Chan Wing-Lok, Ma Tiffany, Cheung Kwok-Leung, Choi Horace, Wong Josiah, Lam Ka-On, Yuen Kwok-Keung, Luk Mai-Yee, Kwong Dora
Department of Clinical Oncology, The University of Hong Kong, Hong Kong.
Department of Clinical Oncology, The University of Hong Kong, Hong Kong.
J Geriatr Oncol. 2021 May;12(4):557-562. doi: 10.1016/j.jgo.2020.10.013. Epub 2020 Oct 27.
Older patients experience a higher risk of treatment-related toxicity (TRT). The G8 screening tool was developed to separate cancer older patients fit to receive standard treatment from those who are frail and experiencing functional decline due to reduced organ function and multiple comorbidities. The Cancer and Aging Research Group chemotherapy toxicity tool (CARG-tt) questionnaire was developed to predict chemotherapy toxicity in geriatric patients. This prospective observational study evaluated the performance of G8 and CARG-tt in predicting severe TRT in older Chinese cancer patients.
Chinese patients aged ≥65 with a diagnosis of solid malignancy and scheduled to receive anti-cancer treatment (chemotherapy or targeted therapy) were enrolled from March 2016 to July 2017 at the Department of Clinical Oncology at Queen Mary Hospital in Hong Kong. All patients completed the G8 and CARG-tt screening and pre-treatment assessments before starting treatment. Patients were monitored for any severe TRT, which was defined by grades 3-5 using the National Cancer Institute's Common Terminology Criteria for Adverse Events v4.03, treatment discontinuation, or unexpected hospitalization from starting to 30 days after treatment.
A total of 259 patients (male: 154, 59.5%; median age: 73.4, age range: 65-93) were enrolled in the study. Two hundred and ten (81.1%) patients received chemotherapy while the rest (n = 49, 18.9%) received targeted therapy. Overall, 146 patients (56.8%) experienced severe TRT. The mean G8 score was 12.4 (SD: 2.8). The G8 score had a significant association with unexpected admission (cutoff: 14, 41.3% vs. 26.5%, p = 0.03) but not significant in other types of TRTs. The mean CARG-tt score was 7.67 (SD: 3.7); it was not associated with severe TRTs.
The G8 and CARG-tt demonstrated a weak prediction of severe TRT in older Chinese cancer patients. Future studies need to develop predictive tools for TRT in patients receiving novel antineoplastic therapies, with a focus on subgroup analysis for different populations.
老年患者发生治疗相关毒性（TRT）的风险更高。G8筛查工具旨在区分适合接受标准治疗的老年癌症患者与因器官功能减退和多种合并症而身体虚弱且功能下降的患者。癌症与衰老研究组化疗毒性工具（CARG-tt）问卷旨在预测老年患者的化疗毒性。这项前瞻性观察性研究评估了G8和CARG-tt在预测中国老年癌症患者严重TRT方面的表现。
2016年3月至2017年7月，在香港玛丽医院临床肿瘤学系招募了年龄≥65岁、诊断为实体恶性肿瘤且计划接受抗癌治疗（化疗或靶向治疗）的中国患者。所有患者在开始治疗前均完成了G8和CARG-tt筛查及治疗前评估。对患者进行监测，观察是否发生任何严重TRT，根据美国国立癌症研究所不良事件通用术语标准v4.03，严重TRT定义为3-5级、治疗中断或治疗开始后至30天内意外住院。
共纳入259例患者（男性154例，占59.5%；中位年龄73.4岁，年龄范围65-93岁）。210例（81.1%）患者接受化疗，其余49例（18.9%）接受靶向治疗。总体而言，146例（56.8%）患者发生严重TRT。G8评分的平均值为12.4（标准差：2.8）。G8评分与意外入院有显著相关性（临界值：14，41.3%对26.5%，p=0.03），但在其他类型的TRT中无显著相关性。CARG-tt评分的平均值为7.67（标准差：3.7）；它与严重TRT无关。
G8和CARG-tt对中国老年癌症患者严重TRT的预测能力较弱。未来的研究需要开发针对接受新型抗肿瘤治疗患者的TRT预测工具，并重点针对不同人群进行亚组分析。
