Chemotherapy toxicity in older adults optimized by geriatric assessment and intervention: a non-comparative analysis
journal contributionposted on 2023-01-09, 16:48 authored by Munzir Hamid, Michelle Hannan, Nay Myo Oo, Paula Lynch, Darren J Walsh, Tara Matthews, Stephen MaddenStephen Madden, Miriam O’Connor, Paula Calvert, Anne M Horgan
The Comprehensive Geriatric Assessment (CGA) is recommended to guide treatment choices in older patients with cancer. Patients ≥ 70 years referred to our oncology service with a new cancer diagnosis are screened using the G-8. Patients with a score of ≤14 are eligible to attend the Geriatric Oncology and Liaison (GOAL) Clinic in our institution, with referral based on physician discretion. Referred patients undergo multidimensional assessments at baseline. CGA domains assessed include mobility, nutritional, cognitive, and psychological status. Chemotherapy toxicity risk is estimated using the Cancer Aging and Research Group (CARG) calculator. We undertook a retrospective analysis of patients attending the GOAL clinic over a 30-month period to April 2021. The objective was to determine rates of treatment dose modifications, delays, discontinuation, and unscheduled hospitalizations as surrogates for cytotoxic therapy toxicity in these patients. These data were collected retrospectively. Ninety-four patients received chemotherapy; the median age was 76 (70–87) and 45 were female (48%). Seventy-five (80%) had an ECOG PS of 0–1. Seventy-two (77%) had gastrointestinal cancer, and most had stage III (47%) or IV (40%) disease. Chemotherapy with curative intent was received by 51% (n = 48) and 51% received monotherapy. From the CGA, the median Timed Up and Go was 11 s (7.79–31.6), and 90% reported no falls in the prior 6 months. The median BMI was 26.93 (15.43–39.25), with 70% at risk or frankly malnourished by the Mini Nutritional Assessment. Twenty-seven (29%) patients had impaired cognitive function. Forty-three (46%) had a high risk of toxicity based on the baseline CARG toxicity calculator. Twenty-six (28%) required dose reduction, 55% (n = 52) required a dose delay, and 36% (n = 34) had a hospitalization due to toxicity. Thirty-nine patients (42%) discontinued treatment due to toxicity. Despite intensive assessment, clinical optimization and personalized treatment decisions, older adults with cancer remain at high risk of chemotherapy toxicity.
CommentsThe original article is available at https://www.mdpi.com/
Published CitationHamid M. et al. Chemotherapy toxicity in older adults optimized by geriatric assessment and intervention: a non-comparative analysis. Curr Oncol. 2022;29(9):6167-6176.
Publication Date26 August 2022
- Data Science Centre
- Neurological and Psychiatric Disorders
- Gynaecology, Obstetrics and Perinatal Health
- Published Version (Version of Record)
NeoplasmsGeriatric AssessmentRetrospective StudiesMedical OncologyAgedchemotherapygeriatric assessmenthealthcare utilizationtoxicityOncology & CarcinogenesisComprehensive Geriatric Assessment (CGA)Geriatric Oncology and Liaison (GOAL)Cancer Aging and Research Group (CARG)cancer diagnosisdiscontinued treatmentchemotherapy toxicitypersonalized treatmenthospitalizationolder adults