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Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 208-217

Initial experience of a geriatric oncology clinic in a tertiary cancer center in India

1 Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
2 Utsaah Foundation, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
3 Department of Clinical Pharmacology, ACTREC, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Correspondence Address:
Kumar Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai - 400 012, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CRST.CRST_119_20

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Background: Little is known about the comprehensive geriatric assessment (CGA) profile of Indian patients. We aimed to describe the CGA results of the Indian geriatric oncology patients and identify the incidence of polypharmacy. Methods: The study is a retrospective analysis of the data collected in the geriatric oncology clinic at Tata Memorial Hospital, a tertiary cancer hospital in India. Patients aged 60 years and over with malignancy were evaluated. The baseline social, demographic, and disease details were recorded. All patients underwent a CGA, in which the domains of nutrition, function and falls, psychological status, cognition, comorbidities, social support, fatigue, and polypharmacy were evaluated using various validated tools. Life expectancy and the risk of toxicity from chemotherapy were calculated. Based on the results of the CGA, the patients were referred to various specialists and advised methods to address any identified vulnerabilities. The study was approved by the Institutional Review Board, which granted a waiver of the requirement for written informed consent. Results: A total of 251 patients were assessed between June 2018 and March 2020. All patients had solid tumor malignancies, commonly lung (41%) and gastrointestinal (28%). Fifty-nine percent of the patients were planned for palliative intent therapy. The median age was 70 years (range, 60–100). The median number of caregivers was 4 (interquartile range [IQR], 3–6). The median body mass index (BMI) was 21.9 kg/m2 (IQR, 18.9–24.2). The BMI of 109 patients (44%) was < 21 kg/m2. Seventy-eight percent of the patients had comorbidities, commonly hypertension (45%), diabetes (26%), and heart disease (17%). The median number of medications was 5 (IQR, 2–7), and 51% of the patients were on were on 5 or more medications. Only 4 patients (2%) scored normally in all the geriatric domains tested. Abnormalities were noted in the domains of comorbidities (79%), fatigue (77%), nutrition (65%), function and falls (52%), psychological status (32%), and cognition (18%). Seventy percent of the patients had an estimated >51% risk of developing Grade 3 or higher toxicity if treated with full-dose combination chemotherapy. Conclusion: Ninety-eight percent of the Indian geriatric oncology patients had vulnerabilities in at least one geriatric domain. Polypharmacy was noted in more than 50% of the patients. There was an over 50% predicted risk of severe toxicity from combination chemotherapy in at least two out of every three patients.

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