Colorectal cancer (CRC) is one of the most commonly diagnosed cancers. About one half of cases are diagnosed in patients over 70 years of age. A multidimensional geriatric assessment is recommended in older patients but requires considerable time and resources. The aim of this study was to explore whether the G8 questionnaire to identify frailty may be helpful in decision-making in older CCR patients.
From October 2015 to July 2017, 142 patients over 75 years old were included prospectively. All the patients were assessed on four scales: G8, Pfeiffer, Barthel and TIRS scale, in addition to assessing age, comorbidity and functional status. Positive screening was performed for those older than 85 years, and those younger than 85 with 2 criteria (G8 ≤14, Pfeiffer > 2, Barthel < 90 and TIRS +).
The median age was 80.4 years (75.1 – 88.9). 45% had metastatic disease. 82% had G8 score≤14; 38% decided not to be treated with chemotherapy. 62% were treated with chemotherapy (47% capecitabine, 11% FOLFOX6 and 4% in a clinical trial). 43 % of the patients with G8≤14 started treatment with adapted doses and 39% at subsequent cycles. Of the G8> 14, only 28% were reduced at the beginning and 14% at subsequent cycles. Grade 3/4 toxicities in the G8≤14 versus G8>14. were: plantar palmar syndrome 14.3% vs 0%; hematological 15% vs 0%; gastrointestinal 18% vs 14%; mucositis 3.6% vs 0%; asthenia 11% vs 0%; and renal failure 4% vs 0%.
The G8 questionnaire helps to discriminate which patients are candidates for chemotherapy. If the G8 score is ≤ 14, it supports the decision to reduce the dose and it predicts toxicity. This suggests that G8 could be an instrument that detects frailty in older patients with CRC with the intention of undergoing systemic treatment. After analyzing these results, it is recommended to perform a complete geriatric assesment in these patients to validate our conclusions.
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All authors have declared no conflicts of interest.