NEW methods to determine how older cancer patients will tolerate chemotherapy must be developed to improve treatment, experts have said.
Experts from the University of Dundee have revealed that the Cancer Aging Research Group (CARG) score, a tool used to estimate the risk of severe chemotherapy side effects, is not robust enough for older patients.
The team from the University’s school of medicine, along with Leeds Teaching Hospital’s NHS Trust, found that the CARG score was unreliable in patients aged over 65 who were receiving chemotherapy for the first time.
The group also say that despite a current lack of routine frailty assessment in the UK’s cancer population, they were also able to identify widespread frailty amongst cancer patients.
The findings have been published in the journal BMJ Oncology.
The CARG score was developed to help predict severe chemotherapy-induced toxicity risk in older adults.
The score utilises several performance markers from a patient such as hearing and physical capabilities, alongside personal data such as weight, height and cancer type.
While recommended for use by international organisations, including the American Society of Clinical Oncology, the CARG score had not previously been assessed prospectively in a UK population.
In addition, it has been established for some time that older adults and those with co-existing frailty are more vulnerable to chemotherapy toxicity.
However, it was not previously known how common frailty was in older adults receiving the treatment in the UK.
The Tolerance of Anti-Cancer Systemic Therapy In the Elderly (TOASTIE) study recruited 339 UK patients, all with a minimum age of 65 years-old.
Just over half had been diagnosed with gastrointestinal tumours, while others living with gynaecological, urological, lung and breast cancers were also included.
The group say that analysis of the TOASTIE study data identified a high prevalence of frailty and also revealed that the CARG score was unable to predict risk of high-grade toxicity.
The research team concluded that CARG cannot be considered a robust toxicity prediction tool in an older UK population.
In contrast, frailty screening tools such as the Rockwood Clinical Frailty Scale, which measures frailty based on clinical judgement, had predictive value.
Dr Mark Baxter, from Dundee’s School of Medicine, said: “We are seeing an increasing older cancer population throughout the world, however, the availability of data relating to older adults with cancer is limited.
“This is the first multicentre study in the UK to prospectively report the demographics and pre-existing frailty of a real-world cohort of patients across a range of solid organ tumours receiving chemotherapy.
“Analysis of our data found that pre-existing frailty is common and the CARG score was unable to accurately predict toxicity levels in patients.
“The ultimate goal is to provide personalised care for each individual patient we see in clinic. By identifying and assessing frailty in more detail, we can better predict who is more likely to experience side effects.
“As such, we can have more informed discussions around management decisions.
“There is also now good evidence that targeted interventions based on the findings of the frailty assessment results in better patient outcomes.
“There is a need to develop geriatric oncology services within Scotland and the UK.
“We also need to carry out more research that would allow us to develop a better standard of predictive tools, which would ultimately improve patient outcomes.”
