If severe toxicity does not affect daily living, clinicians may not modify treatment

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If a severe toxicity does not have a long duration of impact on activities of daily living in elderly patients, oncologists are less inclined to modify treatment, according to a study published this month in the journal Cancer.

For the study, researchers enrolled 200 patients 65 years of age or older before they received chemotherapy and recorded the duration and functional impact of grade 3 to 4 nonhematologic toxicities or grade 4 hematologic toxicities, treatment modifications, and severe toxicity recurrence.

Results showed that among 163 evaluable patients, 82 experienced severe toxicity after 1 or more treatment cycles, 10 discontinued treatment due to toxicities, 6 discontinued treatment for other reasons, and 5 patients died. Researchers found that among the 61 patients who received further chemotherapy, 20 did so with dose adjustment and 41 did so without dose modification, of which 16 received secondary prevention.

The study demonstrated that 46% of those that received further chemotherapy without modification experienced toxicity recurrence vs 35% of those who received a dose adjustment.

The findings suggest that with proper supportive measures, recurrence risks of severe toxicity among elderly patients who do not receive dose modifications are similar to those observed in patients with modified treatment.

Study finds genetic variations associated with cisplatin-induced ototoxicity
If a severe toxicity does not have a long duration of impact on elderly patients, oncologists are less inclined to modify treatment.
The National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) and adjustment rules after severe toxicity are derived by consensus, but to the authors' knowledge little is known regarding the determinants of toxicity recurrence, especially in the elderly.
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