Abstract
Introduction Cancer is the leading cause of death worldwide with elderly patients being predominantly
affected. There seems to be a bias against administering chemotherapy to elderly patients
with fewer elderly patients receiving chemotherapy as compared with their stagematched
younger patients because of concerns about their capacity to endure treatment. To
make personalized treatment decisions and to anticipate serious adverse effects, a
toxicity prediction tool that can be computed at the bedside is the need of the hour.
This well-validated score has not been tested in the Indian population. So, we decided
to test the same score in our patients and try to correlate the score with the observed
toxicity.
Objectives This study was aimed to determine geriatric functional status by means of a standardized
geriatric score and to correlate geriatric score with observed chemo toxicity.
Materials and Methods Fifty consecutive elderly patients (age > 60 years) with a diagnosis of cancer and
scheduled for chemotherapy were recruited. These patients were evaluated using the
geriatric assessment tool which is based on functional, nutritional, and psychological
status. After that patient’s pretherapy, chemo toxicity score or geriatric score was
calculated using a published well-validated tool that consisted of 11 prechemotherapy
variables as follows:
a) Age of patient,
b) Cancer type
c) Planned chemotherapy dose,
d) Planned number of chemotherapy drugs
e) Hemoglobin,
f) Creatinine clearance
g) Geriatric questions like -
i. How is your hearing?
ii. Number of falls in past 6 months?
iii. Can take your own medicines?
iv. Does your health limit you in walking one block ? during past 4 weeks
v. How much of time has your physical health or emotional problems interfered with
your social activities (like visiting with friends, relatives etc.)
The patients were then followed from the beginning to the end of six
cycles of their chemotherapy regimen. Toxicities were noted after each
clinical encounter by using the NCI-CTCAE, version 3.0.25.
Results General characteristics: the mean age of participants was 66 years (standard deviation
[SD] = 4.6 and range: 60–85 years). Of them, 60% received polychemotherapy and 82%
received standard doses of chemotherapy. The mean score on activities of daily living
was 66.7, comorbidity score was 2.7, the psychological scale was 63.8, the social-activity
scale was 54.3, and social-support scale was 64.1. The mean pretherapy toxicity score
is 7.24 according to the toxicity calculator. At least one grade 3 to 5 toxicity occurred
in 30% of the patients (66% of grade 3, 20% of grade 4, and 13.3% of grade 5). The
correlation between the predicted score and observed graded toxicity score by Pearson’s
scale (α = 0.05) was 0.63.
Conclusion The prediction model is easy to use, thus increasing the feasibility of incorporation
in daily practice is important. It may enable oncologists to better assess the risk/benefit
ratio and to adjust the treatment accordingly.
Keywords
geriatric - chemotherapy toxicity - myCARG
