Substantial Proportion of Older Patients Receiving First-Line Chemotherapy Experience Functional Decline
In a study reported in Journal of Clinical Oncology, Stéphanie Hoppe, PhD, of Institut Bergonié in Bordeaux, France, and colleagues assessed functional status in older patients with cancer receiving first-line chemotherapy using the Activities of Daily Living (ADL) scale. Clinically significant functional decline was found in 17% of patients, and higher Geriatric Depression Scale (GDS15) scores and lower Instrumental ADL (IADL) scale scores at baseline were independently predictive of decline.
Study Details
In the study, patients aged ≥ 70 years receiving first-line cancer chemotherapy were prospectively considered for inclusion across 12 centers in France. Functional decline was defined as a decrease of ≥ 0.5 points on the ADL scale between the beginning of chemotherapy and the second cycle. Factors associated with functional decline were investigated using pretreatment geriatric assessments, consisting of ADL, IADL, Mini-Nutritional Assessment (MNA), Mini-Mental State Examination (MMSE), GDS15, and Timed Get Up and Go (GUG) test, and comorbidities assessments, including the Cumulative Illness Rating Scale-Geriatrics, MAX2 index, and baseline biologic and clinical information.
A total of 299 patients were included in the analysis. Median age was 77 years (range, 70–93 years), 59% were male, 77% had Eastern Cooperative Group performance status of 0 or 1, 61% presented with no grade 3 or 4 comorbidities, and 37.5% of patients with solid tumors had metastatic disease. The most common cancers were non-Hodgkin lymphoma (32%), colon cancer (26%), and stomach cancer (11%). A total of 45.5% of patients received standard treatments, 16% received standard-reduced treatments, and 38% received adapted treatments.
Functional Decline and Predictive Factors
Of the 299 patients, 50 (17%) experienced functional decline on the ADL scale (median decrease, 0.5 points; range, 0.5–3 points). Functional gain was experienced by 32 patients (11%; median increase, 0.5 points; range, 0.5–2.5 points) and did not appear to be associated with tumor stage or site.
On univariate analysis, abnormal preadmission ECOG performance status, IADL, GDS15, MMSE, GUG, and MNA were associated with increased likelihood of functional decline; weight loss ≥ 10% was of borderline significance and was included in the multivariate analysis. On multivariate analysis adjusting for baseline ADL and MAX2 index, high GDS score (odds ratio [OR] = 2.16 for ≥ 6 vs < 6, P = .03) and low IADL score (OR = 2.87 for ≤ 7 vs > 7, P = .04) at baseline were independently associated with increased risk of functional decline.
The investigators concluded, “Our results outline associations between baseline depression, instrumental dependencies, and early functional decline during chemotherapy for older patients. ADL should be sequentially evaluated early during treatment. Baseline evaluation of GDS15 and IADL may be proposed to anticipate this event.”
Pierre Soubeyran, MD, PhD, of Institut Bergonié, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by the French Ministry of Health, Ligue Nationale Contre le Cancer, and unrestricted grants from sanofi aventis, Amgen, Chugai Pharmaceutical, Pfizer, and Bristol-Myers Squibb.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
