Short summary

The incidence of cancer increases with age and in Denmark 46% of men and 40% of women are older than 70 years at diagnosis. Many of these have other comorbidities and functional limitations. Survival is influenced by the type of cancer but also by the burden of comorbidities and functional limitations. The purpose is to optimize comorbidities and functional performances and to study if comprehensive geriatric assessment can be a supplementary or better tool in the decision making before initiation of cancer treatment.

Rationale

Many elderly patients have comorbidities, the most significant of which are diseases of the heart, lungs and diabetes mellitus. Functional limitations and comorbidities are associated with poor survival in the general elderly population. Comorbidity seems to have little impact in aggressive cancers as for example lung cancer, but has been shown to impair survival in patients with cancers of the head and neck, breast, prostate, and some hematological cancers. Treatment options and tolerability are influenced by comorbidity and age with less extensive offerings to the older cancer patients. Danish 70+ year-old cancer patients use an average of 5 prescription medications. Addition of antineoplastic agents adds to the degree of polypharmacy and further increases the risk of one or more drug-drug interactions.

Comprehensive geriatric assessment (CGA) is a systematic multidimensional interdisciplinary diagnostic process addressing medical illnesses, polypharmacy, nutritional state, physical and cognitive function of elderly patients. In frail medical patients, the use of CGA increases the likelihood of survival and maintenance of functional level. In older patients with cancer, CGA might provide a better evaluation of patients than the usual performance score (PS), resulting in both more and less extensive cancer treatment options, but also a mean to identify and treat comorbidities and functional limitations.

The present study will collect data on CGA in cancer patients with comorbidities. The purpose is to optimize comorbidities and functional performances and to study if CGA can be a supplementary or better tool in the decision making before initiation of cancer treatment.

Description of the cohort

Elderly patients (65+ years) with newly diagnosed/relapse of cancer of different types in in combination with comorbidities or functional limitations.

Patients are referred from cancer treating surgical and oncologic departments at Odense University Hospital.

The patients will have comorbidities and/or functional problems in need of CGA, but be suffering from different cancers (gastro-intestinal, urologic, gynecologic, prostate, breast, hematologic, lung cancer)    

The database is expected to recruit 150 patients/ year.

Data and biological material

Pharmacologic treatment, geriatric interventions in relation to comorbidies, Charlson Comorbidity Score, Barthel-Index-20, Hand-grip, Chair-stand, lungfunction (FEV1, FVC), cognitive function measured by the OMC-test, nutritional assessment (MNA).

Collaborating researchers and departments

Elite Research Center AgeCare at Odense University Hospital

Department of Geriatric Medicine, Odense University Hospital

• Head of Department and Associate Professor Lars-Erik Matzen
• Jesper Ryg, MSc, PhD

Nottingham University Hospital, United Kingdom

• Visiting Professor Tahir Masud

Department of Oncology, Odense University Hospital

• Professor Jørn Herrstedt, DMSc
• Professor Per Pfeiffer, PhD
• Professor Olfred Hansen, PhD,
• Trine Lembrecht Jørgensen, Postdoc., PhD
• PhD-student Stefan Starup Jeppesen
• PhD-student Sambavy Nadaraja