# 037 Chemotherapy Toxicity in the Geriatric Patient
Fast Facts and Concepts #037 PDF
Authors: Thomas Giever DO, Kathryn Denson MD, Nicholas Dreger, Patrick Foy MD, Gabriel Manzi MD
• List 3 crucial questions to ask when assessing an elderly patients appropriateness for chemotherapy treatment.
• Identify potential toxicities associated with common chemotherapy agents.
Context: A geriatric patient with cancer, in the outpatient or inpatient clinical setting.
Action: Determine potential chemotherapy toxicities to elderly patients undergoing treatment for cancer.
Incidence/Prevalence: Cancer is a significant source of morbidity and mortality for the elderly, with 53% of new cancers being diagnosed in those greater than 65 years old. The risk of developing cancer increases in men from 1 in 6 men (between ages 60-69) to 1 in 3 men (after age 70 years); for women the risk increases from 1 in 10 to 1 in 4 for the same age distributions. Data regarding the toxic effects of chemotherapy in geriatric patients is often limited due to frequent exclusion from clinical trials. A Cancer and Aging Research Group study that evaluated 500 patients >65 years (mean 73 years) with stage I to IV cancer showed 1 or more grade 3-5 toxicity occurrence in 53% of patients. The International Society of Geriatric Oncology Taskforce performed a review in 2007 of chemotherapy for elderly patients. The common toxicities associated with various chemotherapy regimens are found in Table 1.
Crucial Questions: Three questions to ask when assessing an elderly patient with cancer include:
1. Will this patient die from this cancer or with this cancer?
2. Is this patient at risk for complications from this cancer?
3. Is this patient able to tolerate cancer treatment?
Prior to initiation of chemotherapy, an extensive evaluation is required to assess appropriateness of treatment for that individual patient. While there is not an absolute age-determined cutoff for receiving chemotherapy, physical, cognitive, functional and social factors help determine a geriatric patient's ability to tolerate chemotherapy.
The most common scale for assessing toxicity from chemotherapy was developed by ECOG and graded from 0-5 with 0 being no change from baseline and 5 being death from toxicity.
Please see the Geriatrics Fast Fact entitled, “Should your patient have that oncology intervention?” for more detailed information on comprehensive geriatric assessment.
Underlying Science: Normal physiologic changes with aging may increase the likelihood of chemotherapy side effects and toxicity in older adults. Elderly patients are often under-represented in cancer clinical trials and thus evidence regarding toxicities is retrospective and anecdotal.
ACGME Competencies: Medical knowledge, Patient care
SEER cancer statistics review 1975-2010. National Cancer Institute, http://seer.cancer.gov/csr/1975_2010/.
Cancer facts and figures 2013. American Cancer Society, http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2013/index
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ECOG Common Toxicity Criteria. Eastern Cooperative Oncology Group. Rober Comis MD, Group Chair. http://ecog.dfci.harvard.edu/general/ctc.pdf
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Author Affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin.
Geriatric Fast Facts are edited by the faculty of the Geriatric Education Teams (GETS) program funded by the Reynolds Foundation, Kathryn Denson, MD, Steven Denson, MD, & Edmund Duthie, MD from the Division of Geriatrics, Medical College of Wisconsin, and are published by the Geriatric Fast Facts Website at the Medical College of Wisconsin. For more information write Kathryn Denson, MD. More information, as well as the complete set of Fast Facts, available at www.mcw.edu/Geriatric-Fast-Facts.htm
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