Geriatric Assessment for the Evaluation of Tolerability to Out-Patient Chemotherapy among Elderly Cancer Patients

Background: The selection of appropriate chemotherapy regimen for elderly cancer patients is usually made based on the physician's subjective assessment of the patient's physical status using parameters such as performance status or age. We prospectively evaluated the utility of geriatric assessment (GA) tool in predicting the tolerability of out-patient chemotherapy for cancer patients above the age of 70. Patients and methods: Between December 2014 to June 2015, 31 patients ≥70 years old planned for out-patient chemotherapy were enrolled and evaluated for the following 9 parameters constituting the GA before the first dose of chemotherapy: 1.ADL (subscale of MOS physical health) 2. IADL (subscale of OARS) 3.Psycological status(GDF-SF) 4. Nutritional status (% loss of weight loss past 6 months) 5.Cognitive function (BOMC) 6.Comoridity (physical health section) 7. Polypharmacy (number) 8.social support (living alone or living with family) 9.Sarcopenia (SMI)[BG1]. Absence of tolerability to out-patient chemotherapy was defined as the discontinuation of all chemotherapy agents within 3 months of starting chemotherapy or the needs for inpatient admission for adverse events. The association between GA and tolerability was analyzed. Results: Median age was 79 years old (range 70-91). Less toxic regimens-defined as those with <10% risk of severe neutropenia or altered dose/schedule regimens- were selected in 15 patients (48.3%). Overall, out-patient chemotherapy was tolerable in only 13 patients (41.9%). In multivariate analysis, MOS physical health based ADL measurement was significantly associated with tolerability of chemotherapy (P<0.01). Conclusion: This study suggests that ADL measurement based on MOS physical health could help in objectively assessing the tolerability to out-patient chemotherapy among elderly cancer patients.