title: Baseline comprehensive geriatric assessment is associated with toxicity and survival in elderly metastatic breast cancer patients receiving single-agent chemotherapy: results from the OMEGA study of the Dutch breast cancer trialists' group.
abstract: OBJECTIVE
  To evaluate the association between baseline comprehensive geriatric assessment (CGA) or the Groningen Frailty Indicator (GFI) and toxicity in elderly metastatic breast cancer (MBC) patients treated with first-line palliative chemotherapy.
  
  
  METHODS
  MBC patients (≥65 years) were randomized between pegylated liposomal doxorubicine or capecitabine. CGA included instrumental activities of daily living (IADL), cognition using the mini-mental state examination (MMSE), mood using the geriatric depression scale (GDS), comorbidity using the Charlson index, polypharmacy and nutritional status using the body mass index. Frailty on CGA was defined as one or more of the following: IADL ≤ 13, MMSE ≤ 23, GDS ≥ 5, BMI ≤ 20, ≥5 medications or Charlson ≥2. The cut-off for frailty on the GFI was ≥4.
  
  
  RESULTS
  Of the randomized 78 patients (median age 75.5 years, range 65.8-86.8 years), 73 were evaluable for CGA; 52 (71%) had one or more geriatric conditions. Grade 3-4 chemotherapy-related toxicity was experienced by 19% of patients without geriatric conditions compared to 56% of patients with two geriatric conditions and 80% of those with three or more (p = 0.002). Polypharmacy was the only individual factor significantly associated with toxicity (p = 0.001). GFI had a sensitivity of 69% and a specificity of 76% for frailty on CGA, and was not significantly associated with survival or toxicity.
  
  
  CONCLUSIONS
  In this study of elderly patients with MBC, the number of geriatric conditions correlated with grade 3-4 chemotherapy-related toxicity. Therefore, in elderly patients for whom chemotherapy is being considered, a CGA could be a useful addition to the decision-making process.
authors: Department of Geriatric Medicine, Diakonessenhuis Utrecht, The Netherlands. Electronic address: mhamaker@diakhuis.nl.
authors: M E
authors: ME
authors: Hamaker
authors: Department of Medical Oncology, Erasmus University Medical Centre - Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands.
authors: C
authors: C
authors: Seynaeve
authors: Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
authors: A N M
authors: AN
authors: Wymenga
authors: Antoni van Leeuwenhoek Hospital/NKI, Amsterdam, The Netherlands.
authors: H
authors: H
authors: van Tinteren
authors: Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands.
authors: J W R
authors: JW
authors: Nortier
authors: Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands.
authors: E
authors: E
authors: Maartense
authors: Department of Medical Oncology, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
authors: H
authors: H
authors: de Graaf
authors: Department of Internal Medicine, Ikazia Hospital, Rotterdam, The Netherlands.
authors: F E
authors: FE
authors: de Jongh
authors: Department of Internal Medicine, Vlietland Hospital, Schiedam, The Netherlands.
authors: J J
authors: JJ
authors: Braun
authors: Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors: M
authors: M
authors: Los
authors: Department of Internal Medicine, Spaarne Hospital, Hoofddorp, The Netherlands.
authors: J G
authors: JG
authors: Schrama
authors: Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, The Netherlands.
authors: A E
authors: AE
authors: van Leeuwen-Stok
authors: Dutch Breast Cancer Trialists' Group BOOG/Comprehensive Cancer Center, Amsterdam, The Netherlands.
authors: S M
authors: SM
authors: de Groot
authors: Department of Internal Medicine, Medical Centre Alkmaar, The Netherlands.
authors: C H
authors: CH
authors: Smorenburg
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D000069287:Capecitabine; D003072:Cognition Disorders / Q000453:epidemiology; D015897:Comorbidity; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003863:Depression / Q000453:epidemiology; D004317:Doxorubicin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005221:Fatigue / Q000139:chemically induced; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016330:Frail Elderly; D015577:Geriatric Assessment; D060831:Hand-Foot Syndrome / Q000209:etiology; D006801:Humans; D008609:Mental Status Schedule; D010166:Palliative Care; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use; D019338:Polypharmacy; D012307:Risk Factors; D013280:Stomatitis / Q000139:chemically induced; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; C506643:liposomal doxorubicin; D003841:Deoxycytidine; D011092:Polyethylene Glycols; D000069287:Capecitabine; D004317:Doxorubicin; D005472:Fluorouracil
keywords: Geriatric assessment; Metastatic breast cancer; Palliative chemotherapy