Impact of Age and Comorbidity on Treatment and Outcomes in Elderly Cancer Patients

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Cancer is a prevalent disease in elderly patients, who are also more likely to have comorbid illnesses than younger patients. Both increasing age and comorbidities are associated with a lower use of aggressive cancer therapies—including surgery, chemotherapy, and radiation therapy—but age is often the stronger determinant. A large proportion of elderly but otherwise healthy cancer patients do not receive aggressive treatments. Although there is an underrepresentation of elderly patients in clinical trials, the available evidence suggests that elderly patients can derive similar survival benefits from aggressive treatments as younger patients. For certain cancers and treatments, elderly patients may experience higher rates of toxicity and therefore require closer monitoring. Patients with comorbid illnesses have worse health-related quality of life at baseline but experience a similar health-related quality of life decline from treatment as healthier patients. However, patients with significant comorbidities are less likely to derive benefit from aggressive treatments. There is a need for studies to better identify, at baseline, patients who are likely to benefit from and tolerate aggressive treatment. A systematic use of sophisticated assessments, such as the geriatric assessment, may allow physicians to select appropriate patients and reduce underutilization of aggressive treatments in elderly cancer patients.

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Age and Comorbidity on Receipt of Aggressive Cancer Treatment

A significant proportion of elderly cancer patients do not receive curative-intent treatments.4, 8, 16, 17, 18, 19, 20 In an analysis of data from the Surveillance, Epidemiology, and End Results-Medicare linked database (SEER-Medicare), approximately 50% of Medicare patients with high-risk prostate cancer did not receive curative therapy concordant with published guidelines.21 Although early prostate cancers are often slow growing and could be followed conservatively, high-risk prostate cancer

Disease Control and Survival Outcomes from Aggressive Treatment in Elderly Cancer Patients

Several studies have examined the potential benefit of aggressive oncological treatments in elderly patients. In a randomized trial of patients aged 70 years or older with stage IIIB or IV non–small-cell lung cancer, patients were assigned to receive vinorelbine (Navelbine, Pierre Fabre Pharmaceuticals, Inc, France) alone versus polychemotherapy with vinorelbine and gemcitabine (Gemzar, Eli Lilly and Co, Indianapolis, IN).43 Polychemotherapy was associated with an improved overall survival

Age and Comorbidity on Treatment-Related Toxicity

Data are mixed regarding whether older patients experience increased treatment-related toxicity compared with younger patients. Pignon et al65 examined the acute and late toxicity from thoracic radiation therapy in a combined analysis of 1,208 lung and esophageal cancer patients treated on 6 European Organization for Research and Treatment of Cancer clinical trials. Patients were analyzed in age-groups ranging from <50 to >70 years. Age was not significantly associated with acute (including

Age and Comorbidity on Patient-Reported Outcomes and HRQOL

HRQOL is increasingly recognized as an important outcome following all forms of cancer treatment and provides patient-centered information that is complementary to physician-assessed toxicity.78, 79 Comorbidities adversely affect the quality of life of cancer patients. In a study of 195 cancer patients older than 60 years, Wedding et al80 measured HRQOL before initiation of chemotherapy. Patients with comorbidities had significantly lower baseline HRQOL, which persisted on multivariable

Summary and Knowledge Gaps

Multiple studies have demonstrated that elderly cancer patients are less likely to receive aggressive treatment, even those with little or no baseline comorbidity. The published literature suggests that in selected elderly patients, including those enrolled on clinical trials, aggressive treatment can provide similar disease control and survival benefit as that for younger patients. There is concern about potentially increased treatment-related toxicity and adverse quality of life effects in

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    Supported in part by a grant from the Doris Duke Charitable Foundation to the University of North Carolina at Chapel Hill to fund Clinical Research Fellow Trevor Royce, MS.

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