Pre-chemotherapy frailty and other clinical factors and their relationship with early chemotherapy toxicity in elderly patients

In parallel with the increasing elderly population, each day more elderly patients are encountered in oncology clinics. Elderly cancer patients equally benefit from the treatment as other patients, while serious side effects, especially hematologic toxicity is more commonly seen in elderly patients. Frailty is a medical syndrome in geriatric age group, characterized by reduced strength, decreased physiologic function and homeostatic reserve, increased vulnerability to the stressors and it might result in dependance and mortality. There is evidence in literature that frailty is associated with increased chemotherapy toxicity. In this study, patients aged ≥65 are enrolled and evaluated in terms of frailty using Edmonton Frail Scale, concurrently their sociodemographic features and treatment details are recorded. The adverse events occurred during the first and second cycle of the chemotherapy are assessed during follow-up. Univariate analysis does not infer any statistically significant association between frailty and serious toxicity, while frailty, female sex and increase in creatinine level identified as independent predictors of grade 3 and more severe toxicity using logistic regression analysis. In addition, evidence exists supporting the hypothesis that low-grade toxicity results in treatment modifications in elderly patients and suggesting that smoking affects the toxicity profile of chemotherapeutics. Although EFS alone is not sufficient to predict chemotherapy toxicity, it might lead to the detection of frail patients, alertness to adverse events during treatment of these patients and performing comprehensive geriatric assessment in these patients. More studies are needed to develop practical tools for detection of the patients with high toxicity risk in daily clinical oncology practice.