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."
-end-
"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.

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