Real-world data suggest that geriatric assessment fails to stratify risk in treating older adults with lung cancer

ABSTRACT

Introduction: Older adults require attention to risks of treatment toxicity. The purpose of this study was to evaluate epidemiological data and clinical outcomes of patients with lung cancer treated with non-curative intent assessed by geriatric assessment (GA) and restricted access to new therapies.

Methods: We evaluated older adults with non-small cell lung cancer treated with palliative chemotherapy or first generation target therapy who underwent GA. Overall survival (OS) was calculated and we performed univariate and multivariate analysis to determine prognostic factors for OS.

Results: Fifty-four patients aged ≥70 years had a median age of 76 years, 76% was classified as Katz A and 50% as Lawton <27. 68.5% were at risk of malnutrition or malnourished; 61.1% had ≥2 comorbidities. The mean OS was 17.1 months. In the univariate analysis, lower survival results were observed for patients with ECOG≥2 (HR=5.9; p<0.001), higher number of metastasis sites (HR=2.0; p=0.04) and liver metastasis (HR=12.6; p<0.001). In multivariate analysis, male gender, ECOG≥2, more than 2 metastatic sites and liver metastases were associated with higher risk of death. We did not observe differences in survival according to functional capacity.

Conclusion: GA showed no prognostic relationship in our small population. Patients with ECOG≥2, more than 2 metastatic sites and hepatic metastasis presented higher risk of death. For the older population, new treatment modalities are fundamental and outweigh the prognostic importance of the clinical factors of GA.

RESUMO

Introdução: Os adultos mais velhos requerem atenção quanto aos riscos de toxicidade do tratamento. O objetivo deste estudo foi avaliar dados epidemiológicos e desfechos clínicos de pacientes com câncer de pulmão tratados com intenção não curativa submetidos a avaliação geriátrica (AG) e acesso restrito a novas terapias.

Métodos: Avaliamos idosos com câncer de pulmão de células não pequenas tratados com quimioterapia paliativa ou terapia-alvo de primeira geração que realizaram AG. A sobrevida global (SG) foi calculada e realizamos análises univariadas e multivariadas para determinar os fatores prognósticos para SG.

Resultados: Cinquenta e quatro pacientes com idade ≥70 anos tinham uma idade mediana de 76 anos, 76% foram classificados como: Katz A e 50% como Lawton <27. 68,5% estavam em risco de desnutrição ou desnutrição; 61,1% tinham ≥2 comorbidades. O SG médio foi de 17,1 meses. Na análise univariada, piores resultados de sobrevida foram observados para pacientes com ECOG≥2 (HR=5,9; p<0,001), maior número de locais de metástase (HR=2,0; p=0,04) e metástases hepáticas (HR=12,6; p<0,001). Na análise multivariada, sexo masculino, ECOG≥2, mais de 2 locais metastáticos e metástases hepáticas foram associados a maior risco de morte. Não observamos diferenças na sobrevida de acordo com a capacidade funcional.

Conclusão: AG não mostrou relação prognóstica em nossa pequena população. Pacientes com ECOG≥2, mais de 2 locais metastáticos e metástases hepáticas apresentaram maior risco de morte. Para a população idosa, novas modalidades de tratamento são fundamentais e superam a importância prognóstica dos fatores clínicos da AG.

Keywords:

Geriatric assessment - Lung neoplasms - Frail elderly.

Descritores:

Avaliação geriátrica - Neoplasias pulmonares - Idoso frágil.

Publication History

Received: 30 June 2021

Accepted: 24 August 2021

Article published online:
24 September 2021

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