“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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“Older women with early-stage, invasive breast cancer had better survival rates than what was estimated by a popular online tool for predicting survival, according to researchers at the Duke Cancer Institute.
“The finding provides a stronger rationale for women over the age of 70 — even those who have additional minor health concerns — to undergo aggressive treatments such as chemotherapy to prevent their cancer from returning.
“ ‘When making decisions about whether or not to use potentially toxic preventive chemotherapy for breast cancer in older women, patients and doctors debate what they should do,’ said Gretchen Kimmick, M.D., M.S., an associate professor of medicine at Duke who is presenting the study findings at the San Antonio Breast Cancer Symposium. ‘This predictive model can help us show patients that they are going to survive long enough to see the benefit of treatment.’ “
“Adjuvant radiation therapy (RT) after lumpectomy for elderly women with early stage triple negative breast cancer (TNBC) improved overall survival (OS) and disease specific survival (DSS), a retrospective analysis of cases from the Surveillance, Epidemiology, and End Result (SEER) database has shown.
“The review showed that adjuvant radiation was associated with an overall six-fold decrease in any death, as well as death from breast cancer, Sean Szeja, MD, of The University of Texas Medical Branch at Galveston, and colleagues reported in a poster session at the American Society of Clinical Oncology (ASCO) Breast Cancer Symposium (Sept. 25-27).
“Some 23 months after diagnosis, 98.2% of women who received lumpectomy and radiation were alive, compared with 85.6% of those who received lumpectomy alone, the investigators said. In addition, the analysis revealed that breast cancer-related deaths were more common in the lumpectomy only group (6%) compared with the lumpectomy and radiation group (1%).”
“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.”
“Three out of four older men with low-risk prostate cancer opted for active surveillance during a 4-year period ending in 2013, according a large prostate cancer database.
“After bottoming out at 22% during 2000 through 2004, active surveillance was the initial option for newly diagnosed low-risk prostate cancer among men 75 or older from 2010 through 2013.
“Rates of active surveillance among men of all ages mirrored those of the older subgroup but remained much lower overall. From 1990 through 2009, the proportion of men in the 10,472-patient cohort entering active surveillance ranged from 6.7% to 14.3%. The rate increased sharply from 2010 to 2013, topping out at 40.4%, as reported online in JAMA.
” ‘In this analysis of a longstanding national registry, we found that after years of overtreatment for patients with low-risk prostate cancer, rates of active surveillance/watchful waiting for low-risk disease increased sharply in 2010 through 2013,’ Matthew R. Cooperberg, MD, and Peter R. Carroll, MD, of the University of California San Francisco, wrote in conclusion.”
“In a single institution study reported in JAMA Surgery, Chung et al found a low axillary recurrence rate and low mortality among women with clinical T1–2N0 breast cancer aged ≥ 70 years who underwent breast-conserving surgery without sentinel node biopsy.
“The study involved 140 women treated at Cedars-Sinai Medical Center between January 2000 and December 2011. Patients had a median age of 83 years (range = 70–97 years); 74% had T1 tumors; 27% had grade 1, 44% grade 2, and 29% grade 3 tumors; 86% were estrogen receptor–positive; 73% were progesterone receptor–positive; 92% were HER2-negative; and 65% had ductal histology. Overall, 98% received chemotherapy, 76% radiotherapy, and 59% hormonal therapy…
“The investigators concluded: ‘Our study demonstrated low axillary recurrence and low mortality for patients with clinical T1–2N0 breast cancer who were 70 years of age or older and who underwent breast-conserving surgery without a sentinel node biopsy.’ “
“Some older women with breast cancer could safely avoid radiotherapy, without harming their chances of survival, a study has shown.
“Older women with early breast cancer who are given breast-conserving surgery and hormone therapy gain very modest benefit from radiotherapy, researchers say.
“The findings suggest that a carefully defined group of patients who are at low risk of recurrence could avoid the health risks and side effects associated with radiotherapy, such as fatigue and cardiac damage.
“Currently older women with early hormone-sensitive breast cancer are offered surgery to remove their tumour, followed by hormone treatment and radiotherapy. Few trials have assessed the benefits of radiotherapy in older women treated by breast-conserving surgery.”
“Adding radiation treatment to hormone therapy saves more lives among older men with locally advanced prostate therapy than hormone therapy alone, according to a new study in the Journal of Clinical Oncology this week from Penn Medicine researchers.
“The researchers found that hormone therapy plus radiation reduced cancer deaths by nearly 50 percent in men aged 76 to 85 compared to men who only received hormone therapy. Past studies have shown that 40 percent of men with aggressive prostate cancers are treated with hormone therapy alone, exposing a large gap in curative cancer care among baby boomers aging into their 70s.
” ‘Failure to use effective treatments for older patients with cancer is a health care quality concern in the United States. Radiation plus hormone therapy is such a treatment for men with aggressive prostate cancers,’ said lead author Justin E. Bekelman, MD, an assistant professor of Radiation Oncology, Medical Ethics and Health Policy at Penn’s Perelman School of Medicine and Abramson Cancer Center. ‘Patients and their physicians should carefully discuss curative treatment options for prostate cancer and reduce the use of hormone therapy alone.’ “
“A new analysis has found that while clinical trial data support omitting radiation treatments in elderly women with early stage breast cancer, nearly two-thirds of these women continue to receive it. The findings are published early online in Cancer, a peer-reviewed journal of the American Cancer Society.
“Results published in 2004 from a large, randomized clinical trial showed that adding radiation therapy to surgery plus tamoxifen does not reduce 5-year recurrence rates or prolong survival in elderly women with early stage tumors. Despite the findings, many doctors still administer radiation to these patients.
“To examine the extent to which elderly women still receive radiation to treat early stage breast cancer, Rachel Blitzblau, MD, PhD, of Duke University, and her colleagues analyzed information from the nation’s largest cancer registry, the Surveillance, Epidemiology and End-Results (SEER) database. The investigators identified 40,583 women older than 70 years of age who were treated with lumpectomy from 2000 to 2009. From 2000 to 2004, before the trial results were published, 68.6% of patients received some form of radiation therapy. From 2005 to 2009, 61.7% of patients received such treatment, although there was a shift in the type of radiation therapy used: fewer patients received standard whole breast radiation, and more received a short course of focused radiation treatment. The results indicate that publication of the trial results had only a very small impact on practice patterns.”