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The early discontinuation of palliative chemotherapy in older patients with cancer

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Abstract

Purpose

Older patients with cancer may have an increased risk of early discontinuation of active treatment (ED), which results in poor outcome in curative or adjuvant settings. We aimed to determine the association between survival and ED and to identify predictors of ED in palliative setting.

Methods

Ninety-eight patients older than 65 years of age who received a comprehensive geriatric assessment (CGA) before palliative first-line chemotherapy were analyzed. Clinical information and CGA results were retrieved from electronic medical record. CGA included Charlson’s co-morbidity index, activities of daily living (ADL), instrumental ADL (IADL), Mini-Mental Status Examination, short-form of the geriatric depression scale, timed-get-up-and-go test (TGUG), and mini-nutritional assessment (MNA). ED was defined as no active cancer treatment (radiotherapy and/or chemotherapy) beyond palliative first-line chemotherapy. Predictors of ED were identified using clinical parameters and CGA.

Results

Active treatment was discontinued after first-line chemotherapy in 30 patients during median follow-up period of 15.1 months. ED after first-line chemotherapy was associated with shorter overall survival (OS; median OS = 3.1 vs. 14.7 months in patients with ED compared with patients without ED, p < 0.001). Eastern Cooperative Oncology Group performance status, living alone, ADL, IADL, MNA, and TGUG were associated with ED (p = 0.001, p = 0.048, p = 0.001, p < 0.001, p < 0.001, p = 0.002, respectively). In multivariable analysis, malnutrition and dependent IADL were the independent predictive factors for ED (odds ratio = 5.03; 95 % confidence interval = 1.50–16.87: odds ratio = 3.06; confidence interval = 1.03–9.12, respectively).

Conclusions

ED was associated with shorter OS in older patients with cancer. Malnutrition and dependent IADL were identified as independent predictive factors for ED.

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Acknowledgments

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry for Health and Welfare, Republic of Korea (study no: 1320370).

Conflict of interest

No author reports a conflict of interest.

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Authors and Affiliations

  1. Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, 463-707, South Korea

    Jin Won Kim, Yu Jung Kim, Keun-Wook Lee, Hyun Chang, Jeong-Ok Lee, Soo-Mee Bang, Jong Seok Lee & Jee Hyun Kim

  2. Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, 463-707, South Korea

    Kwang-Il Kim & Cheol-Ho Kim

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  1. Jin Won Kim
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Correspondence to Jee Hyun Kim.

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Kim, J.W., Kim, Y.J., Lee, KW. et al. The early discontinuation of palliative chemotherapy in older patients with cancer. Support Care Cancer 22, 773–781 (2014). https://doi.org/10.1007/s00520-013-2033-y

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