Side effects with lung cancer chemotherapy more common in older patients

NEW YORK (Reuters Health) - Older patients receiving chemotherapy for advanced non-small-cell lung cancer (NSCLC) experience more adverse events than younger patients, according to a study published online December 28th in the Journal of Clinical Oncology.

Overall, 35% of patients had adverse events - but for patients under 64 years of age, the rate was 29%, whereas for those 65 to 74 and 75 or older, the rates were 42% (OR, 1.70) and 38% (OR, 1.34), respectively.

"The best treatment for older patients with advanced NSCLC is debated," Dr. Elizabeth A. Chrischilles, of the University of Iowa, Iowa City, and colleagues write. "Perhaps in part because of uncertainty about the balance between toxicity, symptom relief, and changes in quality of life and survival, a pronounced inverse association between age and receipt of recommended therapies has been observed."

The current findings stem from a study of 1371 patients with newly diagnosed stages IIIB or IV NSCLC. An adverse event was considered any medical event occurring during chemotherapy.

Overall, 798 patients (58%) received chemotherapy. Consistent with prior findings, as age increased, the likelihood of receiving chemotherapy decreased, especially platinum-based regimens. After adjusting for comorbidities and other potential confounders, 72% of subjects younger than 55 years received chemotherapy, compared to only 47% of those 75 years of age and older.

In contrast to their experience with adverse events, the older patients were less likely than younger patients to have pretreatment acute medical events. These occurred in 18.6% of participants younger than 55 years, versus 9.2% of those at least 75 years of age (adjusted rate ratio 0.49).

"Because older patients have at least as many disease symptoms as younger patients, a logical consequence of lower treatment rates is more disease symptoms and worse quality of life for the oldest patients," the researchers note. "An unanswered question is whether the increased adverse events associated with chemotherapy among the oldest patients who received chemotherapy was offset by improvement in their disease symptoms to provide a net positive effect on quality of life."

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