Ageism in the management of lung cancer

Peake, Michael; Thompson, Sandy; Lowe, Derek; Pearson, M

doi:10.1093/ageing/32.2.171

Cited by 128 publications

(88 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our results on investigations and referral agree with other reports that have found that patients are less likely to be investigated or treated for cancer if they are elderly (e.g., Turner et al, 1999;Peake et al, 2003;Bouchardy et al, 2007). However, most other studies are hospital based and do not investigate what happens in primary care.…”

Section: Discussionsupporting

confidence: 90%

Are GPs under-investigating older patients presenting with symptoms of ovarian cancer? Observational study using General Practice Research Database

2010

View full text Add to dashboard Cite

Background: Recent studies suggest that older patients in the United Kingdom are not benefiting as much from improvements in cancer treatments as their younger counterparts. We investigate whether this might be partly due to differential referral rates using ovarian cancer as an example. Methods: From the General Practice Research Database (GPRD), we identified all women aged 40–80 years on 1 June 2002 with a Read code for ovarian cancer between 1 June 2002 and 31 May 2007. Using these records, we compared the GPRD incidence of ovarian cancer with rates compiled from the UK cancer registries and investigated the relationship between age and coded investigations for suspected ovarian cancer. Results: The GPRD rates peaked earlier, at 70–74, and were lower than registry rates for nearly all ages particularly for patients over 59. The proportion investigated or referred by the GP decreased significantly with age and delays between first coded symptom and investigation showed a U-shaped distribution by age. Conclusions: GPs appear to be less likely to recognise and to refer patients presenting with ovarian cancer as they get older. If our findings extend to other cancers, lack of or delays in referral to secondary care may partly explain poor UK cancer mortality rates of older people.

show abstract

Section: Discussionsupporting

confidence: 90%

Are GPs under-investigating older patients presenting with symptoms of ovarian cancer? Observational study using General Practice Research Database

2010

View full text Add to dashboard Cite

show abstract

“…22,23 Although the prognosis of untreated patients is poor, 19 the mortality and morbidity of surgery, combined with the poor results from conventional radiotherapy, led to the widespread perception among patients and physicians that advanced age combined with the presence of comorbidities is a reason to defer from curative treatment. 24,25 Recent publications have reported local control rates for SRT that are in the range reported with surgery; and, notably for a patient cohort with considerable comorbidities, SRT is associated with a low incidence of grade !3 toxicity (Table 3). 5,26,27 Our results in 193 patients aged !75 years indicate that SRT is well tolerated even in patients with significant comorbidity.…”

Section: Discussionmentioning

confidence: 99%

Stage I nonsmall cell lung cancer in patients aged ≥75 years

Haasbeek

Lagerwaard

Antonisse

et al. 2009

Cancer

163

View full text Add to dashboard Cite

BACKGROUND:The number of patients aged !75 years who present with a stage I nonsmall cell lung cancer (NSCLC) is increasing. Elderly patients often have significant comorbidity and may be unfit for surgery. Furthermore, surgery in the elderly is associated with increased mortality and morbidity. In this study, the authors evaluated the outcomes of stereotactic radiotherapy (SRT) in elderly patients. METHODS: Since 2003, 203 tumors in 193 patients aged !75 years were treated using SRT (118 T1 tumors, 85 T2 tumors). The median patient age was 79 years, 80% of patients were considered medically inoperable, and 20% of patients declined surgery. The median Charlson comorbidity score was 4, and severe chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease Class III or greater) was present in 25% of patients. Risk-adapted SRT schemes were used with the same total dose of 60 grays in 3 fractions (33%), 5 fractions (50%), or 8 fractions (17% of patients), depending on the patient's risk for toxicity. RESULTS: SRT was well tolerated, and all but 1 patient completed treatment. Survival rates at 1 year and 3 years were 86% and 45%, respectively. Survival was correlated with performance score (P ¼ .001) and pre-SRT lung function (P ¼ .04). The actuarial local control rate at 3 years was 89%. Acute toxicity was uncommon, and late Radiation Therapy Oncology Group grade !3 toxicity was observed in <10% of patients. CONCLUSIONS: SRT achieved high local control rates with minimal toxicity in patients aged !75 years despite their significant medical comorbidities. These results indicated that more active diagnostic and therapeutic approaches are justified in elderly patients and that SRT should be considered and discussed as a curative treatment alternative. Cancer 2010;116:406-14.

show abstract

“…29,30 Our study undermines this practice and supports standard definitive treatment for the elderly with good performance status. Predicted risk of Grade ≥3 Esophagitis at seven different D2cc doses as a function of age for a hypothetical patient who is assumed to be a never smoker with a KPS of 85, who is receiving concurrent chemotherapy.…”

Section: Discussionmentioning

confidence: 64%

Lower Incidence of Esophagitis in the Elderly Undergoing Definitive Radiation Therapy for Lung Cancer

Soni

Boonstra

Schipper

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

Introduction-The majority of lung cancer patients are elderly and poorly represented in randomized clinical trials. They are often undertreated due to concerns about their ability to tolerate aggressive treatment. We tested the hypothesis that elderly patients undergoing definitive lung radiation might tolerate treatment differently from younger patients.Methods-125 patients who underwent definitive lung radiotherapy were identified from a prospective institutional database (UM cohort). Logistic regression modelling was performed to assess the impact of age on esophagitis grade ≥3 or ≥2 and pneumonitis grade ≥3 or ≥2, adjusting for esophageal and lung dose respectively, chemotherapy utilization, smoking status, and performance status. The analysis was validated in a large cohort of 691 patients from the Michigan Radiation Oncology Quality Consortium (MROQC) registry, an independent statewide prospective database.Results-In the UM Cohort, multivariable regression models revealed a significant inverse correlation between age and rate of esophagitis for both toxicity levels, (adjusted odds ratio=0.93 for both models, 95% confidence intervals of (0.88,0.98) and (0.87,0.99)), with AUC of 0.747 and 0.721, respectively, demonstrating good fit. This same association was noted in the MROQC cohort. There was no significant association between age and pneumonitis.Conclusions-There is a lower incidence of esophagitis with increasing age even after adjusting for use of chemotherapy. This is a novel finding in thoracic oncology. No age dependence was

show abstract

Ageism in the management of lung cancer

Cited by 128 publications

References 26 publications

Are GPs under-investigating older patients presenting with symptoms of ovarian cancer? Observational study using General Practice Research Database

Are GPs under-investigating older patients presenting with symptoms of ovarian cancer? Observational study using General Practice Research Database

Stage I nonsmall cell lung cancer in patients aged ≥75 years

Lower Incidence of Esophagitis in the Elderly Undergoing Definitive Radiation Therapy for Lung Cancer

Contact Info

Product

Resources

About