Overall Health, Not Just Age, is an Important Factor in Treatment of Non-Small Cell Lung Cancer
Younger patients with non-small cell lung cancer (NSCLC) are more likely to receive treatment than older patients, regardless of overall health and prognosis, according to the results of a study published in the Journal of Clinical Oncology.
Lung cancer remains the leading cause of cancer death in the United States. Non–small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancers.
Many NSCLC cases occur in people over the age of 65, but there is limited information about how best to treat older patients coupled with concern that older patients will not be able to tolerate aggressive treatment. As a result older patients sometimes do not receive treatment that might be of benefit; for example, older patients may be treated with single-agent chemotherapy rather than the combination chemotherapy that is commonly used in younger patients.
Previous research has indicated that older patients with NSCLC who are otherwise healthy can benefit from treatment, while those with comorbidities—or other severe illnesses—are more vulnerable to the toxicity of cancer treatments and therefore less likely to tolerate and complete a course of treatment.
To examine the effects of comorbidity and age on treatment outcomes, researchers used data from the Veterans Affairs (VA) Central Cancer Registry to analyze treatment and outcomes from more than 20,000 veterans over age 65 with NSCLC. They found that regardless of stage of cancer, treatment rates decreased more in association with older age than with comorbidity.
Younger patients—those between the ages of 65 to 74—were more likely to receive treatment, regardless of comorbidity status. In other words, those who were severely ill—and thus less likely to benefit and more likely to be harmed—received treatment at approximately the same rate as patients in the same age range who were not severely ill. In contrast, older patients—those between the ages of 75 and 84—were less likely to receive treatment, even if they had no comorbidities and a better prognosis.
The researchers concluded that physicians appear to base treatment strictly on age, while overlooking other factors. A patient’s overall state of health is an important factor when determining treatment. An otherwise healthy 75-year-old may tolerate treatment well, whereas a severely ill 65-year-old may not. In short, treatment decisions must be individualized rather than based strictly on age in order to target NSCLC treatment to older patients who may benefit.
Wang S, Wong ML, Hamilton N, et al: Impact of age and comorbidity on non-small-cell lung cancer treatment in older veterans. Journal of Clinical Oncology. 2012; 30(13): 1447-1455.
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