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Feliu J, Espinosa E, Basterretxea L, Paredero I, Llabrés E, Jiménez-Munárriz B, Antonio-Rebollo M, Losada B, Pinto A, Custodio AB, del Mar Muñoz M, Gómez-Mediavilla J, Torregrosa MD, Soler G, Cruz P, Higuera O, Molina-Garrido MJ. Prediction of Chemotoxicity, Unplanned Hospitalizations and Early Death in Older Patients with Colorectal Cancer Treated with Chemotherapy. Cancers (Basel) 2021; 14:cancers14010127. [PMID: 35008291 PMCID: PMC8749992 DOI: 10.3390/cancers14010127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 12/15/2021] [Accepted: 12/23/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Chemotoxicity, unplanned hospitalizations (Uhs) and early death (ED) are common among older patients with cancer who receive chemotherapy. Our objective was to determine factors predicting these complications. A predictive score for these three complications based on geriatric, tumor and laboratory variables was developed in a series of 215 older patients with colorectal carcinoma receiving chemotherapy. The use of this score may reliably identify patients at risk to have excessive toxicity with chemotherapy, UH or ED, thus helping to plan treatment, implement adaptive measures, and intensify follow-up. Abstract Purpose: To identify risk factors for toxicity, unplanned hospitalization (UH) and early death (ED) in older patients with colorectal carcinoma (CRC) initiating chemotherapy. Methods: 215 patients over 70 years were prospectively included. Geriatric assessment was performed before treatment, and tumor and treatment variables were collected. The association between these factors and grade 3–5 toxicity, UH and ED (<6 months) was examined by using multivariable logistic regression. Score points were assigned to each risk factor. Results: During the first 6 months of treatment, 33% of patients developed grade 3–5 toxicity, 31% had UH and 23% died. Risk factors were, for toxicity, instrumental activities of daily living, creatinine clearance, weight loss and MAX2 index; for UH, Charlson Comorbidity Score, creatinine clearance, weight loss, serum albumin, and metastatic disease; and for ED, basic activities in daily living, weight loss, metastatic disease, and hemoglobin levels. Predictive scores were built with these variables. The areas under receiver operation characteristic (ROC) curves for toxicity, UH and ED were 0.70 (95% CI: 0.64–0.766), 0.726 (95% IC: 0.661–0.799) and 0.74 (95% IC: 0.678–0.809), respectively. Conclusion: Simple scores based on geriatric, tumor and laboratory characteristics predict severe toxicity, UH and ED, and may help in treatment planning.
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Affiliation(s)
- Jaime Feliu
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
- Correspondence: ; Tel./Fax: +3-491-727-7118
| | - Enrique Espinosa
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - Laura Basterretxea
- Oncology Department, Donostia University Hospital, 20014 Donostia, Spain; (L.B.); (J.G.-M.)
| | - Irene Paredero
- Oncology Department, Doctor Peset University Hospital, 46017 Valencia, Spain; (I.P.); (M.-D.T.)
| | - Elisenda Llabrés
- Oncology Department, Insular University Hospital of Gran Canarias, 35016 Las Palmas, Spain;
| | | | - Maite Antonio-Rebollo
- Oncohematogeriatrics Unit, Institut Català d’Oncologia, IDIBELL Hospitalet, 08908 Barcelona, Spain; (M.A.-R.); (G.S.)
| | - Beatriz Losada
- Oncology Department, University Hospital of Fuenlabrada, 28942 Madrid, Spain;
| | - Alvaro Pinto
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - Ana Belén Custodio
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - María del Mar Muñoz
- Oncology Department, Hospital Virgen de la Luz, 16002 Cuenca, Spain; (M.d.M.M.); (M.-J.M.-G.)
| | | | | | - Gema Soler
- Oncohematogeriatrics Unit, Institut Català d’Oncologia, IDIBELL Hospitalet, 08908 Barcelona, Spain; (M.A.-R.); (G.S.)
| | - Patricia Cruz
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - Oliver Higuera
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
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Feliu J, Pinto A, Basterretxea L, López-San Vicente B, Paredero I, Llabrés E, Jiménez-Munárriz B, Antonio-Rebollo M, Losada B, Espinosa E, Gironés R, Custodio AB, Muñoz MDM, Díaz-Almirón M, Gómez-Mediavilla J, Torregrosa MD, Soler G, Cruz P, Higuera O, González-Montalvo JI, Molina-Garrido MJ. Development and Validation of an Early Mortality Risk Score for Older Patients Treated with Chemotherapy for Cancer. J Clin Med 2021; 10:jcm10081615. [PMID: 33920250 PMCID: PMC8070509 DOI: 10.3390/jcm10081615] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 01/17/2023] Open
Abstract
Background: Estimation of life expectancy in older patients is relevant to select the best treatment strategy. We aimed to develop and validate a score to predict early mortality in older patients with cancer. Patients and Methods: A total of 749 patients over 70 years starting new chemotherapy regimens were prospectively included. A prechemotherapy assessment that included sociodemographic variables, tumor/treatment variables, and geriatric assessment variables was performed. Association between these factors and early death was examined using multivariable logistic regression. Score points were assigned to each risk factor. External validation was performed on an independent cohort. Results: In the training cohort, the independent predictors of 6-month mortality were metastatic stage (OR 4.8, 95% CI [2.4–9.6]), ECOG-PS 2 (OR 2.3, 95% CI [1.1–5.2]), ADL ≤ 5 (OR 1.7, 95% CI [1.1–3.5]), serum albumin levels ≤ 3.5 g/dL (OR 3.4, 95% CI [1.7–6.6]), BMI < 23 kg/m2 (OR 2.5, 95% CI [1.3–4.9]), and hemoglobin levels < 11 g/dL (OR 2.4, 95% CI (1.2–4.7)). With these results, we built a prognostic score. The area under the ROC curve was 0.78 (95% CI, 0.73 to 0.84), and in the validation set, it was 0.73 (95% CI: 0.67–0.79). Conclusions: This simple and highly accurate tool can help physicians making decisions in elderly patients with cancer who are planned to initiate chemotherapy treatment.
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Affiliation(s)
- Jaime Feliu
- Oncology Department, Hospital Universitario La Paz, IDIPAZ, Cátedra UAM-AMGEN, CIBERONC, 28046 Madrid, Spain; (A.P.); (E.E.); (A.B.C.); (P.C.); (O.H.)
- Correspondence: ; Tel./Fax: +3-491-727-7118
| | - Alvaro Pinto
- Oncology Department, Hospital Universitario La Paz, IDIPAZ, Cátedra UAM-AMGEN, CIBERONC, 28046 Madrid, Spain; (A.P.); (E.E.); (A.B.C.); (P.C.); (O.H.)
| | - Laura Basterretxea
- Oncology Department, OSI Donostialde, Donostia Unibertsitate Ospitalea, Donostialde, Donostia, 20014 Gipuzkoa, Spain; (L.B.); (J.G.-M.)
| | | | - Irene Paredero
- Oncology Department, Hospital Universitario Dr. Peset, 46017 Valencia, Spain; (I.P.); (M.D.T.)
| | - Elisenda Llabrés
- Oncology Department, Hospital Universitario Insular de Gran Canarias, 35016 Las Palmas, Spain;
| | | | - Maite Antonio-Rebollo
- Oncohematogeriatrics Unit, Institut Català d’Oncologia, IDIBELL, Hospitalet, 08908 Barcelona, Spain; (M.A.-R.); (G.S.)
| | - Beatriz Losada
- Oncology Department, Hospital Universitario de Fuenlabrada, 28942 Fuenlabrada, Spain;
| | - Enrique Espinosa
- Oncology Department, Hospital Universitario La Paz, IDIPAZ, Cátedra UAM-AMGEN, CIBERONC, 28046 Madrid, Spain; (A.P.); (E.E.); (A.B.C.); (P.C.); (O.H.)
| | - Regina Gironés
- Oncology Department, Hospital Universitari y Politécnic La Fé, 46026 Valencia, Spain;
| | - Ana Belén Custodio
- Oncology Department, Hospital Universitario La Paz, IDIPAZ, Cátedra UAM-AMGEN, CIBERONC, 28046 Madrid, Spain; (A.P.); (E.E.); (A.B.C.); (P.C.); (O.H.)
| | - María del Mar Muñoz
- Oncology Department, Hospital Virgen de la Luz, 16002 Cuenca, Spain; (M.d.M.M.); (M.J.M.-G.)
| | - Mariana Díaz-Almirón
- Biostatistics Department, Hospital La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain;
| | - Jenifer Gómez-Mediavilla
- Oncology Department, OSI Donostialde, Donostia Unibertsitate Ospitalea, Donostialde, Donostia, 20014 Gipuzkoa, Spain; (L.B.); (J.G.-M.)
| | | | - Gema Soler
- Oncohematogeriatrics Unit, Institut Català d’Oncologia, IDIBELL, Hospitalet, 08908 Barcelona, Spain; (M.A.-R.); (G.S.)
| | - Patricia Cruz
- Oncology Department, Hospital Universitario La Paz, IDIPAZ, Cátedra UAM-AMGEN, CIBERONC, 28046 Madrid, Spain; (A.P.); (E.E.); (A.B.C.); (P.C.); (O.H.)
| | - Oliver Higuera
- Oncology Department, Hospital Universitario La Paz, IDIPAZ, Cátedra UAM-AMGEN, CIBERONC, 28046 Madrid, Spain; (A.P.); (E.E.); (A.B.C.); (P.C.); (O.H.)
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Feliu J, Espinosa E, Basterretxea L, Paredero I, Llabrés E, Jiménez-Munárriz B, Antonio-Rebollo M, Losada B, Pinto A, Gironés R, Custodio AB, Muñoz MDM, Gómez-Mediavilla J, Torregrosa MD, Soler G, Cruz P, Higuera O, Molina-Garrido MJ. Undertreatment and overtreatment in older patients treated with chemotherapy. J Geriatr Oncol 2020; 12:381-387. [PMID: 33109485 DOI: 10.1016/j.jgo.2020.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Inconsistent doses and schemes are commonly used in older patients receiving cancer chemotherapy. We performed this study in patients with cancer and age ≥ 70 years to determine the frequency of undertreatment and overtreatment as well as factors influencing the decision to modify chemotherapy doses. PATIENTS AND METHODS Patients aged ≥70 years starting new chemotherapy regimens were prospectively included in a multicentre study. The schedule and drug doses were determined by the treating oncologist. Pre-chemotherapy assessment included sociodemographics, treatment details and geriatric assessment (GA) variables. Association between these factors and undertreatment (use of less intensive cancer treatment [LICT] in a fit patient) or overtreatment (use of standard cancer treatment in an unfit older patient) were examined by multivariate logistic regression. RESULTS Three- hundred ninety-seven patients were included, 43% of whom received LICT. If not adjusted for GA, toxicity did not differ between those receiving LICT (38%) or standard doses of chemotherapy (37%). If the dose of chemotherapy was analyzed according to the results of GA 61 (15%) patients had been undertreated and 133 (34%) had been overtreated. Undertreatment was related with increasing age and decreased renal function. Factors related with overtreatment were younger age, curative intention of treatment, prescription of G-CSF as primary prophylaxis and adequate cognitive status. Overtreated patients had more grade 3-4 toxicity than those receiving treatment adapted to fragility (42% vs 31%; p < 0.05). CONCLUSIONS The use of chemotherapy without considering GA leads to overtreatment more commonly than undertreatment in older patients with cancer. Oncologists should take into account the results of GA to stratify patients and to avoid under or overtreatment.
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Affiliation(s)
- Jaime Feliu
- Oncology department, Hospital Universitario La Paz, Madrid, Spain; Cátedra UAM-AMGEN, CIBERONC, Spain.
| | - Enrique Espinosa
- Oncology department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Irene Paredero
- Oncology department, Hospital Universitario Dr. Peset. Valencia, Spain
| | - Elisenda Llabrés
- Oncology department, Hospital Universitario Insular de Gran Canarias, Spain
| | | | - Maite Antonio-Rebollo
- Oncohematogeriatrics Unit, Institut Català d'Oncologia, IDIBELL, Hospitalet, Barcelona, Spain
| | - Beatriz Losada
- Oncology department, Hospital Universitario de Fuenlabrada, Spain
| | - Alvaro Pinto
- Oncology department, Hospital Universitario La Paz, Madrid, Spain
| | - Regina Gironés
- Oncology department, Hospital Universitari y Politécnic La Fé, Valencia, Spain
| | | | | | | | | | - Gema Soler
- Oncohematogeriatrics Unit, Institut Català d'Oncologia, IDIBELL, Hospitalet, Barcelona, Spain
| | - Patricia Cruz
- Oncology department, Hospital Universitario La Paz, Madrid, Spain
| | - Oliver Higuera
- Oncology department, Hospital Universitario La Paz, Madrid, Spain
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