Oncology department, Hospital Universitario La Paz, Madrid, Spain; Cátedra UAM-AMGEN, CIBERONC, Spain.
Oncology department, Hospital Universitario La Paz, Madrid, Spain.
J Geriatr Oncol. 2021 Apr;12(3):381-387. doi: 10.1016/j.jgo.2020.10.010. Epub 2020 Oct 24.
Inconsistent doses and schemes are commonly used in older patients receiving cancer chemotherapy. We performed this study in patients with cancer and age ≥ 70 years to determine the frequency of undertreatment and overtreatment as well as factors influencing the decision to modify chemotherapy doses.
Patients aged ≥70 years starting new chemotherapy regimens were prospectively included in a multicentre study. The schedule and drug doses were determined by the treating oncologist. Pre-chemotherapy assessment included sociodemographics, treatment details and geriatric assessment (GA) variables. Association between these factors and undertreatment (use of less intensive cancer treatment [LICT] in a fit patient) or overtreatment (use of standard cancer treatment in an unfit older patient) were examined by multivariate logistic regression.
Three- hundred ninety-seven patients were included, 43% of whom received LICT. If not adjusted for GA, toxicity did not differ between those receiving LICT (38%) or standard doses of chemotherapy (37%). If the dose of chemotherapy was analyzed according to the results of GA 61 (15%) patients had been undertreated and 133 (34%) had been overtreated. Undertreatment was related with increasing age and decreased renal function. Factors related with overtreatment were younger age, curative intention of treatment, prescription of G-CSF as primary prophylaxis and adequate cognitive status. Overtreated patients had more grade 3-4 toxicity than those receiving treatment adapted to fragility (42% vs 31%; p < 0.05).
The use of chemotherapy without considering GA leads to overtreatment more commonly than undertreatment in older patients with cancer. Oncologists should take into account the results of GA to stratify patients and to avoid under or overtreatment.
在接受癌症化疗的老年患者中，剂量和方案常常不一致。我们对年龄≥70 岁的癌症患者进行了这项研究，以确定剂量不足和剂量过大的频率以及影响修改化疗剂量决策的因素。
年龄≥70 岁的新开始化疗方案的患者前瞻性纳入多中心研究。治疗方案和药物剂量由治疗肿瘤学家确定。化疗前评估包括社会人口统计学、治疗细节和老年评估（GA）变量。通过多变量逻辑回归检查这些因素与剂量不足（适合的患者使用较少的强化癌症治疗[LICT]）或剂量过大（不适合的老年患者使用标准癌症治疗）之间的关联。
共纳入 397 例患者，其中 43%接受了 LICT。如果不根据 GA 调整，接受 LICT（38%）或标准剂量化疗（37%）的患者毒性无差异。如果根据 GA 结果分析化疗剂量，有 61 例（15%）患者剂量不足，133 例（34%）患者剂量过大。剂量不足与年龄增加和肾功能下降有关。与剂量过大相关的因素是年龄较小、治疗的治愈意图、预防性使用 G-CSF 和认知状态良好。接受过度治疗的患者比接受适应性治疗的患者毒性更严重（3 级-4 级：42% vs 31%；p<0.05）。
在老年癌症患者中，不考虑 GA 使用化疗会导致过度治疗多于剂量不足。肿瘤学家应考虑 GA 的结果对患者进行分层，以避免剂量不足或过大。
