Risk Factors for Hospitalizations Among Older Adults with Gastrointestinal Cancers.

Older adults (≥65 years) with gastrointestinal (GI) cancers who receive chemotherapy are at increased risk of hospitalization caused by treatment-related toxicity. Geriatric assessment (GA) has been previously shown to predict risk of toxicity in older adults undergoing chemotherapy. However, studies incorporating the GA specifically in older adults with GI cancers have been limited. This study sought to identify GA-based risk factors for chemotherapy toxicity–related hospitalization among older adults with GI cancers. We performed a secondary post hoc subgroup analysis of two prospective studies used to develop and validate a GA-based chemotherapy toxicity score. The incidence of unplanned hospitalizations during the course of chemotherapy treatment was determined. This analysis included 199 patients aged ≥65 years with a diagnosis of GI cancer (85 colorectal, 51 gastric/esophageal, and 63 pancreatic/hepatobiliary). Sixty-five (32.7%) patients had ≥1 hospitalization. Univariate analysis identified sex (female), cardiac comorbidity, stage IV disease, low serum albumin, cancer type (gastric/esophageal), hearing deficits, and polypharmacy as risk factors for hospitalization. Multivariable analyses found that patients who had cardiac comorbidity (OR 2.48, 95% CI 1.13-5.42) were significantly more likely to be hospitalized. Cardiac comorbidity may be a risk factor for hospitalization in older adults with GI cancers receiving chemotherapy. Further studies with larger sample sizes are warranted to examine the relationship between GA measures and hospitalization in this vulnerable population. A major health care cost for older adults with GI cancers is hospitalization. This article identifies geriatric assessment risk factors for chemotherapy toxicity-related hospitalization among older adults with gastrointestinal cancers.

接受化疗的胃肠道（GI）癌症老年患者（≥65岁）因治疗相关毒性而住院的风险增加。先前已表明老年综合评估（GA）可预测接受化疗的老年患者的毒性风险。然而，专门针对胃肠道癌症老年患者进行的包含老年综合评估的研究有限。本研究旨在确定胃肠道癌症老年患者中基于老年综合评估的化疗毒性相关住院的风险因素。 我们对两项用于开发和验证基于老年综合评估的化疗毒性评分的前瞻性研究进行了二次事后亚组分析。确定了化疗过程中非计划性住院的发生率。 该分析包括199名年龄≥65岁且被诊断患有胃肠道癌症的患者（85例结直肠癌，51例胃癌/食管癌，63例胰腺癌/肝胆癌）。65名（32.7%）患者有≥1次住院。单因素分析确定性别（女性）、心脏合并症、IV期疾病、低血清白蛋白、癌症类型（胃癌/食管癌）、听力障碍和多重用药是住院的风险因素。多变量分析发现，有心脏合并症的患者（比值比2.48，95%置信区间1.13 - 5.42）住院的可能性明显更高。 心脏合并症可能是接受化疗的胃肠道癌症老年患者住院的一个风险因素。有必要进行更大样本量的进一步研究，以检验老年综合评估指标与这一弱势群体住院之间的关系。 胃肠道癌症老年患者的一项主要医疗费用是住院费用。本文确定了胃肠道癌症老年患者中化疗毒性相关住院的老年综合评估风险因素。