Our goal is to develop a reliable, physician and patient-friendly, pre-operative Thoracic
Onco-Geriatric Assessment (TOGA) to predict surgical risk in geriatric oncology patients
with thoracic neoplasms of the lung, esophagus, pleura and thymus, modeled upon existing CGA
tools, including the Preoperative Assessment of Cancer in the Elderly (PACE)
Our proposed TOGA wil consist of portions of the PACE and some additional screening tools,
and will be applied prospectively to all patients 70 years old and above seen in the UWCCC
for a thoracic oncology surgery. Residents of nursing homes and assisted living facilities
will be eligible for this study if they are thought to be appropriate surgical candidates;
other institutionalized patients will not. The preoperative TOGA will be performed by either
Drs. Weigel, Maloney, LoConte or Traynor or P.A. Block. The TOGA includes parts of the
PACE, involving assessment of co-morbid illness, Activities of Daily Living [ADL],
Instrumental Activities of Daily Living [IADL], Geriatric Depression Screen [GDS], Brief
Fatigue Inventory [BFI], Eastern Cooperative Oncology Group/Zubrod Performance Status [PS],
Mini Mental State Exam (MMSE), in addition to an American Society of Anesthesiologists
Score[ASA] and mini nutritional assessment (MNA), which were not done in the PACE. The TOGA
should take up to 25 minutes to complete (Audisio, 2006), and will be done at only one time
preoperativelOur hypothesis is that this novel, preoperative Thoracic Onco Geriatric
Assessment (TOGA) will serve to predict outcomes for older patients going though thoracic
oncology surgery, and thus will enhance geriatric patient care through the development of
concise, validated, preoperative risk stratification.
Our hypothesis is that this abbreviated geriatric screening tool will be a better predictor
for surgical and oncologic complications after surgery than performance status alone (which
is currently the only measure of fitness used in routine oncology care). In addition, we
predict that parts of the TOGA, specifically the instrumental activites of daily living
score (IADL), mini nutritional assessment (MNA) and the brief fatigue inventory (BFI), will
be the strongest predictor(s) of outcomes in our thoracic surgery population. The outcomes
data we generate will also be important in quality improvement and standardization of
preoperative risk assessment for elderly patients with thoracic malignancies.
- Patients 70 years old and above seen in the UWCCC for a thoracic oncology surgery.
- Residents of nursing homes and assisted living facilities will be eligible for this
study if they are thought to be appropriate surgical candidates.
- Institutionalized deemed not to be appropriate.