Development and Validation of a Risk Tool for Predicting Severe Toxicity in Older Adults Receiving Chemotherapy for Early-Stage Breast Cancer
Autor: | Supriya G. Mohile, Efrat Dotan, Rachel A. Freedman, Anait Arsenyan, Heidi D. Klepin, Vani Katheria, William P. Tew, Allison Magnuson, Abrahm Levi, Can Lan Sun, Heeyoung Kim, Tanya M. Wildes, William Dale, Arti Hurria, Hyman B. Muss, Harvey J. Cohen, Tracey O'Connor, Cary P. Gross, Mina S. Sedrak |
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Rok vydání: | 2021 |
Předmět: |
Oncology
Cancer Research medicine.medical_specialty medicine.medical_treatment Breast Neoplasms Risk Assessment Cohort Studies 03 medical and health sciences 0302 clinical medicine Breast cancer Internal medicine medicine Humans Prospective Studies 030212 general & internal medicine Stage (cooking) Prospective cohort study Severe toxicity Aged Neoplasm Staging Aged 80 and over Chemotherapy business.industry Reproducibility of Results ORIGINAL REPORTS medicine.disease Chemotherapy Adjuvant 030220 oncology & carcinogenesis Toxicity Female Risk assessment business Cohort study |
Zdroj: | J Clin Oncol |
ISSN: | 1527-7755 0732-183X |
Popis: | PURPOSE Limited tools exist to predict the risk of chemotherapy toxicity in older adults with early-stage breast cancer. METHODS Patients of age ≥ 65 years with stage I-III breast cancer from 16 institutions treated with neoadjuvant or adjuvant chemotherapy were prospectively evaluated for geriatric and clinical features predictive of grade 3-5 chemotherapy toxicity. Logistic regression with best-subsets selection was used to identify and incorporate independent predictors of toxicity into a model with weighted variable scoring. Model performance was evaluated using area under the ROC curve (AUC) and goodness-of-fit statistics. The model was internally and externally validated. RESULTS In 473 patients (283 in development and 190 in validation cohort), 46% developed grade 3-5 chemotherapy toxicities. Eight independent predictors were identified (each assigned weighted points): anthracycline use (1 point), stage II or III (3 points), planned treatment duration > 3 months (4 points), abnormal liver function (3 points), low hemoglobin (3 points), falls (4 points), limited walking (3 points), and lack of social support (3 points). We calculated risk scores for each patient and defined three risk groups: low (0-5 points), intermediate (6-11 points), or high (≥ 12 points). In the development cohort, the rates of grade 3-5 chemotherapy toxicity for these three groups were 19%, 54%, and 87%, respectively ( P < .01). In the validation cohort, the corresponding toxicity rates were 27%, 45%, and 76%. The AUC was 0.75 (95% CI, 0.70 to 0.81) in the development cohort and 0.69 (95% CI, 0.62 to 0.77) in the validation cohort. Risk groups were also associated with hospitalizations and reduced dose intensity ( P < .01). CONCLUSION The Cancer and Aging Research Group-Breast Cancer (CARG-BC) score was developed and validated to predict grade 3-5 chemotherapy toxicity in older adults with early-stage breast cancer. |
Databáze: | OpenAIRE |
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