Predictors of toxicity-related hospitalization in four randomized studies of 5-fluorouracil-based chemotherapy in metastatic colorectal cancer

Abdel‐Rahman, Omar; Ahmed, Osama

doi:10.1007/s00384-019-03252-y

Cited by 9 publications

(11 citation statements)

References 7 publications

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“…This data can be relevant when counseling patients about the realworld risks associated with adjuvant chemotherapy in the setting of colon cancer. Association of older age with higher hospitalization risk is in line with many prior studies (both randomized and population-based) highlighting the heightened toxicity risks associated with chemotherapy in older individuals [14,15]. Although biological age (rather than chronological age) is the standard assessment tool for chemotherapy eligibility, elderly individuals are likely to have more comorbid conditions, and therefore, higher risks of side effects from chemotherapy.…”

Section: Discussionsupporting

confidence: 78%

Hospitalizations among early-stage colon cancer patients receiving adjuvant chemotherapy: a real-world study

Abdel‐Rahman

Tang

Koski

2021

Int J Colorectal Dis

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Objective To assess the patterns of hospitalizations among early-stage colon cancer patients receiving adjuvant chemotherapy and to identify high-risk groups that may benefit from more careful monitoring in a real-world, population-based context. Methods This is a population-based study using linked administrative databases from the province of Alberta, Canada. Any events of hospitalization among patients with non-metastatic colon cancer undergoing upfront surgery followed by adjuvant chemotherapy were reviewed. Multivariable logistic regression analysis was used to examine factors associated with risk of hospitalization, and the impact of hospitalization on overall survival was assessed through Kaplan-Meier estimates and Multivariable Cox regression analysis. Results A total of 2257 patients were considered eligible and were included in the current analysis, including 483 patients (21.4%) who were hospitalized within 6 months of the start of adjuvant chemotherapy, and 1774 patients (78.6%) who were not. The following factors were associated with a higher hospitalization risk: older age (OR: 1.02; 95% CI 1.01-1.03), higher comorbidity (OR: 1.48; 95% CI 1.31-1.67), women (OR for men versus women: 0.79; 95% CI 0.64-0.98), living in the North zone (OR for Edmonton zone versus North zone: 0.60; 95% CI 0.42-0.87), and CAPOX chemotherapy (OR for CAPOX versus FOLFOX: 1.50; 95% CI 1.12-2.00). Patients with a history of hospitalization during adjuvant chemotherapy had a worse overall survival compared to patients who were not hospitalized (P < 0.001). ConclusionIn this study, one out of five colon cancer patients were hospitalized during adjuvant chemotherapy. Older individuals, women, those with higher comorbidity, and those receiving adjuvant CAPOX were more likely to be hospitalized.

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Section: Discussionsupporting

confidence: 78%

Hospitalizations among early-stage colon cancer patients receiving adjuvant chemotherapy: a real-world study

Abdel‐Rahman

Tang

Koski

2021

Int J Colorectal Dis

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“…The inconsistent results might have originated from racial differences among the patients and the small sample size of both studies. In addition, we found more digestive adverse events in patients with ECOG score ≥1, which was consistent with previous studies that showed that patients with poor performance scores were less responsive to chemotherapy 18,29 . However, mediation analysis showed that the incidence of digestive adverse events did not lead to poor survival.…”

Section: Discussionsupporting

confidence: 92%

“…Lund et al reported that age had no impact on disease-free survival and CRC mortality 28 . In a recent study, advanced age and poor performance status were negative predictors of severe adverse events and long hospitalization 29 . In the present study, the incidence of adverse events was comparable between the old and young patients, except for digestive adverse events, which were more common among young patients using oxaliplatin and 5-FU.…”

Section: Discussionmentioning

confidence: 93%

Relationship between adverse events of adjuvant chemotherapy and survival outcomes: mediation analysis of Chinese colorectal cancer patients

Chang¹,

Tong²,

Zhou³

et al. 2020

Preprint

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Purpose：We focus on adverse events in colorectal cancer patients with advanced age, high Eastern Cooperative Oncology Group scores and comorbidities. Methods：408 Chinese colorectal cancer patients undergoing adjuvant chemotherapy at Peking Union Medical College Hospital were included. The cumulative incidences of different adverse events and mediation analyses were analyzed with respect to age, Eastern Cooperative Oncology Group status and comorbidities. Results：Young patients and patients with Eastern Cooperative Oncology Group score 1 had a significantly higher incidence of digestive adverse events related to adjuvant therapy. There were no significant mediation effects of adverse events on survival. Conclusion：Advanced age did not directly lead to poor survival outcomes and adverse events. Although higher Eastern Cooperative Oncology Group scores and comorbidity led to impaired survival and higher incidence of adverse events, the latter had no mediation effects on survival outcomes.

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“…Elderly patients are more likely to experience toxicity from fluoropyrimidine-based regimens [17]. Our data showed that toxicity was more frequent in older patients (>70 years).…”

Section: Discussionmentioning

confidence: 55%

Clinical factors related to severe enterocolitis after adjuvant CAPOX for colorectal cancer: a retrospective analysis

Felismino

Jesus

Uchóa

et al. 2020

ecancer

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Background: CAPOX regimen is a standard option in stage III adjuvant colon cancer. Gastrointestinal toxicity is well described with fluoropyrimidine regimens and can be lifethreatening. Identification of risk factors associated with severe gastrointestinal toxicity may help clinicians when choosing the adjuvant regimen. Materials and Methods: We retrospectively analysed 61 patients treated with adjuvant CAPOX. Our primary objective was to estimate the incidence of severe chemotherapyinduced enterocolitis among patients treated with CAPOX. A secondary objective was to describe the main demographic and clinical characteristics of these patients. A univariate logistic regression was performed to estimate the odds ratio (OR) with a 95% CI to identify a predictor for severe enterocolitis. Results: Grade 3 diarrhoea was reported in 10 patients (16.3%). Admissions to hospital due to toxicity occurred in nine cases. Reasons for hospitalisation were severe enterocolitis in eight cases (13.1%) and rectal bleeding plus thrombocytopenia in one case. Age > 70 years (OR 9.6; 95% CI 1.81-50.6; p = 0.008), primary surgery involving right/transverse colon (OR 16.8; 95% CI 2.88-98.8; p = 0.002) and Angiotensin II Receptor Blocker (ARB) use (OR 8.14; 95% CI 1.64-40.3; p = 0.010) were associated with severe enterocolitis. Conclusion: Our data showed that adjuvant CAPOX induced severe enterocolitis in 13.1% of patients. In addition, we found that advanced age, right colectomy and concurrent use of ARB were statistically associated with these events. Awareness of these factors could be easily incorporated into the treatment decision and patient orientation.

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Predictors of toxicity-related hospitalization in four randomized studies of 5-fluorouracil-based chemotherapy in metastatic colorectal cancer

Cited by 9 publications

References 7 publications

Hospitalizations among early-stage colon cancer patients receiving adjuvant chemotherapy: a real-world study

Hospitalizations among early-stage colon cancer patients receiving adjuvant chemotherapy: a real-world study

Relationship between adverse events of adjuvant chemotherapy and survival outcomes: mediation analysis of Chinese colorectal cancer patients

Clinical factors related to severe enterocolitis after adjuvant CAPOX for colorectal cancer: a retrospective analysis

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