Frailty and malnutrition predictive of mortality risk in older patients with advanced colorectal cancer receiving chemotherapy

Introduction: In general, geriatric assessment (GA) provides the combined information on comorbidity and functional, nutritional and psychosocial status and may be predictive for mortality outcome of cancer patients. The impact of geriatric assessment on the outcome of older patients with colorectal cancer treated with chemotherapy is largely unknown. Methods: In a prospective study, 143 patients with colorectal cancer who were 70 years and older were assessed before chemotherapy by Mini Nutritional Assessment (MNA), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Groningen Frailty Indicator (GFI) and Mini Mental State Examination (MMSE). Results: Fifty-four (38%) patients received adjuvant chemotherapy and 89 (62%) patients received palliative chemotherapy. Malnutrition and frailty were prevalent in 39 (27%, assessed by MNA) and 34(24%, by GFI) patients, respectively; whereas cognitive impairment was prevalent in 19 (13%, by IQCODE) and 11 (8%, by MMSE) patients, respectively. In. patients with palliative chemotherapy, poor MNA scores were associated with receiving less than 4 cycles, of chemotherapy (p = 0.008). Poor MNA and GFI scores were associated with increased hazard ratios (HR) for mortality for patients with palliative chemotherapy: HR = 2.76 (95% confidence interval [CI]: 1.60-4.77; p < 0.001) and HR = 2.72(95% CI: 1.58-4.69; p < 0.001), respectively, after adjustment for several clinical parameters. Conclusions: Malnutrition and frailty were strongly associated with an increased mortality risk in patients who underwent palliative chemotherapy. Furthermore, a poor score on MNA was predictive for less tolerance of chemotherapy. Our findings may help the oncologist in future decision making and advice for elderly patients with colorectal cancer. (C) 2013 Elsevier Ltd. All rights reserved.