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Predicting Chemotherapy Toxicity in Older Adults With Cancer: A Prospective Multicenter Study
Open accessAbstract
Purpose: Older adults are vulnerable to chemotherapy toxicity; however, there are limited data to identify those at risk. The goals of this study are to identify risk factors for chemotherapy toxicity in older adults and develop a risk stratification schema for chemotherapy toxicity. Patients and Methods: Patients age ≥ 65 years with cancer from seven institutions completed a prechemotherapy assessment that captured sociodemographics, tumor/treatment variables, laboratory test results, and geriatric assessment variables (function, comorbidity, cognition, psychological state, social activity/support, and nutritional status). Patients were followed through the chemotherapy course to capture grade 3 (severe), grade 4 (life-threatening or disabling), and grade 5 (death) as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events. Results: In total, 500 patients with a mean age of 73 years (range, 65 to 91 years) with stage I to IV lung (29%), GI (27%), gynecologic (17%), breast (11%), genitourinary (10%), or other (6%) cancer joined this prospective study. Grade 3 to 5 toxicity occurred in 53% of the patients (39% grade 3, 12% grade 4, 2% grade 5). A predictive model for grade 3 to 5 toxicity was developed that consisted of geriatric assessment variables, laboratory test values, and patient, tumor, and treatment characteristics. A scoring system in which the median risk score was 7 (range, 0 to 19) and risk stratification schema (risk score: percent incidence of grade 3 to 5 toxicity) identified older adults at low (0 to 5 points; 30%), intermediate (6 to 9 points; 52%), or high risk (10 to 19 points; 83%) of chemotherapy toxicity (P < .001). Conclusion: A risk stratification schema can establish the risk of chemotherapy toxicity in older adults. Geriatric assessment variables independently predicted the risk of toxicity.
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“we also adjusted the association of frailty with outcomes, by risk group as determined by the calculator.(11)”
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Wildiers, H. P. M. W., Heeren, P., Puts, M. T. E., Topinková, E., Janssen-Heijnen, M. L. G., Extermann, M., Falandry, C., Artz, A. S., Brain, E. G. C., Colloca, G. A., et al. (2014) · Journal of Clinical Oncology · doi:10.1200/jco.2013.54.8347 · Cited by 1,854
Self-citationMohile, S. G., Dale, W., Somerfield, M. R., Schonberg, M. A., Boyd, C. M., Burhenn, P. S., Canin, B., Cohen, H. J., Holmes, H. M., Hopkins, J. O., et al. (2018) · Journal of Clinical Oncology · doi:10.1200/jco.2018.78.8687 · Cited by 1,479
Self-citationExtermann, M., Boler, I., Reich, R. R., Lyman, G. H., Brown, R. H., DeFelice, J., Levine, R. M., Lubiner, E. T., Reyes, P., Schreiber Frederic, J., et al. (2011) · Cancer · doi:10.1002/cncr.26646 · Cited by 1,147
Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis
Levit, L. A., Balogh, E. P., Nass, S. J., & Ganz, P. A. (2014) · Cited by 956
Theou, O., Brothers, T. D., Mitnitski, A., & Rockwood, K. (2013) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12420 · Cited by 665
Metadata
- Authors
- Hurria, A., Togawa, K., Mohile, S. G., Owusu, C., Klepin, H. D., Gross, C. P., Lichtman, S. M., Gajra, A., Bhatia, S., Katheria, V., Klapper, S., Hansen, K., Ramani, R., Lachs, M., Wong, F. L., & Tew, W. P.
- Affiliations
- City Of Hope National Medical Center (US)
- Arti Hurria, Kayo Togawa, Smita Bhatia, Rupal Ramani, and F. Lennie Wong, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte; Kurt Hansen, University of California Davis School of Medicine, Sacramento, CA; Supriya G. Mohile, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, Shira Klapper, and William P. Tew, Memorial Sloan-Kettering Cancer Center; Mark Lachs, Weill Cornell Medical College, New York; Ajeet Gajra, State University of New York Upstate...
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2011-09-01
- Volume
- 29
- Issue
- 25
- Pages
- 3457-3465
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- PMC
- PMC3624700
- OpenAlex
- W2153294383
- Cited by
- 1,841
- References
- 43
- Citations by year
- 2026: 98 · 2025: 98 · 2024: 117 · 2023: 119 · 2022: 153 · 2021: 149 · 2020: 148 · 2019: 147 · 2018: 143 · 2017: 129 · 2016: 134 · 2015: 114 · 2014: 112 · 2013: 87 · 2012: 73
- FWCI
- 43.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Oncology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Amgen
- GlaxoSmithKline
- American Society of Clinical Oncology
- Celgene
- Genentech
- National Institute on Aging (K24AG022399, 1K08 AG 24842, K08AG024842, K23AG038361, K23AG026749)
- National Cancer Institute (U10CA098543)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- chemotherapy toxicity, older adults, geriatric assessment, risk stratification, risk prediction model, comorbidities, functional status, nutritional status, cognitive status, laboratory parameters, geriatric oncology
- MeSH terms
- Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Neoplasms, Predictive Value of Tests, Prospective Studies, Comorbidity, Survival Rate
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