Prediction of hospital admissions and grade 3–4 toxicities in cancer patients 70 years old and older receiving chemotherapy

Abstract

Aim To predict chemotherapy toxicity and hospitalisations in elderly patients using clinical and laboratory parameters. Methods Records of cancer patients 70 years old or older who received adjuvant chemotherapy or first‐line chemotherapy for a cancer in a single centre were reviewed. Factors associated with hospitalisations, grade 3–4 toxicities and dose reductions during treatment were evaluated. Results A total of 275 patients included in the study. Most patients (53.8%) were 70 to 75 years old. One hundred and five patients (38.2%) had a hospital admission during or within a month after their chemotherapy treatment. The only factor associated with admissions in the multivariate analysis was ECOG performance status (PS) >1 (p = .008, odds ratio 2.66, 95% CI: 1.28–5.53) and hypoalbuminaemia approached significance. Grade 3 and 4 toxicities were associated with a lower creatinine clearance in the multivariate analysis (p = .01, odds ratio 0.98, 95% CI: 0.97–1.0), and dose reductions were associated with metastatic stage (p = .03, odds ratio 1.88, 95% CI: 1.05–3.35). A combined index with all four parameters was associated with all three outcomes of interest. Conclusion ECOG PS, stage, albumin and creatinine clearance may be predictive of hospital admissions, grade 3–4 toxicities and dose reduction rates in cancer patients 70 years old and older receiving chemotherapy.

Prediction of Chemotoxicity, Unplanned Hospitalizations and Early Death in Older Patients with Colorectal Cancer Treated with Chemotherapy

“…The identification of risk factors for UH could lead to the implementation of preventive measures. Risk factors for UH have been identified in the general population of patients with cancer [ 46 , 47 , 48 ] and older patients with cancer [ 49 , 50 ]. A predictive score for UH in old patients receiving chemotherapy has also been proposed [ 51 ].…”

“…Variables related to the tumor (disease stage), pharmacokinetics (renal function and albumin), nutritional status (weight loss and albumin) and comorbidities (Charlson comorbidity score) correlated with UH. Other studies have also found that comorbidity [ 46 , 47 , 48 , 49 ], poor nutritional status [ 50 ], low albumin level [ 46 , 51 ], cognitive function [ 14 ] and depression [ 14 ] increase the risk of UH. Serum albumin decreases 15–20% with age, even more in the case of poor nutrition.…”

Prediction of Unplanned Hospitalizations in Older Patients Treated with Chemotherapy

“…Falls have also been identified as a risk factor for increased toxicity [16]. On the other hand, some studies have found that comorbidity [8][9][10][11]18], chemotherapy, poor nutritional status [10], and low albumin level [8,19] increase the risk of UH. Serum albumin decreases 15-20% with age, even more in patients with poor nutrition.…”

“…Cancer related 53 (29) Chemotherapy toxicity 37 (19) Lung infection 30 (16) Other infections 22 (12) Falls and fractures 13 7Cardiac events 9…”

An evaluation of the Index4 tool for chemotherapy toxicity prediction in cancer patients older than 70 years old

“…Clinical and laboratory information enabling calculation of baseline index4 and the Cancer and Aging Research Group (CARG) risk were extracted from charts and recorded. Index4 is calculated by adding 1 point each for ECOG performance status (PS) above 1, creatinine clearance below 40 mL/min, albumin below 35 g/L and stage 4 cancer (Supplemental Table 1) 7 . For the calculation of CARG risk category, several parameters are taken into consideration and are attributed 1 to 3 points 5 .…”