Patterns of care and outcomes among elderly individuals with primary malignant astrocytoma

Abstract

Object This study was undertaken to evaluate the association between age at diagnosis, patterns of care, and outcome among elderly individuals with anaplastic astrocytoma (AA) and glioblastoma multiforme (GBM). Methods Using the Surveillance, Epidemiology and End Results database, the authors identified 1753 individuals with primary GBM and 205 individuals with primary AA (diagnosed between June 1991 and December 1999) who were 66 years and older and whose records were linked to Medicare information. To facilitate gathering of prediagnosis comorbidity and postdiagnosis treatment information, only those individuals were included who had the same Medicare coverage for 6 months before and 12 months after diagnosis. The odds of undergoing various combinations of treatments and the associations with outcome were calculated by tumor type and age and adjusted by various predictors. Results Age was not associated with treatment differences in individuals with AA. Very elderly individuals (≥ 75 years old) with GBM were more likely to have biopsy only (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.78–3.59), surgery only (OR 1.47, 95% CI 1.15–1.87), or biopsy and radiation (OR 1.39, 95% CI 1.07–1.82) and were less likely to receive multimodal therapy. Regardless of patient age or lesion histological characteristics, survival was decreased in patients treated with biopsy only. Individuals with GBM who had surgery only or biopsy and radiation had worse outcomes than individuals treated with surgery and radiation. There were no differences in survival by lesion histological characteristics. Very elderly individuals with malignant astrocytomas were more likely to receive limited treatment (most pronounced in individuals with GBM). Survival variation correlated with treatment combinations. Conclusions These findings suggest that in clinical neurooncology patient age is associated with not receiving effective therapies and hence worse prognosis.

Optimal management of elderly patients with glioblastoma

“…Recent large population-based cohorts of patients with GB demonstrated a marked decrease in median survival with increasing decade of age, and in particular showed a median survival of approximately 6 months in patients age 65 and older. [4][5][6]14 With an aging population and improved diagnostic tools the incidence of GBM has been steadily increasing over the last 20-30 years, and this increase is almost exclusively observed in patients older than 70 years. 15 Median age at diagnosis for GB was 64 years over the years 2002-2006 from a large United States (US)-based cancer registry.…”

“…6 Similar results were reported from three other population-based reviews and are in part felt to be related to the general poorer condition of older patients with newly diagnosed GB as well as an increasing incidence of comorbidities in this older cohort. 1,5,6,14 In a review by Kita and colleagues, best supportive care only was increasingly the treatment given to older patients: in those aged 55-64, 65-74, and 75 years it was given in 27%, 44%, and 75% of patients, respectively. 5 In addition, the report on the Ontario experience documented that the proportion of patients spending 100% of their survival time in hospital in the age groups 60-69, 70-79, and 80 increased from 21.9%, to 38%, and 49.5%, respectively, so that clearly the quality of survival decreases with increasing age in a population-based review.…”

Short‐term outcomes of craniotomy for malignant brain tumors in the elderly

“…It has been demonstrated that gross total resection has a survival advantage compared with partial resection and certainly compared with biopsy alone. 2,3 Few studies have explored the association between age and short-term postoperative outcomes, and the reports have been conflicting. [19][20][21][22] By using samples from patients who underwent resection of both primary and metastatic tumors, 2 studies associated age with an increased risk of major complications.…”

“…Fourth, we did not have data on the size, exact location, number, or type of primary lesions for patients who had metastasis (n ¼ 380); whether patients received whole-brain radiotherapy before resection; or the extent of resection, all of which have been previously identified as affecting survival. [2][3][4][5] However, postoperative complications and short-term mortality reportedly were similar between patients who underwent craniotomy for a single tumor resection versus multiple tumor resections 4 and, although it has been observed that the type of primary lesion affects overall survival, 25 no study to date has demonstrated a difference in postoperative short-term outcomes. Fifth, because there are suboptimal data on preoperative and postoperative neurologic function, these results cannot be compared against studies that only assessed neurologic function as a postoperative complication.…”

“…Several studies have demonstrated that surgical tumor resection, with and without additional treatment, prolongs the survival of patients with both primary 2,3 and metastatic brain tumors. 4,5 However, a recent study conducted in a nationally representative sample of US adults 6 confirmed a persistent disparity in surgical resection rates for the elderly.…”