High serum vitamin B12 levels associated with C-Reactive Protein (BCI) in older cancer patients.

BACKGROUND A Comprehensive Geriatric Assessment (CGA) has been proposed to assess prognosis and to adapt oncological care in older cancer patients. However, few biological markers are incorporated in the CGA. METHODS This comparative study on older cancer patients was realized before final therapeutic decision and during a CGA including biological markers. Our objective study was to know if the serum vitamin B12-CRP index (BCI) can help to estimate early death and unplanned hospitalization. Associations between BCI and unplanned hospitalization or mortality were analysed using ordered multivariate logistic regression. FINDINGS We included 621 older cancer adults in outpatient care with a median age of 81 years (range 70 to 98 years) from September 2015 to May 2018. In this study, 5,6 % of patients died within 3 months; 8,8% had unplanned hospitalization within one month and 11,4 % had unplanned hospitalization within 3 months. HCbl was present in 83 patients (13.4%) and 34 patients (5.5%) had BCI > 40 000. According to the multivariate analysis, BCI was a prognostic factor of mortality within 3 months and unplanned hospitalizations at 1-and 3-months. Impaired ADL and palliative care were also risk factors for mortality within 3 months. Impaired IADL, low albumin level and palliative care were risk factors for unplanned hospitalization at one month. INTERPRETATION BCI could be routinely added to the CGA process, as part of a pretreatment workup, in order to assess more precisely the frailties and to adapt oncological care in older patients treated for cancer. IMPLICATIONS FOR PRACTICE Aging comes with an increase of frailties and comorbidities. To identify frailties in older cancer patients we use Comprehensive Geriatric Assessment (CGA), which allows us to adapt each treatment plan in accordance with the individual needs of the patients and in therapeutic care. However, biological characteristics are not included in this assessment. Our study shows that hypercobalaminemia and Vitamin B12-CRP index (BCI) may also be potential markers for cancer with poor prognosis in particular in the older population. These biological markers can be used in geriatric oncology and generale medicine.