Treatment Recommendations and Estimation of Toxicity in Older Patients with Glioblastoma
Lauryn Hemminger1, Wade Whitt1, Sarah Cawley1, Jacqueline Behr1, Jennifer Serventi1, Andrea Wasilewski2, Nimish Mohile1, Sara Hardy1
1University of Rochester Medical Center, 2Givens Brain Tumor Center
Objective:
Describe provider treatment decisions and estimation of toxicity independent of geriatric assessment (GA) in older adults with glioblastoma (GBM).
Background:
Older adults (>/=65) with GBM are vulnerable to over and under treatment and increased toxicity. Geriatric assessment predicts toxicity in patients with cancer, but data is limited in neuro-oncology.
Design/Methods:
IRB-approved prospective study of 26 older adults with GBM enrolled at a single academic institution. Patients completed GA prior to treatment including G8 geriatric screen and comprehensive geriatric assessment (CGA). Providers recommended treatment and estimated toxicity based on clinical judgement and independent of GA. Demographics and treatment intolerance (delays, cessation or modification) were collected. Ordinal logistic regressions evaluated if G8 or CGA components were associated with treatment recommendation or treatment intolerance.
Results:
19/26 were men, median age 73, 11 MGMT methylated, 7 gross total resection, 9 subtotal, 10 biopsy. 77% (20/26) had G8 score </= 14, indicating need for CGA. Disease-directed therapy was recommended for all patients. Of patients with G8 </= 14, 5% (1/20) were recommended for clinical trial, 35% (7/20) 6 weeks radiation + chemotherapy, 35% (7/20) 3 weeks radiation + chemotherapy, and 25% (5/20) 3 weeks radiation alone. There was no association between G8 score or CGA components and treatment recommendation. 54% (14/26) experienced treatment intolerance; 13/20 who received radiation + chemotherapy and 1/6 who received radiation alone. The most common toxicity was fatigue requiring chemotherapy dose modification. Age was predictive of treatment intolerance (p=0.048). Providers predicted treatment intolerance 54% (14/26) of the time.
Conclusions:
Treatment recommendations based on clinical judgement were independent of GA, suggesting that providers did not detect geriatric vulnerabilities found on G8 or CGA in majority of older patients with GBM. Treatment toxicity is common in older patients with GBM and underestimated by providers. Prospective studies should evaluate whether GA can guide treatment recommendations and reduce toxicity.