Associação entre avaliação geriátrica inicial e tolerabilidade ao tratamento quimioterápico em pacientes com neoplasia maligna do sistema digestório após um período de 3 meses
Data
2023-03-27
Autores
Santos, Marcos Dumont Bonfim 
Orientadores
Forones, Nora Manoukian
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A OMS (Organização Mundial de Saúde) define como idoso aquele indivíduo com idade maior ou igual a 60 anos em países em desenvolvimento. É sabido que devido as alterações sociodemográficas como aumento da expectativa de vida, houve aumento da prevalência do diagnóstico de câncer neste subgrupo populacional. Associado ao fato de historicamente esses indivíduos serem pouco representados nos principais estudos clínicos oncológicos, surge o desafio de uma melhor maneira de avaliação destes pacientes que possuem inerentemente características fisiológicas distintas. Neste contexto consolida-se a Avaliação Geriátrica Ampla (AGA) como ferramenta adequada de aplicação. Objetivo: Avaliar com base nos domínios da AGA pacientes idosos com neoplasia maligna do trato digestivo que iniciarão tratamento quimioterápico e associar com a tolerabilidade ao tratamento após 3 meses. Método: trata-se de um estudo prospectivo que incluiu pacientes com neoplasia do trato digestivo: esôfago, estômago, pâncreas, vias biliares, colón e reto com avaliação no início e após 3 meses de quimioterapia. Foram selecionados paciente com idade igual ou superior a 60 anos. A AGA foi aplicada no início do tratamento. A tolerabilidade ao tratamento foi definida neste estudo pela toxicidade e pela manutenção ou não do tratamento escolhido ao final de 3 meses. Resultados: Foram incluídos 50 pacientes com mediana de idade de 68 (60 a 86) com câncer do aparelho digestivo, a maioria colorretal (42%). Em relação ao estadiamento 7 eram estadio II, 18 estadio III e 25 estadio IV. Dentre os diversos domínios avaliados na AGA, correlacionaram-se com toxicidade: AIVDS (Atividades Instrumentais de Vida Diária) e o estado nutricional. A proporção de pacientes que apresentavam algum grau de dependência para atividades instrumentais foi maior entre aqueles que desenvolveram a toxicidade grau 3 (p= 0,048). Houve maior proporção de desnutridos entre os pacientes que desenvolveram toxicidade grau 3 (p=0,003). Em relação ao desfecho: a proporção de pacientes dependentes para atividades instrumentais foi maior entre os que não conseguiram seguir com o tratamento através de 2 instrumentos para AIVDS, escala de Lawton (p=0,020) e questionário Pfeffer (p=0,024); houve maior proporção de desnutridos entre os pacientes que necessitaram suspender ou modificar o tratamento(p=0,002). Conclusões: Os domínios de funcionalidade e nutrição associaram-se com a toxicidade e manutenção do tratamento após 3 meses.
Introduction: The WHO (World Health Organization) defines elderly as individuals aged 60 years or older in developing countries. It is known that due to sociodemographic changes such as increased life expectancy, there was an increase in the prevalence of cancer diagnosis in this population subgroup. Associated with the fact that historically these individuals are underrepresented in the main oncological clinical studies, the challenge of a better way of evaluating these patients, who inherently have different physiological characteristics, arises. In this context, the Comprehensive Geriatric Assessment (GGA) is consolidated as an adequate application tool. Objective: This study aims to evaluate, based on the domains of the CGA, elderly patients with malignant neoplasm of the digestive tract who will start chemotherapy treatment and associate it with the tolerability of the treatment after 3 months. Method: this is a prospective study that included patients with neoplasia of the digestive tract: esophagus, stomach, pancreas, biliary tract, colon and rectum, evaluated at baseline and after 3 months of chemotherapy. Patients aged 60 years or older were selected. The CGA was applied at the beginning of the treatment. Treatment tolerability was defined in this study by toxicity and maintenance or not of the chosen treatment at the end of 3 months. Results: We included 50 patients with a median age of 68 (60 to 86) with cancer of the digestive tract, most of them colorectal (42%). Regarding staging, 7 were stage II, 18 stage III and 25 stage IV. Among the various domains evaluated in the CGA, the following correlated with toxicity: IADL (Instrumental Activities of Daily Living) and nutritional status. The proportion of patients who had some degree of dependence for instrumental activities was higher among those who developed grade 3 toxicity (p= 0.048). There was a higher proportion of malnourished patients among patients who developed grade 3 toxicity (p=0.003). Regarding the outcome: the proportion of patients dependent for instrumental activities was higher among those who were unable to continue with the treatment using 2 IADL instruments, the Lawton scale (p=0.020) and the Pfeffer questionnaire (p=0.024); there was a higher proportion of malnourished patients among patients who needed to suspend or modify treatment (p=0.002). Conclusions: The evaluation of functionality and nutrition domains were associated with toxicity and maintenance of treatment after 3 months.
Introduction: The WHO (World Health Organization) defines elderly as individuals aged 60 years or older in developing countries. It is known that due to sociodemographic changes such as increased life expectancy, there was an increase in the prevalence of cancer diagnosis in this population subgroup. Associated with the fact that historically these individuals are underrepresented in the main oncological clinical studies, the challenge of a better way of evaluating these patients, who inherently have different physiological characteristics, arises. In this context, the Comprehensive Geriatric Assessment (GGA) is consolidated as an adequate application tool. Objective: This study aims to evaluate, based on the domains of the CGA, elderly patients with malignant neoplasm of the digestive tract who will start chemotherapy treatment and associate it with the tolerability of the treatment after 3 months. Method: this is a prospective study that included patients with neoplasia of the digestive tract: esophagus, stomach, pancreas, biliary tract, colon and rectum, evaluated at baseline and after 3 months of chemotherapy. Patients aged 60 years or older were selected. The CGA was applied at the beginning of the treatment. Treatment tolerability was defined in this study by toxicity and maintenance or not of the chosen treatment at the end of 3 months. Results: We included 50 patients with a median age of 68 (60 to 86) with cancer of the digestive tract, most of them colorectal (42%). Regarding staging, 7 were stage II, 18 stage III and 25 stage IV. Among the various domains evaluated in the CGA, the following correlated with toxicity: IADL (Instrumental Activities of Daily Living) and nutritional status. The proportion of patients who had some degree of dependence for instrumental activities was higher among those who developed grade 3 toxicity (p= 0.048). There was a higher proportion of malnourished patients among patients who developed grade 3 toxicity (p=0.003). Regarding the outcome: the proportion of patients dependent for instrumental activities was higher among those who were unable to continue with the treatment using 2 IADL instruments, the Lawton scale (p=0.020) and the Pfeffer questionnaire (p=0.024); there was a higher proportion of malnourished patients among patients who needed to suspend or modify treatment (p=0.002). Conclusions: The evaluation of functionality and nutrition domains were associated with toxicity and maintenance of treatment after 3 months.