Prognostic factors of the loss of autonomy (LoA) in older patients with cancer receiving first-line chemotherapy.

Abstract

9012 Background: Actual data on prognostic geriatric factors of health outcomes are lacking. We aimed to examine whether a decrease in autonomy for activities of daily living (ADL) after a first cycle of chemotherapy influences elderly cancer pts prognosis, and to determine prognostic factors of this LoA from a range of biological and geriatric evaluation factors. Methods: Pts> 70 years receiving 1st-line chemotherapy for a range of cancers were included in this multicentre prospective study. A LoA was defined as a decrease of 0.5 or more points on the ADL scale between the beginning of treatment and the 2nd cycle (ADL scored 6 to 0). The association between a LoA and OS was examined and prognostic factors were sought from the pre-treatment Geriatric Assessment data (CIRS-G, IADL, MNA, MMSE, GDS et Get up and Go) and from baseline biological and clinical information (age, sex, tumor extension and localization, performance status, BMI, weight loss, albumin, CRP, haemoglobin levels, leucocyte and platelet count, creatinine clearance). Pts completely dependent at baseline (ADL score 0) were excluded as a LoA was not possible. Results: Among 364 pts included, 299 pts were evaluable and 50 experienced a LoA. A LoA was significantly associated with an increased risk of death (RR 1.518, 95%CI[1.079-2.135]). Biological and clinical factors were not associated with LoA but pre-treatment low GDS15, dependencies on the IADL, low MMS, slow Get Up and Go, low ECOG-PS and poor MNA were found to be prognostic of a LoA in univariate analyses. In the multivariate model, low GDS (OR 2.4, p=0.01, 95%CI [1.23-4.66]) and dependencies on the IADL (OR 3.0, p= 0.027, 95%CI = [1.13-9.09]) were independently associated with an increased risk of LoA. Conclusions: Our study underlines the close link between LoA during treatment and poorer prognosis of elderly pts with cancer. Pts with a pre-treatment low GDS15 and IADL-dependent were the most likely to experience LoA after the 1st chemotherapy cycle. This research suggests that the GDS15 and IADL should be included as part of any screening for elderly pts before treatment.