Elderly/Long-Term Care

Elderly lung cancer patients experience more adverse events during chemotherapy than younger patients

Non-small-cell lung cancer (NSCLC) is primarily a disease of older persons, with 47 percent of patients being at least 70 years or older at the time of diagnosis. NSCLC causes 80 percent of lung cancer deaths and in one-half of such cases, the cancer has spread to other organs by the time of diagnosis. Chemotherapy can improve survival for NSCLC patients and it may have acceptable adverse event (AE) rates. However, a new study shows that elderly patients suffer more AEs than younger patients.

In the study of 1,371 patients with advanced NSCLC, 72 percent of those younger than 55 received chemotherapy, while only 47 percent of those aged 75 and older received chemotherapy. Older patients were more likely to experience AEs during treatment than younger patients. The highest AE incidence was among 65- to 74-year-olds, who suffered nearly twice as many AEs as patients 55 and younger. For the subset of AEs particularly related to chemotherapy use—neuropathy (disturbed nerve function), fever with neutropenia (low white cell count, predisposing one to infection), and sepsis—the highest rates were also observed in the 65 to 74 age category. By contrast, pretreatment AE rates were lower among those 75 and older (9.2 percent) than among those 55 and younger (18.6 percent). This probably reflected selection of the fittest elders for treatment. An unanswered question is whether the increased AEs associated with chemotherapy among the oldest patients were offset by improvement in their disease symptoms to provide a net positive effect on quality of life.

The researchers conclude that the tradeoff between the increased AEs associated with chemotherapy and reduced disease-related symptoms is a prime example of the need to include patient preferences in medical decisionmaking. This study was supported in part by the Agency for Healthcare Research and Quality (HS16094).

See "Adverse events among the elderly receiving chemotherapy for advanced non-small-cell lung cancer," by Elizabeth A. Chrischilles, M.S. Ph.D., Jane F. Pendergast, Ph.D., Katherine I. Kahn, M.D., and others in the February 1, 2010, Journal of Clinical Oncology 28(4), pp. 620-627.

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