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Mathematisch-Naturwissenschaftliche Fakultät - Jahrgang 2020


Titel Evaluating onco-geriatric scores and medication risks to improve cancer care for older patients
Autor Imke Ortland
Publikationsform Dissertation
Abstract The cancer therapy of older patients is challenging, being more complex than the therapy of younger patients. Older cancer patients show a higher toxicity risk during therapy and drug-related problems are common. In order to individualize cancer care in this heterogeneous population, short tools combining geriatric assessment with oncologic parameters were developed for predicting toxicity during chemotherapy: the CARG (Cancer and Aging Research Group) and the CRASH (Chemotherapy Risk Assessment Scale for High Age Patients) score. The aim was to compare the scores regarding their predictive performance in a clinical routine setting. Moreover, this thesis aimed at evaluating medication-related risks in older cancer patients.
In a prospective, single-center observational study, the CARG and the CRASH score were assessed for patients ≥ 70 years before the start of their systemic cancer treatment. The CARG score predicts severe overall toxicity. The CRASH score is divided into three subcategories, predicting severe overall, hematologic, and nonhematologic toxicity. Moreover, physicians’ judgments regarding the patients’ toxicity risk were documented. Grade ≥ 3 toxicity according to the Common Terminology Criteria for Adverse Events (CTCAE) was captured from medical records. The predictive performance of the scores was assessed by analyzing the proportion of patients with severe toxicity per risk category, logistic regression, and the area under the receiver operating characteristic curve (ROC-AUC). Furthermore, the prediction performance was compared with other commonly used predictors. The evaluation study of the CARG and the CRASH score comprised 120 patients (50% female, mean age 77.2 years). Severe toxicity was experienced by 81% of patients; 67% showed signs of hematologic toxicity. The predictive performances of the CARG score and the combined CRASH score were similar for overall and nonhematologic toxicity. For hematologic toxicity, the hematologic CRASH score performed better than the CARG score. Neither physicians’ judgment nor the ECOG nor age indicated adequate predictive performance for overall toxicity.
Medication risks in older cancer patients were investigated regarding polymedication (defined as the use of ≥ 5 drugs), potentially inadequate medication (PIM; defined by the EU(7)-PIM list), and relevant potential drug-drug interactions (rPDDI; analyzed by the ABDA interaction database). Before the start of cancer therapy, patients took on average 5 drugs as long-term medication and 52% of patients were exposed to polymedication. More than half of patients used at least one PIM (mostly drugs for acid-related disorders). Approximately one third of patients experienced rPDDI.
In conclusion, the CARG and the CRASH score exhibited similar predictive performance for overall and nonhematologic toxicity. However, the hematologic CRASH score should be preferred for predicting hematologic toxicity. Both scores performed better than clinical judgment alone and thus may be used for supporting therapy decisions in clinical routine. Medication risks were common in older cancer patients, raising the need for interdisciplinary interventions to ensure medication safety in this cohort.
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© Universitäts- und Landesbibliothek Bonn | Veröffentlicht: 19.03.2020