Excess mortality and undertreatment in elderly lung cancer patients: treatment nihilism in the modern era?
Treatment of elderly patients with lung cancer is significantly hindered by concerns about treatment tolerability, toxicity and limited clinical trial data in the elderly; potentially giving rise to treatment nihilism amongst clinicians. This study aims to describe survival in elderly patients with...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2021-05-01
|
| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/7/2/00393-2020.full |
| _version_ | 1818741113699172352 |
|---|---|
| author | Jonathan Pham Matthew Conron Gavin Wright Paul Mitchell David Ball Jennifer Philip Margaret Brand John Zalcberg Rob G. Stirling |
| author_facet | Jonathan Pham Matthew Conron Gavin Wright Paul Mitchell David Ball Jennifer Philip Margaret Brand John Zalcberg Rob G. Stirling |
| author_sort | Jonathan Pham |
| collection | DOAJ |
| description | Treatment of elderly patients with lung cancer is significantly hindered by concerns about treatment tolerability, toxicity and limited clinical trial data in the elderly; potentially giving rise to treatment nihilism amongst clinicians. This study aims to describe survival in elderly patients with lung cancer and explore potential causes for excess mortality. Patients diagnosed with lung cancer in the Victorian Lung Cancer Registry between 2011–2018 were analysed (n=3481). Patients were age-categorised and compared using Cox-regression modelling to determine mortality risk, after adjusting for confounding. Probability of being offered cancer treatments was also determined, further stratified by disease stage. The eldest patients (≥80 years old) had significantly shorter median survival compared with younger age groups (<60 years: 2.0 years; 60–69 years: 1.5 years; 70–79 years: 1.6 years; ≥80 years: 1.0 years; p<0.001). Amongst those diagnosed with stage 1 or 2 lung cancer, there was no significant difference in adjusted-mortality between age groups. However, in those diagnosed with stage 3 or 4 disease, the eldest patients had an increased adjusted-mortality risk of 28% compared with patients younger than 60 years old (p=0.005), associated with markedly reduced probability of cancer treatment, after controlling for sex, performance status, comorbidities and histology type (OR 0.24, compared with <60 years old strata; p<0.001). Compared to younger patients, older patients with advanced-stage lung cancer have a disproportionately higher risk of mortality and lower likelihood of receiving cancer treatments, even when performance status and comorbidity are equivalent. These healthcare inequities could be indicative of widespread treatment nihilism towards elderly patients. |
| first_indexed | 2024-12-18T01:51:28Z |
| format | Article |
| id | doaj.art-acc8c472de1d40c9ad327e357ecf945d |
| institution | Directory Open Access Journal |
| issn | 2312-0541 |
| language | English |
| last_indexed | 2024-12-18T01:51:28Z |
| publishDate | 2021-05-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj.art-acc8c472de1d40c9ad327e357ecf945d2022-12-21T21:25:02ZengEuropean Respiratory SocietyERJ Open Research2312-05412021-05-017210.1183/23120541.00393-202000393-2020Excess mortality and undertreatment in elderly lung cancer patients: treatment nihilism in the modern era?Jonathan Pham0Matthew Conron1Gavin Wright2Paul Mitchell3David Ball4Jennifer Philip5Margaret Brand6John Zalcberg7Rob G. Stirling8 Dept of Respiratory Medicine, The Alfred Hospital, Melbourne, Australia Dept of Respiratory Medicine, St Vincent's Hospital, Melbourne, Australia Victorian Comprehensive Cancer Centre, Melbourne, Australia Olivia Newton-John Cancer Wellness and Research Centre, Melbourne, Australia Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia Dept of Palliative Care, St Vincent's Hospital, Melbourne, Australia Dept of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia Dept of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia Dept of Respiratory Medicine, The Alfred Hospital, Melbourne, Australia Treatment of elderly patients with lung cancer is significantly hindered by concerns about treatment tolerability, toxicity and limited clinical trial data in the elderly; potentially giving rise to treatment nihilism amongst clinicians. This study aims to describe survival in elderly patients with lung cancer and explore potential causes for excess mortality. Patients diagnosed with lung cancer in the Victorian Lung Cancer Registry between 2011–2018 were analysed (n=3481). Patients were age-categorised and compared using Cox-regression modelling to determine mortality risk, after adjusting for confounding. Probability of being offered cancer treatments was also determined, further stratified by disease stage. The eldest patients (≥80 years old) had significantly shorter median survival compared with younger age groups (<60 years: 2.0 years; 60–69 years: 1.5 years; 70–79 years: 1.6 years; ≥80 years: 1.0 years; p<0.001). Amongst those diagnosed with stage 1 or 2 lung cancer, there was no significant difference in adjusted-mortality between age groups. However, in those diagnosed with stage 3 or 4 disease, the eldest patients had an increased adjusted-mortality risk of 28% compared with patients younger than 60 years old (p=0.005), associated with markedly reduced probability of cancer treatment, after controlling for sex, performance status, comorbidities and histology type (OR 0.24, compared with <60 years old strata; p<0.001). Compared to younger patients, older patients with advanced-stage lung cancer have a disproportionately higher risk of mortality and lower likelihood of receiving cancer treatments, even when performance status and comorbidity are equivalent. These healthcare inequities could be indicative of widespread treatment nihilism towards elderly patients.http://openres.ersjournals.com/content/7/2/00393-2020.full |
| spellingShingle | Jonathan Pham Matthew Conron Gavin Wright Paul Mitchell David Ball Jennifer Philip Margaret Brand John Zalcberg Rob G. Stirling Excess mortality and undertreatment in elderly lung cancer patients: treatment nihilism in the modern era? ERJ Open Research |
| title | Excess mortality and undertreatment in elderly lung cancer patients: treatment nihilism in the modern era? |
| title_full | Excess mortality and undertreatment in elderly lung cancer patients: treatment nihilism in the modern era? |
| title_fullStr | Excess mortality and undertreatment in elderly lung cancer patients: treatment nihilism in the modern era? |
| title_full_unstemmed | Excess mortality and undertreatment in elderly lung cancer patients: treatment nihilism in the modern era? |
| title_short | Excess mortality and undertreatment in elderly lung cancer patients: treatment nihilism in the modern era? |
| title_sort | excess mortality and undertreatment in elderly lung cancer patients treatment nihilism in the modern era |
| url | http://openres.ersjournals.com/content/7/2/00393-2020.full |
| work_keys_str_mv | AT jonathanpham excessmortalityandundertreatmentinelderlylungcancerpatientstreatmentnihilisminthemodernera AT matthewconron excessmortalityandundertreatmentinelderlylungcancerpatientstreatmentnihilisminthemodernera AT gavinwright excessmortalityandundertreatmentinelderlylungcancerpatientstreatmentnihilisminthemodernera AT paulmitchell excessmortalityandundertreatmentinelderlylungcancerpatientstreatmentnihilisminthemodernera AT davidball excessmortalityandundertreatmentinelderlylungcancerpatientstreatmentnihilisminthemodernera AT jenniferphilip excessmortalityandundertreatmentinelderlylungcancerpatientstreatmentnihilisminthemodernera AT margaretbrand excessmortalityandundertreatmentinelderlylungcancerpatientstreatmentnihilisminthemodernera AT johnzalcberg excessmortalityandundertreatmentinelderlylungcancerpatientstreatmentnihilisminthemodernera AT robgstirling excessmortalityandundertreatmentinelderlylungcancerpatientstreatmentnihilisminthemodernera |