Nutritional and functional status impairments to predict early death in elderly patients with advanced non-small-cell lung cancer (NSCLC).

Abstract

e20600 Background: Early death for some patients can be explained by direct effect of tumor or can be secondary to cancer treatment.As for many patients it is not fully predictable, the factors influencing and determining early death in older individuals receiving chemotherapy for advanced NSCLC were analyzed. Methods: Advanced NSCLC patients, > 70 years, ECOG performance status 0-1, treatment naïve, stage IIIB and IV, EGFR and ALK negative, were eligible. Geriatric assessment was performed at baseline and included: Performance status, ADLs, IADLs, CIRSG score and index, Mini Nutritional Assessment (MNA), Mini Mental State Evaluation (MMSE), educational and social status assessment, Geriatric Depression Scale (GDS).All patients, according to their classification in frail, vulnerable or fit, received best supportive care, monotherapy or doublet chemotherapy.For all patients data on number of cycles, response, discontinuation of treatment, dose reductions, grade 3/4 hematological and non-hematological toxicity were recorded. Patients who died within 90 days of diagnosis were considered.A descriptive statistic was calculated and a logistic regression analysis with the assessment of factors and covariates influencing early death events was performed. Results: From June 2010 to March 2016, 204 patients were assigned to platinum-based doublet (n = 73) or single-agent chemotherapy (n = 131).Median age was 75, 72% were males, 52% had non-squamous histology. Median number of cycles was 4, and was 3 for comorbidities. IADLs were impaired in 42%, ADLs in 6%,MNA in 15% and MMSE 10% of patients.Sixty-eight percent of patients were dead at the time of the analysis; 24% (49/204) had partial response, 25% (51/204) had stable disease and 51% (104/204) had progressive disease.At multivariate logistic model IADLs (p 0.001, OR 1.4 95%CI 0.4-1.6),MNA (p 0.001, OR 1.35 CI 0.1-1.35) and polypharmacy (p 0.008, OR 1.2 CI 1-1.4) were significantly associated with the occurrence of early death. Conclusions: The identification and management of patients with nutritional and functional impairments could help oncologists to reduce the risk of early death during chemotherapy for advanced NSCLC.