Chemotherapy In Elderly Cancer Patients Research Articles

Cognitive Impairment in Older Cancer Patients Treated with First-Line Chemotherapy.

Simple SummaryChemotherapy-related cognitive impairment is frequently reported by patients and can have a negative impact on their quality of life. Elderly patients appear to be particularly at risk for cognitive decline but they are rarely included in studies. Our study investigated cognitive impairment during chemotherapy and its predictive factors among a large elderly population (≥70 years) treated with first-line chemotherapy. The aim was to identify risk factors before starting chemotherapy in order to manage and help elderly patients with decision making.Older cancer patients are vulnerable to chemotherapy-related cognitive impairment. We prospectively evaluated cognitive impairment and its predictive factors during first-line chemotherapy in elderly cancer patients (≥70 years). Cognitive function was evaluated by the Mini-Mental State Examination (MMSE) with adjusted scores for age and sociocultural level. Multidimensional geriatric assessment was performed at baseline and during chemotherapy including the MMSE, Instrumental Activities in Daily Living (IADL), Mini-Nutritional Assessment (MNA), and the Geriatric Depression Scale (GDS15). Quality of life (QoL) was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire (QLQ-C30). Of 364 patients included, 310 had two MMSE evaluations including one at baseline and were assessed. Among these patients, 86 (27.7%) had abnormal MMSE, 195 (62.9%) abnormal MNA, 223 (71.9%) abnormal IADL, and 137 (43.1%) had depressive symptoms at baseline. MMSE impairment during chemotherapy was observed in 58 (18.7%) patients. Abnormal baseline MNA (odds ratio (OR) = 1.87, p = 0.021) and MMSE (OR = 2.58, p = 0.022) were independent predictive factors of MMSE impairment. These results suggest that pre-existing cognitive impairment and malnutrition are predictive factors for cognitive decline during chemotherapy in elderly cancer patients. Detection and management of these risk factors should be systematically considered in this population before starting chemotherapy.

Investigation of relationship between chemotherapy and nutritional status in elderly cancer patients

To summarize the recent international studies on the correlation between chemotherapy and malnutrition in elderly cancer patients. The relationship between nutrition and chemotherapy in elderly cancer patients is reviewed from the aspects of the incidence of malnutrition, causes of the decline in nutritional status, impact of malnutrition on prognosis, nutrition assessment tools and malnutrition interventions in elderly cancer patients receiving chemotherapy. Key words: Neoplasms; Antineoplastic combined chemotherapy protocols; Malnutrition

Clinical factors associated with the therapeutic outcome of chemotherapy in very elderly cancer patients

BackgroundThe purpose of this study was to detect background factors that might be associated with the therapeutic and curative outcome of chemotherapy in elderly cancer patients aged over 75 years.MethodsA retrospective study was conducted for elderly cancer patients aged over 75 years who had received more than 2 courses of chemotherapy at our hospital. We analyzed the relationships between RECIST outcome and background factors, such as age, sex, clinical TNM stage, pre-treatment history, ECOG performance status, serum albumin, and Charlson comorbidity index using logistic regression analysis.ResultsA total of 103 cancer patients aged over 75 years were analyzed in this study, including 28 with hematological neoplasia, 36 with gastrointestinal tract cancers, 25 with breast cancers, and 14 with other malignancies originating in various tissues. Seventy-one patients (69.1%) had a positive clinical outcome including RECIST CR (complete response), PR (partial response) and SD (stable disease). Multivariate analysis showed that a high serum albumin level of more than 3.5 g/dl and a Charlson comorbidity index score of less than 2 points were positively correlated with a favorable therapeutic outcome.ConclusionsThe results of the current study suggested that serum albumin level and comorbidity index are the principal clinical factors affecting therapeutic outcomes in elderly cancer patients receiving chemotherapy. In the future, these factors may make chemotherapy adaptations, continuity, and effectiveness easier to predict than GA screening.

Can we avoid the toxicity of chemotherapy in elderly cancer patients?

Although approximately 50% of cancer patients are 70 years of age or older, cancer treatment in the elderly remains a therapeutic challenge. The elderly form a very heterogeneous group in relation to their general health state, degree of dependence, comorbidities, performance status, physical reserve and geriatric situation, for which therapeutic decisions must be made in an individualized manner. In addition, changes in pharmacokinetics and pharmacodynamics of the drugs occur with age, as well as the tolerance of the tissues, leading to a narrowing of the therapeutic margin and an increase in toxicity. In the general population, Performace Status (PS) has traditionally been used to estimate tolerance to chemotherapy, but in the elderly population it is not useful. In this review we summarize the current knowledge about the pharmacology of antineoplastic drugs in the elderly and the tools available to help us identify risk of chemotherapy toxicity in these patients.

Analysis of postoperative chemotherapy-related anemia in elderly cancer patients

This study was conducted to investigate the correlation between anemia and postoperative chemotherapy in elderly cancer patients. One hundred and fifty-seven elderly patients ( age ≥ 60) with pathologically confirmed breast, lung and digestive tract cancers, who had HGB ≥ 120 g/L and ECOG scores 0-2, were included in this study. We reviewed their clinicopathological data and analyzed the correlation of anemia in breast cancer patients after 1, 3 or 5 cycles and lung cancer patients after 1, 2 or 3 cycles of postoperative chemotherapy. Among the 157 cases, the overall proportion of anemia was 31.8% (50/157) , with 18.8% in male and 47.2% in female patients (P < 0.001). After three cycles of chemotherapy, the proportion of anemia was 57.9% in lung cancer, 34.5% in breast cancer, 26.3% in gastric cancer and 9.3% in colorectal cancer patients (P < 0.001). The proportion of anemia during 5 cycles chemotherapy (three cycles in lung cancer) was gradually increasing. In the lung cancer patients, anemia was observed in 66.7% of patients who received vinorelbine plus cispiatin regimen and 25.0% of cases who received vinorelbine regimen chemotherapy (P = 0.044). In most elderly patients with normal hemoglobin level and in good conditions, the chemotherapy-related anemia is mild and less frequent. Age should not limit the adjuvant chemotherapy in elderly cancer patients. Attention should be paid to the possibility of anemia in elderly female lung cancer patients receiving multiple cycle platinum-based chemotherapy regimens.

Clinical safety of chemotherapy for elderly cancer patients complicated with hypertension.

To access the safety of chemotherapy for elderly cancer patients complicated with hypertension. Elderly cancer patients who were complicated with hypertension and treated by chemotherapy were recruited. All patients were treated by chemotherapy after an intervention on hypertension by psychotherapy, exercise guidance, salt regulation and nutrition support, therapy on hypertension, as well as prevention on hypertension associated complications. In 68 eligible patients, two suspended chemotherapy because of adverse reactions and 4 because of disease progression. The remaining 62 patients completed chemotherapy smoothly based on good hypertension control. With effective control of blood pressure, chemotherapy for elderly cancer patients complicated with hypertension is generally safe.

Baseline comprehensive geriatric assessment to predict for toxicity of single-agent chemotherapy in elderly metastatic breast cancer patients: Results from the OMEGA study of the Dutch Breast Cancer Trialists’ Group.

1080 Background: A comprehensive geriatric assessment (CGA) systematically appraises the somatic, psychosocial and functional health status of elderly patients. If CGA can predict toxicity of chemotherapy in elderly cancer patients, this assessment could be useful in deciding on optimal treatment. In this analysis, we evaluated the association between frailty on CGA or Groningen Frailty Index (GFI), and grade 3/4 toxicity in metastatic breast cancer (MBC) patients treated with first-line chemotherapy. Methods: In the OMEGA study, MBC patients (≥ 65 years) were randomized between PEGdoxo 45mg/m2every 4 weeks or capecitabine 2000 mg/m2 on days 1-14 every 3 weeks. Baseline geriatric assessment included functional status (ECOG performance status (PS), IADL), cognition (MMSE), mood (GDS), comorbidity (Charlson), polypharmacy and undernutrition (BMI) and GFI. Frailty on CGA was defined as one or more of the following: IADL≤13, MMSE ≤23, GDS ≥5, BMI ≤20, ≥5 medications or Charlson ≥2. GFI score for frailty was ≥4. Results: In total, 78 patients were randomized (PEGdoxo 38, capecitabine 40), median age 75 years (range 65-86). ECOG PS was 0-1 in 78% of patients and 2-3 in 22%. So far, 72 patients were evaluable for toxicity and baseline CGA. Overall, 50 patients (70%) were frail on CGA, and 40 (55%) according to GFI. Grade 3/4 toxicity related to chemotherapy was reported in 30 patients (42%) and 50% of CGA-frail patients experienced grade 3/4 toxicity, compared to 20% of CGA-fit patients (p=0.02). Grade 3/4 toxicity was experienced by 44% of GFI-frail patients, compared to 38% of GFI-fit patients (p=0.39). After correcting for type of chemotherapy and age, toxicity was associated with CGA-frailty (odds ratio (OR) 4.00, 95% confidence interval (CI) 1.77-13.59, p=0.03) while GFI-frailty was not associated with toxicity (OR 1.11, 95% CI 0.85-1.46, p=0.43). Conclusions: In this randomized study on first-line single-agent chemotherapy in elderly MBC patients, baseline CGA demonstrated a good predictive value for grade 3/4 toxicity of chemotherapy but GFI did not.

FOLFOX4 relative dose intensity and factors associated with dose reduction or stop: A cohort study.

e19668 Background: Randomized controlled trials suggest similar efficacy and tolerance of chemotherapy in elderly cancer patients compared to younger. The objective was to assess in real-world setting FOLFOX4 relative dose intensity (RDI) and identify factors associated with dose reduction or stop. Methods: Between January 2007 and February 2010, 86 consecutive patients with colorectal cancer treated by FOLFOX4 were included and followed for first dose reduction (≥15%) or stop during 12 cycles for adjuvant chemotherapy (n=58) and 6 cycles for palliative chemotherapy (n=28). Data regarding patient characteristics and doses were collected using hospital chemotherapy database. Among a subgroup of patients ≥ 70 years, Comprehensive Geriatric Assessment parameters were assessed. Analysis used Kaplan-Meier survival curves, log-rank tests and Cox model. Results: Mean age was 65.3 (±11.5; 44.2% ≥ 70 years), 52.3% were women and 54.4% had a performance status (PS) at 0. Median RDI was 0.89 (Q1: 0.74 – Q3: 0.97). Respectively for FOLFOX4, 5FU and oxaliplatine, 48.4% (95% CI: 35.6-63), 26.7% (12-44.8) and 47.2% (37-61) had a dose reduction or stop within 3 months. Age ≥ 70 years (p logrank=0.007), female sex (p=0.03) and PS of 1 or more (p=0.03) were associated with dose reduction or stop. In multivariate analysis, female sex (adjusted HR = 2.34; 95%CI:1.04-5.57) and age (adjusted HR for one year increase = 1.04; 95% CI:1.00-1.09) remained associated with dose reduction or stop. Neuro-and hematotoxicity were the leading causes of dose reduction or stop of oxaliplatine (48.9%) and 5FU (38.5%) respectively. Patients ≥ 70 years had more often neurotoxicity related to oxaliplatine (46.4% vs 14.8%; p=0.003) than younger whereas no significant difference was found for 5FU. Dependency (adjusted HR=7.35; 95% CI:1.19-45.5; p=0.03) and impaired mobility (6.18; 95%CI:1.16-33.07; p=0.033) were associated with dose reduction or stop after adjustment for age. Conclusions: age was independently associated with FOLFOX4 dose reduction or stop. This can be partly explained by a greater toxicity in elderly for oxaliplatine but not for 5FU. Among elderly, dependency and impaired mobility may be associated with FOLFOX4 dose reduction or stop.

Predictors of treatment failures during chemotherapy: A prospective study on 110 older cancer patients

Several instruments have been proposed to improve treatment decisions in elderly cancer patients, but evidence of their impact in clinical practice is limited. The aim of this study was to analyze the role of clinical and functional factors in predicting serious adverse events, including death, severe toxicity or treatment interruption, during chemotherapy in elderly cancer patients. The survey evaluated elderly with lung or colon or breast cancer treated with chemotherapy, followed by S. Giovanni Battista Hospital. We enrolled 110 consecutive patients older than 70 years of age with lung ( n = 45), colon ( n = 50) and breast ( n = 15) cancer between October 2004 and October 2005. Overall, 73/110 patients (66.4%) experienced adverse events as death ( n = 14), grades III and IV toxicity ( n = 40), or treatment interruption for other reasons ( n = 19). The variables with stronger predictivity were advanced stage, toxicity of treatment, level of comorbidity and Karnofsky performance status (KPS). instrumental activities of daily living (IADL) index and age itself were not independent predictors. In conclusion our results confirm the need of a careful selection of elderly patients suitable for chemotherapy, giving more weight to comorbidity and KPS scores than to age itself. The potential role of other functional evaluations need to be further assessed in randomized controlled trials.

Co-morbidity and functional deficits independently contribute to quality of life before chemotherapy in elderly cancer patients

GOAL OF THE WORK: The quality of life (QoL) of patients with cancer is a major area of concern for both patients and their physicians. The independent contribution of functional impairment and co-morbidity to QoL is unclear. We investigated initial global QoL in 477 patients: 195 cancer patients aged 60 years or older (group A), 152 cancer patients below the age of 60 years (group B), admitted as inpatients for chemotherapy initiation and 130 patients aged 60 years or older admitted for non-cancer-related disorders (group C). Global QoL was assessed by the EORTC-QLQ-C30 subscale, functional status by the Karnofsky Performance Scale (KPS) and the Instrumental Activities of Daily Living (IADL) scale, and co-morbidity by the Cumulative Illness Rating Scale (CIRS). In multivariate analyses, global QoL is significantly associated with KPS, IADL and co-morbidity in group A (r (2) = 0.27), with KPS and IADL in group B (r (2) = 0.23), and with age, KPS and IADL in group C (r (2) = 0.38). IADL contributes to global QoL in addition to the known effect of KPS. In addition, co-morbidity independently influences global QoL in elderly cancer patients.

Morbidity Associated with Free-Tissue Transfer after Radiotherapy and Chemotherapy in Elderly Cancer Patients

Because of their ages and associated medical problems, many elderly cancer patients are treated with radiotherapy and/or chemotherapy to avoid the increased morbidity perceived to occur with prolonged surgical procedures such as tumor resection and reconstruction with free tissue transfer (FTT). The failure of such therapy still often requires tumor resection and reconstruction in irradiated tissue, which may add to the morbidity of surgery. To determine the validity of these concerns, 66 elderly cancer patients who underwent tumor resection and FTT after previous radiotherapy and/or chemotherapy (PT) were compared to a similar group of 64 elderly patients who had not received such previous therapy (NPT). Despite the two groups having similar patient traits, reconstructive-site characteristics, types of flaps used, medical risk factors, and time variables, there were no statistically significant differences between groups for FTT failure (PT3 percent, NPT 6 percent), medical complication rate (PT 16 percent, NPT 27 percent), surgical complication rate (PT 41 percent, NPT 49 percent), or wound-healing problems. The perioperative mortality rate was 2 percent. The authors conclude, that when medical problems are appropriately corrected before surgery, FTT may be safely performed in elderly patients with a high degree of success, acceptable morbidity, and low mortality. Previous cancer treatment does not appear to predispose elderly patients to a higher rate of FTT failure or wound-healing problems after FTT reconstruction.