Impact de l’évaluation gériatrique et de la prédiction de chimiotoxicité sur le choix thérapeutique des anticancéreux

Abstract

Introduction Caring for older adults with cancer can be particularly complex and several unique challenges can arise. Which gives clinical pharmacy an essential place in geriatric oncology that deals with the population of elderly who are at a higher drug induced iatrogenic risk. The aim of our work is to evaluate the application of geriatric assessment (GA) and its correlation with toxicity incidence and therapeutic choice. Material and methods A retrospective analysis was conducted for a period of four months on 65 patients aged ≥ 65 years at cancer center in SÉTIF. For the data collection a farm return has been used, and for the data analysis computer software IBM SPSS and Excel and the online tools CARG and CCI have been used. Results and discussion The majority of patients are in the age range of 65-74 years. Breast cancer is the most common type of cancer in this population followed by metastatic digestive cancers. 50% of patients have multiple comorbidities, 28% use phytotherapy, 80% use polypharmacy and 69.2% developed drug interactions. More than 70% of patients used polychemotherapy, and more of half of the patients received a reduced dose in the first treatment course with an intermediate to high CARG score. Most of the patients have a PS of 0 to 1 and a CCI score higher than 8, they belong to group 2 according to geriatric assessment group classification, they developed a hematological and non-hematological toxicity, renal toxicity occurred in 20 to 30% of patients and anemia in 50% of them. The canonical correlation is statistically significant between the two variables geriatric assessment scores and toxicities while it is not between scores and therapeutic choice and between toxicities and therapeutic choice; however, the elementary analysis of every score separately showed coherence between the scores and the oncologist’s judgment. Our results are consistent with Erin B. Moth and al study. Conclusion The CGA scores are useful to classify patients as fragile and guide therefore the therapeutic choice to avoid as much toxicities as possible, some weaknesses in the CARG score were detected during this study, it does not take into account neither polypharmacy nor liver function tests nor the nature of product used which is very important in the prediction of the occurrence of toxicities in the same way as the oncologist’s estimation.