Chemotherapy-induced changes in the physiologic reserve of elderly patients diagnosed with cancer.

Abstract

e19590 Background: Frailty is a biological syndrome of the elderly that is characterized by the loss of the reserve in multiple organ systems. The aims of this study were a) to identify the presence of frailty in the elderly with cancer, by measuring their functional reserve baseline and after chemotherapy treatment, and b) to assess which of the functional reserve parameters checked suffered a change ≥30%, suggestive of frailty. Methods: Prospective cohort study of oncologic patients ≥70 years of age, evaluated in a Spanish Unit of Cancer in the Elderly (from January 2010 to December 2011). Most of patients (88.9%) had a basal status between 0-1 (measured by the ECOG index). We collected information about the individual's physiologic reserve (skeletal muscle mass [SMM], walking speed, peak-flow, grip strength, creatinine clearance [CC] and Pfeiffer test). Parameters of functional reserve were determined at baseline and 4 months after chemotherapy was started. It was used a pre-post design, and a control group of patients not treated with chemoterapy (group B). To identify significant differences between the results of parameters of physiologic reserve it was used a t-student t test for independent groups. It was calculated the change percentage in each of these variables. Results: We analyzed data from 66 patients in group A (treatment with chemotherapy) and 68 in group B (no chemotherapy). Age average: 78.68 years. Gastrointestinal tumors (37.3%) and breast and gynecologic tumors (32.1%), others (30.6%); 28.8% were metastatic tumors. After chemotherapy, there were no significant differences in walking speed (p =0.323), handgrip strength (p =0.162), peak-flow (p =0.954), cognitive status (p =0.078) or CC (p =0.425). However, there was an increase in SMM (0.618 kg, 95% CI: 0.020 to 1.215, p =0.043). Changes after treatment were as follow: SMM and peak-flow increased by 2%, grip strength decreased by 15% and CC was reduced by 0.05%. Conclusions: The elderly physiologic reserve is not modified as a result of chemotherapy treatment, except for SMM. This change could be related to tumor response achievement. None of the physiologic reserve parameters was useful in this setting, as a "marker of frailty".