Development, validation and clinical impact of a prediction model for 6-month mortality in older cancer patients: the GRADE

Abstract

INTRODUCTION Cancer is a common disease among the elderly, as twothirds of newly diagnosed cancers and three-quarters of cancer-related deaths occur after 65 years of age in Western countries [1]. However, older cancer patients are usually excluded from clinical trials, mainly because of comorbidities and functional impairment [2, 3]. Data from evidence-based-medicine is thus lacking for therapeutic decisions in this population, and one of the main issues is to avoid situations of over-and undertreatment, and to provide guidance for clinicians in the www.aging-us.com

Development and Validation of an Early Mortality Risk Score for Older Patients Treated with Chemotherapy for Cancer

“…The overall 6-month mortality rate in our series was 20%, higher than previously reported (16–17%) [ 1 , 12 ]. Nevertheless, these variations can be possibly attributed to different patients’ characteristics, mainly the rate of patients with stage IV disease, type of tumor, and the inclusion of patients in any line of therapy (first line and beyond).…”

“…Some other studies have also proved the value of ECOG PS [ 1 , 3 , 11 ] and ADL evaluation [ 9 , 42 ] to predict the risk of early mortality in older adults with cancer. Other authors have also described the relationship between tumor stage and risk of early death [ 1 , 3 , 9 , 10 , 12 ]. Similarly, anemia has also been identified as a risk factor for early death in previous studies of elderly patients with cancer [ 43 ].…”

“…Other scores used to predict survival in older adults with cancer have included measures such as gait speed [ 11 , 12 ], or a mini nutritional assessment [ 10 , 12 , 36 ], which are less easily implemented into everyday practice. Currently available scores to predict early mortality in older adults with cancer (at 100 days [ 11 ] and at 6 months [ 12 ]) were developed in heterogeneous populations regarding types of treatment, including patients both on active treatment and only on palliative measures. Our study included only patients planned to begin chemotherapy, making it more useful to oncologists seeing such patients than scores with more heterogeneous populations.…”

“…Several scores and nomograms have been developed to estimate the risk of mortality at 1, 2, 3, and 4 years, both for the elderly population as a whole [ 2 , 7 , 8 ], and for older patients with cancer [ 3 , 9 , 10 ]. There are scores that inform about the risk of death in patients with cancer at 100 days [ 11 ] and 6 months [ 12 ], regardless of the use of antineoplastic therapy. Nevertheless, for the specific case of older people with cancer who are planned to initiate chemotherapy, even though some clinical features have been proposed as potential predictive factors for the risk of mortality [ 1 ], no scoring system is available in this regard.…”

ADL-dependency, D-Dimers, LDH and absence of anticoagulation are independently associated with one-month mortality in older inpatients with Covid-19

“…In contrast, a patient with no ADL-dependency and no depressed mood, and thus a very low risk of one-month mortality, should be actively transferred to intensive care unit if his/her respiratory condition requires it, regardless of his/her chronological age. Among older patients with Covid-19, as with most diseases [14], chronological age should not be the only factor considered for therapeutic decision, to avoid under-or over-treatment.…”