Predicting Risk of Severe Toxicity and Early Death in Older Adult Patients Treated with Chemotherapy.

BACKGROUND: Determining the risk of grade 3-5 toxicity and early death (ED) is important to plan chemotherapy in older adult patients with cancer. Our objective was to identify factors predicting these complications at the time of treatment initiation. METHODS: 234 patients aged ≥70 were subjected to a geriatric assessment and variables related to the tumor and the treatment were also collected. Logistic regression multivariable analysis was used to relate these factors with the appearance of grade 3-5 toxicity and ED. Predictive scores for both toxicity and ED were then developed. RESULTS: Factors related to grade 3-5 toxicity were hemoglobin, MAX2 index, ADL, and the CONUT score. Factors related to ED were tumor stage and the GNRI score. Two predictive scores were developed using these variables. ROC curves for the prediction of toxicity and ED were 0.71 (95% CI: 0.64-0.78) and 0.73 (95% CI: 0.68-0.79), respectively. CONCLUSIONS: Two simple and reliable scores were developed to predict grade 3-5 toxicity and ED in older adult patients with cancer. This may be helpful in treatment planning.

The effect of spirometry on bronchial and alveolar nitric oxide in subjects with asthma.

OBJECTIVE: The effect of spirometric maneuvers on exhaled nitric oxide (NO) at the constant flow rate of 50 ml/s (FE(NO)) has been studied with equivocal results. Furthermore, the effects of spirometry on bronchial NO flux (J'aw(NO)) and alveolar NO (CA(NO)), two measurements increasingly being used in clinical and research protocols, are unknown. The aim of this study was to evaluate the effect of spirometry on FE(NO), J'aw(NO), and CA(NO) in adults with asthma. METHODS: Forty-four adults with asthma were studied. To assess the impact of exhaled NO measurement itself on exhaled NO values, FE(NO), J'aw(NO), and CA(NO) were obtained twice, at baseline and after a resting period of 10 min. Then spirometry (with or without bronchodilator) was performed followed by exhaled NO measurements at 10 min. RESULTS: In the group with pre-bronchodilator study only (n = 26), mean (95% CI) values before spirometry were 37.3 ppb (22.2-52.4) for FE(NO), 2375 pl/s (1613-3137) for J'aw(NO), and 1.65 ppb (0.95-2.35) for CA(NO), compared with 35.5 ppb (21.1-49.0, p = .10), 2402 pl/s (1663-3141, p = .85), and 1.60 ppb (0.64-2.56, p = .87) after spirometry, respectively. Spirometry-induced changes in exhaled NO values were also not significant in the group with both pre- and post-bronchodilators (n = 18). Furthermore, changes in FE(NO), J'aw(NO), and CA(NO) values were similar in the two groups. CONCLUSIONS: Our findings demonstrate that spirometry (with or without bronchodilator) does not induce significant changes in bronchial NO flux or alveolar NO values. Therefore, exhaled NO values may be obtained after spirometric maneuvers.