abstract:
Chemotherapy completion in elderly women with ovarian, primary peritoneal or fallopian tube cancer – An NRG oncology/Gynecologic Oncology Group study
Highlights
- •IADL was correlated with completion of 4 cycles of chemotherapy. (Instrumental Activities of Daily Living (IADL))
- •ADL, social activity, and QOL improved over time.
- •IADL was associated with overall survival in those receiving CP.
Purpose
A
simple measure to predict chemotherapy tolerance in elderly patients
would be useful. We prospectively tested the association of baseline
Instrumental Activities of Daily Living (IADL) score with ability to
complete 4 cycles of first line chemotherapy without dose reductions or
>7 days delay in elderly ovarian cancer patients.
Patients and methods
Patients' age ≥70 along with their physicians chose between two regimens: CP (Carboplatin AUC 5, Paclitaxel 135 mg/m2)
or C (Carboplatin AUC 5), both given every 3 weeks either after primary
surgery or as neoadjuvant chemotherapy (NACT) with IADL and quality of
life assessments performed at baseline, pre-cycle 3, and post-cycle 4.
Results
Two-hundred-twelve
women were enrolled, 152 selecting CP and 60 selecting C. Those who
selected CP had higher baseline IADL scores (p < 0.001). After
adjusting for age and PS, baseline IADL was independently associated
with the choice of regimen (p = 0.035). The baseline IADL score was not
found to be associated with completion of 4 cycles of chemotherapy
without dose reduction or delays (p = 0.21), but was associated with
completion of 4 cycles of chemotherapy regardless of dose reduction and
delay (p = 0.008) and toxicity, with the odds ratio (OR) of grade 3+
toxicity decreasing 17% (OR: 0.83; 95%CI: 0.72–0.96; p = 0.013) for
each additional activity in which the patient was independent. After
adjustment for chemotherapy regimen, IADL was also associated with
overall survival (p = 0.019) for patients receiving CP.
Conclusion
Patients
with a higher baseline IADL score (more independent) were more likely
to complete 4 cycles of chemotherapy and less likely to experience grade
3 or higher toxicity.
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