Tesis

Karakteristik dan Penilaian Kerentanan Sebagai Faktor Risiko Toksisitas Akut dan Selesai Radiasi Tepat Waktu pada Pasien Usia Lanjut yang Menjalani Terapi Radiasi Eksterna di RSCM = Characteristics and Assessment of Frailty as Risk Factor of Therapy Related Acute Toxicities and Delayed Overall Treatment Time in Elderly Patients Treating with External Beam Radiation Therapy at RSCM.

Tujuan: Pasien lansia memiliki risiko lebih tinggi untuk menjadi lemah. Kerentanan menyiratkan bahwa stresor kecil dapat memiliki implikasi negatif yang besar pada domain fisik dan psikologis pada lansia. Alat skrining G-8 dapat mengidentifikasi pasien lansia dengan kanker yang berpotensi rentan. Oleh karena itu kami memutuskan untuk menyelidiki karakteristik demografis lansia dan kegunaan G-8 yang dalam memprediksi toksisitas akut dan penambahan Overall Treatment Time (OTT) pada lansia dengan kanker yang mendapat Radioterapi (RT). Metode: Sebuah studi prospektif observasional dilakukan. Subjek berusia ³ 60 tahun dan didiagnosis menderita kanker serta dirujuk ke Instalasi Pelayanan Terpadu Onkologi Radisi RSUP Dr. Cipto Mangunkusumo. Kami menilai skor G-8 pada subjek sebelum memulai RT. Kami mencatat toksisitas akut dan OTT dan mengidentifikasi prediktor potensial, termasuk hasil G-8. Hasil: Sejumlah 52 pasien menjadi subjek penelitian dengan usia rata-rata 67 tahun (60-81). Menurut G-8, 65% pasien berpotensi rentan. Dari seluruh subjek, 21% menderita kanker kepala leher, 29% kanker ginekologi, 23% kanker payudara, 27% kanker lainnya. Delapan puluh satu persen (81%) subjek mendapat RT dengan tujuan kuratif dan 19% untuk paliatif. Toksisitas akut ³ derajat 3 terjadi di 32 % subjek yang berpotensi lemah dan 0% subjek yang fit (p=0,007). Penambahan OTT terjadi pada 61,8% subjek berpotensi lemah dan 27,8% subjek yang fit (p=0,020). sejumlah 50% subjek tidak mengalami penambahan OTT, 29% subjek ≤ 3 hari dan 21% > 3 hari (rentang penambahan OTT 1 – 40 hari). Toksisitas sangat terkait dengan jenis kelamin, lokasi kanker primer, pemberian kemoterapi konkuren, stadium saat diagnosis, penilaian skor G-8, dan dosis total RT. Skor G-8 yang lebih rendah adalah satu-satunya faktor yang berhubungan dengan penambahan OTT. Pada analisis multivariat hanya pemberian kemoterapi konkuren yang berhubungan dengan toksisitas akut ³ 3, OR 21 (95% CI 2,9 – 151,4; p=0,003). Kesimpulan: G-8 dikaitkan dengan tingkat toksisitas ³ 3 dan penambahan OTT pada pasien lansia dengan kanker mendapat RT. Studi prospektif di masa depan yang menyelidiki apakah G8 adalah prediktor yang baik untuk luaran hasil klinis lain dan kesintasan sangat perlu dilakukan dalam konteks lokal.
Kata Kunci: kanker, radioterapi, G-8, toksisitas, kerentanan, overall treatment time


Aims: Older patients at a higher risk of being frail. Frailty implies that even a minor stressor can have major negative implications on physical, psychological domains. G-8 screening tool shows good screening properties for identifying vulnerable elderly patients with cancer. We therefore decided to investigate the demographic patient characteristics and utility of G-8 associated with acute toxicity and prolonged Overall Treatment Time (OTT) in elderly cancer patients treated with Radiation Therapy (RT). Materials and methods: A prospective observational cohort study is performed. Patients were eligible if aged 60 years or over and diagnosed with cancer and referred for RT at Department of Radiotherapy Dr. Cipto Mangunkusumo Hospital, Jakarta. We use the G-8 questionnaire at consecutive patients before starting RT. We recorded acute toxicity and prolonged OTT and identified potential predictors, including the G-8 score. Results: We investigated 52 patients with a median age of 67 years. From all those subjects, 21% had head and neck cancers, 29% gynaecology cancers, 23% breast cancers, 27% other cancers. Eighty one percent subjects were treated for curative-intent and 19% for palliative RT. According to the G8 score, 65% of the patients were potentially frail. Toxicity grade ≥3 was observed among 32% subjects who were potentially frail according to the G8 and 0% of subject who were fit (p=0.007). Prolonged OTT was observed in 61,8% of potentially frail subject according to the G8 and 27,8 % of subject who were fit (p=0.020). For prolonged OTT 50% subjects have no prolonged OTT, 29% subjects ≤ 3 days and 21% > 3 days (range 1 – 40 days prolonged OTT). Toxicity is strongly associated with gender, type of primary cancer, chemotherapy concurrent, stagging at diagnosis, G-8 score, total dose RT. Lower G-8 score was the only factor that associated with prolonged OTT. On multivariate analysis only chemoradiation was strongly associated with toxicity grade ≥ 3 OR 21 (95% CI 2.9 – 151,4; p=0.003). Conclusions: G-8 was associated with toxicity grade ≥ 3 and prolonged OTT in older patients with cancer who received RT. Future prospective studies should investigate whether the G8 is a good predictor for other relevant clinical outcomes and survival in our local settings.
Keywords: cancer, frailty, G-8, overall treatment time, radiotherapy, toxicity