Department of Medical Oncology, Tekirdağ Namık Kemal University, Tekirdağ, Turkey.
Department of Medical Oncology, Tekirdağ Namık Kemal University, Tekirdağ, Turkey.
J Geriatr Oncol. 2022 Jul;13(6):821-827. doi: 10.1016/j.jgo.2022.03.004. Epub 2022 Mar 28.
In older patients with cancer, it is very important to choose the appropriate treatment because they are at high risk for chemotherapy toxicity. Our study investigated characteristics of Cancer and Aging Research Group (CARG), Geriatric 8 (G8), and Vulnerable Elders Survey (VES-13) screening tools for predicting chemotherapy-related toxicity (CRT) prospectively.
208 patients aged ≥65 years old for whom chemotherapy was planned to treat non-haematological cancer between February 2021-September 2021 were included in the study. The CARG, G8, and VES-13 toxicity tools were completed by the oncologist through face-to-face interviews before starting the first chemotherapy treatment. CRTs during chemotherapy were evaluated according to the National Cancer Institute's Common Terminology Criteria for Adverse Events v4.03. Logistic regression models, the area under the receiver operating characteristic curve (ROC-AUC), and correlation analyses were used for comparing questionnaires.
Median age was 70.4 (range 65-86) years. Of the participants, 103 (49.5%) participants experienced grade 3-5 CRT (32.2% haematological, 28.4% non-haematological) during chemotherapy. ROC-AUC value of CARG was determined as 0.827 (95% CI [confidence interval]: 0.77-0.88, p < 0.001), it was determined as 0.744 (95% CI: 0.68-0.81, p < 0.001) for G8 and 0.726 (95% CI: 0.66-0.80, p < 0.001) for VES-13. In the univariate regression analysis, CARG (OR [odds ratio] = 13.57, 95% CI: 6.0-30.72, p < 0.001), G8 (OR = 3.19, 95% CI: 1.62-6.29, p = 0.001), and VES-13 (OR = 9.5, 95% CI: 5.01-17.89, p < 0.001) were found to be predictive for CRT. The multivariate analysis (included stage, Eastern Cooperative Oncology Group [ECOG] performance status, presence of comorbid disease, platinum-based treatment regimen, taxane-based treatment regimen, CARG, VES-13, G8) showed that CARG (OR = 12.08, 95% CI: 5.11-28.56, p < 0.001), VES-13 (OR = 10.06, 95% CI: 4.92-22.98, p < 0.001), and G8 (OR = 2.20, 95% CI: 1.04-4.69, p = 0.040) screening tools were strong predictors for CRT. The CARG and VES-13 questionnaires were predictive for reducing the initial treatment dose (p = 0.004, p = 0.004, respectively), interruption of treatment (p < 0.001, p < 0.001, respectively), discontinuing treatment (p = 0.002, p = 0.002, respectively), and unexpected hospitalisation (p = 0.012, p = 0.003, respectively).
We showed that all three CARG, G8, and VES-13 questionnaires are helpful tools in the decision-making process for ideal chemotherapy to predict severe CRT; however, CARG and VES-13 questionnaires appear more useful in daily oncology practice than the G8 questionnaire.
在老年癌症患者中，选择合适的治疗方法非常重要，因为他们面临着化疗毒性的高风险。我们的研究前瞻性地调查了癌症和老龄化研究组（CARG）、老年 8 项（G8）和脆弱老年人调查（VES-13）筛查工具预测化疗相关毒性（CRT）的特征。
208 名年龄≥65 岁的患者计划接受化疗治疗非血液系统癌症，他们于 2021 年 2 月至 2021 年 9 月期间入组研究。在开始第一次化疗治疗前，肿瘤学家通过面对面访谈完成了 CARG、G8 和 VES-13 毒性工具。根据国家癌症研究所的常见不良事件术语标准 4.03 评估化疗期间的 CRT。使用逻辑回归模型、受试者工作特征曲线（ROC-AUC）下面积和相关性分析比较问卷。
中位年龄为 70.4 岁（范围 65-86 岁）。在参与者中，有 103 名（49.5%）经历了 3-5 级 CRT（32.2%血液学毒性，28.4%非血液学毒性）。CARG 的 ROC-AUC 值为 0.827（95%CI：0.77-0.88，p<0.001），G8 为 0.744（95%CI：0.68-0.81，p<0.001），VES-13 为 0.726（95%CI：0.66-0.80，p<0.001）。在单变量回归分析中，CARG（比值比 [OR] = 13.57，95%CI：6.0-30.72，p<0.001）、G8（OR = 3.19，95%CI：1.62-6.29，p = 0.001）和 VES-13（OR = 9.5，95%CI：5.01-17.89，p<0.001）均与 CRT 相关。多变量分析（包括分期、东部肿瘤协作组 [ECOG] 表现状态、合并疾病、铂类治疗方案、紫杉烷类治疗方案、CARG、VES-13、G8）显示，CARG（OR = 12.08，95%CI：5.11-28.56，p<0.001）、VES-13（OR = 10.06，95%CI：4.92-22.98，p<0.001）和 G8（OR = 2.20，95%CI：1.04-4.69，p = 0.040）筛查工具是 CRT 的有力预测因素。CARG 和 VES-13 问卷可预测减少初始治疗剂量（p = 0.004，p = 0.004）、中断治疗（p<0.001，p<0.001）、停止治疗（p = 0.002，p = 0.002）和意外住院（p = 0.012，p = 0.003）。
我们表明，CARG、G8 和 VES-13 三种问卷均有助于预测严重 CRT 的理想化疗决策；然而，与 G8 问卷相比，CARG 和 VES-13 问卷在日常肿瘤学实践中更有用。
