Development and Validation of an Early Mortality Risk Score for Older Patients Treated with Chemotherapy for Cancer

Abstract

Background: Estimation of life expectancy in older patients is relevant to select the best treatment strategy. We aimed to develop and validate a score to predict early mortality in older patients with cancer. Patients and Methods: A total of 749 patients over 70 years starting new chemotherapy regimens were prospectively included. A prechemotherapy assessment that included sociodemographic variables, tumor/treatment variables, and geriatric assessment variables was performed. Association between these factors and early death was examined using multivariable logistic regression. Score points were assigned to each risk factor. External validation was performed on an independent cohort. Results: In the training cohort, the independent predictors of 6-month mortality were metastatic stage (OR 4.8, 95% CI [2.4–9.6]), ECOG-PS 2 (OR 2.3, 95% CI [1.1–5.2]), ADL ≤ 5 (OR 1.7, 95% CI [1.1–3.5]), serum albumin levels ≤ 3.5 g/dL (OR 3.4, 95% CI [1.7–6.6]), BMI < 23 kg/m2 (OR 2.5, 95% CI [1.3–4.9]), and hemoglobin levels < 11 g/dL (OR 2.4, 95% CI (1.2–4.7)). With these results, we built a prognostic score. The area under the ROC curve was 0.78 (95% CI, 0.73 to 0.84), and in the validation set, it was 0.73 (95% CI: 0.67–0.79). Conclusions: This simple and highly accurate tool can help physicians making decisions in elderly patients with cancer who are planned to initiate chemotherapy treatment.

The Relationship Between the Presence of White Nails and Readmission Among Rural Older Admitted Patients: A Prospective Cohort Study

“…The presence of white nails can be explained by conditions other than nutrition. Nail bed color can result from abnormalities in the vascular nail bed or substance deposition [16]. Nevertheless, future studies may clarify the pathophysiology of white nails.…”

Prediction of Chemotoxicity, Unplanned Hospitalizations and Early Death in Older Patients with Colorectal Cancer Treated with Chemotherapy

“…These tools could help to decide about the initiation of adjuvant therapy. Prognostic factors have been identified and predictive scores developed to predict ED in older patients, whether they receive chemotherapy [ 60 , 61 ] or not [ 62 , 63 , 64 ]. These studies, as well as ours, point out to tumor stage, nutritional status and performance status as key factors in this regard [ 60 , 61 , 62 , 63 , 64 ].…”

“…Prognostic factors have been identified and predictive scores developed to predict ED in older patients, whether they receive chemotherapy [ 60 , 61 ] or not [ 62 , 63 , 64 ]. These studies, as well as ours, point out to tumor stage, nutritional status and performance status as key factors in this regard [ 60 , 61 , 62 , 63 , 64 ]. Similar results have been reported in two other studies in gastrointestinal tumors [ 12 , 13 ].…”

The Relationship between the Presence of White Nails and Mortality among Rural, Older, Admitted Patients: A Prospective Cohort Study

“…First, serum albumin levels may be strongly related to the mortality of older admitted patients. Serum albumin is affected by various conditions, such as infections, body volume conditions, and nutritional conditions [ 25 , 26 ]. Low serum albumin concentrations can indicate poor nutritional conditions, which can lead to the inability to make albumin.…”