Hsu T, Chen R, Lin S C X, Djalalov S, Horgan A, Le L W, Leighl N
University of Toronto, Toronto, ON;
Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON;
Curr Oncol. 2015 Dec;22(6):385-91. doi: 10.3747/co.22.2623.
Patient function is a key part of the clinical decision to offer chemotherapy and has, in earlier studies, been associated with chemotherapy toxicity. Objective testing might be more accurate than patient-reported or physician-assessed physical function, and thus might be a stronger predictor of chemotherapy toxicity in older adults.
Patients, 70 years of age and older, with thoracic or colorectal cancer were recruited. Three physical tests were performed before commencement of a new line of chemotherapy: grip strength, 4-m walk test, and the Timed Up and Go (tug). Our pilot study explored the association between those tests and chemotherapy toxicity.
The 24 patients recruited had a median age of 74.5 years (range: 70-84 years), and 54.2% had an Eastern Cooperative Oncology Group performance status of 0 or 1. Median score on the Charlson comorbidity index was 1 (range: 0-4). Almost two thirds had metastatic disease, 70% were chemonaïve, and 83.3% were about to receive polychemotherapy. Patients had a mean tug of 13.2 ± 5.7 s and a mean gait speed of 0.74 ± 0.24 m/s; 50% had a grip strength test in the lowest 20th percentile. Grades 3-5 chemotherapy toxicities occurred in 34.7% of the patients; two thirds required a dose reduction or delay; and one third discontinued chemotherapy because of toxicity. Hospitalization attributable to chemotherapy was uncommon (12.5%). A trend toward increased severe chemotherapy toxicity with slower gait speed was observed (p = 0.049).
Abnormalities in objective markers of physical function are common in older adults with cancer, even in those deemed fit for chemotherapy. However, those abnormalities were not associated with an increased likelihood of chemotherapy toxicity in the population included in this small pilot study.
患者功能是决定是否进行化疗这一临床决策的关键部分，并且在早期研究中，已发现其与化疗毒性相关。客观测试可能比患者自我报告或医生评估的身体功能更为准确，因此可能是老年患者化疗毒性更强的预测指标。
招募了年龄在70岁及以上的胸段或结直肠癌患者。在开始新的化疗疗程之前，进行了三项身体测试：握力、4米步行测试和起立行走计时测试（TUG）。我们的初步研究探讨了这些测试与化疗毒性之间的关联。
招募的24名患者中位年龄为74.5岁（范围：70 - 84岁），54.2%的患者东部肿瘤协作组体能状态为0或1。Charlson合并症指数的中位得分为1（范围：0 - 4）。近三分之二的患者患有转移性疾病，70%的患者为初治患者，83.3%的患者即将接受多药化疗。患者的平均TUG时间为13.2 ± 5.7秒，平均步速为0.74 ± 0.24米/秒；50%的患者握力测试结果处于最低的第20百分位。34.7%的患者出现3 - 5级化疗毒性；三分之二的患者需要减少剂量或延迟治疗；三分之一的患者因毒性而停止化疗。因化疗导致的住院情况并不常见（12.5%）。观察到步速较慢的患者出现严重化疗毒性的趋势增加（p = 0.049）。
癌症老年患者中，身体功能客观指标异常情况常见，即使是那些被认为适合化疗的患者。然而，在这项小型初步研究纳入的人群中，这些异常与化疗毒性增加的可能性并无关联。
