“Patients aged 65 years and older are living longer after lung cancer surgery, and with older people representing a rapidly growing proportion of patients diagnosed with lung cancer, this improved survival is especially significant, according to an article posted online today by The Annals of Thoracic Surgery.
“The American Cancer Society estimates that the median age at diagnosis for lung cancer is 70, supporting the premise that lung cancer is predominantly a disease of the elderly. Despite this, older patients with cancer are generally under-represented in clinical cancer trials, including those for lung cancer. This makes the study by Felix G. Fernandez, MD, from the Emory Clinic in Atlanta, and colleagues particularly important.”
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“Chemoradiotherapy (CRT) is associated with survival benefit over chemotherapy (CT) alone for elderly patients with limited-stage small-cell lung cancer, according to a study published online Oct. 19 in the Journal of Clinical Oncology.
“Christopher D. Corso, M.D., Ph.D., from the Yale University School of Medicine in New Haven, Conn., and colleagues examined outcomes for elderly patients (≥70 years) treated with CT versus CRT. Data were included for 8,637 patients with limited-stage small-cell lung cancer in the National Cancer Data Base between 2003 and 2011.
“The researchers found that 43.7 and 56.3 percent of the patients received CT and CRT, respectively. CRT receipt was less likely with increasing age, clinical stage III disease, female sex, and the presence of medical comorbidities (all P < 0.01). Compared with CT, CRT use correlated with increased overall survival on univariate and multivariate analysis (median overall survival, 15.6 versus 9.3 months). Survival benefit associated with CRT was confirmed in a propensity score-matched cohort of 6,856 patients (hazard ratio, 0.52; P < 0.001). In subset analysis, patients who were alive at four months after diagnosis had a survival benefit with concurrent versus sequential CRT (median overall survival, 17.0 versus 15.4 months; log-rank P = 0.01).”
“Alternative medicines are widely thought to be at least harmless and very often helpful for a wide range of discomforts and illnesses. However, although they’re marketed as ‘natural,’ they often contain active ingredients that can react chemically and biologically with other therapies. Researchers performed a comprehensive review of all of the medications taken by senior oncology patients and found that as 26 percent were using complementary or alternative medicines (CAM), in a report published August 12th, in the Journal of Geriatric Oncology.
“ ‘Currently, few oncologists are aware of the alternative medicines their patients take,’ said Ginah Nightingale, PharmD, an Assistant Professor in the Jefferson College of Pharmacy at Thomas Jefferson University. ‘Patients often fail to disclose the CAMs they take because they think they are safe, natural, nontoxic and not relevant to their cancer care, because they think their doctor will disapprove, or because the doctor doesn’t specifically ask.’ “
“In a position statement published online July 20 in the Journal of Clinical Oncology, the American Society of Clinical Oncology has called on the U.S. government and the cancer research community to broaden clinical trials to include older adults.
” ‘Older people living with cancer often have different experiences and outcomes in their treatment than younger cancer patients,’ Julie Vose, M.D., M.B.A., society president, said in a news release from the group. ‘As we age, for example, the risk of adverse reactions from treatment significantly increases. Older adults must be involved in clinical trials so we can learn the best way to treat older cancer patients, resulting in improved outcomes and manageable toxicity,’ she explained.
“More than 60 percent of cancers in the United States occur in people aged 65 and older, the statement authors say, noting the number of seniors will increase in coming years. However, there is a lack of evidence about cancer treatments for the elderly because too few are included in clinical trials, and clinical trials designed specifically for seniors are rare.”
“The prevalence of polypharmacy, excessive polypharmacy and potentially inappropriate medicine use was high among senior patients with cancers, according to results of a pharmacist-led comprehensive medication assessment.
“ ‘Older adults with cancer are particularly prone to medication errors attributed to medication changes, complex regimens and incomplete information handoff between providers,’ Ginah Nightingale, PharmD, BCOP, assistant professor in the department of pharmacy practice of the Jefferson School of Pharmacy at Thomas Jefferson University, and colleagues wrote. ‘Polypharmacy and potentially inappropriate medication use warrant substantial interest and concern on behalf of medical oncologists and oncology health providers because of the perils associated with their use in this vulnerable population.’ “
“A retrospective study found that early-stage non–small-cell lung cancer (NSCLC) patients over 70 years old derive a similar benefit as younger patients from adjuvant chemotherapy following surgical resection. This suggests that age should not preclude patients from receiving adjuvant chemotherapy.
“ ‘Studies conducted in the last decade have provided evidence that adjuvant chemotherapy after surgical resection improves outcomes for patients with resected stages II and IIIA disease and selected patients with stage I (large tumor size) NSCLC,’ wrote study authors led by Apar Kishor Ganti, MD, of the University of Nebraska Medical Center in Omaha. These studies, however, have not focused specifically on elderly patients, and NSCLC has a median age of 70 years at diagnosis.
“The new study was a population-based retrospective review of 7,593 patients with stage IB to stage III NSCLC who underwent surgical resection; 2,897 (38%) were aged at least 70 years. Results of the study were published online ahead of print in Cancer.
“Among the younger patients, 31.6% received adjuvant chemotherapy, while only 15.3% of the older patients received this treatment (P .0001). Both groups saw changes in rates of adjuvant chemotherapy over time, though of different magnitudes: 9.3% of younger patients diagnosed between 2001 and 2003 received adjuvant chemotherapy, which rose by 27.8% by 2009 to 2011. In older patients, the rate was 4.5% in the earlier period and increased by 16.0%. The most common chemotherapy option used in all patients (64.6%) was carboplatin-based doublets.”
“Overmedicating senior cancer patients has become an area of concern for many in the medical community. Instead of strictly blaming healthcare professionals for their lack of oversight, experts point to the failures of available medication management tools.
“Researchers reviewed drug regimens of 234 senior oncology patients and found that 43% of them were taking more than 10 medications at once. They also learned that 51% of study participants were taking potentially inappropriate medications. The report’s findings were published in the Journal of Clinical Oncology (JCO).
“Study participants were seen by an interprofessional healthcare team, which consists of a medical oncologist, geriatrician, clinical pharmacist, social worker and dietician. Researchers used several evaluation tools on patients: the Beers criteria list, the STOPP survey and the HEDIS criteria. Each of which were designed to identify medications with a higher risk of causing adverse events in seniors. According to the report’s authors, these three screening tools were used because they represent the ‘most current, evidence-based, clinically validated criteria in the literature.’ “
“Adjuvant chemotherapy may improve survival for older patients with stage I non–small cell lung cancer, according to an analysis of the SEER–Medicare database.
“However, the regimen also is associated with serious adverse events, according to an analysis of the SEER-Medicare database.
“Weighing the risks vs. benefits of adjuvant chemotherapy is more difficult in older patients, as they have a greater risk for disease recurrence after surgical resection but also have a more limited life expectancy.
“Jyoti Malhotra, MD, of the department of hematology and oncology at Tisch Cancer Institute at Icahn School of Medicine at Mount Sinai, and colleagues conducted a population-based study to compare survival and rates of serious adverse events among elderly patients with T2N0 NSCLC. The analysis included 3,289 patients aged older than 65 years who were treated between 1992 and 2009. All patients had tumors at least 4 cm, and they underwent surgical resection followed by either observation or adjuvant platinum chemotherapy with or without postoperative radiation.”
“The addition of whole-breast irradiation to breast-conserving surgery conferred a modest but statistically significant reduction in risk for ipsilateral breast tumor recurrence among women aged 65 years or older, according to phase 3 study results.
“However, researchers observed a low risk for ipsilateral breast tumor recurrence among all women in the study, regardless of whether they received whole-breast radiotherapy. That finding suggests radiotherapy may be safely avoided in some patients, researchers wrote.
“Ian H. Kunkler, MD, of the department of clinical oncology at Edinburgh Cancer Centre at Western General Hospital, and colleagues evaluated data from 1,326 women aged 65 years or older who had low-risk breast cancer (median age, 70 years; interquartile range [IQR], 67-74). All women underwent breast-conserving surgery and received adjuvant endocrine therapy.”