Older adults constitute the highest prevalence for most common cancers. This population is known to be more vulnerable to chemotherapy toxicities, yet limited data is available due to low numbers of older adults participating in clinical trials to inform this risk1. The aim of this study is to utilize a validated chemotherapy toxicity prediction tool (Cancer and Ageing Research Group)2 in identifying risk factors for chemotherapy toxicity in older adults receiving chemotherapy at Dandenong Hospital.
Between January to July 2018, a retrospective audit was conducted on 39 patients who had completed the chemotherapy toxicity prediction tool prior to commencing a new chemotherapy regimen. The tool included 11 questions about age, cancer type, planned chemotherapy, haemoglobin level, creatinine clearance, presence of hearing impairment, falls risk, ability to self-administer medications, exercise tolerance and social support. The calculated score classified patients into high, moderate and low chemotherapy toxicity risk. The tool was completed by the prescribing oncologist. Only patients ≥65 years with stage I-IV solid tumours were included in the present audit.
Data was collected from 23 patients, out of which 14 patients had been assessed in the geriatric oncology clinic. The median age was 73 years. 57% were females. 82% of patients had gastrointestinal or genitourinary cancers. 17%, 66% and 17% patients were categorised into high, moderate and low-risk score respectively. Upfront dose reduction was implemented in 25% of the high-risk group and 47% of the moderate-risk group. 25% patients in the high-risk group each experienced grade 3 and grade 5 toxicities, while 13% patients in moderate-risk group experienced grade 3 toxicities. In the low-risk group, no dose reduction was given and none encountered Grade ≥3 adverse events.
This audit showed increased adverse events associated with higher risk score on a brief chemotherapy toxicity prediction model. Such a model should be incorporated into standard assessment to better predict complications in this older population group.