OriginalFragilidad y vulnerabilidad como predictores de radiotoxicidad en adultos mayores: un estudio longitudinal en PerúFrailty and vulnerability as predictors of radiotoxicity in older adults: A longitudinal study in Peru
Section snippets
Introducción
A pesar de sus beneficios, el tratamiento antineoplásico suele presentar ciertos efectos adversos. Esto supone un gran reto en pacientes geriátricos, quienes tienen un perfil particular caracterizado por un mayor número de comorbilidades, deterioro físico, mental y exposición a un entorno social con distintos grados de soporte, que los hacen potencialmente vulnerables a los efectos adversos del tratamiento antineoplásico1, 2.
Frente a esta situación, la radioterapia se muestra muchas veces como
Diseño y población
Estudio de tipo cohorte, realizado en adultos mayores del servicio de Geriatría del Centro Médico Naval del Perú (CEMENA), durante el periodo 2013-2015.
El servicio de Geriatría del CEMENA atiende a marinos en actividad o retirados. Se incluyó a los pacientes adultos mayores que tuvieron diagnóstico anatomopatológico de cáncer entre septiembre de 2012 y febrero de 2013 en el CEMENA. Solo se incluyeron a pacientes que realizaron su tratamiento oncológico en dicho hospital, y a aquellos que aún no
Características generales de la muestra de estudio
Se analizaron datos de 181 adultos mayores. La edad promedio fue de 78,1 ± 5,2 años (rango: 62-91 años); todos fueron del sexo masculino; 33 (18,2%) presentaron toxicidad a radioterapia durante el seguimiento; 43 (23,8%) fueron positivos para fragilidad según el fenotipo de Fried; 41 (22,7%) fueron positivos para vulnerabilidad con el VES-13, y 37 (20,4%) con el G-8 (tabla 1).
Los 33 pacientes con radiotoxicidad presentaron en total 86 eventos radiotóxicos: 18 (54,5%) presentaron radiotoxicidad
Discusión
Se evaluaron 181 pacientes, de los cuales el 18,2% presentaron radiotoxicidad. La aparición de radiotoxicidad fue mayor en los pacientes con alteraciones en las escalas de Fried, VES-13, o G-8. La ABC de las curvas ROC más alta la registró el G-8, seguida del VES-13, y del fenotipo de Fried. El mejor índice de Youden para el VES-13 y el G-8 fue encontrado para puntos de corte no usuales.
Nuestros resultados revelan que la fragilidad evaluada con diferentes escalas resulta útil para predecir
Conflicto de intereses
Los autores declaran no tener conflictos de interés con respecto a la publicación del presente artículo.
Agradecimientos
Agradecemos al personal del Centro de Investigación en Envejecimiento (CIEN) de la Facultad de Medicina Humana de la Universidad de San Martín de Porres en Lima, Perú, y al personal del servicio de Geriatría del Centro Médico Naval del Perú (CEMENA) por el apoyo logístico brindado.
Bibliografía (30)
- et al.
Ageing populations: The challenges ahead
Lancet.
(2009) - et al.
Cancer in the elderly: Is it time for palliative care in geriatric oncology?
J Geriatr Oncol.
(2014) Utilizing geriatric skills in radiation oncology
Geriatr Nurs.
(2004)- et al.
Review of current best practice and priorities for research in radiation oncology for elderly patients with cancer: The International Society of Geriatric Oncology (SIOG) task force
Ann Oncol.
(2014) - et al.
Use of comprehensive geriatric assessment in older cancer patients: Recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG)
Crit Rev Oncol Hematol.
(2005) - et al.
Determination of an adequate screening tool for identification of vulnerable elderly head and neck cancer patients treated with radio (chemo) therapy
J Geriatr Oncol.
(2012) - et al.
Evaluation of the Groningen Frailty Indicator and the G8 questionnaire as screening tools for frailty in older patients with cancer
J Geriatr Oncol.
(2013) - et al.
Are frailty markers useful for predicting treatment toxicity and mortality in older newly diagnosed cancer patients? Results from a prospective pilot study
Crit Rev Oncol Hematol.
(2011) - et al.
Rendimiento físico de adultos mayores residentes en zonas rurales a nivel del mar y a gran altitud en Perú
Rev Esp Geriatr Gerontol.
(2015) - et al.
Completion of radiotherapy is associated with the Vulnerable Elders Survey-13 score in elderly patients with cancer
J Geriatr Oncol.
(2014)
G8 and VES-13 scores predict chemotherapy toxicity in older patients with cancer
J Geriatr Oncol.
Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: An update on SIOG recommendations
Ann Oncol.
Geriatric screening results and the association with severe treatment toxicity after the first cycle of (radio) chemotherapy
J Geriatr Oncol.
The respective usefulness of the G8 and a comprehensive geriatric assessment (CGA) to predict intolerance to chemotherapy and survival of fit and vulnerable older patients with hematological malignancies
J Geriatr Oncol.
Comprehensive geriatric assessment: A meta-analysis of controlled trials
Lancet.
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Recognizing Frailty in Radiation Oncology Clinical Practice: Current Evidence and Future Directions
2022, Seminars in Radiation OncologyCitation Excerpt :Antonio et al 34 investigated the use of the VES-13 and CGA in patients (n = 85) over the age of 75 years, with non-small cell lung cancer (NSCLC). Similar to Runzer-Colmenares et al, 31 the VES-13 was used to predict which patients experienced toxicity from radiation therapy and found vulnerable patients with a VES-13 score ≥ 3 had a higher risk of grade 3-4 toxicity. The VES-13 was also analyzed for its ability to predict overall survival (OS) in older patients in this study.
Gait speed as a predictor of mortality in older men with cancer: A longitudinal study in Peru
2022, HeliyonCitation Excerpt :We performed a secondary data analysis from a prospective cohort study that included military veterans (men aged 60 years and older) with an oncological diagnosis and curative therapeutic indications, evaluated and enrolled in 2013 and followed until 2015, in the Geriatrics service of Centro Médico Naval (CEMENA) “Cirujano Mayor Santiago Tavara”, in Callao, Peru. Previous studies have been carried out with this database [24, 25, 26]. In the initial evaluation, we had 1178 potentially eligible participants, however, we excluded 81 due to dementia, 121 for having a score ≤23 in the Mini Mental State Examination, 4 due to incomplete data in the medical records, 9 because they will receive treatment without curative intention, 4 due to treatment discontinuation, 6 were lost during follow-up and 31 did not agree to participate in the study.
A systematic review on the association of the G8 with geriatric assessment, prognosis and course of treatment in older patients with cancer
2019, Journal of Geriatric OncologyCitation Excerpt :Two studies specifically mentioned they also included hospitalized patients [26,44,45], while one study included hospitalized patients only [33,34]. Seventeen studies evaluated patients receiving various treatment regimens [11,12,19,22,23,25,26,29,31,37,38,42,44,45,48–50,52,53,57], eleven focused on patients receiving chemotherapy [9,18,20,21,27,28,30,33,34,36,43,66,67], five on radio(chemo)therapy [24,47,51,54–56], six on surgery [35,40,41,46,58,59,61], one on targeted therapy [32] and one on allogeneic stem-cell transplantation [39]. For five studies, the treatment was unknown [60,62–65].