Prediction of thirty day mortality using clinical risk scores in patients over sixty-five receiving systemic anticancer cancer therapy

Introduction: One third of cancers are diagnosed in patients over the age of 65 (1), given we have an ageing population this is going to increase. Tools have been developed to identify older patients at risk of increased morbidity when receiving SACT such as Geriatric 8 (G8) and Cancer and Ageing Research Group chemotherapy toxicity tool (CARG-TT). This project aimed to assess the ability of these and other frailty assessment tools to predict 30 day mortality amongst older oncology patients.

Method: Morbidity and Mortality data from a regional oncology department was reviewed to identify patients aged >65 dying within 30 days of receiving SACT (cases) and patients surviving >30days (controls). Controls were matched to cases by a number of variables.

CARG, G8, Rockwood clinical frailty score were calculated retrospectively.

Both G8 and CARG scores were dichotomised into high and low risk as per their scoring criteria. Rockwood and other matrices were treated as continuous data. Statistical tests included Chi squared and T-Tests.

Results: 37 cases were identified and matched successfully to controls.

G8 was able to discriminate by mortality (p0.007). Rockwood and CARG were higher amongst cases without reaching significance.

Discussion: The role of an OncoGeriatrician is to perform a Comprehensive geriatric assessment (CGA) and support patients receiving SACT. G8 aims to identify individuals who may benefit from CGA, with evidence suggesting this lowers morbidity (2). In our cohort, G8 was able to identify patients dying <30days post SACT to the level of significance. G8 may be able to predict mortality in older patients receiving SACT.

1. Cancer Research UK
2. S Mohile, M Mohamed, H Xu. Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP-70+): a cluster-randomised study. Lancet. 2021 Nov 20;398: 1894-1904.