urc mondor

Unité de Recherche Clinique Henri Mondor

Predictors of 1-Year Mortality in a Prospective Cohort of Elderly Patients With Cancer.

Ferrat E, Paillaud E, Laurent M, Le Thuaut A, Caillet P, Tournigand C, Lagrange J-L, Canoui-Poitrine F, Bastuji-Garin S J Gerontol A Biol Sci Med Sci. 2015;70(9):1148-55.

<p><b>BACKGROUND: </b>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 inpatients and outpatients with cancer.</p><p><b>METHODS: </b>We prospectively 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 assessments vary. A sensitivity analysis was performed using multiple imputation.</p><p><b>RESULTS: </b>Of the 993 patients (mean age, 80.2 years; 51.2% men), 58.2% were outpatients 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.</p><p><b>CONCLUSION: </b>The predictors of 1-year mortality identified in our study may help physicians select the optimal cancer-treatment strategy in elderly patients.</p>

MeSH terms: Age Factors; Aged; Aged, 80 and over; Comorbidity; Disabled Persons; Female; France; Geriatric Assessment; Humans; Male; Malnutrition; Mobility Limitation; Multivariate Analysis; Neoplasm Metastasis; Neoplasms; Prospective Studies
DOI: 10.1093/gerona/glv025