Current Status Of Primary Chemotherapy Toxicity And Its Correlation With Frailty In Older Patients With Colorectal Cancer

Objective:the aim of this study was to investigate the frailty prechemotherapy and the toxicity postchemotherapy in older patients with primary chemotherapy for colorectal cancer,and to clarity the relationship between frailty prechemotherapy and the toxicity postchemotherapy in older patients with primary chemotherapy for colorectal cancer.Methods:This was a observational study.By continuous sampling method,patients with colorectal caner age 60 and older receiving adjuvant/neoadjuvant chemotherapy(n=116)were selected in July 2020 to December 2020 in six three level of first-class hospital in Shenyang including Medical Oncology,Oncology Surgery,General Surgery,Colorectal Surgery,Anorectal Surgery.Questionnaires were conducted before the patients underwent chemotherapy,which included general information about the patients and their frailty before chemotherapy.The assessment tools included General information questionnaire and Geriatric Comprehensive Assessment(CGA).Chemotherapy toxicity including hematologic and nonhematologic toxicity,were collected from the beginning of the first chemotherapy to the beginning of the second chemotherapy.Spearman rank correlation analysis and ordinal logistic regression analysis were used to analyze The correlation between frailty prechemotherapy and toxicity postchemotherapy.Results:1.The incidence of frailty in older patients with colorectal cancer before primary chemotherapy:A total of 116 patients were collected in this study.prechemotherapy,8 patients(6.9%)were non-frailty,76 patients(65.52%)were pre-frailty,and 32 patients(27.58%)were frailty.2.The incidence of chemotherapy toxicity after primary chemotherapy in older patients with colorectal cancer:Hematological chemotherapy toxicities were 89(76.72%),43 patients(37.07%)with grade 1 toxicity,38 patients(32.76%)with grade2 toxicity,8 patients(6.89%)with grade 3 or above,non-hematological chemotherapy toxicities were 94 patients(81.03%),46 patients(39.66%)with grade 1 toxicity,40patients(34.48%)with grade 2 toxicity,8 patients(6.89%)with grade 3 or above.3.The correlation analysis of frailty and chemotherapy toxicity in older patients with primary chemotherapy for colorectal cancer:(1)Frailty was negatively correlated with hematologic toxicities and non-hematologic toxicities in older patients with primary chemotherapy for colorectal cancer(r_s=-0.443,r_s=-0.535,p<0.001).(2)Indicator of frailty:nutrtion,was positively correlated with hematologic and non-hematologic toxicities in older patients with primary chemotherapy for colorectal cancer(r_s=0.708,r_s=0.603,p<0.001).(3)Indicator of frailty:depression,was negatively correlated with hematologic and non-hematologic toxicities in older patients with primary chemotherapy for colorectal cancer(r_s=-0.266,r_s=-0.484,p<0.001).4.The results of ordinal logistic regression analysis of chemotherapy toxicity in older patients with colorectal cancer after initial chemotherapy:there were significant differences in the hematologic chemotherapy toxicities in four aspects:gender,chemotherapy regimen,type of operation,indicator of frailty:nutrition(p<0.05),in the non-hematologic chemotherapy toxicities in three aspects:gender,indicator of frailty:nutrition and depression(p<0.05).Conclusion:In older patients with colorectal cancer,the incidence of frailty prechemotherapy was high,in which pre-frailty accounted for 65.52%and frailty in27.58%.At the same time,the incidence of chemotherapy toxicity after chemotherapy was 76.72%in hematology and 81.03%in non-hematology.the incidence of grade 1 to grade 2 in patients is very high,accounting for 69.83%and 74.14%,respectively,which is mainly manifested by hemoglobin reduction,neutropenia and leucopenia in haematology,and nausea,fatigue,neurotoxicity and vomiting in non-haematology.Frailty and its two indicators:nutrition and depression were correlated with chemotherapy toxicities.Patients with frailty,poor nutrition and more severe depression had an increased risk of chemotherapeutic toxicities.