Factors Affecting Treatment Resilience in Patients With Oesophago-gastric Cancers Undergoing Palliative Chemotherapy:...

Oesophago-gastric cancers are the fifth most common in the UK. Most patients present with advanced disease and are unsuitable for curative surgery, instead receiving palliative treatment to improve prognosis and symptom burden. Treatment resilience refers to the ability of patients to tolerate their anti-cancer treatment. Palliative chemotherapy can result in significant toxicity; almost 40% of patients are unable to complete their chemotherapy regimen, with this proportion rising significantly in older and frailer patients. Despite most cases occurring in patients over 70, older and frailer patients are often excluded from clinical trials, resulting in limited evidence to guide which patients are most likely to benefit from palliative chemotherapy. This review therefore aimed to appraise evidence regarding treatment resilience to guide clinicians in identifying the most suitable candidates for palliative chemotherapy.

This study was conducted using modified systematic methods. Search results were limited to articles from the last 10 years. Pretreatment characteristics influencing treatment resilience were assessed, as measured by completion rates, dose reductions and toxicities.

Of the 931 papers returned, 14 reports of 13 studies were included in this review. Factors assessed included age, performance status, frailty, lymphopenia and sarcopenia. Frailty and body composition appear potentially reliable indicators of chemotherapy toxicity. Poor performance status may be a possible indicator of treatment non-completion. There was no clear relationship between treatment resilience and age or lymphopenia.

Although this review was unable to specify patient characteristics to reliably predict patient tolerance of palliative chemotherapy, potential factors were identified. Future research should focus on prospective investigation of these factors to support a precision medicine algorithmic approach by multidisciplinary teams in assessing treatment resilience. Age should not necessarily be a barrier to receiving chemotherapy. Decisions regarding palliative treatment may be guided by these factors as well as patient preference.