Younger patients were more likely than older patients to get guideline- recommended treatment for non–small cell lung cancer (NSCLC); conversely, the older the patient, the less likely treatment was provided, according to a large study of veterans that was reported in the May 1 issue of the Journal of Clinical Oncology. Advancing age was the strongest negative predictor of receiving guideline-recommended treat ment, regard less of cancer stage and comorbidity.
“Individualized decisions that go beyond age and include comorbidity are needed to better target NSCLC treatments to older patients who may reasonably benefit,” wrote lead author Sunny Wang, MD, San Francisco Veterans Affairs Medical Center, California. “It is clear that we fixate on age in deciding whether to pursue cancer treatments, including lung cancer treatments. Instead, we should be looking at our patients’ overall state of health,” she stated in a news release from the University of California San Francisco (UCSF).
Previous studies show that older patients in good health can benefit from treatment for NSCLC, while those with comorbidities may not be able to tolerate chemotherapy and radiation. Also, significant comorbidity can lower life expectancy, raising doubt as to the wisdom of subjecting such sick patients to toxic treatments.
The study included 20,501 patients aged 65 years and older treated at the San Francisco VA Medical Center and UCSF from 2003 to 2008. Patients were stratified by age (65 to 74 years; 75 to 84 years; and 85 years or older), Charlson comorbidity index score (0, 1 to 3, and 4 or above), and cancer stage (I to II, IIIA to IIIB, and IIIB with malignant effusion to IV).
Guideline-recommended treatment was given to 51% of patients with local, 35% with regional, and 27% with metastatic disease. Rates of treatment decreased more with advancing age than with worsening comorbidity for all stages. Older patients with no comorbidity (who could presumably benefit from treatment) had lower rates of treatment than younger patients with severe comorbidity. For example, the rate of surgery was significantly different in favor of younger patients: 50% of patients aged 75 to 84 years with local disease had surgery compared with 57% of those aged 65 to 74 years with severe comorbidity (P <.001).
“The message from our study is don’t base cancer treatment strictly on age. Don’t write off an otherwise healthy 75-year-old, and don’t automatically decide to treat a really ill 65-year-old without carefully assessing the risks and benefits for that patient,” Wang said in the UCSF news release.
She and her colleagues are currently conducting a follow-up study to compare survival in patients included in the study.