A new system can accurately predict whether an older cancer patient will struggle with severe side effects from chemotherapy, potentially enabling more seniors to get the cancer treatment that is best for them.
|Arti Hurria is a national leader in geriatric oncology. (Photo by p.cunningham)|
No one can precisely predict how much chemotherapy a particular patient can tolerate before its side effects limit treatment, but physicians know that older cancer patients tend to be more vulnerable to side effects. A geriatric assessment tool uses age-related risk factors to better determine chemotherapy’s risks to each unique senior patient. Arti Hurria, M.D., associate professor in City of Hope’s Department of Medical Oncology & Therapeutics Research, was lead author of a prospective multicenter study used to develop the new tool; it was published Aug. 2 online in the Journal of Clinical Oncology.
“Cancer is still primarily a disease of age, and with our graying population there is a growing, critical need for assessment tools to weigh the risks and benefits of chemotherapy,” said Hurria, who directs City of Hope’s Cancer and Aging Research Program. “These data will provide the basis for future intervention studies aimed at decreasing the side effects from chemotherapy so that older patients can receive chemotherapy treatment and maintain their function and health.”
People older than 65 accounted for 60 percent of the more than 1.5 million new cancer cases diagnosed in the U.S. last year, according to the American Cancer Society — and the number of older adults nationwide will mushroom within the next two decades. With the coming growth in cancer cases among seniors, Hurria and her colleagues are searching for tools to make optimal chemotherapy choices in older adults.
“Available data suggest that older adults derive similar benefits from chemotherapy as younger adults, but older patients are less likely to be offered chemotherapy because of concerns regarding their ability to tolerate the treatment,” said Hurria. “The aim of our study was to develop a predictive model for severe and life-threatening toxicity that could help physicians and older patients in discussing and deciding treatment options.”
The study, conducted across seven institutions, enrolled 500 cancer patients between the ages of 65 and 91. Diseases included lung, gastrointestinal, gynecologic, breast and genitourinary cancers.
Before chemotherapy began, researchers gathered dozens of pieces of data about each patient, such as tumor characteristics and lab test results. In addition, their geriatric assessment included information about patients’ need for help with daily activities, as well as their nutrition, social and support network, other medical conditions, and their cognitive function — the ability to think, reason, learn and remember.
After patients underwent chemotherapy, the scientists analyzed their scores to see how well their assessment tool predicted patients’ side effects such as fatigue, anemia and infection.
“We found the system we developed that incorporated geriatric assessment variables demonstrated a greater ability to discriminate risk of chemotherapy toxicity in older patients than the standard Karnofsky Performance Scale, which is used to assess patient response to treatment but does not adjust for age factors,” said Hurria. “In fact, the geriatric assessment variables alone independently predicted the risk of toxicity.”
The National Cancer Institute and American Society of Clinical Oncology supported the research. Collaborating institutions included the University of Rochester Medical Center, Case Western Reserve University, Wake Forest University, Yale University of Medicine, Memorial Sloan-Kettering Cancer Center, and Syracuse VA Medical Center. The research group plans to continue their investigations and refine their model among patients with specific tumor types who are receiving specific treatment regimens.