Is age a barrier to chemotherapy? Rates of treatment in older patients with breast, colon or lung cancer in England in 2014: A national registry study

Battisti, Nicolò Matteo Luca; Wallington, Michael; Ring, Alistair; Payne, Susan N.; Birch, Rebecca; Bomb, Martine; Seligmann, Jenny F.; Kalsi, Tania; Hounsome, Luke; Underhill, Stuart; Mensah, Laverne; Morris, Eva; Selby, Peter J.; Mansi, Janine

doi:10.1093/annonc/mdy297.016

Cited by 6 publications

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“…Incomprehensibly, patients of a female gender are more likely to receive an EGFR and ALK test but less likely to receive a PDL1 test. Again in NSCLC, Aadvanced age was found to be associated with lower uptake of molecular testing (supplementary table 1) similar to that in another study reporting inequity of cancer treatment access 26 . This type of clinician bias in favour of only testing those most likely to exhibit a mutation or those of a younger age should be investigated further for this particular cancer.…”

Section: Discussionsupporting

confidence: 80%

Understanding Molecular Testing Uptake Across Tumor Types in Eight Countries: Results From a Multinational Cross-Sectional Survey

Chambers

Man

Lui

et al. 2020

JCO Oncology Practice

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PURPOSE: The growth in understanding of molecular biology and genomics has augmented the development of targeted cancer treatments; however, challenges exist in access to molecular testing, an essential precursor to treatment decision-making. We used data from a cross-sectional survey to evaluate the differences in uptake of molecular testing, METHODS: Using the aggregated results of a questionnaire developed and distributed to clinicians by IQVIA, including treatment details and investigations undertaken for patients, we compared proportions of patients receiving molecular testing and targeted treatment by cancer type for the United Kingdom, France, Italy, Germany, Spain, South Korea, Japan, and China. We used multivariable logistic regression methods to understand the effect of country on the odds of receiving a molecular test. RESULTS: There was a total of 61,491 cases. Across countries and cancer types, uptake rates for molecular testing ranged between 2% and 98%, with the greatest differences seen in gastric cancers (range, 23% to 70%), and significant variations were observed for both European and Asian countries. China consistently demonstrated a significantly reduced uptake for all molecular tests assessed; however; uptake of drug treatment in gastric cancers after testing positive for the human epidermal growth factor receptor 2 gene was higher than in some European countries (China, 85%; European range, 8% to 66%). The uptake of epidermal growth factor receptor gene testing was greater in some Asian countries relative to the United Kingdom, where incidence of lung cancer is higher (Japan: odds ratio, 3.1 [95% CI, 2.6 to 3.8]; South Korea: odds ratio, 2.7 [95% CI, 2 to 3.4]). CONCLUSION: We have highlighted inequity in access to molecular testing and subsequent treatments across countries, which warrants improvements.

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Section: Discussionsupporting

confidence: 80%

Understanding Molecular Testing Uptake Across Tumor Types in Eight Countries: Results From a Multinational Cross-Sectional Survey

Chambers

Man

Lui

et al. 2020

JCO Oncology Practice

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“…Moreover, standard trial end-points may not be appropriate for older individuals and quality of life (QoL), functional status and cognition may be as important as chance of cure [ 3 ]. These knowledge gaps contribute to considerable variation in treatment in this age group [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Bridging the Age Gap in breast cancer: Impact of chemotherapy on quality of life in older women with early breast cancer

Battisti

Reed

Herbert

et al. 2021

European Journal of Cancer

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Introduction Older patients with early breast cancer (EBC) derive modest survival benefit from chemotherapy but have increased toxicity risk. Data on the impact of chemotherapy for EBC on quality of life in older patients are limited, but this is a key determinant of treatment acceptance. We aimed to investigate its effect on quality of life in older patients enrolled in the Bridging the Age Gap study. Materials and methods A prospective, multicentre, observational study of EBC patients ≥70 years old was conducted in 2013–2018 at 56 UK hospitals. Demographics, patient, tumour characteristics, treatments and adverse events were recorded. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaires (EORTC-QLQ) C30, BR23 and ELD 15 plus the Euroqol-5D (eq-5d) over 24 months and analysed at each time point using baseline adjusted linear regression analysis and propensity score-matching. Results Three thousand and four hundred sixteen patients were enrolled in the study; 1520 patients undergoing surgery and who had high-risk EBC were included in this analysis. 376/1520 (24.7%) received chemotherapy. At 6 months, chemotherapy had a significant negative impact in several EORTC-QLQ-C30 domains, including global health score, physical, role, social functioning, cognition, fatigue, nausea/vomiting, dyspnoea, appetite loss, diarrhoea and constipation. Similar trends were documented on other scales (EORTC-QLQ-BR23, EORTC-QLQ-ELD15 and EQ-5D-5L). Its impact was no longer significant at 18–24 months in unmatched and matched cohorts. Conclusions The negative impact of chemotherapy on quality-of-life is clinically and statistically significant at 6 months but resolves by 18 months, which is crucial to inform decision-making for older patients contemplating chemotherapy. Trial registration number ISRCTN 46099296.

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“…A large review has shown that the overall beneficial effect of hospital type on cancer survival is small [47]. Nonetheless comparing different institutions, the rates for the application of systemic therapies varied widely between hospitals after adjusting for case-mix across all ages as a study from England has shown [48].…”

Section: Discussionmentioning

confidence: 99%

Do hospital type or caseload make a difference in chemotherapy treatment patterns for early breast cancer? Results from 104 German institutions, 2008–2017

et al. 2021

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Background: Over the past decade, chemotherapy has been used more selectively in early breast cancer (EBC) due to better risk stratification. Neoadjuvant chemotherapy (NACT) has evolved to the primary treatment option. The type and size of hospitals is known to have a substantial influence on the kinds of treatment they provide, and therefore on patient outcomes (e.g. rates for pathological complete response, pCR), but it is not yet known how this has affected delivery of chemotherapy for EBC in Germany. Methods: This study analyzed chemotherapy use and pCR rates after NACT for EBC patients treated at 104 German institutions 2008e2017. Institutions were separated into associated hospital type (university hospital; teaching hospital; community hospital) and annual caseload ( 100; 101e250; >250 cases/ year). Results: Overall, 124,084 patients were included, of whom 11.6% were treated at university hospitals, 63.1% at teaching hospitals, and 25.3% at community hospitals. In total, 46,274 (37.3%) received chemotherapy, of whom 44,765 had information available about systemic treatment and surgery. From 2008 to 2017, chemotherapy use declined from 48.3% to 36.4% for university hospitals, from 40.7% to 30.3% for teaching hospitals, and from 42.4% to 33.7% for community hospitals. Furthermore, the proportion of NACT increased the most in university hospitals (from 32.0% to 68.1%); whereas, the rate of pCR (defined as ypT0 ypN0) increased irrespective of institutional type. Analyses regarding annual caseload did not show any differences. Conclusions: The results from this large, nationwide cohort reflect a more selective use of chemotherapy in Germany, irrespective of institutional type or case load.

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Is age a barrier to chemotherapy? Rates of treatment in older patients with breast, colon or lung cancer in England in 2014: A national registry study

Cited by 6 publications

References 0 publications

Understanding Molecular Testing Uptake Across Tumor Types in Eight Countries: Results From a Multinational Cross-Sectional Survey

Understanding Molecular Testing Uptake Across Tumor Types in Eight Countries: Results From a Multinational Cross-Sectional Survey

Bridging the Age Gap in breast cancer: Impact of chemotherapy on quality of life in older women with early breast cancer

Do hospital type or caseload make a difference in chemotherapy treatment patterns for early breast cancer? Results from 104 German institutions, 2008–2017

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