Oncologists' perceptions on the usefulness of geriatric assessment measures and the CARG toxicity score when prescribing chemotherapy for older patients with cancer

Erin B Moth; Belinda E Kiely; Natalie Stefanic; Vasikaran Naganathan; Andrew Martin; Peter Grimison; Martin R Stockler; Philip Beale; Prunella Blinman

doi:10.1016/j.jgo.2018.11.004

Oncologists' perceptions on the usefulness of geriatric assessment measures and the CARG toxicity score when prescribing chemotherapy for older patients with cancer

J Geriatr Oncol. 2019 Mar;10(2):210-215. doi: 10.1016/j.jgo.2018.11.004. Epub 2018 Nov 28.

Authors

Erin B Moth¹, Belinda E Kiely², Natalie Stefanic³, Vasikaran Naganathan⁴, Andrew Martin³, Peter Grimison⁵, Martin R Stockler², Philip Beale², Prunella Blinman²

Affiliations

¹ Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia. Electronic address: Erin.Moth@health.nsw.gov.au.
² Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
³ University of Sydney, Sydney, Australia.
⁴ University of Sydney, Sydney, Australia; Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Sydney, Australia.
⁵ The Chris O'Brien Lifehouse, Sydney, Australia.

PMID: 30503312
DOI: 10.1016/j.jgo.2018.11.004

Abstract

Background: The use of geriatric assessment (GA) and the Cancer and Aging Research Group (CARG) Toxicity Score by Australian oncologists is low. We sought oncologists' views about the value of GA and the CARG Score when making decisions about chemotherapy for their older patients.

Methods: Patients aged ≥65 yrs. with a plan to start chemotherapy for a solid organ cancer underwent a GA and had their CARG Score calculated. Results of the GA and CARG Score were provided to treating oncologists who then completed a questionnaire on the value of these measures for each patient.

Results: We enrolled 30 patients from eight oncologists. Patients had a median age of 76 years and most (77%) were ECOG performance status 0 or 1. Risk category for severe chemotherapy toxicity by CARG Score was low in 7 patients (23%), intermediate in 18 (60%), and high in 5 (17%). The GA provided oncologists new information for 12 patients (40%), most frequently in the domains of function and nutrition. Knowledge of the GA prompted supportive interventions for 7 patients (23%). Oncologists considered modifications to recommended chemotherapy based on the CARG Score for 2 patients (7%) (one more intensive and one less intensive), and based on GA for no patients. Oncologists judged the GA and CARG Score as useful in 26 (87%) and 25 (83%) patients, respectively.

Conclusion: Although oncologists valued the GA and CARG Score, they rarely used them to modify chemotherapy. The GA provided new information that prompted supportive interventions in one quarter of patients.

Keywords: Chemotherapy toxicity; Decision-making; Elderly; Older adult.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Antineoplastic Agents / adverse effects*
Attitude of Health Personnel*
Clinical Decision-Making*
Female
Geriatric Assessment*
Humans
Male
Neoplasms / drug therapy*
Oncologists*
Risk Assessment

Substances

Antineoplastic Agents