Comprehensive geriatric assessment and geriatric interventions

Table 1 summarizes the CGA items and scales and geriatric interventions.

CGA and geriatric interventions

Referral to social worker

Social support

Rehabilitation center

Medical record review

Clinical examination

Charlson score

Activities of Daily Living scale (ADL [18])

Instrumental Activities of Daily Living scale (IADL [19])

Visiting nurse

Social support

Rehabilitation center

Fall in the last year

Balance on one leg

Timed Up&Go test [24]

Fall ≥ 2

Balance on one leg < 5s

Timed up and Go test > 20s

Mini Mental State Examination (MMSE [21])

Mini-Cog [22]

Delirium history

MMSE < 27/30

Mini-COG scoring algorithm

Peroperative caregiver

Confusion Assessment Method (CAM)²⁷

Mini Nutritional Assessment Short Form (MNA-SF [20])

Measurement of current weight

Weight loss (whether voluntary or not) compared to normal weight

Body Mass Index (BMI)

MNA-SF score < 17/30

Recent weight loss > 10%

BMI < 21 kg/m2

Referral to dietician

Nutritional supplement

Male < 26 kg

Female < 16 kg

ADL: activities of daily living, BMI: body mass index, CAM: Confusion Assessment Method, GDS: Geriatric Depression Scale, IADL: instrumental activities of daily living, MMSE: Mini Mental State Examination, MNA-SF: Mini Nutritional Assessment Short Form

Delirium prevention included a free accompanying person bed during the entire period of hospitalization, even in intensive care units. The surgical health care team was trained to perform the Confusion Assessment Method (CAM) [27] to detect post-operative delirium. The CAM was performed twice a day during hospitalization. In the case of malnutrition or probable sarcopenia, oral nutritional supplement was prescribed directly during the oncogeriatric consultations. Post-operative rehabilitation was arranged during oncogeriatric consultations depending on oncogeriatrician opinion of the CGA data (isolation, sarcopenia, functional status, etc.). Completion of geriatric interventions was assessed during whole patients cares.

An additional oncogeriatric consultation was planned for 1 month after surgery and/or in the case of a theoretical indication for adjuvant therapy.