Aims

To explore whether malnutrition risk and body mass index (BMI) a) can predict chemotherapy outcomes in geriatric oncology patients and b) are associated with variables elicited with a Comprehensive Geriatric Assessment (CGA).

Methods

Patients with solid tumours aged ≥ 65 years underwent a baseline CGA before commencement of chemotherapy. Malnutrition risk was assessed using the Malnutrition Screening Tool (MST). BMI was calculated using anthropometric data. Nutritional risk and BMI were compared with other CGA variables, e.g. functional ability, vulnerability and comorbidities; as well as with chemotherapy outcomes (completion, modification or non-completion of the treatment planned at baseline).

Results

56.5% of the 175 participants were at risk of malnutrition. BMI ranged from 15.5–50.9kg/m2, with 36.6% of the cohort overweight compared to geriatric cutoffs. Malnutrition risk was more prevalent in underweight (70.4%) participants, although many healthy (60.6%) and overweight participants (32.8%) also presented at risk. Malnutrition risk was associated with greater risk of depression (p < 0.001), higher ratings of vulnerability according to the Vulnerable Elder’s Survey (VES-13) (p = .042), and less functional independence (Barthel Index, p = 0.007 and IADL, p = 0.001). Higher BMI was associated with more comorbidities (p= 0.001). Patients with a high risk of malnutrition had the best odds of completing the treatment prescribed at baseline; whereas medium risk patients had a 60% reduction in the odds of completing treatment compared to those screened as having a low risk of malnutrition. High risk patients were, however, less likely to receive intensive chemotherapy.

Conclusions

In this study overweight older patients, as determined by BMI, were more likely to complete the chemotherapy planned at baseline; however BMI in this treatment context has many limitations. Malnutrition risk, as measured by the MST, is a more valid and reliable indicator of older patients’ ability to complete planned chemotherapy.