title: The impact of low-grade toxicity in older people with cancer undergoing chemotherapy.
abstract: BACKGROUND
  Significant toxicity in chemotherapy trials is usually defined as grade ⩾3. In clinical practice, however, multiple lower grade toxicities are often considered meaningful. The purpose of this observational cohort study was to identify which level of toxicity triggers treatment modification and early discontinuation of chemotherapy in older people.
  
  
  METHODS
  Patients aged 65+ were recruited in a central London hospital. A total of 108 patients were recruited at the start of new chemotherapy treatment between October 2010 and July 2012.
  
  
  RESULTS
  Mean age was 72.1 ± 5 years, median 72 and range 65-86 years. Of the patients, 50.9% (55) were male with gastrointestinal (49), gynaecological (18), lung (15) and other cancers (26). Chemotherapy was palliative in 59.3% (64/108), curative/ neoadjuvant/adjuvant in the others. Mean number of cycles completed was 4.2 ± 3. Treatment modifications due to toxicity occurred in 60 (55.6%) patients, 35% (21/60) of whom had no greater than grade 2 toxicity. Early treatment discontinuation because of toxicity occurred in 23 patients (21.3%), 39.1% (9/23) of whom had no greater than grade 2 toxicity.
  
  
  CONCLUSIONS
  Many older patients did not complete treatment as planned. Treatment was modified/discontinued even for one or two low-grade toxicities. Further work is required to clarify whether low-grade toxicity has a greater clinical impact in older people, or whether clinicians have a lower threshold for modifying/discontinuing treatment in older people.
authors.affiliation: 1] POPS-GOLD, Department of Ageing & Health, Ground floor Bermondsey Wing, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK [2] Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London, SE1 3QD, UK.
authors.forename: T
authors.initials: T
authors.lastname: Kalsi
authors.affiliation: POPS-GOLD, Department of Ageing & Health, Ground floor Bermondsey Wing, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: G
authors.initials: G
authors.lastname: Babic-Illman
authors.affiliation: Department of Haematology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: P
authors.initials: P
authors.lastname: Fields
authors.affiliation: Department of Clinical Oncology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hughes
authors.affiliation: Department of Medical Oncology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: N
authors.initials: N
authors.lastname: Maisey
authors.affiliation: Department of Medical Oncology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: P
authors.initials: P
authors.lastname: Ross
authors.affiliation: Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London, SE1 3QD, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.affiliation: 1] POPS-GOLD, Department of Ageing & Health, Ground floor Bermondsey Wing, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK [2] Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London, SE1 3QD, UK.
authors.forename: D
authors.initials: D
authors.lastname: Harari
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; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*