Impact of Age and Comorbidity on Non–Small-Cell Lung Cancer Treatment in Older Veterans

Wang, Sunny; Wong, Melisa L.; Hamilton, Nathan; Davoren, J. Ben; Jahan, Thierry; Walter, Louise C.

doi:10.1200/jco.2011.39.5269

Cited by 161 publications

(124 citation statements)

References 49 publications

Supporting

Mentioning

108

Contrasting

Unclassified

Order By: Relevance

“…Pathologic stage is the main prognostic factor guiding recommendation of AC 23 and comorbid conditions can affect patients' response to treatment as well as their likelihood of completing treatment. 24 In the current study sample, increasing stage of disease was positively associated with receipt of AC, but comorbidity was not. When controlling for these factors, we found a significant survival benefit with AC, particularly among patients diagnosed between 2004 and 2005 and 2006 and 2008.…”

Section: Discussionmentioning

confidence: 53%

Use and impact of adjuvant chemotherapy in patients with resected non‐small cell lung cancer

Williams

Gajra

Ganti

et al. 2014

Cancer

View full text Add to dashboard Cite

BACKGROUND Despite clinical trials demonstrating improved survival with adjuvant chemotherapy (AC) for patients with American Joint Committee on Cancer stages I to III non‐small cell lung cancer (NSCLC), it is unclear whether this survival benefit extends to broader populations. The current study evaluated patterns of AC use and examined the impact of AC on survival. METHODS A retrospective analysis was conducted of patients in the Veterans Affairs Central Cancer Registry diagnosed with stages IB to IIIA NSCLC between 2001 and 2008. Descriptive statistics were used to examine patterns of AC use over an 8‐year time period. Cox proportional hazards regression analyses were used to estimate hazards ratios (HR) and 95% confidence intervals (95% CIs) to compare mortality risk among patients treated with and without AC. RESULTS Among 14,306 patients with stages IB to IIIA NSCLC, 4929 underwent surgery and 22% of these received AC. The percentages of patients diagnosed in 2001 through 2003, 2004 through 2005, and 2006 through 2008 receiving AC were 7.0%, 29.8%, and 29.5%, respectively. There was no survival benefit with AC noted for patients diagnosed between 2001 and 2003, but AC was associated with improved survival for the period between 2004 and 2005 (HR, 0.78; 95% CI, 0.67‐0.91) and 2006 through 2008 (HR, 0.79; 95% CI, 0.69‐0.91). Of those patients receiving AC, 89% received platinum‐doublet chemotherapy. Carboplatin remained the most common agent, although cisplatin use reached 43% in the period between 2006 and 2008. The HR for cisplatin relative to carboplatin was 0.96 (95% CI, 0.80‐1.15). CONCLUSIONS There was a significant increase in the use of AC between 2001 and 2008 and AC was associated with an improvement in overall survival. Cancer 2014;120:1939–1947. © 2014 American Cancer Society.

show abstract

Section: Discussionmentioning

confidence: 53%

Use and impact of adjuvant chemotherapy in patients with resected non‐small cell lung cancer

Williams

Gajra

Ganti

et al. 2014

Cancer

View full text Add to dashboard Cite

show abstract

“…In subjects with cancers others than CLL, comorbidity is associated with shortened survival, [18][19][20][21][22][23] and commonly has the greatest impact in patients with early-stage tumors while losing its relevance in patients with advanced-stage tumors. 24 Our study identifies comorbidity as an independent predictor of poor prognosis specifically in patients with progressive CLL treated with chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Interactions between comorbidity and treatment of chronic lymphocytic leukemia: results of German Chronic Lymphocytic Leukemia Study Group trials

et al. 2014

View full text Add to dashboard Cite

© F e r r a t a S t o r t i F o u n d a t i o nthis on-site documentation, causes of death were grouped into the following categories: therapy-related, CLL-related, CLL-unrelated, or unknown. Both studies were approved by the Institutional Review Board and Ethics Committee of the University of Munich and performed in accordance with the Declaration of Helsinki. Comorbidity assessmentFor both trials, comorbid conditions present at baseline had to be assessed and documented in the patient's case report form by the treating physician. Further quantification of the comorbidity burden by use of specific comorbidity scores was not part of the study protocols. Thus, all comorbid conditions reported within the case report form were captured only in a qualitative manner. Health problems resulting from the CLL itself and CLL as the primary disease were not recorded as comorbidity.To assess the comorbidity burden for each patient individually in the absence of quantitative data derived from scores, the number of comorbidities was calculated as the sum of all conditions abstracted from the patient's case report form according to the rules described above. Since information on the severity of comorbid conditions was mostly unobtainable, a retrospective scoring of comorbidity by use of a validated comorbidity score was not reliably possible (although an attempt was made to calculate the Charlson comorbidity index from the available data). 16 For a general description of the spectrum of comorbidities in the study population, each of the concomitant diseases was assigned to disease categories abstracted from the Cumulative Illness Rating Scale. 17 Statistical analysisThe statistical analysis was performed with SPSS 17 software (SPSS Inc., USA) and based on data collected by Results Baseline characteristicsOf the 581 patients recruited into the CLL4 and CLL5 trials, 555 were eligible for this analysis. Twenty-six patients were excluded because of inaccurate diagnosis (n=5), no need of therapy (n=2), previous therapy (n=3), consent issues (n=6), or other reasons (n=10). The characteristics of the study population are summarized in Table 1. The median time of follow-up for all patients was 58 months. Patients treated within the CLL4 and CLL5 trials were younger and older, respectively (median: 58 versus 70 years). Comorbidity burdenThe patients' comorbidity burden at baseline is presented in Table 2 and Online Supplementary Table S1. Fifty-three percent of the patients had at least one concurrent disease. The number of comorbidities ranged from zero to seven (median: 1) and increased continuously with advanced age (P<0.001). Of 139 patients presenting with more than one comorbidity, most had two or three co-existing diseases, while there were only 24 patients with more than three health problems. Impact of comorbidity on overall prognosisBy univariate analysis, patients with ≥2 comorbidities had a significantly shorter median overall survival than patients with <2 comorbid conditions (71.7 versus 90.2 months, P<0.001). ...

show abstract

“…[7,8] Consequently, elderly patients are frequently under-treated, and only one quarter of elderly patients (> 65 years) with advanced NSCLC are reported to receive palliative chemotherapy. [4,9] Advanced age has been a prevalent reason for not administering treatment, contrary to established guidelines. [10][11][12] Platinum-based doublet chemotherapy is considered to be standard of care for elderly patients with an Eastern Cooperative Oncology Group Performance Status (ECOG PS) score of 0-1.…”

Section: Introductionmentioning

confidence: 91%

Do elderly NSCLC stage IV patients benefit from chemotherapy as well as younger? An analysis from clinical practice date

Gironés¹,

Löpez²,

Chulvi³

et al. 2016

JCMT

View full text Add to dashboard Cite

How to cite this article: Gironés R, López P, Chulvi R, Cañabate M. Do elderly NSCLC stage IV patients benefit from chemotherapy as well as younger? An analysis from clinical practice date. J Cancer Metasta Treat 2016;2:379-87. Aim:The aim of this study was to evaluate the efficacy of treatment related to age in metastatic non-small cell lung cancer (NSCLC). We compared young and elders (> 70) in the setting of a regional Spanish hospital. We hypothesized that elder benefit as much as younger patients from chemotherapy in stage IV NSCLC. The study was limited to performance status 0-2. Methods: Clinical and demographic characteristics were reviewed form medical records. Type of treatment was collected and compared, as well as benefit from treatment, in terms of overall survival. Results: 322 patients (162 young, 160 aged) Elderly patients received less active treatment (63% vs. 86%, P = 0.001). Elderly received less chemotherapy, less cisplatin-doublets, more carboplatin-combinations and monotherapy (P = 0.035). The benefits of treatment were similar, regardless of age. Smoking status demonstrated a prognosis impact for elder patients treated with chemotherapy. Those who remained active smokers had a lower overall survival in the aged group. In a multivariate analysis, the Eastern Cooperative Oncology Group, active treatment and non-smoking history were favorable prognostic factors for elder patients. Smoking had not impact on young patients. Conclusion: Elderly patients were undertreated in clinical practice. Treatment showed similar overall survival despite of age. The impact of smoking seems to be more significant in the elderly population. Key words:Non-small cell lung cancer, elderly, chemotherapy, overall survival, smoking habits, platinum-combinations ABSTRACTArticle history:

show abstract

Impact of Age and Comorbidity on Non–Small-Cell Lung Cancer Treatment in Older Veterans

Abstract: Advancing age is a much stronger negative predictor of treatment receipt among older veterans with NSCLC than comorbidity. Individualized decisions that go beyond age and include comorbidity are needed to better target NSCLC treatments to older patients who may reasonably benefit.

Cited by 161 publications

References 49 publications

Use and impact of adjuvant chemotherapy in patients with resected non‐small cell lung cancer

Use and impact of adjuvant chemotherapy in patients with resected non‐small cell lung cancer

Interactions between comorbidity and treatment of chronic lymphocytic leukemia: results of German Chronic Lymphocytic Leukemia Study Group trials

Do elderly NSCLC stage IV patients benefit from chemotherapy as well as younger? An analysis from clinical practice date

Contact Info

Product

Resources

About