Lung cancer chemotherapy decisions in older patients: the role of patient preference and interactions with physicians

Gironés, Regina; Torregrosa, Dolores; Gómez-Codina, José; Maestu, Inmaculada; Tenias, Jose María; Rosell, Rafael

doi:10.1007/s12094-012-0782-6

Cited by 43 publications

(41 citation statements)

References 32 publications

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“…To some extent, this finding probably reflects concern about toxicity in patients with comorbidity. Among patients with lung cancer, Gironés et al123 recently showed that withholding treatment was associated with factors such as poor health, advanced age, depression, and dementia, but not related to symptoms at diagnosis or cancer stage.…”

Section: Resultsmentioning

confidence: 99%

The impact of comorbidity on cancer survival: a review

Søgaard¹,

Thomsen²,

Bossen³

et al. 2013

CLEP

470

403

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BackgroundA number of studies have shown poorer survival among cancer patients with comorbidity. Several mechanisms may underlie this finding. In this review we summarize the current literature on the association between patient comorbidity and cancer prognosis. Prognostic factors examined include tumor biology, diagnosis, treatment, clinical quality, and adherence.MethodsAll English-language articles published during 2002–2012 on the association between comorbidity and survival among patients with colon cancer, breast cancer, and lung cancer were identified from PubMed, MEDLINE and Embase. Titles and abstracts were reviewed to identify eligible studies and their main results were then extracted.ResultsOur search yielded more than 2,500 articles related to comorbidity and cancer, but few investigated the prognostic impact of comorbidity as a primary aim. Most studies found that cancer patients with comorbidity had poorer survival than those without comorbidity, with 5-year mortality hazard ratios ranging from 1.1 to 5.8. Few studies examined the influence of specific chronic conditions. In general, comorbidity does not appear to be associated with more aggressive types of cancer or other differences in tumor biology. Presence of specific severe comorbidities or psychiatric disorders were found to be associated with delayed cancer diagnosis in some studies, while chronic diseases requiring regular medical visits were associated with earlier cancer detection in others. Another finding was that patients with comorbidity do not receive standard cancer treatments such as surgery, chemotherapy, and radiation therapy as often as patients without comorbidity, and their chance of completing a course of cancer treatment is lower. Postoperative complications and mortality are higher in patients with comorbidity. It is unclear from the literature whether the apparent undertreatment reflects appropriate consideration of greater toxicity risk, poorer clinical quality, patient preferences, or poor adherence among patients with comorbidity.ConclusionDespite increasing recognition of the importance of comorbid illnesses among cancer patients, major challenges remain. Both treatment effectiveness and compliance appear compromised among cancer patients with comorbidity. Data on clinical quality is limited.

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Section: Resultsmentioning

confidence: 99%

The impact of comorbidity on cancer survival: a review

Søgaard¹,

Thomsen²,

Bossen³

et al. 2013

CLEP

470

403

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“…Possible confounding factors for treatment (physician bias) have been prevented. [39] The number of cases was relatively high. To date, most studies of elderly lung cancer patients have been from subgroup analysis of phase III studies or were specific studies for elderly patients with fewer patients.…”

Section: Discussionmentioning

confidence: 99%

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

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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:

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“…Nine studies (Cuffe et al, 2012;Girones et al, 2012;Grose, Devereux & Milroy, 2011;Haasbeek et al, 2012;Landrum et al, 2012;Ngeow et al, 2010;Stevens, Stevens, Kolbe, & Cox, 2008;Vinod et al, 2008;Wang et al, 2012) relate to this gap. UK guidelines note that age alone should not exclude a patient from surgery as good outcomes have been reported for some older patients .…”

Section: Gap 4: Older Age and Co-morbidities Influence The Use Of Tmentioning

confidence: 99%

“…Interactions between age, comorbid conditions and performance status are complex; the incidence of comorbidities increases with age and rates of comorbidity are reported as double for lung cancer patients than for the general population (Vinod, Sidhom, Gabriel, et al, 2010). Other possible factors behind variations in treatment utilisation for the elderly and those with comorbid conditions include poor performance status, patient preference and refusal of treatment (Cuffe et al, 2012;Girones et al, 2012;Landrum et al, 2012;Ng et al, 2005;Vinod, Sidhom, Gabriel, et al, 2010). It has been argued that age and comorbidities should not deter clinicians from prescribing chemotherapy in preference to no active treatment (Ngeow et al, 2010).…”

Section: Variations In Treatments Offeredmentioning

confidence: 99%

Evidence-practice gaps in lung cancer: A scoping review

et al. 2016

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Lung cancer is a significant international health problem. Aligning clinical practice with evidence-based guideline recommendations has the potential to improve patient outcomes. This scoping review describes evidence-practice gaps across the diagnostic and management care pathway for lung cancer. We conducted searches of online databases Medline, PsychInfo, Cinahl and the Cochrane Library to identify studies published between 2008 and 2012. Of 614 articles screened, 65 met inclusion criteria. We identified seven evidence-practice gaps: (1) delays in timely diagnosis and referral; (2) curative and (3) palliative treatments are under-utilised; (4) older age and co-morbidities influence the use of treatments; (5) the benefits of multidisciplinary team review are not available to all lung cancer patients; (6) psychosocial needs are unmet; and (7) early referral to palliative care services is under-utilised. The scoping review highlighted three key messages: (1) there are significant challenges in the timely diagnosis and referral of lung cancer; (2) curative and palliative treatments, psychosocial support and palliative care are under-utilised in lung cancer management; and (3) variations in treatment utilisation appear to be associated with non-disease factors such as patient characteristics, provider practices and the organisation of health care services. Future research should focus on designing interventions to overcome variations in care.

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Lung cancer chemotherapy decisions in older patients: the role of patient preference and interactions with physicians

Abstract: Elderly lung cancer patients want to be involved in the decision-making process. Survival was the main treatment objective for more than half of the patients in this study. We have not found other published studies about elderly lung cancer patients' decisions about chemotherapy.

Cited by 43 publications

References 32 publications

The impact of comorbidity on cancer survival: a review

The impact of comorbidity on cancer survival: a review

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

Evidence-practice gaps in lung cancer: A scoping review

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