Chemotherapy in the oldest old: The feasibility of delivering cytotoxic therapy to patients 80 years old and older.
OBJECTIVE
Cancer is predominantly a disease of the elderly. While "older" patients are frequently considered for chemotherapy, little data exist in the population 80 years and older (80+). We investigated outcomes of patients 80+ who received chemotherapy at our institution.


METHODS
A retrospective chart review of patients 80+ initiating chemotherapy for malignant solid tumors from 2005 to 2010 was performed. Baseline demographics, cancer type and chemotherapy data were collected. Primary outcome was the rate of discontinuation due to toxicity. Secondary outcomes included the rate of dose reduction/omission/delay (ROD), hospitalization and blood transfusion.


RESULTS
Chemotherapy was initiated in 318 patients. Baseline demographics included the following: median age 82 years (80-92 years), 56% male, 55% ECOG PS 0-1, 43% Charlson index score of 0-1; 38% were taking ≥ 6 prescription medications. Common malignancies were colorectal (32%), lung (20%), and breast (12%). Most patients (68%) had metastatic disease or received palliative intent therapy (71%). Treatment was first line in 89% of patients, and an up front dose reduction was ordered in 41%. Toxicity caused therapy discontinuation in 32% of cases, while 52% experienced dose ROD. Hospitalization occurred in 32%; 18% required blood transfusions. Baseline polypharmacy was associated with increased hospitalization risk (OR 2.28, 95% CI 1.34-3.88, p=0.002), but dose adjustments were not correlated with any outcome.


CONCLUSIONS
In this study, we observed a high risk of hospitalization or treatment discontinuation due to toxicity, despite frequent dose modifications. As the cancer population ages, validated tools are needed to better select patients for therapy.
Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
Shelly
S
Sud
University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada.
Pamela
P
Lai
Clinical Epidemiology Program, Methods Centre, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
Tinghua
T
Zhang
Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
Mark
M
Clemons
Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada. Electronic address: pwheatleyprice@toh.on.ca.
Paul
P
Wheatley-Price
D000367:Age Factors; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003603:Cytotoxins / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D009864:Ontario / Q000453:epidemiology; D010166:Palliative Care; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D003603:Cytotoxins
Chemotherapy; Elderly; Octogenarian; Toxicity