Lung

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Geriatric Assessment for Older Patients with Non-small Cell Lung Cancer: Daily Practice of Centers Participating in the NVALT25-ELDAPT Trial

  • Elisabeth J. M. Driessen
  • Judith G. M. van Loon
  • Huub A. Maas
  • Anne-Marie C. Dingemans
  • Maryska L. G. Janssen-Heijnen
LUNG CANCER
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Abstract

Introduction

Geriatric assessment (GA) for older patients with lung cancer could provide insight into vulnerability, cognitive impairment, and risk of toxicity. Discontinuation and complications of intensive treatment could potentially be prevented in vulnerable and frail patients. This study aimed to evaluate current clinical practice of GA for older patients with lung cancer in the Netherlands and identify potential hurdles for implementation.

Methods

Pulmonologists and radiation oncologists participating in the NVALT25-ELDAPT trial completed an online questionnaire regarding current practice of GA, added value of GA for treatment decision-making and logistic barriers for patients with non-small cell lung cancer.

Results

15 out of 17 centers responded. Three performed GA as standard procedure, three on indication, eight considered a frailty screening step before GA, and one did not perform GA. Suspicion of cognitive problems was mentioned most often as indication for GA and of added value for treatment decision-making, followed by older age, curative-intent treatment, and stage I–III lung cancer. Administered instruments for screening and extensive GA were diverse. Main barriers to implement GA in clinical practice were logistic problems (timescales and availability of trained personnel).

Conclusion

The use of GA in clinical practice for patients with lung cancer varied widely across centers regarding instruments and domains. Physicians are uniform in their opinion about indications for GA and the added value for treatment decision-making. Research should focus on manageable instruments and important domains to assess for this heterogeneous group of older patients with lung cancer to optimize treatment selection.

Trial registration The NVALT25-ELDAPT trial is registered under trial number NCT02284308. Details are available at http://www.eldapt.org (predominantly in Dutch).

Keywords

Geriatric assessment Non-small cell lung cancer Frailty Questionnaire Elderly 

Abbreviations

ADL

Activities of daily living

CHRT

Chemoradiotherapy

ELDAPT

Elderly with locally advanced lung cancer: deciding through geriatric Assessment on the oPtimal Treatment strategy

GA

Geriatric assessment

GFI

Groningen frailty indicator

GP

General practitioner

ICF

International classification of functioning

IADL

Incremental activities of daily living

MMSE

Mini-mental state examination

MNA

Mini nutritional assessment

NSCLC

Non-small cell lung cancer

NVALT25

Dutch association of medical specialists for lung disease and tuberculosis (study number 25)

PS

Performance status

SPPB

Short physical performance battery

Notes

Acknowledgements

All authors made substantial contributions to the design of the questionnaire, proofreading the manuscript, revising the contents critically, and approving the final version before publication. ED additionally contributed in the distribution, collection, analysis, and interpretation of the data, and drafting the article. We would like to thank Dr. K Smits, Dr. Y Lievens, Dr. M Joore, Dr. B Ramaekers, Dr. F van den Berkmortel, Dr. A Berlanga, R Houben, Dr. A. Dekker, and other project team members for their insights, expertise, and time invested in the development and implementation of the NVALT25-ELDAPT trial.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

408_2018_116_MOESM1_ESM.docx (35 kb)
Supplementary material 1 (DOCX 35 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Elisabeth J. M. Driessen
    • 1
    • 2
  • Judith G. M. van Loon
    • 3
  • Huub A. Maas
    • 4
  • Anne-Marie C. Dingemans
    • 5
  • Maryska L. G. Janssen-Heijnen
    • 1
    • 2
  1. 1.Department of Clinical EpidemiologyVieCuri Medical CenterVenloThe Netherlands
  2. 2.Department of Epidemiology, GROW School for Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
  3. 3.MAASTRO Clinic, GROW School for Oncology and Developmental BiologyMaastricht University Medical CenterMaastrichtThe Netherlands
  4. 4.Department of Geriatric MedicineElisabeth-Tweesteden HospitalTilburgThe Netherlands
  5. 5.Department of Pulmonary Diseases, GROW School for Oncology and Developmental BiologyMaastricht University Medical CenterMaastrichtThe Netherlands

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