Survival and Treatment Patterns in Elderly Patients with Advanced Non-Small-Cell Lung Cancer in Manitoba

Abstract

Lung cancer is the leading cause of cancer death worldwide. Non-small-cell lung cancer (nsclc) is the most common form of lung cancer, with a median age at diagnosis of 70 years. These elderly patients are often underrepresented in the randomized clinical trials upon which chemotherapy plans are based. The objective of the present study was to determine the patterns of treatment and survival in elderly patients with advanced nsclc in Manitoba. An eligible cohort of elderly patients over 70 years of age at diagnosis (n = 497) with advanced nsclc was identified from the provincial cancer registry database for the period 2001–2004. Of the 497 patients identified, only 147 had been evaluated by a medical oncologist, and 82 of the 147 had received chemotherapy treatment, which is 16.5% of the initial cohort. Patients who received chemotherapy were younger than those who did not receive chemotherapy. Most patients receiving chemotherapy (84%) received doublet chemotherapy, with an almost equal split between cisplatin and carboplatin treatment. The median survival times for patients in this cohort were 64 weeks (stage iii nsclc) and 56 weeks (stage iv) with chemotherapy treatment, and 46 weeks (stage iii) and 26 weeks (stage iv) without chemotherapy. Although 50% of patients with advanced nsclc are more than 70 years of age, few are evaluated by a medical oncologist and even fewer are treated with chemotherapy. However, it should be noted that, in the elderly patients who were treated, survival times are comparable to those experienced by younger patients, which is indicative of a benefit of chemotherapy treatment for those elderly patients.

Therapeutic options in older patients with metastatic non-small cell lung cancer

“…For example, in the recently published Surveillance, Epidemiology, and End Results (SEER) database [Davidoff et al 2010], only 25.8% of the 21,285 patients aged at least 66 years diagnosed with NSCLC between 1997 and 2002 received first-line chemotherapy. In a recent analysis of the Manitoba registry [Baunemann Ott et al 2011], only 82 patients, 16.5% of the 497 patients aged over 70 years, were offered chemotherapy. However, in a French prospective hospital-based survey of 1627 patients aged 70 and over with lung cancer (all histological subtypes and all stages), 60% received some kind of chemotherapy [Quoix et al 2010].…”