Karin Ribi1, Stéphanie Rondeau2, Felicitas Hitz3, Ulrich Mey4, Milica Enoiu2, Thomas Pabst5, Anastasios Stathis6, Natalie Fischer7, Kerri M Clough-Gorr8,9. 1. International Breast Cancer Study Group, Coordinating Center, Effingerstr. 40, 3008, Bern, Switzerland. karin.ribi@ibcsg.org. 2. Swiss Group for Clinical Cancer Research, Coordinating Center, Effingerstr. 33, 3008, Bern, Switzerland. 3. Kantonsspital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Switzerland. 4. Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland. 5. Inselspital Bern, Freiburgstrasse 8, 3010, Bern, Switzerland. 6. IOSI (Istituto Oncologico della Svizzera Italiana), 6500, Bellinzona, Switzerland. 7. Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland. 8. Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg, 11 3012, Bern, Switzerland. 9. Section of Geriatrics, Boston University Medical Center, Harrison Ave, Boston, MA, 02111, USA.
Abstract
PURPOSE: To evaluate the efficacy and tolerability of chemotherapy, a geriatric assessment is recommended in elderly patients with cancer. We aimed to characterize and compare patients with aggressive lymphoma by objective response and survival status based on pre-treatment cancer-specific geriatric (C-SGA) and quality of life (QoL) assessments. METHODS: Patients not eligible for anthracycline-based first-line therapy or intensive salvage regimens completed C-SGA and QoL assessment before and after a rituximab-bendamustine-lenalidomide (R-BL) treatment in a phase II clinical trial. Clinical outcomes were compared based on pre-treatment individual and summary C-SGA measures, their cutoff-based subcategories and QoL indicators, using Wilcoxon rank sum or chi-square tests. RESULTS: A total of 57 patients (41 included in the clinical trial) completed a C-SGA. Participants with pre-treatment impaired functional status (Vulnerable Elders Survey-13 score ≥3) were more likely to experience worse outcomes: a higher proportion were non-responders, died before the median follow-up of 31.6 months (interquartile range (IQR) 27.9-37.9) or died during treatment. Non-responders were patients categorized as having possible depression (Geriatric Depression Scale-5 score ≥2) and with worse QoL scores for functional performance. Patients with worse C-SGA summary scores and with greater tiredness were more likely to die during treatment. CONCLUSION: A pre-treatment impaired functional status is an important factor with respect to clinical outcomes in patients receiving an R-BL regimen. Individual geriatric and related QoL domains showed similar associations with clinical outcomes. Whether interventions targeting specific geriatric dimensions also translate in better symptom- or domain-specific QoL warrants further research.
PURPOSE: To evaluate the efficacy and tolerability of chemotherapy, a geriatric assessment is recommended in elderly patients with cancer. We aimed to characterize and compare patients with aggressive lymphoma by objective response and survival status based on pre-treatment cancer-specific geriatric (C-SGA) and quality of life (QoL) assessments. METHODS:Patients not eligible for anthracycline-based first-line therapy or intensive salvage regimens completed C-SGA and QoL assessment before and after a rituximab-bendamustine-lenalidomide (R-BL) treatment in a phase II clinical trial. Clinical outcomes were compared based on pre-treatment individual and summary C-SGA measures, their cutoff-based subcategories and QoL indicators, using Wilcoxon rank sum or chi-square tests. RESULTS: A total of 57 patients (41 included in the clinical trial) completed a C-SGA. Participants with pre-treatment impaired functional status (Vulnerable Elders Survey-13 score ≥3) were more likely to experience worse outcomes: a higher proportion were non-responders, died before the median follow-up of 31.6 months (interquartile range (IQR) 27.9-37.9) or died during treatment. Non-responders were patients categorized as having possible depression (Geriatric Depression Scale-5 score ≥2) and with worse QoL scores for functional performance. Patients with worse C-SGA summary scores and with greater tiredness were more likely to die during treatment. CONCLUSION: A pre-treatment impaired functional status is an important factor with respect to clinical outcomes in patients receiving an R-BL regimen. Individual geriatric and related QoL domains showed similar associations with clinical outcomes. Whether interventions targeting specific geriatric dimensions also translate in better symptom- or domain-specific QoL warrants further research.
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