Management of Frail and Not-Frail elderly cancer patients in a hospital-based geriatric oncology program

Umberto Basso, Singora Tonti, Catia Bassi, Antonella Brunello, Lara Maria Pasetto, Daniela Scaglione, Cristina Falci, Manuela Beda, Savina Maria Luciana Aversa, Micaela Stefani, Eugenio Castegnaro, Fabio Tamellini, Silvio Monfardini

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate management and outcome of patients ≥70 years admitted to our Medical Oncology ward and evaluated by Multidimensional Geriatric Assessment before treatment with standard or "elderly-friendly" chemotherapy regimens, a list of which was developed within our Geriatric Oncology Program based on published clinical trials and personal experience. Patients and methods: Charts of patients treated from January 2004 to January 2006 were reviewed for choice of treatment, tumor response, toxicities and survival. Results: 117 patients (median age 75 years) were divided into Frail (F) (34.2%) and Not-Frail patients (NF: 33.3% Fit plus 32.5% Vulnerable). The two groups did not differ according to the use of "elderly-friendly"chemotherapy regimens (40% of F pts and 39% of NF pts), dose reductions ≥25% (37.5% vs. 31.2%) and grade 3-4 toxicities (52.5% vs. 58.4%). Early interruption of treatment due to toxicity or patient's refusal (42.5 vs. 15.6, p = 0.001) and deaths within 30 days from last chemotherapy administration (22.5% vs. 3.9%, p = 0.003) were significantly different. F patients showed clinical or radiological response in 21.2% of cases, and subjective improvement in 22.6%. After a median follow-up of 19 months, median survival of F patients (6.4 months) is shorter compared to NF group (16.9 months, p = 0.012). Conclusions: The use of "elderly-friendly"chemotherapy regimens was limited to less than a half of cases. F patients may respond to chemotherapy but display higher rates of premature withdrawal and early deaths compared to NF patients, with a shorter survival. Clinical trials particularly aimed at frail patients are urgently needed.

Original languageEnglish
Pages (from-to)163-170
Number of pages8
JournalCritical Reviews in Oncology/Hematology
Volume66
Issue number2
DOIs
Publication statusPublished - May 2008

Keywords

  • Chemotherapy
  • Geriatric oncology
  • Multidimensional geriatric assessment
  • Survival
  • Toxicity

ASJC Scopus subject areas

  • Cancer Research
  • Hematology
  • Oncology

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  • Cite this

    Basso, U., Tonti, S., Bassi, C., Brunello, A., Pasetto, L. M., Scaglione, D., Falci, C., Beda, M., Aversa, S. M. L., Stefani, M., Castegnaro, E., Tamellini, F., & Monfardini, S. (2008). Management of Frail and Not-Frail elderly cancer patients in a hospital-based geriatric oncology program. Critical Reviews in Oncology/Hematology, 66(2), 163-170. https://doi.org/10.1016/j.critrevonc.2007.12.006