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Cancer-specific geriatric assessment and quality of life: important factors in caring for older patients with aggressive B-cell lymphoma

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Abstract

Purpose

To evaluate the efficacy and tolerability of chemotherapy, a geriatric assessment is recommended in elderly patients with cancer. We aimed to characterize and compare patients with aggressive lymphoma by objective response and survival status based on pre-treatment cancer-specific geriatric (C-SGA) and quality of life (QoL) assessments.

Methods

Patients not eligible for anthracycline-based first-line therapy or intensive salvage regimens completed C-SGA and QoL assessment before and after a rituximab-bendamustine-lenalidomide (R-BL) treatment in a phase II clinical trial. Clinical outcomes were compared based on pre-treatment individual and summary C-SGA measures, their cutoff-based subcategories and QoL indicators, using Wilcoxon rank sum or chi-square tests.

Results

A total of 57 patients (41 included in the clinical trial) completed a C-SGA. Participants with pre-treatment impaired functional status (Vulnerable Elders Survey-13 score ≥3) were more likely to experience worse outcomes: a higher proportion were non-responders, died before the median follow-up of 31.6 months (interquartile range (IQR) 27.9–37.9) or died during treatment. Non-responders were patients categorized as having possible depression (Geriatric Depression Scale-5 score ≥2) and with worse QoL scores for functional performance. Patients with worse C-SGA summary scores and with greater tiredness were more likely to die during treatment.

Conclusion

A pre-treatment impaired functional status is an important factor with respect to clinical outcomes in patients receiving an R-BL regimen. Individual geriatric and related QoL domains showed similar associations with clinical outcomes. Whether interventions targeting specific geriatric dimensions also translate in better symptom- or domain-specific QoL warrants further research.

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References

  1. Bailey C, Corner J, Addington-Hall J, Kumar D, Haviland J (2004) Older patients’ experiences of treatment for colorectal cancer: an analysis of functional status and service use. Eur J Cancer Care (Engl) 13:483–493

    Article  CAS  Google Scholar 

  2. Bernhard J, Lowy A, Mathys N, Herrmann R, Hurny C (2004) Health related quality of life: a changing construct? Qual Life Res 13:1187–1197

    Article  PubMed  Google Scholar 

  3. Bernhard J, Maibach R, Thurlimann B, Sessa C, Aapro MS, Swiss Group for Clinical Cancer R (2002) Patients’ estimation of overall treatment burden: why not ask the obvious? J Clin Oncol Off J Am Soc Clin Oncol 20:65–72

    CAS  Google Scholar 

  4. Biesma B, Wymenga AN, Vincent A, Dalesio O, Smit HJ, Stigt JA, Smit EF, van Felius CL, van Putten JW, Slaets JP, Groen HJ, Dutch Chest Physician Study G (2011) Quality of life, geriatric assessment and survival in elderly patients with non-small-cell lung cancer treated with carboplatin-gemcitabine or carboplatin-paclitaxel: NVALT-3 a phase III study. Ann Oncol 22:1520–1527

    Article  CAS  PubMed  Google Scholar 

  5. Borson S, Scanlan JM, Chen P, Ganguli M (2003) The Mini-Cog as a screen for dementia: validation in a population-based sample. J Am Geriatr Soc 51:1451–1454

    Article  PubMed  Google Scholar 

  6. Butow P, Coates A, Dunn S, Bernhard J, Hurny C (1991) On the receiving end. IV: validation of quality of life indicators. Ann Oncol 2:597–603

    Article  CAS  PubMed  Google Scholar 

  7. Chaibi P, Magne N, Breton S, Chebib A, Watson S, Duron JJ, Hannoun L, Lefranc JP, Piette F, Menegaux F, Spano JP (2011) Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients. Crit Rev Oncol Hematol 79:302–307

    Article  PubMed  Google Scholar 

  8. Cheson BD (2007) The International Harmonization Project for response criteria in lymphoma clinical trials. Hematol Oncol Clin North Am 21:841–854

    Article  PubMed  Google Scholar 

  9. Clough-Gorr KM, Noti L, Brauchli P, Cathomas R, Fried MR, Roberts G, Stuck AE, Hitz F, Mey U (2013) The SAKK cancer-specific geriatric assessment (C-SGA): a pilot study of a brief tool for clinical decision-making in older cancer patients. BMC Med Inform Decis Mak 13:93

    Article  PubMed  PubMed Central  Google Scholar 

  10. Clough-Gorr KM, Thwin SS, Stuck AE, Silliman RA (2012) Examining five- and ten-year survival in older women with breast cancer using cancer-specific geriatric assessment. Eur J Cancer 48:805–812

    Article  PubMed  Google Scholar 

  11. Coates A, Glasziou P, McNeil D (1990) On the receiving end—III. Measurement of quality of life during cancer chemotherapy. Ann Oncol 1:213–217

    Article  CAS  PubMed  Google Scholar 

  12. Decoster L, Van Puyvelde K, Mohile S, Wedding U, Basso U, Colloca G, Rostoft S, Overcash J, Wildiers H, Steer C, Kimmick G, Kanesvaran R, Luciani A, Terret C, Hurria A, Kenis C, Audisio R, Extermann M (2015) Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations. Ann Oncol 26:288–300

    Article  CAS  PubMed  Google Scholar 

  13. Extermann M, Meyer J, McGinnis M, Crocker TT, Corcoran MB, Yoder J, Haley WE, Chen H, Boulware D, Balducci L (2004) A comprehensive geriatric intervention detects multiple problems in older breast cancer patients. Crit Rev Oncol Hematol 49:69–75

    Article  PubMed  Google Scholar 

  14. Girre V, Falcou MC, Gisselbrecht M, Gridel G, Mosseri V, Bouleuc C, Poinsot R, Vedrine L, Ollivier L, Garabige V, Pierga JY, Dieras V, Mignot L (2008) Does a geriatric oncology consultation modify the cancer treatment plan for elderly patients? J Gerontol A Biol Sci Med Sci 63:724–730

    Article  PubMed  Google Scholar 

  15. Hall WH, Ramachandran R, Narayan S, Jani AB, Vijayakumar S (2004) An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer 4:94

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hamaker ME, Jonker JM, de Rooij SE, Vos AG, Smorenburg CH, van Munster BC (2012) Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol 13:e437–e444

    Article  PubMed  Google Scholar 

  17. Hitz F, Zucca E, Pabst T, Fischer N, Cairoli A, Samaras P, Caspar CB, Mach N, Krasniqi F, Schmidt A, Rothermundt C, Enoiu M, Eckhardt K, Berardi Vilei S, Rondeau S, Mey U (2016) Rituximab, bendamustine and lenalidomide in patients with aggressive B-cell lymphoma not eligible for anthracycline-based therapy or intensive salvage chemotherapy—SAKK 38/08. Br J Haematol 174(2):255–263

  18. Hurria A, Hurria A, Zuckerman E, Panageas KS, Fornier M, D’Andrea G, Dang C, Moasser M, Robson M, Seidman A, Currie V, VanPoznak C, Theodoulou M, Lachs MS, Hudis C (2006) A prospective, longitudinal study of the functional status and quality of life of older patients with breast cancer receiving adjuvant chemotherapy. J Am Geriatr Soc 54:1119–1124

    Article  PubMed  Google Scholar 

  19. Kim YJ, Kim JH, Park MS, Lee KW, Kim KI, Bang SM, Lee JS, Kim CH (2011) Comprehensive geriatric assessment in Korean elderly cancer patients receiving chemotherapy. J Cancer Res Clin Oncol 137:839–847

    Article  CAS  PubMed  Google Scholar 

  20. Luciani A, Ascione G, Bertuzzi C, Marussi D, Codeca C, Di Maria G, Caldiera SE, Floriani I, Zonato S, Ferrari D, Foa P (2010) Detecting disabilities in older patients with cancer: comparison between comprehensive geriatric assessment and vulnerable elders survey-13. J Clin Oncol Off J Am Soc Clin Oncol 28:2046–2050

    Article  Google Scholar 

  21. Luciani A, Foa P (2011) Reply to M.J. Molina-Garrido et al. J Clin Oncol 29:3202–3203

    Article  Google Scholar 

  22. Merli F, Bertini M, Luminari S, Mozzana R, Berte R, Trottini M, Stelitano C, Botto B, Pizzuti M, Quintana G, De Paoli A, Federico M, Intergruppo Italiano L (2004) Quality of life assessment in elderly patients with aggressive non-Hodgkin’s lymphoma treated with anthracycline-containing regimens. Report of a prospective study by the Intergruppo Italiano Linfomi. Haematologica 89:973–978

    PubMed  Google Scholar 

  23. Merli F, Luminari S, Rossi G, Mammi C, Marcheselli L, Tucci A, Ilariucci F, Chiappella A, Musso M, Di Rocco A, Stelitano C, Alvarez I, Baldini L, Mazza P, Salvi F, Arcari A, Fragasso A, Gobbi PG, Liberati AM, Federico M (2012) Cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab versus epirubicin, cyclophosphamide, vinblastine, prednisone and rituximab for the initial treatment of elderly “fit” patients with diffuse large B-cell lymphoma: results from the ANZINTER3 trial of the Intergruppo Italiano Linfomi. Leuk Lymphoma 53:581–588

    Article  CAS  PubMed  Google Scholar 

  24. Morrison VA, Hamlin P, Soubeyran P, Stauder R, Wadhwa P, Aapro M, Lichtman S (2015) Diffuse large B-cell lymphoma in the elderly: impact of prognosis, comorbidities, geriatric assessment, and supportive care on clinical practice. An International Society of Geriatric Oncology (SIOG) expert position paper. J Geriatr Oncol 6:141–152

    Article  PubMed  Google Scholar 

  25. Morrison VA, Hamlin P, Soubeyran P, Stauder R, Wadhwa P, Aapro M, Lichtman SM (2015) Approach to therapy of diffuse large B-cell lymphoma in the elderly: the International Society of Geriatric Oncology (SIOG) expert position commentary. Ann Oncol 26:1058–1068

    Article  CAS  PubMed  Google Scholar 

  26. Moser A, Stuck AE, Silliman RA, Ganz PA, Clough-Gorr KM (2012) The eight-item modified Medical Outcomes Study Social Support Survey: psychometric evaluation showed excellent performance. J Clin Epidemiol 65:1107–1116

    Article  PubMed  PubMed Central  Google Scholar 

  27. Nabhan C, Smith SM, Helenowski I, Ramsdale E, Parsons B, Karmali R, Feliciano J, Hanson B, Smith S, McKoy J, Larsen A, Hantel A, Gregory S, Evens AM (2012) Analysis of very elderly (>/=80 years) non-Hodgkin lymphoma: impact of functional status and co-morbidities on outcome. Br J Haematol 156:196–204

    Article  PubMed  Google Scholar 

  28. Oerlemans S, Issa DE, van den Broek EC, Nijziel MR, Coebergh JW, Huijgens PC, Mols F, van de Poll-Franse LV (2014) Health-related quality of life and persistent symptoms in relation to (R-)CHOP14, (R-)CHOP21, and other therapies among patients with diffuse large B-cell lymphoma: results of the population-based PHAROS-registry. Ann Hematol 93:1705–1715

    Article  CAS  PubMed  Google Scholar 

  29. Olivieri A, Gini G, Bocci C, Montanari M, Trappolini S, Olivieri J, Brunori M, Catarini M, Guiducci B, Isidori A, Alesiani F, Giuliodori L, Marcellini M, Visani G, Poloni A, Leoni P (2012) Tailored therapy in an unselected population of 91 elderly patients with DLBCL prospectively evaluated using a simplified CGA. Oncologist 17:663–672

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Pallis AG, Wedding U, Lacombe D, Soubeyran P, Wildiers H (2010) Questionnaires and instruments for a multidimensional assessment of the older cancer patient: what clinicians need to know? Eur J Cancer 46:1019–1025

    Article  CAS  PubMed  Google Scholar 

  31. Pasetto LM, Falci C, Compostella A, Sinigaglia G, Rossi E, Monfardini S (2007) Quality of life in elderly cancer patients. Eur J Cancer 43:1508–1513

    Article  PubMed  Google Scholar 

  32. Puts MT, Hardt J, Monette J, Girre V, Springall E, Alibhai SM (2012) Use of geriatric assessment for older adults in the oncology setting: a systematic review. J Natl Cancer Inst 104:1133–1163

    Article  CAS  PubMed  Google Scholar 

  33. Puts MT, Santos B, Hardt J, Monette J, Girre V, Atenafu EG, Springall E, Alibhai SM (2014) An update on a systematic review of the use of geriatric assessment for older adults in oncology. Ann Oncol 25:307–315

    Article  CAS  PubMed  Google Scholar 

  34. Rinaldi P, Mecocci P, Benedetti C, Ercolani S, Bregnocchi M, Menculini G, Catani M, Senin U, Cherubini A (2003) Validation of the five-item geriatric depression scale in elderly subjects in three different settings. J Am Geriatr Soc 51:694–698

    Article  PubMed  Google Scholar 

  35. Saliba D, Elliott M, Rubenstein LZ, Solomon DH, Young RT, Kamberg CJ, Roth C, MacLean CH, Shekelle PG, Sloss EM, Wenger NS (2001) The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc 49:1691–1699

    Article  CAS  PubMed  Google Scholar 

  36. Smith A, Howell D, Patmore R, Jack A, Roman E (2011) Incidence of haematological malignancy by sub-type: a report from the Haematological Malignancy Research Network. Br J Cancer 105:1684–1692

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Soubeyran P, Fonck M, Blanc-Bisson C, Blanc JF, Ceccaldi J, Mertens C, Imbert Y, Cany L, Vogt L, Dauba J, Andriamampionona F, Houede N, Floquet A, Chomy F, Brouste V, Ravaud A, Bellera C, Rainfray M (2012) Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. J Clin Oncol Off J Am Soc Clin Oncol 30:1829–1834

    Article  Google Scholar 

  38. Soubeyran P, Khaled H, MacKenzie M, Debois M, Fortpied C, de Bock R, Ceccaldi J, de Jong D, Eghbali H, Rainfray M, Monnereau A, Zulian G, Teodorovic I (2011) Diffuse large B-cell and peripheral T-cell non-Hodgkin’s lymphoma in the frail elderly. A phase II EORTC trial with a progressive and cautious treatment emphasizing geriatric assessment. Geriatr Oncol Rep 2:36–44

    Article  Google Scholar 

  39. Spina M, Balzarotti M, Uziel L, Ferreri AJ, Fratino L, Magagnoli M, Talamini R, Giacalone A, Ravaioli E, Chimienti E, Berretta M, Lleshi A, Santoro A, Tirelli U (2012) Modulated chemotherapy according to modified comprehensive geriatric assessment in 100 consecutive elderly patients with diffuse large B-cell lymphoma. Oncologist 17:838–846

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Tinquaut F, Freyer G, Chauvin F, Gane N, Pujade-Lauraine E, Falandry C (2016) Prognostic factors for overall survival in elderly patients with advanced ovarian cancer treated with chemotherapy: results of a pooled analysis of three GINECO phase II trials. Gynecol Oncol 143:22–26

    Article  PubMed  Google Scholar 

  41. Tucci A, Ferrari S, Bottelli C, Borlenghi E, Drera M, Rossi G (2009) A comprehensive geriatric assessment is more effective than clinical judgment to identify elderly diffuse large cell lymphoma patients who benefit from aggressive therapy. Cancer 115:4547–4553

    Article  PubMed  Google Scholar 

  42. Tucci A, Martelli M, Rigacci L, Riccomagno P, Cabras MG, Salvi F, Stelitano C, Fabbri A, Storti S, Fogazzi S, Mancuso S, Brugiatelli M, Fama A, Paesano P, Puccini B, Bottelli C, Dalceggio D, Bertagna F, Rossi G, Spina M, Italian Lymphoma F (2015) Comprehensive geriatric assessment is an essential tool to support treatment decisions in elderly patients with diffuse large B-cell lymphoma: a prospective multicenter evaluation in 173 patients by the Lymphoma Italian Foundation (FIL). Leuk Lymphoma 56:921–926

    Article  CAS  PubMed  Google Scholar 

  43. van der Poel MW, Oerlemans S, Schouten HC, Mols F, Pruijt JF, Maas H, van de Poll-Franse LV (2014) Quality of life more impaired in younger than in older diffuse large B cell lymphoma survivors compared to a normative population: a study from the population-based PROFILES registry. Ann Hematol 93:811–819

    Article  PubMed  Google Scholar 

  44. Vellas B, Villars H, Abellan G, Soto ME, Rolland Y, Guigoz Y, Morley JE, Chumlea W, Salva A, Rubenstein LZ, Garry P (2006) Overview of the MNA—its history and challenges. J Nutr Health Aging 10:456–463 discussion 463-455

    CAS  PubMed  Google Scholar 

  45. Wedding U, Pientka L, Hoffken K (2007) Quality-of-life in elderly patients with cancer: a short review. Eur J Cancer 43:2203–2210

    Article  PubMed  Google Scholar 

  46. Wedding U, Rohrig B, Klippstein A, Brix C, Pientka L, Hoffken K (2007) Co-morbidity and functional deficits independently contribute to quality of life before chemotherapy in elderly cancer patients. Support Care Cancer 15:1097–1104

    Article  PubMed  Google Scholar 

  47. Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen ML, Extermann M, Falandry C, Artz A, Brain E, Colloca G, Flamaing J, Karnakis T, Kenis C, Audisio RA, Mohile S, Repetto L, Van Leeuwen B, Milisen K, Hurria A (2014) International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 32:2595–603

  48. Wildiers H, Mauer M, Pallis A, Hurria A, Mohile SG, Luciani A, Curigliano G, Extermann M, Lichtman SM, Ballman K, Cohen HJ, Muss H, Wedding U (2013) End points and trial design in geriatric oncology research: a joint European organisation for research and treatment of cancer—Alliance for Clinical Trials in Oncology—International Society of Geriatric Oncology position article. J Clin Oncol 31:3711–3718

  49. Yoshida M, Nakao T, Horiuchi M, Ueda H, Hagihara K, Kanashima H, Inoue T, Sakamoto E, Hirai M, Koh H, Nakane T, Hino M, Yamane T (2016) Analysis of elderly patients with diffuse large B-cell lymphoma: aggressive therapy is a reasonable approach for ‘unfit’ patients classified by comprehensive geriatric assessment. Eur J Haematol 96:409–416

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This work was supported by the Swiss State Secretariat for Education, Research and Innovation, by Roche Pharma (Schweiz) AG, Mundipharma Medical Company (Schweiz), and Celgene GmbH. The authors thank the patients, their families, and the clinicians for contribution to the trial as well as the staff from participating sites and Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center.

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Authors and Affiliations

  1. International Breast Cancer Study Group, Coordinating Center, Effingerstr. 40, 3008, Bern, Switzerland

    Karin Ribi

  2. Swiss Group for Clinical Cancer Research, Coordinating Center, Effingerstr. 33, 3008, Bern, Switzerland

    Stéphanie Rondeau & Milica Enoiu

  3. Kantonsspital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Switzerland

    Felicitas Hitz

  4. Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland

    Ulrich Mey

  5. Inselspital Bern, Freiburgstrasse 8, 3010, Bern, Switzerland

    Thomas Pabst

  6. IOSI (Istituto Oncologico della Svizzera Italiana), 6500, Bellinzona, Switzerland

    Anastasios Stathis

  7. Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland

    Natalie Fischer

  8. Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg, 11 3012, Bern, Switzerland

    Kerri M. Clough-Gorr

  9. Section of Geriatrics, Boston University Medical Center, Harrison Ave, Boston, MA, 02111, USA

    Kerri M. Clough-Gorr

Authors
  1. Karin Ribi
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  2. Stéphanie Rondeau
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  3. Felicitas Hitz
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  4. Ulrich Mey
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  5. Milica Enoiu
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  6. Thomas Pabst
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  7. Anastasios Stathis
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  8. Natalie Fischer
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  9. Kerri M. Clough-Gorr
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Contributions

Karin Ribi and Kerri Clough-Gorr designed the C-SGA and QoL part of the study, analyzed the data, and wrote the manuscript. Stéphanie Rondeau analyzed the data and wrote the manuscript. Felicitas Hitz and Ulrich Mey designed the clinical study and performed the research. Milica Enoiu, Thomas Pabst, Anastasios Stathis, and Natalie Fischer performed the research.

Corresponding author

Correspondence to Karin Ribi.

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The authors declare that they have no conflict of interest. The authors have full control of all primary data and agree to allow the journal to review their data if requested.

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Ribi, K., Rondeau, S., Hitz, F. et al. Cancer-specific geriatric assessment and quality of life: important factors in caring for older patients with aggressive B-cell lymphoma. Support Care Cancer 25, 2833–2842 (2017). https://doi.org/10.1007/s00520-017-3698-4

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