Tolerance to oral anticancer agent treatment in older adults with cancer: a secondary analysis of data from electronic health records and a pilot study of patient-reported outcomes

Abstract

Background More than 60% of cancer cases occur in older adults, and many are treated with oral anticancer agents. Yet, the treatment tolerability in older adults has not been fully understood due to their underrepresentation in oncology clinical trials, creating challenges for treatment decision-making and symptom management. The objective of this study was to investigate the tolerance of capecitabine, an example of oral chemotherapy, among older adults with cancer and explore factors associated with capecitabine-related side effects and treatment changes, to enhance supportive care. Methods A secondary analysis used combined data from electronic health records and a pilot study of patient-reported outcomes, with a total of 97 adult patients taking capecitabine during 2016–2017, including older adult patients aged 65 years or older (n = 43). The data extracted included patient socio-demographics, capecitabine information, side effects, and capecitabine treatment changes (dose reductions and dose interruptions). Bivariate correlations, negative binomial regression, and multiple linear regression were conducted for data analysis. Results Older adults were more likely to experience fatigue (86% vs. 51%, p = .001) and experienced more severe fatigue (β = 0.44, p = 0.03) and hand-foot syndrome (HFS) (β = 1.15, p = 0.004) than younger adults. The severity of fatigue and HFS were associated with the number of outpatient medications (β = 0.06, p = 0.006) and the duration of treatment (β = 0.50, p = 0.009), respectively. Correlations among side effects presented different patterns between younger and older adults. Although more older adults experienced dose reductions (21% vs. 13%) and dose interruptions (33% vs. 28%) than younger adults, the differences were not statistically different. Female sex, breast cancer diagnosis, capecitabine monotherapy, and severe HFS were found to be associated with dose reductions (p-values < 0.05). Conclusions Older adults were less likely to tolerate capecitabine treatment and had different co-occurring side effects compared to younger adults. While dose reductions are common among older adults, age 65 years or older may not be an independent factor of treatment changes. Other socio-demographic and clinical factors may be more likely to be associated. Future studies can be conducted to further explore older adults’ tolerance to a variety of oral anticancer agents to generate more evidence to support optimal treatment decision-making and symptom management.

Hand-foot syndrome in cancer patients on capecitabine: examining prevalence, impacts, and associated risk factors at a cancer centre in Malaysia

“…In addition, consistent with other studies [ 22 , 23 ], our study showed a significant association between HFS and increasing age. Older patients often present with pre-existing comorbidities and are prescribed with multiple concurrent medications [ 22 , 24 ].…”

“…In addition, consistent with other studies [ 22 , 23 ], our study showed a significant association between HFS and increasing age. Older patients often present with pre-existing comorbidities and are prescribed with multiple concurrent medications [ 22 , 24 ]. Furthermore, a study showed that elderly patients may have reduced drug clearance, leading to higher capecitabine exposure compared to younger individuals [ 25 ].…”

Hand-Foot Syndrome in Cancer Patients on Capecitabine: Examining Prevalence, Impacts, and Associated Risk Factors at a Cancer Centre in Malaysia

“…In addition, consistent with other studies [24,25], our study showed a signi cant association between HFS and increasing age. Older patients, often more frail with potential pre-existing comorbidities and concurrent use of multiple medications, are at an increased risk of adverse reactions to cancer treatment [24,26].…”

“…We also found that female patients were more prone to develop more severe HFS. Sex and gender difference in capecitabine toxicity has been previously reported [24,27], possibly attributed to varying body compositions between males and females [28,29]. A study showed that female colorectal cancer patients had more dose-limiting toxicity than male patients when given capecitabine based on their body surface area [27].…”

Characterization of Time Toxicity in Older Patients with Metastatic Breast Cancer

“…Additionally, treatment protocols for older patients often focus more on oral therapies and avoid intensive therapies such as chemotherapy due to the convenience and exibility in the administration process. [17] Our study did not include oral therapies administered at home, as their contribution to time toxicity is limited. [13,18,19] Less intensive treatment is commonly received by very old patients, because of factors such as prevalence of comorbidities, lower life expectancy, and increased risk of adverse effects contributing to the perception that multi-modal treatments may be less favorable for this patient population, as well as patient preference and shared decision making .…”