New Tool Predicts Chemo Toxicity in Older Cancer Patients

Roxanne Nelson, BSN, RN

June 01, 2016

A simple tool that was developed to predict chemotherapy toxicity in older adults with cancer has now been validated, according to study results.

The prediction model consists of 11 questions — five geriatric assessment questions and six items that are routinely documented in clinical practice, such as cancer type, planned therapy and dose, and laboratory values.

"We found that the model held up in a separate population and it is ready to be used," said lead author Arti Hurria, MD, director of the cancer and aging research program at City of Hope in Duarte, California.

"The model is easily available to anyone who wants to use it. It is really a first step in assessing the patient and planning treatment," Dr Hurria told Medscape Medical News.

The study was published online May 16 in the Journal of Clinical Oncology.

The tool was first developed and internally validated in a cohort of 500 patients (J Clin Oncol. 2011;29:3457-3465). That study showed that the tool identified older cancer patients who were at risk for chemotherapy toxicity, whereas the commonly used Karnofsky Performance Status (KPS) did not.

"We are looking at what makes the patient vulnerable, and that's what the geriatric assessment is about — it gives you a much more in-depth look at who the patient is and what their risk factors are," she said.

Conventional oncology performance status measures — such as the KPS or ECOG — were validated in younger adults and do not address the wide spectrum of health issues seen in older cancer patients.

Instead, it has been widely recognized that geriatric-assessment tools can identify areas of vulnerability that go beyond chronologic age by evaluating other factors, such as cognition, nutrition, social support, psychological state, comorbidity, and medication use, the authors note.

Validation Holds Up

In their study, Dr Hurria and her colleagues sought to validate the model in an independent cohort of 250 cancer patients 65 years and older (mean age, 73 years) who were recruited from eight institutions, diagnosed with any type of solid tumor, and scheduled to receive a new chemotherapy regimen.

All patients completed a prechemotherapy geriatric assessment and were observed throughout the course of their chemotherapy.

The rate of grade 3 to 5 toxicities was similar in the validation and development cohorts (58% vs 53%). In the validation cohort, 34% experienced hematologic toxicity and 55% experienced nonhematologic toxicity.

A risk score of 0 to 5 points was categorized as low, of 6 to 9 points was categorized as medium, and of 10 to 19 points was categorized as high.

The risk for toxicity increased with increasing risk score; it was 36.7% in the low-risk group, 62.4% in the medium-risk group, and 70.2% in the high-risk group (P < .001)

But physician-rated KPS was not predictive of chemotherapy toxicity in either the development study (P = .19) or the validation study (P = .25).

"The tool should be used with any patient 65 years or older, regardless of their health," said Dr Hurria. "Those in better health will generally have a lower toxicity score than a person who is frail."

But "there is still a risk, even if you have a low score, and we may still find areas of vulnerability," she emphasized. "There's still a risk because the score isn't zero."

The model should be part of a patient's initial assessment. Dr Hurria pointed out that other team members can administer it and then give it to the oncologist for review. "This saves time and allows the doctor to review it before even seeing the patient," she added.

The model is available online in English, Spanish, and Chinese.

Dr Hurria reports serving in a consulting or advisory role for GTx, Seattle Genetics, Boehringer Ingelheim, On Q Health, and Sanofi; and receiving research funding from GlaxoSmithKline (Inst), Celgene (Inst), and Novartis (Inst). Several coauthors report relationships with industry, as detailed in the publication.

J Clin Oncol. Published online May 16, 2016. Abstract


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