Adverse events among the elderly receiving chemotherapy for advanced non-small-cell lung cancer
Authors
Chrischilles, Elizabeth A.Pendergast, Jane F.
Kahn, Katherine L.
Wallace, Robert B.
Moga, Daniela C.
Harrington, David P.
Kiefe, Catarina I.
Weeks, Jane C.
West, Dee W.
Zafar, S. Yousuf
Fletcher, Robert H.
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2009-12-30Keywords
AdenocarcinomaAged
Antineoplastic Combined Chemotherapy Protocols
Carcinoma, Non-Small-Cell Lung
Carcinoma, Squamous Cell
Cohort Studies
Female
Follow-Up Studies
Humans
Lung Neoplasms
Male
Middle Aged
Neoplasm Staging
Prognosis
Prospective Studies
Survival Rate
Treatment Outcome
Bioinformatics
Biostatistics
Epidemiology
Health Services Research
Metadata
Show full item recordAbstract
PURPOSE: To describe chemotherapy use and adverse events (AEs) for advanced-stage, non-small-cell lung cancer (NSCLC) in community practice, including descriptions according to variation by age. METHODS: We interviewed patients with newly diagnosed, stages IIIB and IV NSCLC in the population-based cohort studied by the Cancer Care Outcomes Research and Surveillance Consortium, and we abstracted the patient medical records. AEs were medical events occurring during chemotherapy. Using logistic regression, we assessed the association between age and chemotherapy; with Poisson regression, we estimated event rate ratios and adjusted the analysis for age, sex, ethnicity, radiation therapy, stage, histology, and presence and grade of 27 comorbidities. RESULTS: Of 1,371 patients, 58% (95% CI, 55% to 61%) received chemotherapy and 35% (95% CI, 32% to 38%) had AEs. After adjustment, 72% (95% CI, 65% to 79%) of those younger than 55 years and 47% (95% CI, 42% to 52%) of those age 75 years and older received chemotherapy. Platinum-based therapies were less common in the older-age groups. Pretreatment medical event rates were 18.6% for patients younger than 55 years and were only 9.2% for those age 75 years and older (adjusted rate ratio, 0.49; 95% CI, 0.26 to 0.91). In contrast, older adults were more likely to have AEs during chemotherapy. The adjusted rate ratios compared with age younger than 55 years were 1.70 for 65- to 74-year-olds (95% CI, 1.19 to 2.43) and 1.34 for those age 75 years and older (95% CI, 0.90 to 2.00). CONCLUSION: Older patients who received chemotherapy had fewer pretherapy events than younger patients and were less likely to receive platinum-based regimens. Nevertheless, older patients had more adverse events during chemotherapy, independent of comorbidity. Potential implicit trade-offs between symptom management and treatment toxicity should be made explicit and additionally studied.Source
J Clin Oncol. 2010 Feb 1;28(4):620-7. Epub 2009 Dec 28. Link to article on publisher's siteDOI
10.1200/JCO.2009.23.8485Permanent Link to this Item
http://hdl.handle.net/20.500.14038/46919PubMed ID
20038726Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1200/JCO.2009.23.8485