Aim: Evaluating the physiological status of an older person to determine whether systemic-anti cancer therapy will provide benefit is challenging particularly as older persons may have unseen vulnerabilities requiring specific screening and assessment. This study will evaluate treatment patterns and health service use of older people with cancer and compare these with younger patients.
Methods: Patients newly diagnosed with cancer treated between 1 March 2020 and 31 August 2020 at the Austin hospital, Melbourne were retrospectively identified. Clinicopathologic and treatment parameters were collected. Health service utilization was determined by ED presentations, contact to Symptoms and Urgent Review clinic (SURC).
Results: An interim analysis is reported. Of 192 patients, 68 (34%) patients were aged ≥ 70 years and of these 9 (13%) had haematological malignancies and 59 (87%) solid tumours; 50% male, median age 77 (range 70-92 years) and 31 (49%) were ECOG ≥ 1. The most common solid malignancies were colorectal (19%), upper gastrointestinal (18%), and breast (12%). Of the solid organ malignancies, 56% had metastatic disease, with 30% receiving palliative chemotherapy. Most patients receiving chemotherapy were treated at full dose (n=51, 89%), of which 27% (n=14) had treatment discontinued and 27% (n=14) required one or more dose adjustments due to toxicity or disease progression. Patients aged >70 who commenced treatment at full dose, had an ECOG ≥ 1 were more likely to have treatment delayed or modified (33% vs. 19%) and contact SURC or present to the ED (41% vs. 24%, 37% vs. 27%, respectively) due to toxicity.
Conclusion: ECOG is more useful than biological age to identify patients that will experience treatment toxicities and use more health services. Screening using validated geriatric screening tools may provide further insight into unseen vulnerabilities in older people with cancer to enable modification of therapeutic strategies.