Combination of the G-8 Screening Tool and Hand-Grip Strength to Predict Long-Term Overall Survival in Non-Small Cell Lung Cancer Patients Undergoing Stereotactic Body Radiotherapy

SIMPLE SUMMARY: As the world’s population ages, the number of older patients diagnosed with non-small cell lung cancer will increase, and more patients are expected to suffer from comorbidities. Stereotactic body radiation therapy presents a curative modality and is the treatment of choice for patients with localized non-small cell lung cancer that is considered medically inoperable (often due to multimorbidity). However, in these patients, age-related comorbidities—rather than lung cancer—are the leading cause of mortality. To address age-related comorbidities and optimize the general health status of older patients with cancer, the Geriatric 8 screening tool was developed. However, the Geriatric 8 is mainly based on nutritional assessment; therefore, we aimed to evaluate if a combination of the Geriatric 8 and a test of physical functioning, such as hand-grip strength, can lead to more accurate identification of patients who are in need of geriatric care than the Geriatric 8 alone. ABSTRACT: The Geriatric 8 (G-8) is a known predictor of overall survival (OS) in older cancer patients, but is mainly based on nutritional aspects. This study aimed to assess if the G-8 combined with a hand-grip strength test (HGST) in patients with NSCLC treated with stereotactic body radiotherapy can predict long-term OS better than the G-8 alone. A total of 46 SBRT-treated patients with NSCLC of stage T1-T2N0M0 were included. Patients were divided into three groups: fit (normal G-8 and HGST), vulnerable (abnormal G-8 or HGST), or frail (abnormal G-8 and HGST). Statistically significant differences were found in 4-year OS between the fit, vulnerable, and frail groups (70% vs. 46% vs. 25%, p = 0.04), as well as between the normal and abnormal G-8 groups (69% vs. 39%, p = 0.02). In a multivariable analysis of OS, being vulnerable with a hazard ratio (HR) of 2.03 or frail with an HR of 3.80 indicated poorer OS, but this did not reach statistical significance. This study suggests that there might be a benefit of adding a physical test to the G-8 for more precisely predicting overall survival in SBRT-treated patients with localized NSCLC. However, this should be confirmed in a larger study population.