 points ; 30 % ) , intermediate ( 6 to 9 points ; 52 % ) , or high risk ( 10 to 19 points ; 83 % ) of chemotherapy toxicity ( P < .001 ) . CONCLUSION A risk stratification schema can establish the risk of chemotherapy toxicity in older adults . Geriatric assessment variables independently predicted the risk of toxicity RATIONALE Breast cancer is a disease of ageing . Functional independence in elderly patients , measured with the Katz activities of daily living ( ADL ) scale , predicts overall survival and the need for welfare support . Few prospect i ve studies have examined the feasibility of adjuvant chemotherapy and its impact on autonomy in women over 70 years of age with high-risk breast cancer . This multicentre phase II trial was design ed to assess the impact of adjuvant anthracycline-based chemotherapy on these patients ' autonomy . DESIGN AND METHODS In a two-stage Fleming design , women aged ≥70 years with histologically proven hormone-receptor-negative early breast cancer and a significant risk of recurrence ( pN+ or " high risk " pN0 ) received 4 cycles of nonpegylated liposomal doxorubicin 60 mg/m(2 ) and cyclophosphamide 600 mg/m(2 ) every 3 weeks postoperatively , on an outpatient basis . The primary endpoint was the change in the ADL score during chemotherapy . Secondary endpoints include comprehensive geriatric , quality -of-life and acceptability assessment s , tolerability , and long-term outcome . The results for the primary endpoint and other scales at completion of adjuvant chemotherapy are reported here , while long-term follow-up is not yet complete . RESULTS Forty patients ( median age 75 [ 70 - 82 ] ) were enrolled between February 2006 and November 2007 . Chemotherapy had no deleterious impact on ADL , cognition , mental status , or the frequency of comorbidities . In contrast , the number of patients at risk of malnutrition , based on the Mini Nutritional Assessment , more than doubled between baseline and the end of chemotherapy , rising from 15 % to 38 % . Quality -of-life deteriorated in terms of social and role functioning , likely owing to fatigue , loss of appetite , nausea and vomiting . Treatment acceptability was good . The main adverse effect was neutropenia , 15 % of the patients experiencing febrile neutropenia . No cardiac toxicity or toxic deaths occurred . CONCLUSION This study demonstrates the feasibility of an adjuvant chemotherapy regimen combining nonpegylated liposomal doxorubicin and cyclophosphamide in fit elderly women < 85 years with breast cancer .  Although chemotherapy had an impact on social and role functioning , autonomy was not impaired and toxicity was acceptable . Special attention should be paid to nutritional status before and after treatment CONTEXT Patients with gastrointestinal cancer are at high risk for deterioration of nutrition . Home parenteral nutrition ( HPN ) could improve nutritional status and quality of life ( QoL ) . OBJECTIVES The purpose of this study was 1 ) to evaluate the impact of HPN on QoL , 2 ) to assess changes in nutritional status , and 3 ) to assess proxy perception of patient well-being . METHODS We conducted a prospect i ve , observational , and a multicenter study . Inclusion criteria were adult patients with gastrointestinal cancer , for whom HPN was indicated and prescribed for at least 14 days . The physician , the patient , and a family member completed question naires at inclusion and 28 days later . The QoL was assessed by the patients using the Functional Assessment of Cancer Therapy-General question naire , at inclusion and 28 days later . RESULTS The study included 370 patients with gastrointestinal cancer . The HPN was indicated for cancer-related undernutrition in 89 % of the patients and was used as a complement to oral intake in 84 % . After 28 days of parenteral intake , global QoL was significantly increased ( 48.9 at inclusion vs. 50.3 , P=0.007 ) . The patients ' weight improved significantly by 2.7 % ( P<0.001 ) . The nutrition risk screening also decreased significantly ( 3.2±1.1 vs. 2.8±1.3 , P=0.003 ) . CONCLUSION HPN could provide benefit for malnourished patients with gastrointestinal cancer . However , r and omized controlled studies are required to confirm this benefit and the safety profile PURPOSE To determine factors associated with early functional decline during first-line chemotherapy in older patients . PATIENTS AND METHODS Patients age ≥ 70 years receiving first-line chemotherapy for cancer were prospect ively considered for inclusion across 12 centers in France . Functional decline was defined as a decrease of ≥ 0.5 points on the Activities of Daily Living ( ADL ) scale between the beginning of chemotherapy and the second cycle . Factors associated with functional decline were sought from pretreatment abbreviated comprehensive geriatric assessment , including ADL , Instrumental ADL ( IADL ) , Mini-Nutritional Assessment ( MNA ) , Mini-Mental State Examination ( MMSE ) , Geriatric Depression Scale ( GDS15 ) , and Timed Get Up and Go ( GUG ) test  , and from comorbidities ( Cumulative Illness Rating Scale-Geriatrics ) , MAX2 index , and baseline biologic and clinical information . RESULTS Of 364 included patients , 50 experienced functional decline ( 16.7 % ; median , 0.5 points ) . Abnormal preadmission performance status , IADL , GDS15 , MMSE , GUG , and MNA were associated with increased likelihood of functional decline ( univariate analysis ) . In the multivariate model adjusted for baseline ADL and MAX2 index , high baseline GDS ( odds ratio [ OR ] , 2.16 ; 95 % CI , 1.09 to 4.30 ; P = .03 ) and low IADL scores ( OR , 2.87 ; 95 % CI , 1.06 to 7.79 ; P = .04 ) were independently associated with increased risk of functional decline . CONCLUSION Our results outline associations between baseline depression , instrumental dependencies , and early functional decline  during chemotherapy for older patients . ADL should be sequentially evaluated early during treatment . Baseline evaluation of GDS15 and IADL may be proposed to anticipate this event BACKGROUND Mortality prediction is crucial to select the optimal treatment in elderly cancer patients . Our objective was to identify cancer-related factors and Comprehensive Geriatric Assessment ( CGA ) findings associated with 1-year mortality in elderly in patients and out patients with cancer . METHODS We prospect ively included patients aged ≥70 years who had solid or hematologic malignancies and in whom the CGA was performed by geriatricians in two French teaching hospitals . We identified independent predictors of 1-year mortality after study inclusion , using multivariate Cox models stratified on inpatient/outpatient status . We built three multivariate Cox models , since strong correlations linked activities of daily living ( ADL ) , Eastern Cooperative Oncology Group Performance Status ( ECOG-PS ) , and timed get-up- and -go test ( GUG ) results ; and since physicians ' preferences for these three assessment s vary . A sensitivity analysis was performed using multiple imputation . RESULTS Of the 993 patients ( mean age , 80.2 years ; 51.2 % men ) , 58.2 % were out patients and 46 % had metastatic disease . Colorectal cancer was the most common malignancy ( 21.4 % ) . Mortality rates after 6 and 12 months were 30.1 % and 41.2 % , respectively . In all models , tumor site and metastatic status ( p < .001 ) , age > 80 years ( p < .05 ) , higher number of severe comorbidities ( p < .05 ) , and malnutrition ( p < .001 ) were associated with death independently from impaired ECOG-PS ( p < .001 ) , ADL ( p < .001 ) , and GUG ( p < .001 ) . The adverse effect of metastatic status differed significantly across tumor sites , being greatest for breast and prostate cancer ( p < .001 ) . Multiple imputation produced similar results . CONCLUSION The predictors of 1-year mortality identified in our study may help physicians select the optimal cancer-treatment strategy in elderly patients INTRODUCTION In general , geriatric assessment ( GA ) provides the combined information on comorbidity and functional , nutritional and psychosocial status and may be predictive for mortality outcome of cancer patients . The impact of geriatric assessment on the outcome of older patients with colorectal cancer treated with chemotherapy is largely unknown . METHODS In a prospect i ve study , 143 patients with colorectal cancer who were 70years and older were assessed before chemotherapy  by Mini Nutritional Assessment ( MNA ) , Informant Question naire on Cognitive Decline in the Elderly ( IQCODE ) , Groningen Frailty Indicator ( GFI ) and Mini Mental State Examination ( MMSE ) . RESULTS Fifty-four ( 38 % ) patients received adjuvant chemotherapy and 89 ( 62 % ) patients received palliative chemotherapy .  Malnutrition and frailty were prevalent in 39 ( 27 % , assessed by MNA ) and 34 ( 24 % , by GFI ) patients , respectively ; whereas cognitive impairment was prevalent in 19 ( 13 % , by IQCODE ) and 11 ( 8 % , by MMSE ) patients , respectively . In patients with palliative chemotherapy , poor MNA scores were associated with receiving less than 4cycles of chemotherapy ( p=0.008 ) . Poor MNA and GFI scores were associated with increased hazard ratios ( HR ) for mortality for patients with palliative chemotherapy : HR=2.76 ( 95 % confidence interval [ CI ] : 1.60 - 4.77 ; p<0.001 ) and HR=2.72 ( 95 % CI : 1.58 - 4.69 ; p<0.001 ) , respectively , after adjustment for several clinical parameters . CONCLUSIONS Malnutrition and frailty were strongly associated with an increased mortality risk in patients who underwent palliative chemotherapy . Furthermore , a poor score on MNA was predictive for less tolerance of chemotherapy . Our findings may help the oncologist in future decision making and advice for elderly patients with colorectal cancer
BACKGROUND & AIMS The aims of this systematic review were ( i ) to determine the prevalence of malnutrition and cachexia in older cancer patients in a chemotherapy setting , and ( ii ) to report the chemotherapy-related causes of malnutrition and ( iii ) the consequences of malnutrition on the outcomes of these patients .