Patient- and tumor-related predictors of chemotherapy intolerance in older patients with cancer: A systematic review

Abbema, Doris L. van; Akker, Marjan van den; Janssen‐Heijnen, M.L.G.; Berkmortel, Franchette van den; Hoeben, Ann; Vos‐Geelen, Judith de; Buntinx, Frank; Kleijnen, Jos; Tjan‐Heijnen, Vivianne C. G.

doi:10.1016/j.jgo.2018.04.001

Cited by 47 publications

(38 citation statements)

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“…Although some studies reported that tumor types and chemotherapy regimen were associated with chemotherapy toxicity [ 29 ], the results remain controversial because of the heterogeneity of selection criteria and variations in multimodal treatment. In the current study, chemotherapy regimen was associated with overall and severe adverse events after postoperative chemotherapy in patients with CRC; the risk of overall and severe adverse events was higher in patients receiving chemotherapy consisting of oxaliplatin and irinotecan, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Age on Laparoscopic Surgery and Postoperative Chemotherapy in Elderly Patients With Colorectal Cancer

et al. 2020

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PurposeWe aimed to evaluate the postoperative complications of laparoscopic colorectal cancer (CRC) surgery and the adverse events of postoperative chemotherapy in elderly patients compared to younger patients and to identify the factors influencing the termination of postoperative chemotherapy. MethodsBetween June 2015 and May 2018, 188 patients with CRC underwent laparoscopic surgery with curative intent.Patients aged ≥70 were defined as elderly. Postoperative complications and adverse events of chemotherapy were assessed by using the Clavien-Dindo classification and the Common Terminology Criteria for Adverse Events, respectively. The clinicopathological factors were analyzed retrospectively. ResultsSeventy-eight patients were considered elderly with a mean age of 77.5 ± 5.5 years. Overall postoperative complications occurred in 68 patients (36.2%). Age and primary tumor location were independent predictors of overall postoperative complications. Smoking history was the only independent predictor of major postoperative complications. Of 113 patients who were recommended postoperative chemotherapy, 90 (79.6%) patients received postoperative chemotherapy. Overall adverse events occurred in 40 patients (44.4%). The American Society of Anesthesiologists classification and chemotherapy regimen were significantly associated with overall adverse events. The chemotherapy regimen was the only factor significantly associated with severe adverse events. Of 90 patients, postoperative chemotherapy could not be completed in 11 (12.2%). Age was the only factor significantly associated with stopping postoperative chemotherapy (p = 0.003). ConclusionThis study shows that laparoscopic CRC surgery and postoperative chemotherapy were feasible in elderly patients. Further efforts are needed to ensure that elderly patients have the opportunity to make informed decisions regarding postoperative chemotherapy. A c c e p t e d A r t i c l e A c c e p t e d A r t i c l eColorectal cancer (CRC) is a major cause of morbidity and mortality in the elderly because more than 70% of the cases occur in people over 65 years of age [1]. Furthermore, its incidence is expected to increase by 60% by 2030 [2]. With increases in life expectancy, the number of elderly patients who need treatment for CRC will also increase.Surgical intervention is the optimal treatment for patients with resectable CRC. Laparoscopic CRC surgery has advantages, such as less postoperative pain, quicker return of bowel function, shorter hospital stays, better cosmetic effects, and lower incidence of postoperative complications, compared to open CRC surgery [3,4]. In addition, several randomized trials have demonstrated that laparoscopic CRC surgery provided equivalent oncologic results compared to open CRC surgery [4,5]. Therefore, laparoscopic CRC surgery appears to be a suitable treatment for elderly patients. However, during laparoscopic surgery, pneumoperitoneum and changing position affect hemodynamics and the respiratory system, particularly in elderly patients [6]. F...

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Section: Discussionmentioning

confidence: 99%

“…There were various studies identifying factors to discontinue postoperative chemotherapy [ 29 ]. We focused on age and the adverse events of postoperative chemotherapy as factors that stopped chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Effect of Age on Laparoscopic Surgery and Postoperative Chemotherapy in Elderly Patients With Colorectal Cancer

et al. 2020

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“…1;22;23 Furthermore, gait speed and recent falls are fairly consistently associated with prognosis, treatment-related complications and functional decline after treatment, including institutionalisation. [24][25][26][27][28] Treatment can also exacerbate mobility impairment, for example through polyneuropathy which may occur with some types of chemotherapy.…”

Section: Uncovering Geriatric Impairmentsmentioning

confidence: 99%

Optimizing the geriatrician's contribution to cancer care for older patients

Hamaker

Huis‐Tanja

Rostoft

2020

Journal of Geriatric Oncology

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Cancer specialists and geriatricians can struggle to find the best form for their collaboration within geriatric oncology and do not always benefit optimally from the experience and knowledge the other has to offer. To optimize the yield of a geriatric consultation for older cancer patients, the geriatrician needs to know the specific purpose of the consultation, the expected disease trajectory, and some information on the potential benefits and risks of treatment options including best supportive care only. The geriatrician should subsequently focus primarily on the patient, their preferences and priorities with regards to oncologic and non-oncologic outcomes and assess their overall health status through a geriatric assessment that includes at minimum comorbidities, medication review, basic and instrument activities of daily living, mobility, falls, nutritional status, cognition, mood and social support. Reporting back to the cancer specialist should be concise, objective whenever possible and to the point. Within the multidisciplinary team, the geriatrician can contribute with information on health status and reserves, remaining life-expectancy and toxicity risks, and by creating awareness of the limitations of evidence regarding the older population. This will help in reaching a well-tailored treatment decision that balances cancer-related and patient-centred outcome measures and fits within the patient's own preferences for treatment.

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“…Older patients are at higher risk of chemotherapy-related toxicities in comparison with younger adults [ 1 ]. Weekly solvent-based taxanes, such as paclitaxel and docetaxel, are amongst the recommended agents to treat older patients with advanced breast cancer (ABC) [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

EFFECT: a randomized phase II study of efficacy and impact on function of two doses of nab-paclitaxel as first-line treatment in older women with advanced breast cancer

et al. 2020

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Background: Limited data are available regarding the use of nab-paclitaxel in older patients with breast cancer. A weekly schedule is recommended, but there is a paucity of evidence regarding the optimal dose. We evaluated the efficacy of two different doses of weekly nab-paclitaxel, with a specific focus on their corresponding impact on patient function, in order to address the lack of data specifically relating to the older population. Methods: EFFECT is an open-label, phase II trial wherein 160 women with advanced breast cancer aged ≥ 65 years were enrolled from 15 institutions within Italy. Patients were randomly assigned 1:1 to receive nab-paclitaxel 100 mg/ m 2 (arm A) or 125 mg/m 2 (arm B) on days 1, 8, and 15 on a 28-day cycle, as first-line treatment for advanced disease. The primary endpoint was event-free survival (EFS), wherein an event was defined as disease progression (PD), functional decline (FD), or death. In each arm, the null hypothesis that the median EFS would be ≤ 7 months was tested against a one-sided alternative according to the Brookmeyer Crowley test. Secondary endpoints included objective response rate (ORR), clinical benefit rate (CBR), progression-free survival (PFS), overall survival (OS), and safety.

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Patient- and tumor-related predictors of chemotherapy intolerance in older patients with cancer: A systematic review

Abstract: The included studies were heterogeneous with respect to endpoints and included parameters. Nevertheless, the size of the association and the consistency of results suggest that all these factors are relevant for everyday oncological practice.

Cited by 47 publications

References 62 publications

Effect of Age on Laparoscopic Surgery and Postoperative Chemotherapy in Elderly Patients With Colorectal Cancer

Effect of Age on Laparoscopic Surgery and Postoperative Chemotherapy in Elderly Patients With Colorectal Cancer

Optimizing the geriatrician's contribution to cancer care for older patients

EFFECT: a randomized phase II study of efficacy and impact on function of two doses of nab-paclitaxel as first-line treatment in older women with advanced breast cancer

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