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    Adverse events among the elderly receiving chemotherapy for advanced non-small-cell lung cancer

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    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.
    Show allShow less
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2009-12-30
    Keywords
    Adenocarcinoma
    Aged
    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
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    Link to Full Text
    http://dx.doi.org/10.1200/JCO.2009.23.8485
    Abstract
    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 site
    DOI
    10.1200/JCO.2009.23.8485
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/46919
    PubMed ID
    20038726
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1200/JCO.2009.23.8485
    Scopus Count
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    Population and Quantitative Health Sciences Publications

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