Management of Frail and Not-Frail elderly cancer patients in a hospital-based geriatric oncology program.
OBJECTIVE
To evaluate management and outcome of patients >or=70 years admitted to our Medical Oncology ward and evaluated by Multidimensional Geriatric Assessment before treatment with standard or "elderly-friendly" chemotherapy regimens, a list of which was developed within our Geriatric Oncology Program based on published clinical trials and personal experience.


METHODS
Charts of patients treated from January 2004 to January 2006 were reviewed for choice of treatment, tumor response, toxicities and survival.


RESULTS
117 patients (median age 75 years) were divided into Frail (F) (34.2%) and Not-Frail patients (NF: 33.3% Fit plus 32.5% Vulnerable). The two groups did not differ according to the use of "elderly-friendly"chemotherapy regimens (40% of F pts and 39% of NF pts), dose reductions >or=25% (37.5% vs. 31.2%) and grade 3-4 toxicities (52.5% vs. 58.4%). Early interruption of treatment due to toxicity or patient's refusal (42.5 vs. 15.6, p=0.001) and deaths within 30 days from last chemotherapy administration (22.5% vs. 3.9%, p=0.003) were significantly different. F patients showed clinical or radiological response in 21.2% of cases, and subjective improvement in 22.6%. After a median follow-up of 19 months, median survival of F patients (6.4 months) is shorter compared to NF group (16.9 months, p=0.012).


CONCLUSIONS
The use of "elderly-friendly"chemotherapy regimens was limited to less than a half of cases. F patients may respond to chemotherapy but display higher rates of premature withdrawal and early deaths compared to NF patients, with a shorter survival. Clinical trials particularly aimed at frail patients are urgently needed.
Basso
Umberto
U
Division of Medical Oncology, Istituto Oncologico Veneto-IOV IRCCS, Italy. u.basso@tin.it
Tonti
Singora
S
Bassi
Catia
C
Brunello
Antonella
A
Pasetto
Lara Maria
LM
Scaglione
Daniela
D
Falci
Cristina
C
Beda
Manuela
M
Aversa
Savina Maria Luciana
SM
Stefani
Micaela
M
Castegnaro
Eugenio
E
Tamellini
Fabio
F
Monfardini
Silvio
S
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006299:Health Services for the Aged; D006761:Hospitals; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008495:Medical Oncology; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome