Hurria et al developed a score that predicts chemotherapy-related toxicity in an older adult with cancer. This can help to identify a patient who may benefit from a change in the chemotherapy regimen. The authors are from City of Hope Comprehensive Cancer Center, University of California Davis, and multiple other universities in the United States.
Patient selection: age >= 65 years with cancer
Parameters:
(1) age of the patient in years
(2) cancer location (gastrointestinal or GI, genitourinary or GU, other)
(3) dose of chemotherapy
(4) number of chemotherapy drugs
(5) hemoglobin and gender
(6) creatinine clearance using Jelliffe score and ideal body weight
(7) hearing
(8) number of falls in past 6 months
(9) instrumental activities of daily living
(10) ability to walk 1 block (from the Medical Outcomes Study or MOS)
(11) decrease in social activity because of physical or emotional health (from MOS)
|
Parameter |
Finding |
Points |
|
age of the patient in years |
< 72 years of age |
0 |
|
|
>= 72 years of age |
2 |
|
cancer location |
GI or GU tract |
2 |
|
|
other |
0 |
|
dose of chemotherapy drugs |
reduced |
0 |
|
|
standard |
2 |
|
number of chemotherapy drugs |
single |
0 |
|
|
multiple (polychemotherapy) |
2 |
|
hemoglobin and gender |
female and >= 10 g/dL |
0 |
|
|
male and >= 11 g/dL |
0 |
|
|
female and < 10 g/dL |
3 |
|
|
male and < 11 g/dL |
3 |
|
creatinine clearance |
>= 34 mL per minute |
0 |
|
|
< 34 mL per minute |
3 |
|
hearing |
excellent or good |
0 |
|
|
fair to poor |
2 |
|
falls in past 6 months |
none |
0 |
|
|
1 or mroe |
3 |
|
ability to take medications without help |
normal or near normal |
0 |
|
|
somewhat limited or limited a lot |
1 |
|
walking 1 block |
unlimited or limited a little |
0 |
|
|
limited somewhat or a lot |
2 |
|
decrease in social social activity |
none or rare |
0 |
|
|
sometimes to all of the time |
1 |
total score =
= SUM(points for all 11 parameters)
Interpretation:
• minimum score: 0
• maximum score: 23 (the paper mentions 19, which may be the maximal score encountered)
• The higher the score the greater the risk of significant toxicity defined as Grade 3 to 5.
|
Total Score |
Risk of Grade 3 to 5 Toxicity |
Percent of Patients |
|
0 to 5 |
low |
<= 30% |
|
6 or 9 |
intermediate |
52% |
|
10 or 19 |
high |
83% |
Purpose: To identify an older adult with cancer who is more likely to experience significant toxicity following chemotherapy based on the score of Hurria et al.
Specialty: Hematology Oncology, Pharmacology, clinical
Objective: adverse effects
ICD-10: T45.1,
