The Elderly are Less Likely to Receive Recommended Radical Radiotherapy for Non-small Cell Lung Cancer

McAleese, J.; Baluch, S.; Drinkwater, K.; Bassett, Paul; Hanna, G.G.

doi:10.1016/j.clon.2017.06.014

Cited by 17 publications

(9 citation statements)

References 22 publications

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“…On univariate and multivariate analysis, increasing age, lower socioeconomic status and greater distance and remoteness were all significantly associated with lower RTU. Our results align with previous age and non-age specific radiotherapy utilisation studies as outlined below [11] , [31] , [32] , [35] , [36] . Although there has been increasing interest in the medical literature regarding geriatric oncology, reports of age-specific RTU are limited.…”

Section: Discussionsupporting

confidence: 92%

“…Vinod et al, demonstrated a reduction in lung radiotherapy utilisation with increasing age, even in patients of good performance status (ECOG 0-2) [31] . McAleese et al reported that the elderly, defined as age ≥70 years, were less likely to receive guideline-recommended curative intent treatment for non-small cell lung cancer compared to younger patients (40% vs. 60%) [32] . More recently, with advances in treatment techniques and greater access to specialised including stereotactic radiotherapy treatments, there is evidence of increased radiotherapy utilisation in elderly lung cancer patients, with utilisation increasing from 26% to 42% from 1999-01 to 2005–07 [33] as more elderly patients are offered curative radiotherapy as an alternative to surgery.…”

Section: Discussionmentioning

confidence: 99%

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Factors affecting radiotherapy utilisation in geriatric oncology patients in NSW, Australia

Mackenzie

Vajdic

Delaney

et al. 2020

Technical Innovations & Patient Support in Radiation Oncolo

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Background and Purpose: Large non-age-specific radiotherapy utilisation rate (RTU) studies have demonstrated that actual RTU is below the optimal recommended utilisation rate for both curative and palliative intent radiotherapy indications. The optimal utilisation rate for the geriatric oncology cohort of patients has not yet been determined. The purpose of this research was to examine the actual RTU for patients treated in New South Wales (NSW), Australia as a function of increasing age, and the relationship between RTU and tumour site, travelling distance and socioeconomic status. Materials & Methods: NSW Central Cancer Registry data (2009-2011) were linked to the NSW Radiotherapy Dataset (2009-2012). RTU was calculated for patients aged <80 years and 80 years. RTU was defined as the proportion of patients receiving at least a single course of radiotherapy within 12 months of a cancer diagnosis. Results: 110,645 patients were diagnosed with cancer, of whom 27,721 received at least one course of radiotherapy. The overall RTU was 25%. RTU for patients aged <80 years was 28% compared to 14% for patients aged 80+ years (p < 0.001). On both univariate and multivariate analysis, increasing age, residential address in disadvantaged socioeconomic areas and increasing distance to the nearest radiotherapy department were associated with a reduction in RTU. Conclusion: Geriatric oncology patients are less likely to receive radiotherapy than their younger counterparts. Some of the reduction in RTU may be justifiable on the basis of limited life expectancy and comorbidity. Further research is required to determine the co-morbidity adjusted optimal RTU in older patients.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Factors affecting radiotherapy utilisation in geriatric oncology patients in NSW, Australia

Mackenzie

Vajdic

Delaney

et al. 2020

Technical Innovations & Patient Support in Radiation Oncolo

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“…In anticipation of this foreseeable problem, the modern multidisciplinary approach to cancer care has led to the advent of the rapidly expanding field of “oncogeriatrics.” Oncogeriatrics relates specifically to the diagnosis and treatment of cancer in the elderly, in attempt to maximize disease control, while minimizing toxic treatments to these vulnerable treatment group 62 . At present, elderly, frail patients are less likely to receive standard‐of‐care or curative intent oncologic treatment, 27,63,64 a finding has been replicated within the field of head and neck oncology 65 . This is in part due to the increased oncologic treatment associated morbidity that has been demonstrated among both frail and elderly patients 66 .…”

Section: Discussionmentioning

confidence: 99%

“Age is just a number”; frailty as a marker of peri‐operative risk in head and neck surgery: Systematic review and meta‐analysis

2022

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Background: Frailty refers to a patient's reduced capacity to withstand stressors due to a reduction in physiologic reserves. We assessed the impact of frailty on outcomes following head and neck surgery.Methods: We performed a systematic review in accordance with the PRISMA guidelines. Meta-analysis was performed using the Mantel-Haenszel method.Results: Fourteen studies incorporating 182 059 patients were included in qualitative synthesis with 15 953 (8.8%) of patients deemed as frail. Metaanalysis incorporating nine studies demonstrated that frailty is associated with an increased 30 day postoperative morbidity (OR 2.74; 95% CI 1.98-3.80; p < 0.01) and meta-analysis with six studies suggested increased 30-day mortality (OR 2.94; 95% CI 2.62-3.31; p < 0.01). Preliminary meta-analyses between two and five studies suggested that frail patients had reduced overall survival and were more likely to be discharged to a nonhome location or readmitted within 30 days.Conclusions: Frailty appears to be associated with poor short-term outcomes following head and neck surgery and may improve understanding of an individual patient's peri-operative risk.

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“…[22][23][24][25] For older adults who may have significant comorbidities or may be frail or prefrail, radiation therapy thus represents a highly attractive treatment option that may avoid associated mortality and morbidity risks of surgery or chemotherapy, and be more widely accepted and tolerated. 26,27 Given the critical role radiation therapy plays for older adults, the education of future radiation oncologists in geriatric oncology is fundamental to ensuring the needs of older patients are met. However, studies indicate that RO trainees receive very little training and experience in geriatric oncology, despite their interest to receive this.…”

Section: Radiation Therapy and Older Adultsmentioning

confidence: 99%

An International Expert Delphi Consensus to Develop Dedicated Geriatric Radiation Oncology Curriculum Learning Outcomes

Morris

Turner

Thiruthaneeswaran

et al. 2022

International Journal of Radiation Oncology*Biology*Physics

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The Elderly are Less Likely to Receive Recommended Radical Radiotherapy for Non-small Cell Lung Cancer

Cited by 17 publications

References 22 publications

Factors affecting radiotherapy utilisation in geriatric oncology patients in NSW, Australia

Factors affecting radiotherapy utilisation in geriatric oncology patients in NSW, Australia

“Age is just a number”; frailty as a marker of peri‐operative risk in head and neck surgery: Systematic review and meta‐analysis

An International Expert Delphi Consensus to Develop Dedicated Geriatric Radiation Oncology Curriculum Learning Outcomes

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