Toxicities and functional consequences of systemic chemotherapy in elderly Korean patients with cancer: A prospective cohort study using Comprehensive Geriatric Assessment

摘要

Objective: The objective of the present study is to evaluate the functional consequences of chemotherapy and identify risk factors for chemotherapy toxicity using the Comprehensive Geriatric Assessment (CGA) in elderly Korean patients with cancer. Materials and Methods: We prospectively enrolled elderly patients with cancer aged ≥ 65. years, and conducted the baseline and follow-up CGAs before and after systemic chemotherapy. Significant toxicity of chemotherapy was defined as in the study by Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, including grade 4 neutropenia, early withdrawal and/or hospitalization due to grade 3 or 4 toxicities. The association between baseline CGA parameters, changes in CGA parameters and occurrence of significant toxicities was analyzed. Results: A total of 64 patients were enrolled and received systemic chemotherapy (median age: 71, 65-80). Significant toxicity was observed in 16 patients (25.0%). A significant decline was observed in Eastern Cooperative Oncology Group performance status (ECOG PS) (p= 0.002), activities of daily living (ADL) (p< 0.001), instrumental ADL (IADL) (p= 0.003), mini-mental status examination (p< 0.001), and short form of the Geriatric Depression Scale (p= 0.017) after chemotherapy. The baseline ECOG PS was an independent predictive factor of significant toxicity (p= 0.037), and mini-nutritional assessment was marginally associated with the significant toxicity in univariate analysis (p= 0.064). Conclusion(s): Our pilot study revealed a significant decline in physical and neurocognitive functions after chemotherapy in elderly Korean patients with cancer. Future large scale studies with follow-up CGAs are needed to establish predictive tools of chemotherapy toxicities and functional decline in elderly patients receiving chemotherapy.