Influence of Age on Guideline-Concordant Cancer Care for Elderly Patients in the United States

Fang, Penny; He, Weiguo; Gomez, Daniel R.; Hoffman, Karen E.; Smith, Benjamin D.; Giordano, Sharon H.; Jagsi, Reshma; Smith, Grace L.

doi:10.1016/j.ijrobp.2017.01.228

Cited by 45 publications

(36 citation statements)

References 45 publications

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“…Nevertheless, older adult patients pose a challenge in cancer treatment due to their multiple medical comorbidities and age‐related changes . Previous studies have found medical comorbidities to be an important prognostic indicator for older adult HNC patients . It is therefore important that any treatment decision for elderly HNC patients be carefully considered in conjunction with a patient's overall state of health.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of oncologic outcomes in head and neck cancer patients ≥80 years old based on adherence to NCCN guideline for postoperative adjuvant treatment

et al. 2019

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Background There is a paucity of literature characterizing outcomes in older adult patients with head and neck cancer (HNC). This study aims to describe patients from this group, their adherence to National Comprehensive Cancer Network (NCCN) adjuvant treatment guidelines, and the impact of guideline adherence on overall survival (OS). Methods In this retrospective cohort study, we reviewed all patients ≥80 years old with HNC who underwent surgery with curative intent from 2008 to 2016. Adherence to NCCN guidelines was determined in blinded fashion, and quality metrics and OS were compared. Results One hundred fifty‐nine patients met inclusion criteria. The majority of patients (n = 94, 59%) underwent treatment in accordance with NCCN recommendations while 65 (41%) deviated from NCCN guidelines. The two cohorts did not demonstrate a difference in 2‐year OS (62% vs 66%, P = .50). Conclusion Older adult patient outcomes were not different when treatment deviated from NCCN guidelines.

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Section: Discussionmentioning

confidence: 99%

Evaluation of oncologic outcomes in head and neck cancer patients ≥80 years old based on adherence to NCCN guideline for postoperative adjuvant treatment

et al. 2019

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“…Previous studies have investigated the underuse of definitive therapy in elderly patients using the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database 13 and the SEER-Medicare linked database. 31,32 One notable strength of our study is use of the NCDB, which captures approximately 70% of newly diagnosed cancers from across the United States, which is a significantly higher percentage than either CaPSURE or SEER-Medicare.…”

Section: Discussionmentioning

confidence: 99%

Receipt of definitive therapy in elderly patients with unfavorable‐risk prostate cancer

Yang

Mahal²,

Muralidhar³

et al. 2017

Cancer

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Older age was significantly associated with a decreased likelihood of receiving definitive therapy and an increased likelihood of receiving primary ADT in this national cohort of patients with intermediate-risk or high-risk prostate cancer. Notably, approximately 40% to 45% of patients aged ≥80 years did not receive definitive therapy. These findings are alarming given the dismal outcomes of conservatively managed unfavorable-risk prostate cancer. Cancer 2017;123:4832-40. © 2017 American Cancer Society.

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“…Other studies have found that older patients with breast cancer are less likely to receive guideline‐concordant care, even after accounting for patient comorbidities . Moreover, older patients with cancer are not only less likely to receive surgery, but often receive little or no treatment at all . This is partly because cancer‐directed therapy is not appropriate for some older patients and because the benefit of prolonged survival does not outweigh potential adverse effects and impact on quality of life.…”

Section: Selected Findingsmentioning

confidence: 99%

“…73,74 Moreover, older patients with cancer are not only less likely to receive surgery, but often receive little or no treatment at all. 54,73,75 This is partly because cancer-directed therapy is not appropriate for some older patients and because the benefit of prolonged survival does not outweigh potential adverse effects and impact on quality of life. In addition, death from causes other than cancer may be more likely for many older patients.…”

Section: Treatmentmentioning

confidence: 99%

Cancer statistics for adults aged 85 years and older, 2019

DeSantis

Miller

Dale

et al. 2019

CA A Cancer J Clinicians

297

199

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Adults aged 85 years and older, the “oldest old,” are the fastest‐growing age group in the United States, yet relatively little is known about their cancer burden. Combining data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the National Center for Health Statistics, the authors provide comprehensive information on cancer occurrence in adults aged 85 years and older. In 2019, there will be approximately 140,690 cancer cases diagnosed and 103,250 cancer deaths among the oldest old in the United States. The most common cancers in these individuals (lung, breast, prostate, and colorectum) are the same as those in the general population. Overall cancer incidence rates peaked in the oldest men and women around 1990 and have subsequently declined, with the pace accelerating during the past decade. These trends largely reflect declines in cancers of the prostate and colorectum and, more recently, cancers of the lung among men and the breast among women. We note differences in trends for some cancers in the oldest age group (eg, lung cancer and melanoma) compared with adults aged 65 to 84 years, which reflect elevated risks in the oldest generations. In addition, cancers in the oldest old are often more advanced at diagnosis. For example, breast and colorectal cancers diagnosed in patients aged 85 years and older are about 10% less likely to be diagnosed at a local stage compared with those diagnosed in patients aged 65 to 84 years. Patients with cancer who are aged 85 years and older have the lowest relative survival of any age group, with the largest disparities noted when cancer is diagnosed at advanced stages. They are also less likely to receive surgical treatment for their cancers; only 65% of breast cancer patients aged 85 years and older received surgery compared with 89% of those aged 65 to 84 years. This difference may reflect the complexities of treating older patients, including the presence of multiple comorbidities, functional declines, and cognitive impairment, as well as competing mortality risks and undertreatment. More research on cancer in the oldest Americans is needed to improve outcomes and anticipate the complex health care needs of this rapidly growing population.

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Influence of Age on Guideline-Concordant Cancer Care for Elderly Patients in the United States

Cited by 45 publications

References 45 publications

Evaluation of oncologic outcomes in head and neck cancer patients ≥80 years old based on adherence to NCCN guideline for postoperative adjuvant treatment

Evaluation of oncologic outcomes in head and neck cancer patients ≥80 years old based on adherence to NCCN guideline for postoperative adjuvant treatment

Receipt of definitive therapy in elderly patients with unfavorable‐risk prostate cancer

Cancer statistics for adults aged 85 years and older, 2019

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