Chemotherapy Toxicity in Older Adults Optimized by Geriatric Assessment and Intervention: A Non-Comparative Analysis
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 Oncolog...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-08-01
|
| Series: | Current Oncology |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1718-7729/29/9/484 |
| _version_ | 1797489633998667776 |
|---|---|
| author | Munzir Hamid Michelle Hannan Nay Myo Oo Paula Lynch Darren J. Walsh Tara Matthews Stephen Madden Miriam O’Connor Paula Calvert Anne M. Horgan |
| author_facet | Munzir Hamid Michelle Hannan Nay Myo Oo Paula Lynch Darren J. Walsh Tara Matthews Stephen Madden Miriam O’Connor Paula Calvert Anne M. Horgan |
| author_sort | Munzir Hamid |
| collection | DOAJ |
| description | 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% (<i>n</i> = 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% (<i>n</i> = 52) required a dose delay, and 36% (<i>n</i> = 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. |
| first_indexed | 2024-03-10T00:20:24Z |
| format | Article |
| id | doaj.art-f7d3ec10c61b4685a1e698f062b4a12d |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-10T00:20:24Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-f7d3ec10c61b4685a1e698f062b4a12d2023-11-23T15:45:34ZengMDPI AGCurrent Oncology1198-00521718-77292022-08-012996167617610.3390/curroncol29090484Chemotherapy Toxicity in Older Adults Optimized by Geriatric Assessment and Intervention: A Non-Comparative AnalysisMunzir Hamid0Michelle Hannan1Nay Myo Oo2Paula Lynch3Darren J. Walsh4Tara Matthews5Stephen Madden6Miriam O’Connor7Paula Calvert8Anne M. Horgan9Oncology Department, University Hospital Waterford, X91 ER8E Waterford, IrelandOncology Department, University Hospital Waterford, X91 ER8E Waterford, IrelandOncology Department, University Hospital Waterford, X91 ER8E Waterford, IrelandOncology Department, University Hospital Waterford, X91 ER8E Waterford, IrelandOncology Department, University Hospital Waterford, X91 ER8E Waterford, IrelandOncology Department, University Hospital Waterford, X91 ER8E Waterford, IrelandData Science Centre, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, IrelandOncology Department, University Hospital Waterford, X91 ER8E Waterford, IrelandOncology Department, University Hospital Waterford, X91 ER8E Waterford, IrelandOncology Department, University Hospital Waterford, X91 ER8E Waterford, IrelandThe 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% (<i>n</i> = 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% (<i>n</i> = 52) required a dose delay, and 36% (<i>n</i> = 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.https://www.mdpi.com/1718-7729/29/9/484chemotherapytoxicitygeriatric assessmenthealthcare utilization |
| spellingShingle | Munzir Hamid Michelle Hannan Nay Myo Oo Paula Lynch Darren J. Walsh Tara Matthews Stephen Madden Miriam O’Connor Paula Calvert Anne M. Horgan Chemotherapy Toxicity in Older Adults Optimized by Geriatric Assessment and Intervention: A Non-Comparative Analysis Current Oncology chemotherapy toxicity geriatric assessment healthcare utilization |
| title | Chemotherapy Toxicity in Older Adults Optimized by Geriatric Assessment and Intervention: A Non-Comparative Analysis |
| title_full | Chemotherapy Toxicity in Older Adults Optimized by Geriatric Assessment and Intervention: A Non-Comparative Analysis |
| title_fullStr | Chemotherapy Toxicity in Older Adults Optimized by Geriatric Assessment and Intervention: A Non-Comparative Analysis |
| title_full_unstemmed | Chemotherapy Toxicity in Older Adults Optimized by Geriatric Assessment and Intervention: A Non-Comparative Analysis |
| title_short | Chemotherapy Toxicity in Older Adults Optimized by Geriatric Assessment and Intervention: A Non-Comparative Analysis |
| title_sort | chemotherapy toxicity in older adults optimized by geriatric assessment and intervention a non comparative analysis |
| topic | chemotherapy toxicity geriatric assessment healthcare utilization |
| url | https://www.mdpi.com/1718-7729/29/9/484 |
| work_keys_str_mv | AT munzirhamid chemotherapytoxicityinolderadultsoptimizedbygeriatricassessmentandinterventionanoncomparativeanalysis AT michellehannan chemotherapytoxicityinolderadultsoptimizedbygeriatricassessmentandinterventionanoncomparativeanalysis AT naymyooo chemotherapytoxicityinolderadultsoptimizedbygeriatricassessmentandinterventionanoncomparativeanalysis AT paulalynch chemotherapytoxicityinolderadultsoptimizedbygeriatricassessmentandinterventionanoncomparativeanalysis AT darrenjwalsh chemotherapytoxicityinolderadultsoptimizedbygeriatricassessmentandinterventionanoncomparativeanalysis AT taramatthews chemotherapytoxicityinolderadultsoptimizedbygeriatricassessmentandinterventionanoncomparativeanalysis AT stephenmadden chemotherapytoxicityinolderadultsoptimizedbygeriatricassessmentandinterventionanoncomparativeanalysis AT miriamoconnor chemotherapytoxicityinolderadultsoptimizedbygeriatricassessmentandinterventionanoncomparativeanalysis AT paulacalvert chemotherapytoxicityinolderadultsoptimizedbygeriatricassessmentandinterventionanoncomparativeanalysis AT annemhorgan chemotherapytoxicityinolderadultsoptimizedbygeriatricassessmentandinterventionanoncomparativeanalysis |