Is older age associated with a worse prognosis due to different patterns of care?

Abstract

BACKGROUNDThe objective of this study was to find out whether the worse prognosis of older patients with primary or metastatic brain tumors can be explained by different patterns of care compared with younger patients.METHODSA data base that included 430 patients with glioblastomas and 916 patients with brain metastases who underwent radiotherapy at the author's hospital between 1980 and 2000 was analyzed. Patterns of care were compared for different age groups using the chi‐square test.RESULTSIn both patient groups, age turned out to be an independent risk factor. Older age was associated with worse overall survival. Independent of the cut‐off age (< 50 years vs. ≥ 50 years, < 60 years vs. ≥ 60 years, < 65 years vs. ≥ 65 years, and < 70 years vs. ≥ 70 years), there were no statistically significant differences between the age groups concerning the use of different imaging modalities (computed tomography scans vs. magnetic resonance imaging), type of surgery (none vs. biopsy vs. resection), waiting time for radiotherapy (< median vs. ≥ median), radiotherapy treatment planning (simulator‐based vs. computer‐based), use of radiation sources (cobalt unit vs. linear accelerator), and fractionation protocols (conventional vs. modified). When the recruitment period of 21 years was divided into 3 intervals, impressive changes with regard to the patterns of care became apparent. However, the changes were seen similarly throughout the different age groups.CONCLUSIONSOlder age did not limit access to state‐of‐the‐art patterns of care in neurooncology. Patients participated in medical progress irrespective of their age. The worse prognosis of older patients with glioblastomas or brain metastases was not determined by age‐related differences in access to health care. Cancer 2005. © 2005 American Cancer Society.

Postoperative Deterioration in Health Related Quality of Life as Predictor for Survival in Patients with Glioblastoma: A Prospective Study

“…The most consistent factors affecting survival in patients with glioblastoma are age [18] and preoperative functional status, usually evaluated with Karnofsky Performance Status (KPS) [19], [20]. High quality evidence for the efficacy for adjuvant treatment with radiotherapy and temozolomide in selected patients is now available [21], [22].…”

The proteomic response in glioblastoma in young patients

“…Long term survivors of GBM are invariably younger patients [8–10], and in one randomised clinical trial, median survival for GBM cohorts aged <45 years was 48 weeks compared to 19 weeks for those >65 years; and at 18 months 23 % of the younger cohort was alive compared to 3 % of the older cohort [8]. Numerous randomised controlled trials and hospital series have excluded differences in access to health care as the cause for this differential outcome [1, 9–12]. …”

Does Time between Imaging Diagnosis and Initiation of Radiotherapy Impact Survival after Whole-Brain Radiotherapy for Brain Metastases?

“…In a previous study by Lutterbach et al waiting time was examined only for patients who underwent biopsy or resection before WBRT [8]. Median delay was 13 days, but time from initial imaging diagnosis was not reported.…”

“…Given that median survival of patients managed with best supportive care is limited (in the order of 4–6 weeks [6, 7]), one might assume that delays in starting WBRT should be minimised, if such treatment is indicated and the preferred therapeutic option. Clinical data on the impact of variable waiting times between imaging diagnosis of brain metastases and initiation of WBRT on survival after radiotherapy are scarce [8]. Therefore, we evaluated survival of a contemporary cohort of patients treated with WBRT.…”