scholarly journals Development and Validation of a Risk Tool for Predicting Severe Toxicity in Older Adults Receiving Chemotherapy for Early-Stage Breast Cancer

2021 ◽  
Vol 39 (6) ◽  
pp. 608-618 ◽  
Author(s):  
Allison Magnuson ◽  
Mina S. Sedrak ◽  
Cary P. Gross ◽  
William P. Tew ◽  
Heidi D. Klepin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Adults ◽  
Goodness Of Fit ◽  
Validation Cohort ◽  
Early Stage ◽  
Risk Groups ◽  
Early Stage Breast Cancer ◽  
Severe Toxicity ◽  
Chemotherapy Toxicity ◽  
Grade 3

PURPOSE Limited tools exist to predict the risk of chemotherapy toxicity in older adults with early-stage breast cancer. METHODS Patients of age ≥ 65 years with stage I-III breast cancer from 16 institutions treated with neoadjuvant or adjuvant chemotherapy were prospectively evaluated for geriatric and clinical features predictive of grade 3-5 chemotherapy toxicity. Logistic regression with best-subsets selection was used to identify and incorporate independent predictors of toxicity into a model with weighted variable scoring. Model performance was evaluated using area under the ROC curve (AUC) and goodness-of-fit statistics. The model was internally and externally validated. RESULTS In 473 patients (283 in development and 190 in validation cohort), 46% developed grade 3-5 chemotherapy toxicities. Eight independent predictors were identified (each assigned weighted points): anthracycline use (1 point), stage II or III (3 points), planned treatment duration > 3 months (4 points), abnormal liver function (3 points), low hemoglobin (3 points), falls (4 points), limited walking (3 points), and lack of social support (3 points). We calculated risk scores for each patient and defined three risk groups: low (0-5 points), intermediate (6-11 points), or high (≥ 12 points). In the development cohort, the rates of grade 3-5 chemotherapy toxicity for these three groups were 19%, 54%, and 87%, respectively ( P < .01). In the validation cohort, the corresponding toxicity rates were 27%, 45%, and 76%. The AUC was 0.75 (95% CI, 0.70 to 0.81) in the development cohort and 0.69 (95% CI, 0.62 to 0.77) in the validation cohort. Risk groups were also associated with hospitalizations and reduced dose intensity ( P < .01). CONCLUSION The Cancer and Aging Research Group-Breast Cancer (CARG-BC) score was developed and validated to predict grade 3-5 chemotherapy toxicity in older adults with early-stage breast cancer.

scholarly journals Early-Stage Breast Cancer in Older Adults

2020 ◽  
pp. 633-642
Author(s):  
Kwok-Leung Cheung ◽  
Lorenzo Livi ◽  
Etienne Brain
Keyword(s):  
Breast Cancer ◽  
Older Adults ◽  
Early Stage ◽  
Early Stage Breast Cancer

scholarly journals Can Chemotherapy-Related Acute Care Visits Be Accurately Identified in Administrative Data?

2018 ◽  
Vol 14 (1) ◽  
pp. e51-e58 ◽  
Author(s):  
Monika K. Krzyzanowska ◽  
Katherine Enright ◽  
Rahim Moineddin ◽  
Lingsong Yun ◽  
Melanie Powis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Emergency Department ◽  
Adjuvant Chemotherapy ◽  
Acute Care ◽  
Administrative Data ◽  
Validation Cohort ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Algorithm Validation ◽  
Ed Visits

Purpose: There is increasing interest in using administrative data to examine treatment-related complications that lead to emergency department (ED) visits or hospitalizations (H). The purpose of this study was to evaluate the reliability of billing codes for identifying chemotherapy-related acute care visits (CRVs) among women with early-stage breast cancer. Materials and Methods: The cohort was identified by using deterministically linked health databases and consisted of women who were diagnosed with early-stage breast cancer who started adjuvant chemotherapy between 2007 and 2009 in Ontario, Canada. A random sample of 496 patient cases was chosen as the validation cohort. Sensitivity (SN) and specificity (SP) were calculated for three scenarios: chemotherapy-related ED visit, chemotherapy-related H, and febrile neutropenia (FN)–related visit. For FN-related visits, three definitions were considered: general, moderate, and strict. Results: The administrative cohort consisted of 8,359 patients, 43.4% of whom had at least one ED or H, including 1,496 women who had multiple visits that resulted in 6,293 unique visits. Of these, 73.1% were considered CRVs. The algorithm performed well in identifying CRVs that included H either from ED (SN, 90%; SP, 100%) or directly from home (SN, 91%; SP, 93%), but less well for ED visits that did not result in H (SN, 65%; SP, 80%). Depending on which FN algorithm was used, 4.8% to 24% of visits were considered related. The moderate FN algorithm provided the best tradeoff between SN (69% to 97%) and SP (83% to 98%). Conclusion: Administrative data can be valuable in evaluating chemotherapy-related serious events. Algorithm validation in other cohorts is needed.

Abstract P6-08-34:p16INK4aexpression and chemotherapy toxicity in women with early stage breast cancer

2015 ◽  
Author(s):  
Hyman Muss ◽  
Allison Deal ◽  
Arti Hurria ◽  
Natalia Mitin ◽  
Chad Torrice ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Chemotherapy Toxicity

scholarly journals Decline in Cognitive Function in Older Adults With Early‐Stage Breast Cancer After Adjuvant Treatment

2016 ◽  
Vol 21 (11) ◽  
pp. 1337-1348 ◽  
Author(s):  
Marie Lange ◽  
Natacha Heutte ◽  
Olivier Rigal ◽  
Sabine Noal ◽  
Jean‐Emmanuel Kurtz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Adults ◽  
Cognitive Function ◽  
Adjuvant Treatment ◽  
Early Stage ◽  
Early Stage Breast Cancer

scholarly journals Adherence and Persistence With Oral Adjuvant Chemotherapy in Older Women With Early-Stage Breast Cancer in CALGB 49907: Adherence Companion Study 60104

2010 ◽  
Vol 28 (14) ◽  
pp. 2418-2422 ◽  
Author(s):  
Ann H. Partridge ◽  
Laura Archer ◽  
Alice B. Kornblith ◽  
Julie Gralow ◽  
Debjani Grenier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Older Women ◽  
Patient Adherence ◽  
Early Stage ◽  
Tumor Stage ◽  
Oral Chemotherapy ◽  
Early Stage Breast Cancer ◽  
Grade 3 ◽  
Group B

Purpose Patient adherence is critical in evaluating the effectiveness of an oral therapy. We sought to measure adherence among women randomly assigned to capecitabine in a preplanned substudy of a multicenter clinical trial. Patients and Methods Cancer and Leukemia Group B study CALGB 49907 was a randomly assigned trial comparing standard chemotherapy versus oral chemotherapy with capecitabine in patients age 65 years or older with early-stage breast cancer. We used microelectronic monitoring system (MEMS) caps on participants' capecitabine bottles to record pill bottle openings. Capecitabine was given in two divided daily doses for 14 consecutive days of a 21-day cycle for six cycles. Adherence was calculated as the number of doses taken divided by doses expected, taking into account toxicity-related dosing changes. A participant was defined as adherent if 80% or more of expected doses were recorded by MEMS. Results Overall, 161 patients were enrolled. Median age was 71 years (range, 65 to 89 years); 124 patients (83%) persisted with capecitabine to completion of planned protocol therapy. Adherence was 78% across all cycles, and adherence did not vary by cycle (P = .32). Twenty-five percent of participants took fewer than 80% of expected doses and were nonadherent. In a logistic regression model, participants with node-negative disease (P = .01) and mastectomy (P = .01) were more likely to be nonadherent. Adherence was not related to age, tumor stage, or hormone receptor status. Adherence was not significantly associated with relapse-free survival or grade 3 or 4 toxicity. Conclusion Most older women with early-stage breast cancer were adherent to short-term oral chemotherapy in a randomized clinical trial. Age was not associated with adherence.

scholarly journals Impact of Guideline‐Discordant Treatment on Cost and Health Care Utilization in Older Adults with Early‐Stage Breast Cancer

2018 ◽  
Vol 24 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Courtney P. Williams ◽  
Kelly M. Kenzik ◽  
Andres Azuero ◽  
Grant R. Williams ◽  
Maria Pisu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Adults ◽  
Health Care ◽  
Health Care Utilization ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Care Utilization

scholarly journals Cognitive Changes After Adjuvant Treatment in Older Adults with Early‐Stage Breast Cancer

2018 ◽  
Vol 24 (1) ◽  
pp. 62-68 ◽  
Author(s):  
Marie Lange ◽  
Natacha Heutte ◽  
Sabine Noal ◽  
Olivier Rigal ◽  
Jean‐Emmanuel Kurtz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Adults ◽  
Adjuvant Treatment ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Cognitive Changes
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