Shelly Sud1, Pamela Lai2, Tinghua Zhang3, Mark Clemons1, Paul Wheatley-Price4. 1. Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada. 2. University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada. 3. Clinical Epidemiology Program, Methods Centre, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada. 4. Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada. Electronic address: pwheatleyprice@toh.on.ca.
Abstract
OBJECTIVES: Cancer is predominantly a disease of the elderly. While "older" patients are frequently considered for chemotherapy, little data exist in the population 80 years and older (80+). We investigated outcomes of patients 80+ who received chemotherapy at our institution. MATERIALS AND METHODS: A retrospective chart review of patients 80+ initiating chemotherapy for malignant solid tumors from 2005 to 2010 was performed. Baseline demographics, cancer type and chemotherapy data were collected. Primary outcome was the rate of discontinuation due to toxicity. Secondary outcomes included the rate of dose reduction/omission/delay (ROD), hospitalization and blood transfusion. RESULTS: Chemotherapy was initiated in 318 patients. Baseline demographics included the following: median age 82 years (80-92 years), 56% male, 55% ECOG PS 0-1, 43% Charlson index score of 0-1; 38% were taking ≥ 6 prescription medications. Common malignancies were colorectal (32%), lung (20%), and breast (12%). Most patients (68%) had metastatic disease or received palliative intent therapy (71%). Treatment was first line in 89% of patients, and an up front dose reduction was ordered in 41%. Toxicity caused therapy discontinuation in 32% of cases, while 52% experienced dose ROD. Hospitalization occurred in 32%; 18% required blood transfusions. Baseline polypharmacy was associated with increased hospitalization risk (OR 2.28, 95% CI 1.34-3.88, p=0.002), but dose adjustments were not correlated with any outcome. CONCLUSION: In this study, we observed a high risk of hospitalization or treatment discontinuation due to toxicity, despite frequent dose modifications. As the cancer population ages, validated tools are needed to better select patients for therapy.
OBJECTIVES:Cancer is predominantly a disease of the elderly. While "older" patients are frequently considered for chemotherapy, little data exist in the population 80 years and older (80+). We investigated outcomes of patients 80+ who received chemotherapy at our institution. MATERIALS AND METHODS: A retrospective chart review of patients 80+ initiating chemotherapy for malignant solid tumors from 2005 to 2010 was performed. Baseline demographics, cancer type and chemotherapy data were collected. Primary outcome was the rate of discontinuation due to toxicity. Secondary outcomes included the rate of dose reduction/omission/delay (ROD), hospitalization and blood transfusion. RESULTS: Chemotherapy was initiated in 318 patients. Baseline demographics included the following: median age 82 years (80-92 years), 56% male, 55% ECOG PS 0-1, 43% Charlson index score of 0-1; 38% were taking ≥ 6 prescription medications. Common malignancies were colorectal (32%), lung (20%), and breast (12%). Most patients (68%) had metastatic disease or received palliative intent therapy (71%). Treatment was first line in 89% of patients, and an up front dose reduction was ordered in 41%. Toxicity caused therapy discontinuation in 32% of cases, while 52% experienced dose ROD. Hospitalization occurred in 32%; 18% required blood transfusions. Baseline polypharmacy was associated with increased hospitalization risk (OR 2.28, 95% CI 1.34-3.88, p=0.002), but dose adjustments were not correlated with any outcome. CONCLUSION: In this study, we observed a high risk of hospitalization or treatment discontinuation due to toxicity, despite frequent dose modifications. As the cancer population ages, validated tools are needed to better select patients for therapy.
Authors: Linda Pang; Maxine de la Cruz; Jimin Wu; Diane Liu; Mujtaba Naqvi; Eduardo Bruera Journal: Support Care Cancer Date: 2019-02-23 Impact factor: 3.603
Authors: Stéphanie M L M Looijaard; Carel G M Meskers; Monique S Slee-Valentijn; Donald E Bouman; A N Machteld Wymenga; Joost M Klaase; Andrea B Maier Journal: Oncologist Date: 2019-11-20
Authors: Ana Carolina B M Martin; Angelina M Fuzer; Marcia R Cominetti; Normand Pouliot; Amanda B Becceneri; James Almada da Silva; Rebeka Tomasin; Delphine Denoyer; Soo-Hyun Kim; Katherine A McIntyre; Helen B Pearson; Belinda Yeo; Aadya Nagpal; Xiawei Ling; Heloisa S Selistre-de-Araújo; Paulo Cézar Vieira Journal: Oncotarget Date: 2017-08-10
Authors: Stéphanie M L M Looijaard; Carel G M Meskers; Monique S Slee-Valentijn; Donald E Bouman; A N Machteld Wymenga; Joost M Klaase; Andrea B Maier Journal: Oncologist Date: 2019-11-20