title: Management of Frail and Not-Frail elderly cancer patients in a hospital-based geriatric oncology program.
abstract: 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.
authors.affiliation: Division of Medical Oncology, Istituto Oncologico Veneto-IOV IRCCS, Italy. u.basso@tin.it
authors.forename: Umberto
authors.initials: U
authors.lastname: Basso
authors.forename: Singora
authors.initials: S
authors.lastname: Tonti
authors.forename: Catia
authors.initials: C
authors.lastname: Bassi
authors.forename: Antonella
authors.initials: A
authors.lastname: Brunello
authors.forename: Lara Maria
authors.initials: LM
authors.lastname: Pasetto
authors.forename: Daniela
authors.initials: D
authors.lastname: Scaglione
authors.forename: Cristina
authors.initials: C
authors.lastname: Falci
authors.forename: Manuela
authors.initials: M
authors.lastname: Beda
authors.forename: Savina Maria Luciana
authors.initials: SM
authors.lastname: Aversa
authors.forename: Micaela
authors.initials: M
authors.lastname: Stefani
authors.forename: Eugenio
authors.initials: E
authors.lastname: Castegnaro
authors.forename: Fabio
authors.initials: F
authors.lastname: Tamellini
authors.forename: Silvio
authors.initials: S
authors.lastname: Monfardini
mesh_terms: 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