Management and survival of frail elderly cancer patients within a Geriatric Oncology Program

Abstract

8547 Background: Abstention from administration of either chemo- or endocrine therapy to elderly cancer patients deemed frail at the Multidimensional Geriatric Assessment is still controversial, and few data are available concerning the actual survival of such patients. Methods: To evaluate the management and survival of all consecutive frail cancer patients older than 70 years, seen from October 2004 to December 2005 within our Geriatric Oncology Program. Frailty was defined by one or more of the following: age ≥ 85 years, dependence in one or more Activity of Daily Living (ADL), presence of at least three comorbidity of grade 3 or one of grade 4 according to CIRS-G, one or more geriatric syndromes [Balducci L, Cancer Control 2001]. Results: A total of 364 elderly patients were divided into three categories: fit (26.4%), vulnerable (49.5%) and frail patients (24.2%). These 88 frail patients had a median age of 79 years (range, 70–93), 43.2% males. Motives for being considered frail were age alone (13.6% of patients), ADL dependence (25%), comorbidity (14.8%), geriatric syndromes (6.8%) or, more frequently, the co-existence of two or more of these factors (39.8%). Thirty patients (34.1%) underwent chemotherapy: 8 for gastro-intestinal tumors, 7 lung, 7 hematological and 8 other sites. Patients received standard regimens at standard doses (27.6%) or with ≥ 25% dose reduction (24.1%), age-adapted regimens at standard doses (44.8%) or with reduced doses (6.9%). Six patients (20%) derived some clinical benefit but only two (6.7%) showed radiological response. Twenty-two patients interrupted chemotherapy prematurely due to toxicity/death (23.3%) or refusal/drop out (26.7%). All twenty-eight women with estrogen receptor positive breast cancer (31.9% of all frail patients) were prescribed endocrine therapy either adjuvantly, neo-adjuvantly or for metastatic disease, with a predominance of aromatase inhibitors (82.1%) compared to tamoxifen. Thirty out of 88 patients have died, with a 2-year overall survival of 35%. Conclusions: Frailty was observed in one fourth of all our elderly patients, but it did not prevent treatment of tumor with either chemo- or endocrine therapy in 66% of cases. Overall survival of frail elderly patients with cancer appears worse than in geriatric series. No significant financial relationships to disclose.