Predicting early death in older adults with cancer

Boulahssass, Rabia; Gonfrier, Sébastien; Ferrero, Jean-­Marc; Sanchez, Marine; Mari, Véronique; Moranne, Olivier; Rambaud, C.; Auben, Francine; Lévi, J.M. Hannoun; Béréder, Jean-Marc; Isabelle, Bereder; Baqué, Patrick; Turpin, Jean Michel; Frin, Anne-Claire; Ouvrier, Delphine; Borchiellini, Delphine; Largillier, R.; Sacco, Guillaume; Delotte, J.; Arlaud, Cyprien; Benchimol, Daniel; Durand, Matthieu; Evesque, Ludovic; Mahamat, Abakar; Poissonnet, G.; Mouroux, Jérôme; Barrière, Jérôme; Benizri, Emmanuel; Piche, Thierry; Guigay, J.; François, Ετιεννε; Guérin, Olivier

doi:10.1016/j.ejca.2018.04.013

Cited by 51 publications

(44 citation statements)

References 43 publications

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“…Whatever the number of frailty markers, it appears that some markers have their own predictive value. In the older cancer population, abnormal nutrition and poor mobility were significantly predictive for early deaths . Grip strength was also identified as an independent variable that predicted chemotoxicity and various adverse outcomes such as functional decline and postoperative morbimortality .…”

Section: Discussionmentioning

confidence: 97%

Predicting Chemotherapy Toxicity and Death in Older Adults with Colon Cancer: Results of MOST Study

Rétornaz¹,

Guillem²,

Rousseau

et al. 2019

The Oncologist

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Purpose Older patients with colon cancer (CC) are vulnerable to chemotherapy toxicity and death. Establishing simple scores specific for patients with CC to predict severe chemotoxicity or early death is needed to select the best treatment strategy. Subjects, Materials, and Methods This prospective multicenter study included patients aged ≥70 years with CC receiving adjuvant or first‐line metastatic chemotherapy. Frailty markers (nutrition, physical activity, energy, mobility, strength), comprehensive geriatric assessment (functional status, comorbidities, falls, nutrition, cognition, and depression), and usual laboratory parameters were collected. Logistic or Cox regression was used to examine at 500 days the association between frailty markers, comprehensive geriatric assessment, laboratory parameters, and grade 3–4 toxicity or death. Results A total of 97 patients (median age, 79.0 years) received adjuvant (37.1%) or metastatic (62.9%) chemotherapy. During the first 500 days, grade 3–4 toxicity occurred in 49.5%, and 30% died. The predictive model for grade 3–4 toxicity combined (polychemotherapy × 3) + (hypoalbuminemia <32 g/L × 2) + (abnormal grip strength × 1.5) + C‐reactive protein >11 mg/L + Eastern Cooperative Oncology Group performance status (ECOG‐PS), cutoff score >3. The predictive model for death combined (metastasis × 5) + (age × 2) + alkaline phosphatase >100 IU/mL + sex (female) + abnormal grip strength + ECOG‐PS, cutoff score >6. For chemotoxicity prediction, sensitivity was 81.6% and specificity 71.4%. For death prediction, sensitivity was 89.7% and specificity was 83.6%. Conclusion These simple and efficient “ColonPrediscores” will help to better identify older patients with CC with increased risk of chemotherapy‐related toxicity and/or death. Implications for Practice The two scores assessed in this study, called “ColonPrediscores”, offer a major advantage in that they do not need a previous complete geriatric assessment, which makes them an easy‐to‐use tool in oncologic settings.

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Section: Discussionmentioning

confidence: 97%

Predicting Chemotherapy Toxicity and Death in Older Adults with Colon Cancer: Results of MOST Study

Rétornaz¹,

Guillem²,

Rousseau

et al. 2019

The Oncologist

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“…We have previously shown that a gait speed <1m/s is significantly associated with at least one geriatric impairment on the GA, and thus takes the heterogeneity of ageing with cancer into account [18]. A slow gait speed was also found to be independently associated with early death in the recently published Nice Cancer Ageing Survival (NCAS) score [13]. This score predicts early death at 100 days for older cancer patients, but it is not feasible to be "high risk" by comparing the population impact of a risk-based policy to "treat all" (cross line in grey) and "treat none" (baseline) intervention policies.…”

Section: Agingmentioning

confidence: 99%

“…In contrast, the feasibility of administration of the GA depends on the local availability of geriatric expertise. Four clinical and biological scores predictive of early death alongside some items from the GA have been suggested, but they lack of simplicity, and thus remain difficult to implement in daily practice [10][11][12][13].…”

Section: Agingmentioning

confidence: 99%

Development, validation and clinical impact of a prediction model for 6-month mortality in older cancer patients: the GRADE

Angeli

Chouahnia

Canouï‐Poitrine³

et al. 2020

Aging

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INTRODUCTION Cancer is a common disease among the elderly, as twothirds of newly diagnosed cancers and three-quarters of cancer-related deaths occur after 65 years of age in Western countries [1]. However, older cancer patients are usually excluded from clinical trials, mainly because of comorbidities and functional impairment [2, 3]. Data from evidence-based-medicine is thus lacking for therapeutic decisions in this population, and one of the main issues is to avoid situations of over-and undertreatment, and to provide guidance for clinicians in the www.aging-us.com

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“…Nutritional status is associated with increased toxicity during treatment, longer hospitalizations, presence of fatigue and lower survival rates [20,23,46]. In addition, nutritional deficits can trigger cancer cachexia, an abnormality associated with anorexia, skeletal muscle atrophy, loss of adipose tissue and anemia [47,48].…”

Section: Resultsmentioning

confidence: 99%

“…For this reason, it is recommended to conduct a multidimensional geriatric assessment (MGA) before the establishment of the treatment protocol. The evaluation of nutritional status is an important part of this assessment [15,18,19] because it allows early intervention in patients at risk of malnutrition or malnourished, reducing days of hospitalization, the development of infections, toxicity during chemotherapy and increased survival [20][21][22][23].…”

Section: Functionality In Basic Activities Of Daily Living (Adl)mentioning

confidence: 99%

Nutritional Status and Associated Factors in Older Patients with Prostate Cancer: A Cross-Sectional Study in Two Brazilian Cities

Marques¹,

Echenique²

2019

J Nutri Med Diet Care

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Background: Given the heterogeneity of the overall health status of older patient with cancer, it is recommended to conduct a multidimensional geriatric assessment (MGA) before the establishment of the treatment protocol. Nutritional status is an important part of this assessment, as it is associated to poor health outcomes in older adults with cancer. This study aims to identify factors associated with nutritional status in older adults with prostate cancer. Methods: Cross-sectional study of 538 older adults aged 60 or more, with incident prostate cancer before the beginning of the treatment at hospitals of Brazil's Unified Health System. Nutritional status was evaluated with the Mini-Nutritional Assessment Short-Form version. Socio-demographic and clinical variables, besides some dimensions of the MGA (functionality, comorbidity and emotional condition) were evaluated. We estimated the prevalence of subjects at risk of malnutrition or malnourished and analysed the associations between nutritional status and the independent variables using prevalence ratios and Poisson's regression with statistical significance for p value ≤ 0.05. Results: The mean age of the individuals was 69.11 ± 6.43 years and 27.1% were at risk of malnutrition or malnourished. Presence of depressive symptoms (PR 1.78; 95% CI 1.27-2.50), functional dependence in Basic Activities of Daily Living (PR 1.40; 95% CI 1.01-1.94) and age (PR 1.02; 95% CI 1.00-1.04) were independent factors associated with nutritional status. Conclusion: The high prevalence of patients at risk of malnutrition or malnourished and the association with functional dependence, presence of depressive symptoms and age point the importance to assessment the nutritional status in this population.

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Predicting early death in older adults with cancer

Cited by 51 publications

References 43 publications

Predicting Chemotherapy Toxicity and Death in Older Adults with Colon Cancer: Results of MOST Study

Predicting Chemotherapy Toxicity and Death in Older Adults with Colon Cancer: Results of MOST Study

Development, validation and clinical impact of a prediction model for 6-month mortality in older cancer patients: the GRADE

Nutritional Status and Associated Factors in Older Patients with Prostate Cancer: A Cross-Sectional Study in Two Brazilian Cities

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