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Older patients ought to be offered all options
Source: (cancerfacts.com) Sunday, August 31, 2003

ALEXANDRIA, Va. -- Aug. 31, 2003 -- Two new studies show that patients
over 70 years old can benefit from, and are willing to consider,
aggressive treatment for certain types of cancer.

The findings contrast with earlier studies suggesting unwillingness
among some elderly patients to consider aggressive chemotherapy. These
findings underscore the importance of offering the full range of
treatment options to cancer patients, regardless of age.

One study, led by Dr. Steven Schild at the Mayo Clinic in Scottsdale,
Ariz. and the North Central Cancer Treatment Group (NCCTG) examined
physician concerns about toxicity and survival that often keep cancer
doctors from offering aggressive therapy to older patients with Stage
III non-small cell lung cancer (NSCLC).

"Fit elderly patients need not simply be relegated to palliative therapy
or no therapy just because they are older than 70," Schild said in a
prepared statement. "These patients should be fully briefed on the range
of treatment options, including potential risks and benefits."

Schild's study re-****yzed data of a large randomized trial that
compared outcomes of otherwise healthy non-small-cell lung cancer
patients aged
70 years and older who underwent combination chemotherapy and radiation
to outcomes of younger patients who received the same treatment.

While there was no significant difference in survival rates between the
two groups, the elderly patients in the study experienced more side
effects from the therapy, especially in terms of suppression of blood
and immune cell production (myelosuppression) and pneumonia, than the
younger individuals.

The two-year survival rates were 39 percent among patients younger than
70, and 36 percent among the elderly patients. Overall, 18 percent of
the younger patients survived five years compared to 13 percent of those
older than 70.

The study authors conclude that fit elderly patients with locally
advanced non-small-cell lung cancer should be encouraged to receive
aggressive therapy, despite their age.

In the second study, Dr. Martine Extermann and colleagues at the
University of South Florida and Moffitt Cancer Center in Tampa examined
the common perception in the medical community that older cancer
patients – especially Europeans – are unwilling to undergo aggressive
chemotherapy.

"There's a common belief that older European patients are not as
aggressive about accepting cancer treatment as older American patients,"
said Dr. Extermann. "This issue is increasingly important, given the
high rate of cancer among the elderly and the fact that counseling by
physicians is often influenced by assumptions about a patient's
willingness to undergo various treatments."

The study interviewed 320 participants aged 70 years and older via
anonymous questionnaires. Participants were separated into four groups:
French cancer and non-cancer patients and American cancer and non-cancer
patients.

Participants were asked to consider a strong chemotherapy regimen and a
milder chemotherapy regimen, along with their expected side effects,
under varying chances of cure, prolongation of survival and symptom
relief. Participants were then asked to define the minimum benefit for
which they would accept chemotherapy.

The study found that elderly cancer patients in both countries were
equally willing to consider treatment, although older French non-cancer
patients were more reluctant to consider chemotherapy than older
American non-cancer patients.

Of French non-cancer patients 34 percent were willing to accept strong
chemotherapy, compared with 77.8 percent of French cancer patients,
73.8 percent of American non-cancer patients, and 70.5 percent of
American cancer patients.

Given the patients' willingness to consider chemotherapy, the authors
underscored the importance of presenting the full range of treatment
options to all older cancer patients.

"Older cancer patients, whether French or American, are equally willing
to consider the option of chemotherapy," said Extermann. "Given these
findings, physicians should discuss all available treatment options with
their patients, while managing expectations about the potential risks
and benefits of treatment."

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