Prevalence of and factors associated with treatment modification at first cycle in older adults with advanced cancer receiving palliative treatment.

Autor: Mohamed MR; James P Wilmot Cancer Institute, University of Rochester, New York, USA; Department of Public Health Sciences, University of Rochester, New York, USA., Kyi K; Department of Medicine, University of Rochester, Rochester, New York, USA., Mohile SG; James P Wilmot Cancer Institute, University of Rochester, New York, USA., Xu H; Department of Surgery, Cancer Control, University of Rochester, New York, USA., Culakova E; Department of Surgery, Cancer Control, University of Rochester, New York, USA., Loh KP; James P Wilmot Cancer Institute, University of Rochester, New York, USA., Flannery M; School of Nursing, University of Rochester, New York, USA., Obrecht S; James P Wilmot Cancer Institute, University of Rochester, New York, USA., Ramsdale E; James P Wilmot Cancer Institute, University of Rochester, New York, USA., Patil A; James P Wilmot Cancer Institute, University of Rochester, New York, USA., Dunne RF; James P Wilmot Cancer Institute, University of Rochester, New York, USA., DiGiovanni G; James P Wilmot Cancer Institute, University of Rochester, New York, USA., Hezel A; James P Wilmot Cancer Institute, University of Rochester, New York, USA., Burnette B; Cancer Research of Wisconsin and Northern Michigan, NCORP, USA., Desai N; Beebe Healthcare, Lewes, Delaware, NCORP, USA., Giguere J; NCORP of the Carolinas, Prisma Health System, USA., Magnuson A; James P Wilmot Cancer Institute, University of Rochester, New York, USA. Electronic address: allison_magnuson@urmc.rochester.edu.
Jazyk: angličtina
Zdroj: Journal of geriatric oncology [J Geriatr Oncol] 2021 Nov; Vol. 12 (8), pp. 1208-1213. Date of Electronic Publication: 2021 Jul 14.
DOI: 10.1016/j.jgo.2021.06.007
Abstrakt: Introduction: Treatment toxicities are common in older adults with cancer and consequently, treatment modifications are sometimes considered. We evaluated the prevalence and factors associated with treatment modifications at the first cycle in older patients receiving palliative systemic treatment.
Methods: Patients (n = 369) from the GAP 70+ Trial (NCT02054741; PI: Mohile) usual care arm were included. Enrolled patients were aged 70+ with advanced cancer and ≥ 1 Geriatric Assessment (GA) domain impairment. Treatment modification was defined as any change from National Comprehensive Cancer Network guidelines or published clinical trials. Baseline variables included: 1) sociodemographic factors; 2) clinical variables; 3) GA domains; and 4) physician beliefs about life expectancy. Bivariate analyses and multivariable cluster-weighted generalized estimating equation model were conducted to assess the association of baseline variables with cycle 1 treatment modifications.
Results: Mean age was 77.2 years (range: 70-94); 62% had lung or gastrointestinal cancers, and 35% had treatment modifications at cycle 1. Increasing age by one year (odds ratio (OR) 1.1, 95% confidence interval [CI] 1.0-1.2), receipt of ≥second line of chemotherapy (OR 1.8, CI 1.1-3.0), functional impairment (OR 1.6, CI 1.1-2.3) and income ≤$50,000 (OR 1.7, CI 1.1-2.4) were independently associated with a higher likelihood of cycle 1 treatment modification.
Conclusion: Treatment modifications occurred in 35% of older adults with advanced cancer at cycle 1. Increasing age, receipt of ≥second line of chemotherapy, functional impairment, and lower income were independently associated with treatment modifications. These findings emphasize the need for evidence-based regimens in older adults with cancer and GA impairments.
(Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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