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- Title
Predicting Chemotherapy Toxicity in Older Patients with Cancer: A Multicenter Prospective Study.
- Authors
Feliu, Jaime; Jiménez‐Munárriz, Beatriz; Basterretxea, Laura; Paredero, Irene; Llabrés, Elisenda; Antonio‐Rebollo, Maite; Losada, Beatriz; Espinosa, Enrique; Gironés, Regina; Custodio, Ana Belén; del Mar Muñoz, María; Díaz‐Almirón, Mariana; Gómez‐Mediavilla, Jeniffer; Pinto, Alvaro; Torregrosa, María‐Dolores; Soler, Gema; Cruz, Patricia; Higuera, Oliver; Molina‐Garrido, María José
- Abstract
Background: Standard oncology tools are inadequate to distinguish which older patients are at higher risk of developing chemotherapy‐related complications. Materials and Methods: Patients over 70 years of age starting new chemotherapy regimens were prospectively included in a multicenter study. A prechemotherapy assessment that included sociodemographics, tumor/treatment variables, and geriatric assessment variables was performed. Association between these factors and the development of grade 3–5 toxicity was examined by using logistic regression. Results: A total of 551 patients were accrued. Chemotherapy doses (odds ratio [OR] 1.834; 95% confidence interval [CI] 1.237–2.719) and creatinine clearance (OR 0.989; 95% CI 0.981–0.997) were the only factors independently associated with toxicity. Only 19% of patients who received reduced doses of chemotherapy and had a creatinine clearance ≥40 mL/minute had grade 3–4 toxicity, compared with 38% of those who received standard doses or had a creatinine clearance <40 mL/minute (p <.0001). However, no satisfactory multivariate model was obtained using different selection approaches. Conclusion: Chemotherapy doses and renal function were identified as the major risk factors for developing severe toxicity in the older patient. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow‐up in these patients. Implications for Practice: Older patients are more vulnerable to chemotherapy toxicity. However, standard tools are inadequate to identify who is at higher risk of developing chemotherapy‐related complications. Chemotherapy doses (standard vs. reduced) and renal function were identified as the major risk factors for developing severe toxicity in the elderly. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow‐up. Cancer treatment for older patients remains a challenge. This article describes the use of a geriatric assessment tool to target the associatios between certain factors and the development of grade 3 to grade 5 toxicities in patients older than age 70 years.
- Subjects
GERIATRIC assessment; CANCER chemotherapy; COMPARATIVE studies; CONFIDENCE intervals; CREATININE; DRUG toxicity; LONGITUDINAL method; MEDICAL cooperation; MULTIVARIATE analysis; RESEARCH; RISK assessment; TUMORS; LOGISTIC regression analysis; SOCIOECONOMIC factors; DESCRIPTIVE statistics; ODDS ratio; OLD age
- Publication
Oncologist, 2020, Vol 25, Issue 10, pe1516
- ISSN
1083-7159
- Publication type
Article
- DOI
10.1634/theoncologist.2019-0701