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Identifier 000410174
Title Πολυδιάστατη γηριατρική αξιολόγηση και εκτίμηση ποιότητας ζωής και ανοχής στη θεραπεία σε ηλικιωμένους ασθενείς με ανεγχείρητο μη-μικροκυτταρικό καρκίνο πνεύμονα που υποβάλλονται σε χημειοθεραπεία
Alternative Title Comprehensive geriatric assessment and assessment of quality of life and treatment tolerance in elderly patients with inoperable non-small cell lung cancer receiving chemotherapy
Author Καραμπεάζης, Αθανάσιος
Thesis advisor Γεωργούλιας, Βασίλης
Reviewer Μαυρουδής, Δημήτριος
Σαμώνης, Γεώργιος
Λιονής, Χρήστος
Αγγελάκη, Σοφία
Σουγκλάκος, Ιωάννης
Κωτσάκης, Αθανάσιος
Abstract The aim of the current study was to evaluate the role of a Comprehensive Geriatric Assessment (CGA) and its domains, such as functional independence, comorbidity, polypharmacy, depression, cognitive impairment, malnutrition and presence of geriatric syndromes as prognostic and provleptic tools in elderly patients with advanced non-small cell lung cancer (NSCLC) receiving chemotherapy. Cancer is a disease of the elderly with 60% of new diagnosis and 70% of cancer deaths occuring in patients over the age of 65 years. Lung cancer is the commonest type of cancer in developed world and the leading cause of cancer deaths with a median age at diagnosis of 71 years in US. NSCLC representing 85% of lung cancer cases is usually diagnosed in advanced stage, where combination chemotherapy offers a survival benefit in molecular-unselected patients with good perfomance status. Older patients are under-represented in clinical trials while data from elderly-specific trials are conflicting. Therefore, the optimal management for this population remains unclear. Ageing is a highly individualized process and the chronologic age does not always reflect the actual “biologic” age. Olders consists a heterogeneous population depending on their model of ageing. A CGA is proposed for the multidimensional assessment of elders, consisted of validated questionnaires and instruments for the evaluation of functional, emotional and cognitive status, the comorbid diseases, the nutritional status, polypharmacy, presence of geriatric syndromes and socio-economic issues, aiming to guide personalized treatment decision. In this study, 201 patients with advanced NSCLC receiving first-line (n=138) or salvage chemotherapy (n=63) within five phase II and III elderly-specific trials condacted by the Hellenic Oncology Researsh Group (HORG) were prospectively assessed with a baseline CGA and categorised into three groups, as fit (30,3%) vulnerable (45,8%) or frail (23,9%), according to Balducci criteria. Median age was 75 years (range 65-92), while 53% and 42% were over the age of 75 and 80 years, respectively. The univariate and multivariate analysis of CGA domains indicated a significant correlation for severe treatment-related toxicity with age ≥ 75 years, impaired ECOG PS of 2, non-fitness according to CGA and treatment with combination of a classic cytotoxic and a biologic agent, while disease stage and combination treatment were significantly correlated with response to treatment. ECOG PS, combination treatment and cognitive status were identified as significant prognostic factors for survival. The results of the current study revealed that a CGA in older patients with advanced NSCLC is feasible and offers valuable prognostic information for treatment toxicity and survival that can help individualize treatment decision in everyday clinical practice. In addition, the study results can contribute to future clinical research by using the identified prognostic biomarkers as stratification factors of older patients participating in clinical trials but also as domains that merit furter evaluation within ongoing research on the development of optimal tools for geriatric assessment.
Language Greek
Issue date 2017-07-26
Collection   Faculty/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
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