Baltussen, Joosje (2022) THE CARG TOOL CAN PREDICT CHEMOTHERAPY-RELATED TOXICITY IN DUTCH OLDER PATIENTS WITH CANCER: A VALIDATION STUDY. thesis, Medicine.
Full text available on request.Abstract
Background: Older adults are vulnerable to chemotherapy-related toxicity. However, since older adults are underrepresented in cancer research, limited data to guide oncology practice is available. In order to identify older adults at risk for severe chemotherapy toxicity, the Cancer and Aging Research Group (CARG) developed a prediction tool for toxicity that uses various geriatric variables as well as treatment characteristics. This tool was validated in the distinct USA oncology practice. We aimed to validate the CARG tool in Dutch older patients with cancer who were treated with chemotherapy. Methods: All patients ≥ 70 years with cancer and scheduled to receive chemotherapy or chemoradiotherapy at the Leiden University Medical Center (LUMC) or Hagaziekenhuis, were eligible for this prospective cohort study. All patients underwent pretreatment geriatric frailty screening plus five additional questions incorporated in the CARG tool. Grade 3-5 chemotherapy toxicity was assessed during the first two months of treatment. Discriminatory accuracy of the tool was determined by calculating the Area under the Receiver Operating Characteristic (ROC) curve. We stratified patients by concurrent radiotherapy treatment or not, to compare the performance of the CARG tool in both groups. Results: Between December 2015 and November 2019, 144 patients ≥70 years were included. Median age was 75 years (range 70-87). The majority (57%) of patients was treated with concurrent radiotherapy. Severe chemotherapy-related toxicity was observed in 54% of all patients. Stratified by radiation therapy, the Area under the curve (AUC) for patients receiving chemotherapy only was better than the AUC for patients receiving combined chemoradiation treatment (AUC 0.65, 95% CI 0.52 ; 0.79 and AUC 0.53, 95% CI 0.40; 0.66 respectively). Observed toxicity non-significantly increased in CARG risk groups for patients treated with chemotherapy (20%, 46% and 67% respectively, P=.057). Conclusion: The CARG tool was predictive for severe chemotherapy-related toxicity in Dutch older adults treated with chemotherapy only. In contrast, we found a poor performance of the tool in patients receiving chemoradiation.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Schröder, Dr. Carolien and Portielje, Prof. dr. Johanneke and de Glas, Dr. Nienke |
| Faculty: | Medical Sciences |
| Date Deposited: | 09 Aug 2023 11:07 |
| Last Modified: | 09 Aug 2023 11:07 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3619 |
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