Patterns of care in elderly patients with resected non-small cell lung cancer (NSCLC) in South Western Sydney Local Health District (SWSLHD) (#144)
This retrospective study reviewed the influence of age on survival, adjuvant chemotherapy delivery and toxicity in patients with resected NSCLC.
We reviewed electronic medical records for patients with resected, pathologic stages IB-IIIA NSCLC diagnosed between 1/1/2005 and 31/12/2012 in SWSLHD. Information was extracted on baseline patient and tumour characteristics, treatment modalities, chemotherapy delivery and toxicities, and patient outcomes. Elderly patients were defined as older than 65. Fisher’s exact test was used to compare age with patient, tumour and treatment characteristics. Survival analysis was performed using Kaplan-Meier method.
We identified 134 patients who underwent surgical resection, 74 (55%) were elderly (median age 66, range 38-88). The majority of elderly patients were male (63%). Baseline demographics by age were similar except elderly patients appeared to have lower stage disease (IB 34%, IIA 14%, IIB 12% and IIIA 45%, P = 0.02). There were no significant differences by age in histological subtype, smoking, performance status or co-morbidities.
Elderly patients were less likely to undergo pneumonectomy (15% elderly; 30% young; P=0.04), receive adjuvant chemotherapy (32% elderly 65% young P=0.002) or radiotherapy (11% elderly; 22% young; P=0.02). Main reasons elderly patients did not receive adjuvant chemotherapy included stage IB disease (38%), advanced age/comorbidities (32%), patient preference (12%), second malignancy (4%), clinical trial (4%) or not referred/unknown (8%). There was no significant difference by age in terms of chemotherapy delivery, hospitalisation rates or toxicities. However, more elderly patients ceased chemotherapy due to toxicity.
Median follow-up was 22 months (range 1.9 to 96 months) with median recurrence free survival and overall survival for elderly patients of 25.4 months and 31.9 months, respectively. No significant differences were observed for stratification by age or adjuvant chemotherapy.
Adjuvant chemotherapy should not be withheld from elderly patients purely on the basis of age. However, careful patient selection for adjuvant chemotherapy is essential.