| Objective To apply the Modified Cumulative Illness Rating Scale-Geriatric in Chinese version in investigating 1,The prevalence of comorbidity and its impact on chemotherapy safety in esophageal cancer patients, the relationship between comorbidity and age, the incidence of chemotherapy toxicity.2, Comparing the sensitivity of comorbidity and age in the chemotherapy safety.3, Comparing the sensitivity of the score of MCIRS-G,age and kamofsky performance score in evaluating the chemotherapy safety in esophageal cancer patients.4, Summarizing the number of patients with high score of MCIRS-G were not treated with chemotherapy, the protective measures were taken to ensure the safety of chemotherapy of those patients who also with high score of MCIRS-G but access to chemotherapy.Methods A survey was undertaken on esophageal cancer patients in the department of oncology, the first affiliated hospital of Anhui Medical University from October 2007 to September 2008. All the patients were diagnosesed with pathological or cytological methods, and were divided into the elderly group (≥65 years) and the control group (<65 years). Self-administered questionnaire containing demographic,cancer characteristics and treatment methods were used in the study. Comorbidities were assessed with MCIRS-G. Physical status was assessed with KPS.CTCAE Version 3.0 was used to evaluate the adverse effects from the beginning of the treatment to the end of the consequential four weeks. The incidence of chemotherapy toxicity was stratified according to the score of MCIRS-G, age, KPS. Linear correlation was applied to analyze the relationship between the score of MCIRS-G and KPS.Results A total of 102 cases were enrolled. There were 57 patients in the elderly group, the ages ranged form 65 to 84 (mean age=72);45 patients were enrolled in the control group, the ages ranged form 35 to 64 (mean age=56).41 patients had comorbidities in the elderly group (41/57), while 21 in the control group (21/45).There was a significant difference of the prevalence of comorbidity between the two groups (P<0.05).In two groups of comorbidities, a significant difference was found in hypertension(P=0.002) and chronic respiratory diseases(P=0.023) but not the others(P>0.05). In the elderly group, the frequent comorbidities were hypertension (24 cases, 42.11%), and chronic respiratory diseases (16 cases, 28.07%), and in the control group, the frequent comorbidities were digestive diseases such as chronic gastritis (11 cases, 24.44%), cholecystitis and gallbladder stones (n=7cases, 15.56%). MCIRS-G score (z = 5.140, P = 0.000) and the number of systems affected by the complications of the elderly group were higher than the control group. Based on MCIRS-G score and age, 90 patients with chemotherapy were divided into 14,15,16,17and≥18 points. Analysis showed that in the elderly group, with the MCIRS-G scores increased, the blood system toxicity (P= 0.016), liver and kidney function impairment (P=0.034), fatigue (P=0.037) in the different point have a significant different incidence, but the incidence of digestive system toxicity (P = 1.000) did not show significant differences. Trend test in the five points of elderly group,Ⅱ~Ⅲgrade leucopenia rates were 0,16.7%, 60%, 69.2%, 80% (P = 0.001), liver and kidney dysfunction rates were 0,0,20% , 46.2%, 60% (P = 0.002), the incidence of fatigue were 0,16.7%, 30%, 38.5%, 73.3% (P = 0.002).With the increase of MCIRS-G score, the incidence of leucopenia, liver and kidney dysfunction and fatigue increasing. However, There was no change in the incidence of toxicity when stratified by age or KPS. MCIRS-G score was positively correlated with age (r = 0.821, P = 0.000), and was little correlated with KPS (r=0.391,P= 0.384).Conclusion Comorbidity was the more important factor affecting chemotherapy safety of esophageal cancer compared to age. Those elderly patients who were in better health status can tolerate conventional anti-cancer treatments as well as young patients, and can achieve a better chemotherapy effect. It was more sensitive to predict chemotherapy toxicity according the score of MCIRS-G than KPS. Intense monitoring was demanded to ensure the safety of chemotherapy for the patients with high scores of MCIRS-G and severe disease (levels 3-4) accepted chemotherapy. It was recommended that taking MCIRS-G, age and KPS and combining with each other to guide the individual treatment of elderly caner patients,and Modified Cumulative Illness Rating Scale-Geriatric was suggested widely used in oncology clinical. |
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