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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

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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).

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Notes

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

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

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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.

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Authors and Affiliations

  1. Department of Clinical Epidemiology, VieCuri Medical Center, P.O. box 1926, 5900 BX, Venlo, The Netherlands

    Elisabeth J. M. Driessen & Maryska L. G. Janssen-Heijnen

  2. Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands

    Elisabeth J. M. Driessen & Maryska L. G. Janssen-Heijnen

  3. MAASTRO Clinic, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. box 3035, 6202 NA, Maastricht, The Netherlands

    Judith G. M. van Loon

  4. Department of Geriatric Medicine, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands

    Huub A. Maas

  5. Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands

    Anne-Marie C. Dingemans

Authors
  1. Elisabeth J. M. Driessen
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  2. Judith G. M. van Loon
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  5. Maryska L. G. Janssen-Heijnen
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Correspondence to Elisabeth J. M. Driessen.

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Driessen, E.J.M., van Loon, J.G.M., Maas, H.A. et al. Geriatric Assessment for Older Patients with Non-small Cell Lung Cancer: Daily Practice of Centers Participating in the NVALT25-ELDAPT Trial. Lung 196, 463–468 (2018). https://doi.org/10.1007/s00408-018-0116-8

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