Influence of age, comorbidity and performance status on the choice of treatment for patients with non-small cell lung cancer; results of a population-based study

Rijke, Janneke M. de; Schouten, Leo J.; Velde, G. P. M. Ten; Wanders, S; Bollen, E. C. M.; Lalisang, Roy I.; Dijck, J.A.A.M. van; Kramer, G.; Brandt, Piet A. van den

doi:10.1016/j.lungcan.2004.03.011

Cited by 84 publications

(74 citation statements)

References 26 publications

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“…Several studies showed that comorbid conditions may play an important role in decisionmaking among cancer patients. 15,20,21 Chemotherapy is considered more effective in patients with predominantly lymph node/pleural metastases from CUP, whereas it offers only limited benefit to patients with liver, bone, or multiple organ involvement. 6 These data suggest that the site of metastasis may influence the decision to administer chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…19 Several studies have demonstrated that comorbid conditions also may play an important role in decision making. 15,20,21 To reconcile the different outcomes reported by registries and referral centers, we conducted a population-based clinical analysis of consecutive patients with CUP in the Northern Alberta Cancer Registry from 2000 to 2003 to investigate how comorbid conditions, PS, and age may influence the choice of chemotherapy and the prognosis of patients with CUP.…”

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confidence: 99%

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The influence of comorbidities, age, and performance status on the prognosis and treatment of patients with metastatic carcinomas of unknown primary site

Sève

Sawyer

Hanson

et al. 2006

Cancer

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BACKGROUNDThe authors investigated how comorbidities, age, and performance status were related to the choice of chemotherapy and to the prognosis of patients with carcinomas of unknown primary site (CUP).METHODSPatients in Northern Alberta who were diagnosed with CUP during 2000 to 2003 were included (n = 389 patients). Survival was compared by age at diagnosis (ages <65 years, 65‐74 years, and >75 years), comorbidity score (Adult Comorbidity Evaluation‐27 [ACE‐27] scores of 0‐1 and >2), performance status (PS), and other explanatory variables, such as gender, histology, and site and number of metastases.RESULTSThe median age was 68 years, and the median overall survival was 12 weeks. An ACE‐27 overall comorbidity score >2 was found in 34% of patients, and a PS >2 was observed in 50% of patients. Multivariate analysis showed that patients who had a PS ≥2 and a high overall ACE‐27 score had a worse prognosis. The impact of comorbidities on survival was limited to patients with low PS. Patients who were not evaluated at a cancer center were older, had a worse functional status, and had more moderate or severe comorbidities. Among the 257 patients who were evaluated at a cancer center, 108 patients received chemotherapy, and 121 patients had a good PS (0‐1). Age was the only independent variable that was related to the likelihood of not receiving chemotherapy among patients who had a good PS. The median overall survival of the 121 patients who had a good PS was 317 days, and overall survival was not associated significantly with chemotherapy. A logistic regression analysis that included all patients who were evaluated at a cancer center identified young age, good PS, lymph node/pleural involvement, and few comorbidities as variables that were associated independently with receiving chemotherapy.CONCLUSIONSPatients with CUP who were not evaluated at a cancer center were older, had a worse functional status, and had more moderate or severe comorbidities; this referral bias largely explained the differences between data from registries and from tertiary centers. Moderate and severe comorbidities impacted survival in patients with who had a PS ≥2. An age‐related decline was observed in the percentage of adults with good PS who received chemotherapy. The current results suggested that older patients with CUP were under treated and that factors other than PS were involved in the decision to use chemotherapy for the treatment of patients with CUP. Cancer 2006. © 2006 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The influence of comorbidities, age, and performance status on the prognosis and treatment of patients with metastatic carcinomas of unknown primary site

Sève

Sawyer

Hanson

et al. 2006

Cancer

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“…This is seen across all tumor types but is of particular importance in lung cancer where the median age at diagnosis is 68 years (21,22). Also the geriatric patients merit additional careful consideration in view of higher prevalence of co-morbidities and depletion of their physiological reserve which affects therapy adversely.…”

Section: Discussionmentioning

confidence: 99%

Treatment Compliance and Outcome in Geriatric Patients with Locally Advanced Non-Small Cell Lung Cancer: Experience from India

et al. 2016

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Objectives: To evaluate treatment compliance, toxicity and survival in geriatric patients (≥65 years) with locally advanced nonsmall cell lung cancer (LA-NSCLC).Methods: Departmental archive was collected for the details of demographics, treatment and outcome in elderly patients with LA-NSCLC (2008 -2013) (n = 96). Both progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier method. Acute and late morbidity were scored using common terminology criteria for adverse events version 4, radiation therapy and oncology group late morbidity scoring system. Results:Overall treatment completion rate was 65%. The rates of acute grade ≥ 3 hematologic and non-hematologic toxicities were 20% and 17% respectively. Overall rate of late toxicity was 12.5%. The median PFS and OS values were 7.4 months and 10.54 months, respectively. Patients with multiple comorbidities, poor socio-economic background and serum albumin level (< 3.5g/dL) were observed to have poor survival. Survival was lower for non-compliant patients. Conclusions:Curative multi-modality therapy in elderly patients with LA-NSCLC is a challenging task. They are susceptible to poor compliance, treatment-associated toxicities and poor survival.

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“…29 Chemotherapy use declined dramatically with increasing age at diagnosis, consistent with previous findings. 30,31 This may be because of physicians' perception of decreased chemotherapy tolerance or increased risks of toxicity in elderly patients. 30 Older patients with lung cancer often are compromised by the surgery itself and have a prolonged recovery time compared with other cancer operations, such as mastectomy and colectomy.…”

Section: Discussionmentioning

confidence: 99%

“…This may interfere with the receipt of chemotherapy. Elderly patients also may be reluctant to trade quality of life for a perceived survival benefit 31 and may be more likely to refuse chemotherapy. 32,33 We observed significant associations between disease stage and the receipt of chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Temporal trends and predictors of perioperative chemotherapy use in elderly patients with resected nonsmall cell lung cancer

Wang

Kuo

Freeman

et al. 2007

Cancer

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Objectives: This study reports on mid‐term safety and performance of valve‐in‐valve implantation as rescue strategy to overcome acute PPL after TAVI. Background. Moderate to severe para‐prosthetic leaks (PPL) after transcatheter aortic valve implantation (TAVI) have been described with both self‐expandable and balloon‐expandable device.Methods: We analyzed data regarding patients who underwent valve‐in‐valve implantation, enrolled in the ongoing single‐center prospective registry of TAVI, the Padova University REVALVing experience Registry. All procedures were performed by a totally percutaneous approach, using the self‐expanding Medtronic CoreValve (Medtronic, Minneapolis, MN). Results: Out of 87 patients who underwent TAVI, six received valve‐in‐valve implantation because of persisting severe PPL, due to prosthesis malposition. In all patients, the second device was successfully deployed, with a significant reduction in aortic regurgitation: PPL was no longer appreciable in two of six patients, and it decreased from severe to mild or trivial in four patients. Four patients developed atrio‐ventricular block requiring pace‐maker implantation. At follow‐up (6–24 months) two patients died, whereas no prosthesis‐related death occurred. Transprosthesis pressure gradient, effective orifice area, and aortic regurgitation did not change at serial echocardiograms throughout the follow‐up. Conclusions: Valve‐in‐valve implantation using self‐expandable bioprosthesis seems safe and highly effective to overcome severe PPL due to prosthesis malposition early after TAVI. Moreover, the implantation of two valves does not affect the performance of prosthesis at follow‐up. © 2011 Wiley Periodicals, Inc.

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Influence of age, comorbidity and performance status on the choice of treatment for patients with non-small cell lung cancer; results of a population-based study

Cited by 84 publications

References 26 publications

The influence of comorbidities, age, and performance status on the prognosis and treatment of patients with metastatic carcinomas of unknown primary site

The influence of comorbidities, age, and performance status on the prognosis and treatment of patients with metastatic carcinomas of unknown primary site

Treatment Compliance and Outcome in Geriatric Patients with Locally Advanced Non-Small Cell Lung Cancer: Experience from India

Temporal trends and predictors of perioperative chemotherapy use in elderly patients with resected nonsmall cell lung cancer

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