Don’t ignore the elderly when it comes to giving chemotherapy after lung cancer surgery, new research suggests.
“Adjuvant chemotherapy can be given safely to elderly patients and, despite receiving less chemo, elderly patients clearly derive a substantial survival benefit from this treatment,” study author Dr. Carmela Pepe said Friday during a press conference on the opening day of the American Society of Clinical Oncology annual meeting, in Atlanta. “Adjuvant chemotherapy should not be withheld from elderly patients on the basis of age alone.”
But some cancer treatments may go too far. A second study featured at the meeting found continuation of a trend begun in the early 1990s: Aggressive treatment for cancer patients may persist up to two weeks before death.
Platinum-based chemotherapy after surgery for early lung cancer is now the standard of care, with one trial showing a 15 percent survival benefit.
But experts say the role of chemotherapy in elderly patients has not been well-studied, even though they bear a disproportionate burden of this disease.
“Little is known about how well elderly patients tolerate chemotherapy,” Pepe confirmed.
Physicians may also have a tendency to think older patients won’t tolerate standard therapies. “There is a perception of a higher risk of treatment in older patients,” said press conference moderator Dr. Yolanda Colson, of Brigham & Women’s Hospital in Boston.
To fill in the knowledge gap, Pepe, of Princess Margaret Hospital in Toronto, conducted a retrospective review of 327 lung cancer patients aged 65 or younger and 155 lung cancer patients who were older than 65. The patients had participated in a landmark study of adjuvant chemotherapy.
Virtually none of the patients received the full schedule of chemotherapy, with the older group receiving even fewer doses than their younger counterparts. The dose intensity was also significantly less for the elderly participants.
There were no differences in side effects between the two groups, and only one chemotherapy-related death per age group.
In the younger group, patients taking chemotherapy had 12 percent better overall survival odds, which was not considered statistically significant. Older participants taking chemotherapy, however, had a 20 percent overall survival benefit, which Pepe characterized as “striking.”
“This is important data,” said Dr. Corey Langer, medical director of thoracic oncology at Fox Chase Cancer Center, in Philadelphia. “Overall survival for the elderly is cracking right along. Chemotherapy should not be arbitrarily withheld.”
At the same time, there are some older patients who are more frail and who need to be looked at separately, Langer added.
“Doctors need to realize that older patients can still benefit,” he said. “By the same token, they need to be forewarned that we don’t have much data for people 75 and over.”
More studies need to be done in patients over the age of 75 before any conclusions can be drawn, Pepe agreed.
The second study, out of Harvard Medical School and Dana-Farber Cancer Institute, found that the trend toward increased use of chemotherapy and intensive hospital treatment for cancer patients at the end of life continued into the late 1990s.
Researchers had first noted a move toward more aggressive cancer treatment in the early 1990s. After looking at Medicare records for more than 200,000 patients, the Harvard investigators confirmed the practice has continued. In 1993, nearly 10 percent of cancer patients were given chemotherapy in the final two weeks of their lives. By 1999, that had risen to 12 percent, the Associated Press reported.
“Patients are significantly more likely to be receiving chemotherapy within 14 days of the end of life,” said study author Dr. Craig C. Earle, of Dana-Farber Cancer Institute.
And while there are considerable regional variations, the “reliability [of the data] over time suggests these are stable properties of the health system,” he added.