Predicting treatment toxicity in older patients with cancer

Chapter 2 consists of a systematic literature review on CGA in older patients with solid malignancies who receive chemotherapy. We focused on prediction of TRT, mortality and the role of CGA in the decision-making process. Thirteen papers were reviewed. Our results showed that up to 64% of older patients suffer from TRT, but the value of CGA in predicting TRT and mortality in older patients with cancer undergoing treatment with chemotherapy has not been proven. CGA may be valuable in revealing geriatric problems but current evidence for its usefulness to guide treatment decisions in this setting is limited. In Chapter 3 we present the case of a fit 90-year old patient with advanced colorectal cancer, focusing on the dilemmas we faced during multilineage systemic treatment supplemented with a literature review on treating nonagenarians with cancer. We concluded that chemotherapy can be effective and tolerable in nonagenarians, although current evidence on how to identify patients who will benefit from treatment is limited. In Chapter 4 we aimed to determine the value of CGA and medical oncologist’s clinical judgment in predicting unfavorable outcome and explored whether treatment decisions can be based on CGA. This was a prospective cohort study in 110 patients aged ≥ 70 years. Neither CGA, medical oncologist’s clinical judgment or a combination could predict unfavorable outcome. Also we concluded that CGA and clinical judgment did not align in more than one-third of patients. Chapter 5 describes the study aimed to investigate whether cytopenia, as a marker of reduced bone marrow function, at the start of a new line of palliative chemotherapy is associated with TRT in 98 older patients with advanced cancer. Forty-seven percent of patients had cytopenia at baseline and 55% of all included patients developed TRT (CTCAE grade three to five) during treatment (both general and hematologic). No significant association between cytopenia and TRT was found. In Chapter 6 we ev