Predicting Chemotherapy Toxicity in Older Patients with Cancer: A Multicenter Prospective Study
Por:
Feliu J, Jiménez-Munárriz B, Basterretxea L, Paredero I, Llabrés E, Antonio-Rebollo M, Losada B, Espinosa E, Gironés R, Custodio AB, Muñoz MDM, Díaz-Almirón M, Gómez-Mediavilla J, Pinto A, Torregrosa MD, Soler G, Cruz P, Higuera O and Molina-Garrido MJ
Publicada:
1 oct 2020
Ahead of Print:
1 abr 2020
Resumen:
Background Standard oncology tools are inadequate to distinguish which older patients are at higher risk of developing chemotherapy-related complications.
Materials and Methods Patients over 70 years of age starting new chemotherapy regimens were prospectively included in a multicenter study. A prechemotherapy assessment that included sociodemographics, tumor/treatment variables, and geriatric assessment variables was performed. Association between these factors and the development of grade 3-5 toxicity was examined by using logistic regression.
Results A total of 551 patients were accrued. Chemotherapy doses (odds ratio [OR] 1.834; 95% confidence interval [CI] 1.237-2.719) and creatinine clearance (OR 0.989; 95% CI 0.981-0.997) were the only factors independently associated with toxicity. Only 19% of patients who received reduced doses of chemotherapy and had a creatinine clearance >= 40 mL/minute had grade 3-4 toxicity, compared with 38% of those who received standard doses or had a creatinine clearance <40 mL/minute (p < .0001). However, no satisfactory multivariate model was obtained using different selection approaches.
Conclusion Chemotherapy doses and renal function were identified as the major risk factors for developing severe toxicity in the older patient. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow-up in these patients.
Implications for Practice Older patients are more vulnerable to chemotherapy toxicity. However, standard tools are inadequate to identify who is at higher risk of developing chemotherapy-related complications. Chemotherapy doses (standard vs. reduced) and renal function were identified as the major risk factors for developing severe toxicity in the elderly. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow-up.
Filiaciones:
Feliu J:
Oncology Department, Cátedra UAM-AMGEN, CIBERONC, Hospital Universitario La Paz, Madrid, Spain
Jiménez-Munárriz B:
Oncology department, Centro Integral Oncológico Clara Campal, Madrid, Spain
Basterretxea L:
Oncology Department, ESI/OSI Donostialdea, Donostialdea, Spain
:
Oncology Department, Hospital Universitario Dr. Peset, Valencia, Spain
Llabrés E:
Oncology Department, Hospital Universitario Insular de Gran Canarias, Las Palmas, Spain
Antonio-Rebollo M:
Oncohematogeriatrics Unit, Institut Català d'Oncologia, IDIBELL Hospitalet, Barcelona, Spain
Losada B:
Oncology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
Espinosa E:
Oncology Department, Cátedra UAM-AMGEN, CIBERONC, Hospital Universitario La Paz, Madrid, Spain
:
Oncology Department, Hospital Lluis Alcanyis de Xátiva, Valencia, Spain
Custodio AB:
Oncology Department, Cátedra UAM-AMGEN, CIBERONC, Hospital Universitario La Paz, Madrid, Spain
Muñoz MDM:
Oncology department, Hospital Virgen de la Luz, Cuenca, Spain
Díaz-Almirón M:
Biostatistics Department, Hospital La Paz, Universidad Autónoma de Madrid, Madrid, Spain
Gómez-Mediavilla J:
Oncology Department, ESI/OSI Donostialdea, Donostialdea, Spain
Pinto A:
Oncology Department, Cátedra UAM-AMGEN, CIBERONC, Hospital Universitario La Paz, Madrid, Spain
:
Oncology Department, Hospital Universitario Dr. Peset, Valencia, Spain
Soler G:
Oncohematogeriatrics Unit, Institut Català d'Oncologia, IDIBELL Hospitalet, Barcelona, Spain
Cruz P:
Oncology Department, Cátedra UAM-AMGEN, CIBERONC, Hospital Universitario La Paz, Madrid, Spain
Higuera O:
Oncology Department, Cátedra UAM-AMGEN, CIBERONC, Hospital Universitario La Paz, Madrid, Spain
Molina-Garrido MJ:
Oncology department, Hospital Virgen de la Luz, Cuenca, Spain
Bronze, Green Published
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