Allocation of Physiologic Reserve Following Chemotherapy as a Marker of Frailty in Elderly Cancer Patients

ABSTRACT Introduction The aim of this study is to identify the presence of frailty in elderly patients with cancer by comparing their functional reserves before and after treatment with chemotherapy Materials and methods This study is a prospective cohort study of cancer patients over 70 years of age who were consecutively evaluated between January 2010 and December 2011 in the Cancer Consultation in the Elderly program, Medical Oncology Section, Virgen de la Luz General Hospital in Cuenca. Group A comprised patients treated with chemotherapy, and group B comprised untreated patients. For each patient, we collected demographic data, data concerning the cancer and data describing the physiologic reserve relating to each individual (muscle mass evaluation [MME], walking speed, peak-flow, grip strength, creatinine clearance, and Pfeiffer score). The parameters of each patient's functional reserve were determined at baseline (the day of the patient's first visit) and 4 months later. Analyses of the data were conducted to identify whether there were significant differences between the groups for each of the variables under study pre- and post-chemotherapy (Student's t-test and Fisher's exact test for independent groups). Results We analyzed data from 66 patients treated with chemotherapy (group A) and 68 patients who were not treated with cytostatic drugs (group B). The mean age of the patients was 78.68 +/- 4.90 years. There were 38 cases with metastatic tumors (28.8%). In our study there were no significant differences in walking speed (p = 0.323), handgrip strength (p = 0.162), expiratory flow (peak-flow) (p = 0.954), cognitive status (Pfeiffer score) (p = 0.078), or creatinine clearance (p = 0.425). However, in patients treated with chemotherapy, there was an increase in the MME (0.618 kg/m2, 95% CI: 0.020 to 1.215, p= 0.043). Discussion Physiologic reserve in the elderly, measured by walking speed, handgrip strength, creatinine clearance, the Pfeiffer questionnaire and peak-flow, does not change as a result of chemotherapy. Strikingly, the only parameter to undergo significant changes after the use of cytostatic medications is skeletal muscle mass. This work was funded by the "Young Investigator Grant SEOM 2008-2010". Disclosure All authors have declared no conflicts of interest.