Oncology Research and Treatment
Li M. · Schulte N. · Elting F. · Winkler E.C. · Hetjens S. · Berger A.K. · Zschäbitz S. ·
Hofmann J. · Hofmann J. · Hilbertz L. · Kuhn M. ·
Khakzar C. · Jesenofsky R. · Betge J. ·
Zhan T. · Belle S. · Ebert M.P. ·
Härtel N.
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Article / Publication Details
Abstract
Introduction: Colorectal cancer (CRC) is a disease of older patients, but evidence-based guidelines for chemotherapy in older patients are scarce. Geriatric assessment (GA) evaluates a patient´s functional status (FS) and helps decision-making when choosing chemotherapy for older patients. However, the change of FS during chemotherapy is rarely studied as GA is mostly performed once instead of sequentially.
Methods: We performed a subgroup analysis of a prospective, multi-center study EpiReal75. Patients aged ≥75 years with gastrointestinal malignancy prior to initiation of chemotherapy or receiving palliative chemotherapy were screened. We defined geriatric core assessments including Eastern Cooperative Oncology group (ECOG) score, Barthel's activities of daily living (ADL) scale, Lawton's instrumental activities of daily living (IADL) scale and G-8 questionnaire, which were performed at baseline and repeated every three months. Quality of life (QoL) assessed by QLQ-C30 questionnaire and was also reevaluated every three months. We defined any deterioration in any of the geriatric parameters as unstable in the corresponding function.
Results: 28 patients with CRC were enrolled between April 2014 and December 2018. 20 patients were evaluable for statistical analysis with a mean age of 78.5 years (range, 75-88). Most patients received chemotherapy in palliative setting. During 3 months of chemotherapy, 25% of patients became more dependent as measured by ADL or IADL. During a median follow-up of 15 months, patients with unstable ADL or IADL had a significantly shorter overall survival (OS) than those with stable ADL or IADL (p=0.0055 and 0.0253, respectively), without a significant difference in progression-free survival (PFS). Also, unstable IADL correlated with a deterioration in aspects of QoL such as role functioning and emotional functioning (p=0.0189 and 0.0239, respectively). 20% of patients experienced treatment-related grade 3 adverse events (AE), no grade 4-5 AEs occurred.
Conclusion: Sequential GA revealed changes of FS in older patients with CRC receiving chemotherapy. A deterioration of FS during chemotherapy did not influence PFS but had a negative impact on OS and QoL. It is therefore important to maintain FS in older patients with cancer, and regular performance of geriatric core assessments should be encouraged in the clinical practice.
S. Karger AG, Basel
Article / Publication Details
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