The impact of pre-treatment muscle strength and physical performance on treatment modification in older adults with cancer following comprehensive geriatric assessment.

BACKGROUND: Grip strength (GS) and the short physical performance battery (SPPB) have been shown to predict clinical outcomes in older adults with cancer. However, whether pre-treatment GS and SPPB impact treatment decisions following comprehensive geriatric assessment (CGA) is poorly understood. Our objective was to assess the impact of low GS and/or SPPB on treatment modification to initially proposed treatment plans in older adults with cancer following CGA. METHODS: This was a retrospective cohort study of older adults who had undergone CGA before receiving cancer treatment. Data were retrieved from a prospective database in an academic cancer centre and medical records. Treatment modification following CGA was defined as reduced treatment intensity or transition from active treatment to supportive care. Multivariable logistic regression assessed the impact of pre-treatment GS and SPPB on treatment modification following CGA. RESULTS: In total, 515 older adults (mean age: 80.7y) who had undergone CGA prior to cancer treatment were included. Low muscle strength and/or physical performance was observed in 66.4% of participants. Treatment was modified in 49.5% of the cohort following CGA. Low GS and/or SPPB combined was predictive of treatment modification (OR = 1.77, 95%CI = 1.07-2.90, P = 0.025) in multivariable analysis. Additional predictors of treatment modification included palliative treatment intent, comorbidities and malnutrition. CONCLUSIONS: Low GS and/or SPPB combined prior to cancer treatment predicts treatment modification in older adults with cancer and may be useful in treatment decision-making. Management of poor muscle strength and physical performance should be offered to optimize patient care and potentially improve treatment outcomes.

Do clinicians address impairments in muscle strength and physical performance for older adults with cancer?

INTRODUCTION: Low physical function is associated with adverse outcomes in older adults with cancer, but evidence on real-world, clinical management of low physical function in oncology is lacking. We explored whether impairments in muscle strength and/or physical performance triggered downstream management by clinicians, the types of recommended strategies, and the reasons for not providing a referral/strategy for addressing such impairments in older cancer survivors prior to treatment. MATERIALS AND METHODS: We conducted a retrospective, cross-sectional study of older adults who completed a comprehensive geriatric assessment (CGA) prior to cancer treatment in a tertiary cancer centre. Muscle strength and physical performance were assessed through grip strength and the Short Physical Performance Battery (SPPB), respectively. Patients who exhibited an impairment in grip strength and/or SPPB were classified as having abnormal objective physical function. Downstream management strategies and clinicians' reasons for not providing referrals were retrieved from clinical notes and an institutional database. RESULTS: In total, 515 older adults (mean age: 80.7 years) were included. Low grip strength and/or SPPB combined was observed in 66.4% (n = 342) of participants, of whom 54.1% (n = 185) received an acceptable intervention. However, 41.2% (n = 141) were not provided with a referral/strategy by clinicians to address such impairments following CGA. No reasons were provided in clinical notes for not addressing impairments in physical function for 100 participants (70.9%). DISCUSSION: Many older adults with cancer have impaired physical function prior to treatment. However, we found that such impairments are not systematically addressed by clinicians, and documentation was often suboptimal, identifying gaps in patient care that need to be addressed.