A prospective study of the impact of chemotherapy-related toxicities on the quality of life in elderly patients with cancer.

Abstract

e23013 Background: Treatment of cancer in elderly is challenging. Majority of the elderly cancer patients are offered chemotherapy based on their performance scale and geriatric assessment tools are not routinely employed in clinical practice as they are time consuming and cumbersome. Aim: The primary objective was to estimate the incidence of chemotherapy related adverse events in newly diagnosed elderly cancer patients above 65 years of age treated at a tertiary cancer institute in southern India. The secondary objective was to predict and assess the factors associated with chemotherapy related toxicities in the elderly patients using the Cancer and Aging Research Group's (CARG) scoring tool and to study the quality of life and to assess the nutritional status and the mental status in elderly cancer patients above 65 years of age. Methods: A prospective cross-sectional study was done among 179 patients with age ≥ 65 years, a solid organ cancer (any type or stage) from February 2017 to August 2018. Prechemotherapy comprehensive geriatric assessment (CGA) with Older People’s Quality of Life Questionnaire (OPQOL-35), Mini Nutritional assessment (MNA) and Folstein’s Mini Mental status examination (MMSE) was done at baseline, 2 months and 6 months. CARG tool was used to predict the risk of chemotherapy toxicity with the standard and modified dose. Results: The mean age was 68.53 years. Majority of the patients had breast cancer 29.60%. The proportion of lung cancer, prostate cancer, stomach cancer, colorectal and ovarian cancers were 21.80%,10.60%, 9.50%, 14.5% and 7.30% respectively. Other cancers were seen in 5 patients (2.79%). 40 (22.30%) patients had received anthracycline based chemotherapy. 143 (79.90%) had received standard dosing chemotherapy.118 (65.90%) & 125 (69.80%) out of 179 patients had developed hematological toxicities and non- hematological toxicities respectively. According to the ROC curve for the CARG tool risk of toxicity with standard & modified dosing and hematological & non- hematological toxicities, the accuracy of the test is 60.89% indicating its poor predictive validity. There is a decline in the CGA at 2 months follow-up, but there was an improvement after assessment at 6 months. Conclusions: Comprehensive geriatric assessment at base line is required to adequately analyse patient’s risk of chemotherapy related toxicities. In our study, the patients have tolerated the chemotherapy well in spite of receiving standard dosing.