Chemotherapy Completion in Elderly Women With Ovarian, Primary Peritoneal or Fallopian Tube Cancer-An NRG Oncology/Gynecologic Oncology Group Study

Older patients with cancer do not tolerate chemotherapy well and suffer more toxicity than do younger women. There is great heterogeneity among patients of a given chronological age in the ability to tolerate treatment. Previous studies in older patients with cancer have found a relationship between results of a geriatric assessment, chemotherapy toxicity, and overall survival. Few of these studies were conducted in patients with ovarian cancer. A simple assessment to help clinicians predict the ability of a patient to tolerate chemotherapy would have great value. A geriatric assessment can be used to assess for the heterogeneity of functional abilities among older patients with cancer and has the potential to identify prior to treatment those at high risk of toxicity from chemotherapy. There are a number of components in a geriatric assessment, including functional status, comorbid medical conditions, social support, psychological state, nutritional status, and cognition. An assessment of functional status includes Instrumental Activities of Daily Living (IADLs)-self-care skills that allow independent functioning within the community. Instrumental Activities of Daily Living is an easily administered tool. This prospective study investigated the association between pretreatment (baseline) IADL and the ability of elderly patients to complete 4 cycles of chemotherapy without dose reduction or more than 7-day treatment delay. Eligible patients were 70 years or older with primary stage I-IVovarian, peritoneal, or fallopian tube cancer. There was no randomization. Patients and their physicians selected 1 of 2 regimens: CP (carboplatin area under the curve [AUC] 5, paclitaxel 135 mg/m(2)) or C (carboplatin AUC 5). Both regimens were given every 3 weeks either after primary surgery or as neoadjuvant chemotherapy. The IADL and quality-of-life assessments were performed at baseline, precycle 3, and postcycle 4. Between August 15, 2011, and August 12, 2013, 212 women were enrolled: 152 selected CP, and 60 selected C. The average age for patients choosing CP was 77 years, and that for patients choosing C was 84 years. Baseline IADL was higher in patients selecting CP (P < 0.001) and was independently associated with the choice of regimen after adjustment for age and performance status (P = 0.035). No association was found between the baseline IADL score and completion of 4 cycles of chemotherapy without dose reduction or delays (P = 0.21). However, patients with a higher IADL score were more likely to complete 4 cycles of therapy regardless of dose reduction and delay (P = 0.008) and were more likely to have a decrease in grade 3+ toxicity (17% [odds ratio, 0.83; 95% confidence interval, 0.72-0.96; P = 0.013]) for each additional activity in which the patient was independent. After adjusting for chemotherapy regimen, baseline IADL was also associated with overall survival for patients receiving CP (P = 0.019).