The Use Of Modified Cumulative Illness Rating Scale-Geriatric In Lung Cancer Patients

Background:With the aging of the population and rising of cancer incidence,more and more elderly cancer patients have comorbidities.Evaluation of their comorbidities has been used in the diagnosis and treatment of the elderly cancer patients abroad,but hasn't attracted attention in our country,relevant research is lacking.Objective:To apply the Modified Cumulative Illness Rating Scale-Geriatric in Chinese version in investigating the prevalence of comorbidity and its impact on chemotherapy safety in lung cancer patients,to study the relationship beween the score of MCIRS-G and kamofsky performance score(KPS),and to evaluate the clinical application value of this scale.Methods:A survey was undertaken on non-small cell lung cancer patients in the department of oncology,the first affiliated hospital of Anhui Medical University from the October 2006 to September 2007.All the patients had pathological or cytological diagnoses,and were divided into the elderly group(≥65 years) and the control group (＜65 years).This study uesd self-administered questionnaire containing demographic and cancer characteristics.Comorbidities were assessed with MCIRS-G.Physical status was assessed with KPS.The incidence of chemotherapy toxicity was stratified according to the score of MCIRS-G,age,KPS.Linear correlation was applied to analyze the relationship beween the score of MCIRS-G and KPS. Results:A total of 125 cases were enrolled.There were 75 patients in the elderly group, their ages ranged from 65 to 89(mean age=71);50 patients were enrolled in the control group,their ages ranged from 28 to 64(mean age=55).63 patients had comorbidities in the elderly group(63/75),while 30 in the control group(30/50).There was a significant difference of the prevalence of comorbidity between the two groups(P=0.003).The most frequent comorbidities were hypertension and chronic respiratory diseases.With all patients divided into four groups by age:≤54,55～64,65～74,≥75,the average score of MCIRS-G(P=0.000),average number of affected organ systems(P=0.000), average number of affected organ system with severe disease(levels 4-5)(P=0.015) of each group all increased with age.With the increase of the score of MCIRS-G,the incidence of nausea and vomite(P=0.007),leucopenia(P=0.038),aglobulia(P=0.022), fever and infection(P=0.037),fatigue(P=0.010) all significantly increased in 107 cases who accepted chemotherapy.There was no change in the incidence of toxicity when stratified by age or KPS.There was good correlation between age and the score of MCIRS-G(P=0.000),no correlation between the score of MCIRS-G and KPS (P=0.333).Conclusion:Comorbidity was the more important factor affecting chemotherapy safety of lung cancer compared to age.It was more sensitive to predict chemotherapy toxicity according the score of MCIRS-G than KPS.Intense monitoring was demanded when patients with high scores of MCIRS-G and severe disease(levels 4-5) accepted chemotherapy.There was no correlation between MCIRS-G and KPS.It was recommeded to guide the treatment of elderly caner patients using MCIRS-G and KPS together in clinical trials.This Chinese version of Modified Cumulative Illness Rating Scale-Geriatric was considered appropriate to assess comorbidities in Chinese cancer patients.