Aim

The holy grail of geriatric oncology is to identify the elderly patient that would most benefit from current chemotherapy options, and to avoid iatrogenic and disabling toxicity that causes premature morbidity and mortality.  Unfortunately, this goal remains elusive.  Around the world, groups have developed geriatric assessment tools and corresponding scoring systems in an attempt to identify those at risk of chemotherapy toxicity, poor response to chemotherapy, and shortened survival.  This study set out to further identify risk factors for poor oncological outcomes in the elderly, to help guide clinicians treating cancer in the elderly.

Method

A retrospective audit of patients aged >70 years treated at the Royal Adelaide Hospital Cancer Centre.  All patients complete a self-reported geriatric assessment which is reviewed by the multidisciplinary team.  Demographics, geriatric assessment, type and stage of malignancy, intent of treatment, chemotherapy received, dose delays and reductions, and survival were all collected.  Descriptive statistics, survival analysis and regression analysis were performed.

Results

195 patients were reviewed, with a mean age 76 years, 55% male and median four medications.  The common malignancies were gastrointestinal (36%), lung (28%) and genitourinary (21%).  Rates of impairment in selected geriatric domains were IADL 21%, ADL 52%, weight loss 44%, exhaustion 34% and memory loss 17%.  Rates of chemotherapy toxicity were similar across groups.  Measures of function were strong predictors of mortality on univariate analysis, though less prevalent on multivariate analysis.  Predictors in the gastrointestinal and lung subgroups will be presented.

Conclusion

Markers of frailty may be independent of, or due to, the underlying malignancy.  Heterogeneity in disease, treatment and geriatric characteristics in elderly cancer patients makes identifying clear predictors of morbidity and mortality difficult. Further work is required to combine and weight significant geriatric factors to enable the oncologist to make informed decisions for their patient.