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Gendarme S, Zebachi S, Corre R, Greillier L, Justeau G, Bylicki O, Decroisette C, Auliac JB, Guisier F, Geier M, Ricordel C, Frelaut M, Paillaud E, Chouaïd C, Canouï-Poitrine F. Predictors of three-month mortality and severe chemotherapy-related adverse events in patients aged 70 years and older with metastatic non-small-cell lung cancer: A secondary analysis of ESOGIA-GFPC-GECP 08-02 study. J Geriatr Oncol 2024; 15:101506. [PMID: 37211514 DOI: 10.1016/j.jgo.2023.101506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/27/2023] [Accepted: 04/21/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Predictors for mortality and toxicity in older patients with cancer are mainly studied in cohorts with various cancers at different stages. This study aims to identify predictive geriatric factors (PGFs) for early death and severe chemotherapy related adverse events (CRAEs) in patients aged ≥70 years with metastatic non-small-cell lung cancer (mNSCLC). MATERIAL AND METHODS This is a secondary analysis of the multicenter, randomized, phase 3 ESOGIA trial that compared, for patients ≥70 years with mNSCLC, a treatment algorithm based on performance status and age to another algorithm based on geriatric assessment. To identify PGFs of three-month mortality and grade 3, 4, or 5 CRAEs, multivariate Cox models and logistic models, adjusted for treatment group and center, and stratified by randomization arm, were constructed. RESULTS Among 494 included patients, 145 (29.4%) had died at three months and 344 (69.6%) had severe chemotherapy toxicity. For three-month mortality, multivariate analyses retained mobility (Test Get up and Go), instrumental activity of daily living (IADL) dependence and weight loss as PGFs. The combined effect of IADL ≤2/4 and weight loss ≥3 kg was strongly associated with three-month mortality (adjusted hazard ratio: 5.71 [95% confidence interval [CI]: 2.64-12.32]). For chemotherapy toxicity, Charlson Comorbidity Index ≥2 was independently associated with grade3, 4, or 5 CRAEs (adjusted odds ratio [95% CI]: 1.94 [1.06-3.56]). DISCUSSION Mobility, IADL dependence, and weight loss were predictive of three-month mortality in a population aged ≥70 years treated for mNSCLC, while comorbidities were independently associated with severe chemotherapy toxicity.
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Affiliation(s)
- Sébastien Gendarme
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, 40 avenue de Verdun, 94010 Créteil, France.
| | - Sonia Zebachi
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Service de Santé Publique et Unité de Recherche Clinique, 1 Rue Gustave Eiffel, 94010 Créteil, France
| | - Romain Corre
- Centre Hospitalier Intercommunal de Cornouaille, Service de Pneumologie, 14 Av. Yves Thépot, 29000 Quimper, France
| | - Laurent Greillier
- Aix-Marseille Université, AP-HM, INSERM, CNRS, CRCM, Hôpital Nord, Service d'Oncologie Multidisciplinaire et Innovations Thérapeutiques, Marseille, France
| | - Grégoire Justeau
- CHU d'Angers, Service de Pneumologie, 4 Rue Larrey, 49100 Angers, France
| | - Olivier Bylicki
- HIA Sainte-Anne, Service de Pneumologie, 2, boulevard Saint-Anne, 83000 Toulon, France
| | - Chantal Decroisette
- CH d'Annecy, Service de Pneumologie, 1, avenue de l'Hôpital, Metz-Tessy, 74374 Annecy, France
| | - Jean-Bernard Auliac
- Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, 40 avenue de Verdun, 94010 Créteil, France
| | - Florian Guisier
- Univ Rouen Normandie, LITIS Lab QuantIF team EA4108, CHU Rouen, France; Department of Pulmonology, Thoracic Oncology, and Respiratory Intensive Care & CIC-CRB INSERM 1404 F, 76000, Rouen, France
| | - Margaux Geier
- CHU Morvan, Service de Pneumologie, 2, avenue Foch, 29200 Brest, France
| | - Charles Ricordel
- CHU Rennes, Service de Pneumologie, 2 Rue Henri le Guilloux, 35033 Rennes, France
| | - Maxime Frelaut
- Gustave Roussy, Département d'Oncologie Médicale, 39 rue Camille-Desmoulins, 94805 Villejuif Cedex, France
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service de Gériatrie, 20, rue Leblanc, 75908 Paris Cedex 15, France
| | - Christos Chouaïd
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, 40 avenue de Verdun, 94010 Créteil, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Service de Santé Publique et Unité de Recherche Clinique, 1 Rue Gustave Eiffel, 94010 Créteil, France
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2
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The impact of the modified frailty index on clinical outcomes for patients with stage IV non-small cell lung cancer receiving chemotherapy. J Geriatr Oncol 2022; 13:654-661. [DOI: 10.1016/j.jgo.2022.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/23/2021] [Accepted: 02/23/2022] [Indexed: 01/20/2023]
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Couderc AL, Tomasini P, Greillier L, Nouguerède E, Rey D, Montegut C, Thomas PA, Barlesi F, Villani P. Functional status in older patients with lung cancer: an observational cohort study. Support Care Cancer 2022; 30:3817-3827. [PMID: 35031829 DOI: 10.1007/s00520-021-06752-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE An assessment of the impact of functional status (FS) evaluated using a combination of Activities of Daily Living (ADL) and the short version of the Instrumental Activities of Daily Living (IADL), on 3- and 6- month mortality and on 3-month unplanned hospitalizations in older patients treated for lung cancers. METHOD AND OBJECTIVES This observational retrospective study was conducted between September 2015 and January 2019 at Marseille University Hospital (AP-HM). During this period, all consecutive outpatients aged 70 years or older referred for a comprehensive geriatric assessment (CGA) before the initiation of lung cancer treatment were enrolled. RESULTS Two hundred twenty-seven patients were analyzed: the median age was 78.7 years and 74.0% were male. Almost half of the patients were metastatic (45.4%). Concerning FS, 41.9% of patients had no ADL-IADL impairment, 30.0% had either IADL or ADL impairment, and both ADL-IADL were impaired for 28.1%. Impaired ADL-IADL was associated with poor nutritional status, depression, mobility, and cognitive disorders. In a logistic regression model, ADL or IADL impairment (aOR = 2.1; 95% CI [1.0-4.2]; p = 0.037) and impaired ADL-IADL (aOR = 2.6; 95% CI [1.2-5.3]; p = 0.012) were independently associated with a higher risk of unplanned hospitalizations within 3 months. In the multivariate Cox model, 6-month mortality risk was independently associated with impaired ADL-IADL (aHR = 2.3; 95% CI [1.3-4.4]; p = 0.008). CONCLUSION The combination of ADL and IADL scales to assess FS is a prognostic marker of the mortality risk at 6 months in older patients with lung cancer and should be more largely used by oncologists in treatment decision making.
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Affiliation(s)
- Anne-Laure Couderc
- Internal Medicine, Geriatrics and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France. .,Coordination Unit for Geriatric Oncology (UCOG) PACA West, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France. .,Aix-Marseille University, CNRS, EFS, ADES, Marseille, France.
| | - Pascale Tomasini
- Multidisciplinary Oncology and Therapeutic Innovations Department, AP-HM, Marseille, France.,Aix-Marseille University, CNRS, INSERM, CRCM, Marseille, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations Department, AP-HM, Marseille, France.,Aix-Marseille University, CNRS, INSERM, CRCM, Marseille, France
| | - Emilie Nouguerède
- Internal Medicine, Geriatrics and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.,Coordination Unit for Geriatric Oncology (UCOG) PACA West, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Dominique Rey
- Internal Medicine, Geriatrics and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.,Coordination Unit for Geriatric Oncology (UCOG) PACA West, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Coline Montegut
- Internal Medicine, Geriatrics and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.,Coordination Unit for Geriatric Oncology (UCOG) PACA West, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Pascal-Alexandre Thomas
- Aix-Marseille University, CNRS, INSERM, CRCM, Marseille, France.,Thoracic Surgery Unit, AP-HM, Marseille, France
| | - Fabrice Barlesi
- Aix-Marseille University, CNRS, INSERM, CRCM, Marseille, France.,Gustave Roussy Cancer Campus, Villejuif, France
| | - Patrick Villani
- Internal Medicine, Geriatrics and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.,Coordination Unit for Geriatric Oncology (UCOG) PACA West, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France.,Aix-Marseille University, CNRS, EFS, ADES, Marseille, France
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Couderc AL, Tomasini P, Nouguerède E, Rey D, Correard F, Montegut C, Thomas PA, Villani P, Barlesi F, Greillier L. Older Patients Treated for Lung and Thoracic Cancers: Unplanned Hospitalizations and Overall Survival. Clin Lung Cancer 2021; 22:e405-e414. [DOI: 10.1016/j.cllc.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 02/01/2023]
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Soh CH, Hassan SWU, Sacre J, Lim WK, Maier AB. Do morbidity measures predict the decline of activities of daily living and instrumental activities of daily living amongst older inpatients? A systematic review. Int J Clin Pract 2021; 75:e13838. [PMID: 33202078 PMCID: PMC8047900 DOI: 10.1111/ijcp.13838] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Older adults often suffer from multimorbidity, which results in hospitalisations. These are often associated with poor health outcomes such as functional dependence and mortality. The aim of this review was to summarise the current literature on the capacities of morbidity measures in predicting activities of daily living (ADL) and instrumental activities of daily living (IADL) amongst inpatients. METHODS A systematic literature search was performed using four databases: Medline, Cochrane, Embase, and Cinahl Central from inception to 6th March 2019. Keywords included comorbidity, multimorbidity, ADL, and iADL, along with specific morbidity measures. Articles reporting on morbidity measures predicting ADL and IADL decline amongst inpatients aged 65 years or above were included. RESULTS Out of 7334 unique articles, 12 articles were included reporting on 7826 inpatients (mean age 77.6 years, 52.7% females). Out of five morbidity measures, the Charlson Comorbidity Index was most often reported. Overall, morbidity measures were poorly associated with ADL and IADL decline amongst older inpatients. CONCLUSION Morbidity measures are poor predictors for ADL or IADL decline amongst older inpatients and follow-up duration does not alter the performance of morbidity measures.
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Affiliation(s)
- Cheng Hwee Soh
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Syed Wajih Ul Hassan
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Julian Sacre
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Wen Kwang Lim
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Octogenarians treated for thoracic and lung cancers: Impact of comprehensive geriatric assessment. J Geriatr Oncol 2020; 12:402-409. [PMID: 33097456 DOI: 10.1016/j.jgo.2020.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/30/2020] [Accepted: 10/07/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lung cancer affects older and older old adults and is the leading cause of death by cancer. Comprehensive Geriatric Assessment (CGA) is recommended before and during cancer treatment to guide therapy management in this population. METHODS This study was conducted between September 2015 and January 2019 at Marseille University Hospital (AP-HM). During this period, all consecutive outpatients 70 years or older referred for a CGA before initiation of lung cancer treatment were enrolled. The objective of this study was to compare lung and thoracic cancer management of octogenarians (≥80 years) and their geriatric profile versus patients aged 70 to 79 years (<80 years). FINDINGS In our study, 228 patients were recruited. The median age was 78.7 ± 5 years. There were 94 octogenarians (41.2%), 36.2% of them were diagnosed with stage IV neoplasm and the most common treatment was chemotherapy (43.6%). The logistic regression analysis highlights that handgrip strength was the most commonly impaired domain (OR 2.3; 95% CI [1.3-4.3]) in octogenarians and that they are more likely than their younger counterparts to be treated by targeted therapy (OR 9.8; 95% CI [1.0-92.9]). Overall survival (OS) was similar in both age groups (log rank = 0,95). INTERPRETATION In our study, octogenarians and patients <80 years had equivalent survival, across the different thoracic cancer treatments and tumor stages. Measure of muscle strength in CGA could be very useful in a clinical setting to help improve the management of older old patients treated for lung or thoracic cancer.
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Gironés R, Aparisi F, García-Sánchez J, Sánchez-Hernández A, García Piñón F, Juan-Vidal Ó. Geriatric assessment in clinical practice for patients with stage IV non-small-cell lung cancer: The Grup de Investigació I Divulgació Oncològica experience. Eur J Cancer Care (Engl) 2018; 27:e12950. [PMID: 30357951 DOI: 10.1111/ecc.12950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/27/2018] [Accepted: 09/04/2018] [Indexed: 11/30/2022]
Abstract
Therapeutic decision-making for older patients with stage IV non-small-cell lung cancer (NSCLC) with no identifiable activating mutation is complex. In this prospective study, we evaluated the usefulness of geriatric assessment (GA) in identifying frail patients. Stage IV NSCLC patients ≥70 years of age were evaluated with GA and classified according to this evaluation into three different groups: fit, vulnerable and frail. Classifications based on GA, treatment decision, toxicity and overall survival were analysed. In total, 93 patients were included. Median age was 76 (70-92) years and 90% were men. Most patients had performance status (PS) 0 or 1 (82%), unrelated to their GA (p = 0.006). GA groups were associated with overall survival (p = 0.000), treatment decision (p = 0.0001), and toxicity (p = 0.0001). Chemotherapy was delivered to 100% of fit patients, to 48% of vulnerable patients, and to only 8% of frail patients (p = 0.000). Toxicity was higher in vulnerable patients than in fit individuals (p = 0.000). Multivariable analysis showed PS (p = 0.001), active treatment (p < 0.001) and GA group (p = 0.001) to be prognostic factors related to survival. Our results suggest that GA identified patients with poor natural prognosis.
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Affiliation(s)
- Regina Gironés
- Hospital Lluis Alcanyís, Medical Oncology Unit, Xátiva, Spain
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Can we avoid the toxicity of chemotherapy in elderly cancer patients? Crit Rev Oncol Hematol 2018; 131:16-23. [PMID: 30293701 DOI: 10.1016/j.critrevonc.2018.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/22/2018] [Indexed: 12/27/2022] Open
Abstract
Although approximately 50% of cancer patients are 70 years of age or older, cancer treatment in the elderly remains a therapeutic challenge. The elderly form a very heterogeneous group in relation to their general health state, degree of dependence, comorbidities, performance status, physical reserve and geriatric situation, for which therapeutic decisions must be made in an individualized manner. In addition, changes in pharmacokinetics and pharmacodynamics of the drugs occur with age, as well as the tolerance of the tissues, leading to a narrowing of the therapeutic margin and an increase in toxicity. In the general population, Performace Status (PS) has traditionally been used to estimate tolerance to chemotherapy, but in the elderly population it is not useful. In this review we summarize the current knowledge about the pharmacology of antineoplastic drugs in the elderly and the tools available to help us identify risk of chemotherapy toxicity in these patients.
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Sacco PC, Maione P, Palazzolo G, Gridelli C. Treatment of advanced non-small cell lung cancer in the elderly. Expert Rev Respir Med 2018; 12:783-792. [PMID: 30092728 DOI: 10.1080/17476348.2018.1510322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Lung cancer is predominantly a disease that affects the elderly; about 30-40% of lung cancers are diagnosed in patients aged 70 or more. The increasing number of elderly patients over the next decades is generating a new social and health problem; despite that, these patients are underrepresented in clinical trials and undertreated in clinical practice. Areas covered: The main difficulty in treating elderly patients is to maximize the therapy benefits while minimizing the treatment risk. Elderly patients show a vulnerable clinical profile due to the higher prevalence of comorbid disease, higher polypharmacy interactions and aged organ dysfunction that increase the risk of mortality and toxicity with cancer treatments compared to younger patients. Expert commentary: The choice to treat or not to treat elderly patients cannot be taken only on the basis of the chronological age. Thus, the clinical approach should be to select patients who are effectively suitable for treatment having a better individual functional reserve and a better life expectancy. Elderly patients are a heterogeneous population and those who are fit to receive cancer treatment can be treated similarly to younger patients.
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Affiliation(s)
- Paola C Sacco
- a Division of Medical Oncology , "S.G.Moscati" Hospital , Avellino , Italy
| | - Paolo Maione
- a Division of Medical Oncology , "S.G.Moscati" Hospital , Avellino , Italy
| | | | - Cesare Gridelli
- a Division of Medical Oncology , "S.G.Moscati" Hospital , Avellino , Italy
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Non-Small Cell Lung Cancer in the Elderly: a Practical Approach to Screening, Diagnosis, and Treatment. CURRENT GERIATRICS REPORTS 2018. [DOI: 10.1007/s13670-018-0252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Le Caer H, Borget I, Corre R, Locher C, Raynaud C, Decroisette C, Berard H, Audigier-Valette C, Dujon C, Auliac JB, Crequit J, Monnet I, Vergnenegre A, Chouaid C. Prognostic role of a comprehensive geriatric assessment on the management of elderly patients with advanced non-small cell lung cancer (NSCLC): a pooled analysis of two prospective phase II trials by the GFPC Group. J Thorac Dis 2017; 9:3747-3754. [PMID: 29268382 DOI: 10.21037/jtd.2017.09.51] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background The prognostic role of a comprehensive geriatric assessment (CGA) on the management of elderly patients with advanced-stage non-small cell lung cancer (NSCLC) remains to be established. The objective of this analysis was to determine the prognostic role of each CGA domain on overall survival (OS) among elderly patients with advanced-stage NSCLC. Methods We pooled individual data from two prospective, randomized phases II trials in patients over 65 years old with advanced-stage NSCLC, who were considered fit (0405 trial) or no-fit (0505 trial) based on a CGA. Both trials compared first-line chemotherapy followed by second-line erlotinib with the reverse strategy in terms of progression-free survival (PFS) and OS. Factors prognostic of OS were sought by using the Kaplan-Meier method and the log rank test for univariate analysis, and a Cox model for multivariate analysis. Results Analysis performed on 194 patients (mean age: 77 years, male gender: 70%, never- or ex-smokers: 56%) showed, in univariate analysis that performance status (PS), smoking status, Charlson, simplified Charlson, nutritional scores, and a mobility score were prognostics of OS. In multivariate analysis, PS [HR: 1.4 (1.02-1.9), P=0.04] and the Charlson score [HR: 1.46 (1.07-1.99), P=0.02] were independently prognostic of OS, while the nutritional score [HR: 0.69 (0.46-1.04), P=0.07] and the mobility score [HR: 0.25 (0.06-1.01), P=0.06] were close to significance. Conclusions PS and comorbidities appear to be the main predictors of OS in elderly advanced NSCLC patients selected on the basis of CGA.
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Affiliation(s)
- Hervé Le Caer
- Service de pneumologie, Centre hospitalier de Saint Brieuc, Saint Brieuc, France
| | - Isabelle Borget
- Department of Biostatic and Epidemiology, Gustave Roussy, Villejuif and Paris-Sud University, France
| | - Romain Corre
- Service de pneumologie, Rennes University, Rennes, France
| | - Chrystele Locher
- Service de pneumologie, Centre hospitalier de Meaux, Meaux, France
| | - Christine Raynaud
- Service de pneumologie, Centre hospitalier d'Argenteuil, Argenteuil, France
| | | | - Henri Berard
- CHIA, Centre Hospitalier Inter Armées, Toulon, France
| | | | - Cecile Dujon
- Service de pneumologie, Centre hospitalier de Versailles, Versailles, France
| | - Jean Bernard Auliac
- Service de Pneumologie, Centre hospitalier de Mantes la Jolie, Mantes la Jolie, France
| | - Jacquy Crequit
- Service de pneumologie, Centre hospitalier de Creil, Creil, France
| | - Isabelle Monnet
- Service de pneumologie, Cente Hospitalier Intercommunal, Créteil, France
| | | | - Christos Chouaid
- Service de pneumologie, Cente Hospitalier Intercommunal, Créteil, France
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Schulkes KJG, Hamaker ME, Lammers JWJ, van Rens MTM, Geerts M, van Elden LJR. Multidisciplinary decision-making regarding chemotherapy for lung cancer patients-An age-based comparison. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28940851 DOI: 10.1111/ecc.12768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 11/27/2022]
Abstract
Optimising decision-making in elderly patients is becoming increasingly urgent. We analysed treatment decisions and course of therapy for patients with lung cancer in different age categories: <65, 65-75, and 75 years and older. About 349 patients with lung cancer (median age 67.8 years), discussed at the multidisciplinary team meeting in the Diakonessenhuis Utrecht, the Netherlands, were reviewed. Multidisciplinary decision-making and subsequent clinical course were extracted from medical files. We found that 39% of eligible patients older than 75 years of age started treatment with chemotherapy compared to 80% of the younger patients (<65 and 65-75). When patients did receive chemotherapy, primary and secondary treatment adaptations were effectuated in 58%: for patients aged <65 in 49%, for patients aged 65-75 and >75 years in 66%. For 44% of all patients treated with chemotherapy, unplanned hospital admissions were required: in 42% for the patients <65, in 52% for those aged 65-75 and in 27% for >75 years. The decision-making process and course of treatment for lung cancer vary per age category. In particular, patients between 65 and 75 years of age might be more frail than initially thought. Age and frailty are important characteristics that need more attention.
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Affiliation(s)
- K J G Schulkes
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - J-W J Lammers
- Department of Pulmonology, UMC Utrecht, Utrecht, The Netherlands
| | - M T M van Rens
- Department of Pulmonology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - M Geerts
- Department of Pulmonology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - L J R van Elden
- Department of Pulmonology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
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Lee JJ, Kim J, Sehovic M, Chen L, Extermann M. Using heat maps to assess the multidimensional association of comorbidities with survival in older cancer patients treated with chemotherapy. J Geriatr Oncol 2017; 8:336-342. [PMID: 28739160 DOI: 10.1016/j.jgo.2017.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/15/2017] [Accepted: 07/06/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To date, most comorbidity studies have analyzed either a subgroup of frequent diseases, or used summary instruments such as the Charlson score or the Cumulative Illness Rating Scale-Geriatric (CIRS-G). Yet, comorbidity is a multidimensional construct and impacts function, treatment tolerance, and survival. We assessed how heat maps can unveil specific patterns of comorbidities associated with overall survival (OS) in older cancer patients treated with chemotherapy. MATERIAL AND METHODS We reviewed four trials that prospectively evaluated comorbidities using CIRS-G. Eligible patients were 65years or older and had solid tumors with 30 or more patients per tumor site. Heat maps were constructed based on CIRS-G scores and correlated with OS. RESULTS Among 818 patients accrued, 399 were eligible: Median follow-up was 53.4months and median OS was 19.6months (95% CI: 16.5-24.2). In the univariate model for OS, patients with a severe CIRS-G score in 6 organ categories (3-4 in heart, hematopoietic, respiratory, and musculoskeletal-integument and 2-4 in upper GI and liver) had statistically worse OS than those with lower scores. According to a total risk score (TRS) based on hazard ratios for OS, OS of the low risk group (N=309, TRS<2) was significantly higher (24.3m vs. 10.8m, HR=2.05, 95% CI: 1.58-2.66). TRS was a predictor for OS independently from stage, primary site, prior chemotherapy, ECOG performance status, and IADL (HR=1.94, 95% CI: 1.47-2.57). CONCLUSIONS High TRS was a predictor of poor survival. Comorbidity heat maps appear promising to identify diseases most affecting the OS of older cancer patients.
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Affiliation(s)
- Jae Jin Lee
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jongphil Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Department of Oncology Sciences, University of South Florida, Tampa, Florida, USA
| | - Marina Sehovic
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Lu Chen
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Martine Extermann
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Department of Oncology Sciences, University of South Florida, Tampa, Florida, USA.
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Schulkes KJ, Hamaker ME, van den Bos F, van Elden LJ. Relevance of a Geriatric Assessment for Elderly Patients With Lung Cancer—A Systematic Review. Clin Lung Cancer 2016; 17:341-349.e3. [DOI: 10.1016/j.cllc.2016.05.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/20/2016] [Accepted: 05/24/2016] [Indexed: 12/27/2022]
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Sacco PC, Casaluce F, Sgambato A, Rossi A, Maione P, Palazzolo G, Napolitano A, Gridelli C. Current challenges of lung cancer care in an aging population. Expert Rev Anticancer Ther 2015; 15:1419-1429. [DOI: 10.1586/14737140.2015.1096201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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16
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Ferrat E, Paillaud E, Laurent M, Le Thuaut A, Caillet P, Tournigand C, Lagrange JL, Canouï-Poitrine F, Bastuji-Garin S. Predictors of 1-Year Mortality in a Prospective Cohort of Elderly Patients With Cancer. J Gerontol A Biol Sci Med Sci 2015; 70:1148-55. [PMID: 25834194 DOI: 10.1093/gerona/glv025] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 02/20/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Mortality prediction is crucial to select the optimal treatment in elderly cancer patients. Our objective was to identify cancer-related factors and Comprehensive Geriatric Assessment (CGA) findings associated with 1-year mortality in elderly inpatients and outpatients with cancer. METHODS We prospectively included patients aged ≥70 years who had solid or hematologic malignancies and in whom the CGA was performed by geriatricians in two French teaching hospitals. We identified independent predictors of 1-year mortality after study inclusion, using multivariate Cox models stratified on inpatient/outpatient status. We built three multivariate Cox models, since strong correlations linked activities of daily living (ADL), Eastern Cooperative Oncology Group Performance Status (ECOG-PS), and timed get-up-and-go test (GUG) results; and since physicians' preferences for these three assessments vary. A sensitivity analysis was performed using multiple imputation. RESULTS Of the 993 patients (mean age, 80.2 years; 51.2% men), 58.2% were outpatients and 46% had metastatic disease. Colorectal cancer was the most common malignancy (21.4%). Mortality rates after 6 and 12 months were 30.1% and 41.2%, respectively. In all models, tumor site and metastatic status (p < .001), age >80 years (p < .05), higher number of severe comorbidities (p < .05), and malnutrition (p < .001) were associated with death independently from impaired ECOG-PS (p < .001), ADL (p < .001), and GUG (p < .001). The adverse effect of metastatic status differed significantly across tumor sites, being greatest for breast and prostate cancer (p < .001). Multiple imputation produced similar results. CONCLUSION The predictors of 1-year mortality identified in our study may help physicians select the optimal cancer-treatment strategy in elderly patients.
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Affiliation(s)
- Emilie Ferrat
- Université Paris Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA 4393, UPEC, F-94010, Créteil, France. Primary Care Department, School of Medicine, Paris East Créteil University (UPEC), France.
| | - Elena Paillaud
- Université Paris Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA 4393, UPEC, F-94010, Créteil, France. Geriatric Oncology Coordination Unit (UCOG)
| | - Marie Laurent
- Université Paris Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA 4393, UPEC, F-94010, Créteil, France. Geriatric Oncology Coordination Unit (UCOG)
| | - Aurélie Le Thuaut
- Université Paris Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA 4393, UPEC, F-94010, Créteil, France. Public Health Department, Clinical Research Unit (URC Mondor)
| | - Philippe Caillet
- Université Paris Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA 4393, UPEC, F-94010, Créteil, France. Geriatric Oncology Coordination Unit (UCOG)
| | | | - Jean-Léon Lagrange
- Radiotherapy Department, Henri-Mondor Teaching Hospital, APHP, Créteil, France
| | - Florence Canouï-Poitrine
- Université Paris Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA 4393, UPEC, F-94010, Créteil, France. Public Health Department
| | - Sylvie Bastuji-Garin
- Université Paris Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA 4393, UPEC, F-94010, Créteil, France. Public Health Department, Clinical Research Unit (URC Mondor)
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Cihan S, Odabas H, Ozdemir NY, Yazilitas D, Babacan NA. Treatment Approaches in 102 Elderly Patients With Non-Small Cell Lung Cancer. World J Oncol 2015; 6:276-282. [PMID: 29147416 PMCID: PMC5649946 DOI: 10.14740/wjon894w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/12/2022] Open
Abstract
Background The life expectancy and presence of co-morbidities cause reservations in treatment decisions for elderly patients with cancer. In this study, we retrospectively evaluated 102 patients who are considered as middle-old aged (aged 75 - 84) by gerontologists. Methods Medical records of patients were reviewed. One hundred and two patients with a diagnosis of non-small cell lung cancer (NSCLC) whose follow-up ended with death between March 2006 and May 2013 were examined. Results The median age at diagnosis was 77 (75 - 85) years. Thirty-three patients (67.6%) were over 80 years old. The number of patients with metastasis was 57 (55.8%). Forty-two (41.2%) patients had stage IIIA and IIIB disease. Fifteen of the metastatic patients (26.3%) were given chemotherapy, while 12 of the non-metastatic patients (26.6%) were given chemotherapy. Of the non-metastatic patients, 25 (55.6%) were treated with radiotherapy, and five (11.1%) were treated with chemotherapy. The median duration of follow-up was 4 (1-55) months. Progression-free survival (PFS) was 4 months in non-metastatic patients, and 3 months in metastatic patients. Overall survival (OS) was 4 months. OS rates for 1 and 2 years were 10% and 2%. Conclusion Chemotherapy and radiotherapy may be administered even to patients of this age group. The beneficial effect of chemotherapy in patients with metastasis on OS is an important finding of our study.
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Affiliation(s)
- Sener Cihan
- Department of Medical Oncology, Okmeydani Training and Research Hospital, 34100 Sisli, Istanbul, Turkey
| | - Hatice Odabas
- Department of Medical Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, 34860 Kartal, Istanbul, Turkey
| | - Nuriye Yildirim Ozdemir
- Department of Medical Oncology, Ankara Numune Training and Research Hospital, 06100 Altindag, Ankara, Turkey
| | - Dogan Yazilitas
- Department of Medical Oncology, Ankara Numune Training and Research Hospital, 06100 Altindag, Ankara, Turkey
| | - Nalan Akgul Babacan
- Department of Medical Oncology, Marmara University Pendik Education and Research Hospital, 34860 Kartal, Istanbul, Turkey
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Hsu CL, Chen JH, Chen KY, Shih JY, Yang JCH, Yu CJ, Yang PC. Advanced non-small cell lung cancer in the elderly: The impact of age and comorbidities on treatment modalities and patient prognosis. J Geriatr Oncol 2015; 6:38-45. [DOI: 10.1016/j.jgo.2014.09.178] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/28/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
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Blanco R, Maestu I, de la Torre MG, Cassinello A, Nuñez I. A review of the management of elderly patients with non-small-cell lung cancer. Ann Oncol 2014; 26:451-63. [PMID: 25060421 DOI: 10.1093/annonc/mdu268] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Most patients with non-small-cell lung cancer (NSCLC) are elderly but evidence to guide appropriate treatment decisions for this age group is generally scant. Careful evaluation of the elderly should be undertaken to ensure that treatment appropriate for the stage of the tumour is guided by patient characteristics and not by age. The Comprehensive Geriatric Assessment (CGA) remains the preferred option, but briefer tools may be appropriate to select patients for further evaluation. The predicted outcome should be used to guide management decisions together with a reappraisal of polypharmacy. Patient expectations should also be taken into account. Management recommendations are generally similar to those of general guidelines for the NSCLC population, although the risks of surgery and toxicity of chemotherapy and radiotherapy are often increased in the elderly compared with younger patients; therefore, patients should be closely scrutinised and subjected to a CGA to ensure suitability of the planned treatment. If surgery is indicated, then lobectomy is generally the preferred option, although limited resection may be more feasible for some. Radiotherapy with curative intent is an alternative, with stereotactic body radiotherapy the most likely preferred modality. Adjuvant chemotherapy is also an appropriate approach, whereas adjuvant radiotherapy is generally not recommended. Concurrent chemoradiotherapy should be considered for elderly patients with inoperable locally advanced disease and chemotherapy for advanced/metastatic disease. Efforts should also be made to increase participation of elderly patients with NSCLC in clinical trials, thereby enhancing evidence-based treatment decisions for this majority group. This will require overcoming barriers relating to trial design and to physician and patient awareness and attitudes.
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Affiliation(s)
- R Blanco
- Oncology Service, Consorci Sanitari de Terrassa, Ctra. de Torrebonica sn, Terrassa
| | - I Maestu
- Department of Oncology, Hospital Universitario Dr Peset, Avenida de Gaspar Aguilar, Valencia and
| | | | - A Cassinello
- Medical Department, Lilly Spain, Alcobendas, Spain
| | - I Nuñez
- Medical Department, Lilly Spain, Alcobendas, Spain
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Van Lancker A, Velghe A, Van Hecke A, Verbrugghe M, Van Den Noortgate N, Grypdonck M, Verhaeghe S, Bekkering G, Beeckman D. Prevalence of symptoms in older cancer patients receiving palliative care: a systematic review and meta-analysis. J Pain Symptom Manage 2014; 47:90-104. [PMID: 23764109 DOI: 10.1016/j.jpainsymman.2013.02.016] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 02/21/2013] [Accepted: 02/25/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT Symptom control is an essential part of palliative care and important to achieve optimal quality of life. Studies showed that patients with all types of advanced cancer suffer from diverse and often severe symptoms. Research focusing on older persons is scarce because this group is often excluded from studies. Consequently, it is unclear which symptoms older palliative care patients with cancer experience and what is the prevalence of these symptoms. To date, no systematic review has been performed on the prevalence of symptoms in older cancer patients receiving palliative care. OBJECTIVES The objective of this systematic review was to search and synthesize the prevalence figures of symptoms in older palliative care patients with cancer. METHODS A systematic search through multiple databases and other sources was conducted from 2002 until April 2012. The methodological quality was evaluated. All steps were performed by two independent reviewers. A meta-analysis was performed to pool the prevalence of symptoms. RESULTS Seventeen studies were included in this systematic review. Thirty-two symptoms were identified. The prevalence of these symptoms ranged from 3.5% to 77.8%. The most prevalent symptoms were fatigue, excretory symptoms, urinary incontinence, asthenia, pain, constipation, and anxiety and occurred in at least 50% of patients. CONCLUSION There is a high degree of uncertainty about the reported symptom prevalence because of small sample sizes, high heterogeneity among studies, and the extent of instrument validation. Research based on rigorous methods is needed to allow more conclusive results.
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Affiliation(s)
- Aurélie Van Lancker
- Nursing Science, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Anja Velghe
- Department of Geriatric Medicine, University Hospital Ghent, Ghent, Belgium
| | - Ann Van Hecke
- Nursing Science, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Nursing Science, University Hospital Ghent, Ghent, Belgium
| | - Mathieu Verbrugghe
- Nursing Science, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Mieke Grypdonck
- Nursing Science, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- Nursing Science, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Geertruida Bekkering
- Belgian Interuniversity Collaboration of Evidence-Based Medicine (BICEP), Belgian Center for Evidence-Based Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Dimitri Beeckman
- Nursing Science, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Gironés R, Torregrosa D, Maestu I, Gómez-Codina J, Tenias JM, Costa RR. Comprehensive Geriatric Assessment (CGA) of elderly lung cancer patients: A single-center experience. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2011.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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22
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Rousseau F, Bugat R, Ducreux M, Cvitkovic F, Carola E, Gisselbrecht M, Viret F, Esterni B, Genève J, Brain E. Effect of XELOX on functional ability among elderly patients with metastatic colorectal cancer: Results from the FNCLCC/GERICO 02 phase II study. J Geriatr Oncol 2011. [DOI: 10.1016/j.jgo.2010.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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23
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Lee L, Cheung WY, Atkinson E, Krzyzanowska MK. Impact of Comorbidity on Chemotherapy Use and Outcomes in Solid Tumors: A Systematic Review. J Clin Oncol 2011; 29:106-17. [DOI: 10.1200/jco.2010.31.3049] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The treatment of cancer in patients with comorbidities can be challenging as these individuals are underrepresented in clinical trials. We conducted a systematic review to determine the impact of comorbidity on chemotherapy use, delivery, tolerability, and survival among patients with solid tumors to summarize current data and provide recommendations for future research. Methods All English-language articles from 1990 to 2009 that explored the association between comorbidity and chemotherapy were identified from MEDLINE and EMBASE. Abstracts were reviewed for eligibility, and data on study design and results were extracted. Results Thirty-four articles met the inclusion criteria. Study populations and design were heterogeneous, and the quality of reporting was generally poor. Most studies were retrospective (76%), were based on a cancer registry linked with administrative data (47%), and assessed the overall effect of comorbidity using an index score (76%). Sixteen studies (47%) investigated chemotherapy use, and 29 (85%) addressed survival. The majority reported decreased chemotherapy use (75%) and inferior survival (69%) for patients with comorbidities compared to those without. In 11 of 14 studies, inferior survival was independent of treatment. Of the few studies that addressed chemotherapy tolerability, seven of 10 reported an increased rate of severe toxicity, and three of five reported increased treatment delays for patients with comorbidity. Conclusion Chemotherapy use and outcomes among cancer patients with comorbidities are generally inferior, but the existing evidence is limited and of insufficient quality to determine the relationship between decreased use and inferior survival. Further studies that are prospective and site and stage specific are warranted.
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Affiliation(s)
- Linda Lee
- From Princess Margaret Hospital, University of Toronto, Toronto, Ontario; British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Winson Y. Cheung
- From Princess Margaret Hospital, University of Toronto, Toronto, Ontario; British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Esther Atkinson
- From Princess Margaret Hospital, University of Toronto, Toronto, Ontario; British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Monika K. Krzyzanowska
- From Princess Margaret Hospital, University of Toronto, Toronto, Ontario; British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Comorbidity and polypharmacy in elderly cancer patients: The significance on treatment outcome and tolerance. J Geriatr Oncol 2010. [DOI: 10.1016/j.jgo.2010.06.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Gironés R, Torregrosa D, Gómez-Codina J, Maestu I, Tenias JM, Rosell R. Prognostic impact of comorbidity in elderly lung cancer patients: use and comparison of two scores. Lung Cancer 2010; 72:108-13. [PMID: 20727613 DOI: 10.1016/j.lungcan.2010.07.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Revised: 06/28/2010] [Accepted: 07/04/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND Mean age of patients with lung cancer rises as a result of increasing life expectancy. So, the proportion of patients with serious comorbidity also increases [1,2]. Lung cancer treatment is characterized by a narrow therapeutic index. When life expectancy is short and therapeutic benefit is limited, it is of paramount importance to know the specific cause of death. Comorbidity is understood as a competing cause of death, and is the main exclusion criterion for lung cancer clinical trials. The aim of this study was to determine the prevalence of comorbidity in elderly lung cancer patients seen in an outpatient oncology department and to determine its correlation with survival. PATIENTS AND METHODS Between January 2006 and February 2008, 83 untreated lung cancer patients over the age of 70 years were enrolled in the study. Comorbidity was evaluated according to the Charlson comorbidity index (CCI) [3] and the simplified comorbidity score (SCS) [4]. RESULTS 83 patients (97.6% men, mean age 77 years) were studied. Comorbidities: tobacco consumption (94.6%), cardiovascular diseases (65%), and chronic obstructive pulmonary disease (COPD) (59%). Mean CCI was 3 (range 0-9). Mean SCS was 9 (range 4-19), and 47% of patients had an SCS>9. Comorbidity was fairly well correlated with age, ADL, IADL, and stage. Neither the CCI nor the SCS was related to survival (p: 0.47 and p: 0.24, log rank, respectively). Median survival was 326 days (95% CI, 259-393 days; or 10.8 months, 95% CI 8.6-13.1 months). Main cause of death was lung cancer disease progression (69.5%, 57 patients), with 20 patients (25%) dying of other non-neoplastic causes. Stage was significantly associated with survival (log rank: p<0.001). CONCLUSIONS Although there was a high prevalence of comorbidity in our population, comorbidity was not related to survival. Comorbidity is one of the main reasons for undertreatment of elderly lung cancer patients, but this study indicates that this undertreatment may not be warranted given that those comorbidities may not cause a patient's death. Our data generated more of a hypothesis than a conclusion. Comorbidity should be an impetus for treatment design instead of an exclusion criterion for oncologic treatment.
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Affiliation(s)
- Regina Gironés
- Medical Oncology Unit, Hospital Lluís Alcanyís, Xàtiva, Spain. girones
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Chemotherapy-associated toxicity in a large cohort of elderly patients with non-small cell lung cancer. J Thorac Oncol 2010; 5:90-8. [PMID: 19884853 DOI: 10.1097/jto.0b013e3181c0a128] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The objective of this study was to examine the risks for short-term (< or =3 months) and long-term (>3 months) chemotherapy-associated toxicities in a large population-based cohort of patients with non-small cell lung cancer from 1991 to 2002. METHODS The population consisted of 41,361 men and 30,804 women > or =65 years identified from the Surveillance, Epidemiology, and End Results-Medicare-linked database. The incidence of 50 toxicity-associated end points was calculated for 14 chemotherapy agents. Short- and long-term toxicities with a > or =2-fold increase in incidence compared with the no-chemotherapy group were defined as chemotherapy-associated toxicities. Hazard ratios and 95% confidence intervals for the risk of toxicity were calculated for the four most common chemotherapy agents for non-small cell lung cancer: cisplatin/carboplatin, paclitaxel, vinorelbine/vinblastine, and gemcitabine. RESULTS The most common short-term toxicities (9.2-60%) included acute anemia, nausea, and neutropenia. The most common long-term toxicities (15-37%) included acute anemia, respiratory failure, pulmonary fibrosis, dehydration, neutropenia, nausea, and fever. Multivariate analysis for selected chemotherapies demonstrated that after adjusting for other risk factors and confounders, some short-term toxicities became nonsignificant; however, almost all long-term toxicities remained significant. Long-term toxicity increased over time and was more likely in women, minority populations, those with fewer baseline comorbidities, and across disease stages. CONCLUSIONS The administration of various chemotherapy agents for non-small cell lung was associated with a number of short- and long-term toxicities. The projected survival benefits of chemotherapy must be weighed against the risk of long-term toxicities.
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