Development and Validation of an Early Mortality Risk Score for Older Patients Treated with Chemotherapy for Cancer

Background: Estimation of life expectancy in older patients is relevant to select the best treatment strategy. We aimed to develop and validate a score to predict early mortality in older patients with cancer. Patients and Methods: A total of 749 patients over 70 years starting new chemotherapy regimens were prospectively included. A prechemotherapy assessment that included sociodemographic variables, tumor/treatment variables, and geriatric assessment variables was performed. Association between these factors and early death was examined using multivariable logistic regression. Score points were assigned to each risk factor. External validation was performed on an independent cohort. Results: In the training cohort, the independent predictors of 6-month mortality were metastatic stage (OR 4.8, 95% CI [2.4-9.6]), ECOG-PS 2 (OR 2.3, 95% CI [1.1-5.2]), ADL <= 5 (OR 1.7, 95% CI [1.1-3.5]), serum albumin levels <= 3.5 g/dL (OR 3.4, 95% CI [1.7-6.6]), BMI < 23 kg/m(2) (OR 2.5, 95% CI [1.3-4.9]), and hemoglobin levels < 11 g/dL (OR 2.4, 95% CI (1.2-4.7)). With these results, we built a prognostic score. The area under the ROC curve was 0.78 (95% CI, 0.73 to 0.84), and in the validation set, it was 0.73 (95% CI: 0.67-0.79). Conclusions: This simple and highly accurate tool can help physicians making decisions in elderly patients with cancer who are planned to initiate chemotherapy treatment.

Automated summary

A prognostic score was developed to predict early mortality in older cancer patients, with factors such as metastatic stage, ECOG-PS, ADL, serum albumin levels, BMI, and hemoglobin levels found to be independently associated with 6-month mortality. The score showed high accuracy in both the training cohort and the validation set, suggesting its usefulness in guiding treatment decisions for elderly cancer patients.