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Assessment tool may identify older patients at risk for chemotherapy toxicity
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An assessment tool comprised of clinically relevant questions and specific treatment information accurately predicted risk for chemotherapy toxicity in a majority of older patients with cancer, according to the results of a validation study.
Older adults face an increased risk for chemotherapy toxicity during cancer treatment; as such, they are less likely to be offered chemotherapy than their younger counterparts.
Standard oncology assessment measures have shown a lack of efficacy in identifying older patients at risk for toxicity.
Arti Hurria
“Age is only one factor when predicting an increased risk for toxicity,” Arti Hurria, MD, director of the Cancer and Aging Research Program at City of Hope Comprehensive Cancer Center, as well as HemOnc Today’s geriatric oncology section editor, told HemOnc Today. “We identified key questions that oncologists can ask patients to help them stratify the risk. These are simple questions, and the assessment takes only minutes.”
Hurria and colleagues developed a predictive model for chemotherapy toxicity, using data collected from a longitudinal study of 500 patients aged 65 years or older (mean age, 73 ± 6 years; 56% women) scheduled to receive chemotherapy for a solid tumor.
The researchers created a risk score based on answers to 11 questions and variables, including:
- patient age (≥ 72 years vs. < 72 years);
- cancer type (gastrointestinal or genitourinary carcinoma vs. other carcinoma types);
- planned chemotherapy dose (standard dose vs. reduced upfront dose);
- planned number of chemotherapy drugs (polychemotherapy vs. monochemotherapy);
- hemoglobin (< 11 g/dL vs. ≥ 11 g.dL [men]; < 10 g/dL vs. ≥ 10 g/dL [women]);
- creatinine clearance (< 34 mL/min vs. ≥ 34 mL/min);
- hearing ability (fair, poor or totally deaf vs. excellent or good hearing);
- number of falls in the past 6 months (≥ 1 vs. none);
- ability to take medicine independently (unable to or requiring help vs. without help);
- ability to walk one block (somewhat or very limited vs. not limited at all); and
- the degree to which physical and emotional health has limited social activities in the past 4 weeks (somewhat, very or completely limited vs. minimally limited or not limited at all).
Scores ranged from 0 points to 19 points, which the researchers used to create three risk categories: low (0-5 points), medium (6-9 points) and high (10-19 points).
The risk for chemotherapy toxicity correlated with an increasing risk score in the development cohort, with 53% of patients experiencing grade 3 or higher chemotherapy toxicity.
The analysis also included a validation cohort of 250 patients (mean age, 73±5.8 years; range, 65-94).
Fifty-three percent of patients in the validation cohort were deemed at medium risk for chemotherapy toxicity, with 24% classified as low risk and 23% classified as high risk.
Fifty-eight percent of the validation cohort experienced grade 3 or higher toxicity, with 34% experiencing hematologic toxicity and 55% experiencing nonhematologic toxicity.
The most frequently seen hematologic toxicities included grade 3 absolute neutrophil count (12%) and grade 3 anemia (7%).
Frequent nonhematologic toxicity included grade 3 fatigue (20%) and grade 3 infections (10%).
The risk for toxicity correlated with increased risk scores (low-risk cohort, 36.7%; medium-risk cohort, 62.4%; high-risk cohort, 70.2%; P < .01).
The area under the curve did not statistically differ between the validation cohort (0.65; 95% CI, 0.58-0.71) and the development cohort (0.72; 95% CI, 0.68-0.77).
Clinician-determined Karnofsky performance status did not independently predict toxicity in either group.
The researchers acknowledged study limitations, including the model’s imprecise ability to determine between medium- and high-risk patients in the validation cohort. Further, the sole inclusion of English-speaking patients with solid tumors may limit the model’s generalizability.
The chemotherapy toxicity assessment has been made available, free of charge, on the Cancer and Aging Research Group’s website, Hurria said in an interview.
“We want to make this as user-friendly as possible,” Hurria said. “We encourage everyone to visit the website and try it out, and consider implementing it.” – by Cameron Kelsall
For more information:
Arti Hurria, MD, can be reached at ahurria@coh.org.
Disclosure: Hurria reports institutional research funding from and/or consultant roles with Boehringer Ingelheim, Celgene, GTx, Novartis, On Q Health, Sanofi and Seattle Genetics. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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