Chemotherapy toxicities and geriatric syndromes in older patients with malignant gliomas.
Journal
Journal of geriatric oncology
ISSN: 1879-4076
Titre abrégé: J Geriatr Oncol
Pays: Netherlands
ID NLM: 101534770
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
30
05
2020
revised:
03
07
2020
accepted:
04
07
2020
pubmed:
18
7
2020
medline:
29
7
2021
entrez:
18
7
2020
Statut:
ppublish
Résumé
To describe treatment toxicities and polypharmacy in older patients with malignant gliomas (MG). Advanced age in cancer patients is associated with increased treatment-related toxicities, acute care utilization and functional decline. Most patients with MG are over age 65, yet treatment patterns and toxicities are poorly defined. A retrospective chart review of 125 patients with MG age 65 or older at the University of Rochester from January 2012 to December 2018. 115 patients with glioblastoma and 10 with anaplastic astrocytoma had a median age of 71 (range 65-89) at diagnosis and median overall survival (OS) of 10.3 months. Radiotherapy (RT) was offered and completed in 79% (fractionated, n = 69, hypofractionated, n = 30). 24% of the 98 patients treated with concurrent temozolomide (TMZ) experienced treatment delays (n = 24). Median of 4 cycles of adjuvant TMZ were taken by 61% (n = 76). Delays and dose reductions occurred in 55% during treatment with adjuvant TMZ, most commonly due to thrombocytopenia (n = 29) and fatigue (n = 15). 16/98 patients required transfusions during treatment with concurrent or adjuvant TMZ. At baseline, patients were prescribed a median of 11 medications. OS was longer in patients prescribed less than 8 medications vs. 8 or more (14 vs. 8.6 months, p = .0738). 96% experienced a non-elective hospital admission and 64% reported at least one fall. Older patients with MG experience significant polypharmacy, treatment toxicities and falls. Studies incorporating geriatric assessment tools may better determine associations between geriatric syndromes and survival. Clinical trials in older patients should also include non-survival outcomes.
Sections du résumé
OBJECTIVE
To describe treatment toxicities and polypharmacy in older patients with malignant gliomas (MG).
BACKGROUND
Advanced age in cancer patients is associated with increased treatment-related toxicities, acute care utilization and functional decline. Most patients with MG are over age 65, yet treatment patterns and toxicities are poorly defined.
METHODS
A retrospective chart review of 125 patients with MG age 65 or older at the University of Rochester from January 2012 to December 2018.
RESULTS
115 patients with glioblastoma and 10 with anaplastic astrocytoma had a median age of 71 (range 65-89) at diagnosis and median overall survival (OS) of 10.3 months. Radiotherapy (RT) was offered and completed in 79% (fractionated, n = 69, hypofractionated, n = 30). 24% of the 98 patients treated with concurrent temozolomide (TMZ) experienced treatment delays (n = 24). Median of 4 cycles of adjuvant TMZ were taken by 61% (n = 76). Delays and dose reductions occurred in 55% during treatment with adjuvant TMZ, most commonly due to thrombocytopenia (n = 29) and fatigue (n = 15). 16/98 patients required transfusions during treatment with concurrent or adjuvant TMZ. At baseline, patients were prescribed a median of 11 medications. OS was longer in patients prescribed less than 8 medications vs. 8 or more (14 vs. 8.6 months, p = .0738). 96% experienced a non-elective hospital admission and 64% reported at least one fall.
CONCLUSION
Older patients with MG experience significant polypharmacy, treatment toxicities and falls. Studies incorporating geriatric assessment tools may better determine associations between geriatric syndromes and survival. Clinical trials in older patients should also include non-survival outcomes.
Identifiants
pubmed: 32674977
pii: S1879-4068(20)30295-2
doi: 10.1016/j.jgo.2020.07.001
pii:
doi:
Substances chimiques
Antineoplastic Agents, Alkylating
0
Dacarbazine
7GR28W0FJI
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
134-138Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest Andrea Wasilewski reports consulting fees from Novocure. Ahmar Alam reports no disclosures. Nimish Mohile reports no disclosures.