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CC BY-NC-ND 4.0 · South Asian J Cancer 2021; 10(03): 161-166
DOI: 10.1055/s-0041-1729447
Original Article: Geriatric Oncology

Estimating the Risk of Chemotherapy Toxicity in Indian Geriatric Patient Population and Utility of Chemotherapy Risk Assessment Scale for High Age Patients (CRASH) Score

Aditi Mittal
1   Department of Medical Oncology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
,
Ranga R. Rangaraju
2   Department of Medical Oncology, Max Super Speciality Hospital, Shalimar Bagh, New Delhi, India
,
Amit Agarwal
3   Department of Medical Oncology, B.L. Kapur Super Speciality Hospital, Rajendra Place, New Delhi, India
,
D. Chandragouda
3   Department of Medical Oncology, B.L. Kapur Super Speciality Hospital, Rajendra Place, New Delhi, India
,
Sandeep Batra
4   Department of Medical Oncology, Max Super Speciality Hospital, Saket, Delhi, India
,
Suhail Qureshi
3   Department of Medical Oncology, B.L. Kapur Super Speciality Hospital, Rajendra Place, New Delhi, India
› Author Affiliations Funding Nil.
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Abstract

Background Aging is a heterogeneous process, and elderly population is diverse in health status and functional reserve. The present study was undertaken to predict severe chemotherapy toxicity using the Chemotherapy Risk Assessment Scale for High-Age Patients’ (CRASH) score.

Materials and Methods Elderly patients (age ≥65 years) with malignancy, who were planned to be treated with a new course of cytotoxic chemotherapy, were enrolled. The CRASH score was calculated, and patients were stratified into four categories, that is, low (0–3), intermediate (Int)-low (4–6), Int-high (7–9), and high (<9). Patients developing grade 3/4/5 nonhematologic (NH) or grade 4/5 hematologic (H) toxicity were taken as the development of severe toxicity.

Results Of 100 enrolled patients, 64 (64%) were able to complete their prescribed treatment. Forty-four percent of patients (44 patients) of our study cohort experienced grade-4 H or grade 3/4 NH toxicity. The highest score in each category (heme/nonheme/CRASH) predicts nearly 100% toxicity risk. At a critical value of CRASH ≥ 6.5, the sensitivity is calculated as 100%, while specificity is 89.09%. The accuracy of prediction is 93.88%. The median time taken to develop toxicity was 39.5 days.

Conclusion CRASH score utilizes clinical assessment and basic laboratory values. Yet, it accurately predicts severe chemotherapy toxicity above a critical value of 6.5. Based on the above study, the first 30 days are crucial as 45% of patients experienced toxicity in this time frame. With the help of these clinical predictive markers, the care of elderly will be optimized.

Keywords

chemotherapy - elderly - risk assessment - toxicity


Publication History

Article published online:
04 September 2021

© 2021. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Statista, Hamburg, Germany. Available at https://www.statista.com/statistics/271315/age-distribution-in-india/, Accessed April 12, 2021. Accessed August 17, 2013
  • 2 Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2013, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/archive/csr/1975_2013/, based on November 2015 SEER data submission, posted to the SEER web site, April 2016. Accessed on April 12,2021
  • 3 Clarke M, Collins R, Darby S. et al Early breast cancer trialists’ collaborative group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials. Lancet 2005; 366: 2087-2106
    CrossrefPubMedGoogle Scholar
  • 4 Pignon JP, Bourhis J, Domenge C, Designé L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-analysis of chemotherapy on head and neck cancer. Lancet 2000; 355 (9208) 949-955
    CrossrefPubMedGoogle Scholar
  • 5 Okamoto I, Moriyama E, Fujii S. et al Phase II study of carboplatin-paclitaxel combination chemotherapy in elderly patients with advanced non-small cell lung cancer. Jpn J Clin Oncol 2005; 35 (04) 188-194
    CrossrefPubMedGoogle Scholar
  • 6 Sarkar A, Shahi U. Assessment of cancer care in Indian elderly cancer patients: a single center study. South Asian J Cancer 2013; 2 (04) 202-208
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Hurria A, Togawa K, Mohile SG. et al Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 2011; 29 (25) 3457-3465
    CrossrefPubMedGoogle Scholar
  • 8 Extermann M, Boler I, Reich RR. et al Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer 2012; 118 (13) 3377-3386
    CrossrefPubMedGoogle Scholar
  • 9 Soubeyran P, Fonck M, Blanc-Bisson C. et al Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. J Clin Oncol 2012; 30 (15) 1829-1834
    CrossrefPubMedGoogle Scholar
  • 10 Extermann M, Bonetti M, Sledge GW, O’Dwyer PJ, Bonomi P, Benson III AB. MAX2–a convenient index to estimate the average per patient risk for chemotherapy toxicity; validation in ECOG trials. Eur J Cancer 2004; 40 (08) 1193-1198
    CrossrefPubMedGoogle Scholar
  • 11 Globocan India 2018. Population fact sheets p. 1-2. Available from http://www.gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf [accessed on May 11, 2020].
  • 12 Parikh PM, Bakshi AV. Cancer in the elderly – Get ready for the epidemic. In: Gupta SB, editor. Medicine Update. Vol. 15. Mumbai, India: The Association of Physicians of India 2005: 827-831
  • 13 Wildiers H, Heeren P, Puts M. et al International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 2014; 32 (24) 2595-2603
    CrossrefPubMedGoogle Scholar
  • 14 Hamaker ME, Schiphorst AH, ten Bokkel Huinink D, Schaar C, van Munster BC. The effect of a geriatric evaluation on treatment decisions for older cancer patients–a systematic review. Acta Oncol 2014; 53 (03) 289-296
    CrossrefPubMedGoogle Scholar
  • 15 Freyer G, Geay JF, Touzet S. et al Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Ann Oncol 2005; 16 (11) 1795-1800
    CrossrefPubMedGoogle Scholar
  • 16 Aaldriks AA, Maartense E, le Cessie S. et al Predictive value of geriatric assessment for patients older than 70 years, treated with chemotherapy. Crit Rev Oncol Hematol 2011; 79 (02) 205-212
    CrossrefPubMedGoogle Scholar
  • 17 Balducci L, Corcoran MB. Antineoplastic chemotherapy of the older cancer patient. Hematol Oncol Clin North Am 2000; 14 (01) 193-212, x–xi x–xi.
    CrossrefPubMedGoogle Scholar
  • 18 Crawford J, Dale DC, Kuderer NM. et al Risk and timing of neutropenic events in adult cancer patients receiving chemotherapy: the results of a prospective nationwide study of oncology practice. J Natl Compr Canc Netw 2008; 6 (02) 109-118
    CrossrefPubMedGoogle Scholar
  • 19 Lyman GH, Morrison VA, Dale DC, Crawford J, Delgado DJ, Fridman M. OPPS Working Group, ANC Study Group. Risk of febrile neutropenia among patients with intermediate-grade non-Hodgkin’s lymphoma receiving CHOP chemotherapy. Leuk Lymphoma 2003; 44 (12) 2069-2076
    CrossrefPubMedGoogle Scholar
  • 20 Presant CA, Thompson E, Leberthon B, Vergara L, McGowen P. Effects of weekly paclitaxel or paclitaxel plus carboplatin on functionality and symptoms of geriatric patients with cancer as measured by a brief geriatric oncology module: a pilot experience. Cancer 2005; 103 (12) 2623-2628
    CrossrefPubMedGoogle Scholar
  • 21 Puts MT, Monette J, Girre V. et al Are frailty markers useful for predicting treatment toxicity and mortality in older newly diagnosed cancer patients? Results from a prospective pilot study. Crit Rev Oncol Hematol 2011; 78 (02) 138-149
    CrossrefPubMedGoogle Scholar
  • 22 Bandeen-Roche K, Xue QL, Ferrucci L. et al Phenotype of frailty: characterization in the women’s health and aging studies. J Gerontol A Biol Sci Med Sci 2006; 61 (03) 262-266
    CrossrefPubMedGoogle Scholar
  • 23 Reuben DB, Rubenstein LV, Hirsch SH, Hays RD. Value of functional status as a predictor of mortality: results of a prospective study. Am J Med 1992; 93 (06) 663-669
    CrossrefPubMedGoogle Scholar
  • 24 Wolfson C, Wolfson DB, Asgharian M. et al Clinical Progression of Dementia Study Group. A reevaluation of the duration of survival after the onset of dementia. N Engl J Med 2001; 344 (15) 1111-1116
    CrossrefPubMedGoogle Scholar
  • 25 Hamer M, Bates CJ, Mishra GD. Depression, physical function, and risk of mortality: National Diet and Nutrition Survey in adults older than 65 years. Am J Geriatr Psychiatry 2011; 19 (01) 72-78
    CrossrefPubMedGoogle Scholar