1546P - Assessment of older patients with cancer: Edmonton Frail Scale (EFS) as a predictor of adverse outcomes in a cohort of older patients undergoing sy...

Date 28 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Complications of Treatment
Geriatric Oncology
Presenter Michelle O'Brien
Citation Annals of Oncology (2014) 25 (suppl_4): iv517-iv541. 10.1093/annonc/mdu356
Authors M.M. O'Brien1, E.M. Pfeiffer2, D. Yen1, L. Keenan3, J. McHugh1, P. Doyle1, M. Doherty1, A. O'Reilly1, B. Hennessy4, D. Williams2, A.M. Horgan1, O.S. Breathnach1, W.M. Grogan1, P. Morris1
  • 1Medical Oncology, Beaumont Hospital, 9 - Dublin/IE
  • 2Geriatric Medicine, Beaumont Hospital, 9 - Dublin/IE
  • 3Dept Of Medical Oncology, Beaumont Hospital, Dublin/IE
  • 4Dept Of Medical Oncology, Beaumont Hospital, 9 - Dublin/IE

Abstract

Aim

Older cancer patients (pts) are at risk of toxicity from systemic therapy (ST). The EFS is a geriatric tool assessing frailty covering: Cognition, Health, Independence, Performance, Social, Medications, Nutrition, Mood, and Continence. It is unknown if the EFS can predict toxicity in pts who have already been selected for ST. Prospectively we examined the EFS as a predictor of adverse outcomes in older pts undergoing ST.

Methods

Candidates seen by a Medical Oncologist and deemed appropriate for ST ≥65years, starting new ST were included. EFS, demographics, diagnosis, ECOG performance status (PS) and adverse events using the NCI CTCAE v4.03 were assessed. The association between EFS and toxicity was examined during one treatment cycle using Pearson's correlation coefficient (r).

Results

From Feb-April 2014, 24 pts were included (table), median age 72 years (65–92). EFS results were; No frailty 10 (42%), Apparently vulnerable 8 (33%), Mild frailty 4 (17%), Moderate frailty 1 (4%) and Severe frailty 1 (4%). Many were of good PS (54% had ECOG 1). All toxicities were recorded with most common non-lab toxicities being fatigue 12 (50%) and pain 8 (33%), all ≤grade III. The most common lab toxicities were Hb and Alk Phos. During ST there were 3 (13%) admissions, 6 (25%) had treatments held or dose adjustments and 1 death occurred. Age and ECOG were significantly correlated (r=0.43, p = <0.04). Age was not associated with toxicity events (r=0.19, p < 0.37). ECOG PS was not associated with total number of toxicities (r=-0.05, p < 0.8). A moderate association between EFS and number of toxicity events was seen (r=0.32), but did not reach statistical significance (p < 0.14). Updated results including toxicity on subsequent ST cycles from an expanded cohort will be presented.

Patient Characteristics N %
Sex Male 10 42
Female 14 58
Marital Status Married 10 42
Widowed 8 33
Single 4 17
Divorced / separated 2 8
Work Status Retired 22 92
Part-time employed 1 4
Other 1 4
Cancer Diagnosis Colorectal 6 25
Breast 6 25
Other GI 3 13
Lung 3 13
Genitourinary 2 8
Others 4 17
Stage I-III 12 50
IV 11 46
N/A (Brain) 1 4

Conclusions

Preliminary results suggest elevated EFS score is associated with toxicities during the first cycle of ST. Quantifying frailty could aid formation of a predictive model for adverse events in the geriatric population.

Disclosure

P. Morris: Dr Patrick Morris; Honouraria GSK and Nordic. All other authors have declared no conflicts of interest.