Artikel
Geriatric screening of elderly neuro-oncologic patients
Geriatrisches Screening neuro-onkologischer PatientInnen
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Veröffentlicht: | 25. Mai 2022 |
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Objective: Assuming that elderly patients suffer more severely from side effects of the standard therapies, less aggressive treatment protocols have been established, e.g. the NOA-8 study. This practice has been questioned by several retrospective studies using standard protocol. However, none of these studies have included any geriatric assessment. In a first step, the aim of the present pilot series was to establish and assess a routine geriatric screening in our neuro-oncologic outpatient office.
Methods: Elderly patients (aged ≥ 65 years) in our neuro-oncologic out-patients office were routinely asked to answer a geriatric questionnaire during a 10-month period (02/2021 – 11/2021). We screened patients using the ISAR (Identification of Seniors at Risk) tool consisting of 6+1 questions, dichotomising patients into two groups with low (0 - 2) and high ISAR values (3 - 6). The patient´s daily performance was assessed using the Karnofsky performance scale (KPS), Neurological Assessment in Neuro-oncology (NANO) and Distress thermometer. Data were collected and analysed using the Prism 9 programme (GraphPad Prism).
Results: The present analysis includes a cohort of 268 elderly neuro-oncologic patients treated in 445 consultations. 107 patients suffered from malign and / or life-threatening neoplasms, 161 from benign lesions. 154 patients were female, 114 male. Median age was 71 years (65 – 87 years) and median KPS 90 % (50 – 100 %).
226 patients (84 %) answered 6.8 of the 6 + 1 questions of the ISAR questionnaire. 23 patients (10 %) reported that they had needed regular help before diagnosis and 32 patients (14 %) more help within the last 24 hours. 95 patients (42 %) required a hospital admission in the last 6 months. 40 patients (18 %) had significant vision problems that couldn’t be corrected with glasses and 52 patients (23 %) suffered from serious memory problems. 94 patients (42 %) took ≥ 6 different medications per day. Finally, 68 patients (32 %) needed help filling out the questionnaire. High ISAR values correlated with low KPS values, high NANO values and high distress (each p < 0.0001).
Conclusion: A significant number of elderly neuro-oncologic patients suffer from geriatric impairments. Abnormal geriatric screening correlates with poor general performance, neurological impairment, and high distress. In future, geriatric screening might help to specifically choose a therapy from different options in elderly neuro-oncologic patients.