Abstract
Purpose
Elderly patients with lung cancer tend to be undertreated in comparison to younger patients. The objective of this study is to compare treatment modalities offered to lung cancer patients from 70 years of age or more with patients under 70.
Methods
For this study, an analytical cross-sectional epidemiological study conducted with data from the Brazilian hospital-based cancer registries between the years 2000 and 2011. In addition, odds ratios (OR) were calculated, with a 95% confidence intervals (95% CI), in conjunction with the construction of a logistic regression model.
Results
By analyzing the records of 40,403 patients with lung cancer, we found that overall, patients from 70 years of age or more corresponded to 28.6% of the study population. Squamous cell carcinoma was the most common histological type among patients ≥70 years of age, whereas adenocarcinoma was the more prevalent type among younger patients. In comparison to younger patients, the older ones were treated less often (OR = 0.57; 95% CI: 0.52–0.62). Moreover, older patients were less likely to undergo surgery (OR = 0.69; 95% CI: 0.64–0.75), radiotherapy (OR = 0.86; 95% CI: 0.81–0.92), chemotherapy (OR = 0.61; 95% CI: 0.57–0.64), or an association of two or more treatment modalities (OR = 0.58; 95% CI: 0.54–0.62).
Conclusion
The study finds that Brazilian lung cancer patients ≥70 years of age are often undertreated and higher percentage of early death rates as compared to patients under 70. In regard to treatment, age alone should not determine whether patients with lung cancer are treated or not.
Similar content being viewed by others
References
Alberg AJ et al (2013) Epidemiology of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(5 Suppl):e1S–29S
Barrett K, Pierre A, Leighl N, Brade A (2011) Treatment of the elderly when cure is the goal the influence of age on treatment selection and efficacy for stage III. J Thorac Oncol 6(3):537–544
Blanco R et al (2014) A review of the management of elderly patients with non-small-cell lung cancer. Ann Oncol 2014:1–13
Brunello A et al (2009) Multidimensional geriatric evaluation for older cancer patients as a clinical and research tool. Cancer Treat Rev 35(6):487–492
Costa GJ et al (2006) Survival rates and tolerability of platinum-based chemotherapy regimens for elderly patients with non-small-cell lung cancer (NSCLC). Lung Cancer 53(2):171–176
Costa GJ et al (2016) Epidemiological chances in the histological subtypes of non-small-cell lung cancer in Brazil: na analysis of 35,018 cases. Lung Cancer 97(2016):66–72
Cote ML, Kardia SLR, Wenzlaff AS, Land SJ, Schwartz AG (2005) Combinations of glutathione S-transferase genotypes and risk of early-onset lung cancer in Caucasians and African Americans: a population-based study. Carcinogenesis 26(4):811–819
Davidoff AJ et al (2011) Chemotherapy and survival benefit in elderly patients with advanced non–small-cell lung cancer. J Clin Oncol 28(13):2191–2197
Instituto Nacional de Câncer [INCA] (2015) Estimativas 2016: incidência de câncer no Brasil. http://www.inca.gov.br
Foster JA et al (2010) How does older age influence oncologists’ cancer management? Oncologist 2010(15):584–592
Gajra A et al (2014) Non–small-cell lung cancer in elderly patients: a discussion of treatment options. J Clin Oncol 32(24):2562–2569
Gironés R et al (2011) Lung cancer prognostic impact of comorbidity in elderly lung cancer patients: use and comparison of two scores. Lung Cancer 2011(72):108–113
Gridelli C, Maione P, Rossi A, Palazzolo G, Colantuoni G, Rossi E (2009) Management of unfit older patients with advanced NSCLC. Cancer Treat Rev 35(6):517–521
Gridelli C, Balducci L, Ciardiello F et al (2015) Treatment of elderly patients with non-small-cell lung cancer: results of an international expert panel meeting of the Italian association of thoracic oncology. Clin Lung Cancer 16(5):325–333
Howlader N, Noone AM, Krapcho M et al (2013) SEER cancer statistics review, 1975–2010. National Cancer Institute, Bethesda
Hutchins LF et al (1999) Underrepresentation of patients 65 years of age or older in cancer treatment trials. N Engl J Med 1999(341):2061–2067
Kawaguchi T et al (2012) Chemotherapy is beneficial for elderly patients with advanced non–small-cell lung cancer: analysis of patients aged 70–74, 75–79, and 80 or older in Japan. Clin Lung Cancer 13:442–447
Langer CJ (2011) Clinical evidence on the undertreatment of older and poor performance patients who have advanced non-small-cell lung cancer: is there a role for targeted therapy in these cohorts? Clin Lung Cancer 12(5):272–279
Liu H et al (2013) Surgery for elderly lung cancer. Ann Thorac Cardiovasc Surg 19(6):416–422
Lortet-tieulent J et al (2014) Lung cancer international trends in lung cancer incidence by histological subtype: adenocarcinoma stabilizing in men but still increasing in women. Lung Cancer 84(1):13–22
Moura MADS et al (2014) The magnitude of the association between smoking and the risk of developing cancer in Brazil: a multicenter study. BMJ Open 4(2):1–8
Ng R et al (2005) Undertreatment of elderly patients with non-small-cell lung cancer. Clin Lung Cancer 7(3):168–174
Owonikoko TK et al (2007) Lung cancer in elderly patients: an analysis of the surveillance, epidemiology, and end results database. J Clin Oncol 25(35):5570–5577
Pallis AG et al (2010) Is age a negative prognostic factor for the treatment of advanced/metastatic non-small-cell lung cancer? Cancer Treat Rev 36(5):436–441
Pallis AG et al (2011) Are we treating enough elderly patients with early stage non-small cell lung cancer? Lung Cancer 74(2):149–154
Pallis AG et al (2014) Management of elderly patients with NSCLC; updated expert’s opinion paper: EORTC Elderly Task Force, Lung Cancer Group and International Society for Geriatric Oncology. Ann Oncol 2014(25):1270–1283
Siegel R et al (2014) Cancer statistics. CA Cancer J Clin 64(1):9–29
Smith BD et al (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 27(17):2758–2765
Subramanian R et al (2010) Distinctive characteristics of non-small cell lung cancer (NSCLC) in the young. J Thorac Oncol 5(1):23–28
Wang S, Wong ML, Hamilton N, Davoren JB, Jahan TM, Walter LC (2012) Impact of age and comorbidity on non-small-cell lung cancer treatment in older veterans. J Clin Oncol 30(13):1447–1455
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest regarding the present study.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The internal review board of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) approved the study protocol under reference number 3681 in 2013.
Informed consent
For this type of study, informed consent is not required.
Funding
The authors have no funding to report.
Rights and permissions
About this article
Cite this article
Costa, G.J., de Mello, M.J.G., Ferreira, C.G. et al. Undertreatment trend in elderly lung cancer patients in Brazil. J Cancer Res Clin Oncol 143, 1469–1475 (2017). https://doi.org/10.1007/s00432-017-2412-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-017-2412-8