Predictive Factors for Severe Chemotherapy Adverse Events in Elderly Thai Cancer Patients

Jomtana Siripaibun, MD¹,² ORCID , Komsun Suwannarurk, MD³ ORCID , Naree Chuenkhlay, MNS⁴, Vorada Pheungsripheng, MNS⁴, Kamonwan Soonklang, PhD⁵, Kornkarn Bhamarapravatana, PhD⁶

Affiliation : ¹ Oncology Center, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand; ² Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand; ³ Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand; ⁴ Nursing Department, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand; ⁵ Princess Srisavangavadhana, College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand; ⁶ Department of Preclinical Sciences, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand

Abstract
Background: Elderly patients are at higher risk for severe chemotherapy-related adverse events (AEs), which can impair treatment continuity and cancer survival. In the Eastern Cooperative Oncology Group (ECOG) performance status (PS) is commonly used for pre-chemotherapy evaluation. Physiological decline in elderly patients, however, necessitates a comprehensive assessment. There are a few proven pre-chemotherapy factors that integrate oncologic and geriatric dimensions.
Objective: To identify additional risk factors associated with severe chemotherapy-related AEs, including socioeconomic and geriatric-related factors.
Materials and Methods: This retrospective-prospective study investigated patients with solid malignancy aged ≥60 years who received chemotherapy. Data were collected during each hospital visit. Potential factors included patient demographics, cancer characteristics, treatment plan, and geriatric assessment results. Multivariate analysis identified significant risk factors.
Results: A total of 94 elderly patients (mean age 68 years) were enrolled. Severe chemotherapy-related AEs occurred in 57% of patients (54/94). Based on adverse-event episodes, 19.1% (124/634) were classified as severe. Neutropenia and anemia were the most prevalent chemotherapy-associated AEs. Significant predictive factors included income level, ECOG PS, white blood cell (WBC) count, absolute neutrophil count (ANC), and timed up-and-go test.
Conclusion: Five additional risk factors—income level, ECOG PS, WBC count, ANC, and the timed up and go test—were identified as significant predictors of severe chemotherapy-induced AEs. These findings emphasize the need to consider factors beyond ECOG PS when evaluating the risk of severe side effects in older patients with solid tumors. Incorporating established risk factors into clinical assessments can enhance patient safety and improve therapeutic outcomes.

Received 3 July 2025 | Revised 28 January 2026 | Accepted 26 February 2026
J Med Assoc Thai 2026;109(7):629-37
DOI: 10.35755/jmedassocthai.2026.7.03242

Keywords : Chemotherapy toxicity; Chemotherapy-related adverse events; Elderly cancer patients; Predictive factors; Geriatric assessment


All Articles Download


Information

General info Aims & Scope Editorial Board Submission fees Author Guideline Contact


Related Links

COPE ICMJE CSE PIE-J EQUATOR Network

Plain Text

SCImago Journal & Country Rank

Submit manuscript


INFORMATION

Contact info

People

Editorial Board

Policies

»Section Policies »Publication Frequency » Open Access Policy » Editorial Standards » Subscription Information

JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND
4th Floor, Royal Golden Jubilee Building,
2 Soi Soonvijai, New Petchburi road,
Bangkok 10310, Thailand.
Phone: 0-2716-6102, 0-2716-6962
Fax: 0-2314-6305
Email: editor@jmatonline.com

JMed Assoc Thai
MEDICAL ASSOCIATION OF THAILAND
ISSN: 0125-2208 (Print),
ISSN: 2408-1981 (Online)
The content of this site is intended for health professionals.

Submissions

» Online Submissions » Author Guidelines » Copyright Notice » Privacy Statement

Other

» Journal Sponsorship » Site Map » About this Publishing System

© MEDICAL ASSOCIATION OF THAILAND. All Rights Reserved. The content of this site is intended for health professionals.