The Impact of Comprehensive Geriatric Assessment on Tolerance to Chemotherapy in Older People

Student thesis: Doctoral ThesisDoctor of Philosophy


This thesis evaluates the impact of geriatrician-delivered comprehensive geriatric assessment (CGA) interventions on chemotherapy toxicity and tolerance for older people with cancer. While comorbidities are identified in routine oncology practice, intervention plans for the co-existing needs of older people receiving chemotherapy are rarely made and have rarely been evaluated.

Comparative study of two cohorts of older patients (aged 70+) undergoing chemotherapy in a London Hospital. The observational control group (N=70, October 2010 - July 2012) received standard oncology care. The intervention group (N=65, September 2011 - February 2013) underwent risk stratification using a patient-completed screening questionnaire; high risk patients received CGA. Impact of CGA interventions on chemotherapy tolerance outcomes and grade 3+ toxicity rate were evaluated. Outcomes were adjusted for age, comorbidity, metastatic disease and initial dose reductions.

Intervention participants undergoing CGA received a mean of 6.2+/-2.6 (range 0-15) CGA-based interventions. They were more likely to complete cancer treatment as planned (odds ratio (OR) 4.14 (95% CI 1.50-11.42), p=0.006) and fewer required treatment modifications (OR 0.34 (95% CI 0.16-0.73), p=0.006). Overall grade 3+ toxicity rate was 43.8% in the intervention group, 52.9% in the control (p=0.292).

Geriatrician-led CGA identified many indications for interventions. This approach was associated with improved chemotherapy tolerance. Embedding CGA interventions in oncology practice merits further evaluation.
Date of Award2016
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorFinbarr Martin (Supervisor), Danielle Harari (Supervisor) & Yanzhong Wang (Supervisor)

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