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The Geriatric 8 score is associated with risk of hospitalisation and 6-month survival in patients with incurable pancreatic cancer receiving gemcitabine and capecitabine
Background
Assessing frailty in cancer patients can aid treatment decisions, target geriatric interventions and improve outcomes. The G8 score is a screening tool to detect frailty, however there are limited data on its utility in patients receiving chemotherapy for pancreatic cancer. We assessed the G8 score retrospectively in a population of older patients with incurable pancreatic cancer receiving gemcitabine and capecitabine chemotherapy.
Methods
We performed a retrospective analysis of patients aged 65 or older, who had received Gemcitabine and capecitabine in the Northern Ireland Cancer Centre identified from electronic clinical databases. Clinico-pathological, treatment and outcome data were collected. Outcomes were 6-month survival, grade 3 toxicities, and hospitalisation risk 6 months from starting treatment. Toxicities were graded according to CTCAE v5. Descriptive statistics Fischer’s exact test was used to assess G8 scores and individual domains with outcomes. Univariable and multivariable analysis were undertaken assessing associations between the individual G8 domains and outcomes. Kaplan-Meier techniques were used to assess survival. SPSS version 26 was used.
Results
95 patients treated between 11/2017 and 8/2021, were identified. Median age 73 (IQR 70 – 77) and 53% female. All G8 variables were collected except patient reported health status. 48% had metastatic disease and 52%, locally advanced disease. The median G8 score was 10.5 (IQR 9-12). Median overall survival in patients with a G8 score greater than 12 (n=22) was 13.9 months; and less than 12 (n=73), 8.6 months (log rank 2.4, p=0.118). 6 month and 12 month survival rates in the entire group were 65% and 39%, in G8 >12 77% and 50%, and in G8 12 and less 61% and 36%. Grade III toxicities were observed in 60% in both G8>12 and G8 12 and below p=0.888. Risk of hospitalisation or death in 6 months was associated with weight loss (p=0.048) and reduced BMI (p=0.04). A logistic regression model found the G8 domains were associated with risk of Hospitalisation or death at 6 months in this population (X2=29.9, p=0.008), explained 42.7% of variation of hospitalisation or death and correctly predicted 84.2% of cases. No individual variable was statistically significant in this model.
Conclusions
This retrospective analysis suggests that the Geriatric- 8 score is associated with of risk of hospitalisation or death within 6 months of starting chemotherapy in older patients with pancreatic cancer. Given the poor survival of patients with advanced pancreatic cancer, time spent as an inpatient will have a greater proportional impact on quality of life compared to cancers with longer survival. Geriatric assessment may improve treatment decisions in these patients. Larger prospective studies are required to validate the utility of the G8 score specifically in older pancreatic cancer patients.
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosures
M. Eatock: Advisory / Consultancy: BMS, Merck, Roche. All other authors have declared no conflicts of interest.
