Functional and cognitive impairment, social functioning, frailty and adverse health outcomes in older patients with esophageal cancer, a systematic review

Floor J van Deudekom; Henk G Klop; Henk H Hartgrink; Jurjen J Boonstra; Irene M Lips; Marije Slingerland; Simon P Mooijaart

doi:10.1016/j.jgo.2018.03.019

Functional and cognitive impairment, social functioning, frailty and adverse health outcomes in older patients with esophageal cancer, a systematic review

J Geriatr Oncol. 2018 Nov;9(6):560-568. doi: 10.1016/j.jgo.2018.03.019. Epub 2018 Apr 19.

Authors

Floor J van Deudekom¹, Henk G Klop², Henk H Hartgrink³, Jurjen J Boonstra⁴, Irene M Lips⁵, Marije Slingerland⁶, Simon P Mooijaart⁷

Affiliations

¹ Department of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands. Electronic address: F.J.A.van_Deudekom@lumc.nl.
² Department of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands.
³ Department of Surgery, Leiden University Medical Center, The Netherlands.
⁴ Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands.
⁵ Department of Radiation Oncology, Leiden University Medical Center, The Netherlands.
⁶ Department of Medical Oncology, Leiden University Medical Center, The Netherlands.
⁷ Department of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands; Institute for Evidence-based Medicine in Old Age (IEMO), Leiden, The Netherlands.

PMID: 29680585
DOI: 10.1016/j.jgo.2018.03.019

Abstract

Background: Older patients with esophageal cancer are at high risk of adverse health outcomes, but the association of geriatric assessment with adverse health outcomes in these patients has not been systematically evaluated. The aim of this systematic review was to study the association of functional and cognitive impairment, social environment and frailty with adverse health outcomes in patients diagnosed with esophageal cancer.

Methods: We searched Pubmed, Embase, Web of Science and Cochrane Library for original studies reporting on associations of functional or cognitive impairment, social environment and frailty with adverse outcomes (mortality, functional or cognitive decline, adverse events during treatment, prolonged length of hospitalization (LOS) and health related quality of life (HRQoL)) after follow-up in patients with esophageal cancer.

Results: Of 1.391 identified citations, nineteen articles were included that reported on 53 associations. The median sample size of the included studies was 110 interquartile range (IQR 91-359). Geriatric conditions were prevalent: between 14 and 67% of the included participants were functionally impaired, around 42% had depressive symptoms and between 5 and 23% did not have a partner. In nineteen of 53 (36%) associations functional or cognitive impairment or frailty were significant associated with adverse health outcomes, but the studies were small. In four out of six (67%) associations with the largest sample size (n ≥ 359), functional impairment or social environment were significant associated with adverse health outcomes.

Conclusion: Functional and cognitive impairment, depression and social isolation are prevalent in patients with esophageal cancer, and associate with adverse health outcomes. Geriatric measurements may guide decision-making and customize treatments, but more large studies are needed to explore the clinical usability.

Keywords: Cognitive impairment; Esophageal cancer; Frailty; Functional impairment; Geriatric assessment; Older patients; Social status.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Activities of Daily Living
Aged
Cognitive Dysfunction / complications*
Depression / complications*
Esophageal Neoplasms / complications*
Frailty / complications*
Geriatric Assessment
Humans
Outcome Assessment, Health Care
Quality of Life
Social Isolation*