University of Alabama at Birmingham Birmingham, AL
K. Ragland1, M. Taylor1, and A. M. McDonald2; 1University of Alabama at Birmingham Department of Radiation Oncology, Birmingham, AL, 2Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL
Purpose/Objective(s):Older cancer patients have high rates of treatment-related toxicity and mortality, especially in gastrointestinal (GI) malignancies. Age and clinician-assessed performance status (PS) like Eastern Cooperative Oncology Group (ECOG) are imprecise and do not adequately predict risk. The Cancer and Aging Resilience Evaluation (CARE) registry enrolls adults >60 years, with a geriatric assessment (GA) at time of diagnosis and assigns a frailty index (FI). Our objective was to evaluate whether FI was predictive of early mortality in older adults undergoing GI cancer radiation. Materials/
Methods: Patients enrolled in the single-institution prospective CARE registry at consultation were retrospectively identified. Those with radiation to the esophagus, stomach, pancreas, rectum or anus at the institution were included. Frailty was defined with a 44-item index based on deficit accumulation; categories were robust, pre-frail and frail. ECOG PS was assigned on a 0-5 scale and recorded as 0-1 or 2+. The primary outcome was early mortality- death within 2 months of radiation. Descriptive statistics were performed using Chi Square and point biserial tests. Results: 178 older adults were identified; 63% were male with a median age of 67 years. The median cancer was Stage 3 and 32% received radiation to the esophagus or stomach, 44% to the rectum or anus and 24% to the pancreas. From responses, 76 (43%) were robust, 47 (26%) pre-frail and 31 (17%) frail. 127 (84%) had an ECOG PS of 0-1 and 24 (16%) ECOG of 2+. 155 (87%) were treated with definitive and 23 (13%) with palliative intent. Within 2 months of radiation, 20 (11%) had early mortality. By sub-group, 7% of definitive and 39% of palliative intent patients had early mortality. Overall, FI was significantly associated with early mortality (p<0.001) while EGOG and age were not (p=0.052 and p=0.685 respectively). Of the definitive cohort, FI and ECOG were significantly associated with early mortality (p<0.001 and p=0.015 respectively), while age was not (p=0.763). Overall, the positive predictive value (PPV) of “frail” and ECOG 2+ for early mortality was 0.29 and 0.21 respectively, and the negative predictive value (NPV) of “robust” and ECOG 0-1 was 0.95 and 0.92 respectively. Of the definitive cohort, “frail” and ECOG 2+ had an early mortality PPV of 0.25 and 0.19 respectively, and “robust” and ECOG 0-1 had a NPV of 0.99 and 0.96 respectively. Conclusion: The GA was developed to clinically identify impairments missed in oncologic assessments and aid in predicting toxicity and mortality. We found that the CARE FI was associated with short-term survival among older adults undergoing radiation for a GI malignancy, with higher PPV and NPV than ECOG PS. With better predictions, the GA can aid in choosing more appropriate therapies, like less morbid treatment for frail patients or more definitive treatment for robust patients.
