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 analysis | Multivariate analysis | |||||
|---|---|---|---|---|---|---|
| OR (95% CI) | P-value | OR (95% CI) | P-value | |||
| Analysis | Treatment refusal n = 141 | |||||
| Age | 1.58 (0.53, 4.67) | 0.41 | 1.17 (0.95, 1.445) | 0.15 | ||
| Sex | 0.71 (0.23, 2.15) | 0.54 | ||||
| Cancer site Colon Rectum | 1 3 (1.04, 8.62) | 0.04 | 1 5.61 (1.45, 21.49) | 0.01 | ||
| Tumor Stage II III | 1 0.51 (0.17, 1.54) | 0.23 | ||||
| Polypharmacy | 4.01 (1.39, 11.56) | 0.01 | 5.34 (1.55, 18.40) | 0.01 | ||
| Weight loss >10%/6 months | 0.8 (1.66, 3.86) | 0.78 | ||||
| Yesavage | 1.20 (0.43, 3.40) | 0.73 | ||||
| Social support | 1.71 (0.50, 5.92 | 0.39 | ||||
| VES-13 ≥3 | 5.78 (1.91, 17.47) | 5 medications) | 1.26 (0.43, 3.65) | 0.68 | ||
| Weight loss >10%/6 months | 0.48 (0.10, 2.27) | 0.34 | ||||
| Yesavage | 0.99 (0.40, 2.48) | 0.99 | ||||
| Social support no | 1.68 (0.52, 5.41) | 0.52 | ||||
| VES-13 > 3 | 0.74 (0.65, 0.83) | 0.13 | ||||
| Oncogeriatric group Fit (standard dose) Medium-fit (adapted dose) | 1 0.4 (0.12, 1.29) | 0.12 | ||||
| Analysis | Completion ≥ 80% of planned dose n = 105 | |||||
| Age (younger) | 2.72 (1.10, 6.72) | 0.03 | 1.13 (0.95, 1.35) | 0.16 | ||
| Sex (male) | 2.12 (0.95, 4.78) | 0.07 | 0.50 (0.20, 1.26) | 0.14 | ||
| Cancer site Colon Rectum | 1 0.85 (0.34, 2.14) | 0.73 | ||||
| Tumor stage II III | 1 1.09 (0.42, 2.72) | 0.90 | ||||
| Polypharmacy | 2.31 (0.90, 5.95) | 0.08 | 0.50 (0.20, 12.6.) | 0.09 | ||
| Weight loss >10%/6 months | 1.09 (0.37, 3.27) | 0.87 | ||||
| Yesavage | 1.08 (0.50, 2.34) | 0.85 | ||||
| Social support | 3.24 (1.04, 10.11) | 0.04 | 3.44 (1.01-12.31) | 0.05 | ||
| VES-13 ≥3 | 0.92 (0.29, 2.85) | 0.88 | ||||
| Oncogeriatric group Fit (standard dose) Medium fit (adapted dose) | 1 0.85 (0.36, 1.98) | 0.71 | ||||
| Toxicity | 7.19 (2.43, 21.32) | < 0.001 | 0.13 (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.