title: Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study.
abstract: OBJECTIVE
  Older adults are vulnerable to chemotherapy toxicity; however, there are limited data to identify those at risk. The goals of this study are to identify risk factors for chemotherapy toxicity in older adults and develop a risk stratification schema for chemotherapy toxicity.
  
  
  METHODS
  Patients age ≥ 65 years with cancer from seven institutions completed a prechemotherapy assessment that captured sociodemographics, tumor/treatment variables, laboratory test results, and geriatric assessment variables (function, comorbidity, cognition, psychological state, social activity/support, and nutritional status). Patients were followed through the chemotherapy course to capture grade 3 (severe), grade 4 (life-threatening or disabling), and grade 5 (death) as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events.
  
  
  RESULTS
  In total, 500 patients with a mean age of 73 years (range, 65 to 91 years) with stage I to IV lung (29%), GI (27%), gynecologic (17%), breast (11%), genitourinary (10%), or other (6%) cancer joined this prospective study. Grade 3 to 5 toxicity occurred in 53% of the patients (39% grade 3, 12% grade 4, 2% grade 5). A predictive model for grade 3 to 5 toxicity was developed that consisted of geriatric assessment variables, laboratory test values, and patient, tumor, and treatment characteristics. A scoring system in which the median risk score was 7 (range, 0 to 19) and risk stratification schema (risk score: percent incidence of grade 3 to 5 toxicity) identified older adults at low (0 to 5 points; 30%), intermediate (6 to 9 points; 52%), or high risk (10 to 19 points; 83%) of chemotherapy toxicity (P < .001).
  
  
  CONCLUSIONS
  A risk stratification schema can establish the risk of chemotherapy toxicity in older adults. Geriatric assessment variables independently predicted the risk of toxicity.
authors.affiliation: City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA 91010, USA. ahurria@coh.org
authors.forename: Arti
authors.initials: A
authors.lastname: Hurria
authors.forename: Kayo
authors.initials: K
authors.lastname: Togawa
authors.forename: Supriya G
authors.initials: SG
authors.lastname: Mohile
authors.forename: Cynthia
authors.initials: C
authors.lastname: Owusu
authors.forename: Heidi D
authors.initials: HD
authors.lastname: Klepin
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Lichtman
authors.forename: Ajeet
authors.initials: A
authors.lastname: Gajra
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
authors.forename: Vani
authors.initials: V
authors.lastname: Katheria
authors.forename: Shira
authors.initials: S
authors.lastname: Klapper
authors.forename: Kurt
authors.initials: K
authors.lastname: Hansen
authors.forename: Rupal
authors.initials: R
authors.lastname: Ramani
authors.forename: Mark
authors.initials: M
authors.lastname: Lachs
authors.forename: F Lennie
authors.initials: FL
authors.lastname: Wong
authors.forename: William P
authors.initials: WP
authors.lastname: Tew
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015996:Survival Rate