scholarly journals Prediction of Chemotoxicity, Unplanned Hospitalizations and Early Death in Older Patients with Colorectal Cancer Treated with Chemotherapy

Cancers ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 127
Author(s):  
Jaime Feliu ◽  
Enrique Espinosa ◽  
Laura Basterretxea ◽  
Irene Paredero ◽  
Elisenda Llabrés ◽  
...  
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Creatinine Clearance ◽  
Metastatic Disease ◽  
Daily Living ◽  
Older Patients ◽  
Early Death ◽  
Roc Curves ◽  
Severe Toxicity ◽  
Grade 3

Purpose: To identify risk factors for toxicity, unplanned hospitalization (UH) and early death (ED) in older patients with colorectal carcinoma (CRC) initiating chemotherapy. Methods: 215 patients over 70 years were prospectively included. Geriatric assessment was performed before treatment, and tumor and treatment variables were collected. The association between these factors and grade 3–5 toxicity, UH and ED (<6 months) was examined by using multivariable logistic regression. Score points were assigned to each risk factor. Results: During the first 6 months of treatment, 33% of patients developed grade 3–5 toxicity, 31% had UH and 23% died. Risk factors were, for toxicity, instrumental activities of daily living, creatinine clearance, weight loss and MAX2 index; for UH, Charlson Comorbidity Score, creatinine clearance, weight loss, serum albumin, and metastatic disease; and for ED, basic activities in daily living, weight loss, metastatic disease, and hemoglobin levels. Predictive scores were built with these variables. The areas under receiver operation characteristic (ROC) curves for toxicity, UH and ED were 0.70 (95% CI: 0.64–0.766), 0.726 (95% IC: 0.661–0.799) and 0.74 (95% IC: 0.678–0.809), respectively. Conclusion: Simple scores based on geriatric, tumor and laboratory characteristics predict severe toxicity, UH and ED, and may help in treatment planning.

Early death in older patients with cancer: risk factors of worse outcomes?

2013 ◽  
Vol 4 ◽  
pp. S85
Author(s):  
R. Boulahssass ◽  
V. Mari ◽  
S. Gonfrier ◽  
F. Auben ◽  
A. Abakar-Mahamat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Risk ◽  
Older Patients ◽  
Early Death ◽  
Cancer Risk Factors ◽  
Patients With Cancer

scholarly journals Risk Model for Decline in Activities of Daily Living Among Older Adults Hospitalized With Acute Myocardial Infarction: The SILVER‐AMI Study

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Alexandra M. Hajduk ◽  
John A. Dodson ◽  
Terrence E. Murphy ◽  
Sui Tsang ◽  
Mary Geda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Older Patients ◽  
Risk Model ◽  
Functional Decline ◽  
Activity Of Daily Living ◽  
Mobility Impairment

Background Functional decline (ie, a decrement in ability to perform everyday activities necessary to live independently) is common after acute myocardial infarction (AMI) and associated with poor long‐term outcomes; yet, we do not have a tool to identify older AMI survivors at risk for this important patient‐centered outcome. Methods and Results We used data from the prospective SILVER‐AMI (Comprehensive Evaluation of Risk Factors in Older Patients With Acute Myocardial Infarction) study of 3041 patients with AMI, aged ≥75 years, recruited from 94 US hospitals. Participants were assessed during hospitalization and at 6 months to collect data on demographics, geriatric impairments, psychosocial factors, and activities of daily living. Clinical variables were abstracted from the medical record. Functional decline was defined as a decrement in ability to independently perform essential activities of daily living (ie, bathing, dressing, transferring, and ambulation) from baseline to 6 months postdischarge. The mean age of the sample was 82±5 years; 57% were men, 90% were White, and 13% reported activity of daily living decline at 6 months postdischarge. The model identified older age, longer hospital stay, mobility impairment during hospitalization, preadmission physical activity, and depression as risk factors for decline. Revascularization during AMI hospitalization and ability to walk a quarter mile before AMI were associated with decreased risk. Model discrimination (c=0.78) and calibration were good. Conclusions We identified a parsimonious model that predicts risk of activity of daily living decline among older patients with AMI. This tool may aid in identifying older patients with AMI who may benefit from restorative therapies to optimize function after AMI.

Toxicity and Risk Factors Contributing to Delayed Methotrexate (MTX) Elimination in Adult/Elderly Patients (pts) Treated with High-Dose Methotrexate Therapy (HDMTX), a 2-Year, Single Center Survey.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2439-2439
Author(s):  
Stefan Schwartz ◽  
Peter Martus ◽  
Wolf-Dieter Ludwig ◽  
Renate Arnold ◽  
Markus Ruhnke ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Trials ◽  
Serum Creatinine ◽  
Liver Toxicity ◽  
Lymphoblastic Leukemia ◽  
Advanced Age ◽  
High Dose ◽  
Severe Toxicity ◽  
Urine Ph ◽  
Grade 3

Abstract HDMTX is a well-established regimen used in a variety of neoplasms, including acute lymphoblastic leukemia (ALL) or lymphoma (NHL). Risk factors contributing to a delayed MTX-elimination and toxicity have been studied in pediatric pts with HDMTX (Relling MV, J Clin Oncol 1994, 12: 1667–72). However, data are scarce on risk factors contributing to delayed MTX elimination in adult pts, on toxicities in elderly pts and from pts treated with HDMTX outside clinical trials. We assessed toxicities and risk factors in all non-pediatric pts treated with HDMTX at the Charité in 2003/04. 141 pts (age 16–81y, median 44y) received 614 HDMTX cycles (median dose MTX/m2: 3000mg, range 320–12000mg) for ALL (39), NHL (38), CNS-NHL (36), sarcoma or other solid tumor (28) within (69) or outside (72) clinical trials. In 99/614 (16%) of HDMTX cycles a 15–85% (median 50%) dose reduction was carried out due to renal dysfunction (58), severe toxicity of prior chemotherapy (18) or other reasons (23). Toxicities in 62/614 (10%) HDMTX cycles caused delays of 1–50 days (median 7 days) of scheduled therapy. 61/614 (10%) HDMTX cycles resulted in an increase of serum creatinine values above the upper limit of normal (ULN) (median of 112μmol/L, range 81–386μmol/L). Delayed MTX-elimination (MTX blood level >150μM 24h, >3μM 36h, >1μM 42h, >0.4μM 48h or >0.1μM 68h) occurred in 156/614 (25%) HDMTX cycles. Grade 3/4 toxicities were recorded in 224 (36%) cycles for leukopenia, 127 (21%) cycles for liver toxicity, 116 (19%) cycles for thrombocytopenia, 88 (14%) cycles for fever with neutropenia and 63 (10%) cycles for mucositis/gastrointestinal toxicity. Presence of a 3rd space and comedications with known interference with MTX elimination or nephrotoxic potential were associated with a delayed MTX elimination (p<0.01). Overweight (BMI≥25kg/m2), urine pH<7 at some time after HDMTX and presence of a 3rd space were associated with an increase of serum creatinine values above ULN (p≤0.05). Pts with delayed MTX elimination or an increase of serum creatinine above ULN were older compared to pts with regular MTX elimination (median age 51y vs. 30y and 54y vs. 35y, p<0.01). Pts receiving HDMTX outside clinical trials more frequently experienced delayed MTX elimination (p<0.01). HDMTX frequently causes grade 3/4 hematotoxicity and increases of serum creatinine. Delayed MTX elimination is associated with advanced age and therapy outside clinical trials. Improved supportive care strategies are needed, especially in pts with advanced age, to ensure predictable MTX-elimination and reduce toxicities associated with HDMTX.

Development of a Frailty Score for Older Patients with Myelodysplastic Syndromes and Acute Myeloid Leukemia.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1775-1775
Author(s):  
Barbara Deschler ◽  
Gabriele Ihorst ◽  
Uwe Platzbecker ◽  
Ulrich Germing ◽  
Michael Lübbert
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Activities Of Daily Living ◽  
Cell Transplantation ◽  
Daily Living ◽  
Older Patients ◽  
Treatment Allocation ◽  
Frailty Score

Abstract Abstract 1775 Poster Board I-801 Introduction Treatment options in older patients (pts) with MDS/AML range from best supportive care (BSC) to intensive chemotherapy/hematopoietic stem cell transplantation (IC/HCT), with low-dose chemotherapy or novel non-intensive agents (e.g. hypomethylating agents; HA) as alternatives. Due to frequent age-related physical and/or mental impairments, intensive treatment is not always feasible. As the basis for treatment decision-making is not well defined, the generation of comprehensive assessments of age-specific functional and quality of life (QOL)-aspects in addition to disease-specific risk factor definition therefore is urgently needed. Geriatric Assessment (GA) is expected to offer rational support in this process. Patients and Methods Since January 2004, we have prospectively evaluated the prognostic impact of GA on overall survival (OS) in 195 consecutive pts ≥60 years (yrs) with AML (n=132) or MDS (n=63) in three participating centers, receiving either BSC or HA+BSC or IC/HCT. Of the pts receiving non-intensive treatment, 50% had MDS. GA included eight instruments evaluating QOL, activities of daily living, depression, mental functioning, mobility, comorbidities and performance status (PS). In addition, disease- and patient-specific laboratory parameters were obtained. Results Median age of pts was 71 yrs (range: 60-87 yrs). The primary treatment allocation was BSC in 47 pts (median age: 75 yrs); HA+BSC in 66 pts (74 yrs); IC/HCT in 75 pts (68 yrs). 62% of IC/HCT pts received a matched related/unrelated stem cell transplantation. Application of age-specific tests at the different study centers was readily feasible. The initial multidimensional GA was associated with treatment allocation, age, hematological and functional parameters and treatment outcome. Multivariate analyses revealed impairments in activities of daily living (ADL: Barthel Test, HR: 2.22) and fatigue (measured by EORTC QLQ-C30; HR: 1.68) as significant prognostic parameters for overall survival. Both risk factors were combined to construct a simple risk score for survival. Conducting a Cox regression model with established risk factors, a high risk frailty score in the entire pt population was associated with an elevated HR of 4.17 (p<0.0001), while adverse cytogenetics (AML), blasts >20% and comorbidities >1 proved to be independently associated with HRs of 2.491 (p=0.0001), 2.756 (p=0.0005) and 1.495 (p=0.1281). When this score was applied to pts receiving sole BSC or HA+BSC, highly significant differences in OS could be demonstrated, with p=0.0035 and p<0.0001, respectively. Conclusions Our data demonstrate that GA is a useful and objective tool in the in-depth evaluation process prior to treatment allocation in elderly patients with MDS/AML. A simple prognostic score based solely on ADL and fatigue to predict outcome of patients treated non-intensively has been established. Validation in independent cohorts appears warranted. Disclosures No relevant conflicts of interest to declare.

Efficacy and Safety of Yttrium-90 Ibritumomab Tiuxetan in Older Patients with Indolent Non-Hodgkin Lymphoma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4795-4795
Author(s):  
Silvana Capalbo ◽  
Gaetano Palumbo ◽  
Matteo Dell'Olio ◽  
Maria Grazia Franzese ◽  
Attilio Guarini ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Older Patients ◽  
Response Rate ◽  
Significant Activity ◽  
Severe Toxicity ◽  
First Line ◽  
Ibritumomab Tiuxetan ◽  
Non Hodgkin Lymphoma ◽  
Grade 3 ◽  
Yttrium 90

Abstract Abstract 4795 Introduction Radioimmunotherapy (RIT) has emerged as an important treatment options for patients with non-Hodgkin lymphoma (NHL). Yttrium-90 ibritumomab tiuxetan (Zevalin®) consist of ibritumomab, a murine monoclonal antibody to CD20, conjugated to the metal chelator tiuxetan for retention of the beta emitter Yttrium-90. Clinical trials with this agent have demonstrated significant activity in indolent NHL with mild toxicity. The median age of NHL patients included in these trials is mainly < 65 years. Our aim was to evaluate the effectiveness of Zevalin as treatment option for patient > 65 years old with indolent NHL. Patients and Methods Between November 2005 to June 2009 fifteen patients, five males and ten females, median age 76 years (range 67-82), with indolent NHL (13 follicular and 2 small lymphocytic) were treated with Zevalin. Six patients had stage IV disease, five stage III and four stage II. All patients received an initial infusion of rituximab at a dose of 250 mg/m(e)2 on day 1 and a second infusion at same dose on day 8 followed by a weight-based dose of Zevalin (median dose 1006 MBq; range 668-1260). Eight patients perfomed Zevalin as consolidation after first line therapy with Rituximab plus chemotherapy (6 R-CHOP, 1 R-FN, 1 R-COMP): of these three were in complete remission (CR) and five in partial remission (PR). Seven patients perfomed Zevalin in relapse (four in first and three in second relapse). Results After RIT 13 of 15 patients were evaluable. Overall response rate was 92% (10 CR, 2 PR); in particular all patients in first line of treatment achieved CR. One patient had stable disease. At a median follow-up of 15 months (range 2-34), all patients are alive in persistent CR or PR. One of two patients in PR achieved CR after successive therapy. Treatment was well tolerated; transient thrombocytopenia (grade 3-4) was seen in 9 patients and transient neutropenia (grade 3-4 ) in 6 patients. Only one patient developed herpex-zoster virus infection. Conclusion In our experience, Zevalin produces high response rate (up to 90%) and durable remission without severe toxicity in older patients with indolent NHL. Notably, in first-line treatment, RIT resulted in PR-to-CR conversion in all five patients in PR after the R-chemotherapy. The favourable safety profile of this regimen makes it an effective consolidation treatment for older patients who, because of age and comorbidity, are not eligible for intensive treatment as high-dose therapy and stem cell transplantation. Disclosures: No relevant conflicts of interest to declare.

External validation of two predictive scores of chemotherapy toxicities among older patients with solid cancer, from ELCAPA prospective cohort.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12050-12050
Author(s):  
Maxime Frelaut ◽  
Philippe Caillet ◽  
Stephane Culine ◽  
Elena Paillaud ◽  
Christophe Tournigand ◽  
...  
Keyword(s):  
High Risk ◽  
Prospective Cohort ◽  
Older Patients ◽  
Risk Groups ◽  
Low Risk ◽  
Solid Cancer ◽  
Cancer Type ◽  
Severe Toxicity ◽  
Increased Risk ◽  
Grade 3

12050 Background: Severe chemotherapy toxicities are frequent among older patients, and may have a major impact on mortality, comorbidities, and quality of life. Two scores were developed to predict severe toxicities: Chemotherapy Risk Assessment Scale for High-age patients (CRASH) score, and Cancer and Aging Research Group Study (CARG) score. The main objective of the present study was to evaluate the predictive value of both scores on an external cohort. Secondary objective was to identify individual predictive factors of severe chemotherapy toxicities. Methods: The Elderly Cancer Patients (ELCAPA) survey consists in a prospective cohort including patients aged 70 years or older referred for a geriatric assessment (GA) before anticancer treatment, such as chemotherapy for solid cancer. CARG and CRASH score were retrospectively collected. Main endpoint was grade 3/4/5 toxicities for CARG-score, hematologic grade 4/5 and non-hematologic grade 3/4/5 toxicities for CRASH-score. Calibration and discrimination (Area Under ROC Curve, AUC) were evaluated. Results: From July 2010 to March 2017, 248 patients were included. Among them, 150 (61%) experienced severe toxicity as defined in CARG study, and 126 (51%) as defined in CRASH study. There was no increased risk of toxicity in intermediate and high risk groups of CARG-score compared to low risk group (OR = 0.3, IC95% [0.1 – 1.4], p= 0.1; and OR = 0.4, IC95%[0.1 – 1.7], p= 0.2 respectively, AUC-ROC = 0.55). Similarly, there was no more risk of severe toxicities in intermediate low, intermediate high, and high risk groups compared to low risk groups of CRASH combined score (respectively OR = 1, IC95% [0.3 – 3.6], p= 0.99; OR = 1, IC95% [0.3 – 3.4], p= 0.9; OR = 1.5, IC95% [0.3 – 8.1], p= 0.67; AUC-ROC = 0.52). A multivariate predictive model including cancer type, performance status (PS 0 vs. PS 1-2), number of severe comorbidities (Cumulative Illness Rating Scale for Geriatrics, CIRS-G, ≥1 grade 3 or 4 comorbidity), body mass index (BMI > 25 kg/m² protective vs. normal BMI), and Chemotox score (1 vs. 0) had an AUC of 0.78. Conclusions: Neither CARG nor CRASH score was predictive of severe chemotherapy toxicities in the ELCAPA cohort. There is a need to identify new predictors of chemotherapy toxicity in older patients with solid cancers.

Age-Based Comparison of Hematological Toxicity in Patients with Lung Cancer

Oncology ◽  
2020 ◽  
Vol 98 (11) ◽  
pp. 771-778
Author(s):  
Yuki Sakai ◽  
Qiliang Zhou ◽  
Yoshifumi Matsumoto ◽  
Takuro Saiki ◽  
Masato Moriyama ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Older Patients ◽  
Performance Status ◽  
Laboratory Data ◽  
Age Groups ◽  
Hematological Toxicity ◽  
Male Sex ◽  
Grade 3 ◽  
A Performance

<b><i>Introduction:</i></b> Because of the increasing age of the general population, there is an increasing number of older patients with lung cancer. Cancer chemotherapy often causes severe hematological toxicity in older patients. <b><i>Objective:</i></b> This study aimed to explore the risk factors affecting the hematological toxicity of cytotoxic anticancer drugs in patients with lung cancer. <b><i>Methods:</i></b> Data were retrospectively collected from 194 patients with lung cancer at Niigata University Medical and Dental Hospital, Japan, between April 2011 and March 2016, when the patients underwent their first round of cytotoxic chemotherapy. The patients were divided into three groups on the basis of age: &#x3c;65, 65–74, and ≥75 years. Physiological functions and laboratory data before treatment, as well as hematological adverse events following chemotherapy, were compared among the groups. <b><i>Results:</i></b> Patients aged ≥75 years were significantly more likely to experience grade 3 or 4 neutropenia, compared with patients aged &#x3c;65 years. However, there were no differences in the incidence of anemia or thrombocytopenia among the age groups. The frequency of febrile neutropenia tended to increase with age. Multivariate analysis showed that age ≥75 years, male sex, and a performance status of ≥2 were independent factors for grade 3 or 4 neutropenia. Patients with 2 or 3 of these factors had a significantly higher frequency of neutropenia, compared with patients who had 0 or 1 of these factors. <b><i>Conclusion:</i></b> We found that age ≥75 years, male sex, and a performance status of ≥2 were independent risk factors for grade 3 or 4 neutropenia.

Treatment completion and toxicity of trastuzumab or trastuzumab + lapatinib in older patients (pts): BIG 2-06; NCCTG N063D (Alliance).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11553-11553 ◽  
Author(s):  
Noam Falbel Ponde ◽  
Dominique Agbor-Tarh ◽  
Lissandra Dal Lago ◽  
Larissa A. Korde ◽  
Florentine Hilbers ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Older Patients ◽  
Treatment Completion ◽  
Treatment Results ◽  
Treatment Interruptions ◽  
Treatment Optimisation ◽  
Temporary Treatment ◽  
Grade 3 ◽  
Dose Reductions

11553 Background: Little is known about the toxicity of trastuzumab (T) or of trastuzumab + lapatinib (T + L), approved in the advanced setting, in older pts. We have performed a sub-analysis of the Adjuvant Lapatinib and/or Trastuzumab Treatment Optimisation (ALTTO) trial focused on treatment completion and toxicity of T and T+L in older pts (aged ≥65 years (yr)). Methods: The ALTTO trial (NCT00490139, NCCTG N063D) randomised 8381 pts with early HER2+ BC into 4 arms and we included the T and T+L arms in our analysis. Eligible pts for our study were those having received at least one dose of assigned treatment. Treatment completion was evaluated through the rate of temporary treatment interruptions (TTI), permanent treatment discontinuations (PTD) and lapatinib dose reductions (LDR). Toxicity was evaluated via a selected set of adverse events of interest (AEIs). Risk factors for TTI, PTD, LDR and AEIs were assessed, including comorbidities and polypharmacy at baseline (defined as use 5 or more co-medications) and AEIs during treatment. Results: A total of 430 pts≥65-year-old were identified for this sub-analysis, out of a total of 4190 pts with a median age of 68 yrs (range 65-80). Older pts were more likely to have comorbidities (70% vs 38%). Treatment completion was worse among older pts in the T+L arm but not in the T arm (Table). AEIs were more common in the T+L arm in all patients, with older patients having higher AEI rates (78.04% in older vs 63.38% in younger), particularly diarrhea (60.75% vs 38.0%). Identified risk factors (multivariate) for worse treatment completion in the T and T+ L arms included concomitant use of chemotherapy and the occurrence of grade 3 adverse events, among others. Conclusions: T + L has worse treatment completion and is more toxic in older patients, while T was well tolerated. Identifiable risk factors at baseline and during the course of treatment could be used to aid in regimen selection and management for both T and T + L in their respective indications. Support: UG1CA189823, Novartis;https://acknowledgments.alliancefound.org. [Table: see text]

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