Chemotherapy in the oldest old: The feasibility of delivering cytotoxic therapy to patients 80 years old and older.

OBJECTIVES: Cancer is predominantly a disease of the elderly. While "older" patients are frequently considered for chemotherapy, little data exist in the population 80 years and older (80+). We investigated outcomes of patients 80+ who received chemotherapy at our institution.

MATERIALS AND METHODS: A retrospective chart review of patients 80+ initiating chemotherapy for malignant solid tumors from 2005 to 2010 was performed. Baseline demographics, cancer type and chemotherapy data were collected. Primary outcome was the rate of discontinuation due to toxicity. Secondary outcomes included the rate of dose reduction/omission/delay (ROD), hospitalization and blood transfusion.

RESULTS: Chemotherapy was initiated in 318 patients. Baseline demographics included the following: median age 82 years (80-92 years), 56% male, 55% ECOG PS 0-1, 43% Charlson index score of 0-1; 38% were taking ≥ 6 prescription medications. Common malignancies were colorectal (32%), lung (20%), and breast (12%). Most patients (68%) had metastatic disease or received palliative intent therapy (71%). Treatment was first line in 89% of patients, and an up front dose reduction was ordered in 41%. Toxicity caused therapy discontinuation in 32% of cases, while 52% experienced dose ROD. Hospitalization occurred in 32%; 18% required blood transfusions. Baseline polypharmacy was associated with increased hospitalization risk (OR 2.28, 95% CI 1.34-3.88, p=0.002), but dose adjustments were not correlated with any outcome.

CONCLUSION: In this study, we observed a high risk of hospitalization or treatment discontinuation due to toxicity, despite frequent dose modifications. As the cancer population ages, validated tools are needed to better select patients for therapy.