Adjuvant chemotherapy in older adults with non-small cell lung cancer

Platinum-based adjuvant chemotherapy is the standard of care for patients with early-stage non-small cell lung cancer (NSCLC) treated with surgery. There is a paucity of data regarding the appropriate use of adjuvant chemotherapy in the treatment of older adults. In the absence of prospective randomized controlled trials specific to this population, the available evidence is limited to post hoc analyses of prospective studies in age-unselected populations and retrospective reviews of population databases. The available evidence for treatment of older adults with adjuvant therapy using cisplatin- and carboplatin-based therapy is reviewed. Strategies for future research, as well as the role of geriatric assessment in risk stratification, will be addressed.

The value of geriatric assessments in predicting treatment tolerance and all-cause mortality in older patients with cancer

BACKGROUND

Awareness of the use of geriatric assessments for older patients with cancer is increasing. The aim of this review is to summarize all available evidence on the association between geriatric assessments and relevant oncologic outcomes.

METHOD

A systematic search was conducted in Medline and Embase of studies on geriatric assessment in oncology, focusing on the association between baseline assessment and outcome.

RESULTS

The literature search identified 2008 reports; 51 publications from 37 studies were selected for inclusion in the review. The quality of studies was heterogeneous and generally poor. A median of five geriatric conditions were assessed per study (interquartile range: 4-8). Little consistency was found in the results of the studies. Furthermore, different tools appear to be predictive depending on the outcome measure: frailty, nutritional status, and comorbidity assessed by the Cumulative Illness Rating Scale for Geriatrics were predictive for all-cause mortality; frailty was predictive for toxicity of chemotherapy; cognitive impairment and activities of daily living impairment were predictive for chemotherapy completion; and instrumental activities of daily living impairment was predictive for perioperative complications.

CONCLUSION

Although various geriatric conditions appear to be of some value in predicting outcome in elderly patients with cancer, the results are too inconsistent to guide treatment decisions. Further research is needed to elucidate the role of geriatric assessments in the oncologic decision-making process for these patients.