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Poster display session

5293 - Factors predicting adherence to a tailored-dose adjuvant treatment based on geriatric assessment in elderly people with colorectal cancer: a prospective study.

Date

09 Sep 2017

Session

Poster display session

Presenters

Maite Antonio

Citation

Annals of Oncology (2017) 28 (suppl_5): v158-v208. 10.1093/annonc/mdx393

Authors

M. Antonio1, J. Saldaña2, A. Carmona-Bayonas3, R. Salazar4, V. Navarro5, C. Tebé6, J.M. Borras7

Author affiliations

  • 1 Medical Oncology, Institut Català d'Oncologia Hospital Duran i Reynals, 08907 - L'Hospitalet de llobregat, Barcelona/ES
  • 2 Medical Oncology, Institut Català d'Oncologia Hospital Duran i Reynals, L'Hospitalet de llobregat, Barcelona/ES
  • 3 Medical Oncology, Hospital Universitario Morales Meseguer, 30008 - Murcia/ES
  • 4 Medical Oncology, Institut Català d'Oncologia Hospital Duran i Reynals, 08907 - Barcelona/ES
  • 5 Translational Research Laboratory, Institut Català d'Oncologia Hospital Duran i Reynals, 08907 - Barcelona/ES
  • 6 Statisical Assessment Service, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), 08907 - L'Hospitalet de llobregat, Barcelona/ES
  • 7 Department Of Clinical Sciences, University of Barcelona, 08907 - Barcelona/ES
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Resources

Abstract 5293

Background

Selecting elderly people with colorectal cancer (CRC) for adjuvant chemotherapy is challenging. Comprehensive geriatric assessment (CGA) can help by classifying them according to their frailty profile. The supposed benefit of chemotherapy is based on the rate of treatment adherence. This study evaluated tolerance and adherence to tailored-dose adjuvant therapy based on CGA in a cohort of older patients with high-risk stage II and stage III CRC.

Methods

Prospective study in 193 consecutive patients aged 75 or older. Based on CGA results, we classified patients as fit, medium-fit, or unfit, administering standard therapy, adjusted treatment and best supportive care, respectively. We recorded planned chemotherapy, toxicity, and completion of the treatment. A logistic multivariate analysis was carried out.

Results

Seventeen (15%) of the 141 candidates for chemotherapy (n = 86 fit and n = 55 medium-fit) refused treatment; associated factors included polypharmacy (odds ratio [OR] 5.34, 95% confidence interval [CI] 1.55, 18.40) and rectal location (OR 5.61, CI95%, 1.45, 21.49). Of the 105 patients receiving chemotherapy, 20 (27%) fit and 4 (13%) medium-fit patients experienced grade 3-4 toxicity (p = 0.11) without association to explanatory variables. About 55% of patients treated with chemotherapy received at least 80% of the planned dose (55% fit and 58% medium-fit patients; p = 0.7). Factors associated with completion of chemotherapy were the absence of toxicity (OR 7.67, CI95% 2.41, 24.43) and social support (OR 2.29, CI95% 0.08, 1.04).Table:

491P

Univariate analysisMultivariate analysis
OR (95% CI)P-valueOR (95% CI)P-value
AnalysisTreatment refusal n = 141
Age1.58 (0.53, 4.67)0.411.17 (0.95, 1.445)0.15
Sex0.71 (0.23, 2.15)0.54
Cancer site Colon Rectum1 3 (1.04, 8.62)0.041 5.61 (1.45, 21.49)0.01
Tumor Stage II III1 0.51 (0.17, 1.54)0.23
Polypharmacy4.01 (1.39, 11.56)0.015.34 (1.55, 18.40)0.01
Weight loss >10%/6 months0.8 (1.66, 3.86)0.78
Yesavage1.20 (0.43, 3.40)0.73
Social support1.71 (0.50, 5.920.39
VES-13 ≥35.78 (1.91, 17.47)5 medications)1.26 (0.43, 3.65)0.68
Weight loss >10%/6 months0.48 (0.10, 2.27)0.34
Yesavage0.99 (0.40, 2.48)0.99
Social support no1.68 (0.52, 5.41)0.52
VES-13 > 30.74 (0.65, 0.83)0.13
Oncogeriatric group Fit (standard dose) Medium-fit (adapted dose)1 0.4 (0.12, 1.29)0.12
AnalysisCompletion ≥ 80% of planned dose n = 105
Age (younger)2.72 (1.10, 6.72)0.031.13 (0.95, 1.35)0.16
Sex (male)2.12 (0.95, 4.78)0.070.50 (0.20, 1.26)0.14
Cancer site Colon Rectum1 0.85 (0.34, 2.14)0.73
Tumor stage II III1 1.09 (0.42, 2.72)0.90
Polypharmacy2.31 (0.90, 5.95)0.080.50 (0.20, 12.6.)0.09
Weight loss >10%/6 months1.09 (0.37, 3.27)0.87
Yesavage1.08 (0.50, 2.34)0.85
Social support3.24 (1.04, 10.11)0.043.44 (1.01-12.31)0.05
VES-13 ≥30.92 (0.29, 2.85)0.88
Oncogeriatric group Fit (standard dose) Medium fit (adapted dose)1 0.85 (0.36, 1.98)0.71
Toxicity7.19 (2.43, 21.32)< 0.0010.13 (0.04,0.42)0.001

Conclusions

CGA is useful for selecting elderly patients for adjuvant chemotherapy, adapting the dose to their frailty profile, and identifying adherence-related factors amenable to modification through CGA-based interventions.

Clinical trial identification

Legal entity responsible for the study

Institut Català d'Oncologia

Funding

Fund for Health Research (FIS, PI 1102011) and AGAUR (2014 SGR 0635)

Disclosure

All authors have declared no conflicts of interest.

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