Impact of specific oncologic and geriatric parameters in predicting chemotherapy toxicity and death in elderly cancer patients.

Abstract

e24026 Background: Cancer is mainly a disease of the elderly with more than 75% of patients aged 65 years and more at diagnosis. Comprehensive geriatric assessment (CGA) is usually used to assess elderly cancer patients¹. However, its sensitivity in predicting their outcome is questionable. Methods: We investigated whether specific oncologic and geriatric markers could predict chemotherapy toxicity and cancer-related death in a prospective single center study with 110 chemo-naive patients with advanced cancer. All patients underwent a CGA. Frailty markers as defined by Fried2 as well as basic oncologic data were collected. Bivariate and multivariate analysis were done to assess the relation between the different variables and major toxicity. A Cox regression model for survival analysis was also performed. Results: Median age is 74 years [65-90 years]. 46% have stage IV disease. 27% have aggressive cancer as defined by Hurria et al3. Grade III-IX chemotherapy-related toxicity occurred in 22% of patients. Combined chemotherapy drug regimens, loss of appetite in the last 3 months and polypharmacy at baseline were predictive of chemotherapy toxicity in multivariate analysis. After a median follow-up of 12 months, 59% died of disease progression. In multivariate analysis, advanced cancer stage, initial loss of > 5% body weight within 1 year, altered physical activity and Activity of Daily Living (ADL), anemia and heavy comorbidities (CIRS – G score) were predictive of poor outcome (Table). Conclusions: In elderly cancer patients, poor nutritional status and heavy comorbidities are predictive of both chemotherapy intolerance and death. In addition, markers such as anemia, advanced cancer stage, altered physical activity and impaired ADL predict early death. Balducci L. The Oncologist 2000. Fried LP. J Gerontol A Biol Sci Med Sci 2001. Hurria A. J Clin Oncol 2011. Clinical trial information: 02-02-18. [Table: see text]