Tolerance of Anti-Cancer Therapy in the Elderly

Study Overview
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Brief Summary
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This is a multicentre observational study evaluating frailty and tolerance of chemotherapy in the elderly.

Detailed Description
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This is a multicentre observational study evaluating frailty and tolerance of chemotherapy in the elderly. The number of people with cancer over the age of 65 years is increasing and more older patients are being treated with chemotherapy. Previous research has shown that patients living with frailty are more likely to experience significant toxicity from chemotherapy. A scoring system exists, the CARG (Cancer Aging Research Group) score), which using sociodemographics, tumour/treatment variables, laboratory test results (haemoglobin and creatinine clearance), geriatric assessment variables (function, co-morbidity, cognition, psychological state, social activity/support and nutritional status) predicts the likelihood of patients in this population developing a grade 3-5 toxicity. The CARG score ranges from 0 (lowest toxicity risk) to 19 (highest toxicity risk). This scoring system was developed and validated in the USA (United States of America). It was not however found to be predictive of toxicity in Australia. To date it has not been evaluated, nor is used in routine practice in oncology in the UK (United Kingdom). This study is looking at markers of frailty in patients >65years. The investigators seek to predict those who are at a higher risk of side effects from chemotherapy. The investigators are looking to validate the CARG score in a UK NHS (National Health Service) population and show feasibility of using this in routine practice. The investigators are also evaluating if other scoring systems which are routinely used to assess frailty (but have never been assessed for predicting toxicity) are useful in predicting toxicity. Secondary objectives include describing frailty in this population, exploring patients' perceptions of risk associated with chemotherapy and demonstrating the added value of risk prediction tools compared to clinicians estimates of toxicity risk.

Official Title
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Tolerance of Anti-Cancer Therapy in the Elderly

Conditions
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Frailty, Chemotherapeutic Toxicity

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age >65years About to start first line chemotherapy for a solid tumour based malignancy Chemotherapy given for any intent eg. adjuvant or palliative Estimated survival of >3months Able to comprehend and complete questionnaire. Exclusion Criteria: Medical or psychiatric condition impairing ability to consent Participant is enrolled in another clinical trial Prior chemotherapy for any indication Receiving concurrent radiotherapy (RT) or immunotherapy (IT) Unable to provide informed consent

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To validate the CARG scoring system | To validate the CARG scoring system (a score which is calculated by the doctor using patient information) in a UK real-world population and show feasibility of implementing CARG scoring in routine NHS practice. The investigators will collect the information required and calculate a CARG score for each participant. The investigators will record Grade 3-5 chemotherapy toxicities (as assessed using CTCAEv5) for each participant. The investigators will evaluate if the CARG score is predictive of Grade 3-5 toxicity (as assessed using CTCAEv5) in this UK real-world population. The investigators will record how long it takes to collect this information and calculate the score to see if it is feasible to implement this in a real world setting. | 6 months follow up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Describe frailty in elderly patients (>65years) in the UK NHS prior to starting chemotherapy - demographics | The investigators are reporting demographics: age (years) and gender | 6 months follow up | 
| Describe frailty in elderly patients (>65years) in the UK NHS prior to starting chemotherapy - tumour type | The investigators are reporting tumour type eg. breast cancer, gastric cancer etc. | 6 months follow up | 
| Describe frailty in elderly patients (>65years) in the UK NHS prior to starting chemotherapy - chemotherapy type | The investigators will be reporting chemotherapy drugs delivered | 6 months follow up | 
| Describe frailty in elderly patients (>65years) in the UK NHS prior to starting chemotherapy - laboratory test results (Hb) | The investigators will be reporting laboratory test results prior to first cycle of chemotherapy -haemoglobin (g/L) | 6 months follow up | 
| Describe frailty in elderly patients (>65years) in the UK NHS prior to starting chemotherapy - laboratory test results (CrCl) | The investigators will be reporting laboratory test results prior to first cycle of chemotherapy -creatinine clearance (mL/min) | 6 months follow up | 
| Describe frailty in elderly patients (>65years) in the UK NHS prior to starting chemotherapy using SIOG (International Society of Geriatric Oncology) Geriatric Screening Tool (G8) | Investigators will calculate the SIOG (International Society of Geriatric Oncology) Geriatric Screening Tool (G8) and report the score | 6 months follow up | 
| Describe frailty in elderly patients (>65years) in the UK NHS prior to starting chemotherapy using the Rockwood Clinical Frailty Score (CFS) | Investigators will record the Rockwood Clinical Frailty Score (CFS) and report the scores | 6 months follow up | 
| Evaluate the predictive value of commonly used geriatric assessment tools in predicting chemotherapy tolerance | Frailty scoring systems (G8 and CFS) will be calculated. Grade 3-5 chemotherapy toxicities will (as assessed using CTCAEv5) will be recorded. The investigators will assess if these scoring systems have utility in predicting risk of grade 3-5 chemotherapy toxicity. | 6 months follow up | 
| The CARG score which reports the risk of grade 3-5 toxicity as assessed using CTCAEv5 as a percentage. |  | 6 months follow up | 
| Explore patients perception of risk associated with chemotherapy in this population | Participants will report their perception of likelihood of developing a side effect from chemotherapy which would cause the participant to stay in hospital for one night or longer or have to stop treatment using the following options: Unlikely, Not very likely, Quite likely or Very likely, as well as using a percentage scale as seen below. 0 means I think it definitely won't happen to me → 100 means I think I will definitely need to stop treatment or stay hospital at some point during my treatment 0-----10-----20-----30-----40-----50-----60-----70-----80-----90----100 | 6 months follow up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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frailty, chemotherapy tolerance