The effect of geriatric intervention in frail older patients receiving chemotherapy for colorectal cancer: a randomised trial (GERICO).

BACKGROUND: Older patients with colorectal cancer (CRC) experience chemotherapy dose reductions or discontinuation. Comprehensive geriatric assessment (CGA) predicts survival and chemotherapy completion in patients with cancer, but the benefit of geriatric interventions remains unexplored. METHODS: The GERICO study is a randomised Phase 3 trial including patients ≥70 years receiving adjuvant or first-line palliative chemotherapy for CRC. Vulnerable patients (G8 questionnaire ≤14 points) were randomised 1:1 to CGA-based interventions or standard care, along with guideline-based chemotherapy. The primary outcome was chemotherapy completion without dose reductions or delays. Secondary outcomes were toxicity, survival and quality of life (QoL). RESULTS: Of 142 patients, 58% received adjuvant and 42% received first-line palliative chemotherapy. Interventions included medication changes (62%), nutritional therapy (51%) and physiotherapy (39%). More interventional patients completed scheduled chemotherapy compared with controls (45% vs. 28%, P = 0.0366). Severe toxicity occurred in 39% of controls and 28% of interventional patients (P = 0.156). QoL improved in interventional patients compared with controls with the decreased burden of illness (P = 0.048) and improved mobility (P = 0.008). CONCLUSION: Geriatric interventions compared with standard care increased the number of older, vulnerable patients with CRC completing adjuvant chemotherapy, and may improve the burden of illness and mobility. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02748811.

The association between nutrition impact symptoms, nutritional risk, and risk of reduced overall survival in patients with head and neck cancer. A retrospective study.

BACKGROUND & AIMS: To examine which nutritional impact symptoms (NIS) were most prevalent at the initial state of treatment in outpatients with head and neck cancer (HNC). Secondly, to examine whether there is a potential relation between risk of reduced overall survival to NIS or nutritional risk. METHODS: Retrospective data collection from outpatients with HNC undergoing radiotherapy and/or systemic therapy. A clinical dietitian consulted all patients with the inclusion of a nutritional risk screening according to the Nutritional Risk Screening tool (NRS 2002) and Eastern Cooperative Oncology Group performance status (ECOG), and an assessment of NIS collected with a structured questionnaire, with the prevalence of 16 symptoms and to what degree they were nutritionally limiting. Weight loss at two months follow-up was calculated and patients were categorized as either at low or high risk of reduced overall survival in accordance with a BMI-adjusted weight loss grading system (high, score 0-2; low, score 3-4). RESULTS: A total of 110 patients were included (male, 77%; age, 66 (59-71)). The mean weight loss was 4.5 kg at two months follow-up, increasing with higher BMI. Eighty-six percentage of the patients experienced 3 or more of the present NIS (P-NIS), and 44% of the patients experienced 3 or more of the nutritionally limiting NIS (L-NIS). Patients who have a high risk of reduced overall survival accounted for 45% and consisted of patients with low BMI and high percentual weight loss. No significant difference was found between the two groups in terms of NIS. CONCLUSION: We found NIS to be highly prevalent among patients with head and neck cancer. Women experienced more NIS than men. Half of the patients were categorized as being at high risk of reduced overall survival, but no relation between the risk of reduced overall survival to NIS or nutritional risk was found in this study.