Elderly NHL and DLBCL patients: use of the CGA (comprehensive geriatric assessment) when considering treatment options?

Comprehensive Geriatric Assessment (CGA) includes activities of daily living, instrumental activities of daily living, mood, cognition, nutrition, and the Charlson comorbidity index. Patients with a high comorbidity score and patients who had cognitive impairment were associated with poor prognosis in NHL and DLBCL cases.  CGA can be used to assess elderly patients when considering treatment regimens versus palliative care however, at present this is not routine.

Naito et al. J Clin Exp Hematop 2016; 56(1):43-49

https://www.jstage.jst.go.jp/article/jslrt/56/1/56_43/_article

"In recent years, the CGA, which is used in gerontology to assess functioning in elderly individuals, has been said to be useful in geriatric oncology. Therefore, we examined whether items in the CGA were associated with survival time in elderly patients with Non-Hodgkin Lymphoma (NHL). We conducted the CGA for 93 patients aged ≥ 65 years who had undergone treatment for NHL retrospectively. The CGA includes activities of daily living, instrumental activities of daily living, mood, cognition, nutrition, and the Charlson comorbidity index. For each category, we divided subjects into a “good” group and a “poor” group. In regard to the Charlson comorbidity index, patients were divided into two groups using different cutoffs to divide the groups; the two groups were established according to the division with the largest significant difference in survival time. Multivariate analysis was then performed with the following prognostic factors affecting survival: all CGA items, NHL classification, stage, performance status, and doxorubicin use/non-use. We also performed similar analysis for 43 Diffuse Large B-Cell Lymphoma (DLBCL) patients who had undergone anthracycline treatment. Results are factors affecting survival in NHL cases included comorbidity score ≥ 6 (P < 0.0001), doxorubicin non-use (P = 0.005), and cognitive impairment (P = 0.0488). In cases of DLBCL, survival was affected by comorbidity score ≥ 5 (P = 0.0016). High comorbidity score was strongly associated with survival in both NHL and DLBCL."