Predicting Chemotherapy Toxicity in Older Adults With Cancer: A Prospective Multicenter Study

TLDR

Older adults are vulnerable to chemotherapy toxicity, but data to identify those at risk are limited. The study aims to identify risk factors for chemotherapy toxicity in older adults and develop a risk stratification schema. The prospective multicenter study enrolled 500 patients aged ≥65, collected comprehensive pre‑chemotherapy sociodemographic, tumor, laboratory, and geriatric assessment data, and followed them through treatment to develop a predictive model of grade 3–5 toxicity based on these variables. Grade 3–5 toxicity occurred in 53% of patients, and the derived scoring system stratified risk into low (30%), intermediate (52%), and high (83%) categories, with geriatric assessment variables independently predicting toxicity.

Abstract

Older adults are vulnerable to chemotherapy toxicity; however, there are limited data to identify those at risk. The goals of this study are to identify risk factors for chemotherapy toxicity in older adults and develop a risk stratification schema for chemotherapy toxicity.Patients age ≥ 65 years with cancer from seven institutions completed a prechemotherapy assessment that captured sociodemographics, tumor/treatment variables, laboratory test results, and geriatric assessment variables (function, comorbidity, cognition, psychological state, social activity/support, and nutritional status). Patients were followed through the chemotherapy course to capture grade 3 (severe), grade 4 (life-threatening or disabling), and grade 5 (death) as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events.In total, 500 patients with a mean age of 73 years (range, 65 to 91 years) with stage I to IV lung (29%), GI (27%), gynecologic (17%), breast (11%), genitourinary (10%), or other (6%) cancer joined this prospective study. Grade 3 to 5 toxicity occurred in 53% of the patients (39% grade 3, 12% grade 4, 2% grade 5). A predictive model for grade 3 to 5 toxicity was developed that consisted of geriatric assessment variables, laboratory test values, and patient, tumor, and treatment characteristics. A scoring system in which the median risk score was 7 (range, 0 to 19) and risk stratification schema (risk score: percent incidence of grade 3 to 5 toxicity) identified older adults at low (0 to 5 points; 30%), intermediate (6 to 9 points; 52%), or high risk (10 to 19 points; 83%) of chemotherapy toxicity (P < .001).A risk stratification schema can establish the risk of chemotherapy toxicity in older adults. Geriatric assessment variables independently predicted the risk of toxicity.