Geriatric Assessment as a Predictor of Tolerance, Quality of Life, and Outcomes in Older Patients With Head and Neck Cancers and Lung Cancers Receiving Radiation Therapy

Noam Vanderwalde, Allison M. Deal, Elizabeth Comitz, Lori Stravers, Hyman Muss, Bryce B. Reeve, Ethan Basch, Joel Tepper, Bhishamjit Chera

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Purpose To evaluate the association between functional status based on a geriatric assessment (GA) and outcomes of tolerance to treatment in patients with lung or head and neck cancer receiving radiation therapy (RT) or chemoradiation (CRT). Methods and Materials A prospective cohort study was conducted in patients aged ≥65 years with head and neck cancer or lung cancer undergoing curative intent RT or CRT. Pretreatment GA, health-related quality of life (HRQoL), and patient-reported outcomes (PRO) were obtained. Questionnaires were repeated biweekly during RT and at 6 weeks after treatment. Dysfunction was defined as scores <14 on the Instrumental Activities of Daily Living scale. Poor tolerance to treatment was defined by hospitalization, >3-day treatment delay, change in RT or CRT regimen, or death. Associations of dysfunction with tolerance to radiation therapy, HRQoL changes, and PRO ratings were evaluated. Results Of the 50 patients accrued, 46 had evaluable data. Mean age was 72.5 years (range, 65-92 years). At baseline, 37% had dysfunction. Poor tolerance to RT or CRT occurred in 39%. There was no association between dysfunction and tolerance. Patients with dysfunction had lower baseline HRQoL scores. From baseline to end of RT, those with baseline dysfunction had less of a decline in Role Functioning (P=.01) and Global Health Score (P=.04) domains. However, from end of RT to 6-week follow-up, those with dysfunction were more likely to continue to drop in the Physical, Role Functioning, and Social domains (all P<.01). Dysfunction at baseline was also associated with higher severity of certain PROs. Conclusions Pretreatment dysfunction was associated with continued decline and lack of recovery of HRQoL in this patient population. Larger studies could further elucidate the GA's predictive value.

Original languageEnglish (US)
Pages (from-to)850-857
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume98
Issue number4
DOIs
StatePublished - Jul 15 2017

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geriatrics
Geriatric Assessment
Head and Neck Neoplasms
lungs
radiation therapy
Lung Neoplasms
Radiotherapy
cancer
Quality of Life
health
predictions
pretreatment
ratings
death
Cohort Studies
Therapeutics
recovery
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Geriatric Assessment as a Predictor of Tolerance, Quality of Life, and Outcomes in Older Patients With Head and Neck Cancers and Lung Cancers Receiving Radiation Therapy. / Vanderwalde, Noam; Deal, Allison M.; Comitz, Elizabeth; Stravers, Lori; Muss, Hyman; Reeve, Bryce B.; Basch, Ethan; Tepper, Joel; Chera, Bhishamjit.

In: International Journal of Radiation Oncology Biology Physics, Vol. 98, No. 4, 15.07.2017, p. 850-857.

Research output: Contribution to journalArticle

Vanderwalde, Noam ; Deal, Allison M. ; Comitz, Elizabeth ; Stravers, Lori ; Muss, Hyman ; Reeve, Bryce B. ; Basch, Ethan ; Tepper, Joel ; Chera, Bhishamjit. / Geriatric Assessment as a Predictor of Tolerance, Quality of Life, and Outcomes in Older Patients With Head and Neck Cancers and Lung Cancers Receiving Radiation Therapy. In: International Journal of Radiation Oncology Biology Physics. 2017 ; Vol. 98, No. 4. pp. 850-857.
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abstract = "Purpose To evaluate the association between functional status based on a geriatric assessment (GA) and outcomes of tolerance to treatment in patients with lung or head and neck cancer receiving radiation therapy (RT) or chemoradiation (CRT). Methods and Materials A prospective cohort study was conducted in patients aged ≥65 years with head and neck cancer or lung cancer undergoing curative intent RT or CRT. Pretreatment GA, health-related quality of life (HRQoL), and patient-reported outcomes (PRO) were obtained. Questionnaires were repeated biweekly during RT and at 6 weeks after treatment. Dysfunction was defined as scores <14 on the Instrumental Activities of Daily Living scale. Poor tolerance to treatment was defined by hospitalization, >3-day treatment delay, change in RT or CRT regimen, or death. Associations of dysfunction with tolerance to radiation therapy, HRQoL changes, and PRO ratings were evaluated. Results Of the 50 patients accrued, 46 had evaluable data. Mean age was 72.5 years (range, 65-92 years). At baseline, 37{\%} had dysfunction. Poor tolerance to RT or CRT occurred in 39{\%}. There was no association between dysfunction and tolerance. Patients with dysfunction had lower baseline HRQoL scores. From baseline to end of RT, those with baseline dysfunction had less of a decline in Role Functioning (P=.01) and Global Health Score (P=.04) domains. However, from end of RT to 6-week follow-up, those with dysfunction were more likely to continue to drop in the Physical, Role Functioning, and Social domains (all P<.01). Dysfunction at baseline was also associated with higher severity of certain PROs. Conclusions Pretreatment dysfunction was associated with continued decline and lack of recovery of HRQoL in this patient population. Larger studies could further elucidate the GA's predictive value.",
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T1 - Geriatric Assessment as a Predictor of Tolerance, Quality of Life, and Outcomes in Older Patients With Head and Neck Cancers and Lung Cancers Receiving Radiation Therapy

AU - Vanderwalde, Noam

AU - Deal, Allison M.

AU - Comitz, Elizabeth

AU - Stravers, Lori

AU - Muss, Hyman

AU - Reeve, Bryce B.

AU - Basch, Ethan

AU - Tepper, Joel

AU - Chera, Bhishamjit

PY - 2017/7/15

Y1 - 2017/7/15

N2 - Purpose To evaluate the association between functional status based on a geriatric assessment (GA) and outcomes of tolerance to treatment in patients with lung or head and neck cancer receiving radiation therapy (RT) or chemoradiation (CRT). Methods and Materials A prospective cohort study was conducted in patients aged ≥65 years with head and neck cancer or lung cancer undergoing curative intent RT or CRT. Pretreatment GA, health-related quality of life (HRQoL), and patient-reported outcomes (PRO) were obtained. Questionnaires were repeated biweekly during RT and at 6 weeks after treatment. Dysfunction was defined as scores <14 on the Instrumental Activities of Daily Living scale. Poor tolerance to treatment was defined by hospitalization, >3-day treatment delay, change in RT or CRT regimen, or death. Associations of dysfunction with tolerance to radiation therapy, HRQoL changes, and PRO ratings were evaluated. Results Of the 50 patients accrued, 46 had evaluable data. Mean age was 72.5 years (range, 65-92 years). At baseline, 37% had dysfunction. Poor tolerance to RT or CRT occurred in 39%. There was no association between dysfunction and tolerance. Patients with dysfunction had lower baseline HRQoL scores. From baseline to end of RT, those with baseline dysfunction had less of a decline in Role Functioning (P=.01) and Global Health Score (P=.04) domains. However, from end of RT to 6-week follow-up, those with dysfunction were more likely to continue to drop in the Physical, Role Functioning, and Social domains (all P<.01). Dysfunction at baseline was also associated with higher severity of certain PROs. Conclusions Pretreatment dysfunction was associated with continued decline and lack of recovery of HRQoL in this patient population. Larger studies could further elucidate the GA's predictive value.

AB - Purpose To evaluate the association between functional status based on a geriatric assessment (GA) and outcomes of tolerance to treatment in patients with lung or head and neck cancer receiving radiation therapy (RT) or chemoradiation (CRT). Methods and Materials A prospective cohort study was conducted in patients aged ≥65 years with head and neck cancer or lung cancer undergoing curative intent RT or CRT. Pretreatment GA, health-related quality of life (HRQoL), and patient-reported outcomes (PRO) were obtained. Questionnaires were repeated biweekly during RT and at 6 weeks after treatment. Dysfunction was defined as scores <14 on the Instrumental Activities of Daily Living scale. Poor tolerance to treatment was defined by hospitalization, >3-day treatment delay, change in RT or CRT regimen, or death. Associations of dysfunction with tolerance to radiation therapy, HRQoL changes, and PRO ratings were evaluated. Results Of the 50 patients accrued, 46 had evaluable data. Mean age was 72.5 years (range, 65-92 years). At baseline, 37% had dysfunction. Poor tolerance to RT or CRT occurred in 39%. There was no association between dysfunction and tolerance. Patients with dysfunction had lower baseline HRQoL scores. From baseline to end of RT, those with baseline dysfunction had less of a decline in Role Functioning (P=.01) and Global Health Score (P=.04) domains. However, from end of RT to 6-week follow-up, those with dysfunction were more likely to continue to drop in the Physical, Role Functioning, and Social domains (all P<.01). Dysfunction at baseline was also associated with higher severity of certain PROs. Conclusions Pretreatment dysfunction was associated with continued decline and lack of recovery of HRQoL in this patient population. Larger studies could further elucidate the GA's predictive value.

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