Clinical tools for chemotherapy toxicity prediction and survival in geriatric cancer patients

Chemotherapy is one of the main treatments for cancer and is associated in many cancers with significant benefits in overall and disease-free survival. Nevertheless, it is also associated with adverse effects that make its administration difficult in patients with comorbidities or decreased general status. Older patients belong more often to these categories because of the physiologic effects of aging in organ functions but also because of longer effects of chronic conditions in different organs. As a result, the decision for administration of possibly beneficial chemotherapy to older patients becomes more problematic given that there is a requirement to balance this benefit with a higher probability of severe adverse effects that may even culminate to patient's demise. Thus, the ability to predict accurately the subset of older patients that will develop severe adverse effects with chemotherapy and, conversely, those that will tolerate it with a more acceptable adverse effect profile, is of clinical importance. This article will discuss progress made in devising predictive tools for use in older patients with cancer considered for receiving chemotherapy. A discussion of recent developments on the related but distinct subject of prediction of mortality in geriatric cancer patients with a focus on those receiving chemotherapy will also be included to provide a data-frame of the status of survival prediction tools in geriatric oncology patients.