Daily activities: Exploring their spectrum and prognostic impact in older, chemotherapy-treated lung cancer patients

Background: Performance scores predict benefits and toxicities from chemotherapy. Among older cancer patients, however, many investigators have empirically called for a detailed assessment of activities of daily living, claiming that the utility of performance scores is limited in this older population. This study's goals were therefore twofold: (1) to explore the predictive capability of an activities questionnaire and of performance score with respect to chemotherapy's toxicity and efficacy; (2) to describe the daily activities of older patients as they undergo chemotherapy for incurable metastatic lung cancer. Methods: As part of a multi-institutional therapeutic trial, this study included 48 patients ≥65 years of age with metastatic non-small-cell lung cancer. All were assigned an Eastern Cooperative Oncology Group (ECOG) performance score and completed an activity questionnaire (Voorrips) prior to the initiation of carboplatin and paclitaxel. Patients were monitored for toxicity (CTC, version 2) and cancer status. Results: Within this cohort, ECOG performance scores were poor at predicting grade 3 or worse toxic events (P=0.71, Mantel-Haenszel chi-squared). In contrast, the activity questionnaire categories did predict grade 3 or worse toxicity (P=0.03) with a positive association observed between greater levels of activity and lower toxicity rates. Neither instrument predicted 90-day disease progression, although there was a trend that suggested a positive association between favorable scores and lower progression rates (P=0.051). Patients described a broad range of daily activities. Conclusion: Activity questionnaires capture a broad range of data that may prove useful in predicting toxicity among older cancer patients.