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Chronological Age and Risk of Chemotherapy Nonfeasibility: A Real-Life Cohort Study of 153 Stage II or III Colorectal Cancer Patients Given Adjuvant-modified FOLFOX6. Am J Clin Oncol 2017; 41:73-80. [PMID: 26669742 DOI: 10.1097/coc.0000000000000233] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To assess nonfeasibility of adjuvant-modified FOLFOX6 chemotherapy in patients with stage II or III colorectal cancer. METHODS Consecutive patients managed between 2009 and 2013 in 2 teaching hospitals in the Paris urban area were included in the CORSAGE (COlorectal canceR, AGe, and chemotherapy fEasability study) cohort study. Nonfeasibility was defined by the frequencies of empirical first-cycle dose reduction (>15%), early discontinuation (<12 cycles), and low relative dose intensity (RDI) (<0.85). Risk factors for chemotherapy nonfeasibility were identified using multivariate logistic regression. RESULTS Among 153 patients, 56.2% were male (median age, 65.6 y; 35.3%≥70 y; 7.3% with performance status [PS]≥2). For 5-fluorouracil (5-FU), 20.9% of patients had first-cycle dose reduction and 28.1% early discontinuation; RDI was 0.91 (25th to 75th percentiles, 0.68 to 0.99). Factors independently associated with first-cycle 5-FU dose reduction were aged 65 to 69 years versus those younger than 65 years (adjusted odds ratio [aOR], 5.5; 95% confidence interval [CI], 1.5-19.9) but not age 70 years and older, PS≥2 (aOR, 6.02; 95% CI, 1.15-31.4), higher Charlson Comorbidity Index (aOR1-point increase, 1.4; 95% CI, 1.05-1.82), or larger number of medications (aOR 1-medication increase, 1.19; 95% CI, 1.00-1.42). Oxaliplatin dose reduction occurred in 52.3% of patients and early discontinuation in 62.7%; the latter was more common in the 70 years and older group (92.6% vs. 74.6% in the <65-y group; P=0.01); RDI was 0.7 (95% CI, 0.55-0.88). CONCLUSIONS In the real-world setting, compared with their younger and older counterparts, patients aged 65 to 69 years given modified FOLFOX6 for stage II or III colorectal cancer had higher frequencies of 5-FU nonfeasibility defined based on first-cycle dose reduction, early discontinuation, and RDI; and these differences were independent from PS, comorbidities, and number of medications.
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Versteeg KS, Blauwhoff-Buskermolen S, Buffart LM, de van der Schueren MAE, Langius JAE, Verheul HMW, Maier AB, Konings IR. Higher Muscle Strength Is Associated with Prolonged Survival in Older Patients with Advanced Cancer. Oncologist 2017; 23:580-585. [PMID: 29222198 DOI: 10.1634/theoncologist.2017-0193] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 11/02/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Identifying predictors of treatment toxicity and overall survival (OS) is important for selecting patients who will benefit from chemotherapy. In younger patients with cancer, muscle mass and radiodensity are associated with treatment toxicity and OS. In this study, we investigated whether muscle mass, radiodensity, and strength were associated with treatment toxicity and OS in patients with advanced cancer aged 60 years or older. MATERIALS AND METHODS Before starting palliative chemotherapy, muscle mass and radiodensity were assessed using computed tomography scans and muscle strength was assessed using a hydraulic hand grip dynamometer. Treatment toxicity was defined as any toxicity resulting in dose reduction and/or discontinuation of treatment. Multiple logistic and Cox regression analyses were performed to study potential associations of muscle mass, radiodensity, and strength with treatment toxicity and OS, respectively. RESULTS The participants were 103 patients, with a mean age of 70 years, with advanced colorectal, prostate, or breast cancer. Muscle parameters were not significantly associated with treatment toxicity. Higher muscle strength was associated with longer OS (hazard ratio 1.03; 95% confidence interval 1.00-1.05). Muscle mass and radiodensity were not significantly associated with OS. CONCLUSION Higher muscle strength at the start of palliative chemotherapy is associated with significantly better OS in older patients with advanced cancer. None of the investigated muscle parameters were related to treatment toxicity. Future studies are needed to evaluate whether muscle strength can be used for treatment decisions in older patients with advanced cancer. IMPLICATIONS FOR PRACTICE This study in older patients with advanced cancer showed that adequate muscle strength is associated with longer overall survival. The results of this study imply that muscle strength might be helpful in estimating survival and therefore in identifying older patients who will benefit from anticancer treatment.
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Affiliation(s)
- Kathelijn Sophie Versteeg
- Department of Medical Oncology, VU University Medical Center (VUmc), Amsterdam, The Netherlands
- Section of Gerontology and Geriatrics, Department of Internal Medicine, VUmc, Amsterdam, The Netherlands
| | - Susanne Blauwhoff-Buskermolen
- Department of Medical Oncology, VU University Medical Center (VUmc), Amsterdam, The Netherlands
- Section of Nutrition and Dietetics, Department of Internal Medicine, VUmc, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Department of Medical Oncology, VU University Medical Center (VUmc), Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VUmc, Amsterdam, The Netherlands
| | - Marian A E de van der Schueren
- Section of Nutrition and Dietetics, Department of Internal Medicine, VUmc, Amsterdam, The Netherlands
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Jacqueline A E Langius
- Section of Nutrition and Dietetics, Department of Internal Medicine, VUmc, Amsterdam, The Netherlands
- Faculty of Health, Nutrition and Sport, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Andrea B Maier
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, VU University, The Netherlands
- Department of Medicine and Aged Care, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
| | - Inge R Konings
- Department of Medical Oncology, VU University Medical Center (VUmc), Amsterdam, The Netherlands
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Kalsi T, Babic-Illman G, Fields P, Hughes S, Maisey N, Ross P, Wang Y, Harari D. The impact of low-grade toxicity in older people with cancer undergoing chemotherapy. Br J Cancer 2014; 111:2224-8. [PMID: 25268369 PMCID: PMC4264435 DOI: 10.1038/bjc.2014.496] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 07/24/2014] [Accepted: 08/16/2014] [Indexed: 12/27/2022] Open
Abstract
Background: Significant toxicity in chemotherapy trials is usually defined as grade ⩾3. In clinical practice, however, multiple lower grade toxicities are often considered meaningful. The purpose of this observational cohort study was to identify which level of toxicity triggers treatment modification and early discontinuation of chemotherapy in older people. Methods: Patients aged 65+ were recruited in a central London hospital. A total of 108 patients were recruited at the start of new chemotherapy treatment between October 2010 and July 2012. Results: Mean age was 72.1±5 years, median 72 and range 65–86 years. Of the patients, 50.9% (55) were male with gastrointestinal (49), gynaecological (18), lung (15) and other cancers (26). Chemotherapy was palliative in 59.3% (64/108), curative/ neoadjuvant/adjuvant in the others. Mean number of cycles completed was 4.2±3. Treatment modifications due to toxicity occurred in 60 (55.6%) patients, 35% (21/60) of whom had no greater than grade 2 toxicity. Early treatment discontinuation because of toxicity occurred in 23 patients (21.3%), 39.1% (9/23) of whom had no greater than grade 2 toxicity. Conclusions: Many older patients did not complete treatment as planned. Treatment was modified/discontinued even for one or two low-grade toxicities. Further work is required to clarify whether low-grade toxicity has a greater clinical impact in older people, or whether clinicians have a lower threshold for modifying/discontinuing treatment in older people.
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Affiliation(s)
- T Kalsi
- 1] POPS-GOLD, Department of Ageing & Health, Ground floor Bermondsey Wing, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK [2] Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London, SE1 3QD, UK
| | - G Babic-Illman
- POPS-GOLD, Department of Ageing & Health, Ground floor Bermondsey Wing, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - P Fields
- Department of Haematology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - S Hughes
- Department of Clinical Oncology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - N Maisey
- Department of Medical Oncology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - P Ross
- Department of Medical Oncology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Y Wang
- Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London, SE1 3QD, UK
| | - D Harari
- 1] POPS-GOLD, Department of Ageing & Health, Ground floor Bermondsey Wing, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK [2] Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London, SE1 3QD, UK
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Mohile SG, Klepin HD, Rao AV. Considerations and controversies in the management of older patients with advanced cancer. Am Soc Clin Oncol Educ Book 2012:321-328. [PMID: 24451757 DOI: 10.14694/edbook_am.2012.32.168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The incidence of cancer increases with age. Oncologists need to be adept at assessing physiologic and functional capacity in older patients in order to provide safe and efficacious cancer treatment. Assessment of underlying health status is especially important for older patients with advanced cancer, for whom the benefits of treatment may be low and the toxicity of treatment high. The comprehensive geriatric assessment (CGA) is the criterion standard for evaluation of the older patient. The combined data from the CGA can be used to stratify patients into categories to better predict risk for chemotherapy toxicity as well as overall outcomes. The CGA can also be used to identify and follow-up on possible functional consequences from treatment. A variety of screening tools might be useful in the oncology practice setting to identify patients who may benefit from further testing and intervention. In this chapter, we discuss how the principles of geriatrics can help improve the clinical care of older adults with advanced cancer. Specifically, we discuss assessing tolerance for treatment, options for chemotherapy scheduling and dosing for older patients with advanced cancer, and management of under-recognized symptoms in older patients with cancer.
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Affiliation(s)
- Supriya Gupta Mohile
- From the Geriatric Oncology Program at the James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY; Wake Forest School of Medicine, Winston-Salem, NC; Division of Geriatrics, Duke University Medical Center, Durham NC
| | - Heidi D Klepin
- From the Geriatric Oncology Program at the James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY; Wake Forest School of Medicine, Winston-Salem, NC; Division of Geriatrics, Duke University Medical Center, Durham NC
| | - Arati V Rao
- From the Geriatric Oncology Program at the James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY; Wake Forest School of Medicine, Winston-Salem, NC; Division of Geriatrics, Duke University Medical Center, Durham NC
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