New studies demonstrate importance of offering range of treatment options to elderly cancer patients

August 28, 2003

Two new studies show that elderly patients can benefit from, and are willing to consider, aggressive treatment for certain types of cancer. These findings underscore the importance of offering the full range of treatment options to cancer patients, regardless of age. They also contrast with earlier studies suggesting unwillingness among some elderly patients to consider aggressive chemotherapy.

Elderly and Younger Lung Cancer Patients Benefit Equally From Combined Chemotherapy and Radiation Treatment

The first study, led by Steven Schild, MD, and colleagues at the Mayo Clinic in Scottsdale, Arizona and the North Central Cancer Treatment Group (NCCTG) examined concerns about toxicity and survival that often keep cancer doctors from offering aggressive therapy to older patients with Stage III non-small cell lung cancer (NSCLC).

"Fit elderly patients need not simply be relegated to palliative therapy or no therapy just because they are older than 70," said Dr. Schild. "These patients should be fully briefed on the range of treatment options, including potential risks and benefits."

In a retrospective analysis of a Phase III trial, this study compared outcomes of otherwise healthy NSCLC patients aged 70 years and older who received a combination of chemotherapy and radiation to outcomes of younger patients who received the same treatment.

The elderly patients in the study experienced more side effects from the combined modality therapy, especially myelosuppression (suppression of the bone marrow's production of blood cells and platelets) and pneumonia, than the younger individuals.

However, no significant difference in survival rates was found between the two groups. The two-year survival rates were 39 percent among patients younger than 70, and 36 percent among the elderly patients. The five-year survival rates among younger patients and elderly patients were 18 percent and 13 percent, respectively.

The study authors conclude that fit elderly patients with locally advanced non-small-cell lung cancer should be encouraged to receive aggressive therapy, despite their age.

Older American and European Cancer Patients Willing to Undergo Aggressive Treatment

The second study, led by Martine Extermann, MD, Assistant Professor of Oncology and Medicine at the University of South Florida and Moffitt Cancer Center in Tampa, Florida, examined the common perception in the medical community that older cancer patients - especially Europeans - are unwilling to undergo aggressive chemotherapy.

"There's a common belief that older European patients are not as aggressive about accepting cancer treatment as older American patients," said Dr. Extermann. "This issue is increasingly important, given the high rate of cancer among the elderly and the fact that counseling by physicians is often influenced by assumptions about a patient's willingness to undergo various treatments."

The study interviewed 320 participants aged 70 years and older via anonymous questionnaires. Participants were separated into four groups: French cancer and non-cancer patients and American cancer and non-cancer patients.

Participants were asked to consider a strong chemotherapy regimen and a milder chemotherapy regimen, along with their expected side effects, under varying chances of cure, prolongation of survival and symptom relief. Participants were then asked to define the minimum benefit for which they would accept chemotherapy.

The study found that elderly cancer patients in both countries were equally willing to consider treatment, although older French non-cancer patients were more reluctant to consider chemotherapy than older American non-cancer patients.

Thirty-four percent of French non-cancer patients were willing to accept strong chemotherapy, compared with 77.8 percent of French cancer patients, 73.8 percent of American non-cancer patients, and 70.5 percent of American cancer patients. Similar results were found for the milder regimen of chemotherapy. Study authors noted that on average, the participants' expected benefit of both chemotherapy regimens - in terms of symptom relief, curing the cancer or prolonging survival - was high, in many cases unrealistically so, despite a wide range of responses.

Given the patients' willingness to consider chemotherapy, the authors underscored the importance of presenting the full range of treatment options to all older cancer patients.

"Older cancer patients, whether French or American, are equally willing to consider the option of chemotherapy," said Dr. Extermann. "Given these findings, physicians should discuss all available treatment options with their patients, while managing expectations about the potential risks and benefits of treatment."
"The Outcome of Combined Modality Therapy for Stage III Non-Small-Cell Lung Cancer in the Elderly." Steven Schild, M.D. et al.; Mayo Clinic. Vol 21, No 17 (September 1), 2003, pp 3201-3206.

"Are Older French Patients As Willing As Older American Patients to Undertake Chemotherapy?" Martine Extermann, M.D., et al.; Moffitt Cancer Center. Vol 21, No 17 (September 1), 2003, pp 3214-3219.

The Journal of Clinical Oncology is the semi-monthly peer-reviewed journal of the American Society of Clinical Oncology (ASCO), the world's leading professional society representing physicians who treat people with cancer.

ATTRIBUTION TO THE JOURNAL OF CLINICAL ONCOLOGY IS REQUESTED IN ALL NEWS COVERAGE. For the full text of any JCO article call 703-519-1423 or 212-584-5014.

The JCO News Digest is also distributed via email. Please let us know if you would like to be added to our email distribution list.

American Society of Clinical Oncology

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to