Predicting the risk of chemotherapy toxicity in older patients: The Chemotherapy Risk Assessment Scale for High‐Age Patients (CRASH) score
Martine Extermann,I. Boler,Richard R. Reich,Richard R. Reich,Gary H. Lyman,Richard Brown,J. Defelice,Richard M. Levine,Eric T. Lubiner,Pablo Reyes,Frederic J. Schreiber,Lodovico Balducci +11 more
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TLDR
Tools are lacking to assess the individual risk of severe toxicity from chemotherapy, and such tools would be especially useful for older patients, who vary considerably in terms of health status and functional reserve.Abstract:
BACKGROUND:
Tools are lacking to assess the individual risk of severe toxicity from chemotherapy. Such tools would be especially useful for older patients, who vary considerably in terms of health status and functional reserve.
METHODS:
The authors conducted a prospective, multicentric study of patients aged ≥70 years who were starting chemotherapy. Grade 4 hematologic (H) or grade 3/4 nonhematologic (NH) toxicity according to version 3.0 of the Common Terminology Criteria for Adverse Events was defined as severe. Twenty-four parameters were assessed. Toxicity of the regimen (Chemotox) was adjusted using an index to estimate the average per-patient risk of chemotherapy toxicity (the MAX2 index). In total, 562 patients were accrued, and 518 patients were evaluable and were split randomly (2:1 ratio) into a derivation cohort and a validation cohort.
RESULTS:
Severe toxicity was observed in 64% of patients. The Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score was constructed along 2 subscores: H toxicity and NH toxicity. Predictors of H toxicity were lymphocytes, aspartate aminotransferase level, Instrumental Activities of Daily Living score, lactate dehydrogenase level, diastolic blood pressure, and Chemotox. The best model included the 4 latter predictors (risk categories: low, 7%; medium-low, 23%; medium-high, 54%; and high, 100%, respectively; Ptrend < .001). Predictors of NH toxicity were hemoglobin, creatinine clearance, albumin, self-rated health, Eastern Cooperative Oncology Group performance, Mini-Mental Status score, Mini-Nutritional Assessment score, and Chemotox. The 4 latter predictors provided the best model (risk categories: 33%, 46%, 67%, and 93%, respectively; Ptrend < .001). The combined risk categories were 50%, 58%, 77%, and 79%, respectively; Ptrend < .001). Bootstrap internal validation and independent sample validation demonstrated stable risk categorization and Ptrend < .001.
CONCLUSIONS:
The CRASH score distinguished several risk levels of severe toxicity. The split score discriminated better than the combined score. To the authors' knowledge, this is the first score systematically integrating both chemotherapy and patient risk for older patients and has a potential for future clinical application. Cancer 2011. © 2011 American Cancer Society.read more
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International Society of Geriatric Oncology Consensus on Geriatric Assessment in Older Patients With Cancer
Hans Wildiers,Pieter Heeren,Martine Puts,Eva Topinkova,Maryska L.G. Janssen-Heijnen,Martine Extermann,Claire Falandry,Andrew S. Artz,Etienne Brain,Giuseppe Colloca,Johan Flamaing,Theodora Karnakis,Cindy Kenis,Riccardo A. Audisio,Supriya G. Mohile,Lazzaro Repetto,Barbara L. van Leeuwen,Koen Milisen,Arti Hurria +18 more
TL;DR: There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base.
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TL;DR: A committee of experts to examine the quality of cancer care in the United States and formulate recommendations for improvement presents the committee’s findings and recommendations.
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Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: Asco guideline for geriatric oncology
Supriya G. Mohile,William Dale,Mark R. Somerfield,Mara A. Schonberg,Cynthia M. Boyd,Peggy S. Burhenn,Beverly Canin,Harvey J. Cohen,Holly M. Holmes,Judith O. Hopkins,Michelle C. Janelsins,Alok A. Khorana,Heidi D. Klepin,Stuart M. Lichtman,Karen M. Mustian,William P. Tew,Arti Hurria +16 more
TL;DR: Geriatric assessment (GA) should be used to identify vulnerabilities that are not routinely captured in oncology assessments and clinicians should take into account GA results when recommending chemotherapy.
Journal ArticleDOI
Validation of a Prediction Tool for Chemotherapy Toxicity in Older Adults With Cancer
Arti Hurria,Supriya G. Mohile,Ajeet Gajra,Heidi D. Klepin,Hyman B. Muss,Andrew E. Chapman,Tao Feng,David D. Smith,Can Lan Sun,Nienke A. de Glas,Harvey J. Cohen,Vani Katheria,Caroline Doan,Laura Zavala,Abrahm Levi,Chie Akiba,William P. Tew +16 more
TL;DR: This study externally validated a chemotherapy toxicity predictive model for older adults with cancer that should be considered when discussing the risks and benefits of chemotherapy with older adults.
Journal ArticleDOI
Screening for Vulnerability in Older Cancer Patients: The ONCODAGE Prospective Multicenter Cohort Study
Pierre Soubeyran,Carine Bellera,Jean Goyard,Damien Heitz,Hervé Curé,Hubert Rousselot,Gilles Albrand,Véronique Servent,Olivier Saint Jean,Isabelle Van Praagh,Jean-Emmanuel Kurtz,Stéphane Périn,Jean-Luc Verhaeghe,Catherine Terret,Christophe Desauw,Veronique Girre,C. Mertens,Simone Mathoulin-Pélissier,Muriel Rainfray +18 more
TL;DR: With good sensitivity and independent prognostic value on 1-year survival, the G8 questionnaire is currently one of the best screening tools available to identify older cancer patients requiring geriatric assessment, and it should be implemented broadly in daily practice.
References
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“Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician
Marshal F. Folstein,Marshal F. Folstein,Susan E B Folstein,Susan E B Folstein,Paul R. McHugh,Paul R. McHugh +5 more
TL;DR: A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
A practical method for grading the cognitive state of patients for the clinician
TL;DR: The Mini-Mental State (MMS) as mentioned in this paper is a simplified version of the standard WAIS with eleven questions and requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
Book
Applied Logistic Regression
David W. Hosmer,Stanley Lemeshow +1 more
TL;DR: Hosmer and Lemeshow as discussed by the authors provide an accessible introduction to the logistic regression model while incorporating advances of the last decade, including a variety of software packages for the analysis of data sets.
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